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Govind Rao

More efficient health system would save lives, money | CIHI - 0 views

www.cihi.ca/...release_10apr14

from heather reforms accord

shared by Govind Rao on 15 May 14 - No Cached
  • April 10, 2014—Today, the Canadian Institute for Health Information (CIHI) released a new study on the efficiency of the Canadian health system. Measuring the Level and Determinants of Health System Efficiency in Canada examines why health system efficiency varies across Canada, what could be done about it, and what a perfectly efficient health system might look like. The study estimates the average level of inefficiency to be between 18% and 35%. This means that up to 24,500 premature deaths could be prevented every year—without additional spending. “An efficient health system gets the best health outcomes for what it spends. We found there are opportunities to improve health system efficiency in Canada by tackling existing organizational and delivery challenges as well as population-level factors,” says Jeremy Veillard, Vice President, Research and Analysis, at CIHI. “The combination of these interventions could substantially reduce premature deaths in Canada, at no additional cost.
Irene Jansen

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Inc... - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached
  • Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
  • Irene Jansen on 31 Mar 13
     
    Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob
Govind Rao

Doctors now victims of policies they supported - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|kwrc|20151202|234937168

from heather Ontario cupe hospital doctors cuts privatization

shared by Govind Rao on 03 Dec 15 - No Cached
  • Waterloo Region Record Wed Dec 2 2015
  • Anyone in Ontario with access to radio, TV or Facebook will have heard about the ongoing battle between the province's doctors and the Kathleen Wynne government. Having had a pay cut unilaterally imposed on them by the government, Ontario's doctors have swung into action. They've begun an aggressive campaign to let Ontarians know that Wynne's Liberals are undermining patient care.
  • How is care being hurt? Well according to the docs' social media posts, doctors are overworked. Many doctors are forced to overwork routinely, they say, and often under appalling conditions. In one example, a doctor is entering her 36th hour of work, has not eaten for nine hours, and is six months pregnant. Clearly, under such conditions no one can provide anything close to optimal levels of care.
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  • The doctors' campaign has, however, prompted me to wonder how it is that paying doctors more will function to alleviate conditions of overwork?
  • Also concerning is that the doctors' recent efforts to link declining levels of government investment in health care come in the wake of both long-standing and ongoing efforts to standardize, regulate and privatize care in the sector. More than this, through their organization, the Ontario Medical Association (OMA), physicians have long stood silently by and watched as other front-line workers have been forced to battle against the Dalton McGuinty and Wynne governments' efforts to freeze wages, cut hospital funding and otherwise undermine the working conditions of health-care workers, from cleaners to tradespeople to registered practical nurses and personal support workers.
  • To put matters into perspective, over the past five years, government spending on doctors has increased - in real terms - by an average of 2.5 per cent a year. Over the same period, government spending on other health-care staff has declined by an annual average of -0.5 per cent. In other words, whereas doctors have seen a 29 per cent increase to their pay over the past seven years, other health-care staff have seen their wages decline in real terms.
  • Of course, declining wages are not necessarily reflective of working conditions. In that regard, it is notable that Ontario hospitals now receive less funding per capita than hospitals in every other Canadian province. As a result, Ontario hospitals - often with the support of doctors and their representative associations - have worked to find "efficiencies" in ways that have frequently increased the workload of front-line staff, and thereby undermine the conditions these workers face and the quality of care they are able to provide patients.
  • A visit to any Ontario hospital will make clear that it's not just doctors who have been going above and beyond. Rather, workers throughout the hospital have been stretching, often under increasingly difficult circumstances, to provide excellent care with far fewer resources than are required. And like Ontario's doctors, they are failing; our hospitals are not as clean as they need to be in order to prevent the spread of hospital acquired infections, readmission rates are climbing and too many patients are forced to fend for themselves at home.
  • Ontario's doctors have nonetheless continued to push for the province to open more private surgery and procedures clinics, even as those clinics leach badly needed resources from our hospitals and undermine care in ways that have been well documented in jurisdictions like the United Kingdom.
  • Government-sponsored and doctor-supported programs that have aimed to increase the efficiency of the province's health-care system through, for example, jargon-laced policies like "continuous quality improvement" or the "health-based allocation model" have actually worked to undermine patient care. By ignoring the voices of front-line staff, many doctors and administrators have conspired to streamline and standardize care in ways that cut off key lines of communication and create a series of very predictable but nonetheless "unexpected consequences" that undermine patient care and frequently fail to generate the promised level of savings.
  • Nonetheless the OMA's recent efforts, like those of doctors throughout the province are both laudable and bang-on: there is a crisis in health care in Ontario, and the cuts that the Wynne government has imposed are having a serious and deleterious impact.
  • Those cuts, however, have hardly been focused on doctors' salaries, but have instead focused on other health-care workers and on hospitals. Ultimately, working conditions, wages and the quality of patient care have long been sacrificed at the altar of efficiency and austerity.
  • What the OMA should consider is the degree to which Ontario's doctors are now victim to the cold and careless logics of efficiency, standardization and privatization, which they both helped author and supported.
  • Until Ontario's doctors and the OMA find ways to bridge the divide that they have helped to open between themselves and other health-care workers, any improvement to their wages will not lead to long-term and sustainable improvements in our health system and the quality of care we provide patients together.
  • Michael Hurley is president of the Ontario Council of Hospital Unions (OCHU), the hospital division of the Canadian Union of Public Employees (CUPE) in Ontario. CUPE represents more than 75,000 health care staff provincewide.
  • Doctors are campaigning against a pay cut imposed by Kathleen Wynne's government, but Michael Hurley writes that they have supported efficiencies and standardizations in other parts of the health-care system.Sean Kilpatrick, Canadian Press file photo
Heather Farrow

