Healing Health Care
For much of the past decade, Canadians named health care the most important issue facing Canada. But recently the public spotlight has shifted to other issues, like climate change and the global economic crisis.
This may be part of the reason why many say that health care policy over the past few years has lacked vision and boldness. Rather than planning for the future by supporting research, harnessing technology, and finding new sources of health care funding, governments seem fixated on containing the cost demands of the present.
The articles below, written by some of Canada's top health care analysts, researchers, and policy makers, suggest ways in which governments can not only bring costs under under control, but also make Canada's health care system the envy of the world.
Why Research Matters
by Christopher Paige
Vice President of Research, University Health Network; Senior Scientist, Ontario Cancer Institute.
- First Posted: Jan 18 2010 00:12 AM
- Updated: 5 months ago
Health care innovation saves patients' lives and fuels our knowledge economy. It should not be left to chance funding.
I will declare my bias at the start. I work in a research hospital and have done so for most of the 35 years I have conducted medical research. I am surrounded by passionate people who care about the immediacy of their mission. Real life health problems, medical mysteries – some without any known solutions – present themselves day after day.
Research hospitals are mission oriented, impact driven, centres of learning. More than 75 per cent of the medical research done in Canada is conducted within their walls.
These institutions are a unique resource where patients, health care professionals, and scientists work together to discover new ways to recognize, prevent, and treat disease. They attract top medical talent to Canada and partner with industry to increase treatment options and test new technologies. Increasingly, they are the basis for commercial activities that will turn Canadian investment in health research into fuel for the knowledge-based economy.
So why are they in trouble?
Because somewhere along the way, the idea that you must build the cost of innovation into your business plan – a basic tenet of responsible business practice – has disappeared. Innovation has increasingly fallen victim to cost containment. And the way that care and research are funded in this country does not help.
Most provincial spending on health care is restricted to current practice without looking to the future. Federal funding is not normally tied to the expectation that the delivery of health care for Canadians will improve.
No real business – particularly one with such a heavy reliance on technology – will excel without a rational plan to invest in change.
There are a number of ways to focus Canada’s health care spending on improved health, but the most direct route would be to develop a national network of “credentialed” research hospitals with the mandate and funding to innovate and share their successes with the rest of the health care system.
A working model of this idea is the designated Comprehensive Cancer Centers in the United States, which receive operational funding for the “development of more effective approaches to cancer prevention, diagnosis, and treatment.” Canada could develop such a program with institutions competing to become designated as a Canadian Research Hospital (CRH).
CRHs would be held accountable for success in innovation and dissemination of knowledge through a process of rigorous international review every five to seven years. The entire organization, from the most senior administrator to the lab-based technologist, would be accountable for creating an environment in which current practice is subject to rigorous evaluation. Grants would be given to institutions based on their ability to leverage the millions of dollars they spend on health care into a living laboratory to improve health.
With the addition of a small fraction (only two to three per cent) of funding to the health budget, and the expectation of improved health outcomes for Canadians, we could transform the health care system.
The research hospital where I work pioneered the development of a checklist used in operating rooms to improve communications. This was the basis for the WHO-sponsored international Surgical Safety Checklist project, which demonstrated that following a simple checklist improved outcomes and significantly reduced errors and complications.
Last year, the lack of donor organs led our surgeons to investigate ways to fix damaged lungs and develop a system which now makes more lungs suitable for transplant. Already, 19 of our patients are breathing freely with these lungs, as will many more as our system is adopted by clinics across Canada and around the world. Research is holding the promise that these techniques may be applied to other organs for transplant.
These are two examples of innovations made possible by funding from outside the hospital budget. The ability to innovate in health care should not be left to chance funding. It needs to be built into the fabric of designated research hospitals with the expectation that continued designation would be based on the institution’s ability to improve the health of Canadians through research and a strategy for implementing those findings at the provincial and national levels.
Comments
Re:Marks
“ There are complications in providing a designated part of the hospital budget for research - ones associated with the movement of funding towards care when the vast majority of hospital funds come from the healthcare budget and are related to indicators of health improvement. However, the English Department of Health recently (2005) modified it's R&D funding program and has intitiated centres of excellence in research designated as Biomedical Research Centres. These are consortia between hospitals and academic institutions that must show how research funding has been used in clinical, health services and public health research (not siphoned into care or used to pay for basic biomedical studies). Early indicators suggest that the system works relatively well - and it certainly uses transparent approaches to determining where the best research will be done and placing R&D dollars appropriately. The Biomedical Research Centre designation also comes on top of R&D funding available to all hospitals based on their applications for research activity funding.
Eddy Nason