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Tuesday, May 31, 2011

Collaborative Renewal

Guest blogger Judith Shamian is president of the Canadian Nurses Association (CNA) and president and CEO of the Victorian Order of Nurses (VON). She is also a professor at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, a co-investigator with the Nursing Health Services Research Unit, and was the executive director of the Office of Nursing Policy at Health Canada for five years.

The Health Council of Canada’s latest progress report on health-care renewal in Canada is an excellent tool that showcases something we all want to know: What’s working well across the country, and what’s not? Knowing the answer is an important step in helping successful innovations spread more quickly to other jurisdictions.

The report also provides valuable insights on challenges common to all regions. Canada’s registered nurses believe that these shared obstacles can best be tackled through a comprehensive and sustained plan of attack that involves the strong collaboration of federal, provincial and territorial governments.

The report reveals: “Even where provinces and territories are pursuing similar broad goals, they are generally doing so independently of one another.” This is very telling, as it is symptomatic of the fragmented nature of Canada’s health system. The right kind of nationwide improvements could leverage the value of health care innovation much more effectively than piecemeal provincial and local approaches alone. Upcoming negotiations focusing on a new federal, provincial and territorial health accord represent a crucial window of opportunity to engage Canadians and the entire health care community in the renewal of our health system.

Take, for example, the adoption of electronic health records, where the report indicates steady but uneven progress across the country. How is it that Canada, a world leader in information technology, is still using an archaic mix of paper-based patient records and multiple stand-alone electronic information systems that are not compatible? Imagine the efficiency gains possible if you could go from a family practice office to the hospital and then to a rehab centre knowing that each care provider could access the exact same essential facts of your health history. This means you wouldn’t have to remember all the details and repeat yourself at every encounter. Health care providers would know, for example, about your allergies, whether your tetanus vaccination is up-to-date and what medications you have been prescribed – a significant contribution to your safety as a patient.

This is just one example of the benefits that a national approach to health system renewal can bring to health care in all the provinces and territories.

National collaboration on wait times is another. While good progress has been made in addressing wait times for certain procedures, registered nurses are working to further reduce and manage their effects on Canadians and the health system – across the continuum of care. See examples presented in a recent report from the Canadian Nurses Association (CNA), Registered Nurses: On the Front Lines of Wait Times – Moving Forward.

The progress report comes at an extremely opportune time, as several groups of health professionals are driving initiatives to accelerate collaborative action on health system renewal. In fact, the coming weeks will see CNA launch a national expert commission on health system improvement entitled The Health of Our Nation – The Future of Our Health System. Stay tuned for more details!

Key Words: Electronic Health Records, Access and Wait Times

1 comment:

  1. I feel there are two major issues to be addressed. On the issue of electronic health records, while some progress has indeed been made to make information more accessible, there is a long way to go. One of the challenges is that the priorities of IT professionals are not the same as those of front-line care providers, especially in high-presure settings such as acute-care hospitals. Until such time as computers are made as quick and easy to use, and the information stored in the EHR as quickly accessible, as a paper chart, paper charts will still be used; it's that simple. Right now, multiple logins and complicated passwords, security policies that do not respect the work flow of nurses, physicians and other health care professionals, and the lack of easily portable platforms all make the idea of going paperless too frightening for most.

    On the larger issue of improving access to primary care and chronic disease management, the provinces are going to have to develop the courage to take on the powerful physicians' lobby and ditch "fee for service" once and for all, and allow more Registered Nurses, including Nurse Practitioners, to operate independently of physicians, or collaboratively with physicians while maintaining professional autonomy. Until then, the health care system will remain physician-centred and episodic, leading inevitably to long ER waits and repeated hospitalizations.