Surrey plan, Alberta test offer health care models

VICTORIA - Anybody wondering about the future of their local hospital should pay close attention to the overhaul of medical services in Surrey.
The problem was crowding at the Surrey Memorial Hospital, in the emergency room and the wards.
But the solution backed by the province wasn't a bigger hospital, or even just a larger ER. Instead the services are being carved up into separate centres, with the aim of reserving acute care hospital beds and high-end emergency care for those who really need them.
So the health region has just opened a "minor treatment unit" for people who don't really need the full emergency service but show up there anyway. Instead of clogging the waiting room and sitting for hours - and creating more delays for people who really need emergency care - they get sent off to the minor treatment centre.
A massive ambulatory care centre is going to be built nearby, sort of a junior hospital. People who need outpatient care, day surgery and other activities that don't require the acute care support can be treated there. It will include a primary care clinic housing family doctors, and people to help with chronic disease management.
The idea is simply. Get every patient into the system where it makes sense. Increased specialization allows cost-efficiencies and wait time management, and you can avoid the high cost of having someone who only needs minor first aid clogging a busy emergency room.
Health Minister George Abbott is an enthusiastic backer of the approach, being tried for the first time in B.C. He expects a similar strategy any time hospitals are built or expanded. "What we're seeing is very much a model for the future," Abbott says.
Hospitals in Salmon Arm, Kamloops, Kelowna and Nanaimo are already under increasing pressure. Abbott says a similar approach will be taken in those communities, although changes will likely be incremental.
The Canadian Centre for Policy Alternatives released a study this month that advocated taking the concept farther. Dr. Michael Rachlis said governments should be building more specialized surgical clinics for minor procedures and low-risk surgery. A clinic that does only knee and hip replacements can deliver faster, better care at lower cost, just like a service station that does only oil changes.
Rachlis also wants governments to pay a lot more attention to "queue management," the science of moving people from start to finish smoothly and quickly. He argues people wait too long for surgery even when enough operations are being done, because the system is clunky. Patients move through a series of tests and specialists visits with little co-ordination and frequent long delays. Simply managing that process efficiently cuts waiting times.
A report on an Alberta experiment this week confirmed that the approach can work. In the first eight months of a new approach to hip and knee replacements, the wait from getting a referral to specialist to surgery was cut to three months. It had been averaging 20 months.
The project included money to keep operating rooms open. But many of the gains came from managing patients' progress through the system, and eliminating needless waits for tests or to see specialists or physiotherapists. A change as simple as scheduling all tests and consultations for each patient for one day cut out long delays.
Any increased costs were recovered. People who wait almost two years for surgery lose income and suffer, and their health deteriorates. Because patients got surgery before their health began to fail, the average hospital stay was cut from 6.2 days to 4.3 days - an enormous cost saving.
Some of the principles may be harder to apply in smaller centres, although the idea of clinics that are also "minor treatment units" may may good sense where a full emergency room can't be justified.
But the new approaches, in Surrey and across the mountains in Alberta, show that health care problems can be solved within the current system.
Footnote: B.C. needs to make improvements. The province is meeting most of the first handful of wait time standards agreed to by the provincial health ministers. But the province isn't close to providing knee and hip surgery within the required six months. More than half the patients wait longer than that. Many wait much longer.