“Our business is at an inflection point. We can continue down the path we’ve been on … or we can make the significant and difficult changes necessary, ” said Gavin Hattersley, Molson Coors CEO to The Globe and Mail recently, and so it may be with health care after COVID-19. Many crises have been predicted to produce lasting changes to society’s status quo ante, changes subsequently proven minimal to ephemeral, as Andrew Coyne recently noted his column in The Globe. It is just possible, however, likely even, that some long-advocated changes to health care’s organizational structure and ways of working will have been shown to be so effective that they will remain imbedded in the “new normal” when the crisis is over. Normally a slow evolutionary process, often in the face of determined resistance, the pace of change in health care may prove to have been accelerated by tiny RNA virus particles infecting their new human hosts.
A telling example is the use of information and communications technologies to supplement, if not replace face-to-face with virtual contacts between people and their care givers. Increasingly enabled and enriched by technology’s development over many years, the necessity of social distancing, combined with decisions by governments to remunerate physicians for providing services virtually by telephone, e-mail, visual “apps” and the like, has almost instantly overcome previous objections and warnings raised against its use. There may well be some modifications subsequently; one related to the privacy and security of the digital transmission of health information, but it is hard to see the practice of virtual health services being “dialled back” when the COVID-19 crisis is over.
Witness also the once intractable alternate level of care (ALC) issue; necessity has proved again to be the mother of invention. Collectively, health care’s providers, working together region by region, have shifted ALCs out of acute care hospitals to create there the capacity to accommodate anticipated surges of patients suffering COVID-19’s worst life-threatening symptoms. It’s a good move for hospitals and for those acutely ill with the new virus. Once we know its effect on the health and quality of life of those ALCs in their new out-of-hospital environments, this too may well become standard practice among the providers of health-care services, region by region.
Also, a newly calm and controlled environment in ERs has replaced that of crowded waiting rooms, “hallway medicine,” and ambulances lined up in the parking areas short months ago. Has this new normal been the result of family physicians now caring around the clock, on weekends, and as well for those absent patients? Or are they ill at home avoiding care they would have sought previously out of fear of contracting COVID-19 in an ER or clinic? Only time and analysis of the relevant data will tell.
Such questions remain to be answered before these and comparable changes will be made permanent. But there is no doubt that the COVID-19 crisis has demonstrated that problems previously thought intractable can be resolved, and quickly, by local/regional care providers working together as integrated systems, using their own resources and ingenuity. Will such bottom-up, collaborative planning and execution continue to prevail when the COVID-19 crisis is over? There have been many as yet unsuccessful to failed attempts to transform Canada’s infamous “field of silos” into systems of health and healthcare services. Will the stimulus of this crisis provide successful examples of how to build real systems successfully where top down direction by government ministries and their proxies has failed?
We will await answers when the crisis has ended.
Don Drummond, Chris Simpson, Duncan Sinclair, and David Walker and are all members of the health policy council at Queen’s University. Don Drummond is also a Senior Fellow at the C.D. Howe Institute and a member of their COVID-19 crisis working group.