Fix health-care backlogs, save money and ease health-worker burnout? There is a way.
OTTAWA — COVID-19 has thrown Canada’s already struggling health-care system into chaos, forcing impossible choices when it comes to how to rebuild once the pandemic has ebbed.
Hospitals were forced to cancel elective surgeries during pandemic peaks, making already protracted lists now so long physicians are concerned patients will die while they wait.
Meanwhile nurses are burnt out from the last year and a half of operating in a pandemic to the point that they’re exiting the industry in droves, leaving hospitals and health systems with the distasteful choice to either plow through surgeries or shore up nursing staff.
Almost 560,000 fewer surgeries were performed over the first 16 months of the pandemic compared to 2019, according to the latest figures from the Canadian Institute for Health Information. And the cost of addressing those backlogs is expected to run into the billions.
But a Harvard professor from the former Soviet Union with an affinity for Canada claims he has the solution, and it’s already working in some Ontario hospitals.
In extremely oversimplified terms: make surgeons work weekends.
“It means that you reduce the waiting time for surgery in Canada,” said Eugene Litvak, president of the non-profit Institute for Health Care Optimization in Massachusetts.
“It means that more patients will get treated.”
It all comes down to how hospitals admit patients, he said.
Litvak said a graph tracking patient flows would resemble an erratic electrocardiogram, with steep peaks and valleys, signalling a potential health disaster.
He said most people with common sense would assume the inconsistent ebbs and flows in hospital occupancy are caused by unpredictable health emergencies.
“But here is the secret: that the common sense and the health-care delivery are not compatible,” said Litvak.
In fact, he said, most of the variability is caused by scheduled procedures.
“It is easier for me to predict when somebody will break a leg and come to the hospital than when scheduled surgery will take place. And that’s the core of the problem,” he said.
Litvak says surgeons typically prefer to schedule their procedures early in the week to avoid getting called in to check on patients over the weekend.
That means surgical patients take up more beds earlier in the week, leaving people in the emergency room with long waits to get admitted. Hospitals are jammed by mid-week and nurses are overloaded with patients, he explained.
Litvak says the most common approach in Canada involves forming taskforces or issuing recommendations, a tactic he says addresses only the symptoms rather than the cause of escalating backlogs.
A more concrete solution, he suggests, should involve flattening the troubling peaks and valleys by putting equal demand on the system every day of the week when it comes to scheduled surgeries.
The idea isn’t a new one. Dr. Harvey Fineberg, former president of the National Academy of Medicine, extolled the merits of evening out hospital admissions in Canada at a health policy speech put on by Alberta Innovates in 2014.
“You can work miracles on the flow of patients in the availability of resources and in the emptying of the emergency rooms,” Fineberg told his audience, which included officials from Alberta Health Services.
“This is something that can be done without a single dollar investment in capital.”
The University Health Network in Toronto, which runs the biggest surgical program in the country, adopted the Institute for Health Care Optimization’s method shortly before the pandemic hit.
It involved redistributing the workload throughout the week, making sure there were a similar number of cases that needed intensive post-surgical care each day, for example.
At the same time, the hospital defined how emergent different cases were and what resources would be needed to deliver the care.
Emergency surgeries also got dedicated operating rooms, so scheduled procedures could run full-tilt with limited unexpected interruptions.
The result was a more predictable schedule for OR staff, fewer cancelled surgeries, cost savings and more work getting done.
“It is the silver bullet in that we’re doing more than we’ve ever done with less, more efficiently,” said Dr. Shaf Keshavjee, chief surgeon at UHN and president of the American Association for Thoracic Surgery, the world’s top academic society for cardiac and thoracic surgeons.
“We’ve created capacity to do more. So we are working at 105, 110 per cent.”
While the method can’t attract more nurses or offer a break to bone-weary doctors, it has allowed the Toronto hospitals to plow through backlogs accumulated during the pandemic more quickly.
“I can tell you our backlog has gone from 4300 down to 3200. We’ve cleared about 1,000 cases,” Keshavjee said.
And because Litvak’s method demands an accounting of what kind of resources are needed for which cases, Keshavjee also knows the backlog likely won’t be cleared until March 2023.
Keshavjee says the method isn’t without challenges, saying it requires a definite adjustment from staff.
“It is a culture shift and you have to do the work. Your hospital has to want to do it,” he said.
And although the system seems relatively simple, he says the approach adopted by UHN is relatively unique in Canada. Though that could change now that more Canadian health authorities are reaching out to Litvak since the emergence of the Omicron variant of COVID-19, which threatens to pull the country into another potentially massive pandemic wave.
Litvak desperately hopes more hospitals will consider putting his method to work to save both health-care dollars and Canadian lives.
“Given the new variant, it is very much needed,” Litvak said. “I just cannot watch what is going on.”
This report by The Canadian Press was first published Dec. 12, 2021.
