Herb Emery is a professor at the School of Public Policy at the University of Calgary.The recently elected NDP government in Alberta raised eyebrows with its relatively small cabinet of 12 ministers. But that is just a taste of what is to come. Unless Premier Rachel Notley can achieve what PC administrations failed to do and halt the inexorable increase in health-care spending, she will soon have an even smaller cabinet. Just two: the Premier and her minister of health. Spending on health care in Alberta is very high and is increasing quickly. Since 1980, the amount spent on health has increased from 18 per cent of all provincial government revenue to more than 40 per cent. The amount devoted to all other spending has, of course, correspondingly fallen: from 82 per cent of revenue in 1980-81 to less than 60 per cent.Over the period 1999-2000 to 2013-2014, spending on health grew at an average annual rate of 8.7 per cent while total provincial revenue grew at an average annual rate of 6 per cent.

This is the crux of the problem: The cost of health care is growing significantly faster than government revenue.As a result, we face the prospect of steadily declining investments in education, social services and other spending. Less than 20 years from now, health spending will absorb more than 65 per cent of all government revenue. The “problem” with health care has never been a shortage of money. The problem has been that we are not getting better outcomes for having thrown so much of our tax revenues at it.Despite the enormous increase in spending on health, Albertans have no better health outcomes or access to service than other Canadians or than they enjoyed 20 years ago.Those are the facts. Given those facts, what can be done to protect spending on education and social services and all the other components of non-health spending from being steadily eroded by health care? Can we raise tax rates? Raising tax rates will solve the problem only if we raise them a bit more every year.

Since we eventually run out of income to give to the tax collector, this can only delay the inevitable.Can we find “efficiencies” in the system? Alberta spends more on health care than all but one other province to achieve comparable health outcomes. From this perspective, Alberta health care has plenty of funding, but does not use it well. Simply cutting out fat has not proven to be successful over the long-term. Fairy Lights For RentWe know that is true from our experience with the Klein-era cuts. Buy Nike Shoes BulkThose efforts resulted in only a temporary lull in the inexorable increase in health spending.Best Pond Vacuum CleanerCan we cut back on what the health-care system provides? Yes, but understand that this means delisting medical services and merely shifting responsibility for payment from taxpayers to the patient.

It means asking Albertans to pay out of pocket for their health care, and for those unable to afford care to go without.Are those our only choices? Yes, they are, unless we consider changing the emphasis of the publicly funded health-care system away from acute care – fixing us when we break – and toward maintaining our health – keeping us from breaking. This will reduce the flow of people into the acute-care system and save the publicly funded system from going broke. This requires a re-orientation of scarce dollars away from acute care and toward an investment in preventive health care. Importantly, it requires a challenge to the status quo that emphasizes acute care to the detriment of investments in health promotion.We need to move from paying for services provided by doctors and/or a hospital to paying for services provided by an appropriate professional in an appropriate setting.We should have a payment structure in health that covers care in the community, and team-based and patient-oriented care.

Other provinces are experimenting with these approaches. We should be watching and learning, and even trying these new approaches.These changes are not simple, and with the election of the NDP, we are about to learn if the problems with health care were the fault of the long-serving PC government or vested interests wanting to sustain an inefficient, unnecessarily expensive medical treatment system with little regard for the interests of patients or the health of Albertans. This practice was recognized as an Emerging (Commendable) Practice by the Health Council of Canada using the Health Innovation Portal Evaluation Framework SNAPSHOT:  This innovative practice has been developed as part of a provincial quality improvement effort to enhance the patient journey, improve health outcomes, and standardize care delivery. Established throughout Alberta in 2011, the purpose of the Strategic Clinical Networks is to engage clinicians and patients in decision-making about clinical services planning and to support clinical practice improvement by implementing clinical practice guidelines (CPG), developing care ‘pathways’, improving the patient experience and more.

