About 150 people turned up for the annual general meeting of the Nova Scotia Health Authority in Truro yesterday.
The NSHA oversees a yearly budget of $2.1 billion used to operate the province’s hospitals and ambulances, deliver diagnostic tests and mental health treatment, recruit family doctors and nurse practitioners, as well as provide wellness programs aimed at keeping people healthy and preventing cancer and heart disease. The Health Authority employs 24,000* people in the province (including medical staff) and was formed five years ago through the amalgamation of nine district health authorities.
Janet Knox, the president and CEO of Health Authority who led the planning and has been the leader at the helm for the past five years, is retiring at the end of August. Health Minister Delorey stiffly thanked the nurse and former administrator of the Valley Regional Board for her dedication and exemplary service. In her final speech, Knox acknowledged the ongoing challenges faced by the province during her leadership.
“Nova Scotians have high rates of preventable chronic diseases,” Knox told the audience of mostly doctors, nurses, and health care professionals. “Our population is aging… more care providers are retiring as global demand for them increases. This makes vacancies more difficult to fill. Our health system has not adapted fast enough to respond to these realities. As a result there are Nova Scotians who don’t have a family doctor or nurse practitioner, or who are waiting too long for mental health care, a test or procedure or a nursing home placement.” (The bold type for emphasis belongs to Knox.)
So while the 2018 annual report details 130 new hires of doctors and 130 new hires of nurse practitioners, and increased access to mental health services for the most urgent cases (90% were seen within seven days), and hundreds more citizens got new hips and knees, this progress still feels akin to placing a finger in a dike. Our health system as it is today can never meet everyone’s demand for a doctor and will become less sustainable as more baby boomers grow old.
I asked the outgoing CEO with 40 years experience as both a nurse and a senior administrator running the previous Valley Regional Health Authority* to describe her vision for “adapting” health care to respond to these ongoing pressures. Knox started with some grim facts to explain why our current system that relies on hospitals to treat the sick must be “transformed” to focus instead on keeping people well. Five years after collapsing the nine district health authorities into one provincial organization, Nova Scotia’s rates for cancer, heart disease, diabetes, and COPD remain the highest in the country. (We’re Number 1!) Sadly, the McNeil government’s stated goal in 2013 of using savings from administration to provide more front-line services to people has done nothing to improve these results.
“We need to do things differently and we need to be flexible,” said Knox. She talks about how any change at a hospital often results in pushback and how people in that same community might receive a greater benefit from a recreational program, a bike trail, heart-smart cooking class, or school breakfast for kids.
“I’m not suggesting everything we do is wrong but it must start to be focused around what people need,” said Knox. “Otherwise, why are we still sitting with the top four chronic diseases in the country? We are now up to six thousand new diagnoses for cancer a year and if we helped everybody think about healthy lifestyle, exercise, rest, and not drinking so much alcohol — those are four factors that all contribute to cancer. Transforming the system means thinking about health differently than we have in the past.”
Essentially, the 80 or so collaborative care clinics or teams around the province that include a range of health professionals such as doctors, nurse practitioners, physio and occupational therapists, nutritionists, and mental health counsellors embody this vision for providing healthcare differently. Stay out of emergency rooms and long-term care as long as you can. These are services provided in the towns and villages and neighbourhoods where people live. Hospitals exist for emergencies, complex surgeries, and diagnostic tests.
“When I took on this job nearly five years ago,” Knox concluded, “I believed that a province-wide health authority offered Nova Scotia the best opportunity to modernize and transform our health system to better meet the needs of our residents today and to create a healthier future. I still believe that. I continue to be inspired by conversations with our teams, partners, patients and families who want us to spend more time promoting health and wellness and less time protecting the status quo.”
Janet Knox sat down amid polite applause. There’s still a long road ahead to get there. Her eventual successor as president and CEO of the Nova Scotia Health Authority, who will oversee a $2.1 billion budget and lead 30,000 employees, is being sought by a Toronto head-hunting firm.
“Trust us, we know this is an important hire,” said Board chair Frank van Schaayk. He said in the event the new president is not ready to start in September, the Board has a plan to appoint an interim leader. The NSHA Board also met for two hours yesterday with acting deputy health minister Tom Marrie (a former Dean of Medicine at Dalhousie University) who replaced Denise Perrot and will serve up to six months during the transition.
* As originally published, this article misstated the number of NSHA employees, and the branch of the Health Authority which Ms. Knox administered.
Janet Knox stopped short of addressing the desperately needed solutions; NSHA needs to stop doing some of what it started out doing, recognising that it is not changing outcomes for people.
Stop adding more administrative layers to this top heavy organisation.
Devolve decision making so that frontline staff can weigh in to develop actual solutions to community specific issues.
Offer them industrial engineers and health economists, to set up pathways of care that work.
Stop trying to standardise everything…..you have failed to deliver by using this approach.
Build trust by acknowledging that your plan has failed at many levels and offer the actual numbers to people and the media; how many family doctors were present in 2015? You credentialled them, and asked what services they provided. Inform us about how many have left and retired since then.
Senior leaders in primary care, were party to the wrecking ball approach that you took towards primary care in your effort to build collaborative clinics. They do not have our trust, and need to be changed.
Janet Knox is correct, of course; preventative care is always better. These conversations always focus on how people need to get exercise and eat better…..but it’s rarely mentioned that many people are living in poverty or struggling to keep their heads above water. When a bottle of pop is 99 cents and a gallon of milk is 6 dollars, lots of people will choose pop over milk, particularly if they’re cash-strapped. If I was Queen of the Universe I’d:
1. Tax the crap out of shitty food and make good food dirt cheap.
2. Introduce mandatory cooking classes in schools so that kids learn to cook fresh food from scratch – starting at the junior high level and spanning the rest of their public school years.
3. Reintroduce daily physical education classes in schools so if they go home after school and sit on their derrieres all night in front of a screen at least they’ve had an hour of physical activity at school.
4. Come up with a housing strategy so that people don’t have to spend 70% of their income for adequate housing.
5. Introduce legislation to force employers to pay decent wages and provide 4 weeks of mandatory vacation time, which would alleviate stress. We rarely discuss stress as a major cause of disease, yet many people are living under stress due to inadequate income or overwork in poorly paid jobs.
None of this will every happen, of course. We’ll shovel money into private ventures (like the Cat Ferry, for example) that do absolutely nothing to improve the lives of people yet pretend that it’s all our faults and that all we need to do is just eat right and exercise more.
“Take my advice. I wasn’t using it anyway.”
Key point here – Janet Knox says that the health system needs to be “transformed” to focus on keeping people well, rather than treating the sick, which is what we do now.
I have heard health professionals continuously say the same thing for about 15 years so this isn’t a new idea and (anecdotally) it seems to be accepted by a lot of people who matter.
Janet Knox was the CEO for 5 years so presumably held a lot of power to drive change. Did she explain why she didn’t or couldn’t change the system other than the vague response that there is ‘pushback’.