The following is the keynote address delivered at the Aberdeen Health Foundation Annual General Meeting, February 27, 2014, by Murray Hill, Chair of the Pictou County Health Authority
I want to thank the Aberdeen Health Foundation for the opportunity to speak at this, your 2014 Annual General Meeting.
I have been involved with hospital foundations and health authorities for some time. I am currently Chair of the Pictou County Health Authority, a position I’ve held for the past 12 years. I also currently Chair the Council of DHA Chairs for Nova Scotia. I’ve been asked to speak to that experience and offer my thoughts on what may lie ahead for us.
I hope I do it some justice because the subject matter is important. It’s important because when you strip away all else, our health matters most. And that health begins with caring: caring for our individual self, caring for our family, and caring for our community.
I’ll begin by offering some context.
Last year, $211 billion dollars was spent on health care in Canada. That’s 11.6% of our GDP, up 2.6% from the previous year and amounts to just shy ($12) of $6,000 for every Canadian.
Where was it spent? It’s spent equally between hospitals and drugs & doctors. Hospitals – 30% / drugs 16% / physicians 15%. During my time as Board Chair the expenditure for drugs has crept past what we spend on physicians.
Canada does not have a “free” healthcare system; it has a very expensive healthcare system. Who’s paying for it? Currently, its 70% publically funded and 30% privately funded but I suspect that will change in our near future.
How does Canada compare to our peers? We’re about mid-pack among developed nations.
So, …we spend most of our money – a lot of money – on fixing sick people. That’s where our attention is as well.
I offer this example of how focused we are on healing the sick (rather than maintaining wellness)? In this age of enlightenment, where we make evidence supported, KPI (Key Performance Indicator) based management decisions, where we know more than we ever did about what we do, Sunnybrook Hospital in Toronto can only get ½ of their staff to take a flu shot.
That’s a tough one for me to comprehend. My guess is it’s probably because most of what we learn about health comes from the study of illness – fixing sick people versus keeping people healthy.
We need to get much better at focusing on the wellness side. And doesn’t that perspective manifest itself wonderfully in this Wellness Centre and what it represents in our community.
I want to add a bit of context around our social environment in Nova Scotia.
Between 2001 and 2012, 17 of the18 counties in Nova Scotia saw a decline in the number of age 50 and under residents of between 14 and 37 per cent.
In 11 of those 18 counties (we weren’t among these), the decrease in that age group was more than 20 per cent. 1 in 5 residents under 50 left. Guysborough lost 37 per cent. What an amazing statistic: a one third reduction in the number of residents below 50 years of age … in a single decade.
Just two counties (Halifax and Colchester) experienced any population growth at all between 2006 and 2012. and I would argue Colchester’s growth came from HRM’s urban sprawl.
Someone should study this further, write a report on it and how it impacts our future. Maybe call that report “Now or Never….”.
How healthy are we? The residents of Nova Scotia have the dubious distinction of having the shortest life span of all Canadians. It gets better. We who live in Pictou County live the shortest life span of Nova Scotians.
One of my reasons for highlighting this data describing our demographic and health status is to support my contention that the health care needs of Northern Nova Scotia are distinct. What works elsewhere probably won’t meet our exact needs.
I suggest to you that one size does not fit all. For the same reasons that Nova Scotians don’t share the same healthcare needs as Albertans, we don’t share the same healthcare needs as Halifax Regional Municipality. We need to customize [or fine tune} the healthcare afforded our residents. We know how to do that and I’ll speak more on it in a moment.
Before I get further into what I’m going to speak on this evening, let me tell you what I don’t intend to speak on:
– I won’t spend time discussing why (preventable) chronic disease will make this current generation of children the first in history to live shorter lives than their parents. Statistically, more parents will be burying their children than vice versa.
– I won’t spend a lot of time discussing the fact that 95% of the patients getting new hips and knees in our system are over-weight. Maybe its time we started to balance our hurry to secure more surgeons with the more obvious need.
– I won’t spend time discussing how Nova Scotia spends half our provincial tax dollars on the delivery of health care, making our Health Authority the second largest local employer. We bring in about $1.5 million a week to our local economy not including our fee-for-service physician earnings.
– I won’t spend time discussing the $7.5 million the province had us remove from our local healthcare services over the past 4 years.
– I won’t talk about healthcare facilities being one of the three pillars – along with education and recreation – needed to attract and retain people to work and live in our community.
I also don’t want to talk about what I see when I look at healthcare here. What I want to talk about are some of the metrics others use when they describe healthcare in Pictou County. What are those non-resident views of us?
– Over the past decade, your Health Authority is seen as having had a leadership role in innovation at the provincial level. That’s a significant transition from your former outlier status.
