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Plastering cracks in health care fixes nothing

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CALGARY — Just before Christmas the Health Quality Council of Alberta (HQCA) released the Continuity of Patient Care Study. It’s a disturbing report.

Disturbing, because it uses the case of Greg Price, a 31-year-old cancer patient, to highlight problems with patient flow. Greg died after 59 weeks of multiple hand-off’s, poor communications, and excessive delays. This makes for difficult reading.

Greg’s father is quoted as saying: "We believe he died prematurely because of multiple gaps and failures in the so called system of healthcare in Alberta... The healthcare system should provide continuous, collaborative... care."

He’s right. That’s what the system should do. But the system won’t. Because it can’t. It isn’t designed to provide continuous, collaborative, care. It’s designed to provide discontinuous and fragmented care. Which is why, despite the hopes and efforts of Greg’s family for change, nothing will come of his death.

This leads to the second reason this study is so disturbing. It’s such an obvious effort to cover-over systemic problems with solutions designed to fix nothing other than public opinion. The HQCA press release announcing the Study was entitled: "HQCA study shines a light on opportunities to improve." A better description would have been, "HQCA successfully spins another Alberta Health Services disaster".

This is consistent with the HQCA’s record as health system cheerleader. The HQCA, for example, regularly conducts surveys of patient satisfaction designed to make AHS look good. And who can forget the elaborately titled: Review of the Quality of Care and Safety of Patients Requiring Access to Emergency Department Care and Cancer Surgery and the Role and Process of Physician Advocacy.

Described as damning by the media, it’s a joke among heath care quality professionals. (i.e.; the recommendation to "shorten emergency department throughput" always gets a laugh, displaying, in four words, a simultaneous ignorance of the meaning of throughput and the purpose of an emergency department.)

The Continuity of Patient Care Study carries on in this tradition. The study’s authors confirm the system’s problems — it’s fragmented and complex. People work in silos. It’s difficult for patients to move from one silo to the other, even when they are lucky enough to figure out what silo to go to next. The spaces between these silos are the cracks in the system structure the Study calls "breaks in the continuity of care" and Greg’s father calls "multiple gaps".

Thirteen recommendations are made. Of these, two deal with practices at the Medical Examiner’s office. The remaining 11 deal exclusively with plastering over the cracks. Better communications here, a new website there. Not one recommendation addresses why these cracks, why these functional silos, exist in the first place. All attention is on the walls. No one is looking at the foundation. If the HQCA were housing inspectors, we’d all be living amongst the rubble in tents. Why isn’t anyone looking at the foundation? Because silos are the inevitable outcome of the command and control strategy pursued by AHS, and endorsed by the HQCA. This strategy builds ever-more silos in pursuit of economies of scale. The new ‘super-lab’ proposed for Edmonton is an example. The resulting gaps between silos disrupt patient flow, ensuring others will share Greg Price’s experience. When the inevitable occurs, we’ll get another study recommending better communications and a new website.

Plastering over cracks doesn’t fix anything. Neither does feel-good cheerleading. Making this point in his report on the space-shuttle Challenger disaster, Richard Feynman wrote: "For a successful technology, reality must take precedence over public relations for nature cannot be fooled."

In the politics of health care, public relations takes precedence over reality, for pretty much the same reason.


Robert Gerst is a partner in charge of operational excellence and performance analytics at Converge Consulting Group Inc. He is author of The Performance Improvement Toolkit and numerous peer-reviewed articles.






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