B.C. continues to punish schools and hospitals with carbon fines - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|fjah|20160804|253080856

bc hospital environment

shared by Heather Farrow on 04 Aug 16 - No Cached
  • Alaska Highway News Thu Aug 4 2016
  • The B.C. government says it has achieved carbon neutrality in the public sector for the sixth consecutive year. But that neutrality continues to be accomplished by punishing schools, hospitals and other public institutions that are financially constrained from investing in energy efficiencies by fining them. Every year, as part of its carbon neutral government policy, the B.C. government forces Crown corporations, school and hospital districts and municipal government that fail to become carbon neutral to pay carbon offsets. It's a form of cap and trade that applies only to the public sector. In 2015, it collected $15.6 million in carbon fines from the public sector. It then uses some of the money it collects to buy carbon credits in the private sector to help businesses reduce their own carbon footprint by investing in energy efficiency, fuel switching and other projects that reduce greenhouse gas emissions.
  • In 2015, B.C.'s public sector produced 44,000 tonnes fewer greenhouse gas emissions than in 2010, according to the Ministry of Environment's annual Carbon Neutral Government report, released Thursday, July 28. That's the equivalent of taking 9,400 cars off the road. But when the data is "normalized for weather," the public sector actually generated more GHGs in 2015 and 2014 than it did in 2013, according to Hadi Dowlatabadi, a University of BC professor and research chairman for applied mathematics and integrated assessment of climate change. "They are claiming declines because they're doing emissions based on actual weather," he said. "When you do weather normalized, this is the second year in a row - 2014 and 2015 were both higher than 2013. It's their own data." Health authorities and school districts continue to get hammered under the carbon neutral policy, with the Fraser and Interior Health Authorities forced to pay close to $1 million each in carbon offsets in 2015.
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  • Health authorities overall in B.C. paid a little over $5 million in 2015 in carbon offsets. School districts paid $3.5 million. Hardest hit are districts like Surrey, where growing enrolment means more portables, which are not energy efficient. The Surrey school district was forced to pay $388,750 in carbon offsets in 2015. Vancouver school district paid $361,950. In 2015, the B.C. government bought $7.2 million worth of credits, the bulk of which went to forestry conservation projects, which are controversial. In 2015, an improved forestry management project for the north and central cost region of the Great Bear Rain Forest received $1 million. The Haida Gwaii area of the Great Bear Rain Forest received $3.1 million. The Cheakamus Community Forest in Whistler received $297,458. Dowlatabadi thinks investing in carbon sinks, like forestry conservation, is the least valuable investment, when it comes to getting actual, measurable carbon reductions. For one thing, the actual carbon reduction that results from simply letting trees grow is difficult to measure, and the investment can be wiped with a single forest fire or pest infestation.
  • Dowlatabadi would rather see any carbon credits the province collects go into funding energy efficiency projects that will help schools and hospitals actually achieve the carbon neutrality the policy is supposed to encourage. He thinks the amount the government is currently investing is far too little. "If you're the government, you can buy debt at 3% or less, and capitalize all your future offset debt," he said. "You've got $15 million a year, you could borrow $15 million at 3% for years into the future and invest all of that in improving the infrastructure in the province, rather than putting it into a forest that could go up in smoke tomorrow."
Irene Jansen

