Tuesday, February 21, 2012

I am sick, and I am tired of waiting..

"...we should not have to accept this ten hour wait as unavoidable, and be content to watch our tax dollars bleeding to death on the Emergency Department waiting room floor."

Over the last two years, I have been required to undergo two separate rather significant surgeries. Throughout these experiences, I have had the opportunity to be under the care of dozens, if not hundreds of health care professionals, from doctors, nurses, orderlies, even a cleaner that took time to sit beside me and share stories from my home province of Newfoundland. Without exception these people were incredible, caring and clearly cared about my condition. All comments below must consumed with an absolute understanding that I have all of the respect in the world for each and every one of them, and all of the individuals that have chosen to make healthcare a part of there life, without exaggeration, I owe my life to a good number of them.

Yesterday, as a result of complications of one of my surgeries, I had no choice but to visit a local emergency room. Thus it began.

Within the waiting area, it did not take long for the message from the Emergency Room staff to circulate around the waiting room that the wait will be in excess of 10 hours. Before you succumb to the temptation to comment on this with the inner workings and challenges of dealing with ER patients, including triage, ambulance arrivals, low staffing, over usage etc, etc, I am very familiar with the mechanics of attending to patients in this environment. Having a mother who was head nurse at an ER provided me with lifelong insight to the challenges behind the swinging doors of this part of our health care system.

With respect to all of the challenges that meet the ER process, a waiting time of 10 hours is ridiculously unacceptable, and should be an embarrassment to anyone involved that considers this as “just the way it is”.

I am unsure as to why we (the customers of this service) typically consider this acceptable level of service? Maybe it is the mystery of the health care system, the intimidation of what goes on behind those ER swinging doors. Maybe mere citizens are willing victims of this completely unacceptable level of service, because our life (on occasion) depends on the service and we are willing to take whatever we are given.

Interesting that if we were are forced to endure these ridiculous wait times dealing with government services that we found less intimidating (such as transportation, education, public safety) the streets would be filled with protesters, and the newspapers will be filled with letters to the editor. Consider (locally) the amount of protesting and rights groups up in arms about a rather inert subject as Hydro Fracking, yet, the timely emergency health care of our citizen can be virtually ignored.

I trust that I was unequivocally clear that I do not in any way hold the health care workers responsible for this almost laughable poor service to the public, but without question I think the accepted “process” or “system” bears 100% of the responsibility. Obviously something within the structure of these public services is fundamentally broken. Almost without exception, when the topic of this service is aired, it is met with outcry from those that are responsible, or accountable is that there is not enough money, or we do not have enough staffing... I cannot disagree more.

Feeding more money, more resources into a system that is broken, will not resolve any issues (other than waste). Building new walls and waiting areas will not fix the problem. Changing the lighting and painting lines on the floor will not help.

Also, the finger is frequently pointed at us, the receivers of the service.. “Pay for use” models have been implemented and failed in the past, in order to discourage using this service, and the echo of “people are misusing the emergency services”. This is incredibly is pointing the finger at the customers for poor service.

I can only imagine how the board of directors of a publicly traded company would be laughed out of their jobs; if they decided that as a result of over demand of their product or service that they are going to take steps to discourage the purchase of their product.

Maybe in the public service, overcoming demand with a broken system is impossible? Not a chance. Many years ago, in New Brunswick, all vehicle registrations came due on the same date. Line-ups on the last day were out the building and long into the parking lot, hours of waiting resulted. UNTIL, someone within the public service, came to the realization that this is not appropriate treatment to their clients (taxpayers), they showed the courage to start with a blank slate and consider all aspects of their process. Changes were made, and now, the process of renewing your vehicle registration takes less time than depositing money in your bank account. It can be done.

We need to find someone with similar courage to be willing to look, from the grass roots, the method that emergency services are delivered to the public. Working with existing budgets, existing staffing levels, a basic wash of the accepted ways of doing things, and rebuild it with the patients in mind. Impossible??? Not a chance. Private sector businesses do this daily, motivated by profit; continuous quality improvement programs are in place, private businesses deal with actually cutting budgets and still improving customer experiences.

