Lewis: A Team Canada approach to health care could eliminate woes

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If you want to explain what oxymoron means, start with the phrase “co-operative federalism.” Fed-bashing has long been the go-to move for premiers in search of an enemy to blame for whatever ails their fiefdoms.

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Ottawa certainly did its part, afflicted by a seemingly irresistible urge to express its piñata gene (see: the Atlantic Canada heating oil carbon tax exemption). Short months ago, it looked like an impending supermajority for the leader who declared the federation broken and promised to put Humpty-Dumpty back together again.

And then along came the new world order that changed the game overnight. Patriotism surged. We have seen the enemy, and it isn’t us. We were suddenly embarrassed by interprovincial trade barriers and resolved to get out of our own way. Now it’s Team Canada, the muted rah rahs from the Smith-Moe alliance notwithstanding.

The team hastily assembled to play in the international trade war tournament, but external threats alone won’t end our familial squabbles. Team Canada’s long-term future lies in tackling our domestic dysfunctions.

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Canada is not broken, but health care lurches from crisis to crisis, unable to right itself. It would be a big win were Team Canada to set its sights on decluttering health-care federalism — call it the chaos dividend. These three investments could generate huge returns.

One is licensure and regulatory reform. There is a staggering amount of bureaucratic bloat, redundancy and uneven capacity across the country. The duplication creates maddening barriers to mobility.

Small professions struggle to do even the basics, and the regulatory toolkit for assessing fitness to practise consists mainly of blunt instruments.

The calls for national licensure have gone unheeded; it’s time to get on with it. Then begins the harder work of reforming regulation to keep up with rapidly changing science, artificial intelligence and interprofessional practice.

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Regulation was designed for a slower-moving world. Today it is reactive and fragmented, and a brake on innovation; reformed, it can be its ally.

A second key area is health information. Canada is plagued with electronic health records that don’t talk to each other and are incapable of producing real-time performance reports to improve practice.

There is no strategy to deal with the coming avalanche of data generated by home-based diagnostic and monitoring technologies. Residents of England have online access to 10 times as much information on how their system performs than Canadians have on theirs.

Too much of our data is a stranded asset that compromises practice, planning, research and accountability. The information train runs on tracks where the gauge changes every two kilometres, and you need an entry visa to get to the dining car. Only a well-funded pan-Canadian effort can fix it.

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A third vital innovation is health workforce education. Health science and technology are advancing at dizzying speeds. AI is already better at diagnosing dozens of conditions than highly specialized clinicians.

Machines can monitor critically ill patients with tireless precision and detect warning signs invisible to the most observant nurse. An incredible amount of clinical evidence and advice is available on a smartphone to practitioners and the public.

These developments rival the printing press and telephone and shake the foundations of health workforce education to their core. Do graduates need to memorize information they can find in 15 seconds?

There is consensus that primary care should be team-based, yet team-based training is difficult where programs are individually designed and accredited, and occupations emphasize their uniqueness. These are wicked issues to address, and no jurisdiction has a hope of solving them alone.

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At the heart of today’s trade wars lies a deep suspicion of co-operation, collaboration and interdependence. (There is also very bad arithmetic.) Health-care systems are constitutionally provincial, and all health-care delivery is local.

But health care is intensely knowledge based, and it improves only when best practices spread and become standardized, and the barriers to innovation and talent come down.

Both neglecting and duplicating vital infrastructure compromise health system performance. The neglect stems from short-sightedness, the duplication from parochialism.

Team Canada has assembled to fight a tariff war. It should stay together to exchange the dubious satisfactions of autonomy for the liberating potential of collaboration. That’s real patriotism.

Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan. He can be reached at [email protected].

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