The quality of healthcare in Canada is increasingly under attack by users of the system and by the media.

Quality is defined but not limited to a number of issues including: infection control, emergency-room wait-times, diagnostic wait-times and surgical-wait times. All of the above have a money connotation and are linked to the financial circumstance of governments.

Infection control has been the subject of national media attention for months. The CBC launched a series on caesarian-related infections in a British Columbia hospital. Dr. Lynne Johnston, head of the infectious disease unit at the QE II Hospital in Halifax has been quoted as saying that the rate of ‘staff infections such as MRSA has more than doubled in her hospital since 2002.

The CBC reports that hospital-acquired infections, including C. difficile, MRSA and necrotizing fasciitis affect about 250,000 Canadians every year. Infections that originate in hospitals kill an estimated 8,000 Canadians a year. The cost of treating those infections is estimated to be more than $100 million a year because patients who acquire hospital infections often double their stay recovering from the infections.

The sad fact is that infections are preventable. Dutch hospitals are proving it with strict patient isolation policies and a “seek and control” approach to infection control. The question is why not in Canada. It seems that infection-control budgets are the first to be cut when budgets are tight. Cleaning staff and nurses are the first to go when hospital boards face a financial crunch.

Bring it a little closer to home. A few weeks ago, an 84 year old woman was taken to a New Brunswick hospital with severe and sudden diarrhea. She spent nearly twelve hours in emergency before being admitted to the hospital. In emergency, she was treated for dehydration and put on intravenous. Once admitted, she was taken to an upper floor and left in the hallway for the night, next to the nurse’s station. The nurses had no idea what she was suffering from or what was causing her problem.

The morning after her admission and following numerous family interventions, she was moved into a single room and the occupant of that room was moved to a ward. That’s only part of the story.

The walls on her floor were peeling wallpaper. The floors were dirty. They were cleaned and scrubbed after she moved in, not before. The halls outside the room were filthy and the utility rooms were disgraceful. The patient was eventually diagnosed with a contagious bacterial infection and her room was designated as an isolation room.

There’s more. This woman was on blood thinning medication and because she was dehydrated, her dosage was lowered. To combat the bacterial infection, she was put on a high-dosage antibiotic. A few days later, the high-dosage blood thinner was reinstated. The following morning, the woman suffered a stroke.

Apparently, staff and volunteer care-givers failed to recognize the signs of stroke until the woman’s daughter alerted nurses to her mother’s right-side paralysis. The nurses responded quickly and with considerable expertise. Fortunately and at last report, the woman is recovering well and has returned to her home.

This woman’s saga started with her twelve hour wait in emergency. Waiting time is the bug-bear of healthcare in New Brunswick and indeed, much if not all of Canada. We wait in emergency, we wait for access to diagnostic technology, we wait for hospital beds, we wait for surgical interventions and we wait for the system to be fixed.

Governments are so blinded by healthcare costs and so battered by reaction to their cost-cutting efforts that they hide behind studies, royal commissions and budget constraints to justify inaction. Surely there are things we can do to improve the system and things we can do to prepare ourselves for future demands on the system.

New Brunswick has a tiny population of 758,000 people. Three or four hospitals would serve us well if they were mandated to high service standards and supported by a high quality clinic-entry system and a space-age transportation service.

What if we replaced local and regional hospitals with doctor/nurse clinics and 24 hour service in every community of the Province with a population of 3,000 plus. What if we demanded service standards that produced clinical nurse assessments within 15 minutes of patient arrival and doctor assessments/treatments within 60 minutes of a patient’s assessment by a registered nurse or nurse practitioner?

What if we employed a fleet of jet-helicopters in the Province that could deliver patients from community clinics to emergency hospital rooms in 30 minutes? What if we set hospital receiving standards that would provide diagnostic or treatment service on arrival for helicopter-delivered patients?

What if we set standards that would require that hospital patients receive emergency treatment on demand? What if we set standards that would require that patients receive treatment and/or procedures related to life-threatening circumstances within 30 days of diagnosis. What if we required that life-style and comfort-producing surgical procedures be referred to private sector hospitals and clinics?

My scenario of standards and what-ifs may sound expensive or even far-fetched but I suspect they would be a lot less expensive than maintenance of the existing infrastructure. Indeed, I would suggest that replacement of existing hospitals with three new state-of-the art, provincial hospitals combined with appropriate staffing would achieve the standards outlined above and would reduce the cost of New Brunswick’s healthcare system.

The system we have today is inefficient and unfriendly to customers. Demands on the system are growing and will continue to grow. We have to do something to fix it before it’s too late.