Category Archives: Canadian Healthcare

Thresholds and wait times

I have been thinking quite a lot recently about thresholds for health care intervention. In health care, if there is a scarcity of a resource, then the threshold for intervention typically goes up and if there is an excess of a resource, the threshold of intervening goes down.

Let’s take an example; If you have an illness that responds well to antibiotics and you go to a very busy physician, she will say, “Take a full course of the antibiotic and you will be OK. “If she is not so busy, she might say, “Take the antibiotics and book an appointment in two weeks.”

Both are equally good responses but apportion the doctor’s time differently.

Because health care tends to be supply driven, when the supply goes up it always gets used, but with a lower threshold of use.

A second important idea in health care is coming to understand the consequences of a shift in population morbidity from acute infectious disease to long term chronic conditions. If someone has an acute infections disease there is usually a very clear test to see if the disease is present and a very clear protocol for responding to it. However in the case of chronic conditions the measures are often less clear and individual patients can respond differently to medical treatment.

A good example of this change is the identification of diabetes or hypertension in a patient. Here there are lots of borderline cases and a variety of responses are possible. Pharmaceutical companies have been very aware of this change and have found ways to bring medications to the supply system for lower and lower thresholds. There are now drugs available for pre-diabetic conditions, for earlier and earlier indications of possible heart disease and so on.

If we take these two ideas together then we can find new ways of thinking about waiting lists.

When waiting lists were very long in the UK, I met a doctor, while I was working there, who confided in me that when he had a patient who wanted her varicose veins stripped, he would say, “Of course. I will put you on the waiting list.” This meant to him that she would never have the procedure because the list was so long and she was at the bottom of it. This would save him from having to spend time explaining to her why he thought that the procedure would do no good aesthetically and why it was not necessary for health reasons.

Waiting lists are often managed by managing the threshold for intervention. If there was an acute problem then people would jump the queue. A study by colleagues at the King’s Fund showed that acutely ill patients had very short waits for surgical procedures. It would be interesting to see how much that has changed since then.

We have also learned that because of the change in our understanding of cancer, “watch and wait” is a good way to respond to many early detections of cancer. That is very hard for us to take, since we have been raised to think that every last bit of cancer must be eradicated form your body or else you will die. It is worth wondering how much some of these lists are part of this watch and wait way of thinking.

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A Five-year Plan for the NHS

Several weeks ago, Simon Stevens who is head of the English National Health Service (NHS), published Five Year Forward View. The report details his plan for the NHS, and it’s well worth a read because it is remarkably relevant to the Canadian context.

He describes a context that is quite similar to ours: an aging population with multimorbidity as the major epidemiological feature. The excellent hospital sector and well-developed primary care network of general practitioners is not adequate or entirely appropriate for the population served by the NHS.

He recognizes that there must be a “radical upgrade in prevention and public health”  (NHS 9). The failure to do this in the last decade has resulted in “a sharply rising burden of avoidable illness” (NHS 3). In Canada, the weakness of public health initiatives has been marked by similar increases in obesity, diabetes and other preventable conditions.

Secondly, he sees that patients must “gain far greater control of their own care – including the option of shared budgets combining health and social care. The 1.4 million full time unpaid carers in England will get new support, and the NHS will become a better partner with voluntary organisations and local communities” (NHS 3).

This is clearly what must happen in Canada too, but there are few policymakers here who have such thoughts because of the severe limitations on the boundaries of our healthcare system. The relationship between the system and voluntary organizations is pretty sparse, and the idea of giving patients and caregivers control over any funds for their care is certainly not top of mind. It is time to include patients and family caregivers in discussions about their perceived needs and consider new ways of providing funds to meet them.

Thirdly, the document argues that:

The NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases. (NHS 3)

Importantly, he does not plan any structural changes in the NHS. Reforms will not involve changing the governance or boundaries of the many organizations that make up the NHS. It will include strengthening primary care, integrating access to a wide variety of services that will avert unnecessary hospital visits, and increasing the already abundant community services (which are notably sparse in Canada).

We recommend that policymakers take a good look at the document and consider how it might be applied in the Canadian context.

