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| Teaming up for quality — How can we make the most of our health care workers? | 2009-02-18 15:54:34 |
Teaming up for quality — How can we make the most of our health care workers?
Do we get the best from our health care practitioners? The answer to shortages and wait times is not necessarily to train more doctors and nurses. We can also use our existing human resources more effectively.
One way to achieve this could be the use of interprofessional teams – teams of different health care providers, such as physicians, nurses, dieticians, and pharmacists – who work together to provide the specialized care a patient needs, when they need it.
At hospitals and health care centres across the country, collaboration among professionals is providing patients with specialized care from a wide range of health care providers. This frees up physicians to see people who will most benefit from their specific skills.
Canada spent $23 billion to pay for physicians’ services in 2008, compared to $19 billion for all other health professionals combined. Team care can use these health care dollars more effectively, while also improving the overall quality of care.
At the West Winds Primary Health Centre in Saskatoon, their interprofessional team includes nurse practitioners, pharmacists, social workers, physical and occupational therapists, mental health and addiction workers, alongside physicians and others.
A healthy 18-year-old coming in for a regular checkup might not need to draw on the expertise of several members of the team, but working collaboratively matters very much in providing quality care for a senior with a host of chronic ailments, like diabetes, high blood pressure, heart disease, and depression combined.
One in nine Canadians suffer from some kind of chronic illness. Teams of health care providers can deliver more effective and efficient care in the management of chronic disease. A patient with high cholesterol can meet with the dietitian, rather than a hurried physician, to talk about how to change his eating habits.
In 2002, primary health care faced a crisis in Peterborough, Ontario. One in four residents didn’t have a family doctor, the local hospital’s emergency room was one of the busiest in the province and the growing seniors population was creating a new set of demands on the health care system. Dr. Don Harterre and a small group of colleagues decided a team-based model could be the answer. Over the next few years, they worked hard to bring everyone onside. The idea met the challenge. Today, over 97% of Peterborough’s residents have five teams serving their health care needs. ER visits have significantly dropped and the area is attracting new, young family practitioners to join the teams.
In the rural community of Twillingate, Newfoundland, an integrated health care team helps residents better manage their chronic conditions. This enables them to stay in the community to receive the complex care they need, rather than traveling more than five hours to the nearest large medical centre.
Meanwhile, in the Kootenay region of British Columbia, another human resource innovation has partnered critical care nurses with paramedics, forming Critical Care Transport Teams. These teams combine the advanced life-support know-how of a critical care nurse with the scene-response capabilities of the paramedic. Together, they provide emergency care faster and more effectively to patients in remote areas. This allows the local doctor or nurse practitioner to keep working in place, rather than travel with the patient to hospital, often a plane-ride away.
For patients and communities who need it, team care looks like good value for money. But team care is not yet the norm in Canada. That will take greater up-front investments in the education of health care providers and in support systems (like electronic health records) to make it easy for team members to communicate about their patients.
What do you think?
1) What is preventing us from changing the range of services that various health care professionals can deliver?
2) How would you feel about seeing a nurse practitioner for your primary health care, rather than a family doctor?
For more information:
Read about the value of effective primary health care and interprofessional teams.
o The Health Council of Canada’s paper Value for Money: Making Canadian Health Care Stronger
o Fixing the Foundation: An Update on Primary Health Care and Home Care in Canada, also from the Health Council of Canada.
o Teams in Action: Primary Health Care Teams for Canadians
Watch videos from the Health Council of Canada.
o "Teams Work, Patients Win" How team-based health care is improving access to primary health care in Peterborough, Ontario.
o Paving the way through teamwork (managing chronic disease in Twillingate, Newfoundland)
o Critical care teamwork in rural BC
o Putting patients at the centre of care (Group Health Centre in Sault Ste. Marie)
o Reforming education to build team-based care at Memorial University of Newfoundland
| Your responses |
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| Team work = quality Java Posted: 2010-03-05 15:20:01 Interprofessional teams are certainly a promising practise. The right person offering the right service. The family doc can not do it all, nor should they even try. Perhaps this model can revolutionize the old "fee for service" , assembly line medicine, which is so out of step with healthcare delivery. |
| Autoimmune disease does have a cure Bevin Black Posted: 2010-01-27 12:54:51 http://autoimmunityResearch.org/preprints/ProalAnnals2009Peprint.pdf http://autoimmunityResearch.org/WaterhouseAnnals2009Preprint.pdf http://AutoimmunityResearch.org/preprints/AR-Proal-Metagenome.pdf http://AutoimmunityResearch.org/preprints/AR-Albert-VitD.pdf http://TrevorMarshall.com/Bioessays-Feb08-Marshall-Preprint.pdf There are a million pages on the Marshall Protocol site, so this should narrow your search a bit. This is not a treatment like Doctor Zamboni in Italy, where he treats symptoms. This is the CURE, using Molecular Medicine, from the best Research Scientists in the world Trevor Marshall cured himself, then all his staff. I was one of the first 50 people in the world that he cured of Sarcoidosis. Bevin Black |
| Sarcoidosis Bevin Black Posted: 2010-01-27 12:37:17 I was treated with Prednisone for Sarcoidosis in 1996. It temporarilly make you feel better, but will not cure you as all the Doctors told me it would. They said that I had a 20% chance of living 5 years. After taking the Marshall Protocol, I have made it to 59 years, and am now cured. According to Dr. Marshall's site, No one has ever been cured with Prednisone! The Marshall Protocol is being used by thousands of people worldwide to cure over 20 autoimmune diseases. Dr. Greg Blaney of Vancouver, is having great success, even treating MS with the Protocol. It works, it is safe, and is a fraction of the cost of standard treatments that don't work. Check out some of the information available. http://autoimmunityResearc.org/preprints/BlaneyAnnals2009Preprint.pdf Bevin Black |
| Why is the leading cause of disability in Canada never mentioned in any report? Linda Wilhelm Posted: 2009-05-04 05:55:39 I have Rheumatoid Arthritis. Arthritis is the leading cause of disability in Canada, a major reason for the use of the health care system and yet every report neglects to mention this and arthritis patients continue to lack quality care across the country. I urge you to follow the UK and US and begin looking at what Arthritis cost Canada, both in direct Health care costs and indirect costs. Team care is vital for all people living with arthritis but one cannot achieve an optimal health outcome if it is not implemented for inflammatory arthritis |
| Do as the indians do PatrickLouch Posted: 2009-04-23 08:59:49 http://www.economist.com/business/displaystory.cfm?story_id=13496367 More procedures, less administration. Faster procedures, less bureaucracy. More specialization makes more expertise. |
