The Patients’ Association of Canada

Over the last several years I have been part of The Patients’ Association of Canada (PAC). It began in June of 2007 out of the experience of a number of patients in their contacts with the health system. The founding group was made up of patients, many of whom also have some special knowledge of the system. Doctors, nurses, health care managers, medical sociologists, researchers, health care consultants, social workers, among others are represented in PAC.

In our organizing meetings held in 2007 and early 2008, the group began by sharing experiences. These included single elective interactions with the health care system, recurring encounters for chronic conditions, emergency episodes, and interventions to support the care of spouses, children, and parents. These varied experiences produced a shared interest in PAC, and gradually illuminated some of the many areas where members felt that the system worked well and not so well. There was a high degree of appreciation for those organizations and individual practitioners who offered personalized, humane, and caring support. There were also areas where systematic improvement could occur.

C Difficile and Complexity

Yesterday the Healthcare Commission, the major inspectorate of the NHS came out with a report on the C difficile epidemic at Stoke Madeville Hospital. The report castigates the management of the hospital for focusing only on meeting government targets and losing sight of its responsibilities for infection control.

The Chief Executive of the period was fired and a new acting Chief Executive has responded to the Commission report by agreeing with its conclusions and promising to collaborate with the commission to make sure that such breaches no longer occur.

What is interesting to me is that the commission actually does recognise that the centre has put extreme pressure on individual organizations to meet government targets and that this resulted in reducing the priority given to infection control.

Toyota Lean

I have been watching management "fads" come in to health care over the last number of years. Almost every one of them seems to be capable of being viewed either reductively or as an aspect of complexity; and most have been applied in both ways as well.

Quality Improvement, TQI, Balanced Scorecard, Patient focus, Leadership development, purchaser provider, performance management, the Learning Organization, and now "Lean Toyota" can all be seen as recipes to be applied to fragmented and dysfunctional organizations and systems. They can also be seen as new ways of thinking that incorporate much of what this group has been calling "complexity."