 

National Health Service. Five Year Forward Review. England: National Health Service, 2014. Web.

Canada’s Healthcare System Today: A Need for Change

About 40 or 50 years ago, Canada’s healthcare system was pretty good. These days it is no longer addressing the needs of Canadians so well. It still provides proper care for people with acute illnesses by way of excellent surgeons, well-trained specialists, and an increasing number of family practice professionals. But by and large, it is not very good at dealing with the four main causes of mortality today – cancer, heart disease, lung disease and diabetes, and the population that is most affected by them, those 65 and over.

One of the great successes of the modern era has been the dramatic increase in life expectancy. People in the developed world lived for an average of 35 to 40 years in 1850 (Reynolds). People born in Canada today can expect to live for more than 80 years (Statistics Canada). This increase is typically common knowledge.

What is less widely known is that the increase in longevity also brought with it an increase in healthy years lived. As late as the 19th century, most people over 40 suffered from one chronic condition or another. Many of these conditions were primarily the result of the infectious disease that they survived as children or young adults. Today, chronic conditions affect most people over the age of 65. So we can describe the improvement from 1850 to now by saying that we have an added 25 years of disease-free life. Of those over 65, 89% have been diagnosed with at least one chronic condition. And in fact, 25% between 65 and 79 years old report having four or more chronic conditions (Public Health Agency of Canada).

The causes of chronic diseases today are different from those of 1850: they tend to occur as a result of lifestyle, environmental or genetic factors, rather than earlier infectious disease. Also, chronic conditions tend to be diagnosed at an earlier stage. When medicare was introduced in Canada in the 1950s and 1960s, chronic conditions often manifested in their acute phase – heart disease as heart attacks, lung disease as cancer and so on, and they were treated in acute care hospitals. Today we diagnose these conditions far earlier. We can identify early stages of the four main chronic killers and we know that early diagnosis is very effective in slowing the progress of these conditions and even reversing them.

Unfortunately our system is not well-structured to keep people with early stages of chronic disease healthy. We do not provide the health education, systematic support for changes in eating habits, and exercise and lifestyle recommendations that would avert the slow development of these chronic conditions. The result has been a tremendous boon for drug companies. Because we have inadequate support in the community for helping people to deal with pre-diabetic conditions, high cholesterol counts, increased blood pressure or reduced lung capacity, our primary care system relies almost entirely on referrals to specialists and to medication.

The result has been that we have an overmedicated population that spends more than $900 per capita on prescription drugs (Lexchin and Gagnon). Another survey found that 76% of people over the age of 65 had taken a prescribed medication in the last two days (Ramage-Morin). We are second only to the United States in our consumption of prescription drugs.

In my next blog entry, I will describe services that are part of the National Health Service in England that have enabled the UK to keep people with chronic conditions healthier, avert institutional care for a longer time and have significantly less drug consumption.

 

Canada. Government of Canada. Statistics Canada. Life expectancy, at birth and at age 65, by sex and by province and territory. Ottawa: Statistics Canada, 2009. Web. 3 No v 2014.

Canada. Public Health Agency of Canada. The Chief Public Health Officer’s Report on the State of Health in Canada 2010. [Ottawa]: Public Health Agency of Canada, 2010. Public Health Agency of Canada. Web. 3 Nov 2014.

Lexchin, Joel and Gagnon, Marc-André. “CETA and Intellectual Property: The debate over pharmaceutical patents.” http://labs.carleton.ca/canadaeurope/wp-content/uploads/sites/9/CETD-Policy-Brief_CETA-and-pharmaceutical-patents_MG_JL.pdf. Oct 2013. 7 pages. Web. 27 Oct 2014.

Ramage-Morin, Pamela. “Medication use among Senior Canadians.” Component of Statistics Canada Catalogue no. 82-003-XPE . Health Reports 20.1 (2009). Web. 3 Nov 2014.

Reynolds, Neil. “Good news: life’s no longer short.” The Globe and Mail 19 Feb 2010. Web. 3 Nov 2014.

