This has been a very busy week for us. With both Nicole and Russell in soccer we are busy just about every evening. Add in a meeting with our school, a 5 hour trip to emergency, and a trip to the Manitoba Legislature and it is all a bit overwhelming. I am really enjoying sitting in the sun room today and enjoying the sunshine and doing some reading.
It seems I kicked over a few rocks this week. Since my visit to the Legislature, I have been approached by the Minister of Health's office and have had two media stories written about our visit to the ER on Wednesday. It is always a dangerous thing to go public about any issue. Once you go public you lose control of the narrative. The story can evolve into something it was never intended to be. It is a risky thing to do. I don't recommend it.
What prompted me to go public with this issue was that Health Care needs a shake up. We have big problems and big problems require big solutions. Solutions that may be controversial and will definitely challenge the status quo. We have been talking about the problems in health care for years and years and effectively we have only been able to maintain a status quo. The status quo is not acceptable.
Our little 5 hour trip to emergency on Wednesday was nothing. A mere speed bump in our travels through the health care system. We have had many other more spectacular trips to Emergency. Our experience on Wednesday was nothing new or unusual. This is what we expect. What infuriated me most on Wednesday is how we can't get the small things right. A simple treatment that should have taken a few minutes; took hours. Not only is it a waste of our time but we are utilizing valuable resources in a most inefficient way.
What isn't mentioned in the news stories are all of the very diligent people who were working for us and trying to solve issues while we were in Emergency. The last thing I would ever want to do is give the impression that someone wasn't doing there job or were under performing; they were not. Many of the people I saw on Wednesday, I will have to sit down with again at our Child Health Quality Council meeting on June 3. I hope they don't throw anything at me.
So why is health care so chaotic? To put it very bluntly and perhaps a little overly simplistic. The system is setup to fail. Communication within health is an unmitigated disaster. No one talks to each other. There are so many policies and processes, everyone assumes that "someone" will take care of it. Unfortunately, "someone" is not employed by the health care system. These same polices often conflict with other policies and in many instances are poorly understood. After reviewing some health care policies I have also noticed that many of the policies are very restrictive and limit creativity. It is very difficult to conceive of every possible scenario and policies need to be drafted so that professionals can use their discretion. They are smart; let them use their years of education and experience.
The second major problem is health care is that it is politician centred; not patient centred. Decisions at high levels are based on political expediency and not for the long term benefit of health care. If a program offers a good photo op; it gets the green light. Doesn't matter if it has no tangible benefit (Quick Care Clinic in Southdale...Really??). I talk about family centred care and putting patients first all of the time. Patients are outgunned and under represented in health care. Who is supposed to be looking after and listening to the needs of patients? Our elected representatives. I don't believe our MLAs are representing the interests of their constituents. The voice of the patient is rarely heard and often dismissed in political circles. Its all about window dressing and the next election cycle for politicians. Health Care is highly contentious political issue. Any elected official who presents any ideas for "real" change in health care will commit political suicide. This is certainly not a unique issue to Manitoba as we have seen first hand how Alberta Health Services operates and I don't see a great deal of difference between Manitoba and Alberta except Alberta has significantly more financial resources; not to say they are using it wisely.
The third major problem, from my perspective, is the need for a continuum of care. Hospitals and health care is built around programs. The Renal program or the Cardiology program. This creates a disconnected and stuttered approach to health care. This week we had meetings with our school (Education System), our Child Development Worker (Disability Services Manitoba), went to Emergency based on information received from our school. Once we learned we needed medical intervention we dealt with Cardiology, Infectious Diseases, the Emergency Dept at Children's and Canadian Blood Services where our medication came from. That is 6 different groups we dealt with this week. 6 groups who report to different bosses, who are part of different government departments and all have different mandates and priorities. Who is the only consistent voice for our son. Us; the parents. Is it any wonder that the level of care is so inconsistent. There is no continuity.
Susan and I get the tag of being "high functioning" which is a blessing and a curse. It is good because most people we work with embrace our input and know we are trying to help and can be self-sufficient with a little guidance. It is a curse because these same professionals begin to depend on us so they can spend time with other families who might need more assistance. In many cases we are left to struggle on our own. With the complexities we face and many issues we deal with. In many situations we are left too sort out our issues on our own. I often think of those who don't have our resources. How do they cope with the system or do they simply slip thought the multitude of cracks in the system.
Folks, this is serious. At one point in time we will all need health care. Making fundamental changes to health care is a scary proposition. There will be mistakes and many unforeseen challenges but it is fundamentally necessary.
Saturday, May 23, 2015
Wednesday, May 20, 2015
When is the Emergency Room not an Emergency Room?
The whole adventure started yesterday morning with a call
from our school principal. She informed
us that a student in our school had a case of chicken pox. This was the second case in two weeks. With Russell being immune-compromised this is
an issue. Fortunately, this was not
Russell’s day to be at school. And he
had not been at school since last Wednesday.
