Five Tips to Success

It's not the first time I've been asked what have been the influences on my life that have allowed me to flourish in my personal and public life. Contemplating "success" (as I stand with my feet in the chilly Spring Atlantic ocean), I am happy. The sensation of the ocean breeze, the smell of the salt air, the cool sand and the sharp tingle as the water breaks over my feet... I am alive, and I am happy.

Success is being open to your own potential and not being afraid of it:

1. Listen: to others, without your own inner monologue getting in the way. Really pay attention to what people have to say. 

2. Respect: yourself first: don't sell yourself short. And then, respect others: avoid the inherent noise based on what people look like, sound like, dress like..

3. Trust: your instincts. If what someone says sounds wrong to your inner self, it probably is. Do the research. Check things out. But trust your gut.

4. Focus: keep your eye on the ball. Set up your plan (short term, mid-term, long-term) for your goals for yourself. Review regularly.  When you need to be flexible, do it.

5. Leap: and don't be afraid. All that stuff about doors closing and windows opening-- it's true. Don't be afraid to take a chance: "I wonder what would happen if..."

6. Enjoy (I know, I said Five things, but...): don't take yourself too seriously. A sense of humour and a smile always helps.

Optimistic healthcare

I seem to think about this blog like the box of cookies I found in the living room cabinet, where I had stored it for 'later'... and then forgot it was there. Fortunately, they were still edible... not sure what the shelf-life for chocolate cookies is, really. Who cares. Chocolate is chocolate.

Okay, but I think perhaps if I keep writing my thoughts, eventually my hard thinking will permeate someone else's brain and there will be a groundswell of surprisingly intelligent actions re: healthcare-- sort of like how suddenly everyone decided to really like coffee or cupcakes. Maybe really liking healthcare reform will be next...

I live in hope.

I am not a young person. In fact, most of my friends are tipping into being what I would have considered old-- when I was younger. Sixty seemed like ancient; now it's behind me, and I have to admit, most of the time, I don't think of myself as 'old'. But I know, deep down, that eventually I will be not so flexible or full of energy.

I was walking the dog (or he was walking me) this evening & I passed an elderly couple-- the man walking in front of his wife by a few paces... we said hello & something about the weather... and his wife, walking behind, a smile on her face, just kept walking. I have seen them around the neighbourhood before & I know the woman has some form of dementia-- lives at home with her husband, who obviously takes good care of her. And I think, "So, what will happen when there are so many more of us... in that age group, with these needs?".

We have Community Care Access Centres that are supposed to be system navigators here in Ontario. But they don't work. They REALLY don't work. Everyone I speak with (who doesn't work at a CCAC) feels this way. There are components of these centres that are good, and people that want to do the right thing-- I don't disagree with that... but there are so many "wrong" things about this set-up-- and I have seen them across the province, acting the same way.

To be politically correct is to remain silent in this case. We have a new Minister of Health, but he's said he doesn't have plans to change the current structure of the LHINs and CCACs. I hope that once he has the opportunity to really look at their mandate and how they function, he will realize that there are far more effective ways of providing these services.

I certainly don't have answers. But I have questions. For example, how is it that the CCACs say the patients/clients in the community "belong" to them-- and that the agencies have no right to engage clients in (for example) studies (that have been through Ethics & have approval) without the express approval of the CCAC? Why is there a layer of bureaucracy at the CCAC that demands nurses fill in paperwork and have to ask permission to change visit schedules, dressings, etc.? (and often from non-nurses at the CCAC)? Why was there an enormous amount of time, money and energy spent on introducing "Outcome Based Pathways" (which were mandated by the OACCAC across the province-- and this has now been shelved???

Answer me these questions-- along with why the OACCAC office is on the "Mink Mile" on Bloor Street in Toronto-- (look it up on Google maps if you don't believe me: 130 Bloor Street West, Toronto, Ontario M5S 1N5) tucked in with Cartier, Louis Vuitton, Gucci, etc.... where the bathroom in the OACCAC has marble tiles that would each pay for someone's compression stockings for a couple of years...

