Bloated bureaucracy killing Canadian health care

When I started my consulting practice in 1975, Royal Inland Hospital had 440 beds (now 246) and was run by four people

Editor, The Times:

When I started my consulting practice in 1975, Royal Inland Hospital had 440 beds (now 246) and was run by four people: an administrator, his assistant, a director of nursing and a director of planning. This included two satellite hospitals.

Now we have hundreds of administrators and their subordinate armies working in multi-story towers and, overall, they do a lesser job. The reality is we are facing a health-care crisis unlike in any other developed country.

How did we get here? The unbridled growth of health bureaucracies has led to them taking control of resources and clinical decision-making, supplanting frontline physicians who they regard as an impediment to their growth and ill-defined goals.

Our system is expensive and inefficient compared to other universal systems.

There is not a health or finance minister in the country who believes the current level of rising costs is sustainable and the system fails to fulfil its promises to the public.

What about the facts and data? The Commonwealth Fund ranked Canada 10th of 11 developed countries in health care. Within Canada, the Wait Times Alliance identified B.C. as the worst performing province, ranking last in value for money and low (23rd) in quality alongside 29 European countries.

Physicians have presented governments with solutions, only to be swept aside. Government have instead wasted hundreds of millions of dollars on more than 300 health care task forces and commissions.

Our provincial Liberal government is about to embark on another multimillion-dollar health-care public forum roadshow beginning this month. This, in their minds, is considered an action initiative when faced with a health-care crisis.

Our system is not working. Due to government policies, we have a critical doctor shortage and five-million Canadians don’t have a family physician.

In the 1970s, we were fourth in the world in doctors per population and government policies and their myriad bureaucrats have reduced us to 26th.

Despite very long wait lists, including joint repair and replacement, there are more than 170 young orthopedic surgeons who are unable to work because of the denial of OR space and hospital privileges.

The solution lies with applying lean methods to government structures and processes to reduce workforce numbers.

One health sector public administration employee in Canada serves 1,415 Canadians.

In Germany, which has superior health-care access, the ratio is 1:15,545. That’s a greater than 10-fold difference. Turkey’s total health sector public administration workforce has just 3,612 employees for a population of 74 million.

Canada, with a population of half that, has more than 24,000 employees, plus innumerable agencies, boards and councils bloating that number.

We must topple the bureaucratic pyramid to have a hope of reform.

Our health-care processes are lethargic, inefficient and unproductive. The system requires excessive approvals (courage in numbers).

There is overproduction of documentation to accommodate the whims of bureaucrats.

Waiting is waste contributing to a wait list workforce just to manage the wait list (more bureaucrats). Economic data show Canada is actually paying more in order to keep patients waiting rather than get on with it.

Our goal through bureaucracy reduction should be the Swedish model of guaranteed care: three days or fewer to see a GP, 10 days to see a specialist and 90 days or fewer for all necessary procedures medical and surgical once deemed necessary by a specialist — not, as Health Minister Terry Lake envisions ,by a “health-care team”. Lake’s idea has been tried and it doesn’t work.

Doctors and nurses and allied health personnel are able to deliver these guarantees, but bureaucrats and politicians must get out of the way and stop the experiments.

If I wake up coughing blood, I want to see a doctor in ER now. I want to see a specialist now. I want the CT scan now. I want the OR booked now.

Take our health care back to the future. Voice your concerns.

Dr. Dennis Karpiak


Kamloops, B.C.