Unlikely that he had been exposed.
Good news.
I proceeded to make the call I don’t enjoy making. I called Russell’s Cardiology clinic to let
them know about the situation. I get the
impression they are more protective of Russell than we are. I guess that is why we love them. I gave them as much information as I
could. They agreed that Russell’s odds
of being exposed to the Chicken Pox was not likely but with a second case being
reported in the school they were concerned that the virus was “in the community.” They made a compelling case that we should
take some preventative action. They
consulted with Infectious Diseases who agreed.
We were given two clear options.
We could take an oral medication for about 10 days which would give him
some immunity for the 10 days he is on the med or we could come into the
hospital and take an IV medication that would protect Russell for about a
month. The logic was that in about a
month, hopefully the virus would have come and gone through the community and
Russell would no longer be at risk. We
chose to come into the hospital and give up 4 hours of our lives (the time it
would take the IV to run) and try to protect Russell for a month.
Our Cardiologist made arrangements last night with the Emergency
Room to make the necessary arrangements. We would come into
Emerg to start the IV at 8:00 this morning.
Like good parents we packed up this morning and headed to
the hospital. We arrived at the triage desk at Children’s Hospital. Upon hearing the word “chicken pox” we were
immediately taken to an isolation room where we complete the rest of the
registration process. This was a good
start; things went south quickly. We
were then informed that no one knew why we were there and no arrangements had
been made. They were now trying to reach
our cardiologist to figure out a plan.
So awesome.
You have to keep in mind that I am assuming at this point
that we have now entered the ER triage process.
In other words, the ER Doctor cannot see us (by policy) until other more
urgent patients are seen. Russell, to
our knowledge, does not have chicken pox.
The only risk he might present is that he possibly could be
carrying. Because we are in an isolation
room; we pose no risk and there is absolutely no urgency by the hospital to do
anything with us until all other more urgent cases are seen. Is
this irritating and frustrating; yes.
Is the hospital following policy; yes.
After waiting 2 ½ hours we saw the ER Doctor. A quick exam and she ordered the med we
needed. Yes, the med our Doctor had
requested the night before that should have been waiting for us. The med we required is a blood product and
has to be requested from Canadian Blood Services. Just another little wrinkle that slows the
process down. After 4 hours of waiting
my wife was informed that they did not have any medication on hand and they
were now looking for other sources. So,
now it was looking like our trip may have all been a waste of time. At this point I was noticeably irritated.
Shortly after, our nurse contacted my wife again and said
that they had located the medication and that it was not administered by an IV
but by a simple injection. A 3 second
injection! The nurse went on to say that
they were in the process of preparing the injection and that we would be ready
to go in a few minutes.
Don’t get me wrong.
Not having to wait around for an IV to run was fantastic news but what
about all of the other information we were given. This really didn't add up.
We checked the data on the medication (which we requested)
for and it seemed to be the correct thing.
Russell got his medication, we waited for 20 mins and went home. We waited around 5 hours to get a simple
single injection. The frustrating part
to me was that I could find no fault in what we went through. Yes, there was some communication issues but
this is what our health care system calls quality health care. From my point of view if this is an example
of the system working then this simply is not good enough.
From the beginning of the process no one
considers our schedule and the inconvenience to us. I had to take time off work for this. My wife had to use up one of her valued days
off. Russell missed a day of
school. This is never considered when
building these processes.
Patients need to start demanding more and better service. If this is public health care, the public must
speak up and be heard.
Tuesday, February 24, 2015
Our Boy has an Opinion...Who Knew?
I read an interesting blog this morning from another parent
writing about her son’s experience of a recent day surgery. This family is one of the “jaded” few who are
very familiar with hospital trips as her son has some complex health issues.
I laughed as this Mom shared her story. Her son is old enough to understand what is
going on and is now offering his own opinion on the whole experience. My how these kids change. It isn’t just a matter of getting your kid
doped up and having the medically induced calm.
They are real people who have their own distinct ideas and feelings and
most importantly they have a voice.
We are now going through this with Russell. It is really interesting to try to imagine
what your child is thinking as he goes through the process of hospital visits,
clinic visits, evaluations, and procedures.
We don’t have to imagine as much anymore as Russell is now sharing his
opinion of the whole process. Russell’s
perspective is rather unique. As a
result, some of his comments are very interesting. A week ago I was interviewed by the Winnipeg
Sun to discuss measles, vaccines, and immune suppression. A picture of Russell and I appeared in the
paper. Now Russell is skeptical of
anyone taking his picture, and he asks “is this going to go in the paper?” We think this reaction is quite humorous but
it reminds us that our boy is growing up and is understanding more and more
about his unique situation.
I have been talking to Russell more and more about some of
the volunteer work that I do which invariably involves sharing part of our
family’s experience and specifically his story.