| UTILIZE THE VARIOUS SKILLS OF PROFESSIONALS AND OTHERS AS APPROPRIATE Eric Odell Posted: 2009-03-27 12:40:00 Recognize that the physician has an implied overall responsibility for the care of a patient. Support the role of the physician and enhance the quality and timeliness of care by utilizing the skills of nurse practitioners and other para-medicals.The same principles should apply to the support staff...if the individual is qualified to do the job let them do it - not be restricted by self-serving labour agreement language. ENCOURAGE PHYSICIAN/PATIENT CONSIDERATION OF PALLIATIVE CARE VS INTENSIVE CARE WHEN IMMINENT END OF LIFE IS EXPECTED Is incurring huge costs of intensive care with all its impersonal surroundings better avoided through palliative care emphasis on comfort and quality of life during the final days of life? |
| Refusing to face death. benvandermeer Posted: 2009-03-17 03:14:37
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| Health care teams are vital blynn Posted: 2009-03-12 12:03:07 The family physician would likely be more effective if he/ she had the support of a team. Too many people fall through the cracks as they do not get adequate education, assessment, etc. As a dietitian, I know that most physicians do not have the time or knowledge to educate on nutrition. Many physicians do not have access to a dietitian via referral either. Outpatient dietitians are limited and there are long waits. There are a number of private practice dietitians in the community, but most patients aren't willing to pay for the service (it's not "covered"). Now mostly working with inpatients, I find that I can continue to receive regular work, plus working within a healthcare team, we can each do our part in helping the patient become well again. It's too bad that we can only do that when people are at their sickest, though. |
| Primary Care is understaffed JennJilks Posted: 2009-03-12 11:08:23 Even if we had choice, as many people suggest, we still do not have enough staff to fill positions from PSWs, to nurses or physicians. The government has made good decisions by putting Nurse practioners in place of no health care at all. We have midwives to do the work and care for women with normal pregnancies. That said, we need choices in terms of place, location, and health care professional. It is rural areas where those with low socioeconomic status, and lack of education, cannot access services. We must provide transportation and a basket of services for Ontarians. www.jilks.com |
| Primary Health Teams must be the new Core of the Health System Phil Jost Posted: 2009-03-12 10:01:31 The Canadian people know that a national health system transformation is needed to ensure that future healthcare services will be there when they need it. Most importantly, the Canadian people expect the leaders in the health system to get the job done The federal and provincial governments, although somewhat fractured in their delivery, have provided a common vision of a healthier future for all Canadians. This vision is built on a foundation of dedicated teams of primary health providers working together at the front lines of health delivery in communities across the country. Nurses, nurse practitioners, mental health workers, nutritionists, pharmacists, and the Canadian people â to name a few â are rising to the challenge to build a healthier future. However, for the most part, the most important members of the healthcare teams, the physicians are noticeably absent. The physicians are telling us that they donât have the time to take their role as team leaders because they are already too overworked. Recent studies (Health Council of Canada, 2005, Page 16) confirm that 45% of physicians are experiencing serious symptoms of burnout. They are so overwhelmed that 60% of physicians are now limiting new patients, and as a consequence the millions of Canadians, in both rural and urban areas, without a family physician are growing rapidly. To make matters worse, because there are fewer medical graduates, and even fewer choosing to be family physicians, the family physician workforce is shrinking at a disturbing rate. In addition, those that do choose family practice are refusing to work the extended hours of their predecessors. It is abundantly clear that if the Canadian health system is to meet the growing needs of it's rapidly aging population, the physicians of this country need support now. As pointed out at the beginning of this article the support that is needed is already being offered by groups of dedicated, clinically competent professionals. However, these professionals need the leadership of physicians, willing to step outside the box, and embrace positive change to better serve and improve the health of an increasingly under-serviced Canadian population. Unfortunately, even though the writing is clearly on the proverbial wall, recent surveys tell us that only a dismal 3.1% (Ibid, Page 17) of physicians in traditional practices have any intention of working within the collaborative team models available to them. Unless these same physicians soon step forward, the window of opportunity to a healthy future for generations to come opened by the billions of hard earned tax dollars in the 2003 and 2004 Health Accords, ----- may, instead close forever. The people of Canada expect, and deserve much better from those they entrust with their health and the health of their families. In the meantime, while the Canadian people wait, the future health of a nation hangs in the balance. Phil A. Jost, MBA |
| Leadership Tracy Lister Posted: 2009-03-09 09:59:37 Your workers are only as good as your leaders. Healthcare has too many people in leadership roles without leadership skills or even appropriate skills for the type of work they are doing. How can they possiblily promote an efficient department when do not possess skill to be in the position. A good example of this is having foodservice workers managing foodservice departments rather than dietitians or foodservice managers. |
| Contributing factors to patient outcomes and wait times been there Posted: 2009-03-09 09:21:23 Over the past 20 years health care has changed significantly. Hospitals were origianally focused on direct patient care. The standard of care was excellent. More recently the hospital has become more like a corporation with an increase in employees that do not provide direct patient care and a decrease in employees that do provide direct patient care i.e. nurses. The hospitals may give statistics that show no decrease in nurse patient ratio but they fail to mention that the acquity of the patients being cared for has increased tenfold. Patients used to stay in hospital for a week after they had their appendix out 20 yrs ago. Many patients didn't need total patient care. Now most patients require total care. How does this contribute to increased hospital stays? Nurses who are overburdened with increased paper work coupled with overburdened workload of patients that require total care leads to less than ideal working conditions. Patients don't recieve the care they need. A possible example may be that patients may not get turned in bed as often as they should leadingto secondary problems like bed sores that inevitably increase the patients hospital stay. Waiting for proceedures may also be a contributing factor i.e. a patient waits several days for a PICC line insertion and develops sepsis while waiting because PICC line insertions are only available week days for funding reasons. The same goes for surgery wait times. Many surgeons would be happy to get more O.R. time but operating rooms are not utilized effectively. Only emergency O.R.'s are done evenings and weekends because it costs the hospital alot of money to staff the operating rooms. How can we improve the situation? Return to a focus on direct patient care as a priority and cut down on area which do not provide or directly support direct patient care. |
