AHS/healthcare system debacles

[revelations]

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Gonna try and explain it but this is all from memory so take with a grain of salt.

Basically AHS is having the same thing happened as CBE. There are multiple funding streams from the government in the sense of one overall set of funds but then also more targeted credits. UCP ran on a platform of not cutting funds and so the main overall funding isn't being touched (which is what the UCP keeps touting). But what is happening is a bunch of individual targeted programs and being slashed or eliminated. Which in the end means there's less funding for staff which is why they're talking about jobs being eliminated.

A large majority of the jobs will be lost through attrition (someone leaves and the spot isn't filled) but this also means that work just gets dumped onto others. Particularly with nurses this is quite bad because many are forced to work a lot of OT as it is. So if you start cutting jobs one of two things happens. Either there are less beds which means longer wait times and less care, or the existing nurses pick up more shifts, work more OT, and you spend more money in the end anyways.

Any truth to this?

[Mitsu3000gt]

Good luck finding efficiencies in a Hospital environment like the emergency department where they aren't allowed to turn people away for any reason, so some homeless guy who comes in says he has chest pain (the guaranteed way to get in fast) just to get a soft bed for the night gets $10K of diagnostics for nothing. Further to that, to avoid a malpractice suit, the doctors order lots of testing to be thorough but also to cover their own ass (the doctors also get paid per test they order). AHS is a complete disaster but I feel like the changes that would actually make a major difference (i.e. not admitting 90% of people who show up because it's not an actual emergency and they haven't even tried going to a clinic/GP) are impossible. The problem is they would get sued the one time they turned someone away who ended up having a major problem, so they have to treat everyone the same and run tests on absolutely everyone. Believe me, the staff would LOVE things to be done differently. It's one of those situations where the solutions are obvious, but they can't implement them for the 1% of times it doesn't work or they're wrong.

Personally I think they should do a 3 strike system for "frequent flyers" who are drug seeking or bed seeking, but one day one of those people would be turned away and would die, so you're back to square one. Same deal if you haven't gone to your GP/Clinic first and it's obviously not an emergency - you should just be sent home at that point. Again, will never happen.

[pheoxs]

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Any truth to this?

As always the truth lies somewhere in the middle. There will ALWAYS be anecdotal evidence of one place having excessive waste that people use push their agendas.

Both sides have agendas, the UCP are pushing one and the unions are pushing theirs.

I do think AHS can make cuts and is likely making this sound worse than it really is but perhaps look at McDonalds as an example.

McDonalds is often viewed as one of the most efficient organizations in the world but a typical McDonalds store still has 3-4 actual managers (I'm not counting the bullshit 'swing managers' and other crap they label, I mean actual management level). They typically have a restaurant manager and 1-3 assistant managers based on the store size. In a 24/7 environment there are a lot of duties passed along to the active manager, as well as a lot happening in the background. I don't know the specifics of AHS but someone has to do schedules, has to keep on top of training/certifications, has to order supplies, has to deal with any employee drama, has to deal with discipline, performance evaluations, etc.

I'm not saying AHS doesn't have issues, I'm just saying using the example of 'one unit has 3 different managers' doesn't actually mean a thing towards being inefficient.

If they actually wanted to reduce health care spending they should make all the Alberta healthcare cards expire and produce new ones with photo ID to ensure people are actually residents to receive service. Right now anyone can come here and get free health care even while not being a resident and we are one of (or the only?) provinces to have paper ID with no picture.

[dirtsniffer]

Management to staff ratios are a great way to look at middle management levels. 5-6 staff to one manager is typical from what I've seen in the private sector. Willing to wager in AHS or CBE management it is 3-1 or worse.