I have to realize this is “his” story and that I am just a part of “his”
story. I hope that in the next few years
he is OK with sharing his story. He has
a very unique perspective to add as I can only tell the story from my point of
view. His view could be much different
(than mine) and I think we have much to learn from him.
Many people would think that after all that Russell has been
through that he would be a seasoned veteran and would be so used to his many
medical appointments. The truth is that
he is extremely wary of hospital visits and makes no secret of the fact that he
wants nothing to do with Doctors or anything medical. Our regular blood work has gotten a lot
better but Russell makes no secret that he can’t stand the whole process. When I think about it and try to understand
where he is coming from I have to come to the conclusion that he has good
reason to be “difficult” and to express his anger at being poked and prodded. This has changed my attitude. Instead of trying to keep Russell “quiet” and
to have him “behave” I let Russell express exactly how he feels. I feel he’s earned it. If he wants to yell his head off when a
needle goes in his arm; the yell away. I
don’t like it and as a parent it upsets me but if it helps him blow off some
steam…I can swallow my pride for a few minutes and let him scream. Yes…other parents in the waiting room are
probably horrified at my son’s behaviour but I have to get past that. It’s not about me and what others think of my
parenting skills.
That is the interesting part of our medical experience. Our story did not end when we received a
heart transplant and came home from Edmonton.
We have constantly been challenged by new issues that just seem to crop
up, almost on a continual basis. Our
journey is far from over…there are many more chapters to be written. Just when we start to get into a routine and
we get comfortable something comes up and we are sent on a new adventure. Let’s just hope that there are more positive
adventures than negative ones.
Wednesday, December 24, 2014
Merry Christmas - 2014
The fun thing about blog posts is that you can be completely self-indulgent. Where else can you so blatantly be "all about me."
As we approach another Christmas I saw a picture from the Stollery Children's Hospital showing all of the preparations for Christmas morning. The "Beach" is the play area on the 4th floor which was jammed with presents and all of the other items that will be distributed to the kids in the hospital on Christmas morning. It really is Santa's workshop. The amount of effort put into this is truly amazing and it does really make Christmas special for families who are unfortunate enough to have to spend Christmas in the hospital.
As we approach another Christmas I saw a picture from the Stollery Children's Hospital showing all of the preparations for Christmas morning. The "Beach" is the play area on the 4th floor which was jammed with presents and all of the other items that will be distributed to the kids in the hospital on Christmas morning. It really is Santa's workshop. The amount of effort put into this is truly amazing and it does really make Christmas special for families who are unfortunate enough to have to spend Christmas in the hospital.
This image reminded me of our Christmas at the Stollery. Our Christmas wish was very different that year. We were waiting for a heart transplant and it would have been amazing to have received our donor heart on Christmas, but it was not meant to be. In fact Christmas Eve we learned that we had been offered a heart the night before but it was too large for Russell by the smallest of margins and it went to another child instead. A child who happened to be at the next bed. Our frustration on that do was very evident. We were especially thankful to a special elf who spent time with is on that Christmas Eve. That special elf was Russell's Berlin Heart brother who was also waiting for a heart. It was hard to be frustrated or angry when talking to someone who had the exact same issue.
To all of Santa's Helpers at the Stollery who are working feverishly this Christmas...I wrote this note below. I hope you enjoy!
'Twas the Night Before
Christmas
'Twas the night before
Christmas, 6 short years ago,
Where we found
ourselves, far from our home.
I remember the cold
that memorable night.
As our tiny boy, was
far from alright.
In the Stollery's care
our boy stayed in good stead
His heart beat held
steady with a device by his bed.
Our future uncertain,
our outcome unknown
A new heart for
Christmas; our impatience had grown.
Our journey had started
three months before.
His heart
fell ill and could not take anymore.
My 8 week old boy's
heart was nearing the end.
His heart was sick and
could not be mend.
ICU and hospital our
new home became
A heart for a
transplant became our new aim.
The days turned to
weeks and our fate seemed so grim.
The watching and
waiting were doing us in.
One offer, then
another; not quite a right fit
Could Christmas bring
that one special gift?
Christmas day came and
went, our gift did not come
Another day had come
and gone; unanswered prayers to some.
One day passed and then
another, an end not in sight
We doubted and fretted;
would our boy win this fight?
But unknown to us the
stage had been set.
In a city far away in
the Pacific Northwest.
Another young boy was
clinging to life.
A story filled with
sorrow and unfortunate strife.
The stage was now set;
a decision was made.
A call of compassion
and plans were well laid
Early that morning just
before the New Year
A heart had been found;
joy replaced fear.
The waiting was over; a
new chapter began
Our gift of new life
was all part of the plan.
As I think of this time
and memories so fond.
We stop and remember my
son's kindred bond.
A selfless choice, by a
father and mother.
A new beginning for us;
an end for another.
