Health Committee on Nov. 29th, 2012

[Dr. Michel Tétreault]

Thank you for your question.

I am suggesting support for research and education provided by university partners on a subject such as Lean transformation in health care. As I understand it, that is not solely a provincial responsibility.

Yesterday, I was having breakfast with the dean of the University of Manitoba's Asper School of Business. The reason I met with him was to ask him to set up the partnership, to encourage people to come and benefit from learning opportunities, and to send us research candidates, all for the purpose of broadening what we know about this field. We have questions about how we're doing things today, what is working and what isn't. People in the business and health worlds need to come together so we can learn together.

The ultimate goal is to incorporate this more business-oriented learning into the curriculum taught to every health professional. The business educators at Montreal's HEC and the Asper School of Business want to develop curriculum on health-related business practices for their candidates. And I think the federal government could contribute to that.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much.

My next question will be to Mr. Racette.

In your presentation you briefly talk about a national health agenda. Could you describe in more detail what it would include?

[Ray Racette]

The majority of the national agenda is on quality and safety, so it's identifying a number of patient safety or quality issues that nationally they want to work on. The safety of medication for the elderly is very large. Care of the elderly is a very large national agenda. They're already old, but they're also aging, so how do they manage that?

There is the use of technologies. We talked about Lean. They are a very savvy system, in terms of being very efficient with their processes.

One of their big issues is how to manage wait-lists, but when they talk about wait-lists, they're not talking about five things; they're talking about wait-lists for every type of specialist, every type of thing that somebody will need to queue for. So their goal, really, is to be very smooth and very short on wait-lists, regardless of what they are for. They have a requirement that if they don't meet wait-lists within 30 days, that patient can be cared for in another country and they have to pay for it.

Those are the types of things they work on within the national agenda.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

What I'm mostly interested in is whether we in Canada could have a federal national health agenda, or whether that can apply only to Sweden and we cannot have a similar agenda or strategy here.

[Ray Racette]

You could look at another country that has the same kind of constitution as Canada—Australia. In the first place, in the Australia Constitution Act of 1901, they established the role of the federal and the state governments. They have the same distribution of powers, but they have standing structures in place that create linkages. Or you could talk about a national agenda. They have a standing committee on health, which is made up of all the federal and state ministers of health. They meet on a regular basis, not just occasionally.

Second, the deputy ministers of health, federal and state, all meet through the Australian Health Ministers' Advisory Council. They advise the ministers, but together they have been able to achieve a national consensus on the reform agenda for Australia. They have one issue that we don't have in Canada—in Australia the states cannot tax for health care, whereas in Canada the provinces can. You can imagine how hard it was for them to create a discussion in which the federal power owns all the taxing powers, while the states own all the responsibility for delivery. Despite that bigger difference than what we have in Canada, they were able to achieve structures that allowed the discussion to occur.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

That's interesting.

I was highly surprised when you mentioned that in Sweden they spend less but they get more bang out of their buck. Are there ways we can also be more efficient in Canada, some concrete ways? If we're talking about federal jurisdiction, all the better, but how come our health systems are so rusted?

[Ray Racette]

They have been able to create capacity across all the settings. They look at the home as a setting of care. They look at housing as a setting of care. They look at all the different options where they have patients, and they work very hard on making sure the patient is in the right setting. They have to balance a few things, cost and quality and safety, but because they look at all the opportunities for where the patient can be, and they insure in all of them, they do a much better job of putting the patient in the right setting.

We struggle in some ways because we only insure in certain settings. Patients want to be in settings where they don't need to pay out of pocket, and many of those settings are already congested. They have done a better job of looking at all their opportunities for where the patient could be, and they have created options for the patients to be in those settings. In particular, they maximize care in the home. Their hospital beds are only slightly less costly than ours. And their nursing home beds are a lot lower—patients are really cared for where they can't be in the home setting. We know the patients value that, but the system also supports it if the patient can be there.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

You mentioned that in Sweden 97% is public funding. We see a new trend in Canada of having individual patients pay more in several ways. Compare the two approaches, and give me your opinion on where private money is appropriate or if we should stick to public funding.

[Ray Racette]

They've been able to demonstrate that you can have a complete system and do it on essentially 100% public funding, so there is evidence that you can actually make it work in a heavily public funded system.

In Canada, 30% of our spending is private, and that is growing as the public system gets more constrained. But one area they fund that we don't is dental care. They provide dental care to the age of 19. They know that if you start off with good oral health, as you go into your adult years, you will be healthier for the rest of your life. We have that on the private side, and people who don't have private insurance end up losing on that proposition.

They do some things like that. They do the same with the elderly regarding oral care. When you are on a pension, you often can't afford it. They are quite strategic about what they invest in to keep people healthy. Their thinking on some of this public policy is pretty good.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Racette.

I am going to ask some questions now of the panel. This has been a very interesting panel today, very diverse on a number of levels.

Dr. Montaner and Dr. Kerr, thank you for your presentations today. I want to also congratulate you, Dr. Montaner, on your Queen's Diamond Jubilee Medal. It is well deserved. Congratulations.

I was very amazed, because I've known some of you very well over a very long period of time and have seen the kinds of things you're doing. This committee has been very brave in doing innovative study. What we attempted to do in the beginning was to look at processes all across our country to see and share the most innovative processes. It's like—I don't know if you've studied this—Ausubel's advanced organizers. The theory states that you piggyback on ideas and you understand where those ideas come from.

Along the way we've talked a lot about preventive medicine, in other words, dealing with people to live healthy lifestyles. We have an aging demographic, as you know. We have a population of children who are obese, so that is something that we have looked at. The committee has also looked at end-of-life issues, if someone is chronically ill, staying home as long as they can.