– Your Health Authority currently delivers the full suite of robust services expected from Regional hospitals in Atlantic Canada.
– Your Health Authority has added on-site helicopter Medivac to complete that suite of services.
– Your Health Authority possesses an MRI and a suite of very modern diagnostic imaging equipment, much of it acquired with the generous support of this Foundation. For that matter, your Health Authority is described as being very well equipped generally.
– Your Health Authority is described as being strategically placed, equipped and functioning to provide “state of the art” trauma services. That service is accomplished within the magical “golden hour” required to save the lives of people in crisis. “Golden hour” refers to the markedly better outcomes that result from being able to secure trauma services within an hour of your accident or incident. That “golden hour” capacity is provided in Pictou County to more Nova Scotians than all our counterparts outside Capital and Cape Breton Districts.
– Using the metric of 8 consecutive balanced operating budgets, your Health Authority is seen as possessing the longest continuous run of fiscal responsibility of any Authority in the province.
– Your Health Authority is viewed as being successful in recruiting and retaining physicians. It delivers the full Regional Hospital suite of general and specialist services and as well as several key specialist services, including one of four provincial sites for orthopedic surgery.
– Your Health Authority is seen as unique in Nova Scotia in that all residents can currently access a family physician if they so choose. I know of no other location in Nova Scotia where that statement applies.
– Your Health Authority, through the exceptional hard work of many, is seen as having transitioned its work environment to become a preferred employer among physicians. They actively compete for placement here.
– Your Health Authority is viewed as offering residents a more complete suite of services than is offered to your neighbours. That means that residents here will receive treatment for about 90% of your healthcare needs without leaving Pictou County. That compares to receiving treatment for 80% of your health care needs in either of your neighbouring communities.
– Your Health Authority is statistically the safest rural hospital in Nova Scotia. Few medical errors is indicative of better medical care.
– Always acknowledging the need for continuing improvement, your Health Authority is viewed as offering its citizens outstandingly good results in all areas of its service delivery.
– Your Authority statistically achieves a service satisfaction level where 96% of your patients would recommend you to others. I will repeat that: Your Authority statistically achieves a service satisfaction level where 96% of your patients would recommend you to others. That makes your Authority comparable in that metric to some of the best hospitals anywhere.
And yet, while others see us as I’ve just described, in true Pictou County fashion, I suspect we would eagerly debate their assessment of our services. I’m not going to dig any further into that although there’s a significant body of work to do there.
I want to talk a bit about the genesis of what I’ll call transitional change in our local healthcare delivery.
How did we get from where the Authority was to where it is; and, most importantly, where it should aspire to be?
I suggest to you we are where we are by design, not by circumstance. The Authority is where it is because of a history of hard work and dedication by a lot of people on staff and in our community. In particular, over the past decade, the Authority has benefited from the stellar work of an exceptional management team to analyze, develop and adapt services …. and begin to implement a Plan developed by leadership from our community.
What I want to speak to is moving forward from this point to complete implementation of that Plan.
A number of years ago, some leaders within our community agreed to dedicate considerable effort toward instituting transformational change in health care delivery in Pictou County. That effort formally started on a day in the Museum of Industry with a critical review of services, undertaking a basic but necessary SWOT analysis (strengths: weaknesses : opportunities: threats).
That frank analysis pointed to the need for change.
– It pointed to the need for helicopter Medivac facilities at the Aberdeen.
– It looked at the manner we conducted business internally (customer service) and within our medical teams (collegiality).
– Very importantly it pointed to the need to draft a formal plan that would guide us toward our future.
– And it also pointed to the need to establish working partnerships within the institution, within our community and within our province, all capable of delivering our future healthcare services.
It’s noteworthy that all of the goals set out in that initial SWOT analysis have been accomplished. While our services will always be a piece away from perfection, measurable advancement was and is being achieved. Many facets of that service will require continuing attention – perhaps the best example would be establishing and maintaining the relationships within our community needs to deliver the best healthcare possible. That will always need our collective attention.
The Plan I want to speak to was developed six years ago. It’s called our Master Program / Master Plan and titled Healthy 2020 – A Vision for our Community Healthcare Needs in the Year 2020.
Subsequent to the initial SWOT sessions I just spoke about, a group of 20 or so community leaders offered their attention over some 6 months to steer the drafting of Healthy 2020. That effort involved many hours of consultation with every sector of the team that delivers local health care services. It also involved listening to every recipient of those services. As well, it involved talented consultants who specialized in the planning of tailoring hospital services to meet community needs.