At this time of year I
remember our plight
And our special gift
that ended our fight.
Our Christmas wish to
one and all.
Is of joy, and peace
and thanks above all.
Merry Christmas from Donald, Susan, Nicole, and Russell
Wednesday, December 17, 2014
A Day in the Life of a Patient Advocate
For the most part our life is routine. We go to work, we come home, we get groceries; its all very normal. However, there are symptoms that things aren't quite so "normal." Whatever "normal" means.
As we fetch groceries we park in the handicapped spot. I'm sure we get the evil stares from people who see a family with young kids using a handicapped spot. After all; things look so perfect. Looks can be deceiving.
Those that know us; know we have two cardiac patients in our family. My wife and my son. My son will be celebrating his 6th anniversary of his heart transplant on Dec 30th. Thanks to modern medicine we can lead a relatively normal life. Relatively.
I find myself routinely taking someone to medical appointments or on the phone with the pharmacy. There always seems to be something going on. I am a patient advocate, not by choice, but by necessity, but what does being a patient advocate mean?
Patient advocacy is another term that gets bandied about in medical circles without a lot of real understanding. We talk about patient engagement, family centred care, in similar terms. They all sound good and have become the trend in health care policy. All part of "politically correct" health care. When people ask me what my thoughts are on these topics I try to give practical examples from my personal experience.
Today was patient advocacy day for me.
It started at about noon today. I received a phone call from my son's cardiology clinic with my son's blood test results. He gets blood tests every couple of weeks to monitor the level of anti-rejection
in his system. We have been having issues the past couple of months maintaining his levels. This is odd seeing that his levels have been rock solid steady for more than 5 years. In discussion, with our Doctors and discussing all of the potential issues we suspected that we may have received a bad batch of medication. It is unlikely; but possible. We got a new batch and we managed to get things somewhat stable. Today, we encountered the same strange levels that we encountered almost two months ago. Could we have received a second bad batch? That seemed truly unbelievable. Again, we discussed every possible explanation and came to the same conclusion. Bad medicine.
For the second time we had to rush to get a new batch of medicine in time for the evening dose (My son takes his med twice a day.) This time we wanted to get a new compound made at a different pharmacy. Despite our best efforts we would not get a new batch until the next day. Our son would miss two doses. Not great news.
My first question to our cardiologist was a question I have used many times before. "On a scale of 1 to 10; how worried should I be?" After that discussion I felt a lot better as I was re-assured that this was a manageable situation and that, although not ideal, it wasn't the cataclysmic apocalypse that i might have feared. My second question was how could we get medication to my son and not have him miss two doses. I explained that if my son were sick and I presented at Emergency, the hospital would be obligated to provide his medications if we had forgotten ours at home. I asked if there was any way we could get the med from the hospital. I would even agree to admitting him to hospital if it would satisfy hospital policy. I really like our cardiologist and have a tremendous amount of respect for her. She realized that missing two doses was not an acceptable scenario to me and she also realized that admitting us to hospital or going to Emergency would be a huge waste of hospital resources. She left me in the clinic waiting area and called the hospital pharmacy and asked if they could make up enough medicine for a couple of days; to ensure we had enough med until we could get our medication from our community pharmacy. We had a small batch of medication in about 10 mins.
The story I have shared is an experience we have had many times. I have had to advocate on behalf of my family on many occasions. Patients cannot sit back and expect the "system" to meet their needs. The process has to be interactive. There is also no way I could advocate for my family without educating myself. Through every experience I have had in health care I have learned and I try to apply that knowledge when I support my family and how they are cared for.
This was just one day in the life of someone who the health care system has become an integral part. I live in constant fear of how others are able to navigate health care because I know many people do not have the experience or support to effectively advocate. Every patient whether they be 8 or 80 need effective advocates to help support them and either help them be their own advocate or advocate for them if they are unable.
As we fetch groceries we park in the handicapped spot. I'm sure we get the evil stares from people who see a family with young kids using a handicapped spot. After all; things look so perfect. Looks can be deceiving.
Those that know us; know we have two cardiac patients in our family. My wife and my son. My son will be celebrating his 6th anniversary of his heart transplant on Dec 30th. Thanks to modern medicine we can lead a relatively normal life. Relatively.
I find myself routinely taking someone to medical appointments or on the phone with the pharmacy. There always seems to be something going on. I am a patient advocate, not by choice, but by necessity, but what does being a patient advocate mean?
Patient advocacy is another term that gets bandied about in medical circles without a lot of real understanding. We talk about patient engagement, family centred care, in similar terms. They all sound good and have become the trend in health care policy. All part of "politically correct" health care. When people ask me what my thoughts are on these topics I try to give practical examples from my personal experience.
Today was patient advocacy day for me.