| Health Revisted Ginger Posted: 2009-03-04 05:22:28 1. Over Credentialed Decline in bed side "care ready" nurses (RNs) is not because of Harris or Rae but rather the transition of the two year-hospital based RN program in the 1980s to the 4 year nursing degree program. The time to produce RN increased dramatically and eliminated (due to limited academic university spaces) the number of potential excellent care focused candidates. Today, 8% of Nurse graduates NEVER work upon graduation because Nursing was never seen as a vocation- rather it was seen as a personal "title". An extraordinary number of degree nurses migrate quickly to "non bedside care positions". There is NO measured value added outcome to our health system as a result of producing only degree nurses compared to the previous diploma nurses. In fact, a decline in available nurses contributes to decrease positive health outcomes. OT/PT Assistance: No reason why under the direction of the regulated professional that more OT/PT assistance could be used. Current wait lists for post stroke patients as an example place them in high risk categories due to delay in receiving timely rehabilitation. Recommendation: Bring back the care focused tow year RN programs and expand OT/PT Assistants programs at community colleges with definitive career opportunities. 2. Technology for disease management: Increase use of technology on Virtual care management. Diabetics as an example to use internet gate way to virtual doctor. Monitoring blood glucose, blood pressure, wound management, etc BEFORE patient ends up in emergency department with gangrene! 3. Public Health at pre natal and pre school and public school and high school. Wellness education on diet, smoking, exercise etc. Make it part of the new generation wellness culture. |
| teams will cost more realist Posted: 2009-03-03 13:22:19 Health care teams are going to cost more not less and although they may be able to be of assistance in terms of the shortage of nurses and doctors, the reason we have a shortage in the first place is because of government's inability to fund all that are required. So there are substitutions made. I can't blame the gov't for doing this as I don't see that they have much choice. But the improved access will be more expensive. Even though one can say that providing access will eventually save costs to the system later, the growing technologies and diagnostics and new treatments are going to cost a ton of money. If we really wanted equality for all Canadians we would ramp up education and spend more money on public health programs but allow private options for patients. The complaint that more private care will create a shortage of providers will not apply when naturopaths, dieticians, physiotherapists, pharmacists are allowed to prescribe and diagnose and treat....but just imagine how quickly the specialists' wait times will rise when this starts and the wait times for MRIs etc.....the result of HPRAC is that we are going to have a much more expensive system than we have already with longer wait times for definitive care. and why can a patient pay for a naturopath to prescribe a pile of supplements and all kinds of therapies with no scientific evidence to back them up but a patient cannot pay for scientifically proven care that government rations? |
| Patients come First elsiegerdes Posted: 2009-03-02 12:56:21 It is my humble opinion that we are not getting value for money: I gave input to Romanow commissssion, many moons ago... There is too much tied up in some Professionals;better use of Nurse practioners,pharmacists, nutritionists,other experienced people,home support and care would go a long way towards supporting person with chronic illness When will we be able to see the needs of 'patients come first' concept matrialize. Elsie Gerdes Pres, BCOld Age Pensioners Org |
| Share the Care Jondalar Posted: 2009-02-28 17:24:48 The Medical Association exercises too much control over the operation of the health care system. It would be benificial to reditribute responsibilities amongst health care professionals. Expand the independent role of Nurse practioners. Authorize Pharmicists to order tests and permit them to prescribe meds. Rethink basing administraters saleries on a par with the private sector. |
| Use the skills of each professional and employee Monica Vandenhoven Posted: 2009-02-27 18:44:24 I would recommend an analysis of the job description for all professionals and employees. Then, examine the knowledge/skills attained while in school, college and university and through in-service courses etc. This committee would have business people and a member from each of the health professions. Their goal would be to delete and/or add responsibilities to the job descriptions of all professionals and employees. After the new recommendations were passed by administration, they would be tested for one year. Outcomes woould be measured in all areas of health care. The above committee would then reconvene to determine if the new proposals produced improved care and efficiency. If not, then, back to the drawing board to discuss how changes could be made to the above recommendations and/or new ones added. All health care agencies need to be run like a business but with a heart. |
| support health care workers by aligning staff to patient care needs Lin Arthur Posted: 2009-02-27 09:35:17 IN Ontario local health integration networks (LHINs) have become the gateway for funding. In our LHIN, that gateway has become a vault and in LHIN 13 hospitals are being held hostage to a balanced budget agreement prior to review of and recommendations for new staff mixes and program operational improvements. This is impacting our ability to provide safe, quality patient care and is distressing our valuable health care providers. In an environment where we absolutely must be fiscally responsible, it is imperative that we exercise care not to throw out the baby with the bath water as Harris did in the '90's. At that time hospital cutbacks resulted in innumberable nurses and doctors leaving the country and we have only just begun to recover from that insult when this one began. My particular interest is physiotherapy services. Deregulating this service has resulted in many patients not receiving the care they need simply because they cannot afford to pay for it. In the absence of support for out-patient services, hospitals have dropped their outpatient physiotherapy as these services are no longer reimbursed by the government and many are reviewing their inpatient staffing levels with an eye to cutbacks. We are already doing now "more with less" and we are crossing the line into "less with less" at a time when the system will have greater demands imposed by the baby boomers. It is a time to pump money into the system, it is time to review how we spend our money before taking it away and ask ourselves do we have the right people doing the right job for the right reasons. As a manager, I am well aware of the pressures in play but also acutely aware that decisions made at high levels are made in the absence of all of the information needed to make them well. Please step in and open the vault, encourage the LHINs to review thoroughly before they cut funding and let's preserve the precious resources we have before once again nurses, doctors and leave Ontario and Canada- away from our patients who need us. |