Laura Osman, The Canadian Press
Senate report recommends Canada develop targeted suicide prevention strategies
Senators sit in Senate of Canada Building in Ottawa, on Wednesday, Sept. 23, 2020. A Senate report released today says that if Canadian governments at all levels targeted their suicide prevention strategies towards men and Indigenous people, who die most by suicide, the landscape of the issue can transform. THE CANADIAN PRESS/Justin Tang
By Fakiha Baig
A Senate report released Thursday says Canada can make major strides in suicide prevention if all levels of government develop strategies tailored towards men and Indigenous people, the groups facing the highest suicide rates.
The Senate Committee on Social Affairs, Science and Technology also says the Federal Framework for Suicide Prevention Act has done little to bring down the rate of suicides across Canada since it was adopted in 2016 because it does not prioritize evidence-based interventions for suicide prevention and does a poor job at tracking the issue.
Sen. Patrick Brazeau, a member of the Algonquin community of Kitigan Zibi and a committee member, says he pushed for a study of suicide in Canada after he tried to take his own life twice almost a decade ago.
“I was hurting,” the senator says in the report.
“Some people have lost cherished ones to this and just can’t handle it, but for those who can handle it, it is very important they share their voices and stories … There are many people having problems in Canada today.”
The report found that men account for 75 per cent of suicides in Canada. Indigenous leaders told the committee that “Inuit experience suicide at roughly 6 to 25 times the national rates, depending upon region and also demographics.”
The report said men die more by suicide because “men choose more lethal means of suicide, like firearms.”
Brazeau says Canada needs to conduct a gender-based analysis of the programs available because the report has found there are more prevention efforts available for women than for men.
Brazeau says this could be because, historically, men have also been taught to hide their emotions which makes taking care of their mental well-being more difficult.
“(We think) men are strong, men are supposed to be tough, and men don’t have to get help, and they’ll sort it out on their own,” Brazeau said. “I’m living proof that’s not the case.”
The report said various evidence-based approaches can reduce suicide among the overrepresented groups, including “means restrictions.”
“Means restriction aims to make the most common and lethal methods of suicide more difficult to access” the report says, recommending Canada limit gun ownership and strengthen border surveillance on firearms trafficking.
The reports states multiple factors, including the effects of colonialism, have hurt Indigenous well-being and the 2016 framework needs to acknowledge this.
“Realities differ quite a bit from First Nations, to Métis, to Inuit and; from urban Indigenous peoples to those on reserves, or in rural areas,” the report says.
“Witnesses emphasized the importance of providing accessible care and intervention to all Indigenous peoples, whether they live in urban, rural, or remote environments.”
It also emphasized programming for suicide prevention should involve Indigenous care.
The Senate report says primary care physicians can also greatly benefit from suicide prevention efforts.
The federal Minister of Mental Health and Addictions Carolyn Bennett has told the Senate “the College of Family Physicians is currently planning to extend the two-year residency to three years to accommodate additional training in mental health, addictions and pain,” the report says.
Bennett did not immediately respond to a request for comment on the report but the Senate says the minister has informed the committee work is being done to update the 2016 framework.
The report also calls for Canada to create a national suicide data collection system that is consistent from province to territory and urged the existing 2016 framework to formally acknowledge the disproportionately high suicide rates among Indigenous people, as well as men and boys.
Brazeau says the Senate’s next step is to discuss the report with the federal government, which will then prepare a response to its findings.
“It’s important that future governments take those recommendations and focus on the target populations,” Brazeau said.
If you or someone you know is thinking about suicide, support is available 24/7 by calling Talk Suicide Canada (1-833-456-4566) or, for residents of Quebec, 1 866 APPELLE (1-866-277-3553).
This report by The Canadian Press was first published June 8, 2023.
WHO’s Global Digital Health Certification Network
From the youtube channel of Dr. John Campbell
With notes from the World Health Organization website, Dr. John Campbell explains the WHO’s Global Digital Health Certification Network. To see the WHO’s press release click here or scroll below the video where it is attached.
Press release from the World Health Organization
The European Commission and WHO launch landmark digital health initiative to strengthen global health security
The World Health Organization (WHO) and European Commission have announced today the launch of a landmark digital health partnership.
In June 2023, WHO will take up the European Union (EU) system of digital COVID-19 certification to establish a global system that will help facilitate global mobility and protect citizens across the world from on-going and future health threats, including pandemics. This is the first building block of the WHO Global Digital Health Certification Network (GDHCN) that will develop a wide range of digital products to deliver better health for all.
“Building on the EU’s highly successful digital certification network, WHO aims to offer all WHO Member States access to an open-source digital health tool, which is based on the principles of equity, innovation, transparency and data protection and privacy,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “New digital health products in development aim to help people everywhere receive quality health services quickly and more effectively”.
Based on the EU Global Health Strategy and WHO Global strategy on digital health, the initiative follows the 30 November 2022 agreement between Commissioner Kyriakides and Dr Tedros to enhance strategic cooperation on global health issues. This further bolsters a robust multilateral system with WHO at its core, powered by a strong EU.
“This partnership is an important step for the digital action plan of the EU Global Health Strategy. By using European best practices we contribute to digital health standards and interoperability globally—to the benefit of those most in need. It is also a powerful example of how alignment between the EU and the WHO can deliver better health for all, in the EU and across the world. As the directing and coordinating authority on international health work, there is no better partner than the WHO to advance the work we started at the EU and further develop global digital health solutions,” said Stella Kyriakides, Commissioner for Health and Food Safety.
