Forty years and counting

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My health care career began on April 26, 1971 as the Assistant Administrator of Swift Current Union Hospital in Swift Current, Saskatchewan. Considering the financial challenges the health care system is experiencing today, it’s ironic that I owe that first job to the fact that the hospital was running a deficit and the administrator was told to hire an assistant. Still, as I look back on my 43 years as a health care system leader, I count myself lucky to have had the incredible opportunity to be associated with so very many outstanding  people, and to bear witness to their remarkable levels of ability and commitment to patients.

I recall an era when it would have been unethical to perform open heart surgery on an individual over the age of 70. Today, it is the exception when the same surgery is performed on a patient under the age of 70. And surgery is just one field that has been transformed by the introduction of new technology.

Medical research has led to many other advances, including customized pharmaceuticals and gene therapy –  two innovations that have great potential for radical change and improvement in medical care. With the promise of so many breakthroughs now on the horizon, never in history has there been a better time to require care.

All of this has had a profound effect on the role of hospitals, and will continue to impact the work we do in the future. In order to be sustainable, our hospitals will need to be resourceful and versatile in establishing new approaches to care that meet the changing needs of our patients, and of society in general.

The real questions that will require answers as we establish priorities for our health care system of the future  include: “ What can we do as enabled by technology?”, “ What should we do when it comes to making difficult, ethical decisions such as end-of-life care?”,  and “ What can we afford to do as driven by our financial reality?”

Very soon we will be nearing the gorge between the ability of our publically funded health system to provide services, and what taxpayers can afford to pay. Of course, there is always the public policy choice of going to higher levels of taxation to increase our capacity to pay.

This would obviously be a very unattractive option that should only be pursued after we have (a) removed the maximum amount of wastage from expenditures on non-value-added costs in health care delivery, and (b) optimized efficiency.
We have a great deal of work to do in the elimination of such practices as the  unnecessary use of antibiotics, diagnostic services, consultations, hospitalizations  and ambulatory visits. These savings need to be identified, harvested and then directed towards supporting the growing costs of effective, evidence-based therapies. Tackling this issue may require a fundamental re-alignment of incentives amongst providers, and that will require considerable political stamina to garner the needed public support.

Over the years, voices for change have fallen to deaf ears when politically sensitive topics such as the over professionalization of care delivery are brought to the table. The health care provider lobby looking out for the interests of professional groups has been very successful at protecting the status quo on behalf of its members.

Governments have been timid in their attempts to move forward with changes in legislation and/or regulations that would be required to change scope of practice. There is a real fear of a backlash from professional groups whose economic interest may be threatened.

How, as a society, can we deal with the power of the health care lobby? Or do we even want to deal with it? We know that the labour input costs for most health care providers in North America are at least 30 per cent higher than Western Europe. Perhaps the public does see value in paying higher levels of compensation in order to have access to highly trained and committed health care professionals. But does this then lead us right back to the need to pay higher taxes?  What level of compensation can the public today afford to pay?

I have painted a rather bleak picture of the future ahead, but I do want to finish with a few notes of optimism. I have had the privilege of serving as CEO of two of Canada’s outstanding research hospitals – a total of 23 years at Vancouver Hospital and Hamilton Health Sciences. In those roles, I have been exposed to the leading edge of what lies ahead in health care delivery.

I know that Canada’s research hospitals are rapidly moving towards standardization of best practice as an effective way to achieve higher quality and reduce costs. Evidence-based practice is now part of the everyday ethos of decision making. In addition to care delivery, research hospitals are also positioned to play a societal leadership role in dealing with major issues such as futile, expensive, end-of-life care, and the sensitive issue of end-of-life choices.

Investment in health research makes Canada healthier, wealthier and smarter. Research hospitals, along with their community partners, will be leaders in determining the most effective way to keep people out of hospital through advancing prevention and providing community-based support. However, to reap the full rewards of research advances, innovation needs to be paired with investment and the political will to make choices that will help sustain our system.

I will end my career this coming year knowing that our system has immense ability to rise to meet the challenges that each new decade brings. My joy as an administrator has been largely driven by the wonderful people I have worked with and the incredible resilience and caring they demonstrate every day.