So how is the Ontario government putting a stop to the profligate spending and arrogance demonstrated time and time again in this bureaucratic nightmare (for anyone who is NOT part of the CCAC...). ? So far, doing nothing.

As I said, I know there are good people within the CCACs. But I also know that there are enormous flaws in this system that require a complete re-working of the Empire. Because that's what it's become. And frankly, before I and my cohort really need the healthcare services, as our lives unravel like old sweaters, or like the elderly couple out walking in my neighbourhood-- I worry-- how long will they be able to manage? And how will the bureaucratic fortress of the CCACs be in any position to help?

You know, this is not right. We need to have intelligent decisions made-- and the people making the decisions need to be, not policy analysts & accountants & business-people, but nurses and doctors and allied healthcare workers along with patients and their families. We need a strong Ministry of Health to help do this-- and a solid electronic healthcare information/data system too-- one that can keep track of data and ensure we are doing the right thing, and spending our money wisely.

Because it is OUR money. I don't want to pay for rent in the Mink Mile when I'm told a patient can't have a service or a dressing because it costs too much.

Healthcare that would work

There always seems to be great attention paid to how to improve the healthcare system in this country. First, I think we have a pretty darn good system--thanks to Tommy Douglas and the legacy of our system of universal healthcare. But that being the pat on the back, we need to now take a long look at how this system needs updating. and I'm not just talking about a new hair-do, or repainting the front door to something more trendy... we need a big time overhaul.

To start with, the pyramid of care, with the physician at the peak, has got to go. From what I've seen from my MD friends and colleagues, they don't wanna be at the top--they want some quality of life, some down-time and the opportunity to really do the best they can without feeling like they are dancing on the head of a pin all the time.

I had to have eye surgery--nothing major, just a little laser weld-job on a retinal tear ("just" I say...), and it happened at the Ivey Eye Institute in London about a month ago-- my optometrist found the tear and sent me over to the Institute right away--she called them & they said, "C'mon over...we're waiting for you!!" In 3 hours, I'd seen a Clinical Clerk, a Year 2 Resident, a Year 4 Resident, and finally the surgeon, who was refreshingly knowledgeable, professional and quick: fixed me up in a matter of minutes.

But when I went back for the check-up, before heading up to the cottage, I arrived for my 9:30 appointment and he finally saw me for the requisite 10 minutes (if it was even that long) at 11:00am. In the intervening time, I'd seen the poor man dashing around, trying not to look superhuman or like a clone of himself, seeing a vast array of patients for a variety of things. All by himself. I asked him where his minions were, and he said, "Oh, they're all off learning things elsewhere"...and I thought, this is really the place for a Nurse Practitioner. or two. You could easily have 2 NPs seeing these patients and confirming "yup, that tear is healing" or "nope... there's a problem... now you need to see the surgeon". Then, the surgeon is used for his/her skills and the NP can see the garden variety patients. Believe it or not, the NP can be taught these skills--and best, know how to provide education, follow-up info and recognize when there is a problem when the surgeon really does need to be consulted.

Wow, if we had a system like that, imagine how many patients could be seen? Imagine how useful the surgeon's time would be--and how many actual surgeries he/she could perform? and, bonus, what about putting the surgeon on a salary, instead of fee-for-service? That way, he/she would have benefits, a pension, sick days...all the things "normal" professionals have.

I would bet that the majority of MDs would love a system where they could actually do what they have been highly trained to do--if they had colleagues (e.g., NPs) whom they could trust to do the other, less complex stuff. And, bonus, they could be paid a salary that would give them a reasonable wage. Gee, we could get rid of the bureaucracy of OHIP (does anyone actually know how much OHIP costs us??). Old doctors could retire, young doctors could have kids and families and time off, and other healthcare providers (like NPs) could work to their scope of practice and provide the excellent care, based on knowledge, research and (that over-used term) best practice. Patients would get the very best, and it would be faster, more appropriate and less expensive.

What's wrong with that picture, then? Why isn't this the way we are doing things? Well, old habits die hard, and those people who are entrenched in power can't understand how this "new way" could possibly be better, safer, more effective and efficient. If the MD is no longer top of the healthcare foodchain, how could that possibly work?

