Tuesday, June 19, 2012

What Ontario’s action plan means for patients and the system

By Rik Ganderton, President and CEO, RVHS
In this blog I will talk about the Ontario Government’s Action Plan for Health Care and why it (or something similar) is needed to ensure that we and our children will have a sustainable, quality health care system in the future.

The time for action is past due really. It’s a thorny, difficult issue that has been around for at least two decades and it’s one that few have been keen, or able, to tackle head on, although many have tried unsuccessfully. I think the difference this time is that there is a comprehensive plan with real incentives and disincentives to drive the change.
Health Minister Deb Matthews puts it this way. “We can’t keep spending our health dollars the way we used to. If we don’t change, we simply won’t be able to guarantee sustainable universal public health care for ourselves, our children and our grandchildren.”
I have to agree.
-Starting the conversation-
That’s why we are talking about Ontario’s Action Plan for Health Care. The transformation required and set out in the government’s plan is the most significant change in health care since the introduction of Medicare in the 1960s. In my view, it’s long overdue.
Rouge Valley Health System has been discussing this internally and externally with our local political leaders in recent weeks. (Our April 27, 2012 presentation to them is available to the public.)
Now it’s time we talk about the changes needed and what they might mean to our organization, our patients and to our communities. One June 7, I spoke to municipal councillors on Durham Region’s Health and Social Services Committee about Ontario’s Action Plan for Health Care and what it could mean. (Here is a link to that presentation.)
-The right path-
We believe the province’s action plan is the right path to pursue and we want you, our community, to be aware and as involved as you choose to be in the discussion that is beginning. The plan is based on the principle that good quality costs less. I’m convinced that this is true: it has been our experience at Rouge Valley Health System (RVHS) in the last five years.
Please read the Ontario Action Plan for Health Care for your own education as it will have real impact on our health care system. Here’s what it could mean to you and your health care system.
·      For decades the bricks and mortar of the hospital have been the centre of the health system and many services have grown around and with the hospital. This is a costly and ineffective way of organizing care as its focus is on acute intervention, rather than managing wellness, health, personal responsibility and management of disease at home with community support.
·      In the future, patients will be at the centre of the system. To drive change in the system, the way it is funded will change from global budgets, inflated by some amount on an annual basis, to patient-based funding.  That will create incentives for all providers to deliver more high quality, cost effective care in the right setting.
·      We will see much greater involvement of primary care (your family doctor, community agencies and clinics) in the system, coupled with greater access and greater accountability of that sector for managing care – particularly of those with chronic diseases such as cancer, diabetes and cardiac issues. This expansion of primary care’s role will be supported with greater funding, shifted primarily from hospital and physician payment components of the funding pot. We’re already hearing some of that debate in the media.
·      From a hospital perspective our role will change. We will become a part of the system focused on the patient, as opposed to being the focal point of the system. We will focus on those complex cases, the difficult surgeries, the most critically ill but treatable patients. We will no longer be the provider of all things to all people.
·      All current hospital services won’t stay in hospitals. Surgical centres, private clinics and other community-based providers will perform services that people are accustomed to receiving in a hospital.
·      Higher performing hospitals, with lower costs per patient and higher quality outcomes, will be assigned more patient volumes for complex treatments and procedures they are doing best.
·      As a result, hospitals will have to be more competitive on quality care for patients and cost.  This is an example of good quality costing less.
·      During the next three years, funding of hospitals will shift from global budgets to a variable patient-based budget with incentives for quality and efficiency. By 2015, 70 per cent of hospital funding will be variable based on performance, compared to the three per cent currently in place. John Aldis, our RVHS vice-president, corporate and post acute services, and chief financial officer, puts it this way: “This is a very dramatic change over a short period of time and has the potential to be disruptive as hospitals adjust their plans in response to funding shifts.  Some hospitals will get more money, while many will get a funding cut.  There will be significant pressure to integrate services within and among hospitals to deliver higher quality care more cost effectively.” (Read his March 15, 2012 blog on this.) Worldwide research shows that consolidation of service improves quality and efficiency, particularly for low volume complex procedures. This will clearly impact where patients get their service, and where physicians and staff work.
·      Funding reform will be a huge improvement over the current funding model because it is patient based, takes into account the complexity of patients’ conditions, provides incentives to hospitals for their efficiency and will include incentives for providing better quality outcomes for patients.
·      The implications of Ontario’s Action Plan for Health Care are that quality of care will be improved in the province and costs will be lowered as services migrate to the best performers in the most appropriate care setting. It’s the migration, or transfer of services, from one hospital to another, or from a hospital to a community-based provider, that will test public anxieties and political fortitude to forge ahead.
·      Services, staff, doctors and volunteers will move based on where it is best for patients to receive various health care services. Integrations of programs among hospitals, or with community providers will become the norm.
·      Mergers of hospitals will clearly be on the table to create critical mass and improve quality while driving down cost inefficiency. That will generate some talk!!
Our experience in implementing transformational change at Rouge Valley will be invaluable as we start on this journey. In recent years, our team of RVHS Board of Directors, doctors and staff have succeeded at:
·      Eliminating our deficit;
·      Generating surpluses needed for reinvestment in our facilities and medical equipment;
·      Constant improvement through the Lean philosophy.
-Collaborative Care-
Our latest focus has been on making the best use of our team’s skills for our patients through collaborative care. In short, collaborative care respects the full skill set of every staff member and makes their jobs more focused on the very things they trained for, and entered health care for, in the first place.
In a collaborative care setting: nurses do more patient care and fewer other duties; allied health staff concentrate on the roles they are trained for in diagnostic imaging and other areas; and personal support workers focus on their duties for patients. Each person’s job is designed to serve patients to the best of their abilities, rather than being diluted with less-relevant tasks. Plus, it makes coming to work more much meaningful and enjoyable for everyone – and that’s a benefit to patients as well. In essence it’s the right provider, doing the right job at the right time in the right place in the right way!
The next few years will be filled with (hopefully) intelligent debate and (hopefully) less rhetoric as anxieties flare over what the changes could mean in the location of services and who performs them.
The bottom line is that the system has to change. The changes stemming from the action plan will be centred on improving quality care for patients and sustaining our essential health care system. We wholeheartedly support this.
Stay tuned!