Confession, I must admit I was a little rattled to read about the health care costs being unsustainable with the advancing tsunami of seniors, not only on the horizon but lapping up the beach. And let me tell you I can’t create a scarier picture than some all-inclusive resort filled with beaches of 70 year olds in Speedos.
I think, (therefor I am…to quote the Moody Blues) for the first time in my life I can actually say I come from a place of innocence. I grew up in a time when health care was health CARE not health administration.
I grew up in a time when nursing was a “calling” not a profession. I grew up in a time when nursing students studied in hospitals and, in exchange for room and board (sometimes a stipend), they provided an inexpensive labour force. And I say that with the greatest of respect.
I have never formerly studied healthcare but I have grown up in it. By the time I was sixteen I had logged close to eight years in the Children’s Hospital. My last discharge from the Children’s Hospital was in 1966 and straight into the hippy era of anti-war activism. But that’s fodder for another day. Suffice it to say I made a “positive transition” to “independent living” almost ten years before they even became concepts.
In the early 70’s I did a student stint at a very inaccessible at Mount Royal College in Calgary. However in those times no one talked access or inclusion, you fought it on a case by case basis and you fought it yourself. It was while at Mount Royal that I begun to hone my activist skills including the anti-Vietnam war marches.
From College it was on to community health for the rest of the 70’s. My community career ended following three years with the Canadian Mental Health Association. As a provincial mental health advocate I liaised with numerous health facilities, other community organizations and policy makers. I began to witness the movement from health care to health administration. It was the early days of “before we deal with the patient lets see what the policy says”.
In 1979 I was recruited for a position at Calgary’s inner city hospital, the Holy Cross, and left community health work. Initially I really enjoyed that work and you can’t understate the importance of job satisfaction. In the labour market job satisfaction is the difference between a career and a job. In my ten years at the Holy I held four different positions. for four of those years I sat as president for the District 93 Nurses Union of Alberta (UNA). That involved a lot of interaction with health administrators, so yes, I think I have a pretty good idea of what health “care” use to look like.
My first involvement as an adult patient came in the 80’s. I required a couple of what were really minor surgeries. One in the very hospital I worked for and the other in the biggest teaching hospital in Calgary, the Foothills. These were my first “patient” experience in almost twenty years and it was an eye opener. I began to realize the health system didn’t know what to do with non-traditional patients.
Health care was changing but it was easier to write it off as seeing through the eyes of an adult rather than that of a young kid in the Children’s Hospital. I may not have consciously recognized it at the time but the move had started to muddy the waters between health “care” and health “administration”.
Most of my working life has involved careers where I was about five years ahead of the “credential generation”. In the late 70’s and early 80’s nursing, like so much of the health industry, was entering the credential stage and everything was becoming about “degrees”. An increasing amount of nurses were returning to school to achieve their nursing degree. The writing was on the wall that if a nurse wanted to work her way up in hospital management then that degree was essential.
I had spend almost ten years as a “mental health therapist” but due to one of the many “restructuring management” processes that began happening in health care my position was reclassified to a social work title. I was left with the options of returning to university to complete a social work degree, leave the career or do what I did and open a restaurant. That was a whole different phase in my life but I digress.
After leaving my career in health “care” (and I CANNOT stress that “care” enough) I worked my way to the position of a policy analyst with the BC provincial government. This introduced me to the world of policy development. I quickly realized that the process I used to do a mental health assessment was the same process I used to analyze a policy. The content was different but the process remained the same. I was using the same skills I just had to understand the language of the content. So in 1990 I left the world of health care which was changing radically and moved into the world of public administration.
Did I mention I was married to a nurse? Since my wife was a nursing administrator most of our socializing was with other health care professionals. I heard a lot of discussion regarding “new administrative policies” and all of the issues involved in initiating them.
To position themselves for this new world of health “administration” many were taking courses to update their resumes. By this time we had twenty years of credentialism well established in the psyche of society and specialized training became accepted as the new norm in health care. It wasn’t patient care courses they were taking, it was business administration programs. While so many were busy adding to their credentials nobody was paying attention to the slow crawl from “care” to “administration”.
Health administrators keep themselves busy by reorganizing this, restructuring that or standing beside some politician for electioneering purposes. While they are busy playing administrator frontline care workers are burning out faster than Elton Johns Candles in the Wind. These ridiculous severance packages paid out to many health administrators, in my humble opinion, bordered on criminal. $680,000 pay out and all the public really hears is Dr. Cookie. How many bedside bucks did that eat up? How many times does the tax payer have to pay for the cost of administrative screw ups for “administrative job creation” like Ontario’s infamous eHealth? We now have a “health administrative” system that is run by too many people who have never been at the bedside!
It is only by understanding how our current federal government manipulates the health administration process that you really start to learn how the tide has changed on health care. In 1957, the majority Liberal government under Louis St. Laurent passed the Hospital Insurance and Diagnostic Services Act. The government of that day agreed to fund 50% of the costs incurred under this Act to every province that adopted them. That was one of the founding foundations of the Canada Health Act.
So do I know about health care? I may not be academically “credentialed” when it comes to the health “care” but knowledge of the system covers over fifty years as an experienced user and contributor to the system. After spending most of my life watching our national healthcare system being build, I am now watching it slowly disappear. The only thing de-compensating faster than what was out health “care” system is the physical shape to my aging body. I know healthcare, I know public administration but I’m not to sure about health administration.
I know this is no longer the healthcare of my youth. I know this is not the world of my youth. I understand that the innocence of my youth is lost but I will not sit back while forty years of my life’s work is just thrown out the window under the guise of administration. I am prepared to work at establishing solutions that will improve and add life to our current system. But let me be very clear on what we are trying to improve here. Do you want health administration or health care because they are very different?
Just one man’s opinion!