A Vision for Healthcare

A Vision for Healthcare –

110 Ideas

Patient Service

1. Put patients first before budgets and policies.
2. Treat all patients like family, like our most privileged patients.
3. Compassion should motivate care, not medical riddles.
4. Care for all – the poor and isolated – not just the rich who can go to the USA.
5. Give money back guarantees for poor service, long waits, bad outcomes.
6. Provide for patients in remote areas.
7. Offer comprehensive, high quality care for all.
8. Cover basic drugs.
9. Cover basic dental needs.
10. Remove delay for refugee health cards.
11. Encourage ‘minor’ visits.  Opportunity to prevent and educate.

Patient Involvement

1. Give patients choice – let patients choose their providers, etc.
2. Empower patients with their own electronic medical record
3. Reward patients for healthy choices/health management
4. Reward patients for health: exercising, ideal body weights, fat tests, alcohol, smoking…
5. Patients need to know, and be able to impact, what gets spent on their behalf.  They need some control.
6. Involve patients in hospital/system decisions
7. Give patients accountability – showing up for appointments, following through on tests/consultations, etc.
8. Offer health education, training, etc. with income tax deductions if taken
9. Allow patients to save for health costs: e.g. we knew all our kids would need massive dental work…allow for tax sheltered savings…health-spending accounts.
10. Reward patients for daytime access (no user fees, etc.)…
11. Make the right actions easy for patients.
12. Do not allow insurance as an employment benefit…must have patients actively involved in purchase/management

Providers

1. Hire and train the highest quality providers.
2. Hire for, and reward, attitude – compassion, positivity,
3. Put the most responsible providers in control – e.g., MDs in hospitals, RNs in pub health clinics, PTs in rehab…
4. Provider that will deliver the highest quality care should deliver that care.
5. Allow movement and retraining

Leadership

1. Align incentives between patients, physicians, nurses and hospitals
2. Decrease bureaucracy
3. Allow providers to operate without over-regulation; maximize provider efficiency
4. Allow local control – let lowest unit able to manage something, manage it
5. Let physicians run own business
6. Allow MDs to fully incorporate
7. Physicians should play a major role in running hospitals
8. Let physicians define ontology of medicine
9. Embrace complexity; challenge ideology
10. Use non-uniformity at fringes
11. Allow pockets of innovation
12. Give hospital MACs (Medical Advisory Committee) positive power, not just veto.
13. Build skills based hospital boards
14. Reward innovation and individuality (e.g., genomics)
15. Encourage speaking up – remove cone of silence
16. Please patients, not politicians…remove fear of speaking out, fear of losing funding/retribution
17. Let physicians leverage their knowledge by hiring staff and billing for services
18. Pay physicians competitively for administrative positions

Quality

1. Allow providers to define quality – don’t dictate it
2. Colleges should investigate egregious behaviour; not everything; not dictating quality
3. Have providers/clinics/etc prove their excellence instead of regulating/inspecting/overseeing it.
4. Allow innovative groups to develop (QMPLS)
5. Use guilds and associations to demonstrate quality

Accountability

1. Uphold total transparency of results, funding, decisions.
2. Encourage senior admin to speak out.
3. Patients should review service provided by hospitals.
4. Publish efficiency, outcomes, patient satisfaction/preference for GP/NP/Midwife
5. Transparency for performance and spending.
6. Create ‘second opinion’ category for care…be transparent about it
7. Scorecards on performance across system: turn-around for lab, DI,
8. Publish management ratios/bureaucratic efficiency.

Spending

1. Remove hospital global budgets – need activity based funding
2. Do not tie health spending to election cycle
3. Develop a master vision – all party support – for healthcare
4. Stop last minute budget dumps at year-end.
5. Outsource management as much as possible…use business expertise.
6. Use business excellence.
7. Allow research to occur in hospitals without 25% tax
8. Empower front line providers to innovate and reward great ideas
9. Information sharing forum…instead of Quantitative bias to publication…. academic publications strangle great ideas…positive study bias.
10. Stop pretending profit is evil – it provides hospitals, equipment, uniforms, IT, salaries, benefits, and even union operations.

Labour Groups

1. Should not dictate performance
2. Should be transparent
3. Use Rand only for negotiation
4. Membership should be voluntary
5. Should be held accountable for time wasted and cost.
6. Should share the risk of loss, not rewarded for poor output with more staffing.
7. Hospitals must be allowed to become non-unionized without reprisal
8. Hospitals should not be given staff contracts…should be part of neg’n
9. Reward staff who stay healthy and avoid sick time
10. Reward staff for skipping break-times and eliminate tradition of double breaks.
11. Stop unlimited sick time
12. No more protected labour-group tenure – eliminate low performers
13. Let physicians hire own staff in hospitals regardless of labour group

Complaints/Legal

1. Tort reform – eliminate the medico-legal lottery winnings
2. All complaints to central group…if valid suffering, pay patient
3. Automatic flat-rate payment for bad outcomes
4. Allow no-fault idea or innovation improvement…not immediately to lawsuits.
5. Allow MDs to not treat instead of testing and treating to avoid suits
6. Allow MDs to decline service without fear of reprisal

Legislation

1. Reform PHA – administrative structure, credentialing, leadership…
2. Revise LTC – patient choice of preferred bed, transfer delays
3. Review CHA – 5 principles (give them teeth or adjust them)
4. Decrease legislation and taxation of innovation, industry, and research.
5. Allow private care in public facilities
6. Allow patients to purchase when necessary.  They do already.
7. Allow private ownership and leadership of hospitals

Unique Publicly Funded Issues

1. Transparency for public performance and spending.
2. Stop last minute budget dumps at year-end.
3. Attract FPs to work unsociable hours.
4. Support FPs with lab and DI in unsociable hours.
5. Allow sabbaticals…relax regulations
6. Encourage innovation; trials
7. Bill patients who leave against medical advice.
8. Penalize Lack of change/innovation
9. Invest in IT development and incentivize use
10. Offer different levels of public coverage: low, medium, high
11. Review MD-hospital relations – contract with groups or individuals
12. Hold hospitals accountable, too
13. Institute small user fees.
14. Municipalities should pay for ALC/NH beds
15. Have patients pay for care and get tax rebates.