Health Care Reform? Not So Fast!

You’d be hard-pressed to find a better example of ineffective, or perhaps more accurately non-existent, communications than that surrounding the announced, then canceled, decision to close overnight ER services at those six rural hospitals.

Premier Higgs not looking too happy as he announces he is walking back his decision to shut down some rural hospital ER’s from midnight to 8. Photo Credit: CBC

I can only imagine the hurried damage control meetings that took place prior to Premier Higgs’ walking back that announcement over the long weekend. Whoever was involved had to have been kicking themselves wondering what in hell were they thinking in the first place by springing this on people out of the blue, and bringing on the potential fall of the government. Talk about big consequences for screwing up, but what a reminder of how important effective communications is.

This is not to say that even with solid communications there wouldn’t have been a backlash from those communities. More on that in a moment, but first let’s look at the communications because it is revealing on several levels.

First, internal communications is actually more important than external communications, even though it is the latter that gets all the attention. It’s pretty obvious the government’s own MLAs weren’t even sold on the changes, at least not to the point whether they could comfortably stand in unity with the government, and communicate the benefits to their constituents. Bruce Northrup and Robert Gauvin are evidence of that.

And since they couldn’t get the internal communications nailed down, there was no hope of ever convincing local residents the changes would serve them better in the long run.

Robert Gauvin announces he is quitting government to sit as an Independent. Photo Credit:cimtchau.ca

Government MLA Bruce Northrup promises constituents he will vote against the proposed changes. Photo Credit: Global News

But back to Gauvin and Northrup. Despite the terrible internal communications, it’s hard to imagine they didn’t pick up somewhere along the line that the proposed changes would benefit their constituent’s health care needs overall. This by freeing up doctors who were seeing hardly any patients overnight, and few still any with real emergencies, so they could instead see many more through the day, people who because of the backlog, were going without medical attention and who knows what conditions some of them may have that may be worsening to a threatening level without them even being aware of it. And this is not to mention the better care that would be provided long term patients awaiting nursing home placement, plus the fact the status quo is unsustainable and promises to only get worse with the aging population and with fewer doctors and nurses because of retirements and the necessity, already playing out more and more often, of closures because of staffing shortages. 

The bottom line here is that changes are needed. It has become clear that all the details that should have been ironed out weren’t, and that’s on Horizon and Vitalité as well as the government. But that aside, for Northrup to simply state he can’t support it, and worse for Gauvin to call it an attack on rural New Brunswick, shows a major disconnect.

It also raises a key question for these two MLAs. Did they not understand the necessity of the changes and how they could actually benefit their constituents? If they didn’t, if these changes were as big a surprise to them as they were to the rest of us, that means the Premier seriously dropped the ball. But if they did know, it raises the question of where an MLA’s responsibility lies. Should they stand with their constituents, even if they know that once the dust settles those constituents will actually be better served healthcare-wise if the changes are made? Those protesting the changes praise Northrup and Gauvin for standing with them. That’s understandable given the situation was never effectively communicated to them. But was it the right thing to do? I don't know the answer to that. An MLA shouldn’t function as part of some nanny state, determining what is best for people, but is there ever occasion when their responsibility is to act in the best interests of their constituents even if those constituents don’t realize it at the time?

But what if the communication had been done effectively. It certainly wasn’t but even if it was, would it have made a difference? Not necessarily.

Photo Credit: pinterest.com

The late business management guru Peter Drucker once said “culture eats strategy for breakfast.”  The poor communications aside, this as well is something the Higgs government should have considered.

To put Drucker’s famous quote into context, it doesn’t matter how much sense closing these ERs overnight makes. It doesn’t matter how extensive the benefits to the local community would be. None of it matters because that’s strategy and it can’t compete with culture, which is having an ER open 24/7, just in case.

Photo Credit: en.horizonnb.ca

St. Thomas University Communications Prof Jamie Gillies touched on this on a panel on CBC Radio last Friday when he said that people in Canada consider emergency rooms to be the first line of defense in health care. To paraphrase him “if you get sick anywhere in Canada you always have an emergency room to go to.” He added that to take that away in a community, even though it would only be for eight hours through the night, people would see it as the same as losing their hospital.

Now, part of the redo involves further consultation. But on the radio just this morning, the mayor of one of the affected communities said that no matter what, 24/7 ER service in his town is non-negotiable.

That’s the culture.

Anyway, the whole fiasco made for an interesting and insightful week as I guess is inevitable when a government does something that takes it to the brink. I couldn’t help but notice the major divide on social media between those who saw the announced changes as an attack on rural New Brunswick, and those who applauded Higgs because they felt they were finally seeing a government with the guts to do the unpopular to save a health care delivery system that is unsustainable.

But which side will carry the day? Is the takeaway for Higgs from all of this, to back away from any unpopular changes to health care delivery whatsoever, for fear of losing the government over it, or is it that New Brunswickers finally understand that change is necessary, and will be accepted as long as it is communicated well and rolled out properly?

I like to think the latter, but I shan’t be betting on it.

Thank you for reading. And remember, shares are always appreciated.