The Canadian Cardiovascular Congress

It is clear that there has been a major shift in focus from acute to chronic care – chronic disease is now on everyone’s mind. I am currently writing this blog entry from the Canadian Cardiovascular Congress, where the first welcoming session began with a long talk by Perry Kendall, Provincial Health Officer of British Columbia. His audience of heart professionals was given a short primer on public health issues. He began by pointing out how much the Lalonde report had changed our understanding of the health field and specifically noted that only a quarter of good health was due to interventions by our current healthcare system. He then covered a range of topics – everything from inequalities in health to obesity. Not a mention was made of infectious diseases, not even Ebola.

The longest part of his talk was about the difficulty in changing the amount of unhealthy food that is being distributed in Canada by a very well-organized food industry. The industry has tried to minimize and even block change in every area from labelling to sodium and sugar content of foods. They declare publicly that they are in favour of these changes, but they work very hard to defer them or stop them entirely. Kendall said that reducing the sugar and fat content of processed food is hard work and would continue to be. For example, the first attempt to introduce voluntary reductions of salt in processed foods at the federal level was rejected out of hand by the Prime Minister’s Office. Efforts to do this at the provincial level will be long and drawn out because of the large number of constituencies. And because compliance is voluntary, there is no certainty when and how the food industry will respond.

He talked quite a bit about the contributors to chronic disease in Canada and could not cover everything. I noticed that on one of his slides there was some material that he did not speak to at all. It is an area where doctors themselves contribute to the ill health of people with chronic diseases, and it seemed like the part they really needed to hear. According to the slide, a significant portion of people with chronic conditions are made worse by overmedication. It was somewhat surprising to me that Kendall did not allude to this problem at all. Here is an area where the heart community could make a difference to public health by developing better practices. Perhaps they were aware of these efforts and there was nothing for Kendall to add.

This became a bit more problematic when I looked through the program. The Platinum sponsors of the congress are AstraZeneca, Bayer, Bristol-Myers Squibb, and Pfizer. I went into the exhibition hall and one of the handouts was a “passport” that you could have stapled at all the important stations to win an iPad. The Passport participants were almost all drug companies. In fact, the exhibition hall was filled with exhibits by drug companies and equipment companies. Becel was the only healthy food company with a stand, and there were almost no exhibits devoted to chronic care prevention.

Right now in Canada, we are the second highest users of prescription drugs in the world after the United States. We spend over $900 per person per year on prescription drugs (Lexchin and Gagnon). I think that this is because our healthcare system offers few options to doctors. If you get high blood pressure, an early stage of heart disease, it is easiest to offer medication to control it. If you have high cholesterol, it is similarly easiest to provide statins. And if you have multiple conditions you will have a good chance of being prescribed many different drugs. Often as you get older these many drugs can cause their own problems.

Our healthcare system is not set up to offer the range of supports needed to avert the four main chronic conditions: heart disease, lung disease, cancer and diabetes. But this deficit is becoming more obvious. I hope that the next Cardiac Congress will be more devoted to averting early stages of heart disease in a drug-free manner, by imposing lifestyle changes. It is time for the change to be more thoroughgoing.

 

Lexchin, Joel and Gagnon, Marc-André. “CETA and Intellectual Property: The debate over pharmaceutical patents.” http://labs.carleton.ca/canadaeurope/wp-content/uploads/sites/9/CETD-Policy-Brief_CETA-and-pharmaceutical-patents_MG_JL.pdf. Oct 2013. 7 pages. Web. 27 Oct 2014.

Thanks to you

As President of Patients Canada, I’m excited to share with you some important progress for the organization and for patient partnerships generally. I invite your feedback and comments. Find more information about Patients Canada here.


I would like to thank a few of the many people who have helped Patients Canada over the past few years. In the last few weeks, Patients Canada has been represented at several conferences by speakers and patient panels. At a conference sponsored by the McGill University Health Centre in Montreal, there were more than 40 patients present from across the country. They joined over 100 providers from the hospital to consider the future of patient partnerships in healthcare.

