Dr. Peter Blair is the Program Medical Director of Surgical Services at Fraser Health and a surgeon for over 30 years. During our conversation, Dr. Blair described how Fraser Health was able to reduce surgical wait lists by broadening their surgical services to more effectively meet the needs of patients. He also shares insightful commentary about the complexities of our healthcare system.
Q: You are currently the Program Medical Director for Surgical Services at Fraser Health.
PB: I went into administration five years ago because I wanted to make a difference at a broader level across the healthcare system. But it was challenging to manage my surgical practice and the obligations I had to my patients with my administrative work. So now that I’m retired from surgery I have more time to support our 11 surgical sites, such as the new Jim Pattison Outpatient Care and Surgery Centre, which I enjoy.
In my new full-time role, I’m looking forward to making change at the Health Authority level, but also at the provincial and maybe even national level. In my mind, when you’re looking down from 30,000 feet you see the “big picture,” not just individual systems or services, and that’s where I hope to make the most impact.
Q: Fraser Health has reduced surgical wait lists substantially. How did you do it?
PB: Well, I’ll start by saying it was a team effort. We have an excellent team of data analysts and other experts at Fraser Health and together we’ve been looking at this for two years now.
It really comes down to data – having the right data available and the right people to study it. We collected all the data we could about surgical wait times and worked with surgeons’ offices to help them prioritize patients who were on the wait list.
We started with patients whose health situation had changed and they no longer needed surgery, or had moved away, and removed their names from the list. We then focused on patients who had been waiting for surgery for a long time, that is, over the 52 week target set by the province. These patients were moved to the top of the list and we got them done.
Essentially, we re-distributed our surgical services by adjusting the surgeon’s existing OR time, or by finding extra OR days at a different facility. It actually worked quite well.
Of course, there was a budget we needed to work with to make it all happen. We hope to maintain this level of service at Fraser Health over the next year.
Q: Why was this so important to you and your team?
PB: It was very clear that something had to be done. As a surgeon for many years, I’m very passionate about equal access – it’s one of the tenets of the Canadian healthcare system – and getting people off the surgical wait list is one way we can equalize access.
It took some time and cooperation for things to fall into place, but when you talk about OR time surgeons pay attention. It’s their professional trademark, if you will. It’s no secret this profession attracts individuals who love to work hard and the standards for surgeons are extremely high. That’s terrific because we’re providing excellent care to patients, but it can also create an influx in the number of patients waiting for surgery. We can only manage that within certain limits, so it’s really about making decisions that improve the way we deliver care to patients.
At the end of the day we’re here to meet the patients’ needs and it’s important for clinicians to work together. We’re doing that more than ever before and it’s phenomenal to see.
Q: Has the emphasis on patient-centred care made a difference to your work?
PB: Definitely. Patient-centred care is obviously something we should be doing anyway, but I think Fraser Health’s new mandate which aligns to the Ministry’s has highlighted the way we need to focus our efforts. As clinical professionals you have to put the patient in the middle – if we all do that then we can’t go wrong.
I also think it’s brought more awareness to patient safety. Hospitals are expected to be transparent about outcomes. We know that complications can have a profoundly negative impact on patients and the entire healthcare system. Adverse events are costly and they interfere with our productivity. So I think it’s great we are taking a closer look at our safety profiles.
I’ve certainly seen a shift in healthcare culture over the past few years. I think this will benefit patients, but also improve our services and reduce healthcare costs.
Q: Only a small percentage of doctors use PSLS to report safety events. Why do you think that is?
PB: You need to simplify the form, make it quicker to complete. A colleague of mine says he asks nurses to report adverse events in PSLS because “it takes too much time.” This is something I hear a lot.
The other interesting challenge is that surgeons tend to not use their Health Authority email. So at Fraser Health we’ve started notifying surgeons about a PSLS event in their personal email and sending a link to the event in their Health Authority email. It’s a start, but we need to do more if we want reporting to become standard practice for doctors.
It’s my view that all care providers, regardless of their position or title, need to be on top of patient safety and see value in reporting and learning systems like PSLS. Doctors can no longer say “that’s the nurse’s job.”
Q: So attitudes are changing?
PB: Yes, I think so. There’s a lot more trust between surgeons and administrators than when I started in this profession 30 years ago. There used to be conflict between doctors and healthcare leaders, for example, but now that’s virtually gone. We’ve come a long way in how we work together, so we’re able to move forward if it means better care for patients.
The demographics have also changed. I started at a time when most surgeons were men. Today we see a lot more women in surgery, and other clinical professions, and I think this is having a positive impact on how our healthcare system will evolve. There’s certainly a greater emphasis on building relationships, working together to resolve differences, which is great.
Q: Does that make you optimistic about the future of healthcare in BC?
PB: I’m optimistic by nature, so yes, but I do have some concerns. At the top of my list is sustainability. When you compare our system to others in the world, particularly Europe, you begin to see that what we offer patients is actually a fairly bare bones range of services. We certainly have a lot of pride in our healthcare system, but we don’t rank at the top and we have a lot of work to do in terms of sustainability. Our healthcare system makes up 40% of our provincial budget, so where’s that going to end up?
But, generally speaking, I think we’re on a good trajectory forward.
Q: What can we do as a society to help sustain our healthcare system?
PB: One thing we can do is help people understand what it means to live a healthy lifestyle – 15% of British Columbians still smoke and that’s a huge cost to our healthcare system. Obesity and lack of exercise are the other big areas.
We need to educate the public about health, but a public advertising campaign isn’t going to change anything. We need to look at society as whole. If we really want to improve our healthcare system we need to reduce poverty and work on providing equal access for the same services – look at the big picture.
You can reach Dr. Blair by email at Peter.Blair@fraserhealth.ca