On December 12th, I wrote about how the BC Government, under its new agreement with the Doctors of BC, will be providing money to help doctors work with health authority administrators and others to foster health system improvements. Dr. Ron Collins' story about how he became a champion for change shows why encouraging physicians to come forward with their good ideas is so essential to the health system.
Dr. Collins is a Kelowna anesthesiologist who is a physician lead on the Enhanced Recovery After Surgery (ERAS) project now underway in 10 sites in BC. As I wrote on Dec 17th, the ERAS goal is to reduce patient surgical complications, speed healing and shorten hospital stays.
Collins is passionate about smart and effective health system improvement. But Collins didn't always feel so engaged. In fact, for about the first 15 of his 23 years in Kelowna, he did his job diligently at the Kelowna General Hospital, but did not bother to get involved in the tussle and fray of systems change.
"Up until then, I'd happily gone to my operating room, done my work, and gone home at the end of the day," recalls Collins, now 60. “Back then I would have described administrators as the enemy; they seemed solely interested in penny-pinching, and sometimes that undermined our work on the front line."
Collins will never forget a key incident, however, that helped change his view. It was around 2006, when a bulk order came in with a new type of kit for epidural anesthetic delivery — the injections of drugs into patients' spinal column to alleviate pain. "The anesthesiologists hadn’t been included in the decision to change. It was a vastly inferior product. I was head of the department and after a week of trying to work with it, I declared it clinically unsafe. But it was going to cost the hospital a lot of money to break the contract with the supplier."
In a tense hospital meeting, with many people present, Collins demonstrated the problem, showing the deficiencies of the new version compared to the old. Dr. Collins also pointed out the flaw in the decision process where the doctors who had to use the product daily were not even consulted on which product to buy.
He fully expected to be reprimanded by hospital superiors, whom he assumed would only be interested in cutting costs. Instead, he was supported and lauded for coming forward; the contract was broken, the previous product promptly reinstated. But for Collins, the pivotal moment came at the end of the meeting when current Interior Health (IH) president and CEO Dr. Robert Halpenny, then VP of medicine, told him: "You are absolutely right about flaws in the process, and if you have some ideas, I'd love to hear them.”
Now, for the last decade, Collins has brought forward a lot of ideas — and has become an ever-more active champion for innovation in patient care and physician-led change in the Interior and across BC. He is now being invited to speak to groups across Canada about how to foster physician-engagement and how to bring about smart change in the vast and complex behavioural culture of health care.
Most recently, he is the lead on the ERAS project, which aims to transform the whole process of care around surgical procedures, starting with colorectal surgery. As detailed in a previous post, the ERAS project is part of a world-wide movement that includes putting in place over 20 processes of care before, during and after surgery. Through extensive research, these new processes seem to get patients healing better and faster, while reducing surgical complications and shortening hospital stays. A win for all, as they say: better patient outcomes, more availability of hospital beds and more cost-effective surgical budgets. The project is being funded by the Specialist Services Committee, on of the joint committees of government and Doctors of BC.
Collins has an important message for other BC doctors: "The health care climate has changed in BC. There is an increased emphasis on quality and physician engagement ... bring your ideas to the table. It is not that scary once you are in the door."
Not only is it not so scary, now $18 million over five years under the 2015 Physician Master Agreement has been earmarked to support doctors to come to table with their ideas. Doctors can usually only bill for direct clinical care given to patients in specific billing codes. Now, as a first in Canada, doctors in BC will be compensated for the time such meetings and involvement will take. The health care climate, indeed, is changing in BC.