In Toronto, a panel of patients presented their perspective to more than 800 members of Family Health Teams from across Ontario. Sandra Dalziel, Cathy Fooks, Alies Maybee, Emily Nicholas, and Sara Shearkhani presented their thoughts about how Family Health Teams can better partner with patients and family caregivers. Next week we will have a patient panel at a Conference Board Health Summit; Brian Clark will be introducing patients as part of a Health Workforce conference in Ottawa; and I will be going to Vancouver to speak about patient decision support in cardiac care. We have been representing the patient perspective across Canada for more than four years and these five conferences mark a significant change that has been developing over that time.

Our first conference was the Patient Centred Primary Care Summit in 2010. We’d been sent a notice about it and upon looking through the agenda, we found that there were no patients listed as participants however there were many meetings about patients. There were researchers on patient centred care, researchers on shared decision making, and even researchers on patient participation. This was a conference on patient centred care and we felt that it was time to bring patients to it. We called on Maureen O’Neil from the Canadian Foundation for Health Improvement (CFHI) to give us a hand, and her organization graciously gave up their slot. We drafted in André Picard from The Globe and Mail; Martin Dawes, the Professor of Family Medicine at McGill; and Abe Fuchs, a former Dean at the McGill medical faculty. They joined two patients, Elke Grenzer and I. We all spoke to the need for the patient voice to be present in healthcare – including conferences like that one.

We learned that many organizations had been working towards patient centred care with little or no patient representation and so this was a wonderful opportunity to begin to change that. Patients Canada, among others, has been bringing the patient voice to meetings across the country for the last four years. Now patients are routinely consulted, and participate actively in conferences and working meetings in healthcare organizations across the country. The last few weeks are not so unusual these days!

In 2007, we worried that patient centred care would come and go – that it would just be another flavour of the month, and we were determined not to let that happen. Our organizing group included Kevin Leonard, Alex Jadad, Elke Grenzer, Murray and Larry Enkin, John Feld, Rosalee Berlin, Ariane Hanemaayer, Anita Stern, and Jan Plecash. They kept us clear to our purposes. We got early help from people from other organizations such as Sandra Dalziel of Patient Destiny, lots of people at CFHI, Vaughan Glover of the Canadian Association for People-Centred Health, Zal Press who started Patient Commando, Ted Ball of Quantum Transformation, and we have received constant support from the Centre of Global eHealth Innovation. Joyce Resin from Impact BC, Willow Brocke from Alberta Health, and many others across the country lent an early hand to keep the movement alive. Individuals like Vytas Mickevicius and Neil Stuart gave lots of time and effort to help organize what has become Patients Canada.

We are growing apace and in November we will have a reunion of early joiners to bring everyone up to date. Here are some of the successes we’ve noted over the past few years:

  • From these few people and with the help of our Communications Coordinator, Christina Spencer, we now reach many thousands of people through our website, open meetings, and social media channels such as Facebook and Twitter.
  • We have had Patients Canada Volunteers as speakers at dozens of conferences across Canada.
  • We have partnered with the Ontario Medical Association (OMA) to sponsor the very successful Patients’ Choice Awards.
  • We have had several books published with the enormous help of Ryan Devitt, and now we have contracts for more to come.
  • We have held four successful conferences that brought together patients, providers, researchers, policymakers, and almost everyone interested in healthcare.
  • We have sat on more than fifty healthcare committees concerned with research, policy development, quality improvement, and patient and family advisory committees. This has been achieved with the help of volunteers and a dedicated staff including Karthiha Krishna and Jennifer Carroll.
  • We have visited organizations across the country to see how they partner with patients and have helped many individuals and organizations to begin and develop the process of patient partnerships.

We are particularly excited for our current initiative. We have received an array of patient health experiences and worked with an ongoing panel of patients and others to identify Key Performance Targets (KPTs) that will make the experience of healthcare better for everyone. We have developed a number of targets and last week I included six of them in my blog. We are currently working on many others as part of a five-year research and application exercise that will, we expect, result in significant change. This work has already had an impact on the primary care performance indicators used by Health Quality Ontario and has informed some of the new standards for healthcare organizations being developed by Accreditation Canada.

