North Shore Focus:
“Given the current government health costs and
operational directives, what do you anticipate our health care system
will look like in three years?”

THE current government directives provide
the opportunity to integrate and rationalize
cur system. But can we really do it?

By A.J. (Bob) Smith
Special to the News

The initiative requires a “shared vision” by the gov-
ernors and providers mixed with an element of hnan-
cial reality,

By working together, the highly skilled health care
team we have in our community can lead us to a seam-
less continuum of care from which we will all benefit.
We should be able to create a world-class model right
here — adjusted by our own special social and eco-
nomic character.

The health reform path we have been on, however, seems to be one of
confrontation. This is unfortunate but it has been the direction for the last
four years. It is unlikely to change. In this type of environment achieving
our potential will be dulled by conflict.

We should realize that the key player in effecting the necessary change is
the family physician.

Doctors already provide the bulk of community health services. They
contribute heavily to the outstanding health status we enjoy today and they
are the strength from which we must be working to shape the future.

Doctors recognize that there will be a shift from a fee-for-service system
to contract or “capitation” pay.

This change will act as an incentive to form large practice units to
become more efficient. The new practice structures will naturally lead to
the involvement of other health providers, including midwives, social work-
ers, nurses and physiotherapists.

A new type of health care team will evolve and if handled well, the
arrangement will yield significantly improved service and financial benefits.

These health service organizations will rely on the rapidly evolving
information technologies that will produce a community health informa-
tion network (CHIN).

. The CHIN will enable practitioners to access health information to
serve their clients in an accurate and timely manner yet maintain patient
confidentialicy. We can expect wait lists to shrink and the productivity of
health service providers to increase. ;

The North Shore Health Board (NSHB) appears to have overlooked
this collaborative opportunity in favor of entering into a form of competi-

-tion with their announced Community Health Centres.

_. To fund the NSHB initiatives we can expect significant changes in the
organization of Lions Gate Hospital. It will be weaned away from its‘acute
care, sub-specialty, regional role. A reduced level of medical and surgical service will result.
The hospital’s arnple space will be converted to meet the need for long-term care.

Meanwhile, trauma and specialized inedical and surgical care will transfer to the highly
skilled service areas available in Vancouver. Diagnostic and support services, including labora-
tory processing and eventually radiology interpretation, will also be provided by the Targer
neighboring region. .

: le will Secome much more aware of public health initiatives such as immunization, smok-
ing and alcoho! hazards, pollution and the threat of various infectious diseases.

Unfortunately because it is so hard to evaluate this type of activity, the service will function
with less than optimum compliance of the public. Mentzl heaith services as well as alcohol and
drug programs will reorganize for the umpteenth time but rievertheless continue to ride on
the “back burner” as government debates the need for clearer policy in these critical areas.

--The need for a separate governing board will finally prove unnecessary. The government
will realize, as it did with the Richmond and Burnaby regions, that the present situation is an
impediment to improved services.

FORMER LGH boss Bok
Smith ... dismayed by health
reform confrontation.

— Bob Smith is a former Lions Gate Hospital CEO

“We should realize
that the key player in
effecting the necessary
change is the family
physician.”

— Bob Smith

“The role of Lions
Gate Hospital and the
services provided by
North Shore physi-
cians will continue to
be: essential.”

— lnge Schamborzkl

Health care
is on track

WITH the establishment of the North
Shore Health Region, and more specifically
one governing body that is responsible for
the delivery of health services on the North
Shore, the opportunity to create an inte-
grated, accessible, efticient, and cost effec-
tive health delivery system is now achiev-
able.

By Inge Schamborzki

HEALTH region's chief execu- Special to the News

tive officer Inge Schamborzki

.-. $ee@S more Service options. It is important to emphasize that individuals and

families will continue to be able to choose whatever
health services they wish to access.

The combined resources of three previously independent community
health organizations — North Shore Health, North Shore Home Support ©
Services and North Shore Community Menta! Health — are being inte-
grated to form three, new multi-disciplinary teams that will provide a vari-
ety of health services to the west, central and eastern geographic areas of
the region.

As soon as appropriate space is identified, these teams will be physically
located in those communities. By dissolving three agencies and integrating
services into these teams, there will also be a reduction in the number of
administrators and support staff.

