Monday, March 28, 2016

Cum Minus Facerent Malum

Cum Minus Facerent Malum

It was not our plan, but my wife and I had quite the adventure this weekend.  We set out for a relaxing urban adventure but in the blink of an eye the adventure turned to rushed visits to two Emergency Departments and some emergency surgery.  A few days have passed, but it has given us the opportunity to reflect on what went well and what did not.

First off we do understand that we live in a busy big city and this was a vacation weekend, but taking all that into consideration, this still would not be considered a totally happy experience. 

A little background first.

In Canada, our healthcare story has been quite a ride.  At the beginnings of Canada the crafters of the country’s confederation saw health care as a matter best left to the province.  It was not that big a deal or interest for a national government to get engaged with.  All that changed almost 50 years ago (to the day) in 1966 when the federal government decided that if healthcare was going to be seen as equal sea-to-sea-to-sea, the feds would need to get engaged, and made an absolute commitment to contribute 50 percent of provincial costs.  Public attitudes were mixed, but the politicians of the day knew better and so the path was set.  It was written in stone. 
It took about 10 years to figure out that this was costing a bomb and government of the day decided to erase the stone and renege on payments. The stone was re-written with a new written in stone commitment called the Canada Health Act.   

Ever since the creation of the new Act, the Canadian system has been progressively gutted, less and less federal funds, and the closure of mental health hospitals, and consolidation of health facilities, and continuous reductions of staff.  It has been an experimental Leaning of healthcare on a national scale, without any Keizen.  (If only they had implemented a Poke Yoke – error prevention – program).

All of which brings me to this weekend.  We were sent to one gutted emergency department to find overly busy, swamped folks trying to cope.  The emergency doc, did what he could do and then we were put into a taxi to go to the the other
ER because they were the only ones who had an appropriate surgeon working that day.  

It felt like we were living an episode of M.A.S. H. 

At the other place the mess was infinitely bigger with stressed out staff absent of any vestige of interest or care. After being shuttled around we ended up sitting with a herd of patients in an open corridor without any interest or care or food or medication or even water.  (When I told the staff my wife was in a lot of pain, the nurse on staff to me to get out of her staff room).  This in an institution that proudly pronounces its mission statement “Embed patient-centered practices in the delivery of all care and services.”

After too many hours in the back hall we were finally seen by the appropriate surgeons and had the definitive measures completed. 

So when the smoke cleared, if you use life versus death as the outcome measure, our adventure was a roaring healthcare success; but by any other measure, not so much.  

The number of Opportunities For Improvements were far too many to enumerate, with the exception of the one where the first ER informed the second ER that we were coming but got the name totally wrong, so that when we arrived, no one knew who we were or what was going on.  Of the ones that I will not mention here, two were serious breaches.  Not many, perhaps, but those were the ones that I observed in one afternoon on one day, and I wasn't seeking them out.  

So as much as this sound like a personal grumble, that was not the point.  It is to make the point that for the last 50 years politicians and consultants have made step after step, to get healthcare under control and they have failed miserably.  All the major Leaning initiatives have been failures.  The care has not got better, it has got worse. 

As a Quality oriented healthcare person, this gives me serious pause.  What we are seeing is a lot of Doing and Checking and Acting but either with NO Plan or worse a TOXIC Plan. Deming would be shaking his head.

Nobody can be proud of this mess.


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