Complicated and complex systems: What would a new perspective of medicare look like?

Sholom's presentation (attached) for the Advances in Health Informatics Conference 2010 as part of the Think Tank on “Revisiting eHealth Strageties” on Friday, April 30 from 1:00 – 4:30 pm at the University of Waterloo’s Health Sciences Campus (School of Pharmacy, Kitchener), regarding the place of patient information in complex systems.

For more information about patient information, see here.

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.

3 Etapas de las Organizaciones de Salud Barcelona

Spanish version of "3 Stages of Health Organizations," presented July 2, 2009 at The New Santa Creu and St. Pau Hospital, Barcelona.

Knowledge Transfer and the Complex Story of Scurvy

The story of scurvy is an object lesson in adaptive policy development. The Royal Navy has traditionally been accused of delaying the application of research results for about 50 years before it introduced the use of fresh lemons and limes to eliminate scurvy among its sailors. In fact, the complex history of this policy shows just the opposite. It demonstrates the navy introduced citrus fruits well in advance of accepted scientific research, and that this introduction was a significant factor in the Napoleonic Wars. The story of the fight against scurvy in the UK can help us understand that adaptive policy development is not a new phenomenon.

5 Futures of Community Care

The South West Community Care Access Centre in London, Ontario, held a large conference on the future of Community Care on February 24, 2009. This was the lead off session. The audience was 250 people from across the community and the health care system who were sitting at small tables of 6 to 8 people. The presentation precipitated discussion at the tables about five future scenarios for community care, including the effects of market dominance, scientific breakthroughs, environmental movements, global recessions, and the recognition of health complexity. Votes were taken about which of these futures people preferred and which they thought was most likely before and after their discussions.

5 Scenarios About Growing Old

A presentation made at the Markhaven Home for Seniors Annual General Meeting, May 12, 2008. The presentation explores five differing visions of society, each with distinct organizing principles and governing values, and hence, different implications for the experience of aging. The scenarios highlight the question of aging and its possible meanings in the future, as a way of focusing thought on the present and important issues of planning.

Increasing Efficiency while Improving Patient Experience: Operational Efficiency and Economies in Health Care

The presentation explores thinking and practice in health care on the problem of operational efficiency. Beginning with Frederick Taylor's principles of scientific management and their application to the assembly-line, the presentation utilizes brief case studies in which the human factors traditionally excluded from economies of industrial production, may be seen as highly relevant to the organization of health care. The case studies offer valuable comparisons between efficiency goals and unintended consequences in which 'the human factor' plays a large role. Examples range from production at Dell Computers to the very humane efficiencies of the Shouldice Hospital and their implications for practice elsewhere.

Primary Care and Uncertainty

A presentation in three parts, comprising: a collection of historical ideas about health, disease and primary care; a synopsis of our current understanding of health, disease and care; and considerations for future directions in our understanding and practice.

Reconnecting to Care: A Nursing Initiative at the Baycrest Geriatric Health System

Sholom Glouberman, Joy Richards, Marilyn El Bestawi, Rhonda Seidman-Carlson, Lorne Teperman

This paper describes and examines a change program for nursing services in Complex Continuing/Long Term Care (CC/LTC) at the Baycrest Centre for Geriatric Care in Toronto. It presents a brief history of the rise of CC/LTC services and the difficulties associated with them. In particular it claims that demographic, professional and institutional changes have produced a differentiated specialization of supports which tend to disregard some necessary aspects of daily support for patients, and devalue the role of direct care workers in these settings. The "Reconnecting to Care" (RTC) initiative is a response the to these changes by nurses at Baycrest. In detailing why Baycrest has decided to get back to basics and reconnect to care and how it has begun to do this, this paper provides an overview of the reasons for this initiative, a little of how it has been implemented so far, and some initial lessons for nursing leaders and others.

Birth and Death: The Limits of Scientific Contributions

Delivered at the Enkin Lectureship on January 24th, 2007 at the Michael G. DeGroote Centre for Learning and Discovery in Hamilton, Ontario. This presentation addresses the increase in “grey zones” in birth and death that arise from our deepening scientific understanding.