Mediocrity and Shortsighted Thinking

[SunriseChampion]

I have a feeling not. Call me cynical, but I wouldn't be surprised *at all* that government would rather have the responsibility off their balance sheet, overall savings or not (another perverse outcome that happens a lot - saving money overall is different from saving money in my budget).

AoD

No chance I'd call you cynical.....your theory is a lot less cynical than mine. Incidentally, this makes it more likely.

 

[JGHali]

So a starter example, for obvious reasons, I hope, I have to omit some details to protect the privacy of persons involved. (healthcare)

So sometime back, a certain GTA hospital admitted a patient on a Friday. The patient was stone cold sober, but unable to walk a straight line or even stay up for any distance (balance issues).

Said hospital admitted the patient at around lunch on a Friday.

They knew, in order to ascertain the patients condition, they would need to do an MRI.

The hospital does not operate MRIs on the weekend unless its deemed an emergency.

The MRI being fully booked for the balance of that Friday, the patient stayed as admitted through the weekend and then Monday, by which the time the backlog was so bad, that the patient had to wait till Tuesday for an MRI.

Not being able to comment specifically on the situation, but if the whole point of admission was only to expedite an MRI, it was absolutely unnecessary. But if the patient was indeed ataxic and got admitted for that reason, delaying definitive imaging diagnosis (which may or may not be revealing) might not have changed that much. MRIs don't add much acutely and if there was something critical, some element of it usually gets picked up on CT first. Anyway, that's just a devil's advocate comment.

To point out that the cost of an admitted patient in acute care shows on the books as roughly $1,200 per day, assuming they are an 'average' patient. (not high need)

A patient confined to a bed, is more expensive.

A delay of 4 days in accessing an MRI creates a sunk cost of $4,800

The cost of operating the MRI on Saturday and Sunday for one 8-hour shift, much lower, labour and power inclusive.

Does anyone else see a problem?

ICU beds cost ~$1,000 per day, but regular floor beds aren't quite that expensive. Not saying it isn't wasteful to have an unnecessary admission, but the cost isn't quite as bad. What's more, many radiology departments have techs "on call" on weekends and evenings, especially for typically more elective studies like MRI. So it isn't necessary cheap to call someone in unless you really need to.

Related note, MRIs are purchased by individual hospitals in Ontario. Typically at a rate of 3-5 per year across the province. The hospitals are required to fund raise for them, the province won't cover the cost.

At roughly $4,000,000 per machine, this eats up a lot of time and fundraising costs for local hospitals.

Of greater concern however, is that by purchasing one-offs there are no discounts.

If the MRIs were batch tendered by the province, say, 15 over a 3 year period from one provider, there would be volume discounts. The exact numbers would vary, but 20% is a safe bet.

That means, on $60,000,000 over three years, the province could save at least $12,000,000 by buying province-wide.

That doesn't count the savings from shifting away from fundraising which often requires significant costs all its own.

But you don't necessarily need to buy a bunch of machines at once because these magnets last a while (but the tech changes a fair bit too).

The issue in Ontario is that there really is no health care "system" as everything is disorganized. Toronto has hospitals next door (or across the street from) each other whose IT systems don't talk or are entirely different. The weirdest situations occur, where places like Sinai and UHN have common staff IDs but separate IT systems. And of course SickKids does its own thing, as does St Mike's, Sunnybrook, Humber... it goes on! And every hospital has its own board and own CEO making high six figures.

The rest of the country long since did away with this structure and moved to proper regional (or provincial!) health authorities. They have their own problems, but in Alberta you can access province-wide records from a single account. But then Ontario also an obsolete Catholic school system while other provinces - where religion historically has been far more contentious (e.g. Quebec and Newfoundland) - got rid of theirs almost 20 years ago.

 

[Northern Light]

Not being able to comment specifically on the situation, but if the whole point of admission was only to expedite an MRI, it was absolutely unnecessary. But if the patient was indeed ataxic and got admitted for that reason, delaying definitive imaging diagnosis (which may or may not be revealing) might not have changed that much. MRIs don't add much acutely and if there was something critical, some element of it usually gets picked up on CT first. Anyway, that's just a devil's advocate comment.



