Chapter 1
The Need for Health Care
to Evolve
A lot has been written about health care and what can be done to improve it. And indeed, many things have been done. Pilot projects, a lot of talk and books abound. But that seems to be where it stops. Why does this happen? It may have to do with the way health care has fallen out of synchronization with society. Some of the ideas we see presented may be good on their own, but they are limited. To catch up to the way society is developing, such proposed changes must instead happen on a larger scale. Yes, we currently spend a lot of money and yes, we have large hospitals and employ thousands. But it's not working. By this I mean health care has been done on a small scale. Each physician with their own office, each hospital concentrating mostly on the local population with many small-scale departments to become a general hospital. This narrow focus has dominated the system to date. It also puts limits on health care that needs to be eliminated. But maybe if a new, larger picture is laid out, keeping the best of the current system, folding in some of the pilot projects, adding some new ideas and then you will have a more Integrated Quality Sustainable Accessible (IQSA) system. Imagine it. Not all medical visits have to be to a doctor's office. And not all admissions have to be at a hospital. It can be done. This book is about just such a system and it's called the IQSA system.
Health care has changed immensely since 1966 when the Government of Canada created the Medical Care Act. It made health care public and was a big step forward at the time. The IQSA system enables health care to remain public. It brings health care into the 21st century by updating it to match the way big business functions, especially retail and often manufacturing. Many do so by working 24/7 producing and selling in large quantities. Being a public health care system meant people did not have to go into poverty to pay for essential medical care. People were very happy with it because at the time, they understood it was a first step. But many today are waiting on the necessary second step to take it from an insurance policy to an integrated system.
The ideas for this long awaited second step are about to explode onto the scene like the embers from a smoldering fire blown into a tinder dry forest. Some of these ideas may take hold, but whether health care is private or public, will be up to you because both systems will benefit from the IQSA system presented in this book.
Hopefully we will not lose what Tommy Douglas realized. If you or your child needed any kind of medical attention, the system would be there to pay the physician to look after you, either in the office or the hospital. You along with every other member in your community could go to your family doctor, and they would know you by name and could look after any aliments that you may have. This was a good system and people did like it but with time the costs rose, the system slowed down and became unable to cope with the changes that were happening everywhere. Knowledge in the medical field began to expand rapidly, along with new drugs, treatments, and diagnostic equipment. This might be playing a role in added stress.
A general change in the work/life balance for most in society is flourishing. Few people in any vocation want to spend most of their time at work. This applies to family physicians and their work habits also with fewer working at delivering babies, working in nursing homes or the hospitals. This combined with a higher medical workload due to fewer physicians and an aging population has made things increasingly taxing on both doctors and the elderly.
Keeping pace with these changes by restructuring the way health care is delivered did not happen. At one time a person could make an appointment with the family physician and get in the next day. The physician could make an appointment for a test within a week, and you could see a specialist within two weeks.
But those days are long gone. Just finding a family physician has become difficult. In turn, family physicians tell us that they do not have enough support mechanisms, especially those in rural areas and they feel overworked as do many others. Some of these problems may have started with the physicians but they have now migrated to affect all employees in the health care sector. As all those working in the system become disillusioned as a result, they begin to look elsewhere for employment. Working at improving the system is therefore a must if it is to be there in future. The question, then, becomes what should be done to improve it.
A fresh look at fixing the health care system starts with understanding its history and, society in general. This is because the health care system is not a stand-alone entity. Health care must fit into the way society functions today. This leads to a closer look at how society has evolved in the last century. The health care system did keep pace with society through the 1970s, that is when the last big change to regionalization took place, but since then, it has fallen out of synchronization with the way society functions. Today, anyone can go shopping in huge warehouse-type stores or, if you prefer, you can shop online at any time of day or night that suits you and your schedule best. The array of products and services available for purchase have also grown immensely. People travel much more than they did in the 1940s, 1950s, and 1960s as well (not including Covid lockdowns).
Looking at these factors gives us a starting point. To understand better, a closer look must be taken. It must be understood how society managed to develop these advances. Not all can be attributed to mass manufacturing and technology, but a good portion can be. This is what has raised our standard of living.
Making a product in large quantities allows for a lower selling price thus making it available to more people and increasing profits; this is why it is done. Technology allows for more automation and 24/7 sales. Health care needs to be available to more people. But for the last two decades or so, increasing numbers of people have been unable to get the care they require in a timely fashion. The product or service must be available when it is needed. This is easy to say but not so easy to do. Mass manufacturing is accomplished on an assembly line. It is an essential part of manufacturing. When examined closely, we see that it is creating a smooth flowing process in which each assembly step can be replicated with a predetermined degree of quality, speed, and safety. This is what health care requires. In Henry Ford's time it would be difficult to say that he was automating the process because there were much fewer machines as compared to today. But I would argue that it was the beginning of the automation process because automation is nothing if not a process. The difference at that time was that people had to do most of the assembly work whereas today, a machine might do it.
No matter whether man or machine, neither would work properly if the process had not been carefully developed beforehand. The order and the method had to be perfected. Today with computers, we call it a program or an algorithm. In Henry's time, as it is with health care today, it was a process.
Ford had worked diligently on his own car, designed it, built it, and raced it. When it was ready, he began to experiment with the assembly of his automobile. As he perfected his assembly line (the process), he began to realize additional benefits. Things were moving along much faster than he anticipated. He discovered that the speed of the line was dependent on its slowest point. This is very applicable to health care. He would work diligently at relieving the pressure at that point until things flowed a little more smoothly. At one point, Ford was producing eight cars for every one of his competitors. A smooth health care process would do this. This also meant that he was consuming material at a much higher rate thereby allowing him to purchase in bulk at a much lower price. This would apply to many areas in health care.
Ford also found that because his employees on the assembly line were not required to do a large number of different tasks, they could easily learn to do what was required of them whether it be electrical work or welding, lessening the need for high-cost tradesmen (i.e., electricians and welders whose scope of work was wide). If health care was divided up into a number of smaller tasks, people could possibly be employed with less training. Increasing profits through the savings in the high-cost trades and other measures allowed Ford to pay his average assembly line employee a very good wage, unheard of at the time. He believed that the average worker should be able to afford a car, so he priced his cars equivalent to that of four months of an employee's wages. All health care providers must be paid adequately.
How can we enroll the benefits of our manufactured lifestyle into health care and reap the rewards, such as lower costs, faster service, higher quality, and quicker access for everyone? It is possible, as you will read. In the early days before Henry Ford's Model T the automobile industry consisted of custom engineered, craft-built cars. The process used was sometimes referred to as craft production. It could also be called custom engineering because each part was handmade to fit where it was specifically needed. Often this required filing the part so it would only fit on the vehicle it was intended for. Craft built refers to the fact that all work was completed...