| Enough erin-123 Posted: 2009-02-27 08:59:03 I am sick and tired of central planning nabobs assuming it's their business to meddle in what must be the most fundamental human right there is: how I arrange the medical care of my own body. What's completely missing from the health care system is a basic human right: choice. Need an operation? Just try asking a few hospitals for references of their surgeons so you can make an informed choice on who you will invite to re-arrange the insides of your own body. Then wait for the gales of laughter. You don't choose, we do! Want a copy of your medical records? You know, the information you paid for about your own body? Oh, no, not possible. Those are OUR records, not yours. Want them transferred to another medical facility? Sign this form allowing us to transfer them directly to them - no you can't just have them and take them with you - who do you think you are, the person concerned or something? Having a baby in a public hospital? We don't even pretend to care about your wishes - we post signs informing you that we decide for you who handles perahps the single most important moment of your life - it's whoever happens to be on the rotation. Don't like the service? Well, it bothers us as professionals, but on the other hand, who cares? You're not the client. You don't pay us. Well, you do, but you don't, so just don't make waves, just be thankful we were nice enough to fit you into "the system" - the only one that is allowed by law. You see, we take your money from you, and spend it as WE see fit. One of the ways we see fit is to have stupidly short GP visits. Got more than one problem? Feel like you need more info about the one we're talking about? Sorry - your ten minutes are up. Get out, make another appointment so we can make another billing and come back. Don't like it? Too bad - you're not the one who doles out the cash. And I've got a three month waiting list, no risk of running out of business. And the whole thing is defended to the hilt by a bunch of communist ideologues ranting about the evil rich and the oppressed poor. 'Cause you see, when a woman wants an abortion, her right to control what happens to her body is absolute - but when someone evil enough to be able to pay for his own surgery wants to have some say in who, when, where and how, well, that's just too outrageous to possibly allow. We do believe in human rights, just so long as they don't conflict with our communist ideals. |
| For the patients Robert Posted: 2009-02-26 04:20:13 Hello- Healthcare as a profession is no longer the realm of one group any more then a forest is just trees. While some may stand taller or be seen from further off in the distance it is the way in which it functions as a diverse group that creates the majesty that inspires and allows for further growth. Health care must come to see itself as this stlye of functioning team. It is not the people that are the difficulty because we are already biololgical in nature it is the processes that must become more natual in functioning. We must see our interconnections as has be already pointed out but also our interconnectablity and how that can benifit us and make us stronger to the task at hand, but weaken us if we do not attempt to lift and support one another as well. Healthcare is a short term achievement for long term knowledge, each person helped conntributes to the next and so on and so on. The patients now being served are the template on which we ourselves may be served. We in the healthcare system must see that the person that stands in front of us could in fact be us one day, and because that person is in a system that is publically funded they are also responsible for it. We all share the crayons that paints the larger picture of that forest though simplistic in view it is complicated to achieve so.. Acute issues must be acute issues and hospitals must define themselves to the public at large as this being there main function. They are not substitutes for the doctors offices and family health teams. They are the tallest tree to be seen along with research connections to them to sustain potential better outcomes to acute dilemns as well as that interconnection of knowledge and reasearch material. This should not remove them from the responsiblity of chronic disease research but rather the point where the river leads to the sea it is known as the base and can be seen from far off and a point of direction in which to head. Chronic issues must be dealt in a more paced envirinoment closer to home or in the home. Methods taught to family on how best to support loved ones and that it is ok for them to look after the people they care about. Professional backing always there as the hands that help but not the back bone that carries the weight. This will require individuals accepting responsiblity, and it should be promoted and taught by healthcare, because when people know more about their cars then their bodies healthcare is not doing it's job. To deal with the fluctuations that occur over long term illiness that may or may not result in loss, but loss will occur and this too must come as an area of knowledge growth for healthcare to sustain itself. To long healthcare has self promoted as means to avoid the natural outcome of living but this has lead more to a fear of death then a joy of living. Death as uncomfortable a subject as it is will come to us all and certainly will become a focus with the demographs facing the healthcare system, having a life that when we are in decline we can be remember with a smile may not, but healthcare and its knowledge and studies of the many aspects of life can through paced and assisting with professions deliver this too individuals long term. In like this knowledge can be returned to provide support to healthcare workers who themselves through the nature of their work face loss and the unknown. In conclusion, healthcare must see itself as a biodiverse system not a machine, a culture that is always willing to learn, a system that does not think water travels down the path of least resistence but the one of the greatest opportunity to move forward no matter how it falls it brings about life. It must share its knowledge with the expectation that it will take time and no one person can really obatin all the fame for reaseach especially now that it takes lifetimes to achieve. The processes must always be held accountable. Processes build on learning, teaching and communication between groups and individuals thus providing an efficent means by which the worker can guide their patients and assist their team mates to achieve the best possible outcomes for their patients so that the patients they may one day be experience the same. |
| Accountability renita Posted: 2009-02-25 11:02:48 i don't understand why we don't place more accountability on a individual basis with a preventable chronic illness. I realize this would be overwhelming at the beginning but don't we have to start somewhere? I do understand that i am responsible for taking care of myself. If i start retaining water i don't run to the doctor for water pills, instead i understand it's because i have Not been drinking enough water. Your body understands this and will retain the water until it decides that it doesn't have to retain it because you are getting enough. Just makes sense! Same goes with so many other "chronic anything"..ex: heart burn; it's a combination a foods your eating or a specific food..there is so many!..Why can't we all have a opportunity to be taught this in public school? As well as blood type diets as well as so many other subjects? Our doctors (especially emergency doctors) are overwhelmed with grocery lists of complaints that can mostly be resolved by dietary changes before they become chronic if we begin to make a real change in our public school education system. I believe prevention will alleviate alot of our health care costs. Food is responsible for alot of our chronic illness. Either to much or to little of coarse depending on your blood type and each case is based on it's own merits. It just makes sense. |
| Acceptance of all Health Professionals... Deborah Posted: 2009-02-25 10:36:13 Without including professionals such as Chiropractors, Naturopaths, Homeopaths, Environmental Illness specialists and the like, and not just Nurses, no health team will be effective. Teams need to work & consult together, not just spell each other off. Doctors have negligible training in such things as diet and prevention. These are extremely important if the costs of health care are to truly come down. |
