Quote:
Originally Posted by OldDartmouthMark
Of course I'll leave it to the medical professionals to chime in if they wish as my impressions may not be completely accurate.
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Well, I am a physician, and there are so many flaws in the health care "system", I don't even know where to begin.
My biggest pet peeve is the increasing centralization and bureaucratization that has occurred in health care over the last 25 years. I'm sure the situation is the same in NS as it is in NB. In NS, except for the IWK, every other hospital in the province is controlled by a single health care authority based in Halifax. In NB, there are francophone and anglophone authorities based in (of all places) Bathurst and Miramichi.
The net result of this centralization is a fossilization of the decision making process and paralysing bureaucratic inertia. This infects all aspects of health care, but I will use the equipment procurement process as an example.
In my department, first we determine what the requirements are for new or replacement medical equipment. We then prioritize our list (sometimes we make compromises between what we think we might be able to get, and what we really need or want). This list is then sent to our LMAC (local medical advisory committee) for review and prioritization with the needs and wants from other departments in our institution. This is fine, and this process is usually fair (beyond the usual pettiness and jealousy that you find in any organization). The new list is then submitted to the RHA MAC to enter into a competition with all other hospitals in the province for further prioritization. This is where the process falls apart. While you can usually have a conversation with your local colleagues about what the priorities should be for your own hospital, once you start negotiating with other facilities, then things become much more complicated. Some institutions are stronger than others, and may be able to form strategic regional alliances with other nearby institutions at the expense of other institutions with more worthwhile projects elsewhere in the province. This process is decidedly not fair. Who's to say if a new CT scanner in one hospital is more important than ICU upgrades in another? A smaller hospital might have a greater need, but is frozen out by a larger and more influential institution. This happens all the time.
Finally the (flawed) procurement list is presented to the RHA management committee (and board) for final review. Usually the amount of money they have to spend on procurement is only a small fraction of what is necessary, and more politics ensues. Senior managers and board members are not medical people and often don't fully understand the arguments. This process is further complicated by the fact that the majority of the RHA board members are politically appointed rather than elected. As such, the final decision usually ends up with significant political interference, and being more what the provincial government wants rather than what the hospital actually needs. Depending on the government of the day, one hospital (or region) may be favoured over another. There are powerful lobby groups out there who can influence the process, especially based on regional, cultural or linguistic needs.
Net result is that we as a department have become extremely cynical over the entire process. We hardly ever get what we want (although we are getting better at working the system). Instead, we tend to wait until our equipment irrevocably breaks down, at which point it becomes an emergency purchase, and this bypasses the routine procurement process.
Is this how the system should work?????
In the old days (before regionalization), when I was chief of the department, and my hospital was a publicly funded but independent health care facility, if we (as a department) decided there was a piece of equipment that we needed (or wanted), all I would have to do is wander down the corridor to the admin wing and talk to the VP in charge of our department. He would take charge of the procurement process and he was invariably tremendously helpful. Now, we really don't know who to talk to (the administration is in the Miramichi and we have very little contact with them), and the whole system is now designed to be obstructive to change and/or innovation. As a result, physicians end up feeling powerless, and instead of being proactive and taking the lead in changing the system, more often than not, we just start treating medicine as simply a "job", rather than a calling, and simply put our time in at work, keep our head down and try to stay out of trouble.
Why bother trying to change the system when it is so resistant to change in the first place??????
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