It started at about noon today. I received a phone call from my son's cardiology clinic with my son's blood test results. He gets blood tests every couple of weeks to monitor the level of anti-rejection
in his system. We have been having issues the past couple of months maintaining his levels. This is odd seeing that his levels have been rock solid steady for more than 5 years. In discussion, with our Doctors and discussing all of the potential issues we suspected that we may have received a bad batch of medication. It is unlikely; but possible. We got a new batch and we managed to get things somewhat stable. Today, we encountered the same strange levels that we encountered almost two months ago. Could we have received a second bad batch? That seemed truly unbelievable. Again, we discussed every possible explanation and came to the same conclusion. Bad medicine.
For the second time we had to rush to get a new batch of medicine in time for the evening dose (My son takes his med twice a day.) This time we wanted to get a new compound made at a different pharmacy. Despite our best efforts we would not get a new batch until the next day. Our son would miss two doses. Not great news.
My first question to our cardiologist was a question I have used many times before. "On a scale of 1 to 10; how worried should I be?" After that discussion I felt a lot better as I was re-assured that this was a manageable situation and that, although not ideal, it wasn't the cataclysmic apocalypse that i might have feared. My second question was how could we get medication to my son and not have him miss two doses. I explained that if my son were sick and I presented at Emergency, the hospital would be obligated to provide his medications if we had forgotten ours at home. I asked if there was any way we could get the med from the hospital. I would even agree to admitting him to hospital if it would satisfy hospital policy. I really like our cardiologist and have a tremendous amount of respect for her. She realized that missing two doses was not an acceptable scenario to me and she also realized that admitting us to hospital or going to Emergency would be a huge waste of hospital resources. She left me in the clinic waiting area and called the hospital pharmacy and asked if they could make up enough medicine for a couple of days; to ensure we had enough med until we could get our medication from our community pharmacy. We had a small batch of medication in about 10 mins.
The story I have shared is an experience we have had many times. I have had to advocate on behalf of my family on many occasions. Patients cannot sit back and expect the "system" to meet their needs. The process has to be interactive. There is also no way I could advocate for my family without educating myself. Through every experience I have had in health care I have learned and I try to apply that knowledge when I support my family and how they are cared for.
This was just one day in the life of someone who the health care system has become an integral part. I live in constant fear of how others are able to navigate health care because I know many people do not have the experience or support to effectively advocate. Every patient whether they be 8 or 80 need effective advocates to help support them and either help them be their own advocate or advocate for them if they are unable.
Saturday, August 16, 2014
Project Management 101 - City of Winnipeg take note.
I'm posting about an issue I have never tackled publicly before. Typically, my posts are related to health care but that is just one part of my life.
Over the past couple of years I have watched the incompetence of our civic leaders in Winnipeg attempt to address the debacle that has become many of the capital projects they have undertaken in recent years. The Police Headquarters, fire halls, shady land deals....the list goes on and on. Finally, the results of several audits have been handed over to the RCMP for investigation. It is clear the story is far from over. The question for most members of the public is how do things get so bad and go on for so long? To shed a little light on this I have to explain a little about my experience.
For the past 20 years or so I have worked in and around Project Management. I have worked mostly in construction and heavy industry. 5 years ago I joined Canada Post as they embarked on the largest capital modernizations in their history. A 2 Billion dollar upgrade to their aging mail processing infrastructure. Yes...that's Billion with a "B". For the past 4 years I have been working with CPC (Canada Post Corporation NOT Conservative Party of Canada) as the Cost Controller for Postal Transformation for the Western Canada Region. In other words, every dime of CPC money spent on the project has to go though a rigorous cost control process to validate any expenditure. If you want to spend project money you have to comply with cost control and I'm the cost controller.
Many times I wondered what value my role really brought but when I read the countless stories reported in the media about civic mismanagement of contracts it validated my position and what I was doing. In the back of my mind as I would read about all of that was going on at city hall I would think to myself, "that could never happen here." Because CPC is a crown corporation there is an almost fanatical attention to transparency and accountability. We need to be beyond squeaky clean. We have been audited so many times by both internal and external auditors I've completely lost count. There are literally dozens of people at CPC who are monitoring and controlling our projects to ensure the success of the program and ensure that we are fiscally responsible. With this much planning and organizing and as our project is now coming to an end...how have we done? Strangely enough, our budget was $2 Billion dollars. What will we have spent? Ironically, $2 billion dollars. In addition, has our projects been completed on schedule? Yes they have. In fact our projected financial benefits are being exceeded. This brings me to the subject of why I'm writing this post.