If any private business was met with the challenge of too many customers and declining customer service, without a moment’s thought EVERY option,. EVERY change, EVERY rebuild would be considered to increase satisfaction, and maintain all of their clients and try to earn even more loyal customers. In these boardrooms, the demand to spend more money to offer continued mediocre service and maintain a process that does not work, would result in those who suggest it, packing their personal belongings and seeking new employment.

I insist that we should not have to accept this ten hour wait as unavoidable, and be content to watch our tax dollars bleeding to death on the Emergency Department waiting room floor.

On a personal note, I was unable to tolerate the physical discomfort of sitting waiting for ten hours, I returned home, and my condition remains undiagnosed.


  1. A few thoughts on this... I fully agree that our health care system is hurting but here are my qualifiers about your piece:

    1. Your piece is a good critique of the system state but it doesn't provide any actual answers or suggestions to make improvements. I don't fault you for this because these problems are immensely complicated. They span from budgeting to human resources, mis-use and politics(rural healthcare for example).

    2. Do you vote and have you voted for somebody that has ideas on changing the system? Have you supported their campaigns and worked on their policy platforms? These are ways to make concrete pushes for change.

    3. Have you taken steps to improve your own health situation? Our healthcare system would have a lot less burden if individuals payed more attention to their own preventative health.

  2. Excellent points, and my responses:
    1. As with the majority of my Blog Articles, I am most focused on bringing light to issues that are staring us in the face, yet often over looked. I try to position my thoughts to make my readers make their own decisions, and more closely look at issues.. at the risk of this appearing to be a cop out to your question, I have considered solutions (intentionally not including them in my observations stated in my post).

    Some of these solutions may include, finding (internationally) Emergency departments that ARE providing timely treatments, and implement those best practices, having ER staff work on Pay Per treatment, vs salaried positions, including nurse practitioners to manage less critical cases, a thorough study of what processes are causing delays (tests, x-rays, procedures)and understand and eliminate these delays), Doctors assigned "defined" health issues - trauma, flu, life threatening - focus results in efficiencies).
    2. In fairness, no I have not, although, I suspect that fundamental changes in "health care" is suicide to any politcal candidate, and I may be incorrect, but I have yet to see a politicians platform include anything more than funding cuts or expenditures.. not a focus on level of service. And I insist looking only at the finacial feeding or starving of this are of health care is not a factor on rebuilding the service. I repeat myself, but private sector is a clear example of doing more with less.
    3. I intentionally do not go too deep in personal issues in my blog, however, again to respond.. the personal actions I have taken are moot to my point, as I am firmly entrenched that the users of this service (for whatever reason) should not and can not be held in any way accountable for receiving ridiculously unacceptable service that they pay for (taxes). Just because I am in a line up at McDonalds and only want fries, does not justify them as a company to make me wait, uninterested in my business, nor offer me cold or half cooked french fries.

    1. 1. Yes, that does appear to be a cop out. In order for critique to be constructive it needs an actionable response. Without that it is just bellyaching.

      2. There have in fact been examples of parties and individual politicians that have taken other approaches to healthcare reform. I don't agree with all of their platform but here is a good example from the Greens. http://greenparty.ca/media-release/2011-04-27/greens-stress-link-between-healthcare-and-active-living

      3. To your example, if you are in line at McDonalds and refuse to more forward to order, blocking the people behind you and yourself from getting your fries, then you are to blame for the poor service. Effectively the thousands of people who are clogging our system with preventable issues (smoking, bad eating habits, lack of exercise) are also blocking the line.

  3. 1. Possibly stating facts is on its own constructive.. as you have taken the time to read, and reply as well as do research on your own (as per the link in your#2 item)... along with the dozens of readers that have already read this article, awareness on its own is a step to improve the status. I trust that there are very well educated and paid (by taxpayers) employees of this broken system that are responsible, and their purpose for employment to resolve these issues. Otherwise, what are the throngs of 6 figure public employees accountable for this, doing? But, as a response to your comments on my not personally providing solutions.. I will take that under advisement and consideration on changing the "purpose" of my blog.