ICU beds cost ~$1,000 per day, but regular floor beds aren't quite that expensive. Not saying it isn't wasteful to have an unnecessary admission, but the cost isn't quite as bad. What's more, many radiology departments have techs "on call" on weekends and evenings, especially for typically more elective studies like MRI. So it isn't necessary cheap to call someone in unless you really need to.



But you don't necessarily need to buy a bunch of machines at once because these magnets last a while (but the tech changes a fair bit too).

The issue in Ontario is that there really is no health care "system" as everything is disorganized. Toronto has hospitals next door (or across the street from) each other whose IT systems don't talk or are entirely different. The weirdest situations occur, where places like Sinai and UHN have common staff IDs but separate IT systems. And of course SickKids does its own thing, as does St Mike's, Sunnybrook, Humber... it goes on! And every hospital has its own board and own CEO making high six figures.

The rest of the country long since did away with this structure and moved to proper regional (or provincial!) health authorities. They have their own problems, but in Alberta you can access province-wide records from a single account. But then Ontario also an obsolete Catholic school system while other provinces - where religion historically has been far more contentious (e.g. Quebec and Newfoundland) - got rid of theirs almost 20 years ago.

Patient never left hospital.

Broken Back due to tumor up against spine.

Received neuro surgery to repair the back, but that happened a full week after admission, due to the MRI delay.

The surgeon implied that the delay in the MRI may have been a factor in the surgery not having the hoped for outcome.

Surgeon said MRI should have been same day, and surgery would have deemed sufficiently urgent to be scheduled for the first available OR

 

[Northern Light]

The issue in Ontario is that there really is no health care "system" as everything is disorganized. Toronto has hospitals next door (or across the street from) each other whose IT systems don't talk or are entirely different. The weirdest situations occur, where places like Sinai and UHN have common staff IDs but separate IT systems. And of course SickKids does its own thing, as does St Mike's, Sunnybrook, Humber... it goes on! And every hospital has its own board and own CEO making high six figures.

The rest of the country long since did away with this structure and moved to proper regional (or provincial!) health authorities. They have their own problems, but in Alberta you can access province-wide records from a single account. But then Ontario also an obsolete Catholic school system while other provinces - where religion historically has been far more contentious (e.g. Quebec and Newfoundland) - got rid of theirs almost 20 years ago.

You seem expert in this field.

We could probably have a dedicated thread for healthcare system issues.

I'm very familiar with them myself, as a result of being the caregiver and advocate for a couple of patients over the last several years.

I'm also an activist by nature (and past profession, though, not in healthcare)

But I've come to understand many of the challenges outlined by yourself and find them (and others) incredibly frustrating when you see how much better we could do with the existing resources.

More resources are undoubtedly needed, but there's no reason, on the whole, that we couldn't cut medical error rates in 1/2, hospital acquired infections in 1/2, manage waits more effectively, cut ER times in non-complex cases by 70% and reduce overall waits by a 1/3.

Plug in 5% more money, plus some strategic capital spend and non-system supports (dental, assistive devices etc.) and we could do so much better.

But there's too much to use AoD's word inertia! Sigh.

 

[TrickyRicky]

Going into broad general terms I think this is a complicated issue. The trouble with solutions or problem solving on a macro scale is that it's really hard to predict the future and really hard to understand the unintended consequences of the actions we want to take. Toronto itself, the general subject of this forum is a perfect example of this. I think Robert Fulford's "Accidental City" thesis is very sage. By any number of metric Toronto is in the top tier of Cities around the globe and yet there really is no one in charge, no vision, no particularly identifiable strength or aptitude, no managerial excellence, no direction etc. That is not to say there aren't or haven't been extraordinary people doing extraordinary work to build this city, it's prosperity and institutions. I also suspect this is not anything to say about Toronto exceptionalism and more a general indictment of smart management and planning. Basically, we suck but all the money, tradition, and smarts in the world can't really do all that better.

 

[SunriseChampion]

I also suspect this is not anything to say about Toronto exceptionalism and more a general indictment of smart management and planning. Basically, we suck but all the money, tradition, and smarts in the world can't really do all that better.

For as long as people are involved, it will always be thus.