By Annamarie A. Fuchs, Creator. Partners in Health | Conversations
June 22, 2023
If all you have is a hammer, everything looks like a nail.
Abraham Maslow
Most people believe that the more data we collect, the more insight leaders will have about the health system. Sadly, this is often not the case. Data has enormous power but on its own it will not enable us to design the system transformation that is needed. We have massive infrastructures in healthcare at every level devoted to nothing but data collection, analysis, and reporting. And we rely on that data to tell us if we’re on the right track. So, data in healthcare has value, correct? It can. But if we don’t have the right health information sharing mechanisms in place and if we rely on the inappropriate use of and investment in data, it can also have considerable disadvantages in our effort to accomplish what matters – to improve quality outcomes.
Background
In 2016 Dr Don Berwick from the Institute of Healthcare Improvement wrote an opinion piece for the American Medical Association Journal. In that article entitled “Era 3 for Medicine and Health Care”[1] he offered a brief history of the health system distinguished by three distinct ‘eras’ that provided context to the rapidly declining morale among physicians and other healthcare professionals.’
Era 1 saw the rise of the profession as noble, unapproachable, fully self regulated, and never challenged. Idealism was the core value of health professionals. In Era 2, Berwick proposed that in order to manage rapidly rising variations in practice, address social injustices, and deal with soaring costs, the focus shifted almost entirely to data collection and measurement for the purposes of accountability, scrutiny, and transparency. Over time, physicians became angry as inconsistent and inappropriate measures forced misinterpretation and attempts to control their work which was in “pursuit of the social goals of fundamentally better care, better health, and lower costs.” Excessive measurement was the result and much of that measurement is, to this day, useless, irresponsible, and contradictory to the values and priorities that the medical profession holds dear.
Berwick proposed that it was time for a new era he named ‘Era 3’ or the “moral era” where the highest priority should be to “first reduce mandatory measurement … and to measure only what matters, and mainly for learning.”[2] He went on to recommend that decision makers in the U.S. should commit to reducing (by 50% in three years and by 75% in 6 years) the volume and total cost of measurement currently being forced on the health care system. He believed that by creating datasets informed by clinicians while listening to the voices of the people they serve, decision makers would finally be in a position to enable improvements in quality outcomes while saving vast amounts of time and cost associated with reports that have little to no usefulness to a fractured system in chaos.
Fast forward to 2023.
In 2023, the healthcare world, held its collective breath as we began to ease out of the COVID-19 pandemic. Sadly, it was evident that COVID-19 had merely exposed what we already knew was happening – the system is broken. COVID-19 had simply exacerbated the issues that were already there. Just open any news feed on any given day and you will find articles from communities across Canada where emergency departments close for days at a time due to staff shortages. Surgical wait lists that were unacceptable before COVID-19 are now forcing health authorities to launch urgent solutions to treat as many people as possible in as short a time as possible. And if you speak to people who have been attempting to access the system lately, you’ll likely find shocking stories of delays, exacerbations of illness, and even deaths. A single example reported by the Guardian in January of this year offered the story of Nova Scotia’s Allison Holthoff whose death was yet another a tragic example of what is happening in “Canada’s already overburdened health system.”[3] This should not be happening in the 21st century!
Canada’s New Funding Announcements
On February 7, 2023, the Prime Minister’s office released “Working together to improve health care for Canadians”[4] where discussions of shared priorities between the federal and provincial / territorial governments resulted in an increase in total health funding by $196.1 billion over 10 years including $46.2 billion in new funding.”[5] The paper goes on to specify details associated with the funding such as the transfer of $2 billion as an immediate top up along with funds to be released over 5 years and 10 years that are expected to enable the provinces and territories to advance their shared priorities in four specific areas as follows:
- Family health services
- Health workers and backlogs
- Mental health and substance use, and
- A modernized health system
Alongside these funding announcements which were, for the most part, welcome and badly needed, provincial and territorial governments were also required to commit to improving how health information is collected, shared, and used. Governments were also asked to develop action plans that would articulate in detail how the funds would be spent and how progress would be measured.
Let me be clear. Data and health information sharing is crucial and stewardship over the use of funds is what all Canadians should expect from our elected leaders. But to demand action plans and yet more examination of ways to share data when experts such as Dr. Vivek Goel, Dr. Ewan Affleck[6] and others have already done the work is irresponsible. (See the link in footnote #6 to the pan-Canadian Health Data Strategy documents.) The right data used for the right purposes and made readily available at the right time that is designed and informed by clinicians alongside the voices of the people they serve is essential if we want to see the change that is critically needed in the health system.
What do we need?
- We need to stop collecting data for data’s sake.
- We need to collect less data and focus on data collection for learning and improvement.
- We need to stop developing new strategies for health information sharing and simply invest in what we already know needs to be done.
- We need to demand that federal and provincial elected officials stop requiring adherence to data that is inconsistent and inappropriate to meet the needs of the population.
- We need to recognize and eliminate the widespread duplication in data collection and analysis that costs money and constrains innovation and usefulness while failing to allow for improved patient outcomes and provider satisfaction.
Concluding thoughts.
The World Health Organization acknowledges “health as a human right that recognizes a legal obligation on states to ensure access to timely, acceptable, and affordable healthcare where a state’s obligation to support the right to health … is reviewed through various international human rights mechanisms.”[7]
When healthcare finally becomes nothing less than a human right that MUST be preserved and strengthened by all governments irrespective of election cycles, we may finally see the right data being collected for the right purposes for populations that will, over time, become healthier because the system has been transformed to allow us to gain access to the right care in the right place when we need it.
[1] Berwick, D. Era 3 for Medicine and Health Care. Journal of the American Medical Association. April 5, 2016, Volume 315, Number 13. http://jama.jamanetwork.com/
[2] Ibid
[3] Cecco, Leyland. Emergency room death highlights Canadian healthcare crisis. January 11, 2023. https://www.theguardian.com/world/2023/jan/11/canada-healthcare-crisis-emergency-room-death
[4] https://www.pm.gc.ca/en/news/news-releases/2023/02/07/working-together-improve-health-care-canadians
[5] Ibid
[6] https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-members.html
[7] https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health
