CUPE Health Care

Her innovative approach, currently focused on creating a centre for aboriginal infant, child and family health based at St. Michael’s Hospital

Part of the remedy is creating health services that take into account local knowledge and traditions and the needs of the specific population

Health Canada said of the 33 manufacturers with active licences, 12 have conducted recalls related to hip replacements in the past five years.

Regulators such as Health Canada and the U.S. Food and Drug Administration require fairly rudimentary, small studies on devices over a short period of time without a control group

like to see a mandatory system to track implant failures and to contact patients

This growth could be significantly reduced to 2.3 per cent if a sizable investment (e.g., 0.4 per cent of GDP or $5 billion) is made in home care now.

We need to change the philosophy of home care: It should become a right and not a privilege as it is now.

a public long-term care insurance plan should be created

to cover the necessary services from public (“in kind”), private, social economy or voluntary organizations

We should not opt for “cash-for-care” allowances as in some European countries since this type of benefit has undesirable effects: the creation of a “grey market” with untrained and underpaid workers, risk of financial abuse, poor quality services, and keeping women in traditional roles.

To finance this universal publicly funded insurance plan, a specific fund should be created to which the current budget for long-term care would be transferred to ensure a clear separation of this money from the rest of the health care funding.

It is time for a Continuing Care Act in Canada that would prioritize integrated care and home care, and include the creation of a public long-term care insurance plan

Réjean Hébert is a geriatrician and professor at the Research Centre on Aging of the Université de Sherbrooke.

But do we ever step back and ask if we really need to do all the tests we are doing? Does all the work have to be done by a highly paid pathologist or can we hive off some routine tasks to pathology assistants? Does every hospital need a lab that does a full range of tests, or should they centralize and specialize?

Why do we have tougher rules for forklift operators than physicians?

In Canada, we don’t have a culture that says quality and patient safety are paramount.

David Hume, the 18th-century Scottish philosopher. Hume realized that, although people talk about causes as if they are real facts—tangible things that can be discovered—they’re actually not at all factual. Instead, Hume said, every cause is just a slippery story, a catchy conjecture, a “lively conception produced by habit.” When an apple falls from a tree, the cause is obvious: gravity. Hume’s skeptical insight was that we don’t see gravity—we see only an object tugged toward the earth. We look at X and then at Y, and invent a story about what happened in between. We can measure facts, but a cause is not a fact—it’s a fiction that helps us make sense of facts.

our stories about causation are shadowed by all sorts of mental shortcuts

when it comes to reasoning about complex systems—say, the human body—these shortcuts go from being slickly efficient to outright misleading

causal explanations are oversimplifications

the power of statistical correlation, which has allowed researchers to pirouette around the problem of causation

statistical significance, invented by English mathematician Ronald Fisher in the 1920s. This test defines a “significant” result as any data point that would be produced by chance less than 5 percent of the time. While a significant result is no guarantee of truth, it’s widely seen as an important indicator of good data, a clue that the correlation is not a coincidence

require that we understand every interaction before we can reliably understand any of them

we often shrug off this dizzying intricacy, searching instead for the simplest of correlations. It’s the cognitive equivalent of bringing a knife to a gunfight.

Although the scientific process tries to makes sense of problems by isolating every variable—imagining a blood vessel, say, if HDL alone were raised—reality doesn’t work like that. Instead, we live in a world in which everything is knotted together, an impregnable tangle of causes and effects

the R&D to discover a promising new compound now costs about 100 times more (in inflation-adjusted dollars) than it did in 1950. (It also takes nearly three times as long.)

it’s not just MRIs that appear to be counterproductive

an in-depth review of biomarkers in the scientific literature

83 percent of supposed correlations became significantly weaker in subsequent studies

we’ve constructed our $2.5 trillion health care system around the belief that we can find the underlying causes of illness, the invisible triggers of pain and disease

If only we knew more and could see further, the causes of our problems would reveal themselves. But what if they don’t?

We keep trying to fix the back, but perhaps the back isn’t what needs fixing.

more than 40 percent of them were later shown to be either totally wrong or significantly incorrect

two leading drug firms, AstraZeneca and GlaxoSmithKline, announced that they were scaling back research into the brain. The organ is simply too complicated, too full of networks we don’t comprehend.

85 percent of new prescription drugs approved by European regulators provide little to no new benefit

According to the Centers for Disease Control and Prevention, things like clean water and improved sanitation—and not necessarily advances in medical technology—accounted for at least 25 of the more than 30 years added to the lifespan of Americans during the 20th century

the things we can see will always be bracketed by what we cannot

Labour’s shadow health secretary Andy Burnham said the move was the clearest sign yet of the government’s determination “to turn our precious NHS into a US style commercial system, where hospitals are more interested in profits than people.”

“This free market NHS re-organisation opens the door to an explosion of private work in the NHS, meaning longer waits for NHS patients,” he said.

Until quite recently, you could say that pharmaceutical drugs were far more regulated than medical devices.  That's changing, albeit slowly.  Last June, the Auditor General issued a report on the job Health Canada is doing regulating medical devices.  Among the main conclusions:  more than 45 percent of the time Health Canada does not meet its service standards for timely review of medical device submissions

As well, Health Canada has not established what levels of activity are needed to protect the health and safety of Canadians. 

look at a product or service from a customer's perspective and identify waste, or aspects a customer wouldn't pay for by choice

"The old way of cost-cutting was absolutely wrong-headed," he said. "I realized for the first time why we were so mistaken in the '80s and '90s when we were cutting budgets and ending up with poor service at the end of the day."

high-level executives will run their proposed priorities before teams of lower-level managers and front-line workers, then consider their feedback before proceeding

Phase 2 will take several years and involves building up local expertise and getting more than 43,000 workers in the province's health regions, the Saskatchewan Cancer Agency, the Health Quality Council and the Health Ministry thinking like a synchronized lean machine: Identify waste, test a possible fix, evaluate the outcome and repeat.

one contract for about six months of lean leadership to do the first phase of planning - hoshin kanri - and a longer-term contract to help roll out the lean system

the first contract was awarded in October to American consultants John Black and Associates, and SAHO plans to award the second longer-term contract in January

how much taxpayers are spending on these senseis is not being made public

The most important aspect, Broten said, is that the perspectives and knowledge of front-line workers carry weight in any changes.

The Children's Hospital of Saskatchewan is the first capital project in the province where the lean approach is influencing design.