Quality, cost, and continuity – A reflection on Falling Through the Cracks: Greg’s Story

Posted May 24, 2018

Dr. Greg Powell, O.C., MD FRCPC

The business of any healthcare system is that of helping people. When people think about their healthcare experience, they reflect on the care they received and what happened to them, or the outcomes of that care; these are the core features of healthcare quality.
Healthcare Quality and Safety Management: A Framework for Alberta, July 2017

Last week, I had the opportunity to attend the premiere of the short film Falling Through the Cracks: Greg’s Story. This film tells the story of a young man, Greg Price, and his journey through the healthcare system that ultimately ended in his unexpected and tragic death.

I have extensive experience with the Canadian healthcare system, both as a patient and provider. My expertise lies in emergency medicine, so I am all too familiar with unexpected and tragic loss. However, Greg’s story is not about a sudden accident. Greg’s story is about getting a diagnosis and treatment, and the gaps in communication along the way that prevented him from receiving timely, quality care. The film does an excellent job of showing us what his care journey felt like and unfortunately, it feels uncomfortably familiar and relatable. Even with limited experience with the healthcare system, it is very easy to see how Greg was able to ‘fall through the cracks’.

Last week’s film screening also included a panel discussion about the implications of this film for Albertans and Alberta’s healthcare system. What an impactful conversation among the panel members and with the audience. I hope that others, like myself, walked out of the theatre thinking perhaps progress is possible if we put our shoulder behind it.

That is the catch, though. What should ‘putting our shoulder behind it’ look like? And, do we have the courage to push?

With respect to the second question, I say yes. There is an increasing appetite for innovation in healthcare in Alberta, making this an opportune environment to put time and energy into this. Also, we are not doing this alone. One of the questions posed by the film audience was, “Is this problem uniquely Albertan?” The answer to this question was simple: No. Making improvements to continuity of care* is a priority for many jurisdictions, across Canada and internationally.

So, we are in this together as we consider, develop, and implement solutions to improve continuity of care. As we do this, we should be considering the foundational work done by the Health Quality Council of Alberta (HQCA) in their 2013 and 2016 reports that identified and then followed up on recommendations on how we can stimulate the greatest improvement in continuity of care for the greatest number of patients. Now, as we engage further in this work and revisit those recommendations, there were three points from the panel discussion worth raising to make sure they stay top of mind and are not sidelined or lost in the hustle bustle of our day-to-day responsibilities.

It’s not about public vs. private

Rather, as stated by one of the health experts on the film discussion panel, “It is about a blend of public and private healthcare that is well-regulated.”

I appreciate that creating this balance and accountability structure would be complicated. However, we (Albertans and Canadians) should feel more urgency to try and simplify the steps to get there and make this goal achievable.

Manage your own healthcare information

Until we have an integrated health system, patients must become partners and advocates to proactively manage their own healthcare. This includes managing healthcare information. Alberta does not have a clinical information system (CIS) that allows providers to access all of our healthcare information. So, patients need to be prepared to ask questions and provide answers to their care team. Additionally, patients can and should feel confident to ask for copies of their healthcare information (e.g. test results) and help to understand that information.

We should focus our conversations and actions less on cost and more on quality

When we sit down to have conversations about how to improve healthcare for Albertans, the Alberta Quality Matrix for Health dimensions of quality: acceptability; accessibility; appropriateness; effectiveness; efficiency; and, safety should be the North Star. This common language for quality was agreed upon by Alberta’s health system leaders more than a decade ago and still resonates.

However, in my experience, current conversations about healthcare quality get derailed by a preoccupation with cost. This opinion was reinforced during the panel discussion at the film screening.

So, it begs repeating until we can reprogram our thinking and reactions to proposed change—

Improving healthcare quality does not equate to increased costs. In fact, just the opposite. Cost savings are actually realized by addressing the six dimensions of quality.

In closing, I strongly encourage you to see this film and consider what you can do, both individually and in your community, to ‘put your shoulder behind it’ and make quality a priority in healthcare.

Dr. Greg Powell, O.C., MD FRCPC, is Vice-Chair of the HQCA Patient and Family Advisory Committee


* Continuity of care can be defined as “the degree to which a series of discrete healthcare events is experienced as coherent and connected and consistent with the patient’s medical needs and personal context”. 2013 Continuity of Patient Care Study