This partnership will include close collaboration in the development, management and implementation of the WHO GDHCN system, benefitting from the European Commission’s ample technical expertise in the field. A first step is to ensure that the current EU digital certificates continue to function effectively.
“With 80 countries and territories connected to the EU Digital COVID-19 Certificate, the EU has set a global standard. The EU certificate has not only been an important tool in our fight against the pandemic, but has also facilitated international travel and tourism. I am pleased that the WHO will build on the privacy-preserving principles and cutting-edge technology of the EU certificate to create a global tool against future pandemics,” added Thierry Breton, Commissioner for Internal Market.
A global WHO system building on EU legacy
One of the key elements in the European Union’s work against the COVID-19 pandemic has been digital COVID-19 certificates. To facilitate free movement within its borders, the EU swiftly established interoperable COVID-19 certificates (entitled ‘EU Digital COVID-19 Certificate’ or ‘EU DCC’). Based on open-source technologies and standards it allowed also for the connection of non-EU countries that issue certificates according to EU DCC specifications, becoming the most widely used solution around the world.
From the onset of the pandemic, WHO engaged with all WHO Regions to define overall guidelines for such certificates. To help strengthen global health preparedness in the face of growing health threats, WHO is establishing a global digital health certification network which builds upon the solid foundations of the EU DCC framework, principles and open technologies. With this collaboration, WHO will facilitate this process globally under its own structure with the aim to allow the world to benefit from convergence of digital certificates. This includes standard-setting and validation of digital signatures to prevent fraud. In doing so, WHO will not have access to any underlying personal data, which would continue to be the exclusive domain of governments.
The first building block of the global WHO system becomes operational in June 2023 and aims to be progressively developed in the coming months.
A long-term digital partnership to deliver better health for all
To facilitate the uptake of the EU DCC by WHO and contribute to its operation and further development, WHO and the European Commission have agreed to partner in digital health.
This partnership will work to technically develop the WHO system with a staged approach to cover additional use cases, which may include, for example, the digitisation of the International Certificate of Vaccination or Prophylaxis. Expanding such digital solutions will be essential to deliver better health for citizens across the globe.
This cooperation is based on the shared values and principles of transparency and openness, inclusiveness, accountability, data protection and privacy, security, scalability at a global level, and equity. The WHO and the European Commission will work together to encourage maximum global uptake and participation. Particular attention will be paid to equitable opportunities for the participation by those most in need: low and middle-income countries.
Dr. John Campbell’s Presentation notes:
WHO’s Global Digital Health Certification Network https://www.who.int/initiatives/globa…
WHO has established the Global Digital Health Certification Network (GDHCN). Open-source platform, built on robust & transparent standards, that establishes the first building block of digital public health infrastructure, for developing a wide range of digital products, for strengthening pandemic preparedness
Background Member States used digital COVID-19 test and vaccine certificates As the directing and coordinating authority on international health work, at the onset of the pandemic, WHO engaged with all WHO Regions to define overall guidance for such certificates and published the Digital Documentation of COVID-19 Certificates
https://www.who.int/publications/i/it… https://www.who.int/publications/i/it… there is a recognition of an existing gap, and continued need for a global mechanism, that can support bilateral verification of the provenance of health documents
The GDHCN may include Digitisation of the International Certificate of Vaccination or Prophylaxis, verification of prescriptions across borders
International Patient Summary Verification of vaccination certificates within and across borders Certification of public health professionals (through WHO Academy) Expanding such digital solutions will be essential to deliver better health for people across the globe.
The GDHCN has been designed to be interoperable with other existing regional networks EU-WHO digital partnership https://www.who.int/news/item/05-06-2… • LIVE: WHO and @EU… https://commission.europa.eu/strategy… WHO and the European Commission have agreed to partner in digital health.
This partnership will work to technically develop the WHO system with a staged approach to cover additional use cases, In June 2023, WHO will take up the European Union (EU) system of digital COVID-19 certification to establish a global system, that will help facilitate global mobility
This is the first building block of the WHO Global Digital Health Certification Network (GDHCN)
Dr Tedros Adhanom Ghebreyesus WHO aims to offer all WHO Member States access, On the principles of equity, innovation, transparency and data protection and privacy Stella Kyriakides, Commissioner for Health and Food Safety
This partnership is an important step for the digital action plan of the EU Global Health Strategy, we contribute to digital health standards and interoperability globally
Thierry Breton, Commissioner for Internal Market The EU certificate … has also facilitated international travel and tourism I am pleased that the WHO will build on …. cutting-edge technology … to create a global tool against future pandemics
One of the key elements in the European Union’s work against the COVID-19 pandemic has been digital COVID-19 certificates. WHO will facilitate this process globally under its own structure … allow the world to benefit from convergence of digital certificates. Expanding such digital solutions will be essential to deliver better health for citizens across the globe.
The WHO and the European Commission will work together to encourage maximum global uptake and participation.
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