Strategic Clinical Networks (SCNs) have been developed in Alberta as part of the province’s quality improvement effort to enhance the patient journey, improve health outcomes, and standardize care delivery. Essentially, SCNs are province-wide teams comprised of health care professionals, researchers, community leaders, patients and policy makers, organized around a specific clinical focus.  The purpose of each network is to engage clinicians and patients in decision-making about clinical services planning and to support clinical practice improvement by implementing clinical practice guidelines (CPG), developing care ‘pathways’, improving the patient experience and more. SCNs were established throughout the province in 2011. Alberta began with six focused networks: One senior leader in Alberta has described a SCN as “… almost like a program-based model of delivery where you get a group of health care professionals, largely physicians - but not exclusively physicians - together to talk about how they can systematically standardize the care for important populations of patients.” 

Another leader stressed that “the networks get diverse groups to start working together on common targets, standardizing care pathways, and then showing that it actually [makes] a difference to the patient’s experience and the patient’s outcomes.” Each SCN has been asked to align their work with Alberta Health Services’ priorities, as well as provincial priorities and take on a major “reassessment” project, with the goal of identifying and potentially eliminating harmful, outdated, ineffective and/or inappropriate processes, procedures, technologies, drugs or care programs.  Each SCN has been asked to develop a focussed research and innovation program, in collaboration with academic partners.  Since a large part of the work of SCNs is implementing clinical practice guidelines, there is also collaboration with, and learning from, groups doing similar work in other provinces.  Finally, the aims of Alberta’s SCN initiative align with the Institute for Healthcare Improvement’s (IHI) “Triple Aim framework” which is predicated on: improving the health of the population;

enhancing the patient experience of care (quality, access and reliability); and reducing/controlling the cost of care, or adding “value for money.” Scientific literature has shown clinical networks to be a proven model in reducing variation and improving care, by promoting the use/uptake of clinical experience, knowledge and research.  As well, clinical networks have been proven to be effective mechanisms to ensure collaboration, joint decision-making and shared learning. The Strategic Clinical Network’s approach—involving a collaborative structure, integrated decision making and physician and patient engagement—is a recent development and has yet to be formally evaluated. Within Alberta Health Services, there are plans for each clinical network to undergo an assessment according to a maturation framework developed from existing corporate instruments and approaches. The purpose is to make an assessment of a network’s ‘baseline maturity’ and establish appropriate characteristics by which to measure a network’s trajectory of maturation.

Periodic evaluations will help to ensure that the SCNs are maturing and developing in such a way as to achieve their goals. Additionally, a Collaborative Research in Outcomes (CRIO) grant from Alberta Innovates – Health Solutions will facilitate a future comparative study comparing Alberta’s new strategic clinical networks with similar networks in the province of New Brunswick. The research study will evaluate outcomes in four networks (two from each province) in a comparative case study design. Earlier pilot work verified the feasibility of such a study and informed the design of the evaluation plan. Many high performing health care systems have adopted a system-wide approach to establishing, promoting, and implementing evidence based clinical best practices.  In its development, Alberta’s Strategic Clinical Network approach reviewed the experiences of clinical networks implemented in other jurisdictions, including Scotland, England and Australia. These models also informed the design of the Operational Clinical Networks (OCNs; ie.

Critical care, emergency, and surgery), that have been established in Alberta. “Lessons learned” for effective network design and success factors were also taken from the experience of the Canadian Institutes of Health Research (CIHR) and its 13 partner institutes throughout the country. Within the province of Alberta, there are plans for the SCN model to be further expanded to other clinical domains. Six more SCNs will be phased into operation over the course of 2013, including: CONTENT WAS ADAPTED FROM THE FOLLOWING SOURCES AND RELEVANT WEBSITES: Alberta Health Services: Strategic Clinical Networks A Primer & Working Document (August 7, 2012 – V5) http://www.albertahealthservices.ca/hp/if-hp-ce-scn-primer.pdf Alberta Strategic Clinical Networks Terms of Reference: http://www.albertahealthservices.ca/hp/if-hp-clin-network-tor.pdf Health Council of Canada Interviews with senior leaders in Alberta, 2012. Health Council of Canada Interview with Alberta Health Services staff, 2013.