Factory Efficiency Comes to the Hospital - NYTimes.com - 0 views

www.nytimes.com/...11seattle.html

lean us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The system is just one example of how Seattle Children’s Hospital says it has improved patient care, and its bottom line, by using practices made famous by Toyota and others. The main goals of the approach, known as kaizen, are to reduce waste and to increase value for customers through continuous small improvements.
  • checklists, standardization and nonstop brainstorming with front-line staff
  • The program, called “continuous performance improvement,” or C.P.I., examines every aspect of patients’ stays at the hospital, from the time they arrive in the parking lot until they are discharged, to see what could work better for them and their families.
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  • Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million
  • the hospital avoided spending $180 million on capital projects by using its facilities more efficiently
  • It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.
  • Similar methods are now in place at other hospitals and health systems, including Beth Israel Deaconess Medical Center in Boston, Park Nicollet Health Services in Minneapolis and Virginia Mason Medical Center, also in Seattle.
  • To increase the number of surgeries the hospital could perform, Dr. Chand’s team spent about $20,000 overhauling the process to sterilize instruments, avoiding a $3.5 million expenditure to expand that department. More efficient scheduling in the M.R.I. department reduced the average waiting time for non-emergency M.R.I.’s from 25 days to 1 to 2.
  • Eugene Litvak, president and chief executive of the Institute for Healthcare Optimization and an adjunct professor of operations management at the Harvard School of Public Health.
  • “The health care industry could be on the verge of an efficiency revolution, because it is currently so far behind in applying operations management methodologies,” says Professor Litvak.
  • not everyone believes that factory-floor methods belong in a hospital ward.
  • Nellie Munn, a registered nurse at the Minneapolis campus of Children’s Hospitals and Clinics of Minnesota, thinks that many of the changes instituted by her hospital are inappropriate. She says that in an effort to reduce waste, consultants observed her and her colleagues and tried to determine the amount of time each of their tasks should take. But procedure times can’t always be standardized, she says. For example, some children need to be calmed before IV’s are inserted into their arms, or parents may need more information. “The essence of nursing,” she says, “is much more than a sum of the parts you can observe and write down on a wall full of sticky notes.”
Irene Jansen

Factory Efficiency Comes to the Hospital - NYTimes.com - 0 views

www.nytimes.com/...11seattle.html

us lean tqm waits hospitals

shared by Irene Jansen on 07 Feb 12 - Cached
    • Irene Jansen
      Irene Jansen on 07 Feb 12
       