How can a bloated government bureaucracy deliver a multi-billion dollar project on time and on budget? What is Canada Post doing differently than the City of Winnipeg? The City of Winnipeg like any government organization has procurement policies, and a robust procurement process. In my career I have bid on many City of Winnipeg tenders. The process is there. Many big government proponents, wanting to "fix" the problem, want to bring in sweeping policy changes or new legislation. New rules are not what is needed. Enforcement of the existing rules are what is required. So, why are the rules not being adhered too. The bottom line is leadership. Who is making decisions at senior levels. Let me explain:
If a member of our project team needs to get some work done and they need it done quickly, we may not have time to go through all of the processes that our procurement policies require. Does this mean we stop? Not at all. We have mechanisms built into our policies to address "emergency" situations. Depending on the size and complexity of the request; approval to proceed may require authorization from our CFO or in some cases they may go all the way to our CEO. This is where leadership becomes very important. I am simplifying here, but the bottom line is that if we want to bypass our own purchasing rules all we need is a signature from a senior executive. This is where our leaders set the tone. If this process becomes routine and a standard practice, then it really minimizes the effectiveness of the rules that have been set in place. From personal experience, if I am sending requests on a regular basis to Deepak Chopra to be authorized I would expect my career opportunities to be significantly curtailed. That is a good thing. Our senior leaders have made it abundantly clear that "exceptions" are sometimes necessary but will NOT be the norm.
To speculate on what is happening at City Hall in Winnipeg, it is clear that a culture has developed over time that there is a certain way of doing business. That culture has lead to complacency and an acceptance of issuing contracts and doing deals that do not comply with their own internal policies. This is an obvious leadership issue and unfortunately it has gotten so out of control that the RCMP have to step in.
I have a great deal of respect for our project managers and executive for the way they have managed our projects (at CPC). What we have done has worked and that is proven by tangible results. We have consistently delivered on time and on budget. This all sounds great and I know it sounds like i've drank the "Canada Post Kool Aid." but there is also another harsh reality. To manage a project in this way and to be completely publicly transparent is extremely expensive. It takes a tremendous amount of effort and additional cost to manage a project in this way. In the private sector you would never need to operate in this way. In the private sector projects can be delivered much cheaper because they do not need to be accountable to a taxpayer. If you ever wonder why people joke about how governments buy $2000 toilets etc it is because to be transparent and accountable takes a huge bureaucracy and that it is a really expensive proposition. Government run projects are expensive because the public demands it. That is not a bad thing; it is just reality. The other grim reality of government programs is that even if the budget is spent wisely and all of the money is accounted for it doesn't mean the project itself will deliver the desired benefits. In other words, if the project from the first time it was conceived was a dumb idea, the best management in the world will not change the fact that it was originally a really dumb idea. Think about that for a second. The two biggest line items of the provincial budget are Health Care and Education. What are the two departments that Manitobans most complain about and feel they aren't getting the service they expect? Health Care and Education. Not surprising.
The real tragedy of what has gone on at City Hall is that there is a large (and expensive) bureaucracy in place. In spite of having all of the pieces in place they have still failed, in a spectacular way, to ensure taxpayer dollars are managed properly. It's time for senior leadership to step up.
NOTE: As an employee of Canada Post, I am complying with Canada Post Social Media Policy. The opinions expressed here are my own and do not represent the opinion or policy of Canada Post.
Over the past couple of years I have watched the incompetence of our civic leaders in Winnipeg attempt to address the debacle that has become many of the capital projects they have undertaken in recent years. The Police Headquarters, fire halls, shady land deals....the list goes on and on. Finally, the results of several audits have been handed over to the RCMP for investigation. It is clear the story is far from over. The question for most members of the public is how do things get so bad and go on for so long? To shed a little light on this I have to explain a little about my experience.
For the past 20 years or so I have worked in and around Project Management. I have worked mostly in construction and heavy industry. 5 years ago I joined Canada Post as they embarked on the largest capital modernizations in their history. A 2 Billion dollar upgrade to their aging mail processing infrastructure. Yes...that's Billion with a "B". For the past 4 years I have been working with CPC (Canada Post Corporation NOT Conservative Party of Canada) as the Cost Controller for Postal Transformation for the Western Canada Region. In other words, every dime of CPC money spent on the project has to go though a rigorous cost control process to validate any expenditure. If you want to spend project money you have to comply with cost control and I'm the cost controller.
Many times I wondered what value my role really brought but when I read the countless stories reported in the media about civic mismanagement of contracts it validated my position and what I was doing. In the back of my mind as I would read about all of that was going on at city hall I would think to myself, "that could never happen here." Because CPC is a crown corporation there is an almost fanatical attention to transparency and accountability. We need to be beyond squeaky clean. We have been audited so many times by both internal and external auditors I've completely lost count. There are literally dozens of people at CPC who are monitoring and controlling our projects to ensure the success of the program and ensure that we are fiscally responsible. With this much planning and organizing and as our project is now coming to an end...how have we done? Strangely enough, our budget was $2 Billion dollars. What will we have spent? Ironically, $2 billion dollars. In addition, has our projects been completed on schedule? Yes they have. In fact our projected financial benefits are being exceeded. This brings me to the subject of why I'm writing this post.
