Pressure and intimidation used to sell new Saskatchewan Surgical Initiative

The Saskatchewan Surgical Initiative (SSI), a plan to shorten surgical wait times and improve the experience of surgical patients in Saskatchewan, was publicly released by Health Minister Don McMorris at a Regina news conference on March 29, 2010.

Among the plan’s 25 initiatives will be a surgical referral website for patients, standardized safety checklists in operating rooms and contracting of third-party surgical care [i.e. private clinics] to increase the province’s surgical capacity, a provincial government news release said.

The plan is in response to the 2009 Patient First Review (released October 15, 2009) and the Wall government’s promise in throne speech on October 21, 2009, to reduce surgical wait times in Saskatchewan to no longer than three months over the next four years.

Surgeons, family physicians, nurses, therapists, health care administrators, health sector organizations and associations, health unions and former surgical patients collaborated on the plan.

“The Saskatchewan Surgical Initiative is guided by the cooperative effort of two important advisory groups,” the plan states.

“The Executive Sponsorship Group provides strategic leadership, advice and direction for the Surgical Initiative and champions the transformation of the patient’s surgical experience in Saskatchewan. This group represents higher-level decision makers and is made up of 22 members from the Health Quality Council, Regina Qu’Appelle, Saskatoon and Cypress health regions, Saskatchewan Union of Nurses, College of Physicians and Surgeons of Saskatchewan, Saskatchewan Medical Association, Saskatchewan Registered Nurses Association, Kaizen Institute Lean Advisors, senior leaders of the Ministry of Health, and two patient advisors.

“The Guiding Coalition represents the front line experience and is comprised of 65 members including physicians, nurses, therapists and other providers, all 12 health regions, health care unions, regulatory bodies, Health Quality Council, Ministry of Health, and three patient advisors.”

In his message in the report, McMorris said the plan “is just the beginning of a transformation of the broader health-care system. In time, other initiatives will follow, such as improving primary health care and fully realizing our vision of a patient- and family-centred health system.”

To achieve this end, the report concludes that a sustainable health system requires “unity of purpose and alignment of priorities.”

“If everyone is working to put patients and families first, that common vision helps to inform even the most difficult choices about service delivery and resource allocation. With everyone pulling in the same direction, there is much less waste of energy. This has been seen with the Saskatchewan Surgical Initiative, where the differing perspectives and interests of providers, administrators, and patients, and others are coming together in an exciting synthesis.”

The “success” of the plan “will depend on the energy, innovations and commitment of the thousands of health care professionals and providers, leaders and managers, patients and families who affect or are affected by the surgical care experience.”

What remains unclear is how the Wall government plans to get health care workers to buy into the initiative and pull in the same direction. Part of the answer might be contained in the meeting notes for the Executive Sponsorship Group (ESG).

Records obtained from the Health Ministry through a freedom of information request show that the ESG met at least twice before the Patient First Review was released and the Wall government’s speech from the throne.

The notes of the September 2, 2009, meeting indicates that the role of the ESG is to: “Champion the transformation of patient’s surgical experience in Saskatchewan.”

“Specific Actions” of the ESG include breaking down “artificial barriers” among regional health authorities, institutions and organizations. It also involves using “influence” and “policy” to make life “uncomfortable for people to maintain the status quo.”

The ESG will “demonstrate courage and commitment” by “staying the course,” and not being afraid to “tackle the tough conversations.” It will be “unified around our vision – moving towards a common vision.”

The “General Required Actions/Behaviours” of the ESG includes an “unwavering commitment to vision and aims” while asking “the tough questions of the Guiding Coalition and others.”

It would appear that the government is prepared to tackle any dissension or resistance to its plan with pressure and intimidation.

The ESG conducted a teleconference on October 29, 2009 – the same day the Wall government issued a news release officially announcing that a “surgical care working group” had begun work on developing an “implementation plan” to improve surgical care and reduce wait times. The meeting notes provide the names of those that participated or weren’t able to attend. The group’s composition is clearly top-heavy in Health Ministry representation.

At the meeting, the group agreed to add one patient advisor to the ESG membership, and 3 patient advisors to the Guiding Council (GC).

It was also agreed that union representatives would be invited to join the ESG and GC. However, it appears union involvement came with the understanding that it would be for “perspective and advice, not advocacy.”

The next meeting of the ESG was held on November 20, 2009. Records also show that the group was scheduled to meet again, in Saskatoon, on January 25, 2010.

The meeting notes give no indication whether the ESG will disband once the implementation plan is completed or carry on as the Wall government’s transformation of health care in Saskatchewan continues.