Economist Don Drummond has provided the Ontario government with a wide range of recommendations to save costs and cut spending at a time when the provincial economy resembles the walking wounded. He had a lot to say about health care spending too.
Drummond talks about shifting the focus from an acute care to chronic care, and recommends upstream investments in wellness and better health, fuller utilization of providers like nurse practitioners, and better integration of the many silos that characterize the health “system”. All these moves can increase access to health and wellness that is effective and satisfying to patients, while controlling costs.
These targeted recommendations acknowledge a larger truth that’s been evident for decades: that the acute treatment of illness represents just a small fraction of the many factors that really create human health. The other factors that create health in a society merit our collective close attention. The Commission cautions all governments however, to ensure that that cutbacks in areas beyond the formal health care system do not further jeopardize the health of citizens; we must be especially careful not to push Canadians further into poverty, knowing that determinants such as income and food security have a critical impact on our health.
Drummond’s recommendations also speak to the deployment of health care human resources, something near and dear to the National Expert Commission. While the Commission is four months away from filing its own report, it has already zeroed in on a fundamental truth – innovations that maximize the full potential of nursing practice can save costs and improve health outcomes for Canadians. In consultations with nurses across Canada, the Commission has found that Canada’s nurses have stepped past the high-minded platitudes about “health system transformation” to demonstrate that better utilization of nursing practice is just one of many patient-centred initiatives that are cost-efficient and feasible to implement quickly. Sadly, the Commission has been reminded that many of these options have been staring us all in the face for years. It would be new and refreshing if we could make the shift toward health and wellness actually happen.
The use of interdisciplinary care teams and the deployment of more nurse practitioners are prime examples. Both improve the quality of care while saving costs, but neither has been fully integrated into long-term planning across Canada. What other kinds of solutions are we talking about? In Ontario alone: a reduction in healing time for pressure ulcers saving $18,000 per patient based on nursing interventions; a savings of more than $350 million annually by implementing best nursing practices in wound care; and shifting just a quarter of frail elderly patients out of our acute hospital beds and into safe home care could save $23 million per year. These are real solutions being offered up by nursing that we can implement now. Every 10% reduction in expenditures for chronic illness in Ontario could result in $1.2 billion/annum savings for the province; getting there means leveraging nursing practice to its full scope and thinking creatively about where and how nurses deliver services.
Research being gathered by the Commission – some of which has been around for years – reveals that nurses have a knack for figuring out how to improve processes, clinical protocols and patient care, while saving time and money. Already the Commission has ample evidence showing how efforts to prevent, rather than treat, illness has a decided impact when it comes to health savings. To ensure its credibility, the Commission’s research also reviews the comparative effects and costs of models of nursing intervention on patient outcomes, such as morbidity and mortality, and system outcomes, such as health resource use.
Whether as part of interdisciplinary teams or alone in a citizen’s home, nursing best practice interventions can and do make a difference. On top of what nurses bring to high-level public policy discussions across Canada, the fact is that they are the health care professionals who work most closely with real Canadians where they live, work, learn and play. And they are eager to step up to the plate, doing their part to help transform the health care system in tangible ways.
Following consultations a broad cross-section of nurses, organizations and citizens, the Commission is readying a report of evidence and innovations to show how nursing contributions can be leveraged as governments search for ways to sustain our national health care system. Governments serious about saving costs while improving health outcomes should pay attention.
National Expert Commission
Canadian Nurses Association