      sounds similar to what was done in a Vancouver hospital to improve efficiency of surgeries, cited in a CCPA report on public solutions to reduce waits
  • Using C.P.I., the hospital has reduced the waiting time for many surgeries from three months to less than one.
  • Lack of space in the recovery room was another logjam, and the hospital planned a $500,000 renovation to enlarge it. But a C.P.I. team saw that if a child’s parents went to a common waiting room during surgery, instead of an individual recovery room, more surgeries could be scheduled. Parents were given beepers to alert them when their child would arrive in the recovery room — and maps and colored lines on the walls helped point the way. Plans for the expensive renovation have been scrapped.
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  • Medical buildings often have standard benchmarks — basing the number of examination rooms, for example, on the expected volume of patients. Ms. Brandenberg and her team instead used C.P.I. to map out common paths that patients, staff members, supplies and information would flow through. They worked in an empty office building, using cardboard mock-ups of surgical sites, recovery rooms, anesthesia areas and waiting rooms. Fifty staff members then play-acted various scenarios to test the design’s effectiveness. The final design reduces walking distances and waiting times for patients by grouping related facilities together and creating rooms that can be used for more than one purpose. The hospital was able to shave 30,000 square feet and $20 million off of the new building
  • Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million, Mr. Hagan says. And as patient demand has grown in the last six years, he estimates that the hospital avoided spending $180 million on capital projects by using its facilities more efficiently. It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.
  • checklists, standardization and nonstop brainstorming with front-line staff
  • The program, called “continuous performance improvement,” or C.P.I., examines every aspect of patients’ stays at the hospital
  • The system is just one example of how Seattle Children’s Hospital says it has improved patient care, and its bottom line, by using practices made famous by Toyota and others. The main goals of the approach, known as kaizen, are to reduce waste and to increase value for customers through continuous small improvements.
  • “The health care industry could be on the verge of an efficiency revolution, because it is currently so far behind in applying operations management methodologies,” says Professor Litvak.
  • All medical centers, especially larger ones, would have significant return on investment by using operations management techniques like C.P.I., says Eugene Litvak, president and chief executive of the Institute for Healthcare Optimization and an adjunct professor of operations management at the Harvard School of Public Health.
  • Similar methods are now in place at other hospitals and health systems, including Beth Israel Deaconess Medical Center in Boston, Park Nicollet Health Services in Minneapolis and Virginia Mason Medical Center, also in Seattle.
  • TO be sure, not everyone believes that factory-floor methods belong in a hospital ward. Nellie Munn, a registered nurse at the Minneapolis campus of Children’s Hospitals and Clinics of Minnesota, thinks that many of the changes instituted by her hospital are inappropriate. She says that in an effort to reduce waste, consultants observed her and her colleagues and tried to determine the amount of time each of their tasks should take. But procedure times can’t always be standardized, she says. For example, some children need to be calmed before IV’s are inserted into their arms, or parents may need more information. “The essence of nursing,” she says, “is much more than a sum of the parts you can observe and write down on a wall full of sticky notes.”
  • one-day strike by the Minnesota Nurses Association against six local health care corporations, including her employer, partly in protest of lower staffing levels her union thinks have resulted from hospitals’ “lean” methods
  • the Lean Enterprise Institute
  • George Labovitz, a management professor at Boston University, says there are limits to performance-improvement methods in hospitals. “Human health is much more variable and complex than making a car,” he said, “so even if you do everything ‘right,’ you can still have a bad outcome.”
  • Joan Wellman & Associates, a process improvement consulting firm in Seattle
  • examine the “flow” of medicines, patients and information in the same way that plant managers study the flow of parts through a factory
  • In a typical workshop at Seattle Children’s, a group of doctors, nurses, administrators and representatives of patients’ families set aside a 40-hour week to work through C.P.I. methods. They plot each “event” a patient might encounter — like filling out forms, interacting with certain staff members, having to walk various distances or having to wait for assistance — and brainstorm about how each could be improved, or even eliminated.
  • it never ends
  • Standardization is also a C.P.I. cornerstone. Last year, 10 surgeons at Seattle Children’s performed appendectomies, and each doctor wanted the instrument cart set up differently. The surgeons and other medical staff members used C.P.I. to come up with a cart they all could use, reducing instrument preparation errors as well as inventory costs.
Govind Rao

U.S. ranks near bottom in efficiency of health care spending | ScienceBlog.com - 0 views

scienceblog.com/...ciency-of-health-care-spending

from heather case study funding US-Canada

shared by Govind Rao on 18 Dec 13 - No Cached
  • A new study by researchers at the UCLA Fielding School of Public Health and McGill University in Montreal reveals that the United States health care system ranks 22nd out of 27 high-income nations when analyzed for its efficiency of turning dollars spent into extending lives. The study, which appears online Dec. 12 in the “First Look” section of the American Journal of Public Health, illuminates stark differences in countries’ efficiency of spending on health care, and the U.S.’s inferior ranking reflects a high price paid and a low return on investment.
  • December 16, 2013
Govind Rao

