The Health Care Transformation in Scotland

Meaningful discussion around health care reform in Canada has been paralyzed for years by fears that advocacy for anything other than the status quo must necessarily mean that an “American-style” system is desired.

By defining ourselves so negatively – as being whatever the United States isn’t – we have created a highly politicized environment that over-simplifies a complex problem, polarizes and dichotomizes an issue with multiple shades of grey, and marginalizes those who ask tough, sincere and intelligent questions.

We’ve become scared to talk about it for fear that we will somehow become labelled as un-Canadian. After all, polls continue to show that our health care system is seen as one of the nation’s most treasured assets.

Driving to work this snowy morning, I drove past the big statue of Sir John A. Macdonald in City Park in Kingston. We’ve heard a lot about Sir John A. lately; this past summer was filled with 19th Century character actors downtown – delighting the many tourists who visited this year. A musical (Sir John, Eh?) is about to debut. No city is prouder of Canada’s first prime minister than Kingston – the city “The Old Scot” called home.

So, I thought to myself, no one could possibly be more Canadian than the Scottish-born Sir John A. Macdonald. Given this, maybe some lessons from the Scottish health care system wouldn’t seem so threatening to the Canadian sensibility.

For those of you who haven’t heard, Scotland has been doing some pretty wonderful things in the health care sector. You might even call them transformative.

It started on the floor of their Parliament. There was a problem, so they discussed and debated it. The health care system wasn’t in good shape, they said to themselves, and something has to be done about it.

So they assembled a tremendous amount of collective will and set to work. With all in agreement, they successfully de-politicized the issue and began a process of reform based on 3 pillars: person-centred care; effective, safe care; and elimination of wasteful or harmful variation.

The tools they used were simple. Collective will, benchmark setting, published results, and a little extra money in targeted areas (not much). There were no changes in governance or personnel.

What have they accomplished? Well, plenty.

Elective surgeries now have a very short wait time (median 25 days). The time from family doctor referral through to treatment completion is less than 18 weeks in 92% of cases. The hospital standardized mortality rate for the whole country has decreased by 11.4% (a similar drop in the US would result in the prevention of almost 400,000 deaths!). They’ve fully implemented a surgical checklist, and have seen a 20% reduction in ICU mortality rates.

Finally, and impressively, they have seen a reduction in hospital admissions for people 75 years and older as they have taken concrete steps to integrate health care with social care.

Their motto – “doing common things uncommonly well” – says it all. They set collective goals, then set about meeting them. By publishing their data and progress publicly, they acknowledged their accountability to their citizens. Nothing fancy; nothing revolutionary. They just started functioning like a real system.

We could learn a lot from casting an eye across the pond. Sir John A. would be delighted, I am sure, to see his fellow Canadians learning what lessons Scotland has to offer.

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