How can a bloated government bureaucracy deliver a multi-billion dollar project on time and on budget? What is Canada Post doing differently than the City of Winnipeg? The City of Winnipeg like any government organization has procurement policies, and a robust procurement process. In my career I have bid on many City of Winnipeg tenders. The process is there. Many big government proponents, wanting to "fix" the problem, want to bring in sweeping policy changes or new legislation. New rules are not what is needed. Enforcement of the existing rules are what is required. So, why are the rules not being adhered too. The bottom line is leadership. Who is making decisions at senior levels. Let me explain:
If a member of our project team needs to get some work done and they need it done quickly, we may not have time to go through all of the processes that our procurement policies require. Does this mean we stop? Not at all. We have mechanisms built into our policies to address "emergency" situations. Depending on the size and complexity of the request; approval to proceed may require authorization from our CFO or in some cases they may go all the way to our CEO. This is where leadership becomes very important. I am simplifying here, but the bottom line is that if we want to bypass our own purchasing rules all we need is a signature from a senior executive. This is where our leaders set the tone. If this process becomes routine and a standard practice, then it really minimizes the effectiveness of the rules that have been set in place. From personal experience, if I am sending requests on a regular basis to Deepak Chopra to be authorized I would expect my career opportunities to be significantly curtailed. That is a good thing. Our senior leaders have made it abundantly clear that "exceptions" are sometimes necessary but will NOT be the norm.
To speculate on what is happening at City Hall in Winnipeg, it is clear that a culture has developed over time that there is a certain way of doing business. That culture has lead to complacency and an acceptance of issuing contracts and doing deals that do not comply with their own internal policies. This is an obvious leadership issue and unfortunately it has gotten so out of control that the RCMP have to step in.
I have a great deal of respect for our project managers and executive for the way they have managed our projects (at CPC). What we have done has worked and that is proven by tangible results. We have consistently delivered on time and on budget. This all sounds great and I know it sounds like i've drank the "Canada Post Kool Aid." but there is also another harsh reality. To manage a project in this way and to be completely publicly transparent is extremely expensive. It takes a tremendous amount of effort and additional cost to manage a project in this way. In the private sector you would never need to operate in this way. In the private sector projects can be delivered much cheaper because they do not need to be accountable to a taxpayer. If you ever wonder why people joke about how governments buy $2000 toilets etc it is because to be transparent and accountable takes a huge bureaucracy and that it is a really expensive proposition. Government run projects are expensive because the public demands it. That is not a bad thing; it is just reality. The other grim reality of government programs is that even if the budget is spent wisely and all of the money is accounted for it doesn't mean the project itself will deliver the desired benefits. In other words, if the project from the first time it was conceived was a dumb idea, the best management in the world will not change the fact that it was originally a really dumb idea. Think about that for a second. The two biggest line items of the provincial budget are Health Care and Education. What are the two departments that Manitobans most complain about and feel they aren't getting the service they expect? Health Care and Education. Not surprising.
The real tragedy of what has gone on at City Hall is that there is a large (and expensive) bureaucracy in place. In spite of having all of the pieces in place they have still failed, in a spectacular way, to ensure taxpayer dollars are managed properly. It's time for senior leadership to step up.
NOTE: As an employee of Canada Post, I am complying with Canada Post Social Media Policy. The opinions expressed here are my own and do not represent the opinion or policy of Canada Post.
Friday, August 8, 2014
What is Family Centred Health Care?
If you were to "Google" Family Centred Care or Patient centred care you would see words like "collaboration", "respect", "communication" etc and these are all appropriate adjectives to describe family centred care but the words are meaningless unless there is a real understanding of how to put them into practice and to effectively engage patients and families.
It has become clear to me that a gap exists between families who want to participate in their own health care and a health care system who wants to effectively engage their patients.
I have been fortunate to be able to speak to nursing students and health care professionals on a semi-regular basis. I have learned a tremendous amount. As a patient family many times you feel that people are not listening to you or don't care. As I have interacted with health care professionals I have learned how much they truly care and want to engage with their patients. I have seen that they too are frustrated that they cannot make a greater difference in the lives of their patients.
I read an interesting article recently. (I have attached the link at the bottom of this blog.) The article talks about how patients can better manage their chronic health conditions if they had better access to their health information. Some of the examples are really interesting. The article focuses on some technical advances that gives patients information through an app for their smart phone. That's a great advancement but what the article seems to avoid is the need for more interaction between patient and health care provider. Having an app that provides you information is great but it seems to reinforce the idea that patients do not need to have direct access to their health care providers. This is where the gap in communication between patient and doctor exist. A 5 -10 minute "verbal" conversation between you and your Doctor every 6 months is not effective communication.