The end of efficiency - will appropriate care become the new system of rationing hospit... - 0 views

diablogue.org/...of-rationing-hospital-services

from heather union hospital Ontario cuts

shared by Govind Rao on 11 Jun 14 - No Cached
  • Posted on June 10, 2014
  • The relentless pursuit of efficiency may be coming to an end for Ontario hospitals. Thank goodness.
Govind Rao

Expand private sector role in health care system - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|mott|20150704|224145999

from heather NB privatization cleaning hospital

shared by Govind Rao on 06 Jul 15 - No Cached
  • Times & Transcript (Moncton) Sat Jul 4 2015
  • New Brunswick Health Minister Victor Boudreau has announced the provincial government will seek a deal with a private firm this fall to take over management of cleaning services as well as food preparation and delivery to all New Brunswick hospitals.
  • To that we would normally say 'good news and high time,' but the story doesn't appear to be simple as that. In conjunction with the minister's announcement a departmental spokesperson says government is "only outsourcing the management of the services . . . CUPE (Canadian Union of Public Employees) staff will remain in their union and will continue to be employees of the province of New Brunswick." The minister also said the move to hire a private company to manage these services will save the province millions of dollars through 'efficiencies' it will bring in.
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  • But if union workers are still on the job, it seems highly likely to us that all union rights previously achieved by way of collective bargaining with the actual employer - you taxpayers by way of government - are still in play. CUPE representative Norma Robinson has already voiced concerns. She says the department has already told the union that it is taking bids from three big private-sector providers - Sodexo, Aramark and Compass Group - toward signing a 10-year contract in three or four months. She is certainly within her rights to ask what impact that contract will have on the contract public sector workers have with government.
  • Perhaps the minister prefers to wait until the contract is signed before saying more, but it seems to us that whatever efficiencies the successful bidder intends to achieve will depend a lot on how it and the union co-operate within the strictures of collective agreements. It is one thing to centralize a kitchen service, for example, and another to respect any pertinent contractual language, such as 'manning' and seniority. Ms. Robinson already sees this move as the first step toward privatization of health care. While Ms. Robinson has said nothing further in that regard, some might interpret that statement as a harbinger of labour unrest for the health department over the course of that private 'management contract.'
  • Having said that, we are optimistic that some efficiencies will be achieved immediately if all management functions are removed from the collective agreements; it is logical to expect as much given the bidding process should get taxpayers to the lowest price possible for those specific functions. And while we sympathize with union concerns, we endorse privatization of health care; the more the better.
  • Not long ago union voices were predicting dire consequences when laundry services were centralized for the sake of efficiency. They didn't happen. Should anyone voice similar concerns about a private-sector management contract about, for example, the quality of hospital food, many a patient might chuckle. This government is trying to reduce massive debt and stop deficit spending. Thus it is welcome news to also hear Horizon Health Network CEO John McGarry suggest private health-care firms could move such professions as physiotherapy, audiology and dietetics out of the province's hospitals, which he also notes are too numerous.
Irene Jansen

Health spending hits record (Saskatchewan) - 0 views

www.leaderpost.com/...story.html

Saskatchewan budget

shared by Irene Jansen on 21 Mar 13 - No Cached
  • the province's health regions and the cancer agency must find $54 million in efficiencies.
  • RHAs received a 4.5-per-cent increase over last year's funding but must find 1.5 per cent in efficiencies.
  • Keith Dewar, CEO of the RQHR, would have welcomed more funding, but said: "If you go across the country, this is a relatively good budget from a health system perspective."
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  • all health regions are using Lean principles to find efficiencies and cost savings in the system, but acknowledged it will be a challenging year for the Regina Qu'Appelle Health Region (RQHR), which currently has a $23.5-million deficit.
  • introduction of Collaborative Emergency Centres (CECs) in rural communities
Govind Rao