| Health teams make sense anastasia Posted: 2009-02-25 07:43:56 I agree with everyone who is saying we need health care teams, and that people should be seen by the most appropriate person. Why are doctors giving inoculations and seeing people with sniffly noses? Why do some people bring their perfectly normal kids to pediatricians? I'm all for nurse practitioners dealing with the conditions and tasks they are trained for, doctors dealing with what they are trained for, and specialists dealing with special conditions. This would help to ensure that work is spread out more equitably and that the more expensive care is given where it is needed. |
| Health Care vs health care Finnekins Posted: 2009-02-24 18:00:20 It seems to me that a Health Care system that demands 40% of the provincial budget is symptomatic of a system that is out of whack. Yet, as is often the case with the medical profession itself, we seem to focus on symptoms and not the underlying problems. I wholeheartedly disagree with Dr. Danielle Martin (from the video) that the 40% figure is not an issue - only how we spend it. Care of ones health should be a personal responsibility. If we take good care of our health, we will have little need for Health Care. A very extensive host of todays ailments are caused directly by poor lifestyle choices. We, as a people, tend to stuff ourselves with junk food (often times unbeknownst to us, as the junk is advertised as being healthy). We wash the junk down with sodas and pad ourselves on the back for chosing diet pop (wrong choice!). Obesity statistics tell us clearly that we don't excercise enough. Sickness in our lives should be an exception - not a way of life. If you have a medical condition, get on the Internet and do some research. You may be enlightened. If you still think you should be seeing a health professional, at least you can now have an intelligent conversation about your ailment. When we have made an effort to take care of our health, and we still have problems, then it is wonderful to have a responsive medical community to turn to. Many of the services are excellent - I wouldn't want to be without them. However, a visit to the doctor's office should (in my opinion) be a last resort; for more than the reason of economics. We should not accept sickness as a way of life. We must educate ourselves and never let Health Care be a crutch (pardon the pun). Accepting, without question, that 40% of the provincial budget goes to Health Care is uncanadian. Let's get off of our collective flabby asses and cut that number in half! The problem is not with the resources of the Health Care system, but with the patients. Get healthy, stay healthy and cut down on the trips to the doctors office. That way, to answer the question, there will be more than enough health care workers to go around. |
| How can we make the most of our health care workers? cumming Posted: 2009-02-24 17:17:30 I agree that we need to set up clinics operated by nurses, nurse practitioners, phasmacists, nutricient nurses to do the day to day health care. Nurses are already doing 80% of the work that doctors did. When I go to the doctor he sits outside the office and plays on the computer while his nurse is in the office looking after me. At the end of the visit , the doctor comes in and says hi is everything alright???We pay a high price for this minute. Bloodwork - if it is yearly routine, patients should be able to go to the hospital or blood clinic and there should be requisitions there for routine blood work. you pick up one put done your name and continue on. The doctors are spending less time working and more time buying real estate. Lets get our act together and let the real health teams in place and everyone will have access to health care in our province. Doctors could be set up in the bigger hospitals to see patients who have cronic or critical conditions instead of making their business of seeing patients need prescription refills. WE NEED TO CHANGE AND APPRECIATE OUR NURSES AND WHAT THEY CAN DO FOR US IN THE DAY TO DAY HEALTH CARE SYSTEM. PEOPLE ARE GOING TO START TO DIE IF WE DONT BECAUSE PHYSICIANS ARE ONLY LOOKING AT THE QUICK DOLLAR AND WHERE THEY CAN EASILY MAKE IT. |
| technology is outpacing ability to fund realist Posted: 2009-02-24 13:46:12 Of course, we would all like health care to stay free at the point of access and have all the bells and whistles when we need them. Unfortunately, this is not likely to happen given current trends. Making the most of our health care workers by expanding scopes ie pharmacists prescribing, np clinics, physiotherapists ordering diagnostic tests, is likely to drive up health care costs by increasing access. Increased access has a cost. The best way to make the most of health care workers is to allow them to support patients as patients learn themselves and are EXPECTED to act responsibly in terms of their health. Self-care is likely to be come more common in terms of chronic disease and patients can be supported either through improved communication technology or through more widespread use of standardized medical information on reliable portal sites. But a fully qualified physician should be available to respond to inquiries....not saying nurses shouldn't be involved and they can be....just saying many patients are capable of doing what a nurse can do when they understand the details of their illness. However, providing self-care without having access to a reliable objective health practitioner is not a good idea. But until there are other revenue sources other than the public purse, increasing scopes of practice for various providers is going to cause major funding problems. More people prescribing, diagnosing, ordering tests....it is all going to cost...big time. |
| Best Qualified Person Charshaw Posted: 2009-02-24 12:27:59 I think we should determine who the least paid qualified person is to perform a given function and then revise the professional permitted acts accordingly. Nurses can administer flu shots and other immunizations, conduct pap tests, screen colds and flus for potential complications, referring high-risk cases to family physicians. Physicians should diagnose and Pharmacists should prescribe. I also think that allocating a health care budget per citizen and permitting people to 'shop' around for their healthcare would introduce some competition and make for a level playing field. At the moment, physicians may fire patients but the reverse is not true and this is totally out of sync with every other component of our commercial activities. Competition keeps people sharp and keeps out the undesirables. Patients should be provided with guidelines regarding which tests and screenings are required at what age and the follow-through should be left in the hands of the patient. We should not be paying family physicians to nag people. Neither should we be incentifying doctors to perform tests that might prove more injurious than helpful (e.g. mammograms). Why can't members of the public book and order their own tests in keeping with recommended guidelines. Of course, results need to be reviewed by a qualified healthcare practitioner but the latter would now have time to see more patients. We don't need more Aces, we need to shuffle the deck and play all our cards better. |
| Why do Doctors want Privitization Anyways ? stevehartwell Posted: 2009-02-24 09:06:00 Why do Doctors want Privitization anyways ? Do they really want to return to the good old days of being paid with chickens and tomatoes, and burying most of their patients before those patients reach the ripe old age of 30-40? Can Doctors REALLY be so stupid as to not realize that's what Privitization will mean ? - well, yes, they are that stupid. |
