It is obvious that this is the next step in rebuilding our healthcare system.

Everyone agrees that healthcare is broken.  Everyone agrees that healthcare is broken.

Everyone knows that adding a few more beds won’t fix a broken system.

Everyone knows that the public sector can’t fund the rebuild.

What is needed is a major reconfiguration of the economics that underpin our healthcare system.

Australia recognized this 30 years ago when the Australian government started a private health insurance company.

Everyone had  universal coverage. Some Australians could opt for private which they did. The private insurer was owned by the government.

Having private premium dollars entering healthcare allowed the Australian government to build and expand private healthcare infrastructure.

What a brilliant solution.

Would this work in Canada. Of course.

Politicians can’t discuss this option or they will be ousted.

Bureaucrats have the stabililty and enough security to discuss it and possibly table it.

The life insurance industry and the infrastructure industries should come together to lead the advocacy with the bureaucrats.

A major public affairs consultancy should do the packaging.

The public will buy in big time. The public does not want to wait 2 to 3 years for minor surgery.

So why are waiting for more people to suffer and possibly die without the care that they need and deserve.

Get your heads out of the sand.

The post Privatizing Healthcare Comes To The Editorial Page- Really ! Raymond Rupert health system disruptor. appeared first on Raymond Rupert.

An Emerging Sub- Specialty for Patients with Complex Conditions

Linda N. Geng, M.D., Ph.D., Abraham Verghese, M.D., and Jon C. Tilburt, M.D.   NEJM Dec 23 2021

Patients with unusual, perplexing, or complex symptoms and conditions are not well served by
the fast-paced U.S. health care system.

An estimated 20 to 30% of all primary care consultations are for “medically unexplained symptoms” for which standard evaluations have resulted in no medical diagnosis.1,2

Although clinicians may be tempted to assume that psychological factors account for these symptoms, this large and heterogeneous group of patients also includes those with rare diseases, atypical presentations, new or unknown conditions, and complex illnesses
that challenge standard evaluation.

These patients have varied presentations and outcomes, but they often share a common experience: long, exasperating diagnostic journeys in which they bounce from specialist to specialist in an ultraspecialized health care system that rewards high throughput rather than individualized care.

In recent years, medical centers around the world have been exploring ways to help patients with puzzling ailments who fall through the cracks of established health care systems, reflecting the emergence of “consultative medicine” as a diagnostic specialty.

This emerging specialty, rooted in generalism, aims to integrate the best of the Oslerian diagnostic tradition with the multidisciplinary collaboration and modern technologies needed to tackle uncertain, difficult, or complex diagnoses.

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1) stems from a loss of faith in a society’s central institutions; 

2) establishes a set of ideas from what was once the fringe of the intellectual world, placing them at the centre of a revamped political order; and 

3) involves a coherent leadership group committed to the change.

Disruptions don’t always change who is in charge – they are, in fact, sometimes necessary to preserve a government that is on the verge of failure. But they will at the very least change the way that a governing group thinks and acts.

Disruptions bring a profound shift in people’s understanding of how the world around them works.

Ideological change is crucial for major societal change because societies promote ideologies that support their way of doing business – and if the way of viewing the world doesn’t change, the way of doing business isn’t going to change either.

What I am suggesting is that, when a political system is undermined by events such as economic failure, defeat in war or environmental catastrophe, that political system is going to have to change or fail.

Success or failure depends on the choices that leaders make, and the ability to give people a fresh set of ideas that will help them see a new way forward.

The outcome of a disruption is often completely unexpected to contemporaries, and that is precisely because ideas from outside the mainstream were used to shape the solutions to the problems of the time.

We can’t know in advance exactly how a disruption will end. What history can teach us is what the circumstances are that lead to a disruption. It can make us realise what we might be facing as a result of the situation we are in today.

Source:

David Potter is Francis W Kelsey Collegiate Professor of Greek and Roman History and Arthur F Thurnau Professor at the University of Michigan.

Aeon digital magazine  Jan 8 2022.

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We have watched it from our kitchen window.

Now there are two giant white monoliths at each of the Avenue Rd subway stops.

Each monolith likely cost $10M to $20M to build. Possibly more.

This puzzles me.

In Paris, London, Berlin and Rome, to get into the subway, you go the corner or wherever and walk down some stairs.

There are no giant white monoliths.

So why do Torontonians need to spend $10M to $20M on white monoliths at each stop.

I suppose that those persons with dementia or visual deficits or both will find it easier to navigate.

Did anyone ask the public if they wanted giant white monoliths?

Did we ever hear of participatory budgeting? I have read about it in “How To Solve Public Problems” by Beth Noveck. She is very smart.

What if the city or province had ask me the resident and tax payer what I thought of giant white

monoliths?

