Quality of Health Care

I saw the story about former Deputy Health Minister Penny Ballem speaking publicly about some of her experiences and views for the first time since her resignation, on Sean Holman's website, Public Eye Online. The following day the Vancouver Sun ran with the story as did CBC. It is not unusual for Holman to break a story, but it is unusual for him to get credit.

Longwoods Publishing, a publisher of academic, scientific and professional journals, regularly produces educational events for leaders in health care. Ballem spoke at one of Longwoods' "Breakfast with the Chiefs". Her 64 minute presentation is available as a Google Video on the Internet. Those who don't have time to view the full presentation might want to speed forward and catch the last 15 minutes when Ballem spoke frankly about quality in health care. That's when she said: "Giving more money to physicians doesn't help in terms of productivity." During a short question and answer period 58 minutes into the presentation she said that only 20% of patients get the correct drugs post MI (Myocardial Infarction) and that the MACs (Medical Advisory Committees) need to be told: "You're killing people."

Ballem made a minor swipe at the Campbell government when she criticized it for making policy shortly after a "bad hair day in question period". It appears that the major difference between the Premier's Office and Ballem was over the issue of dealing with physicians and how to hold them accountable for quality of care. Most of Ballem's presentation could have come directly from Gordon Campbell as he broke his arm patting himself on the back at his annual fundraiser. She said that breaking union contracts was painful but necessary, and she spoke about improving decision making by reducing the number of decision making bodies so that people with broad spans of authority could be put in one room to make necessary changes. Even those who disagree with Ballem should pay careful attention to her argument that the easy gains have been wrung out of the system and further progress depends on involving the doctors in a way that deals with productivity and quality. Ironically, she spoke about how it is essential to build relations in order to do that but at the same time used the kind of plain talk that prompted refutation from Dr. Bill Cavers, chairman of the BCMA's General Practitioner Services Committee.

The "Conversation on Health" often looks like a thinly veiled effort by the Campbell government to convince British Columbians that we can't afford health care. Clicking on the Conversation's website reveals a clock that ticks off how much has been spent since the viewer clicked; a Hospital Employees' Union site counts how many US residents have gone bankrupt because of health costs since the viewer clicked onto its site. In her CBC Early Edition interview, Ballam echoed the words of Ted Hughes when he spoke about Campbell's cuts to child protection by saying that the evidence doesn't support the Premier's position. Many others have made the same point since Finance Minister Carole Taylor made the ridiculous claim that health would absorb 71% of the provincial budget by 2017.

If the Conversation on Health is going to be useful, it has to shift from the phony agenda set by Campbell to the issues identified by Dr. Ballem. How can more doctors be made part of the system rather than being put at odds with the system? How can they be made part of the solution so that they enthusiastically support improvements to productivity and quality of care? Allowing queue jumping for the highest bidders, whether they are the WCB, ICBC or private paying patients, isn't going to fix the problem that only 20% of MI patients receive the correct medications on discharge from hospital, or numerous other quality and productivity issues. Dealing with those issues means looking in the mirror and admitting that mistakes are being made, and then involving those who are making the mistakes in fixing them.