We can now declare that we are not a flavour of the month – there will be many more patient partnerships in healthcare, and patients and family caregivers will play an increasingly important role in future healthcare developments. Thanks to everyone who helped so far. We will need you and many more for the future.

Six Key Performance Targets (KPTs) for hospitals

As President of Patients Canada, I’m excited to share the work we’ve been doing on Key Performance Targets (KPTs) with those of you following my blog. It’s a very important project and I invite your feedback and comments. Find more information about Patients Canada on our website.


It’s time to bring together a few small changes that would have a big impact on the patient’s hospital experience with the idea that these changes would be clear indications that hospitals are indeed becoming more patient and family-centred. I have spoken of them individually, but now it’s time to bring a few of them together and explain how they are derived from our experiences with healthcare.

I was talking with someone who wanted to know more about bringing back dignity to the hospital gown and I mentioned that there were other examples of Key Performance Targets (KPTs) derived from experience.

“For example,” I said, “parking costs can be really burdensome for some people.” I was about to go on when she interrupted me.

“Oh, when my husband had a stroke, I was paying more than $75 a day in parking as I visited him in the morning, afternoon and evening for more than two hours. There were no in and out privileges for visitors. It was awful, but I felt I had no choice.”

I elicited similar responses whenever I went on to explain the various targets together. It seems that they are high on the list of changes that many patients want to see improved. Listing them together often elicits clear recognition of things that niggle but are rarely expressed.

The list of obvious but relatively unnoticed performance targets that will improve patient and family experience includes

  1. A change in the policies surrounding hospital gowns
  2. The reduction or elimination of parking fees for visitors and families of patients
  3. That there is a chair in the triage position in Emergency Departments for a family member or friend who accompanies the patient
  4. That hospitals adopt an open visiting policy so that friends and family members can visit patients any time
  5. That all hospital notes are readily available to patients (and whenever possible, their families) so that they can review them at will
  6. That food policies in hospital are open to allow and even enable family and friends to bring food from home to patients, by, for example, having a patient and family accessible refrigerator and microwave oven on every hospital unit

These six changes in policy and practice would go a long way to making hospitals more patient and family friendly. We encourage hospitals to adopt them.

Process for developing Key Performance Targets (KPTs), developed by Patients Canada.

A solution to hospital gowns

In many discussions about patient experiences in healthcare there are allusions to the loss of dignity that many patients experience when they enter the hospital. Often patients who value their privacy are subjected to extraordinary intrusions which would be intolerable in any other circumstance. Often, because it is such an ordinary part of the hospital experience, we do not see the indignities that occur as a matter of course. The most glaring of these is the hospital gown. Patients’ bodies are only partly covered by a gown that seems to be a mandatory requirement in hospitals almost everywhere. We have forgotten the reasons for it, but assume that gowns are designed to allow doctors and nurses easy access to the patient’s body.

hospital gowns 1It first occurred to me that this was a privacy issue which is not covered by the current privacy regulations, as it’s currently fixed on keeping medical records away from prying eyes. Many patients believe that at least the same amount of attention that’s paid to safeguarding medical records should be paid to keeping their bodies private. I believe that this is yet another hangover from the early days of scientific medicine when patients gave their bodies over to science once they entered the hospital. This is clearly privacy issue of significance to patients.

Last week journalist Tom Blackwell of the National Post wrote a long and varied feature on the issue and interviewed not only physicians, but also patients and representatives from Patients Canada. The article pointed out that the vast majority of patients had no medical need to be so accessible to doctors or nurses, and it was even suggested that the gowns contributed to health deterioration that led to increased returns to hospital.

A few days later I received an email from a friend in England who found the article and presented a solution that is being tried in some parts of the NHS: the Dignity Giving Suit. She has allowed me to use images from the site to show a few of the alternatives. She also included her response to the article:

We have designed the innovative patented Dignity Giving Suit which affords patient’s dignity, whilst allowing surgical and medical teams full dignified access to the patient for procedures, lines, leads, drips, drains and catheters. Patients have access to the Dignity Giving Suit to enable them to purchase a version of the hospital Dignity Giving Suit, in a choice of patterns which allow them to feel comfortable and in control in their own choice of ‘pajama’. Their own version of the Dignity Giving Suit can be worn in all departments of the Hospital, including MRI and Xray until they require the Hospital’s sterile version, and for recuperation at home. The Hospital version has been in some Hospitals in the UK for over a year with more hospitals currently trialling or ordering.

