This is a blog I have been wanting to write for a long time and have not. Maybe I have been afraid to, heck I know I have been afraid to, and I really thought someone more intelligent and articulate would speak up. What-ever the reasons for not writing sooner I am now. I am however amazed that others have not spoken up as I know the frustrations I feel are not unique to me and are felt more by staff in the hospital than by people like me who are outside the hospital and public health system.
I have worked in Healthcare for about 25 years, 20 of them as a Registered Healthcare Professional. I belong to a Professional and Regulated body known as CARTA (College and Association of Respiratory Therapists of Alberta). I should state they do not have any part in what I am about to say. Though what I am about to say is common knowledge in the Healthcare Profession and frequently discussed and rarely (if ever) argued. Still people at the top who make the decisions carry on in some oblivious way.
Essentially this is the issue. We live in financial silos with narrow definitions as to what we can and cannot do. Additionally, we have these rules contained in rule books we call Policies and Procedures (P&P). As time goes by those P&P books get thicker and thicker and people become increasingly scared to vary from them. One of my first managers when I was in Healthcare working for the BC Ambulance Service (BCAS) summed it up this way, “you can tell how screwed up an organization is by the size of it’s Policy and Procedures Book” (paraphrased as best I can remember). He also suggested that P&P’s become something for lazy people to hide behind (I suspect often it is more likely scared than it is lazy). Now don’t get me wrong, I am not against those Policies and Procedures, they are very important. The problem is that we have so many, we don’t know what they say, or even why they say it. I believe it is always important to understand “why” a P&P is there. I would suggest that why they say things is more important than “what” they say. I am digressing though as that is not the real point I want to make.
About 15 years ago, I got a job working in Healthcare in a mid-sized Hospital of about 200+ beds. Shortly after I was hired some bright person (sarcasm there) ordered a hiring freeze. What did that mean? It meant they could not hire any more casuals to cover extra or missed shifts. When someone was sick we had no casuals, so one of the full-time personal would be called and paid double time. When a patient had to be transported to a larger center a staff member was called in at double time because there were insufficient casuals. Who does this kind of math and how is this supposed to save money? Why would you pay someone $50.00 an hour because it was too expensive to hire someone else at $25.00/hour? Does that save money? It doesn’t but it complies with a hiring freeze policy someone put into place, and you don’t want to go debate the policies with superiors. Thus, the tax payers paid twice as much to me (thank you) and others instead of giving someone else a job. Does this not sound a little crazy?
Wait, I’m just getting started, because that is not the most bizarre thing I have seen. Presently I am working in medical sales. It is a good profession. I have found that for the most part people in this profession are good people, they care, have integrity, and really do try to make Healthcare better. I like selling good products, the kind you would be crazy not to purchase (or so you would think). Not making sense yet? I’m getting there.
I have this one product “I was” selling. Anyway, this product cost about $20,000.00. Pretty expensive, right? Actually, not that bad as medical equipment goes, but not cheap either. So, this item cost about 20K, and there is this study, done in Canada, by Ontario Health. It is hard to find a less biased study than that and it was speaking about the same population I was selling in to. This study stated you could save approximately $225,000.00 dollars per year in Healthcare acquired infections by using this device. What a deal, you give me $20,000.00 and I give you $225,000.00 in savings (anyone remember the old adage “a penny saved is a penny earned”). I wish I could find that kind of deal for my mortgage. If you can do that for my mortgage give me a call, I’d buy that product. Should have been an easy sale, right? I laugh… it was not, the Nurses wanted the device but could not get approval. They sent me to the head purchasing agent for that Health Region, I sat down and we talked (he is nice fellow). He says, “Owen, we have no money to purchase that”. I ask something like, “but you have $225,000.00 to treat the infections caused by not using this device?”. He says, “yes, but that is a different budget”. I am aghast (this was a few years ago, and the first time I had ever had this conversation, sadly it would be repeated), I say something to the effect of “well why don’t you just move $20,000.00 from that budget to your capital budget (such a simple solution to me)?”. He tells me it does not work that way. That would be against the spending policies… And we wonder why is Healthcare so expensive? Policies and spending guidelines are required, I am not against them, but why can no-one see when they do not work and find a way to adjust?
If the policy was we don’t move sick patients from their hospital rooms and we knew the hospital was about to be destroyed, I would hope we would move the patients!!
The case above would be bad if it were limited to one device, or one time but it is not. There are many products like that being sold by many vendors, I am only one and I probably have at least ½ a dozen products that can offer massive savings, but no one can buy them. The one I have spent the most time with lately is a VeinViewer (see some of my other posts). It can save significant quantities of money EVERY year, many nurse clinicians see the value and desperately want to have access to one. It limits risks of negative sequalae with IV sticks, it can save time for staff, it can save money and improve patient care, improve patient satisfaction and it is the Standard of Care. Can I sell any? Not at present. Why? Spending freezes. It makes me shake my head.
We can continue to spend money in copious quantities to treat the problems, but not to prevent them. Why? Because there is a spending freeze to save money???? Do you get why I am shaking my head? Why I’m writing this?
I hope people might discuss this issue, maybe the media will investigate some of the dysfunction in Healthcare (actually they can’t because staff is afraid to talk, they worry about retribution), maybe the right politician will investigate someday and perhaps things will begin to change. I believe in public Healthcare, I am a Registered Respiratory Therapist, I am proud of that, I want to help, it is why I picked this profession. I focus most of my time to trying to promote products I believe in, products I feel can improve and change healthcare for the better, because they matter, they can make a difference. I do not believe I am unique. I really hope I have not offended anyone with this post, I believe it is an important post. It is not meant to be offensive, but rather to help people see the elephant in the room. This can be a tough gig, I am OK with that but I really have to wonder why we don’t change things, why we don’t create a culture where positive change is nurtured and rewarded. We really can do better.
I firmly believe our Healthcare is fixable and can operate better at a lower cost. I believe that if we put the right people together solutions can be found. I do not believe blanket spending freezes fix anything. I think they only exacerbate the problems. Still it is a favorite position for Governments.
How would I fix Healthcare? I would give more power to some of those minions on the front lines (at least make it so they are not afraid to talk) and I would listen to them. I would suggest that if they want to make a change they make an argument that should include things like:
1) Improving patient care,
2) Improving staff experience/job satisfaction (roll-over of competent staff is expensive), not to mention patients do not like grumpy healthcare workers
3) Financial benefits to the Healthcare System
Can other things be done? Heck yes, but you need to engage the guys at the bottom and you need to reward people who excel, innovate, and make a difference. Sadly those people are often scared to innovate and change things because they are worried about negative retribution for arguing against the Top down policies. That is not the kind of culture that can thrive, change, and survive, that is perhaps the real problem with our Healthcare system. It is a real shame though because it could be great, Canada’s Healthcare System could be the best by a long margin. I truly believe that. Then again, that is just my opinion.
Lungs For Life 
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