Light years ahead: Digital hospital opens doors; Humber River set to open, with robots ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|tost|20151016|231507893

from heather hospital Ontario it technology

shared by Govind Rao on 16 Oct 15 - No Cached
  • Toronto Star Fri Oct 16 2015
  • It's hard to be envious of anyone stuck in a hospital bed, but the new Humber River Hospital draws more comparisons to a swanky hotel than a gloomy facility reeking of antiseptic and teeming with nerves. Step through the doors of the state-of-the-art hospital and you'll find robots that mix drugs and transport goods, bedside touchscreens that allow patients to video-chat with doctors, and machines that process blood samples in minutes, automatically entering results into electronic records. All of that catapults the facility, set to open Saturday at Keele St. and Hwy. 401, light years ahead of its former digs, which were desperate for an upgrade.
  • "Patients could hold hands in the beds, it was so tiny ... It was time to replace the old buildings," said chief operating officer Barb Collins as she wandered the halls of the cutting-edge facility, being heralded as North America's first fully digital hospital. That title hasn't been fully researched, but no one has called yet to disprove the claim. So Collins is content to keep trumpeting the hospital's innovative features, which include robotic equipment that can position and scan patients at any angle, digital patient records accessible from patient rooms and, for people who are under walking restrictions, wristbands that alert staff when they start to wander.
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  • The measures make age-old tasks more efficient. They might also dredge up worries about a patient's every move being tracked and whether it's entirely safe to have machines mix and process toxic drugs. To the skeptics, Collins responds: "It's safer to have an alarm telling me if (a patient) got out of bed and fell, than not knowing," and "Robots are robots, but they still need monitoring."
  • That's why employees will be on hand to double-check robot-filled prescriptions and to ensure equipment is working correctly, while still delivering a human touch. If you're fretting about how many employees were cut loose to make way for technology, the hospital has an answer for that, too. Rather than using technological efficiencies to axe jobs, the hospital has hired 700 more employees to staff the hospital's 656 rooms - 80 per cent of which are single-patient spaces.
  • Unlike the old Humber River Hospital, the private rooms allow the hospital to nix restricted visiting hours and to place chairs that convert into beds in every room for use by family members - who "are encouraged to stay over." For out-of-town family or those who face extenuating circumstances, there is even an "amenity" suite on each floor, with a bed and bathroom for overnight stays.
  • Implementing the policy and building the hospital into a futuristic facility "hasn't been all smooth," says Collins. There were tussles about getting electronic features to "speak to each other" and naysayers to prove wrong, including a former deputy health minister, whom Collins refused to name, who insisted renovations could be made to the old hospital instead of building a new one. That deputy minister has since had a change of heart, claims Collins, but it's hardly a surprise to her. After 15 years planning the new facility, she says without hesitation: "This could well be a model."
  • Bedside terminals act as a computer, phone, record display, menu and radio. Built-in cameras let patients communicate with family members or nurses.
Heather Farrow

Health care shouldn't be about efficiency | Windsor News - Breaking News & Latest Headl... - 0 views

windsorstar.com/...e-shouldnt-be-about-efficiency

medicare cuts coalition hospital Ontario

shared by Heather Farrow on 31 May 16 - No Cached
  • May 28, 2016 7:0
  • In these precarious times of publicly funded health care, the powers that be have made decisions based mostly in fear and scarcity. Our universal health care system has been reduced to a business model with efficiency as its platform. It is not surprising then that today our health care is lacking and Canadians are anxious. Albert Einstein once said, “No problem can be solved by the same consciousness that caused it”.
  • I try to practice abundance and the belief there is always enough for need (never for greed). It has served me well both professionally and personally. The benefits of a health care system equally provided for all is incalculable.  This is the time to hold our principles to the fire and not abandon them in fear of something as banal as money.  Be both humble and courageous and start by advocating for all Canadians in a ground roots province wide referendum led by the Ontario Health Coalition today, Saturday May 28. COLLEEN ADAMS, Windsor
Heather Farrow

Doctors go 'Lean' to cut wait times, improve health-care efficiency | Ottawa & R - 0 views

www.ottawasun.com/...improve-health-care-efficiency

Ontario lean doctors

shared by Heather Farrow on 12 May 16 - No Cached
  • May 11, 2016
  • Family doctors in Eastern Ontario are learning the business lessons of banks and carmakers as a way to make their practices more efficient.
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
  • ...1 more annotation...
  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Irene Jansen

