Health Cover

Leader of the Pack

Edmonton is No. 1 in the first-ever ranking of health service in Canada’s major centres

Brian Bergman June 7 1999
Health Cover

Leader of the Pack

Edmonton is No. 1 in the first-ever ranking of health service in Canada’s major centres

Brian Bergman June 7 1999

Leader of the Pack

Edmonton is No. 1 in the first-ever ranking of health service in Canada’s major centres

Brian Bergman

When it comes to his health, Harry Meadows has seen better days. In recent years, the 83-year-old former teacher and clergyman has undergone intestinal surgery, suffered head injuries due to severe falls, developed a tremor in his hand and gone partially deaf. “It seems,” says Meadows, who retains a healthy sense of humour, “like it’s one damn thing after another.” Hospitalized for months at a stretch because of his ailments, he appeared destined to spend his days in a nursing home. But because of an innovative outpatient program offered by Edmonton’s Capital Health Authority, Meadows and nearly 300 other elderly and frail residents are bused in regularly to three central facilities where physicians, nurses and

therapists attend to their medical needs. And at the end of each day, Meadows and the others get to do what many in their condition can only dream of doing—they return to their own homes.

The program Meadows benefits from, known as CHOICE (Comprehensive Home Option of Integrated Care for the Elderly), is the first of its kind in Canada. According to a recent survey, the CHOICE initiative has reduced the amount of time its elderly clients spend as hospital patients by roughly half and cut their visits to emergency wards by 25 per cent—not to mention saving taxpayers an estimated $2 million annually in related healthcare costs. CHOICE is also one example of

why Edmonton tops the list in Maclean’s national ranking of hospital and health-care services. Among other things, Edmonton scored extremely well by registering a low number of preventable hospital admissions, by treating people as outpatients whenever possible and by Boasting a high rate of early discharge for hospital patients. Those are all indicators of efficiency in minimizing the time patients spend in hospitals and maximizing health-care resources in the community.

Those in charge of Edmonton’s Capital Health Authority —a $ 1.6-billion-a-year enterprise that oversees the seven major hospitals in the city and surrounding area, as well as almost every other aspect of health services in the region—say the Macleans findings reflect their determined strategy to blend hospital and community health resources into a seamless web. “I want to run the best health region in the country,” says Sheila Weatherill, the health authority’s president and chief executive officer. “I want it to be a well-oiled machine that serves some very satisfied customers.”

The rankings suggest that Weatherill is well on the way to achieving her goals. That is perhaps all the more remarkable given the economic and political climate in which she and her colleagues have operated during recent years. After Premier Ralph Klein led his Conservatives to re-election in 1993, he slashed government spending in a successful bid to eliminate the province’s $3.2-billion deficit. Health-care funding was cut by about 18 per cent. Hospital closures quickly ensued, as did a dramatic reduction in the number of acute-care beds—some 650 in the Edmonton region alone.

As it reined in spending, the Klein government ordered a massive reorganization in the way health-care services are delivered. Starting in 1994, Alberta’s 250 hospital and healthcare boards merged into 17 regional and two provincial authorities. A child of those reforms, the board of directors that now runs the Capital Health Authority replaced nine separate hospital and public-health boards that existed at the time.

The Alberta government began to reinvest new dollars in health care as early as 1996, which in turn is allowing the regional boards to start to recover lost ground. Last week, the Capital Health Authority tabled a 1999-2000 budget of $1.15 billion that takes into account a need to hire 388 new staff, 295 of which will be in nursing. All the same, the province’s health-care system is still feeling the effects of the massive, short-term cuts imposed in the mid-1990s. Robert Bear, chief clinical officer for the Capital Health Authority, points out that, in terms of hospital beds per 1,000 of population, Edmonton ranks among the lowest in the country, and that waiting times at emergency rooms and for some hospital procedures remain unacceptably long. “This is still a system under stress,” says Bear. “There is very little flexibility in it.”

But in Edmonton’s case, at least, the move to consolidate hospital boards and a wide range of community health services under one umbrella appears to be paying dividends. In addition to saving money, says Bear, it allows senior managers to respond to patient needs much more quickly than dealing with several hospital boards and agencies possibly

Alberta began reinvesting in health care as early as 1996, but the system still feels the effects of massive cuts

working at cross-purposes. Last winter, as in many other parts of the country, influenza and pneumonia outbreaks clogged the city’s emergency rooms. But because the health authority controls everything from rehabilitation facilities to nursing homes and acute-care beds, it could constantly monitor where the pressure points existed—and act to relieve them. “We have the executive authority to quickly move money and beds around,” says Bear. “Everyone is on the same team and has the same objectives.”

Some of the key players on the team say they are also impressed by the recent changes. Arvind Koshal, a highly regarded heart surgeon and director of the Edmonton region’s cardiac sciences program, says he has experienced fewer bureaucratic hurdles since health services were consolidated. “When I have a problem, I don’t have to go to four or five different audiorities and convince each one of them,” says Koshal. “And I find now that if we make a good case, we can get the money we need.” In fact, because the provincial government has chosen to target new funds towards high-tech procedures such as heart surgery, Koshal’s division has flourished even during a period of fiscal restraint. Last year, Edmonton’s cardiac unit performed more heart transplants—a total of 32—than any other unit in Canada. Koshal’s department also did 230 pediatric open-heart operations, second only to Toronto.

A spokesman for Alberta Health Minister Halvar Jonson

said the government welcomed the fact that Edmonton had topped the Macleans rankings. “We’re pleased the system is performing well,” said Garth Norris. “Certainly the whole move towards community and home-based care was a major focus of our restructuring.” Opposition Liberal Leader Nancy MacBeth said the government should not be too quick to pat itself on the back. She noted that many of the issues plaguing the health-care system in Alberta and elsewhere-—including emergency ward congestion and surgical waiting lists—were not factored into the Macleans rankings because of the lack of nationally comparable figures. As for Alberta’s move towards consolidating health services, the rankings suggest that it is, at best, a mixed success, says MacBeth. The Calgary Regional Health Authority—dogged by organizational infighting and skyrocketing deficits—placed 12th.

Even among those who had the most right to be pleased by the Macleans findings, the response was one of guarded optimism. “We’re on the right track, but there’s still a lot of work to be done,” says Weatherill. “My generation, the baby boomers, want everything—the newest drugs, the best technologies—and we want it fast. The thing that keeps me awake at night is thinking about the gap between public expectations of the health-care system and how we pay for that.” For Weatherill and her colleagues, such challenges leave little time for resting on their laurels.