| Doctors have abandoned us stevehartwell Posted: 2009-02-24 08:57:55 DEspite what I'm about to say, I'd still rather be sick or hurt in Canada than in any other country, except maybe Cuba. Ok, having said that - I don't want a two-tier system. I want what we used to have, all the bells and whistles, for a lot less money. When Tommy Douglas started Public Health Care in the 1960s, his Provincial System worked so well, it had Surplus left over every year to invest in new technologies and training programs and infrastructure and hiring more people. But we all know the worst facts of today. Almost 200 Billion $ and every year things get worse for we the patients, while those at the 'top' get richer and richer off our sufferings and deaths. It is impossible to find a Doctor, become a new patient of a Doctor, any Doctor, let alone one we trust. AND, they refuse to accept responsibility for what they do wrong. Which is pretty much everything. Emergency is a total joke. Wait times should NEVER be longer than 30 minutes, which even that is far too long. Doctors have abandoned us. We should abandon them. Doctors should NOT be the prima donnas of Health Care anymore. 99.9 % of what needs treating does NOT require a Doctor !!! Our daily Health Care System should be given over to those who do care about us - the Nurses and Paramedics and Technicians and - STOP THE CORRUPTIONS OF THE PHARMACEUTICAL COMPANIES and those other scumbags that want to privatize Health Care. THAT is how we'll get the best bang for our buck. |
| Add a little incentive and see what happens James J. Carty Posted: 2009-02-24 08:52:43 I think that part of the answer is to allow privatization in health care delivery. Yes, I said privatization, and if there is profit with the progress, that is what an incentive is. What I mean by privatized delivery is to allow professionals to set up clinics to provide services, but the only way they get paid is through the existing public health insurance system. There would be no ability to charge extra, no two tier health insurance, at least no more than we have today. Anybody with a health card could go, same as we do today. The provinces already set the standards for heath care and the prices that are to be paid through the various provincial health insurance programs and in many provinces, we already have some privatization. For instance, if I go for an x-ray, whether I go to a private clinic or to an ER, the cost to the health insurance is the same, yet the private clinic has better equipment, lower wait times, nicer waiting rooms etc. Why is that? I live in Ottawa, in the news this morning they announced that wait times for MRI's were up to one year. Apparently you can get one the same day for a pet. That makes you wonder a bit. If private MRI clinics were allowed, how long do you think it would take to get the wait time down to a reasonable level? The key is to keep the universal health insurance that we already have and maintain the same standards and regulatory over site that is already in place. The only difference would be that if someone is willing to risk their own money to provide a better service for the same costs, let them. |
| Stop the waste mandy Posted: 2009-02-24 07:44:01 Hospitals, Nursing Homes, Retirement Homes and Home care is wasting money on luxuries in the patient surroudings. Keep construction simple. Money need to be put on the backs of the patient, client and resident. Who cares if the floors are wood or marble? We spend so much money on foolish luxuries and then we can't maintain them because we lack cleaning staff. Spend money only on nurses and drs. while we are at it. Start looking at Regulation of Personal Support Workers, they will help keep the nursing budget down. Keep our patients in hospital a little longer, then they would not need to be rushed back and the cost of reregistering all over again would be cut down quite a bit. Keep our seniors out of emergency rooms by providing better care in nursing homes. Regulate Retirement homes so that we can keep a better eye on our seniors in these facilities. Get rid of CEOs they have not managed our health care money up to now. Fire them all and put someone in there that can oversee proper distibution of our health care dollar |
| Team approach is more effective BN Posted: 2009-02-24 06:57:01 In the area of tobacco intervention, a team approach has been shown to be more effective in clinical trials. I'm currently involved in a funded project that is piloting systematic tobacco intervention in primary care using the team approach. Our approach is to train and support Medical Office Assistants to perform some of the components (asking about tobacco use, providing self-management coaching, working with the patient to set an action plan for quitting, referring them to community resources and scheduling follow-up appointments. The physician continues to oversee the patient's overall health, and monitors medication use if required. This is intended to enable the practices to deliver best practice guideline care without increasing the burden on the physician to extend visits, which they have identified as a barrier to providing best practice care. In addition, different clinical team members have different skills and can complement each other by working in different ways with the patient. This approach also includes the most important member of the team, the patient. The patient is involved in setting their action plan and receives follow-up support. The goal of our project is to increase the delivery of proven intervention while not increasing costs and also increasing patient and provider satisfaction. |
| The system is a joke meridyth Posted: 2009-02-23 20:41:50 I hate Canadian health care. I hate having to make an appointment with my GP to see a specialist. If I have a bunion on my foot (and I do) why do I need to see the GP when I know I need an Orthopedic surgeon? If I go in to my GP with sunspots that are growing and painful.... why do I have to wait 5 months to see a dermatologist? By the time I get in --- well I could be in serious trouble. Why is the system reactive instead of proactive? All of these visits to my GP! I have to make an appointment to discuss various health concerns... because they only deal with one thing per visit... WASTE OF MONEY AND TIME. My last appointment with my GP I was told by the receptionist that I had FIVE MINUTES! I would rather pay a user fee and get 10 minutes! Any why do we cap salaries. If a GP wants to work 5 days a week ---8 hours a day seeing patient -- let them. No wonder there is a shortage of doctors. Canadian health care is a joke... a sacred cow that needs to be overhauled. we cry about two-tier. It all ready is. Ask someone who has benefits from work about their level of care vs. someone without benefits. Ask Stephen Harper and his family about their access to health care... I bet they get more than FIVE MINUTES with their G. |
| wastage lee Posted: 2009-02-23 18:59:43 There are many problems in Canada's health care. If it consume 40% of budget we know that we are either not healthy ( contrary to what we claim) or the system is inefficient or we have cost that are not beneficial to people. First of all this governement need to control health care providers and thier lobby. we should allow all systems of medicine such as ayurveda , sidha, unani, homeopathy etc to practice in canada. Allopathic system only look at removing the symptoms but no wholistic approch. more money for prevention. doctors should be on salary. allow foreing trained doctors and dentist to practice here in Canada. create an agency to look the wastage happening in each institutions, areas of health care delivery. I have seen so much wastage of money and material. for example in Ontario one health care provider's patient load is only 10 patient at a given time but paid almost 150000 in expense for that position. we don't need such expensive service to yeild a little. I am tired of seeing this wastage everyday. but who will listen to me? |