I would have said that like Paris, London, Berlin and Rome, I would like to go to the corner and walk down some stairs to the subway.

Maybe projects that cost billions of dollars should have input from regular citizens on what should be spent on infrastructure like subways.

I vote for participatory budgeting in 2022 and beyond.

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Ms. Stevenson, an intensive care unit nurse at Eskenazi Health in Indianapolis for the past seven years, cries as she talks about her patients and their families, making clear the grinding toll of the pandemic on already exhausted hospital work forces.

“We’re pretty short-staffed,” Ms. Stevenson said. She added: “It’s getting harder.”

Instead of taking holiday vacations this weekend, workers at strained hospitals across the nation are working 16-hour shifts. Some have been on the job every day for weeks. Festive meals have been replaced with protein bars and sports drinks.

This Christmas weekend, with the United States facing another surge of illness stoked by a proportion of the population that remains unvaccinated, frontline workers are again sacrificing time at home with family to tend to Covid patients. In Indiana, which has among the highest rates of hospitalization and lowest rates of vaccination in the country, the situation is especially acute.

from the New York Times  Dec 25 2021

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The common cold and flu are endemic.

We just co-exist with the cold and the flu.

Unfortunately, some patients do die from the flu.

A winning combination for COVID will likely be tripartite:

1. full vaccination including annual boosters
2. rapid testing at least weekly or possibly more often and certainly with any coryza like symptoms
3. oral anti-virals for COVID.

Welcome to our new world. Now all we need is for Health Canada to approve the oral antivirals and we are on our way to co-existing with COVID.

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When the Nova Scotia Progressive Conservatives surged to an upset victory in August, most commentators attributed the party’s success to a promise made by its Leader, Tim Houston, to improve health care. His proposed solution was captured by one line of his platform: “We need more beds, more staff, and more technology.”

And indeed, to overcome the next wave of the pandemic and to improve health care, a basic variation of this theme is being proposed by just about every government.

However, a recent Canadian Institute for Health Information report indicates that Canadian health care costs are continuing to soar. Can anyone really believe that things are as simple as Canadians being better off with “more” – especially with a nationwide health care human resources crisis under way?

The health care work force is being depleted. Droves of nurses, physicians, personal support workers and others are suffering from burnout or PTSD, and quitting their jobs in record numbers. According to Statistics Canada, the job vacancy rate in health care is at a historic high, up more than 50 per cent from last year.

Without question, the one and only resource needed to sustain and improve health care systems across the country is human: that is, qualified and engaged health professionals. However, simply adding “boots on the ground” or producing superficial one-off financial incentives to attract staff – such as Quebec’s $18,000 bonuses for nurses – will unfortunately not succeed.

The burnout will only be exacerbated by the enormous backlog of work still to tackle. The all-consuming response effort to the peak of the COVID-19 pandemic left hundreds of thousands of Canadians waiting anxiously for potentially life-saving diagnostic testing, surgical procedures that were deemed non-urgent, and a host of consultations and basic health services.

These must now be reintroduced alongside regular day-to-day operations, led by this dwindling, traumatized and exhausted work force. The solution is not, as Sunnybrook Health Sciences Centre chief executive officer Andy Smith suggests, to ask everyone to work at 130 per cent until we’ve caught up. Working through the backlog that way would likely take years – and at a profound human and financial cost.

This may seem counterintuitive, but the first step in solving the crisis is not to immediately act. First, we need to invest time in formally debriefing the experiences of the pandemic thus far, lest they go to waste. This means asking leaders and staff at all levels, patients, families and communities where health care services got things right, and who was underserviced or treated inequitably. Prioritizing the time to determine which systemic improvements are within our reach is crucial.

Second, the keys to solving many of our problems lie in the data – the terabytes of information on patient experience, clinical outcomes and staff engagement that are waiting patiently in servers to be mined and analyzed. Health care leaders need to be equipped with the tools, competencies and, again, the time to continuously analyze this information and make informed decisions for systems improvement.

Third, these decisions must be considered through the lens of the whole system – including its work force, patients, communities and continuum of care – as opposed to just a single element at the expense of others. For example, increasing the number of hours worked by individual nurses and physicians can also increase their fatigue, absenteeism and turnover, as well as medical errors, all of which diminish the overall performance of the health system. Similarly, giving key personnel one-time bonuses will only momentarily prolong the inevitable that will occur when these same workers return, only to endure the same chaotic workplace conditions.

The responsibility of carving out time and space to reflect, to dig into the data, and to address issues in a systemic way does not belong to front-line workers; their job is to save lives. It is their leaders – and more specifically, middle-level health care managers – who can actually enact change. They’re the ones who will need to have agile, adaptable and innovation-oriented mindsets to extricate time for reflection, to look at data, and to propose solutions.

