Nabi: Improving Healthcare Doesn’t Have to Be so Difficult

More than 20 patients have died in recent weeks in connection with an outbreak of C. difficile in Ontario hospitals (Image by José Goulão)

Over the last few weeks, an outbreak of the C. difficile bacteria has caused over 20 deaths in hospitals around Ontario. The Canadian Press has reported that, according to a doctor in Toronto’s University Health Network, this level of infection is just “par for the course.” When we hear statements like that, it should make us stop and think about the state of our healthcare system. If fatal bacterial outbreaks are common enough to be business-as-usual, how healthy can our hospitals really be?

A study conducted last year by the U.S.-based Commonwealth Fund shows that, while medicare may be the sacred cow of Canadian public policy, looking beyond our borders will reveal the truth: our healthcare system is underperforming, expensive, and inefficient. While Canada did place better than the U.S., that brought us to second-last place among OECD nations.

In that same survey, our dead-last rankings on timeliness and quality of care are certainly cause for concern. And the current C. difficile outbreaks illustrate the need for a new model of healthcare in this country.

The simple explanation for our healthcare woes is that hospitals are hotbeds of disease. They act as centralized nodes of sickness that perpetuate positive feedback loops of infection.

One way the Ontario government has tried to tackle this problem is by requiring all hospitals to report hand hygeine compliance rates - in essence, a public record of how often healthcare workers wash their hands.

The results are startling. At Guelph General Hospital, where one of the deaths linked to C. difficile was reported, only 68 per cent of healthcare workers washed their hands before contact with a patient. At St. Catharines General Hospital, where the greatest number of deaths have occured, handwashing rates struggle to approach 69 per cent.

While it’s not possible to link individual cases of C. difficile directly to handwashing practices (one death in Niagara-on-the-Lake occurred in a hospital with handwashing compliace rates better than 80 per cent), the Ontario Ministry of Health and Long Term Care identifies “proper and frequent hand hygiene” as a way to minimize the spread of infection of the bacteria. Furthermore, the recent deaths linked to C. difficile tend to come from hospitals that have handwashing compliance rates below the provincial average of 72 per cent – Guelph, St. Catharines, Welland, and Niagara Falls, to name a few.

So, what should be done? Obviously the enforcement of proper hand hygeine practices are a no-brainer, but considering our larger failings on timeliness and quality of care, it’s time to redraw the framework of medicare.

Smaller-scale, community-focused health centres are a viable alternative. And they are supported in theory by Ontario’s Health Minister, Deb Matthews; however, no financial backing has come out of that support. It’s high time the Minister recognized that the shortcomings of our highly institutionalized system will not be fixed by throwing more money at it.

At a conference for the Association of Ontario Health Centres this past June, Minister Matthews praised community health centres for their ability to treat people effectively, and to do so in an economically efficient way. She said that an investment in community health centres “is the right economic choice for government to make.”

It’s time for the provincial government to make good on that statement and get serious about community health centres. The latest funding agreements for such centres were announced when George Smitherman was still Health Minister. Those funds expired in 2008.

If we’ve learned anything from this episode, it’s that large hospitals are ill-equipped for dealing with outbreaks, and that they can actually create the kinds of conditions that encourage infections to spread: massive numbers of sick people in a concentrated area, lax hand-washing procedures, and a siloed bureaucracy that can’t act quickly enough.

Community health centres provide an excellent model for primary health care that can take pressure off of our overburdened hospital network. Funding committment for the creation of more community health centres is the best place to start: Ontario has 444 municipalities, but only 70-odd community health centres.

This presents a massive opportunity for Dalton McGuinty to take action on a perennial election issue: the effectiveness of public healthcare. With a strong, supportive network of community health centres, our healthcare system will be better equipped to deal with the next outbreak.