The “tipping point” is a concept first identified by Malcolm Gladwell in 2000 as “the moment of critical mass, the threshold, the boiling point.”
For many years, we have heard about inadequate funding of the health system, serious provider shortages, our aging workforce, heavy reliance upon part-time and casual staffing, low morale and productivity, streamlining the health system, and improving the quality of health services, patient safety and access to the system. Numerous initiatives have been implemented, with some having success in improving the health system’s effectiveness and efficiency.
These initiatives and our work are set against the backdrop of the health system’s increasing lack of affordability and the fear that, at some point, we will “hit the wall.” The health system’s ever increasing costs are rapidly consuming other worthy public expenditures, particularly social programs such as education and training, personal and family supports, and community and recreation.
The recent Canadian Institute of Health Information (CIHI) report notes that health care costs have reached $5,800 per year per person. “Total spending on health care in Canada is expected to grow by more than $7 billion this year to reach a forecast $200.5 billion in 2011. Spending is expected to increase by 4% over last year, the lowest annual growth rate seen in the last 15 years. The average annual growth in health care spending between 1998 and 2008 was 7.4% – higher than inflation and population growth.
CIHI’s President and CEO, John Wright stated, “…In light of global economic uncertainty and efforts (in Canada) to address government deficits, it’s important to examine what’s been driving health care costs in order to better plan for the future of the health system” (CIHI).
When do we reach the tipping point – that is, when our expenditures on health care leave no room for any other public expenditures? Given that nearly three quarters of health care expenses relate to human resources, are there not possibilities to be far more effective and efficient? Can health care be delivered more safely and with higher quality at the same time?
The Health Profession Act’s fundamental concepts (in 2000) of competencies and overlapping authorities to perform restricted activities have yet to be realized. Instead, we continue to focus on “scopes of practice,” which often belie poor utilization of regulated nurses (LPN, RN and RPN), workplace issues, morale, collective bargaining and inter-professional tensions.
LPN’s could contribute far more regulated nursing competencies in the public health system. In the summer of 2011, one half of respondents to the CLPNA’s survey observed that they were fully utilizing their knowledge, skills and clinical judgment at work. This is a modest improvement from the CLPNA survey in 2002, when only one third of respondents indicated that they were fully utilizing their competencies.
The current circumstances are not fiscally responsible. They are not in the interest of quality care and safety. They reduce pride in the nursing professions, and contribute to significant and expensive burnout and turnover.
We must truly demonstrate progress on a system-wide, as opposed to “demonstration project” scale. Let’s begin by abandoning the old terminology – scopes of practice, turf battles, territoriality, my tasks versus your tasks, inter-professional rivalries, staff mix, etc.
The CLPNA is heartened in its recent discussions with Alberta Health and Wellness, Alberta Health Services, the three nursing regulatory colleges, educators and other stakeholders to create a compelling vision and action plan for collaborative practice.
We must avoid reaching the tipping point with our precious health system and nursing health human resources.
Canadian Institute of Health Information (CIHI) retrieved from www.cihi.ca.