According to the site, these hospital suits allow patients to retain their dignity while “giving healthcare practitioners unrestricted access to their patients”. What we need now is a philanthropist who can restore the dignity of patients and help create the next major change in healthcare.

Alternatives to the traditional hospital gown

André Picard: Elderly people in emergency rooms

André Picard’s recent column that details the horrors of Canada’s emergency rooms is a powerful account of how much our system needs to take into account the experiences of patients and families as it begins to reform itself.

In Canada, there are 14 million visits to the emergency room with about one third of patients arriving in ambulances. He provides statistics for wait times in Quebec but they are probably not that different in other provinces. Patients who arrive by ambulances are a different story. If they are trauma cases they are seen almost immediately – within 10 minutes, but they are about 1% of this group of patients. The others are triaged relatively quickly like everyone else, but then they wait even longer than those who walk in on their own. They are the frail older people, usually with multiple chronic conditions like COPD and heart disease. According to André Picard they wait, on average, 18.4 hours in the ERs in Quebec. He goes on to say

Remember, that’s an average; waits of 24 to 48 hours are not uncommon. We stick them in hallways, behind curtains or in transformed broom closets. These patients, in their 70s, 80s and 90s, are essentially living on a gurney for days with little or no access to meals, toilets or privacy, and they are often alone.

The ones who are alone are usually brought in from nursing homes or other long stay facilities, because there is not adequate nursing care in their home institutions. The nursing staff in such facilities may not be able to set up an appropriate IV or do a particular test, or provide some other technical service that might be required. As the direct care requirements for patients in long-term care increases because of their increasing age, and as technical medical and nursing care become more complex, the capacity of long stay facilities to keep people in house decreases and the medical and nursing protocols require that they be sent to hospital. The entry for such patients has traditionally been the emergency room. According to the Quebec commissioner who reviewed the situation, 60 per cent of patients who go to the emergency room should not be there at all. André Picard says

They should be treated in primary care, by physicians or nurse practitioners. But lots of people don’t have a regular doctor and very few of those who do can get same-day appointments for urgent (but not emergency) problems….

Some of the gurney-bound are waiting for a hospital bed, but only about one-third are admitted to hospital. Beds are in short supply because there are many frail seniors already stuck living in hospital with nowhere to go for lack of home care or long-term care beds….

The majority of elderly ER patients have the same dilemma: They’re not sick enough to be hospitalized, but too sick to go home alone, or back to a nursing home where there is no medical care.

He concludes that

We don’t need bigger ERs. We need to shift resources from hospitals into primary care for the ambulatory and home care and community care for the non-ambulatory. Until we do, our parents and grandparents will continue to fill emergency departments and fester in hospital hallways, gasping for care.

But the system is incredibly slow to change. The inability of the system to respond to these terrible situations really shows that there is a need for the injection of new players: Patients are beginning to participate in healthcare as partners, and their experiences will count more and more in the co-design of new services and the articulation of patient friendly policies. They can help the system respond to the true needs of patients and families.

Four Key Performance Targets (KPTs) for eHealth

As President of Patients Canada, I’m excited to share the work we’ve been doing on Key Performance Targets (KPTs) with those of you following my blog. It’s a very important project and I invite your feedback and comments. Find more information about Patients Canada on our website.


eHealth has changed considerably over the last year. Patients now have apps that allow us to monitor our heart rates, photograph the inside of our ears, even perform an electrocardiogram using our mobile phones. These technological breakthroughs are enthralling and no doubt will begin to transform healthcare in the future.

But in a far more prosaic way, we see the beginnings of what and how we want out of eHealth. Canada Health Infoway is helping family practices adopt ways to book appointments online. Yesterday Infoway announced the second wave of registration for this initiative: they will provide financial support to practices that introduce e-booking. After the first wave more than 700,000 Canadians can book appointments online. To see examples of e-booking initiatives presently underway across Canada, click here, or read the latest benefits evaluation report on e-booking.

