Bending the cost curve in the health system – Canadian Government Executive

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January 11, 2013

Bending the cost curve in the health system

Arguably, healthcare is approaching a sustainability tipping point. Rising costs, limited financial and human resources, coupled with issues such as lack of timely access, quality and safety of care for patients persist.

Traditionally, the government approach to this problem is to cost-cut. Cost-cutting is often reactive, arbitrary, and can become damaging to morale and corporate culture.

In healthcare, cost-cutting can result in cutting what is valued most by patients since they are often overlooked or not asked what they value in terms of their care. As such, cost-cutting should not be the focal point of healthcare sustainability. Rather, safety, quality and value from the patient’s perspective should be the foremost priority of the healthcare system. In achieving these goals, cost savings often follow.

Similarly, cost-cutting can have an adverse effect on the very efficiency and savings we seek: putting a health system in a situation of “feast versus famine” that can lead to poor decision-making about the structure and management of the system. For example, meeting a short-term reduction in funding can force decisions about programs and services (often on the prevention/promotion side of the equation) that both increase costs over the longer-term and result in poorer health outcomes for patients.

Bending the cost curve through addressing the efficiency of primary drivers such as clinical quality, staffing, patient flow, supply chain and unaligned services is crucial. Specifically, looking for value in existing programs and services is a good place to start.

Our goal is to achieve a culture shift in the healthcare system so that providers, staff, and administration think differently about the business of delivering care. For instance, in one of our acute care facilities there was sustained success in reducing time from door to disposition for pediatric emergency patients:

•    95% reduction in defect of having pediatric patients waiting for triage in adult emergency;
•    56% reduction in lead time for pediatrics patient registration and triage process;
•    100% reduction in defect of nursing taking vital signs and asking certain questions twice;
•    Improved signage, including removal of outdated and duplicate signs; and
•    Implementation of 10 new standard work processes for emergency and registration.

This improvement is one of many that has been sustained over a number of months and is a great example of the work the healthcare system is undertaking to improve patient care.

Sustained and continuous improvement not only requires a shift in how we provide existing programs and services, but also requires us to shift our thinking toward innovative ways to provide care, for instance, proactively focusing on ensuring preventative care is accessible to patients.

In Saskatchewan, we are looking to improve the seamlessness of the patient care journey by introducing an ambulatory care centre in Regina that would serve southern Saskatchewan citizens as a one-stop shop for healthcare. The Plains Surgery and Outpatient Care Centre will allow patients to receive a number of related healthcare services in one centre while ensuring things patients value most, such as accessible, timely care, in a welcoming environment are provided.

In some of our smaller communities where recruitment and retention of health professionals can be a challenge, innovative primary care models and collaborative emergency centers are being designed and implemented changing the way we provide care. The models are intended to provide care more efficiently to patients through interdisciplinary care teams that will work collaboratively to better meet the needs of the patients and communities they serve with a focus on improved patient experience and increased access to care. These sites are built on partnerships between health regions, communities and providers. Currently, eight primary healthcare sites have been identified, with potential for expansion.

Beyond investing in innovative methods to provide care, empowering and engaging patients and families in their own care through encouraging programs such as tele-health and self-management of chronic conditions is an important part of this shift. This means not merely treating a problem as it presents itself but taking the extra time to get to know the patient and let them tell their story in order to better help empower the patient to take control of their own health.

The future sustainability of the healthcare system is dependent not on cost-cutting, but on identifying and sustaining improvements of existing programs and services and in delivering care through non-traditional innovative care models.  

Dan Florizone is Saskatchewan’s deputy minister of Health.

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