I have a lot of empathy for you, Minister of Health, and for all the staff of this great health and social services system. I have even more for those who have to resort to hospital emergencies. We all admit that the problems have been going on for decades. We understand that there is no magic or instant solution. However, beyond putting out fires would require a paradigm shift since past solutions have proven unsuccessful.
With all due respect, it seems that the current efforts will not be enough to unclog the emergency room. In this short message, I would like to invite all the players in the system to go beyond the established patterns and to imagine new solutions.
One could, to use an image, say that the emergency situation is like “the canary in the mine”, an indicator of what is not working in our system. This is focused on healing and is characterized by medical-hospital-centrism. There would be a whole analysis to be done on this subject, but that is not my point. There are different types of problems, some are temporary, others structural.
Some specific solutions can alleviate the problem, but they are insufficient, such as the addition of socio-medical-hospital personnel. The main limitation of this solution is that these resources are rare and that their training requires a lot of time. Their positive effects will only be felt in the medium or long term.
To continue with an allegory, one could say that the emergency situation is like a culvert built for a certain volume of water. In the event of a major flood, it overflows and it could be washed away. The road teams will tend to monitor the bridge, to consolidate it to deal with the most urgent. This is what is happening in our network right now. All players are focused on day-to-day emergencies. It’s a normal reflex, managers and stakeholders have no choice. They have to face the crisis.
But who in the network can take a step back and imagine practical and realistic solutions? Do we really know the profile of emergency users? Do we know what proportion of users should be referred elsewhere? I assume that this information exists in certain research centers or organizations. Is this information brought to the attention of the Minister?
Back to our flooded culvert… Who works to regulate and reduce the volume of the river?
A matter of education
The overcrowding in emergency rooms is not primarily due to a deterioration in the state of health of the population. Is it not rather attributable to the lack of health education and the weakness of community care upstream of the disease?
Much remains to be done in health education, but who is in charge? For example, consider the positive impacts on health and quality of life of anti-smoking campaigns. How many cancers and other diseases have been prevented in this way? No one can deny that the reduction in smoking has reduced the number of hospitalizations and visits to emergency rooms over the past thirty years.
Institutionally, our CLSCs are the weak link in the front-line network. They are a far cry from the initial design planned by the Castonguay-Nepveu commission. The establishment of real minor emergency services in CLSCs could ease the pressure on hospital emergencies, which would become, in a way, second-line services.
Preventively, greater investment in health-related social economy enterprises and in community organizations would also help reduce the pressure on emergency rooms. For example, let us mention that crisis intervention and suicide prevention centres, detoxification clinics and shelters for the homeless help alleviate emergencies.
Having served on the board of some of these organizations, I know how vulnerable, under-resourced and under-funded they are. It should be noted that there are regional disparities in this matter. It would not be a matter of simply devoting millions to this sector, but of developing a new strategy and reorienting the system towards prevention and the strengthening of social ties in our society.