| No quick solution; public education is necessary vricci Posted: 2009-02-23 18:37:40 Although the inclusion of more nurse practitioners would help, I do not see a quick fix for our health care woes - i.e. long waiting times at the ER, prescription/medical errors leading to further morbidity and mortality, long waits in a doctor's waiting rooms followed by an incomplete examination, and long wait times to see a specialist. I feel that it is a long range project that should focus on public health education at an early age. There is a complacent and general ignorance surrounding the general public's knowledge of health and wellness, so much so that many adults do not even know where a major organ such as their liver is located. The educational curriculum should find more room for health matters, and not just on a superficial level where students are asked to recall facts; the curriculum should be structured in such a way that would allow a student to analyze, evaluate and apply material already learned. This will encourage the student to become an active member when it comes to informed decision making on personal and community health and health care matters. |
| why so many use emergency wards miss yoka Posted: 2009-02-23 15:07:16 There are long waits in emergency wards because so many Canadians don't have a doctor. Walk-in clinics do their best, but tend to send you off for blood work, which is another day and another long wait. Or the walk-in clinic will hand you off to a specialist and that is a wait of usually at least 2 or 3 months. Why wait months to see a specialist if you can wait 10 hours in an emergency ward and get all your tests done onsite? It's a lot faster using an emergency ward, despite the long initial hours of waiting. And at least you feel like you are being taken seriously! To stop the flow to emergency wards, we need more nurse practitioners in walk-in clinics. And walk-in clinics need to hold longer open hours. People should also be able to make appointments in clinics and be guaranteed a minimum of 15 minutes with a professional (not be called in and then wait in an empty room for 10 minutes and see a doctor for only 5 minutes). I wish we had more Registered Nurses Assistants in hospitals (remember them?), more nurse practitioners in walk-in clinics, and more doctors in emergency wards. Maybe the key is to start with more RNAs. |
| Pay vs demand LV Posted: 2009-02-23 14:04:20 In order to address the doctor shortage in most rural areas, are the doctors being paid by the demand in their area? As a health professional, I consistently look for jobs in the rural areas as I am paid more than my contemporaries in the urban areas. If there were more doctors , would the demand for ER services decrease? |
| Doctors can help cut costs LD Posted: 2009-02-23 13:48:46 Some questions I have. When a person has had a prescription that is taken for extended periods , the Doctor requests that you make an appointment before he will allow the prescription to be refilled. You walk in the office, there is no examination, you are just handed a refill order to take to the pharmacy and the office visit is paid by the government. Couldn't this be as easily done over the phone saving the dr visit and therefore saving the government money ? The whole appointment takes less than 5 minutes. |
| DONT Move to a Health Care Professional Team Debby Gear Posted: 2009-02-23 13:14:03 I have been informed by a recent letter that significant changes my family medical care will be changing to a team as Halton Care Professionals. Unless you like walk in clinics do not go this route. I have experienced this type of practice when it was done as a pilot project in Burlington Ontario and in the end, my experiences were extremely dissatisfying. Once the system was put into place I NEVER again was able to see my family doctor even though I was told I would be able to. My care was pushed to the doctor of the receptionists choice and as much as possible to a Nurse Practitioner, even though I objected to this and clearly stated it. I was informed that I either see the Nurse Practitioner or have to wait weeks or months for an appointment. For certain services like physicals I would have to wait in excess of 8 months to be seen by my physician, but they would only book 6 months in advance. In the end I was strong armed to what their mandate was, regardless of my own wishes or needs. In the end to receive a refill for birth control, I would have to be seen by the Nurse Practitioner or wait for several months to see a physician and go without during that time frame. In addition, I was never able to develop any sort of report with any of the doctors as I would never see the same one twice for a given condition. I still feel very deceived as I remember being reassured that I would be able to continue seeing my physician and there would be minimal changes. Secondly I found it very difficult to request NOT to be treated by a specific physician within a group. It was very awkward to have to explain repeatedly that I did not like the care of a specific medical professional and then to have to face them as they walked by while making a follow up appointment at the clinic. My perception of the service is it was the same as going to a walk in clinic as I only was able to see the doctor the receptionist chose to allow me to see, and for that I had to make an appointment and wait a day or two. This was albeit better than the 4-5 days that I had experienced with a one-on-one patient care, but I did not like the hit and miss care that I received with some of the doctors that I had seen. I was told multiple times that if I wanted an appointment with my family physician I would have to wait between 4-6 weeks to see my General Practitioner. And to be specific of an occurrence of my frustration, during one of my appointments my physician was available, as my mother-in-law was able to book with her during that time, and the following day we ran into each other in the waiting room. Where oddly enough I was there with an appointment to see her physician she was there to see mine. The four years that I tolerated the system, was in my opinion BEYOND AWFUL from my patient perspective. When initially approached to convert to this system I was sold that it would be a fantastic and it would improve the services which I was receiving and make wait time shorter and would open up services. I was informed that there would not be a problem in making an appointment with the doctor that I had gained a report with, which in reality was completely untrue. In the four years that I was in the program I experienced nominal improvements in wait times but significant decline in the actual service. When I was with the Burlington group and seen an opening with my current physician I jumped at the chance. I was totally elated that I had a doctor in the community that I lived in and was able to see that physician. I hated the walk-in clinic feeling that I was left with in and the âat the receptionsâ convenience that I was manipulated under in the Burlington office. |
| Making the most of health care workers mimi Posted: 2009-02-23 13:00:04 I'm lucky I have a good family doctor. He doesn't know everything but he takes time and won't rush you out of the office. He's very, very busy and when he retires I don't know what I would do. I would like to see a nurse to have my prescriptions renewed and to ask her questions, etc. and then have her/him refer me to my doctor if needed. Traditional and alternative medicine need to get together. I am lucky I have a separate plan that pays in full and in part for acupuncture, massage, naturalpathic care and chiropractor care. Not everything can or should be solved with a prescription and a "come back and see me in a few months and we'll try something else" approach. |
