“Many of our health organizations are second to none in terms of science and technical expertise - meaning outcomes will be very good. But the persons, the patients, may not be at the centre of that. They’re rather an object to which things are to be done. To me, People-Centred means to rebalance that institutional state.”
Through his former consulting firm Ideas to Action, and in his current role at Alberta Health Services, Don Juzwishin supports innovative healthcare backed by research and the best evidence available. If a healthcare promise doesn’t deliver, Don’s going to know or he’s going to find out. Along with a host of previous health technology and policy research-related positions, Don is Director of Health Technology Assessment and Innovation with Alberta Health Services in Edmonton, Alberta. As such he’s had to do not only a lot of thinking about healthcare – which new technologies or policies are useful and economical, and why – but he has also become committed to care that actually works for the modern patient.
An ‘evidence-based’ focus like Don’s is often touted in healthcare administration and research circles these days. But Don is happy to report that it’s not just PR. “Buzzwords tend to come and go and be the flavour of the moment. The question we really have to ask, is ‘evidence-based’ a sustained and relevant kind of characteristic? In the medical world, there’s a very high preponderance of thinking how it is that facts, the science, support the practice. There’s a lot of things we do that we believe to be effective but may not be, and may even be dangerous! For instance, decades ago there was an approach to freeze the stomach to help ulcers, but they quickly learned that over time it more often killed the patients. So this buzzword is not hollow; it is a commitment to identifying the very best approach; seeking out therapeutic interventions proven to be clinically- and cost-effective, where there’s no less effectiveness in outcome.”
But good outcomes and practices, to Don, happen at all levels and types of care – including the basic level of the health record itself.
“At present, mothers actually have to carry logbooks in their purses on their kids’ chronic issues, so they can carry it on to the next care provider from the last one. The airlines and banks have been electronically storing information and making it accessible for their needs for decades; why don’t we put people back in the centre and give them the control for that? Currently, when you’re prevented getting access to your health records, it’s because the providers are incapable of delivering the information in such a way as to prevent someone else getting access to it. But banks can do it; so can the airlines; what’s wrong with us?
“Things are structured right now by interests to preserve the status quo, and one of the things we can demonstrate quite clearly is that Canadians are not getting value. See the recent Health Council of Canada report. The kinds of dollars per capita spent on health care aren’t reflective of the kind of care or health status we’re getting. Look at the waiting lists – the reason given for waiting lists is ‘because GP’s aren’t working long enough hours’. Ye,s that’s some of the issue; but do we need more GP’s or do we need to change the way care is delivered?
“The same is true about interventions, for instance first- and second-trimester screenings for metabolic disorders. The worth of such screenings is well proven and yet governments are dragging their heels. Why? Why are they dragging their feet?
“In terms of the social, historical, and political context, health care and medicine have been most recently owned by the state. It was structured so the professional organization has the responsibility to monitor the performance of individual members. And we empower governments and healthcare provider organizations to fund and deliver healthcare services.
“What happened with that, was that the pendulum swung too far towards the fact that somebody else besides the individual was responsible for the delivery of health care and the health of the population. It made us lose sight of what’s important to the individual, because it substituted the needs of the institution and what works best for them, for what works best for the individual. For instance when appointments are made: you’re told, ‘Here’s the time available,’ and you make it work. This was not a malicious motivation, but one that suits the effective functioning of the institution. And human needs were molded to conform.
“I don’t think people realize how close we are to losing what we have. Rather than throwing the baby away with the bathwater, let’s admit that, Yes, the current health care setup makes for good shareholder value for those working within it, and it creates good economic diversity, but does it do so on the backs of individuals who are then left without adequate access to care on their terms?”
To Don, People-Centred healthcare means welcoming seismic shifts which will rewrite the scripts for governments, provider institutions, and the public.