One way is to start looking at using the right people for the right job. Value engineering (a theory I particularly like) seems to fit this--choose the person who is the best fit for the job--get out of the old assumptions that only one "type" can do a job. So, why not have a clinic where the surgeon sees the complex patients, and the NPs (or RNs working to their full scope of practice) who are trained by the surgeon, see those patients who are likely to be "normal" or "routine".

why not? We need to start changing the way we do the "business" of healthcare.

Spring! Time to re-create!

Ah! This Spring has jumped the ice and snow (what ice? what snow?) and we have lolled in sunshine, warmth and daffodils, rather than snow shovels, winter parkas, layers of mittens, scarves, hats and boots...it feels as if we have escaped something. SSHHH... a couple of days ago, there was snow--for a brief few minutes anyway, and I thought "good, the winter stuff is still hanging in the front hall!". But before I could reach for the boots, it had stopped.
Today was sunny; I ate my lunch outside by the pond and considered the garden, the fountain that needs replacing, what plants might need to be moved... All the while, the cardinals, and other less flashy birds hung out by the bird feeder, swatting away the squirrels who seem inordinately fat this year (squirrels: a topic for another more rant-like post!!).
Today is full of potential. I'm always travel-hungry in the Spring, but this year I am feeling the rush of hopefulness, despite the gloom/belt tightening around us (another topic for another day). I see potential in this world: opening up the box to look outside--there is Spring.

So much has happened!!

It has been a long time since I've written anything here--life gets in the way, with changing jobs, more renovations, thinking about how and what I want to do... Right now I am enjoying working in an environment where I can actually feel change happening--where there are opportunities to be creative in ways that will improve patient care, by sharing knowledge.

I like this concept. It seems that we spend a lot of time spinning our wheels or reinventing the wheel-- looking for solutions to what are actually fairly simple things. For example, in my world, how to heal a wound is sometimes not the important question, but exploring the reasons behind why a wound won't heal would be the place(s) to look.

If you take away someone's specialty bed because the "system" will only cover the cost for 2 months, and the person has a wound that is likely not going to heal because the individual is unable to walk...then economically, what is the purpose of continuing to throw nursing care, dressings, etc at someone who really won't heal without that bed surface or some way to off-load the pressure and manage the drainage?

so in my "new" world, can I make change happen? Maybe not quick enough for this patient, but perhaps help to put in place some mechanisms so we pay more attention to the underlying (ha ha) issues rather than the "put a bandaid on it and walk away" approach. I hope so. For now, I'm an optimist.

September: the new year!

I always consider September as the new year. Having been a student for such a long time, I guess that's only normal...and the Fall signals the turning of the seasons to something more introspective than the perfusion of blossoms and warmth of summer, when basking in the sun, enjoying the long days and silken evenings is coming to a close. Although this year, the summer is still in full swing (hot, humid days; flowers rioting in the garden and pond).

The first day of school used to be the moment to step into those plaid, slightly scratchy wool jumpers, long socks, brushed hair pulled back with barrettes... but now, the first day of school will be shorts and tee-shirts, flip-flop sandals. Can't imagine anyone wearing wool in this heat!

And for me, I'm starting a new job next week, so that will be exciting and different... no shorts & tees, but I'll pass on the wool jumper too.

summertime

Mid-summer. All the activities of paring down (the yard sale earlier this month) and relaxing (the Home County Folk Festival, visiting some wineries in the Niagara region) are just the thing for our short time with summer.

When I consider complaining about the heat (it was 33 degrees C. today), I just have to look back at some of the photos of the winter--and this winter was particularly "challenging" in terms of the amount/frequency of snow!! I like winter for a couple of weeks, when the snow is white and crispy. But longer than that, and I'm ready to consider moving to some climate where winter and snow don't drag on.

So the summer heat is refreshing and delightful as I watch my garden unfold in various blooms. The dog lies down beside the pond, cooling his belly on the flagstones. I make sure the bird feeders are topped up, the fountains continuing to burble...and relax in the fragrant warmth of summertime. Too short...