Since the early months of 2020, front-line health care workers have been front and centre in our minds and in our politics. But that symbolism isn’t enough, nor are simplistic solutions. The path forward will require a serious consideration of logistics – and it will require health care systems to shift the focus up the organizational chart and provide support to those who will be the ultimate catalysts of improved health care.

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The benefits of this approach can lead to better member experience, higher quality of care, and reduction of avoidable healthcare costs. The urgency and importance of personalized engagement has only grown through the COVID-19 pandemic, reflecting the shifting nature of care as well as consumer openness to engaging in different ways.

In order to better understand how personalization could improve healthcare outcomes and consumer experience, McKinsey conducted consumer research¹ to examine the practical applications of personalization in discharge planning. This investigation included how post-admission engagement could potentially reduce unnecessary healthcare costs and readmission experiences. This research builds on two decades of work that posits how transitions of care and supported discharge programs after an acute exacerbation can reduce avoidable readmissions.²

Good follow-up care (such as ensuring medication adherence, adherence to the right rehabilitation and physical therapy, remote monitoring of symptoms, and timely follow-up checkups) may lead to better outcomes. When this follow-up care fails (for example, due to a lack of access, a lack of health literacy, or other factors), a patient is more likely to end up back in a hospital or with a need for additional care.

This personalized care approach is especially relevant as consumers reflect on COVID-19. As discussed in “Helping  healthcare stakeholders understand the human side of the COVID-19 crisis: McKinsey Consumer Insights,” a third of respondents expressed interest in their providers offering support through telemedicine options, COVID-19 testing, and information on avoiding becoming ill. On a broader level, by reducing avoidable unnecessary outpatient and inpatient events, stakeholders can relieve the overall health system capacity, prioritizing those in need of immediate help.

Source: McKinsey

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Individuals at any level of an organization who are doing work of exception value and having an extraordinarly high impact.

Impact players have a mode of thinking that leads to high value contribution and high impact and better outcomes.

Impact players see everyday challenges differently than others. They see opportunities and not messy chaotic problems belonging to others.

Impact players react differently to uncertainty.  They do the job that is needed. They finish stronger. They ask and adjust and they make work light and easier.

Impact players tap into the unwritten rules in an organization.  They get the culture- the unspoken norms and values.

As problems become messier and mutate faster than a formal organization can respond, agility and resilience must come from the culture and the high impact players. 

The daily decisions and action of people and NOT the organizational structure. Impact players are able to decode the culture to understand what is doable and what needs to be done and what should not be touched.

The impact player asks him/herself if they should stay in their own lane? Sometimes they have to change lanes.

Impact players see themselves as problem solvers. They are not trapped by antiquated organizational structures. They go beyond the formal roles to solve problems.

Those in healthcare have much to learn from Liz Wiseman in her book Impact Players.

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These older clients should be reaching out to their trusted advisors when they are approached by strangers eager to be friends and to get too close too soon. That is what happened to a recent victim of elder fraud.

Case Study:

Ellen was 68 years of age. She lived in a small community in her own home. It had been fully paid for years ago. Her husband had died 3 years ago. She was lonely and somewhat isolated. Her daughter lived about 90 minutes away.

A couple befriended Ellen. They were charming and very warm and accepting. They were entertaining. They told stories about their exciting life experiences. Ellen was enthralled.  She and the couple became very close. They told her about some excellent investments. They invited her to invest. She trusted them. She signed some blank cheques for them and some other documents. She did not ask her advisor for help. She did not ask her daughter for advice.

The outcome was catastrophic. The couple were slick fraudsters. They had Ellen sign applications for mortgages. They had her sign some blank cheques.  She did not know their real identities.

Unfortunately, Ellen has severe dyslexia. She can not read or write. She is able to converse. She had always worked but this learning disability has been life long.

The first thing that the crooks did was to wire $100,000 into her bank account and then withdraw it with the blank cheques. They did this a few times to groom her bank account for what followed.  They were also laundering money. Illicit money.

Then Ellen got notices from the 3 mortgage companies demanding payments. The first mortgage was for $280,000.  The fraudsters applied for the mortgage secured by her home which was worth about $850,000.  The mortgage money floated into her account and then was withdrawn by the fraudsters. The bank had seen large transactions that had cleared so nothing was suspected.  The total fraud was over $500,000.  Ellen will likely have to sell her house to pay down the mortgages.

This was a perfect opportunity for Ellen to call her advisor. To read the documents. To uncover the fraud. And to save her estate.

Unfortunately, Ellen did not have an advisor and thus became a victim of elder fraud.  This is a very important role for advisors to take in preventing elder fraud.

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