Is Canada Really in The Worst Healthcare Crisis Ever?
Stop me if you have heard this one before, “A person walks into an emergency room, and waits.”
It is estimated that over six million Canadians are without a doctor. Emergency rooms are closing due to lack of staffing, wait times for home care are long, there is a lack of availability of long-term care beds and the gaps in public health response keep growing; the list goes on. Every day we are inundated with news reports focused on the lack of doctors and nurses about how the health system is worse now than it has ever been and the need to spend more to improve access to everything. But is it worse? Or do we just have better channels to tell the same story to a broader audience?
In February 2005, a Moose Jaw Times Herald front page story highlighted the accomplishments of a local manufacturing facility. It had just received the Industry Week Top Ten Plant award. This award recognizes facilities that have achieved and sustained a significant level of operational transformation. I was the person on the ground, in Moose Jaw, SK, supporting this transformation. Edna, the head of quality from the Moose Jaw Union Hospital in the Five Hills Health Region, read the article and initiated a visit to understand how we did what we did. Edna is a very passionate and persuasive person and quickly became one of my most cherished mentors. Over the next few months, she convinced me to leave a very lucrative private sector position and join the local public health region. We started applying a quality improvement mindset and the Lean methodology at the hospital level, which quickly spread to the region, and then the province. A significant amount of change was implemented provincially creating better care for patients and a more engaged workforce.
In March 2009, Healthcare Quarterly published an article “Leading Lean – A Canadian Healthcare Leaders Guide” focused on five different Canadian facilities using Lean methodologies to improve the health system. Five Hills Health Region was part of the story and the only organization implementing Lean across the whole health system.
Fast forward to today, almost twenty years from the first time I walked through hospital doors and saw it through a quality improvement lens. As I move into the final stretch of my career, with a growing desire to make a significant difference, I feel compelled to work harder at solving the seemingly unsolvable issue of access for everyone. The current news is unrelenting.
Healthcare staff are burnt out, we are in the worst shape ever, calls for privatization are increasing, there is a shortage of 60,000 nurses, six million Canadians are without a doctor and the stories about lack of access just keep coming. So, the question is this: Are we actually in the biggest crisis healthcare has ever seen?
I am going to focus on the last twenty years, my tenure in this field. Currently, Canada has the largest population ever, forty-one million and growing, an increase of 25% since 2005. Overall national health spending has doubled and equalized for inflation, it is roughly a $100 billion-dollar national increase. The federal government has made significant healthcare funding commitments. Physician numbers have increased to 25 per 10,000 people compared to 20 per 10,000. We have more nurses than ever. We have some of the most advanced medical interventions globally and we have world class facilities to deliver that care in most provinces.
So how could we be worse off?
The focus of my 2009 article was on the emerging trend of embedding Lean methodologies into healthcare – creating the same repeatable, successful and sustainable transformations that manufacturing has become known for; from ways to engage all staff at every level to improve day to day operations; and the thought that this knowledge and past successes in manufacturing would transfer into increasing efficiencies and improving processes for healthcare staff. They could then spend more time with the people they are caring for and reduce their staff members’ work burden and stress levels.
The foundation of the Lean methodology is rooted in respect for people. Respect for people is demonstrated in designing a work environment that allows the staff to work at the top end of their skill set and the fact that they can spend 85 to 90 per cent of their day doing the exact job they were hired to do – not firefighting, not doing unrelated tasks and not reworking. It is about giving them an environment within which, when they leave, on time and at the end of their shift, they feel energized about what they accomplished. The Lean tool set is then applied to build a congruent work environment to enable staff to deliver on their promises. This tool set includes things like process mapping, process understanding, process improvement projects, staff engagement in change, understanding the needs of the people they serve and metrics to monitor improvements, for a start.
So the question that begs to be answered is that if Lean is so great, why has it not stuck and why have we not implemented it across the country? To answer this question, let’s look at what has changed over the past twenty years.
The significant advancements over these years are clinical, not operational or cultural. When I first started working in healthcare, there was a revolutionary advancement in hip replacements. You could go in on a Monday and walk out on a Friday with a new hip. That was unheard of. Today you can walk in at 7 am and walk out with a new hip at 6 pm.
We have MRI-guided brain surgery, robotic leg fracture surgery, tomosynthesis mammography for finite breast cancer detection, significantly more non-invasive procedures and the impressive list goes on and on. Healthcare innovative brilliance is not the issue in the Canadian health system – getting all the paperwork done is. The lack of nationally connected interoperable EMRs is mind boggling. So are the increasing regulations due to unwarranted risk mitigation, budgeting incongruency and don’t get me started on political interference. We have significantly advanced the clinical operations while leaving the administrative burden to fester. Continuing with the hip replacement example, the documentation and work burden for one patient previously was spread over five days. Now clinical and administrative staff must complete the same, and in many cases even more administrative burden per patient, five times in a week. This is fundamentally the root cause driving workload and burnout. This doesn’t mean that great things were not achieved using quality improvement over the past twenty years.
The Facts:
- The province of Manitoba’s Lean program achieved an annual reduction of two million patient wait days through administrative process improvements.
- Prince Edward Island reduced average lengths of stay in acute care by almost two days across the province.
- Ottawa’s long-term care homes achieved a year without urinary track infections.
What is missing is the sustainability. Changes in leadership or government brought directional change and if that leadership group did not value the program went unfunded and nonprioritized.
The good news is, that this is solvable. We have proven that in the past and, it can be sustained.
The relatively short amount of time Canadian healthcare has been trying to implement process improvement is but a drop in the improvement bucket. The early failures, leadership direction changes, twisting priorities, changing political landscapes and increasing public demands are all normal. Canada’s primary issue with implementing a quality improvement mindset within a healthcare environment is fundamentally based in the leadership team’s ability to commit and maintain the strategy during the previously mentioned distractions.
Understanding that it is more than training a few staff, opening a transformation office and completing a few projects off the sides of people’s desks. The health systems that can maintain ongoing adaptive quality improvement and full staff involvement over the long haul, years and decades long, are the ones that will advance care and maintain staff engagement.
Edward Deming, the grandfather of process improvement was quoted: “A bad system will beat a good person every time”. Healthcare is a complex adaptive system and ever evolving. The health system that has a workforce and environment that is agile, adaptive and fully engaged, guided by principled value-based leadership and a learned practical tool kit to make sustainable change, will be the one that changes the narrative across the Canadian health system forever.
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We realize the constraints you are under to make lasting change and that’s where we come in. If your team is ready to transform your healthcare operation to improve their workplace wellbeing, and the care they provide, we are ready to help you make that happen. With proven success and the right skills to define and close the gaps to create lasting improvements, coupled with the empathy and understanding of your responsibilities and challenges, we can be the perfect partner to effect the changes you want to see. Let’s have a conversation to see what is possible. Remember… ‘nNothing ventured, nothing gained’.
Author: Dale Schattenkirk, Healthcare Partner, The Poirier Group
Published: Longwoods.com (January 2025)