We've also found out that across the country the lines are blurred. It used to be that the doctors did one thing, the nurses did one thing, and the patient was sort of left out there. Now it has become a more collaborative circle where the patient is very much engaged in their health care. We've also seen in some of the northern areas that emergency responders, who we will have at the committee in due course, have taken on the issues when they make home care visits. They do IVs and things like that because there's nobody else around to do that. That happens up north in Nunavut and places like that.

What we are trying to do is look outside the paradigms that we generally had. I think today is just a classic example of people who have honoured us by coming here today and sharing best practices.

Dr. Bohm, one thing I know about is your clinic at the Concordia Hip and Knee Institute, which does amazing things with hips and knees. You had the same stream—I don't think you talked about it—where the doctors are so involved in terms of the design of better hip and knee replacements. I've actually gone into your labs.

Colleagues, if you go into their labs, they have rows and rows of hips and knees. I don't know if I ever want my hip and knee replaced. You look at that, and they're so interested in making it even better.

Could you speak a bit to that collaboration? It's quite unique.

[Dr. Eric Bohm]

Thank you for the opportunity. It's hard to cover everything we do in 10 minutes. We do have a very active collaboration between clinicians, surgeons, physical therapists, and our engineering colleagues as well.

We've developed several areas of interest. One is an implant retrieval and analysis laboratory. You can imagine that as new implants are developed, they can be tested in the laboratory but be put into patients and fail for some reason you haven't thought of. When we take these implants out, because we do the bulk of the revision work in Manitoba, we're able to put these implants into our retrieval lab and our engineers can actually look at them, look at reasons for failure, and we can learn from that.

[The Chair, Conservative, Joy Smith]

There's a collaboration with the surgeons as well on that, right?

[Dr. Eric Bohm]

Absolutely. We're very involved and have discussions. Our offices are beside each other, so I can walk down the hallway and talk to our Ph.D.s about the case I just did and how I thought it failed, and we can analyze it.

The other component, of course, is the testing of new implants and product development. We have some wear testing machines that we just got up and running two days ago. It's very exciting. We have a lot of laboratory equipment for testing and measuring of implants and surface wear and those kinds of things, again developed and supported by Western Economic Diversification. It's quite a good collaboration.

[The Chair, Conservative, Joy Smith]

Dr. Fotti, it seems that there's a synergy between your best practices at the Pritchard Farm Health Centre and with Concordia. You're doing different things, but the thread that I hear there is one of collaboration and being right on-site with people with different specialties, or special interests, as you put it.

I was talking to a doctor, a neurosurgeon, who has a child with cystic fibrosis. This boy is transitioning from being in a child setting to an adult setting for his medical care because he's turning 18.

I don't think the committee got a picture of the component you put in there, what you called a “spa setting”. That was kind of interesting, that when you go in there it has that setting, and it's done so cheaply. You even have pictures that are donated by people, who buy them from a local artist, and there are huge windows. Could you speak to that?

A lot of people I've talked to feel that their anxiety level comes down when they go into that clinic. Could you speak a little more on that? We've never had that described to our committee.

[Dr. Christopher Fotti]

Yes, certainly.

When we designed the clinic we wanted it to function very well and be a nice pleasant place to be in to work. I can relay the story of my patient with cancer that you've alluded to.

When people come in, if it doesn't look like a hospital emergency room or a doctor's office, they feel more comfortable. When people are really sick, something like that does put a smile on someone's face or makes them feel a little better about coming. I think that's a great thing.

[The Chair, Conservative, Joy Smith]

Seniors are happy that you don't have elevators. They've told me that they hate those elevators and they love the big windows.

This is a component that we don't generally talk about in health care, and I think it's important.

[Dr. Christopher Fotti]

Yes, I think it's pretty important overall for everyone, including the staff. If we have good staff and good doctors, and if it's a pleasant place to be in, we'll have less turnover. That's what you want for the patients ultimately.

[The Chair, Conservative, Joy Smith]

You're from St. Boniface, Dr. Tétreault. I feel very compelled to ask you about your assessment. You don't hide the fact that you want to get better every year. Could you elaborate a little more in the time that we have, the next minute actually, about the checks and balances in your own hospital and asking the patients how they feel about patient care? I know a lot of us have gone into hospitals where we wish somebody would ask us.

[Dr. Michel Tétreault]

Having been a patient myself of one of Dr. Bohm's colleagues—after five months in a wheelchair I walked here from my hotel this morning—I have to say they do great work. That's the voice of the customer, but I don't want to end up in his retrieval lab somehow.

We actually did a school for 28 people from Quebec, Belgium, and Switzerland last summer, and the comment that came back the most often was, “You guys measure everything.” So we do. That has been said today, but it is essential if we want to get better. Yes, the only ambition we have is to be a better hospital next year than we are this year, and a better hospital the year after that.

One thing that I think is critically important...and we're part of a Lean network of 60 organizations—sadly, only about five Canadian organizations—but not everyone in that network does what we do, which is our default position. It is that any improvement work we do will include a patient or family member, unless there's a specific reason not to. That has been extremely powerful for us, so it's not only measuring, but it's also listening to the people who know.

[The Chair, Conservative, Joy Smith]

Thank you so much.

I must say, Mr. Racette, that you've always been so innovative in your thinking.

Dr. Montaner and Dr. Kerr, I learned a lot this morning from what you said, and I really appreciate that your results speak for themselves.

I think we've had an amazing committee this morning. I want to thank my colleagues for their very insightful questions, and I want to thank again our very learned guests for coming today.

With that, the meeting is adjourned.