Lack of co-ordination. Patients do not move seamlessly through the system; there are often big cracks to fall through at transfer points.
Lack of equitable care. Patients want reasonable access to care but feel they are discriminated against based on where they live, their age, their ethnicity and other factors.
Lack of communication and information. When someone is sick or injured, they are frightened. They crave basic information, but everyone is too busy.
Lack of electronic health records. Patients hate repeating their medical histories over and over, and tests are oft-repeated because of lack of modern records.
Lack of respect. All too often, patients feel they are treated as a bother to health professionals. Patients are not cost centres, they are the raison d’être of the system.
Dagnone does not use the term, but reading his report one is left with the sense that the primary frustration with medicare is the total lack of customer service. That does not seem like an insurmountable barrier. In fact, Dagnone concludes that there is no need to dismantle and reinvent the health system but rather the need for a collective will and vision to implement fixes and change the culture of caring. “‘Patient First’ must become more than a mantra. For the sake of patients it must become a movement that is embraced by all who have a stake in creating healthier communities.”
Montreal’s super-hospital saga was a historic farce
It took twenty-two years in the early seventeenth century to build the Taj Mahal, the awe-inspiring white marble mausoleum in Agra, India. It took longer than that for Quebec to build a utilitarian hospital in Montreal in the twenty-first century.
The Taj Mahal is a glowing symbol of eternal love. The “Taj Hôpital” is a shameful symbol of political dithering. In a December 2010 instalment of the absurdist tale, then-Quebec Treasury Board president Michelle Courchesne announced that construction of the Centre hospitalier de l’Université de Montréal (CHUM) would begin the following spring and be completed by 2019. The tentative price: $2.1 billion. Well, she actually announced that there would eventually be another announcement because bids had yet to be tendered. Not to mention there were no final blueprints. And so it went.
The idea of building a Montreal “super-hospital”—merging archaic institutions scattered around the city into one state-of-the-art facility—was first floated in 1991. It was an eminently wise plan, particularly in a city where most health-care facilities were built decades and in some cases centuries ago. But in the health field there is no idea, however sensible, that cannot be bogged down by bureaucracy and perverted by politics. The Quebec super-hospital saga is a case in point. (In the interest of brevity, let’s leave out names and political affiliations: suffice it to say that six premiers and ten ministers of health have been involved in the file to date, and the Liberals and Péquistes have handled it in equally bumbling style.)
In 1995, Quebec’s health minister announced a merger of the three “French” hospitals—Hôtel-Dieu, Notre-Dame and Saint-Luc—to create CHUM. A similar process happened with the “English” hospitals—Montreal General, Royal Victoria, Montreal Chest Institute, Montreal Neurological Hospital and Lachine Hospital—and that was called the McGill University Health Centre (MUHC). In 1999, it was finally decided that CHUM and MUHC should be more than virtual institutions. They would become bricks-and-mortar “super-hospitals.”
Then the real jockeying began. Where would the facilities be built? What would happen with the existing hospital properties? How many beds would each super-hospital have? And so on. Forests were felled and tens of millions of dollars spent to produce studies, including a 2003 commission of inquiry headed by former prime minister Brian Mulroney and former Quebec premier Daniel Johnson.
Back then, CHUM was going to cost $860 million, and the super-hospitals were going to be built and operating by 2007. But a shovel in the ground by this date would prove to be a pipe dream. One of the most politically vicious battles was about the future site of CHUM. It came down to 1000 St-Denis St. (in the heart of downtown) or 6000 St-Denis St. (in tony Outremont). There is enough intrigue in those choices to fill a book—and, in fact, a book has been written. The travails of MUHC, by contrast, were minor. All they had to deal with was contaminated land and angry neighbours near the planned construction site in Notre-Dame-de-Grâce. And, oh yes, the costly foot-dragging of indecisive political leaders and a kickback scandal.
Plans to have the new facilities built as private–public partnerships (PPPs)—an approach in which private enterprise would build the hospitals, then lease them back to government over a thirty-year period—added to the controversy and cost and, in the end, private enterprise would play a token financing role so the government could save face. By 2016, the 772-bed CHUM’s projected total cost was $2.1 billion, along with a $470 million CHUM research centre. Not to mention the $500 million upgrade of Sainte-Justine, the “French” pediatric hospital. MUHC cost about $2.4 billion, including a new five-hundred-bed facility, a new Montreal Children’s Hospital and extensive renovations to the 332-bed Montreal General Hospital. That’s $5.5 billion and counting—though one economist calculated that when the final tally is in, the total will reach $8.6 billion.
That sort of profligate spending is difficult to justify, but the fact remains that all the facilities were needed and overdue. Quebec’s flagship hospitals were crumbling, inefficient and increasingly unsafe. (It’s no coincidence that Quebec had an inordinate number of hospital-acquired infections such as C. difficile.) Quebec’s political leaders should have received credit for their bold investments in health care. Instead, they received derision because they took too long to do the right thing. They lost sight of who really matters: the public. An endless list of excuses was trotted out each time a minister made a new announcement and revised the timeline for construction. But the bottom line is that these hospitals should have been up and running at the turn of the new millennium. The delays served the interests of property developers, construction companies, donors to political parties and various interest groups within the health system, not the sick and injured who needed hospital care.
Almost two and a half decades after planning began, the MUHC finally opened in April of 2015, while the CHUM is slated to open sometime in 2017. That no premier or health minister ever demanded that the shuffling of paper end and the roar of construction equipment begin is a disgrace, plain and simple. In Canada, we talk a good game about patient-centred care. But it will never be a reality unless it becomes a priority and a guiding principle from the upper echelons of power on down.
When even Dr. Optimism is losing faith in medicare, it’s time to fix it
“We have seen a slow and steady decline in what we would all now agree is a deeply troubled health-care system. To be clear, this pillar of Canadian society is eroding … We are losing something of great value. It’s slipping away slowly, incrementally.”
This kind of rhetoric is so commonplace that we have become largely inured to it. At first blush, it’s another medicare-is-doomed pronouncement much as we’ve heard seemingly every day for the past half century or so. But pay attention this time—those mournful words were spoken by Dr. Jeffrey Turnbull, past president of the Canadian Medical Association, in his valedictory address of August 2011.
Turnbull is one of the most unwaveringly hopeful and positive people in medicine. He knows the Canadian health system inside out, and from the bottom up. He cheerfully treats poor, homeless addicts as part of Ottawa’s Inner City Health project. He is equally upbeat as chief of staff at the Ottawa Hospital, a thankless position. He affably headed the CMA, which speaks and lobbies on behalf of the single most powerful and prickly group in the health system, physicians.
If Turnbull is losing faith in medicare, we need to prick up our ears—and roll up