Having the ability to schedule an appointment online is a good example of a Key Performance Target (KPT) for primary care. It marks the launch of widespread electronic communications between patients and our doctors’ offices. When it becomes widespread it will bring Canada closer to the international level of electronic interaction between patients and their doctors.

Through patient surveys we have identified some simple things that patients want as targets in primary care.

Key Performance Target 1: We want to be able to make appointments online

Key Performance Target 2: We want to be able to access test results online

Key Performance Target 3. We want to be able to renew prescriptions online

Key Performance Target 4: We want to be able to communicate with our doctors online

Canada remains among the worst of the developed countries to have these four capacities for patients. Whenever I speak to information technology groups I ask if anyone has their doctor’s email address. So far very few people speak up, if any. Some people can get test results online through MyChart. And the fax machine remains a necessity almost everywhere for renewing prescriptions. But now we have the hopeful sign that in a growing number of practices appointments can be made online.

  1. Making appointments online will begin to spread now as doctors recognize the freedom it gives their administrative staff to do other things.
  2. As patients we can take the lead in expecting that electronic communications should increase. As electronic medical records become more pervasive our family doctors should be able to share test results with us online. In fact, there is a growing movement of creating ‘shared notes’: some doctors are partnering with patients to prepare the notes for each visit and then preparing a copy for them to take home.
  3. There are already no serious technical obstacles to renewing prescriptions online. It has just not been agreed to overcome them. In fact, most of the major pharmacies already allow access to patients prescription history across their entire network. The step to easy prescription renewal is modest.
  4. A small but growing number of Canadian doctors are beginning to circulate their email addresses to patients and are setting up ways for their patients to reach them more easily. Those who have done so have found that patients really appreciate this increased access and the doctors do not find the effort burdensome. In fact, for most it makes their lives significantly easier: It can avert unnecessary visits and more time can be allocated to patients who need more face-to-face time.

We are hopeful that these four performance targets are widely achieved. We look forward to next year’s measurement.

Redesigning hospital rooms from the patient perspective

Last Friday, an article in the New York Times described the patient rooms in the new University Medical Center of Princeton, New Jersey. The architect is Michael Graves who is in a wheelchair after suffering from meningitis some years ago. He brings a strong patient perspective to the design of the hospital’s patient rooms.

For starters, the rooms are singles; there are no double rooms. Research shows that patients sharing rooms provide doctors with less critical information (even less if the other patient has guests). Ample space is given to visitors because the presence of family and friends has been shown to hasten recovery.

Ditto the big window: Natural light and a view outdoors have been regarded as morale boosters since long before Alvar Aalto designed his famous Finnish sanitarium in the 1930s (a “medical instrument,” as he called it), bragging about curative balconies and a restorative sun deck. (Kimmelman, pars. 12 & 13)

And generally, they look more like hotel rooms than hospital rooms.

It’s less antiseptic, cluttered and clinical than your average patient room, more like what you find in a Marriott hotel, anodyne and low-key, with a modern foldout sofa under a big window; soft, soothing colors; and a flat-screen TV. (Kimmelman, par. 23)

The new rooms also include a bedside-to-bathroom handrail to make it easier for patients to go to the bathroom safely on their own.

HospitalroomBringing their perspective to the design of hospitals rooms will make a big difference to the experience that patients and families have in hospitals. The hospital in New Jersey is an excellent and concrete example of the difference it makes to consider the patient experience; patient satisfaction ratings are now in the 99th percentile – not just for the room, but for everything from the food to the care. And staff like working there as well.

In the redesigned room, patients asked for 30 percent less pain medication. According to the article, “Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections” (Kimmelman, par. 6).

This is an excellent example of what Patients Canada has been working towards: including the perspective of patients and their families, and thereby contributing to a better outcome for patients and a better experience for everyone involved.

Kimmelman, Michael. “In Redesigned Room, Hospital Patients May Feel Better Already.” The New York Times. The New York Times Company, 21 Aug. 2014. Web. 25 Aug. 2014.