[Swank]

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Good luck finding efficiencies in a Hospital environment like the emergency department where they aren't allowed to turn people away for any reason, so some homeless guy who comes in says he has chest pain (the guaranteed way to get in fast) just to get a soft bed for the night gets $10K of diagnostics for nothing. Further to that, to avoid a malpractice suit, the doctors order lots of testing to be thorough but also to cover their own ass (the doctors also get paid per test they order). AHS is a complete disaster but I feel like the changes that would actually make a major difference (i.e. not admitting 90% of people who show up because it's not an actual emergency and they haven't even tried going to a clinic/GP) are impossible. The problem is they would get sued the one time they turned someone away who ended up having a major problem, so they have to treat everyone the same and run tests on absolutely everyone. Believe me, the staff would LOVE things to be done differently. It's one of those situations where the solutions are obvious, but they can't implement them for the 1% of times it doesn't work or they're wrong.

Personally I think they should do a 3 strike system for "frequent flyers" who are drug seeking or bed seeking, but one day one of those people would be turned away and would die, so you're back to square one. Same deal if you haven't gone to your GP/Clinic first and it's obviously not an emergency - you should just be sent home at that point. Again, will never happen.

You saved me a lot of typing, I thought I was reading my own words for a minute heh. Doctors don't just order lots of tests to cover their ass, they do it to pad their pockets. Doctors have been caught numerous times ordering excessive tests and also billing for patients they never even laid eyes on, they just add their name to the chart and collect the cash. One was caught and reported for adding his name to a chart for a patient who was dead 2 hours before the doctor even started his shift. That's not just an inefficiency, it's blatant theft and costing us/the province dearly.

GP's also get paid per referral so they bill to see someone and then refer them to emergency for a little top up on their pay. The number of referrals that don't need to go to emergency is appalling.

[Mitsu3000gt]

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You saved me a lot of typing, I thought I was reading my own words for a minute heh. Doctors don't just order lots of tests to cover their ass, they do it to pad their pockets. Doctors have been caught numerous times ordering excessive tests and also billing for patients they never even laid eyes on, they just add their name to the chart and collect the cash. One was caught and reported for adding his name to a chart for a patient who was dead 2 hours before the doctor even started his shift. That's not just an inefficiency, it's blatant theft and costing us/the province dearly.

GP's also get paid per referral so they bill to see someone and then refer them to emergency for a little top up on their pay. The number of referrals that don't need to go to emergency is appalling.

Yeah it's ridiculous. My GF is mid-level management at one of the Emergency departments and the staff are so frustrated with the inefficiencies (among other things), but if AHS wants to pay them $50/hr to take care of people with a dry mouth who come 3 times a day and arrive by ambulance thinking they will get seen faster (spoiler alert: you don't), so be it. Also, a lot of people don't realize that EMS has to wait with that patient until they are seen, and if they are there for a non-emergency but arrived via Ambulance, that could be 4+ hours that an Ambulance isn't on the streets because some idiot didn't want to make an appointment with their GP or go to a walk-in clinic.

If you call Health Link, a lot of the time they just tell you to go to the ER as well because they can't take any chances. It's understandable, but wildly inefficient.

The solutions are fairly obvious, but since there is a tiny chance it might occasionally cost someone their life or bring a big law suit, it will never happen.

[revelations]

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and arrive by ambulance thinking they will get seen faster (spoiler alert: you don't),.

Thats not true - our 2 week old was taken to Childrens via Ambulance specifically because he could get in faster (as mentioned by the EMS techs). Zero waiting - and there was a big lineup.

[Xtrema]

I remembered a Filipino nurse told me AHS has so much waste and her example is not reusing syringe in some instances.

I cringed.

[Mitsu3000gt]

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Thats not true - our 2 week old was taken to Childrens via Ambulance specifically because he could get in faster (as mentioned by the EMS techs). Zero waiting.

Might be different at the Children's, that is definitely not the case at other Hospitals. Maybe Children's has a different triage process but to my knowledge they don't. They would not put your 2 week old ahead of someone with a more serious injury/issue just because he arrived in an ambulance. Chances are your kid was just more sick than other people there, as I can only imagine how many worried first time parents take their kids to the ER for every little thing (not saying you did).

Even if you arrive in the Stars Helicopter you still get triaged according to your injuries. They aren't going to bump you ahead of someone with life threatening injuries because of your mode of transportation.