    2. A quote from your link only re-enforces my disdain with the thought that the blame of poor service lay on the shoulders of the customer

    “Keeping people healthy through promoting active living must be a key goal of our healthcare system. Reducing healthcare costs, reducing crime rates, and maintaining community strength all have links to physical fitness and sport,” said May"

    I insist that these are 2 completely unrelated issues... our ER Dept system is fundamentally broken - regardless of the reasons of our need for its use.. that cannot be an excuse for poor service. Eliminating the need to use these services is obviously a wonderful goal. But for this issue, the volume of traffic, regardless of the reason, must be a factor in rebuilding this mess.
    If we had a problem (as per my main article) with handling the volume vehicle registrations, and the solution by a upcoming political party was to assist people to buy bicycles instead of cars to solve the problem.. I doubt that they would get much voter support.

    3. Not clear on your third comment, but in need of medical attention, I was more than willing to move ahead quickly in the line. I feel that my response to your 2nd comment responds to this one as well. Again, your third comment is blaming the consumers of a service, and not where it should be, the supplier.

    Overall I understand your thoughts.. that if we were a healthier society, it would take the strain off of our ER system. But to be frank, I feel that is simply taking the accountability for taxpayer waste, and government acceptance of poor management and diverting our eyes and blaming the people that pay all of the costs to maintain this system. A fix for populous change to a better lifestyle is a generation long process, a fundamental rebuild of a government service can be a short as a year.

    1. 1. This is a straw man argument. You are relating high salary issues to poor service issues. This is an especially thin argument given your use of business as a model to compare. Look at salaries in business.

      2. According to the CDC 70% of US illness is preventable. I'm sure the stats are similar in Canada. If 70% of the people in that waiting room were not there, would your wait time be more reasonable? As a tax payer I cringe at the thoughts of the money and resources wasted because people don't take basic care of themselves. The people are part of the problem.

      3. The third comment was trying to work with the weak McDonalds analogy. I agree, it should be dropped.

      If you think that fixing healthcare could be done in a year, you should also get the doctor to examine your eyes. Your rose colored glasses might need a new prescription.

  4. Seems we are at an impasse in this dialogue, your subject of the general health of our citizens is a completely, unrelated conversation. I feel comfortable in defending our right as the complete funding for services, and those services falling well short of an acceptable level of service. We do not have the luxury (nor do I feel we should) of shopping elsewhere because of disgraceful service. We have paid extraordinary percentages of our income to pay for a service, and your argument that it is our fault that the service is poor is ludicrous.

    I agree that salaries in private business are also 6 or more digits, however, those salaries are tied to performance.. which is based on revenue and profit, which is 100% based on quality of product, customer satisfaction. If they steer a company in a direction, or maintain a broken business model that offers terrible customer experience.. they will have a short lived career. Huge Salaries are a result of huge performance.. not so as it relates to 10 hour waits for clients in a waiting room.

    Also, I am pleased too that we are done with the McDonalds Analogy. And my rose coloured glasses have seen international business giants turn 180 degrees in a year in order to maintain market share..

  5. Here's a cost effective answer, for starters, that requires no boardroom meetings or more public dollars. It is nothing more than human compassion.

    I know that many healthcare professionals hold back this most important public service and medical intervention for fear of being consumed by the needs of patients and the perceived threat of burn-out. Those are certainly potential and real outcomes but it is more often the result of challenges in setting and holding healthy boundaries while doing 'the work'. Working to find the balance within the individual caregivers (doctors, nurses and paraprofessionals alike) is far less costly, harmful and demoralizing than removing the human compassion that is a primary ingredient to all healthcare and helping professionals roles and responsibilities.

    It is, after all, a privilege to hold these positions and to be paid for the work that, at one time, was a felt sense of responsibility that came with the vocation regardless of conditions and most certainly came without guarantee of pay for services rendered: Even so there was more often than not there was eager willingness from patients and their families to pay, with gratitude, for their health care and health care providers seemed to remain committed to their patients and profession for their entire careers.

    I do understand that this is a different day and era and our health care professionals are trying, in many ways, harder than ever before (it is not hard to see that fact) but I wonder how much time, money and sense of well being we might be able to salvage if we were able to restore more of this type of professional compassion to the health care system that we have, today? How to restore this aspect that is lacking, when our health care system is is as fatigued as our health care providers is....totally beyond me. What say you to this, Mr. Blogger?