ER doc task force report seeks sweeping change grounded in reality By: Tom Brodbeck Posted: 2:53 PM CDT Tuesday, Jul. 25, 2023

Hey there, time traveller!
This article was published 25/07/2023 (1101 days ago), so information in it may no longer be current.

Canada’s emergency room physicians are putting the finishing touches on a new groundbreaking study that could result in the biggest overhaul of Canada’s health system in years — if the politicians decide to listen.

A task force made up of some of the country’s top ER doctors was assembled two years ago by the Canadian Association of Emergency Physicians to take a deep dive into the patchwork of hospital services, primary care and nursing homes and to find solutions on how to save the country’s beleaguered health-care system.

In a draft report slated for release in early fall, the task force makes sweeping recommendations that could drastically alter how medical services are delivered and funded across the country.

The Free Press got a sneak peak of the report.

“Emergency medicine in Canada is failing its patients, its community and the caregivers within the system,” the draft report says. “We know this. We also know that the root causes of our problems extend beyond our departments. For us to survive, our entire ecosystem must change.”

“Emergency medicine in Canada is failing its patients, its community and the caregivers within the system.”–Draft report

Unlike many past reports on health-care reform in Canada, this one (titled “EM:Power — the future of emergency care in Canada”) is neither ideologically nor politically motivated. It seeks practical, realistic solutions to complex medical and system-wide problems.

The task force authors are also not afraid to broach the sensitive topic of private health care (they’re open to it, as long as it improves patient care and doesn’t bleed resources from the public system). What they do not accept is the status quo.

“As we prepare for a post-pandemic world, worsening access block and a crisis of confidence in the ability of the health-care system to fulfill its mission make it clear that we cannot simply return to old models and expect different results,” the report says.

“Governments, health leaders and the medical community require a more comprehensive and collaborative approach to future planning.”

The task force examined health-care systems in other countries to mine best practices. It assessed how Canadian hospitals are run and funded, and how systemic deficiencies upstream and downstream from ERs cause patients to languish for days in emergency department hallways (and why it’s getting worse).

So what does the draft report recommend? A lot.

The task force authors are also not afraid to broach the sensitive topic of private health care… What they do not accept is the status quo.

The central theme is long wait times in ERs are a symptom of broader systemic problems, such as hospital overcrowding, deteriorating primary care, and the lack of long-term care options.

Those are not new observations. However, the report provides detailed research around those issues and offers recommendations in several categories that provide a path to improved patient outcomes.

One of the main findings: Canadian hospitals regularly operate at near-capacity, leaving them with virtually no flexibility to absorb patient surges. There are also no financial incentives for hospitals to improve efficiencies, nor to treat more patients, because most of them receive block funding, or “global budgets,” from government, regardless of patient volume.

“In the Canadian model of global budgets, every arriving patient is a cost to the hospital,” the report says. “More patients mean more stress on hospital resources. This creates an incentive to limit patient care and reduce access.

“Under activity-based funding, every arriving patient is revenue, which motivates efficiency, flow and throughput, allowing hospitals to expand capacity to better meet patient demand.”

The report recommends hospitals shift from global budgets with fixed funding to “activity-based funding,” which takes into account patient volumes. It’s the norm in many other countries. (Some Canadian provinces, such as Ontario, have already started to experiment with it.)

The report recommends hospitals shift from global budgets with fixed funding to “activity-based funding,” which takes into account patient volumes.

The task force, whose recommendations are still under review, calls for hospitals to operate at a bed occupancy rate of 85 per cent (many operate at 95 per cent or higher) to better handle peak periods. It also recommends hospitals establish overcapacity protocols that trigger system-wide responses to patient surges, rather than leaving it up to ERs to handle alone (what usually occurs now).

The task force urges governments to create long-term care transition spaces and to increase Canada’s per capita hospital bed capacity, which is one of the lowest among Organisation for Economic Cooperation and Development countries.

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Canada also needs a national workforce strategy for health-care professionals, the task force recommends. That strategy should include benchmarks such as increasing physician coverage from the current 2.5 doctors per 1,000 people to the OECD average of 3.6.

Governments should also promote the concept of “working to full scope,” including expanded roles for nurses, pharmacists, social workers, and nurse practitioners, the task force recommends.

There’s more in this report — a lot more.

This is just the tip of the iceberg, which, if taken seriously by provincial and federal governments, could be a turning point in the evolution of Canada’s health-care system.

tom.brodbeck@freepress.mb.ca

Tom Brodbeck
Columnist

Tom Brodbeck is an award-winning author and columnist with over 30 years experience in print media. He joined the Free Press in 2019. Born and raised in Montreal, Tom graduated from the University of Manitoba in 1993 with a Bachelor of Arts degree in economics and commerce. Read more about Tom.

Tom provides commentary and analysis on political and related issues at the municipal, provincial and federal level. His columns are built on research and coverage of local events. The Free Press’s editing team reviews Tom’s columns before they are posted online or published in print – part of the Free Press’s tradition, since 1872, of producing reliable independent journalism. Read more about Free Press’s history and mandate, and learn how our newsroom operates.