In 2002, the Canadian senate sought to investigate the state of health in the country and make necessary recommendations. The Standing Committee mandated on matters of social affairs, science and technology took up the matter and set out to investigate as well as come up with a document that would offer detailed information on the state of national health and make recommendations.
The committee was chaired by Senator Michael Kirby, and specifically, it sought to come up with ways that would reduce problems related to maldistribution, jurisdictional competition and undersupply. The committee, on completion of its investigative work and writing of reports, came up with various recommendations that were categorized into six parts.
The overall recommendation was that the federal government was supposed to work with relevant parties in creating a national coordinating body for health care system and which was supposed to be composed of key stakeholders. This paper explores one of the recommendations that were proposed by the committee.
Recommendation Category one
Recommendations on restructuring the current hospital and doctor system to make them more efficient as well as effective in providing timely and quality patient care (Taylor, 2009, p.7).
This is the first of the categories of recommendations that were made by Kirby’s committee as a way of improving conditions of health care system in the country. According to Day, Paul and Williams (2009), Kirby’s report on the status of Canadian health care system noted that there were some grave issues that need to be addressed on matters concerning hospital management.
For this reason therefore, the committee made it clear that there was a need to restructure the hospital managements. This recommendation was prompted by a number of factors. The discussion below looks at the state of Canadian health system and hospital management that prompted such a recommendation.
The context at the time
Before the commissioning of the report and subsequent recommendations were made, the hospital situation in Canada was in bad state. Apart from a few ones, the hospitals in the country were not for profits and their ownership was community based. Some of them were owned by religious bodies while others were either owned by universities or the municipal governments.
In actual sense, the territorial or provincial governments did not own hospitals, and this is despite the fact that the provincial administration was doing a lot of funding for the management of the hospitals in the country. The concept of restructuring was therefore meant to devolve the management of the hospitals plus the doctor system.
The major concept here is care-spending from the provincial administration or governments or what could be termed as the ministries of health in the national government. Once money is released from the national headquarter, the regional health authorities abbreviated as RHAs would take up the matter and design the best way to distribute the money or resources.
In Canada, there existed the municipal doctor system but was superseded by what came to be known as the province-wide medical care program (Taylor, 2009). This program had its own merits but it later degenerated to inefficiency and low productivity among the hospital units that were affected.
This led to an increased need to change the system so that there could be a more accommodative approach that could enhance efficiency in the hospitals. In changing this system, the committee sought to address a number of fundamentals that were realized.
For example, it became apparent that there was need to address the issue of growing waiting times in accessing health services and ensuring that the patients can receive the services in their jurisdictions. It was also critical for the county to start meeting patient service standards that can be regarded as reasonable to all. The overall goal was to ensure that the health provision in the country was up to standards.
Action taken
The government of Canada has adopted various measures in an effort to restructure management and smooth working of hospitals. In a study carried out on 140 Canadian hospitals after a lot of restructuring of these healthcare units, it was found out that the kind of restructuring that was done was changing of the nursing staff mix (Hall, Jan 2005).
There was employment of full time nurses and the government enhanced support roles that utilized issues such as professional practice leaders, clinical specialists in nursing, case managers, nurse educators and nurse practitioners. The government has also done a lot of merging and downsizing as an overall measure of restructuring and there are government sponsored medicines.
However, these measures have not been effective and some of the hospitals have been forced to close. For example, reducing of critical medical services has only resulted to loss of extensive jobs for the hospital workers and mostly the nurses.
Hospital restructuring has also resulted to stress and job insecurity. It can therefore be argued that government response in terms of restructuring has not yielded the fruits that were foreseen by the committee. As such, there is dire need to relook at the issue and put necessary measures.
The government has also come up with what can be termed as a market based restructuring and funding structure for the hospitals. As was proposed by Kirby led committee, there was a need for a neutral funder especially when it comes to ownerships of the institutions. It also detailed on giving the institutions some greater independence from the government.
The government reduced its control on the institution but it then led to the reduction on the number of employees in the institutions. The government also adopted the structure that was proposed by Kirby’s committee; especially on devolution of the responsibilities of the government administration like the territorial governments (Baranek, Deber &Williams, 2005).
Support and opposition of the recommendation
The report gained support and opposition in equal measure. The basis of support and its opposition rested on the fact that the committee suggested that the federal government must take control of the funding rather than leave the matter to other agencies.
The report also came up with a recommendation that the restructuring of the hospitals and the doctor’s system should be a preserve of the government through its branches like the territorial governments. One of the oppositions came from the Health Minister, Jamie Muir. He was opposed to the idea that the government is to support the hospitals in the restructuring process, and specifically in funding everything that the hospitals do.
He was also concerned with the fact that the committee did not provide specific means in which the hospitals could be funded, and pointed that putting generalities in the report may not serve the intended purpose. However, the report as a whole and especially the part of restructuring and government funding was received by other quarters of the senate.
They observed that there was a high need for the government to take indirect control of the running of the hospitals. Although they were to become independent, it was crucial for them to receive funding to enhance their effectiveness. The media too came into the support of the recommendations which largely influenced the public’s perception about the health care system and a need to restructure everything.
The current hospital status in Canada
Hospital care in any country is important and a vital part in the development of a country. It is imperative to note that hospitals do provide communities with healthcare systems that cannot be ignored at all. The federal government has taken care of issues that go with the hospital management, and this to some extent has streamlined effectiveness.
However, the government has allowed the institutions to have independence of sought. Provincial governments have taken up the responsibilities of funding the hospitals and taking care of issues that can generally be regarded as demanding real attention. The government is also taking care of the planning part and providing necessary logistics that can improve health care.
There are evolving values in terms of health care in the country and the government is now seen as a critical player in the provision of the health care. However, there still exist grave concerns especially on quality of the services, and therefore, there is need to rectify some of the policies as well as tightening some issues in terms of doctor system and restructuring
Proposed measures
Basing on some of the concerns that have been raised in the kind of health care system that exists in Canada, there is need to change some policies. In addition, it is high time the restructuring process of hospitals and the doctors’ system so that quality of healthcare system is not compromised. The following are some of the proposals that can help in improving the health care system:
- On restructuring of the hospitals, it is proper to combine or merge of only the hospitals that provide same services rather than combining hospitals that concentrate on different services. This will significantly act as a cost cutting measure since the restructuring process in itself, is an expensive undertaking.
- The combining of services should not compromise the quality of output; that is, the government should first of all put appropriate measures that will ensure that the quality of health care continue to be of high standard. It is imperative to note that the key reason why any restructuring process should be carried out is to improve on the quality of healthcare delivery. This objective must be met if any restructuring process is to be carried out.
- Even with merging of services, there should not be closing of hospitals as patients would be compelled to travel long distances to look for the much needed services.
- Changing of the team of doctors who are supposed to attend to patients should be done carefully so that they are not overly de-motivated. A demoralized team of professional doctors will definitely fail to deliver according to the expectations of both patients as well as healthcare units.
References
Baranek, P.M., Deber, R.B. & Williams, A.P. (2005). Almost home: Reforming home and community care in Ontario. Ontario: McGill-Queen’s University Press.
Day, R.A., Paul P. & Williams, B. (2009). Brunnar and Suddarth’s textbook of Canadian medical-surgical nursing. Philadelphia: Wolters Kluwer Health.
Hall, L.M. (2005). Strategies employed to rebuild nursing following restructuring: Canadian perspectives. Journal of Research in Nursing, 10(1), 57-64.
Taylor, M.G. (2009). Health insurance and Canadian public policy: The Seven decisions that created the health insurance system and their outcomes. Toronto: University of Toronto Press.