It’s the things that go wrong in the health system that often preoccupy us.
While we frequently look for big answers, it is often in the everyday efforts that real change is taking place.
In the past we have seen some hospitals react to funding restraint by simply hacking off clinics or beds, as if they were sawing off a piece of sausage.
Many more have been undergoing process changes that appear to be paying off in both savings and quality of care. This story is just one of many.
Recently Lakeridge Health won an international award for its efforts to reduce incidents of hospital acquired C-Difficile.
Rather than cutting off another piece of the sausage, Lakeridge actually added a second pharmacist to its now three-member anti-microbial stewardship team. That investment is paying off.
In a perfect world hospitals would be publicly funded to meet the health needs of their communities. That would be it.
When the government started talking about funding reform, the thinking was that at last we would be moving closer to a rational system of allocation.
What we got instead was a hybrid of global funding, competition, and a funding formula that was supposed to take into consideration both existing usage and local demographics. Layered on top is a base funding freeze to at least 2018. Money has always been a driver in the health system, but suddenly it appears to be driving everything.
The evidence suggests that the complex and confusing system of funding allocation is creating new inequities that may be even worse than the ad hoc system of the past.
The South Bruce Grey Health Centre, for example, has argued to the South West LHIN that they are being penalized for efficiently combining the resources of four small rural hospitals. The Scarborough Hospital and the Rouge Valley Health System have made it clear that the complex demographic needs of their two communities are not being recognized in their base funding allocation.
What the new funding system appears to be doing is driving a new wave of costly and disruptive hospital mergers. You can’t blame the hospitals for seeking such mergers because they are simply acknowledging the new rules of the game set by the province. In this new world bigger gets more clout gets more funding.
Who is responsible for the unexpectedly diluted chemotherapy cocktail that more than a 1,000 cancer patients received since February 2012? And will we ever know when aspects of the story are being treated as safely guarded secrets?
The issue has been making headlines this week with fingers pointing in all directions.
At least two of the hospitals involved have now taken back the preparation of the drug cocktail – both Durham Region’s Lakeridge Health and the Windsor Regional Hospital have said they are able to prepare it themselves.
London Health Sciences also says they have the capacity to prepare the drugs internally, but LHSC Vice-President Tony LaRocca told the London Free Press that they contract out the work because it is “more practical and efficient.”
Did he really say that with a straight face, especially after knowing the questions London patients and their families must now have?
Ranking the performance of a public hospital has always been fraught with danger. Hospitals have much at stake with the release of performance data, including everything from funding allocations to the bonuses received by top executives.
Let’s say there is much incentive to get creative in the public reporting of such metrics.
In recent years the media have made much about hospital standardized mortality ratios (HSMR), a measure imported from UK that looks at the number of unexpected deaths that take place in a hospital.
Now a study funded by Oshawa’s Lakeridge Health suggests that the HSMR may be subject to considerable gaming to improve the image of certain hospitals.
We sometimes get asked about how we come up with stories for the Diablogue? For us, it’s not a matter of finding stories, but prioritizing material culled from a fast-moving stream.
Last week we focussed on the outrageous decision by Canadian Blood Services to increase imports of American-sourced plasma products while closing the last dedicated Canadian plasma donor clinic in Thunder Bay.
However, there are many issues out there, and only limited BLOG time for us. Here’s just a taste of some of the stories we missed last week:
Part of the fallout from the provincial budget is the decision to postpone a number of capital projects, including new hospitals. Nowhere is this being more felt that in Grimsby, where the community is upset that the new $138.8 million rebuild of the West Lincoln Memorial Hospital has been put on the shelf. The “Rallying for WLMH Committee” has called for a “massive rally” May 2nd. When the hospital faced closure in 1997, more than 7,000 people came out in a similar planned rally.
A new CIHI (Canadian Institute for Health Information) report raised eyebrows when Lakeridge Health and the University Health Network came out at the bottom of list of GTA hospitals. Lakeridge (with sites in Oshawa, Port Perry, Bowmanville and Whitby) pointed out that according to CIHI data, they were doing better than the provincial average on six of seven clinical performance indicators. That includes 80 per cent better than the provincial average when it comes to readmission after hip replacement surgery, and 30 per cent better on knee replacement surgery. An on-line tool that CIHI developed to rate hospitals crashed after it was swamped with users following a front page story in the Toronto Star.