The result of this body of work is manifested in a very detailed, extensively researched document that’s available on our website. I have a hardcopy with me this evening. Use care if you wish to print it off – it’s close to 275 pages long. It’s that lengthy because of the complexity of the work that’s done locally by the Authority. Every aspect of that service is dealt with in painstaking detail.
What Healthy 2020 contains is a combination of expert and community thought on what healthcare services need to be delivered to northern Nova Scotia in the year 2020.
It speaks to the quality of the initial work that little if anything needs to be updated in the interim 6 years since this vision was drafted. It’s as valid a perspective now as it was when it was completed.
But it’s very important that I point out we’re 6 years into our 12 year implementation schedule.
While I urge you to look through the Plan yourselves, I want to offer some examples of what you’ll read:
The relocation of services off the hospital site – moving selected services to the mall – was part of that Plan. Services best delivered away from the acute care sector are now delivered off-site.
Taking down the Professional Centre or Annex or Nurses Residence – depending on your age – was part of that Plan. Something else will occupy that space.
This magnificent facility – the Pictou County Wellness Centre – was part of the Plan. It’s a response to the question of how we positively affect lifestyle choices that impact personal health. The Wellness Centre and Phase One of Healthy 2020 – the work on the ER and Pharmacy – were actually jointly marketed in our community as the Health Agenda. It speaks to the intent that the group leading this initiative called themselves “Citizens For A Healthy Pictou County”.
There are 4 Phases of re-development needed to fulfill the vision of Healthy 2020. Phase One is the rebuilding of the Emergency and Pharmacy. That’s currently completing its final planning stages and will go to tender this spring.
Phase Two, Phase Three and Phase Four are yet to come.
Healthy 2020 is an ambitious Plan … it’s a far reaching Plan … and it’s an achievable Plan.
Irrespective of governance or management structures or issues that may be in place in 2020, the healthcare needs we collectively identified for our community need to be addressed. We owe that to our community … we owe that to our families … we owe that to ourselves.
I’m of the belief that we deserve to continue to have most of our health care needs met within our community. We have the Plan which describes what those needs will be. We have the Plan of how to address those needs.
What we don’t have is a Plan on how we will achieve what we’ve described in Healthy 2020. Time is marching on and the time to act on this is fast approaching.
In closing, I want to again thank the Aberdeen Health Foundation for your continuing leadership and support. Few communities around this province or in Atlantic Canada for that matter have been blessed with the kind of support we have enjoyed. No one at the Health Authority takes that for granted nor should anyone within our community.
I also want to thank the leadership team of the Health Authority. Healthcare continues to be a learning experience for those of us – me in particular – who are not professionals in its delivery. Thank you for your patience, your guidance and your support.
I also want to thank the staff of the Health Authority. These past few years have not been easy and I’d be less than truthful if I was to suggest I think the future holds something different. Through all of this, staff have remained patient centric, empathetic and service oriented. As a former patient of your services …, as a future patient of your services …, as a volunteer among you …, and as a member of this community …, I want to tell you not to ever think your work isn’t appreciated, or isn’t respected, or isn’t valued. It’s all of those.
I want to thank my fellow volunteers who like me, have the privilege of working for those of us in our community who receive health care services. It’s so rewarding to be among such positive, loyal, caring people.
I’m going to repeat something I had the opportunity to say 14 months ago when this Wellness Centre was opened.
We have a truly magnificent history here in our singular community of Pictou County. In my mind, we live in the best community…of the best province…..of the best country in the world!
Some of us can trace our ancestral presence here back several millennia…some for a few centuries….still others for a few years. I’m going to offer a particular perspective on that by paraphrasing a former Prime Minister who said: “…while the past is to be respected and acknowledged, it is not to be worshiped.”
I share his assertion that our greatness lies in our future, not our past.
Maybe it’s as simple as changing our perspective from what’s already been accomplished to looking at what remains possible to achieve.
In that paradigm, this Wellness Centre, for example, transitions from a culmination of collaboration to become a glimpse of the possible …. a glimpse of our future provided we focus on a common vision.
Folks, I believe quite simply that’s our challenge … our opportunity to meet the health care needs – your and my health care needs – into the future. We have a Plan that needs to be executed. We already know what can be achieved from adopting a focused perspective.
The choice is ours.
I will close with two quotes: first from Dr. Gerry Farrell upon the opening of our Palliative Care Unit: the care we provide today should be equal to the care we should expect to receive.
Second, since we started with a Shaw, we should end with one: George Bernard Shaw said: “The people who get ahead in this world are the people who get up and look for the circumstances they want, and if they can’t find them, they make them.”
Thank you for the opportunity to address you.
Chair, Pictou County Health Authority