Private health care energizes forum. Tory leadership candidates show sharp divide. Edmo... - 0 views

www.edmontonjournal.com/...story.html

election privatization alberta

shared by Irene Jansen on 23 Jan 12 - No Cached
  • "There will be no private pay for private health care," Morton said. "We would have to find more efficient ways to deliver publicly paid health care." One possibility includes contracting out publicly paid services to private clinics, he said.
  • Klein-era health minister Gary Mar highlighted his support for publicly funded health care and downplayed his earlier support for developing privately paid health-care options in the province.
  • Doug Griffiths said Albertans already buy health care outside the province, and he won't rule out privatization in Alberta.
  • ...2 more annotations...
  • Rick Orman did not take a stand on privatization, but focused instead on efficiency. "It's taxpayers' dollars. We must respect it. We must spend it more efficiently," Orman said. He has previously said he was not willing to rule out privatization.
  • money the province believes it is owed in health transfers.
Irene Jansen

Public's appetite for efficient health care only goes so far - The Globe and Mail - 0 views

www.theglobeandmail.com/...article2280082

shared services restructuring hospitals ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • By the account of a new Environics poll, a majority of Canadians now believe inefficiency, rather than underfunding, is the biggest threat to health care. Perhaps all those dire warnings from politicians and think-tanks and media outlets about costs growing unsustainably are starting to penetrate.
  • Among the most inescapably necessary reforms is hospital restructuring. In Ontario, governments dating back to Bob Rae’s New Democrats have recognized that it’s no longer practical for hospitals, particularly in rural areas, to function as one-stop shops. Much more cost-efficient, and often better for patient outcomes, is to centralize difficult and expensive procedures in fewer places.
  • for policy-makers, a certain cold-bloodedness is required
  • ...2 more annotations...
  • The hard truth about health policy, acknowledged by anyone who works in the field, is that it’s largely about rationing care.
  • To spend on a rare procedure that could save a single life, for instance, might mean quietly not spending on something else that could spare a dozen.
Irene Jansen

ADF: Hospital Bed Occupancy - 0 views

www.adf.com.au/archive.php

occupancy hospitals

shared by Irene Jansen on 21 Feb 12 - No Cached
  • The Australian Medical Association and the Australasian College of Emergency Medicine have acknowledged that bed occupancy rates above 85% negatively impact on the safe and efficient operation of a hospital. In its Position Statement on "Acute Hospital Bed Capacity" (March 2005), the Irish Medical Organisation has also acknowledged an average bed occupancy of 85% as an "internationally recognised measure" that should not be exceeded.
  • In 2005 the average hospital bed occupancy in the 30 OECD countries was 75%.
  • the risk of cross-infection between inpatients in crowded wards and timely admission to an appropriate ward of patients presenting to emergency departments (ED) or for booked surgery
  • ...12 more annotations...
  • the Department of Health in the United Kingdom (UK)1 has found that bed occupancy rates exceeding 85% in acute hospitals are associated with problems dealing with both emergency and elective admissions. That county has instituted a target bed occupancy of 82% as one of its hospitals' quality measures.
  • Borg3 also found a significant correlation between bed occupancy and MRSA infection rates.
  • The association between nosocomal infection and bed occupancy rate was also highlighted in another UK Department of Health report5 . That report revealed that hospitals with occupancy rates of more than 90% had a 10.3% greater incidence of MRSA infection than those with occupancies below 85%. Furthermore, the UK House of Commons Committee of Public Accounts has "repeatedly noted that high levels of bed occupancy are not consistent with good control of infections" 6 .
  • This model suggests that there is a discernable risk of a hospital failing to provide sufficient beds, and thereby safe efficient care, when average bed occupancies exceed 85%.
  • considering the nature of hospital system, "spare (bed) capacity is essential if an emergency admissions service is to operate efficiently and at a level of risk acceptable to patients".
  • Orendi6 has recently compared the circumstances in the UK with those in the Netherlands where the average hospital bed occupancy rate was 64%, as opposed to 84% in the UK (2005), with the same number of beds per head of population.
  • The lesser pressure on hospital beds may in part have been the result of the special level of care provided to nursing home patients
  • Canadian data also show that hospital bed availability has a significant influence on ED length of stay for admitted patients10 (access block) and thus a delay in patients reaching an appropriate inpatient bed. This was most marked when "hospital occupancy exceeded a threshold of 90%", as also found by Sprivulis et al11.
  • analysis of emergency presentations to an Australian hospital has shown that access block may increase a patient's overall hospital length of stay12
  • increased in-hospital mortality11,13
  • increase in the mortality of patients presenting to EDs in Western Australia11 independent age, season, diagnosis or urgency.
  • there appears to be sufficient evidence to support the contention that bed occupancy rates provide a useful measure of a hospital's ability to provide high quality patient care and that 85% is a reasonable target.
Irene Jansen

