Dean Stéphane Brutus joined his voice to PhD Jaason Geerts, Director, Research and Leadership Development at Canadian College of Health Leaders in this extract of The Globe And Mail opinion editorial published on the December 7th.
When Nova Scotia Tory leader Tim Houston surged to an upset victory in August, most commentators attributed his success to his promise to improve healthcare. His proposed solution was captured by one line of his platform: “We need more beds, more staff, and more technology.” To overcome the next wave of the pandemic and to improve healthcare, a basic variation of this theme is being proposed by every government. However, following the recent Canadian Institute for Health Information report that indicates that Canadian healthcare costs continue to surge exponentially, can anyone really believe that we will be better off simply with “more,” especially with no consensus ceiling to consider?
The context bearing down on us is a nation-wide healthcare human resources (health HR) crisis. The workforce is being depleted, with droves of nurses, physicians, personal support workers, and others who are suffering from burnout or PTSD, quitting their jobs in record numbers. According to Statistics Canada, the job vacancy rate in healthcare is at an all-time high, up more than 50% from last year.
Without question, the one and only resource needed to sustain and improve healthcare systems across the country is human: qualified and engaged health professionals. However, simply adding “boots on the ground” or superficial one-off financial incentives to attract staff---such as the Quebec government’s $18,000 bonuses for nurses---will unfortunately not succeed.
The singular and all-consuming pandemic response during the peak periods has 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 a dwindling, traumatized, and exhausted workforce. The solution is not, as Dr. Andy Smith, CEO of Sunnybrook Health Sciences Centre, suggests, to ask everyone to work 130% until we’ve caught up, which will likely take years – and at what cost?
The first step in solving the crisis is counterintuitive in that 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 did we get it right? Who was under-serviced or treated inequitably? What systemic improvements are within our reach? Prioritizing the time to do this 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. Healthcare 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 workforce, 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, as is done in Quebec for nurses, will only momentarily prolong the inevitable once this same personnel returns to 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 jobs are to saves lives. It is their leaders and more specifically, middle-level health care managers, who sit in the sweet spot to enact change. It is they who require a mindset of agility, adaptability, and innovation to extricate time for reflection, to look at data, and to propose systemic solutions. Since the early months of 2020, front-line healthcare workers have been front and centre in our minds and in our politics. As we look for a path forward, it is time to shift our focus up the organizational chart and provide support to those who will be the ultimate catalysts of improved healthcare.