Fortunately some of these attitudes are changing. In our own situation, we have developed a great relationship with our Cardiology Clinic (Pediatric)where we get blood test results usually within a day and we can effectively manage our son's anti-rejection med levels, his hemoglobin, and his urea and creatinine. We do this all over the phone and it is really quick and effective. Because we have access to the information and a nurse clinician to speak to, we can make any changes we need to and interact to gain a much better understanding of what is going on. This allows us to live a life with a lot less stress, and more importantly because we have more knowledge we can provide more meaningful feedback when we go for a clinic visit and meet with our cardiologist. This is real patient engagement where we (as parents) and the clinic are both equally engaged.
Unfortunately, the same does not hold true when we interact with Adult Cardiology when discussing my wife's health. Trying to speak to a human to get an answer to a simple question is pure agony. You get voicemail, and if you manage to talk to someone, they won't discuss particulars over the phone because of "privacy" issues. If you get past that, then they are reluctant to answer any question no matter how simple without discussing it with the Doctor. Then there is my favourite response of, "if you feel it is serious; perhaps you should go to your nearest emergency room." The frustrating part of going to the emergency room is that Emergency is not equipped to deal with a complex cardiology patient and you will likely end up waiting for hours just so that you can talk to the person you had previously talked to on the phone. It is a never-ending cycle of futility.
It was refreshing to hear a nephrologist speak a few months ago about how she believes it is now becoming a standard of care to be more accessible to patients. She shared how she gives her patients her cell number and her email address. It was so refreshing to hear a specialist advocating for this level of access. She explained that when she first started handing out this information, she was nervous about doing so; fearing she would be inundated. In reality, the volume of requests from patients was very manageable and in many ways made her job easier. Clinic visits became more effective as patients felt much more comfortable and open. It was a win-win. It is really encouraging to hear about the health care system being more open about communication and technological advancements to help provide patients with more information. I just wish someone would mention this to Adult Cardiology.
The reality is effective family centred care and patient engagement are all about "effective" communication and openness. Very big words that are not always understood.
http://www.cihr-irsc.gc.ca/e/48472.html
I have been fortunate to be able to speak to nursing students and health care professionals on a semi-regular basis. I have learned a tremendous amount. As a patient family many times you feel that people are not listening to you or don't care. As I have interacted with health care professionals I have learned how much they truly care and want to engage with their patients. I have seen that they too are frustrated that they cannot make a greater difference in the lives of their patients.
I read an interesting article recently. (I have attached the link at the bottom of this blog.) The article talks about how patients can better manage their chronic health conditions if they had better access to their health information. Some of the examples are really interesting. The article focuses on some technical advances that gives patients information through an app for their smart phone. That's a great advancement but what the article seems to avoid is the need for more interaction between patient and health care provider. Having an app that provides you information is great but it seems to reinforce the idea that patients do not need to have direct access to their health care providers. This is where the gap in communication between patient and doctor exist. A 5 -10 minute "verbal" conversation between you and your Doctor every 6 months is not effective communication.
Fortunately some of these attitudes are changing. In our own situation, we have developed a great relationship with our Cardiology Clinic (Pediatric)where we get blood test results usually within a day and we can effectively manage our son's anti-rejection med levels, his hemoglobin, and his urea and creatinine. We do this all over the phone and it is really quick and effective. Because we have access to the information and a nurse clinician to speak to, we can make any changes we need to and interact to gain a much better understanding of what is going on. This allows us to live a life with a lot less stress, and more importantly because we have more knowledge we can provide more meaningful feedback when we go for a clinic visit and meet with our cardiologist. This is real patient engagement where we (as parents) and the clinic are both equally engaged.
Unfortunately, the same does not hold true when we interact with Adult Cardiology when discussing my wife's health. Trying to speak to a human to get an answer to a simple question is pure agony. You get voicemail, and if you manage to talk to someone, they won't discuss particulars over the phone because of "privacy" issues. If you get past that, then they are reluctant to answer any question no matter how simple without discussing it with the Doctor. Then there is my favourite response of, "if you feel it is serious; perhaps you should go to your nearest emergency room." The frustrating part of going to the emergency room is that Emergency is not equipped to deal with a complex cardiology patient and you will likely end up waiting for hours just so that you can talk to the person you had previously talked to on the phone. It is a never-ending cycle of futility.
It was refreshing to hear a nephrologist speak a few months ago about how she believes it is now becoming a standard of care to be more accessible to patients. She shared how she gives her patients her cell number and her email address. It was so refreshing to hear a specialist advocating for this level of access. She explained that when she first started handing out this information, she was nervous about doing so; fearing she would be inundated. In reality, the volume of requests from patients was very manageable and in many ways made her job easier. Clinic visits became more effective as patients felt much more comfortable and open. It was a win-win. It is really encouraging to hear about the health care system being more open about communication and technological advancements to help provide patients with more information. I just wish someone would mention this to Adult Cardiology.
The reality is effective family centred care and patient engagement are all about "effective" communication and openness. Very big words that are not always understood.
http://www.cihr-irsc.gc.ca/e/48472.html
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