The centres will offer residents a wide range of services and programs, ‘
unimpeded by the barriers that currently exist with three independent
agencies that must be accessed in three separate locations.

Depending on the priorities identified within cach of the communities,
there will be a variety of programs offered ranging from health promotion
and illness prevention to programs with a specific community focus, as
well as health care services.

Ic is envisioned that there will be more health service delivery options
provided in the community and in the home — rather than in the hospital
or long-term care facilities.

Services will be developed so that the transition from care being pro- '
vided in the home to the hospital and back will be “seamless.”

The role of Lions Gate Hospital and the services provided by North .
Shore physicians will continue to be essential.

A role study to review the clinicat services being provided by the hospi-
tal has been initiated to ensure that the services essential to our communi-

y will continue to be available in an efficient and cost-effective way in the
ture.

Hospital and other community agency staff are also currently exploring
ways to reduce costs and avoid service duplication. ;

Community members are our major stakeholders, and they are being consulted to identify
how the health of our community and individuals can be maintained and increased. :

Recently a significant, community-inclusive consultation process was initiated which will
result in the first health plan for the North Shore.

Even though our community is primarily healthy, there are individuals and groups who
are less heaithy by virtue of their socio-economic circumstances, or a number of other factors

that determine health. ; oo

The board is committed to everyone’s health status and will ensure that those who are at
risk are identified and heard.

Given the finite resources available for health services within our region, the board is
committed to ensuring access to health care, to bringing health closer to home: to fostering
significant partnerships with our community, municipalities, school boards, community agen-
cies, volunteers and staff; and to ensuring that there is an appropriate mix of health promo-
tion, care, hospital and rehabilitation programs for all North Shore residents.

— Inge Schamborzki is the Chief Executive Officer of the North Shore Health Board

Hospital wants linkage with community

-From page

In addition, some staff members, pointing to the well-
respected Best’s controversial dismissal and constant changes
at the health facility, say the hospital is rudderless,

Although the hospital budget for 1997-98 is balanced, the
hospital has run a deficit of approximately $800,000 for the
recently completed 1996-97 fiscal year and has exhausted its
reserves. . .

“I see my role in what I’m doing now as providing leader-
ship and maintaining continuity and stability within the hos-
pital (and) provicing quality patient care, in a nutshell,” said
Madill, who spent 29 years as a family doctor before starting

an administrative career that has spanned more than six years.

, Madill said the role review will study the scope of services

_ the hospital delivers to help give the hospital a handle on
where it will be going over the next three to five years.

“We want to look at all the services we provide and
whether we should continue to provide them,” he said.

The review comes amid concern the hospital may not con-

tinue to provide as many services as it does now. Madill, how-
ever, doesn’t see a significant service reduction on the hori-
zon.

“My personal opinion is I don’t think the role of the hos-
pital is guing to change drastically in terms of the services pro-
vided. There may be some recommended changes but I don’t
think it’s going to be major,” he said.

Madiil sees room for improvement however. He believes
the hospital needs to break down barricrs in terms of patients
going from the hospital into the community.

“T think that we need to have much better linkages
berween the hospital and the community services and that we
work together as oppused to us doing our thing and them
doing their thing,” said Madill.

He said that goal has been worked toward for the last four
years, but accelerated with the regionalization process. That
process spawned the North Shore Health Region, which has
taken the hospital under its administrative wing.

Madill said the hospital also wants to look at whether some
services offered at the hospital can be done in the communi-

ty in partnership with other community agencies. That would |
allow people to be treated at less cost outside the hospital.

Meanwhile, the hospital is still fighting a lengthy waiting
list for elective surgery, “everything from tonsillectomies to -
major joint replacement,” said Madill.

Last September, the surgery. waiting list stood at 2,660
operations. Extra surgery dates in the past six months have cut
that number to 2,381, but increased the hospital’s 1996-97
deficit by approximately $120,000.

Physicians, he said, complain about the surgery situation.

“That’s probably a chronic complaint all surgeons have in
all hospitals. It’s not unique to us,” said Madill.

Madili speculates the heavy backlog and “significant”
increase in surgeries over the past few years may be due to
more residents going to North Shore physicians or the greater
demand for operations such as joint replacement and
cataracts. Win’ today’s technology, such operations are more
successful and easier to go through, said Madill.

Admissions to the hospital have held steady at 14,500 or
so annually over the past few years, said Madill. can