| Get rid of incentive payments udanner Posted: 2009-02-23 12:15:20 Currently the OMA and the government are implementing incentive payments for PHYSICIANS ONLY to do preventative health tasks such as fecal occult blood testing, immunizations, pap smears (and a whole host of other tasks) within the Community Health Care Center and Family Health Team model of care. Both models emphasize a team approach to patient care. The problem with this concept is that many of the health preventative tasks can be done by the nurse practitioner or nurse. Currently, within this team environment, if the patient gets their pap smear from the nurse practitioner- the incentive payment goes directly to the physician the patient is rostered with. There is no motive for the physician to share the incentive payments with the team. Hence, the physician may not even have to see the client and the incentive payments go to that physician. The numbers of tasks are gathered through computerized input. The same numbers are used to measure health outcomes produced by the organization. Hence to not input those tasks done by the RN/ NP etc would be a strike against the clinic because the organization would look like its not meeting its targeted outcomes. A quick calculation of the total cost of incentives that a physician in this type of model could get is 10,000 dollars extra. The majority of tasks can be done by another health care provider. Talk about destroying the concept of team health care. I work in this system. I am a nurse practitioner. I have seen real benefits to a team approach to care of a client. However, this political decision is enough to make me want to get out of nursing completely!!! |
| My Vision jenniferj9 Posted: 2009-02-23 12:15:11 includes a greater emphasis on naturopathic preventative health care and personal responsibility. my family doctor retired two years ago and while I think I could get another doctor if I subjected myself to an interview to determine my suitability for the esteemed 'patient' list of some doctor in my city - I have no pressing need at present to do so and almost no desire... instead, I'd like to discuss my health concerns on an ongoing basis with a professional who knows my name when I visit, who remembers the last time I visited, who has at least as good a picture of my medical history as my pharmacist, who can schedule an appointment when I fall ill rather than days or weeks later, who values my time and won't keep me waiting for a scheduled appointment, and who, as a professional courtesy, has some evening or weekend appointments available just like my wonderful dentist, orthodontist and optometrist do... and ideally, that person would be a naturopathic professional, more interested in preventative medicine and healthy lifestyle choices than prescriptions but who could refer me to hospital should any need arise. I also want to see my health file. I want copies of my records. I want to see the bill. I want to approve expenses submitted on my behalf to OHIP the same way I approve expenses submitted on my behalf to my employee benefits program. It's my money - I want to see how I spent it so I can judge for myself if it was worth it. |
| You need to identify social Entrepreneurs... Carl Nattrass Posted: 2009-02-23 11:53:37 What do you think? 1) What is preventing us from changing the range of services that various health care professionals can deliver? You already know what's needed, you identified it yourself, teams and more emphasis on prevention through education and health promotion. What's preventing these ideas from taking hold on a broad scare is a failure to identify social entrepreneurs and provide funding for them to develop their ideas. Do LOTS of SMALL projects and let the market create maturity for you. 2) How would you feel about seeing a nurse practitioner for your primary health care, rather than a family doctor? i would see anyone who could provide appropriate services in a timely fashion and who can provide me with useful information to help my family stay healthy. |
| West Winds in Saskatoon Bonnie Posted: 2009-02-23 11:29:02 This Health Centre sounds good. But...is it Centralized?? Easily accessible?? like parking etc. Also, I feel that Mental Health and Addiction workers should be somewhat separate. In Winnipeg, I think that something like this clinic would really work. It would have to be centralized, or have a couple of them, say, in the southend and the northend. And the eastend as it is rather separated from Greater Winnipeg. And, yes, a clinic for chronic illnesses, and again, centralized. I live in North Winnipeg, and I wouldn't want to travel to the South end for these services. Or more than one of these clinics. Also, clinics for small injuries, like cuts and bruises. I've seen way too many of these patients in the emergency rooms in Winnipeg. Off the wall??? How about turning McPhillips Street Staion into a Huge Clinic with all kinds of doctors and Nurse Practitioners. Or part of it, and still have some room for slots??? And money generated from the slots, could pay for the clinic!!! How about that..... I thought that money from these Casinos where supposed to be for our Health Care. Well the casinos are forever spending money by decorating and redecorating and throwing out old slots and buying new ones. It's no wonder that there's no money left for Health Care. By the way, I am in Winnipeg, in case you're not aware. |
| Who's responsible? robert stephens Posted: 2009-02-23 11:28:28 In a team environment, is there one person who still has overall responsibility? And is that the doctor or another professional within the multi-disciplinary team? |
| Seeing a "Nurse Practitioner" Bonnie Posted: 2009-02-23 11:03:34 Can these nurses prescribe medications? I have high blood pressure and kidney problems. Sometimes, I need to see my doctor for bronchitis, urinary tract infection or?? If these "nurses" can prescribe medication that will not affect my kidneys (and hypothyroidism), then I would see no problem seeing them. But, if the wait time is the same as my doctors, then I would prefer to go to my own doctor. |
| Changing the range of services Bonnie Posted: 2009-02-23 10:57:00 Our Health Care professionals are not listening to the public. A lot of doctors are in practice "for the money". And they are too overloaded to listen closely to our concerns. They shoo you in and out asap. And they know that they can treat us as they wish, because we're "stuck with them" and They Know that we can't find another doctor. We Do Need More Doctors!! My wait time is for one hour and after waiting for one hour, and seeing how busy my doctor is, I Do Not ask about all of my concerns. So, I'm left feeling frustrated and angry, and "oh well", "no one cares",....Then ask around for a "home remedy" that could potentially be dangerous. As is self medication which a lot of us resort to. I live in seniors housing and a lot of the seniors here, feel the same way.. Also, there are some doctors that appear to cater to the ones of their own ethnic group. I know this, because of my own feelings and of others in the waiting room. We see that some of us are shooed in and out, while the same ethnic ones are with the doctor a longer time. My sister goes to one clinic in Winnipeg because she really likes her doctor. The waiting time there is 3 hours!!!! Also, at my age (70), I have a few health concerns that my doctor does not know about, because she doesn't have the time to hear them. Back to the home remedies and self medication. Bottom Line: We Need More Doctors!!!!! My 30 year old niece is under medical and mental care with her doctors. Her medical doctor is retiring soon, and she can't find another doctor. NONE of them are taking new patients. Someone told my that our Health Care money went into building the Casinos..Is this right????? |
| Seeing a Nurse is good HealthCare Concerned Posted: 2009-02-23 09:01:30 I think seeing a nurse practitioner is a great idea. They often know as much about common ailments as doctors and they are more available. |
