Tuesday, August 29, 2017

News Flash: Manitobans are Skeptical of Politicians plans for Health Care

Thank you Captain Obvious!

Much ado has been made about a recent opinion poll release by Probe Research about the changes being made to Health Care in Manitoba.  In short, the poll indicates that 60% of Manitobans believe the Healingourhealthsystem.ca plan is about saving money and deficit reduction, not providing better health care.

First off, this is an opinion poll to gauge the perception of the voting public. This poll is really measuring how well the plan is being communicated and accepted by the public.  What the poll tells us is that the people of Manitoba are skeptical of their political overlords.  That’s probably a good thing, especially when health care is at stake. Governments and the WRHA (Winnipeg Regional Health Authority) don't exactly have a strong record on improvements in health care.  So skepticism of a new plan is no surprise to anyone.

Is this poll a predictor of success or failure of the Government’s plan for health care?  I don’t think so...and that wasn't the purpose of the poll.

Some have called the changes to health care "convoluted" or "confusing."  In reality, that is the current state of health care.  So that isn't changing.

What’s Missing from the Poll?

There is an obvious question I have related to this poll.  Are Manitobans satisfied with the status quo?  Do Manitobans think that an overhaul of our health care system is needed?  That is a poll that I would like to see the results of.  I would predict that the results of the poll would be overwhelmingly in favour of changes to our health care system.  

The problem is what changes should we make?

The difficulty with selecting what improvements should be made is that once you put pen to paper and start setting concrete plans you inherently open yourself up to criticism from every self-proclaimed “expert.”  Let’s face it, being critical is easy.  Generating solutions…now that is the hard part.

To Consolidate or Not to Consolidate?

One of the key strategies to the new health care plan for Manitoba hinges on consolidation of acute care services.  In the case of Emergency rooms, the number will shrink for 6 to 3.  The plan is a lot more involved than that but Emergency Rooms seem to garner the most attention.  A re-alignment of services and reducing services at some sites seems counter-intuitive.  How can reducing services improve health care?

The opposition NDP in this province like to dwell on what happened in the 90’s with health care, so let’s go there.  Do I want to talk about Connie Curran? No!  I want to talk about Justice Murray Sinclair.  Specifically his report on 12 deaths of infants in the early 90’s.  Why is this important to discuss when discussing consolidation?  Because, inadequate services spread too thin resulted in these deaths.  

Much of the media coverage, related to the judicial inquest, blamed the surgeon at the centre of the inquest, Dr Jonah Odim.  Some closer examination reveals a larger systemic problem that existed at that time.  The inquest proved that there was not sufficient volume of patients in Winnipeg/Manitoba to support a pediatric cardiology surgery program.  The one surgeon was inadequate, the nursing staff did not have the support or specialized training, the ICUs did not have the tools to support complex cardiac cases, and the oversight was not adequate.  This was a disaster waiting to happen.

Is this inquest relevant today?  Can we apply some of the lessons today to our broader health care system?  Too some degree, a similar situation exists in Winnipeg hospitals today.  Specialized services, diagnostics, and staffing are dispersed throughout Winnipeg hospitals.  CT scans and MRIs are not available at all hospitals.  In some situations a CT exists but does not operate on off hours.  This means patients are shuttled all over the city for various tests and specialized procedures that may not be offered at their “home” hospital.  A high proportion of medical errors happen during transfers. This is an unsafe condition that needs to be addressed.  Reduce transfers and you will create a safer environment.


I raised the experience of the Pediatric Cardiology because they found a solution to their surgical predicament.  The answer was consolidation. 

In the late 90’s as Justice Sinclair’s inquest was drawing to a conclusion the solution to Winnipeg’s Pediatric Cardiology Surgery program was beginning to materialize.  Winnipeg was not alone in their need for this solution.  Children’s Hospitals in Saskatchewan, Alberta, and British Columbia also had inconsistent coverage for these very specialized little patients.  The solution was to create a surgical reference centre in Edmonton to consolidate Pediatric Cardiac Surgery at the Stollery Children’s Hospital.  One centre in Western Canada to perform all Pediatric Cardiac Surgeries.

It was not the perfect solution but it was the best option available.  20 years later no one is questioning that decision as consolidation has been a resounding success. Former CEO of the WRHA, Arlene Wilgosh, stated this about the Pediatric Cardiology program in Manitoba, 

"Out of these tragedies we established a program that stands with the best internationally." 

Stollery Children's Hospital - Quality Dashboard
Data Source:  Society of Thoracic Surgeons Congenital Heart Surgery Database

Does this mean that this process is perfect? No.  It is a huge burden on families to uproot themselves and make the journey to Edmonton for surgery.  It is daunting for any family.  However, if you had a choice of going to a mediocre surgeon or going to the best?  What would you choose?  Would you take your child to a Doctor who does a Norwood procedure every once in a while or would you take your child to the hospital that has the highest survival rate associated with performing surgeries with the highest risk of mortality, in North America.  (Not Canada…North America!!!)

Yes, the Stollery gets all of the acclaim and media coverage.  Fortunately, with the advent of consolidation of surgical services in Edmonton, our Peds Cardiology program has very quietly and very effectively developed a program, here in Winnipeg that integrates and compliments the services offered by the Stollery.  After you receive surgery at the Stollery or another centre you still require significant follow up and management.  That is what our local program is doing. There is much more to an effective cardiology program than just surgery.  The program in Winnipeg has been built so that Manitoba’s children have access to world class cardiac care.  Not mediocre.  Not so-so.  World Class.  This does not stop with their relationship with the Stollery.  This relationship extends to their relationship with other sites across Canada and the United States.  The bottom line is our kids get the best available treatment possible.   

The Bottom Line

So my question is…do you want the best Emergency Room services that Winnipeg has to offer in three locations…or do want a mish mash of services, inconsistently distributed throughout 6 centres?  The question is really that simple.  Does it mean that a fully equipped Emergency Room is a 5 or 10 minute drive further from your home?  Yes…we don’t live in a perfect world.  No solution is without its negatives…but to me and from lived experiences I want excellent care when I need it.  Geography is an after thought.

Combining your best resources and services and consolidating them under one roof makes a lot of sense.

The Risks:

The challenge for the management team at the WRHA is balancing consolidating resources, in acute care facilities, versus providing relevant community care convenient for everyone to access.  Health care doesn't only happen in hospitals.  That is what will determine the success of the plan in the long term.  The plan cannot only focus on acute care hospitals but also what happens when the patient is discharged.  What supports are in place in the community to support the plan?  Home care, community physicians, walk in clinics, social services, are a big part of this plan and will be critical to its success.  Maintaining continuity of care from hospital to home may prove to be one of the most challenging aspects of this new strategy.

Change is difficult.  The effect of change should not be taken lightly.  However, we need to change and improve our health care.  We have to get very good at change.  This is only the beginning.

Author's Note:
As a parent of a son who has benefited tremendously from the recommendations and actions taken after the Pediatric Cardiac Surgery Inquest we will be forever be indebted to those families who lost their children nearly 25 years ago.  Those families and many who followed were pioneers who have had a long lasting impact on our cardiology program and made it what it is today.  A program that we should be learning from.

These families along with the doctors and nurses who championed change and improvements in a flawed system have always put their children (their patients) first.  They made decisions, not for personal benefit or notoriety but so that children could grow and thrive under very adverse circumstances.  We would be foolish not to learn from them.

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