Former hospital board chairs propose five-point plan to address capacity crisis

Two former hospital board chairs are urging local health administrators to take immediate action to address a growing capacity crisis, arguing that waiting for government intervention is not an option. They propose a five-point plan focused on optimizing hospital systems to increase patient throughput and reduce wait times. The authors note that health systems across Canada and the Western world are struggling with overwhelming demand, exacerbated by an aging population. A 75-year-old conservatively uses three to four times more health care than someone under 50, and seniors often have multiple chronic conditions requiring specialist care.

The authors point to data from the Canadian Institute for Health Information on wait times, including the metric of patients admitted to non-standard accommodations like hallways. "This is not good medicine," they wrote. When the system is overloaded, all patients are disadvantaged, though seniors may be particularly vulnerable. They illustrate the problem with the case of a patient with a parasitic infection who faced months of delays to see a gastrointestinal specialist, underwent unnecessary surgery and lost nearly a third of their body weight over a year.

The first recommendation is for hospital administrations to measure the true volume of care required, rather than planning based on existing capacity. "Today’s planning starts with the capacity the system can offer, not the need," the authors stated. They suggest that skills from outside medicine may be needed to create accurate demand models. Boards and senior leadership must demand this information and clear plans to deliver the needed capacity.

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The second point is to identify and address bottlenecks that prevent patients from receiving expedient care beyond the emergency department. The third calls for developing new care models and clinical pathways with specific emphasis on how specialists are accessed and supported. These models must account for patients with multiple ailments, especially seniors. The fourth recommendation is to create a new role for diagnostic specialists who can assess the most challenging patients by looking broadly for misdiagnosis and unaddressed clinical interactions. The fifth proposal is for flexible avenues for funding improvements that show a return on investment, even if they fall outside preset budgets. "Opportunities are being missed because of this," the authors wrote, noting a lack of mechanism for such funding during their time in governance. They acknowledge that implementing these changes will be a "tall ask" and some issues will be politically sensitive, but argue the pressing demographic reality demands action now.

The authors believe significant improvements can be achieved locally by better understanding capacity needs and developing strategies to address them. They cite the ongoing re-architecting of primary care in Ontario as an example of transformative change, calling it a "formidable undertaking" that has made substantive progress despite capacity shortfalls. "If primary care can undergo transformative change, it can be done elsewhere," they concluded. The recommendations were originally published on Healthy Debate, a forum for health-care journalism in Canada.

With files from The Good Men Project