Is Time Really Money?

Improving the efficiency of what we do is on everybody’s radar these days. Our health care system, our hospitals, and our clinics are no exception. Efficiency stands for doing things right. Doing things right is per se not wrong: nobody can reasonably argue with seeking to eliminate organizational waste in order to deliver health care in a sustainable fashion.

Sustainability, however, pertains to aspects beyond economics and from a provider perspective includes, in my opinion, things that are more difficult to assign a $ value to, such as work place satisfaction and employee engagement. “The only way to do great work, is to love what you do”, as Steve Jobs is quoted having once said. Seeking efficiency by top-down defining the route to the goal in every detail and forcing to fill in yet another form to prove compliance, whether on paper or electronically, adds more often nothing than administrative waste. In fact, it may hinder true productivity of health care delivery to our patients. Too many regulations lead to disengagement of those who do the work, as they become frustrated by feeling forced to just follow the rules (often in front of a computer screen) set by some remote administrative body and no longer being able to focus their energy on what is dear to their heart, e.g. caring for patients. Do those who do the work on the ground not often know best how to reach the goal by adapting their approach to a changing situation/environment? Would it not often be better to clearly define the goal of the organizational unit, not the path to it, and just hold frontline staff accountable for reaching that goal? In many countries, even prototypic hierarchical organizations such as the military have learned their lesson and adopted a goal oriented command model.

Moreover, delivering health care is not a simple assembly line and consists of more than a series of technical processes that are amenable to optimization by engineering. Thus, trying to optimize efficiency in health care delivery using a similar approach to that established for a production plant or an assembly line of cars may defeat its purpose. In fact, it may create new organizational waste – and potentially more than it intends to eliminate. By feeling forced to shut down common sense, providers run the danger of bringing to perfection complying with a “system” and its “administrative processes”, i.e. focus on doing highly efficiently what hinders efficient delivery of care to the patient.

Effectiveness is another fashionable word these days. And efficiency and effectiveness are often and wrongly used interchangeably. Effectiveness, however, stands for doing the right things. We can hardly dispute that health care delivery should be effective. But what is the “right thing” in delivering health care? In a very broad sense, one may say, the right things are to help an individual to stay healthy (prevention) and, if that fails and the individual falls sick, to support the healing process (treatment); sometimes healing (cure) is no longer an option and minimizing suffering (palliation) has to suffice.

Prevention, healing and palliation require content competency with respect to knowledge and technical skills. One may call this the science of Medicine. Effective prevention, healing and palliation, however, go far beyond scientific content aspects and encompass not only interpersonal skills, but even broader domains of human existence. All too often we seem to forget about these. We all have anecdotally witnessed that the best delivery of evidence-based interventions can be futile if a patient has given up fighting. Healing is not fully promoted by efficiently and effectively delivering an evidence-based intervention. Healing encompasses more including promoting the well-being of a sick individual in all his/her dimensions. Only this enables a patient to add his/her part to the healing process and allow making the evidence-based intervention a success. Terms such as Medical Humanities and the Art of Medicine try to address these other dimension of healing. These may include supporting the healing process by healthy food (would you order our hospital food for dinner?), a view of or, even better, spending time in a hospital garden (where have they gone?), exposure to the soothing atmosphere of music or visual art (could you relax on one of our wards?), the company of a caring support person (is there room for them in our patent rooms?), or a comforting chat with a provider (do we have time for that?).

Our hospitals may have become and may continue to become more efficient, but doing efficiently what is not effective, misses the point and is the worst that can happen in an enterprise. Let’s not forget about the other than fiscal dimensions that contribute to effective health care delivery, let’s strengthen the art of medicine and the humanities component of health care.

Recommended reading: God’s Hotel by Victoria Sweet (https://www.amazon.ca/Gods-Hotel-Hospital-Pilgrimage-Medicine/dp/1594486549)

Dr. Peter Nickerson Awarded Medal for Research Excellence

Dr. Peter Nickerson has been awarded the 2018 Kidney Foundation of Canada’s National Medal for Research Excellence.

The award highlights the enduring impact Dr. Nickerson has made to kidney research and the field of transplantation medicine, and acknowledges his record of exceptional accomplishments and contributions at a national and international level.

Dr. Nickerson is a Distinguished Professor of Medicine, Departments of Internal Medicine (Section of Nephrology) and Immunology, Vice Dean (Research) in the Faculty of Health Sciences at the University of Manitoba, and holds several other senior positions including the Flynn Family Chair in Renal Transplant at the U of M.

“As part of a team of renown transplant researchers at the University of Manitoba, Dr. Nickerson is working to unravel the complex factors that influence the success or rejection of a transplanted donor organ. His research focuses on mechanisms of acute and chronic kidney transplant rejection, immunogenetics, non-invasive diagnostics monitoring immune activation, and health policy and system design.”

Please join us in congratulating Dr. Peter Nickerson on this well-deserved acknowledgment from the Kidney Foundation of Canada for his record of outstanding accomplishments in the field of renal transplantation.

 

Congratulations

The strength of any department lies in its’ members and their achievements and awards. Congratulations are extended to:

The United States Patent and Trademark Office (USPTO) has granted a patent to Dr. Suresh Mishra’s team in the Section of Endocrinology & Metabolism on novel “preclinical models for obesity and obesity-linked cancer (Mito-Ob)”. These preclinical models are developed using an innovative approach by simultaneously manipulating adipose and immune functions in the body. Consequently, they spontaneously develop obesity and obesity-linked cancer in a well-defined timely manner, and have created new research opportunities. Their various uses include: 1) Discovery and development of new therapeutic targets for obesity and obesity-linked cancer, 2) Various types of intervention studies and 3) Preclinical drug screening.

Dr. Daniel Sitar, Professor  Emeritus Section of Clinical Pharmacology, has been granted an Honorary Life Membership Award by the College of Pharmacy of Manitoba for meritorious service and professional contributions to Pharmacy.

The Aubie Angel Young Investigator Award for Clinical Research Committee selected Dr. Chris Wiebe (Section of Nephrology) as the 2018 recipient of the Aubie Angel Young Investigator Award. The awards ceremony will take place Tuesday, June 12 at 10am in Theatre B in the Basic Medical Sciences Building.

The 2018 Internal Medicine Residents’ Educator of the Year Award was presented to Dr. Aditya Sharma (Section of General Internal Medicine) in recognition of his dedication and teaching excellence.

Congratulations are extended to Dr. Justin Cloutier who was selected by the 2018 Max Rady College of Medicine and Presidents Council Residents Appreciation Reception planning committee as this year’s recipient of the Resident of the Year Award.

The Dale Iwanoczko Award was awarded to Dr. Jeffrey Wheeler in recognition of his outstanding contribution to the Core Internal Medicine Residency Program demonstrating commitment, compassion, caring and integrity.

The Internal Medicine Subspecialty Resident Teaching Award, recognizing a subspecialty resident who exemplifies excellence in teaching and supervision, was awarded to Dr. Rachel Fainstein.