Hospital Bed Occupancy | BMJ - 0 views

www.bmj.com/...hospital-bed-occupancy

occupancy hospitals safety

shared by Irene Jansen on 21 Feb 12 - No Cached
  • Anthony P Morton, medical statistics/hospital safety Princess Alexandra Hospital Woolloongabba 4102 Australia
  • it is probable that the cost of lowering higher bed occupancy levels would be repaid substantially in reduced adverse event rates (the cost of treating potentially preventable adverse events is substantial)
  • "overcrowding" may be more important with new VRE isolates and this may make sense because this organism is capable of prolonged survival on environmental surfaces
  • ...8 more annotations...
  • There has been considerable recent interest in bed occupancy in Australia4
  • 80% to 85% is widely, if anecdotally, quoted although the 85% level apparently arises from earlier work on queues.4
  • There is a great deal of evidence linking "overcrowding" and adverse events
  • We need to know the true cost of re-work in public hospitals that have become highly "efficient" and this should include costs to patients (who may require extended convalescence on welfare) and society as well as to the hospitals.
  • it seems unrealistic, at least in the foreseeable future, to be able to run a complex computer program in a busy public hospital at intervals to determine optimum bed occupancy
  • cutting bed numbers to promote "efficiency" may have unintended and perhaps unforeseen consequences
  • Now Complexity and Network Science tell us that sustainability and resilience are most important, that some redundancy is essential for resilience, and that as we become increasingly efficient we simultaneously become increasingly vulnerable to failures.
  • lowering average bed occupancy in busy public hospitals to an average of, say, 85% may still be feasible and very worthwhile.
Govind Rao

Government of Canada Funds Research on Teams to Strengthen Healthcare - Press Release -... - 0 views

www.digitaljournal.com/1746160

shared by Govind Rao on 19 Feb 14 - No Cached
  • Government of Canada Funds Research on Teams to Strengthen Healthcare HAMILTON, ONTARIO--(Marketwired - Feb. 19, 2014) - Health Canada Today, Parliamentary Secretary Eve Adams on behalf of the Honourable Rona Ambrose, Minister of Health, announced $6.5 million in funding to McMaster University for a project to study the use of team-based care as a way to achieve better health outcomes for patients and make the system more cost effective.
  • The project: "Teams Advancing Patient Experience: Strengthening Quality," (TAPESTRY), will examine how changing the way a primary healthcare team operates and interacts with its patients can improve the quality and efficiency of primary healthcare services. By integrating resources such as community volunteers, eHealth technologies and system navigation, the project will support patient-centred care and stronger connections to community services. The TAPESTRY project is expected to provide valuable information regarding ways to increase access to primary healthcare services. The initiative aims to generate evidence and develop tools to assist provincial and territorial governments in addressing ongoing primary healthcare challenges.
  • Quick Facts The Government of Canada is one of the largest investors in healthcare research with more than $1 billion invested annually. The Government of Canada has increased health transfers to the provinces and territories to unprecedented levels. This funding will continue to grow, reaching $40 billion by the end of the decade. The need for innovation, both in terms of medical technologies and healthcare delivery systems, is a significant public policy challenge that the Government of Canada is committed to addressing.
  • ...1 more annotation...
  • Quotes "Innovation is critical to improving the efficiency of the healthcare system but also to helping Canadians maintain good health. This project is looking at innovative ways that health professionals can work together to provide care to Canadians." Eve Adams, Parliamentary Secretary to the Minister of Health "We're finding ways to combine the personal touch of community volunteerism and the latest technologies to improve primary health care. The TAPESTRY project will connect citizens with their health care team to encourage early identification of potential health problems. This is important for Canadians and for the efficiency of our health care system." Dr. David Price, Professor and Chair, Department of Family Medicine, McMaster University
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