Monday, November 16, 2015

Pulling the Health Care Andon

By Pascal Dennis

This one’s personal, folks. I’m pulling the andon (Japanese for ‘Help Chain’) on a major Toronto hospital where my mom has suffered a number of indignities – after undergoing successful low back surgery.

The Great Paradox of Health Care once again. Magic within the silos, and too often, indignity between them.

The events I’ll describe could easily have taken place in an American, British, or Australian hospital.

Quick summary: Mama went in for lower back surgery to treat a very painful spinal stenosis. The operation was a success and her orthopedic surgeon and OR staff, superb.

Convalescent care was another story. Here’s a key point summary:
  • No target discharge date or discharge plan

  • No standard discharge process. Everybody we spoke to had a different opinion. Several staff members blamed Mama and our family for our difficulties.

  • Poor communication. Key staff members repeatedly failed to return phone calls or provide clear information on Mama’s condition, treatment and support plan

  • Indifferent staff:

    • Ms. M, the social worker, was especially uninterested in our requests for information. When we finally agreed on a time for a case conference, Ms. M failed to show up. No explanation or apology.

    • Then one morning, without warning, Ms. M told Mama, “Get your clothes on, you’re leaving!”

    • I called Ms. M at once, of course, and explained this was complete surprise. We still didn’t have a discharge date or support plan. “It’s your fault,” she told me. “Why didn’t you have all this done in advance?”

    • In fact, I’d had several in advance chats with CCAC, the agency that handles home care service. They told me, “We can’t do anything till we hear from the hospital about your mom’s condition.”

    • When I pointed this out, Ms. M et al said, ”The CCAC don’t know what they’re talking about!” Then they blamed our family again, for good luck, I suppose.

When I think of Mama’s surgery experience the following words come to mind: professional, capable, and compassionate.

How to summarize Mama’s convalescence experience?
  • Lack of standards, lack of process

  • Lack of communication

  • Shame and blame the patient

  • Denial, deflection and outright lies

(Let me also add that Canadians have no choice. We have to use the existing system. The Canadian Health Care Act essentially outlaws private medicine.)

I’m pulling the andon for all of us who have endured such treatment. (Letters are on their way to requisite senior executives and bureaucrats.)

But all is not lost. We met many excellent people doing their best in this bad system.

Let me also salute the growing number of Canadian hospitals that are in the midst of heartfelt process and cultural transformations.

I’m lucky enough to work with some of you. You’re fighting the good fight, and though it’ll take a long time, you’re going to win.



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