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.
Saturday, August 16, 2014
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
Tuesday, August 5, 2014
You've come a long way baby!
August 5, 2008 will always be remembered as a "perfect" day. Susan and I made the trip to St Boniface hospital in the very early hours and in a few short hours our Russell would be born. From beginning to end it went absolutely flawlessly. This is especially a fond memory considering the train wreck that took place only a few weeks after Russell was born and our 6 month stay in hospital that ensued. The memory of this day had nothing to do with cardiomyopathy, transplants, medication, or any of the medical issues that have become entrenched in our lives.
Today is our son's 6th birthday. Especially significant as we were unsure if he would ever see his first. He truly has come a long way. We have much to celebrate and much to be thankful for. Of course this day would never be possible if it had not been for the dozens of Doctors and nurses who cared for our boy. There is also the obvious gratitude we feel to our donor and their family.
Last night we dug into our picture archives to reminisce. We looked through our Nicole baby pictures and then our Russell pictures. Susan chuckled as the files are all dated. For Russell we have pictures from august and september then nothing until December. Our hospital pictures have been filed separately. Russell is old enough now to begin to understand some of his "rocky" history. Looking at old pictures like this is one of Nicole's favourite activities but for Russell it is not. We could see him last night curl up on the couch and recoil a little. He was expecting to see "hospital pictures". This is why we separated them.
Russell is at an age now where he understands the fear and pain of hospitals. To him this is not a happy memory. He has not put this in the past and moved on; it is still a part of his life.
When we share our story, most people hear about how we came home from Edmonton in March of 2009 and many want to hear it was happily ever after. In essence this is when the work began. We have had one issue after another. The transplant was a success, but as any transplant patient would attest, it is what you have to do or how sick you have to be to get there that has a huge impact on later life. Russell's life will forever be a life that involves medications to suppress his immune system to prevent rejection. This is surprisingly one of the least complicated components of his care. Being in a hospital bed for 6 months and being tube fed for almost a year after; that has long lasting effects. Russell still struggles with eating and his development has been all over the map. This week is a great example of our life. Today we are celebrating Russell's birthday and it will be a great day. On Friday we have an appointment with endocrinology. That won't be so fun as Russell is clinging to the growth chart and there is a possibility that we may have to do treatment for his growth. One step forward...two steps back. This is the way it has been for 6 years. Our little boy is complicated; and this is our new "normal".
Most stories about a heart transplant imply that once all of the waiting is over and a donor heart is finally located; then you have your perfect "hollywood" ending. That's not quite true. The transplant is an amazing gift but there are many steps leading up to the transplant and a lot to recover from after. This doesn't sound encouraging and may even be a little depressing but we have had many highs and many lows. We have had to learn to adapt to that. Today is a great day...and we will celebrate with our boy. He has changed so much in the last little while; he truly is a real character. We savour these moments as we encounter the challenges ahead. What keeps us going is that every moment we are with our boy we know, in spite of all that we have been through, that his life could have ended a long time ago and we would never have had the joy of getting to know this little character. He is 6, he drives us crazy at times and many people who meet him comment on what a huge personality he has. It would have been a tragedy not to have gotten to know this little boy.
Happy Birthday Russell...you truly have come a long way.
Russell is at an age now where he understands the fear and pain of hospitals. To him this is not a happy memory. He has not put this in the past and moved on; it is still a part of his life.
When we share our story, most people hear about how we came home from Edmonton in March of 2009 and many want to hear it was happily ever after. In essence this is when the work began. We have had one issue after another. The transplant was a success, but as any transplant patient would attest, it is what you have to do or how sick you have to be to get there that has a huge impact on later life. Russell's life will forever be a life that involves medications to suppress his immune system to prevent rejection. This is surprisingly one of the least complicated components of his care. Being in a hospital bed for 6 months and being tube fed for almost a year after; that has long lasting effects. Russell still struggles with eating and his development has been all over the map. This week is a great example of our life. Today we are celebrating Russell's birthday and it will be a great day. On Friday we have an appointment with endocrinology. That won't be so fun as Russell is clinging to the growth chart and there is a possibility that we may have to do treatment for his growth. One step forward...two steps back. This is the way it has been for 6 years. Our little boy is complicated; and this is our new "normal".
Most stories about a heart transplant imply that once all of the waiting is over and a donor heart is finally located; then you have your perfect "hollywood" ending. That's not quite true. The transplant is an amazing gift but there are many steps leading up to the transplant and a lot to recover from after. This doesn't sound encouraging and may even be a little depressing but we have had many highs and many lows. We have had to learn to adapt to that. Today is a great day...and we will celebrate with our boy. He has changed so much in the last little while; he truly is a real character. We savour these moments as we encounter the challenges ahead. What keeps us going is that every moment we are with our boy we know, in spite of all that we have been through, that his life could have ended a long time ago and we would never have had the joy of getting to know this little character. He is 6, he drives us crazy at times and many people who meet him comment on what a huge personality he has. It would have been a tragedy not to have gotten to know this little boy.
Happy Birthday Russell...you truly have come a long way.
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