April 2, 2012 - Our health care system has been focused on acute care since its inception however the vast majority of illness these days is chronic rather than acute. Gradually, everyone is beginning to realize that hospitals can no longer be the core of the health care system if we are to respond appropriately.
Last week I went to a community outreach meeting that was being held by a hospital. Representatives from the hospital proudly talked about their utter dedication to patients and their needs, and how they had improved their services over the last few years.
Their premise, however, remained that the hospital is there to deal with acute conditions. If you are not acutely ill then the hospital is not a place for you. This means long waits in the emergency room, low placement on waiting lists, and few services dedicated to continuous chronic care.
The head of pediatrics said that he only wanted to deal with really sick patients, and felt that others should be treated by community-based pediatricians or family doctors. Unfortunately there are not enough community pediatricians and there is not an abundance of family doctors either, but he thought that it is no part of the hospital’s responsibility to respond to that difficulty. A patient pointed out that the hospital had just closed down an on-site after-hours family clinic, and the hospital replied that although they very much appreciated the family clinic, it was not their responsibility - they had just provided space for it. They did not feel that they should make sure that such a clinic was available to reduce pressure on an overloaded emergency room. The evening was a wonderful example of what we have been calling the “acute care focus†of hospitals, which is deeply ingrained in their orientation. The problem is that this limited focus makes it far more difficult to deal with the growing need to avert acute episodes of chronic conditions.
Later in the week I went to Ottawa for the Taming of the Queue Conference – an annual meeting to review where we are with shortening waiting times for several kinds of surgery and emergency rooms. This was the first time that they had invited patients in nine years, and this group of patients from all over the country asked really good and pointed questions. It seems that most efforts to shorten wait lists did not include patients in their committees which is unfortunate because people who are on those lists have a lot of insight about how the waiting is managed. It seems most of the efforts have been about carrots and sticks for providers. The conference was a wake-up call for the value of patient participation in working on these issues.
A similar question arose about the issue of prevention of acute episodes of health disease, like congestive heart failure. It was suggested that CEOs of hospitals might think more carefully about their contribution to prevention efforts.
“How about measuring their performance against the number of patients admitted with preventable conditions like congestive heart failure?†asked one patient.
Why not? It would certainly reduce the silo mentality and might even get hospitals to contribute to those community resources that keep people from becoming acutely ill.