[Brent.ff]

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Thats not true - our 2 week old was taken to Childrens via Ambulance specifically because he could get in faster (as mentioned by the EMS techs). Zero waiting - and there was a big lineup.

You still get triaged is what hes saying. A 2 week old is going to get triaged in front of someone who takes the ambulance for a sore throat

[revelations]

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You still get triaged is what hes saying. A 2 week old is going to get triaged in front of someone who takes the ambulance for a sore throat

You essentially skip the main admitting line up and go direct to the Dr. waiting area.

You still have to wait there if you rode the bus to emerg because of a sore throat, but the process is slightly faster. Obviously not worth 400$ if its not serious.

[Mitsu3000gt]

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You still get triaged is what hes saying. A 2 week old is going to get triaged in front of someone who takes the ambulance for a sore throat

Exactly. EVERYONE gets triaged, they don't give a shit if you walked there yourself or arrived via private escort motorcade. Chances are though, if you arrived via the Stars or something, you are sicker than 90%of the people waiting around, but the mode of transportation has nothing to do with it.

Also there is no obligation to actually pay the ambulance fee from what I have been told, so people abuse it all the time without consequence.

If they somehow triage you on the way there, that might speed things up, but that's not how they do it at every hospital and might be slightly different for Children's.

[Swank]

And if you really think about it you do not want to be in a condition that gets you rushed to the front of the line - you might leave in a box.

[Mitsu3000gt]

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And if you really think about it you do not want in a condition that gets you rushed to the front of the line - you might leave in a box.

A lot of people who get rushed in for "chest pain" or similar leave with a bus ticket or taxi chit, because that is yet another area where AHS panders to the frequent flyers.

[revelations]

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If they somehow triage you on the way there, that might speed things up, but that's not how they do it at every hospital and might be slightly different for Children's.

Thats exactly what happened, and why the process was sped up.

There IS time savings to be had this way, even with a sore throat, but in that case you just end waiting in the Dr. waiting room, instead of main admitting.

Saying that riding the bus to emerg does not get you in faster, is not accurate. It wont triage you above a more serious patient, but given two identical cases, riding the bus will get you in slightly faster.

[Swank]

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A lot of people who get rushed in for "chest pain" or similar leave with a bus ticket or taxi chit, because that is yet another area where AHS panders to the frequent flyers.

I could go on and on about this and other AHS wastes *cough* NARCAN *cough* but probably shouldn't without a thread split

[killramos]

A buddy of mine ran an ambulance out of St Paul.

Not sure there is a politically correct way to say 80% of his job was acting as a free taxi service from the reserve into town, most of them wouldn’t even bother to pretend to go into the hospital once they got there.

Honestly we could probably have a whole dedicated thread to stories about how AHS from top to bottom is fucked.

[jutes]

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A buddy of mine ran an ambulance out of St Paul.

Not sure there is a politically correct way to say 80% of his job was acting as a free taxi service from the reserve into town, most of them wouldn’t even bother to pretend to go into the hospital once they got there.

Honestly we could probably have a whole dedicated thread to stories about how AHS from top to bottom is fucked.

Wife is a RN and saw it all the time when she worked in Saskatoon Emerg. Every Saturday a big van load would come in to emergency with “problems”. It’s not just limited to FN, people are in general morons and use emergency as a fucking walk in clinic.

[revelations]

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A buddy of mine ran an ambulance out of St Paul.

Not sure there is a politically correct way to say 80% of his job was acting as a free taxi service from the reserve into town, most of them wouldn’t even bother to pretend to go into the hospital once they got there.

Honestly we could probably have a whole dedicated thread to stories about how AHS from top to bottom is fucked.

Its not an AHS thing - BCHC is also facing similar issues. Drug problems getting dumped on them with no recourse to deal with the increased dumbfuckery.

Mods - can this be split thread please? AHS/healthcare system debacles.

[dirtsniffer]

If only there was some system where people could be held accountable for their healthcare costs.