Purpose
The purpose of the provincial MSK framework is to enable effective patient centred health care in Manitoba. Methodology is presented in the following in five points.
1. To orchestrate provincial health care of the MSK system in Manitoba
Current system?
Since the Manitoba Regional Health Authorities Act of 1997, provincial health care has been delegated by the Minister of Health to regional health authorities (RHA’s). Health authorities modified preexisting systems in response to a variety of pressures, demands ands proposals. MSK activities are sprinkled through the regions.
What is missing?
A MSK template for regional health authorities to function within was not considered. Neither a provincial annual MSK plan or report exists. Evaluation and future planning are impaired. MSK care planning is buried in other services (such as surgical, medical, or allied health care), or trumpeted as a special programme (e.g. Hip and Knee Institute)
What is added?
The provincial MSK framework becomes the starting point of current provincial MSK inventory and template serving as a compact reference and direction for the health ministry, health authorities, providers and patients. This is permissible through the RHA act of Manitoba.
Benefits of the framework?
The government gets an applicable picture of its MSK responsibility. Each health region has a role in a provincial MSK framework. Patients and providers are part of an inclusive enterprise. The reversal of permanent bureaucratic expansion follows naturally.
2. Integrating top down direction and organization by advising Manitoba Health, with bottom-up participation through regional networks
Current system?
At the top, Manitoba Health lacks appropriate, accurate, unbiased comprehensive MSK data. Current data is limited to some general data on the rate of hip and knee replacements, and some basic statistics on the rate of MSK doctor visits and MSK hospital admissions in the five regions. Other important MSK data is either non existent, non retrievable, or not applicable to patient care.
What is missing?
Manitoba Health tracks only a few MSK issues, so ignorance of much MSK activity and needs prevails. None of the regional long term strategic plans contains an MSK section. Crisis management replaces broad MSK needs.
What is added?
A top down-bottom up strategic MSK plan for each region, under the provincial framework umbrella, is generated.
Benefits of the framework?
The regional details can then be applied on the framework. Workers in the regions and front lines see their work in the context of a provincial MSK grid. Feedback and modulation is possible, as the finer details of the provincial MSK grid are filled in.
3. Orchestration of provincial bone and joint surgery with other medical/surgical disciplines and allied health which are related by their MSK related activities.
Current system?
Bone and joint surgery has expanded to encompass several subspecialties:
- Spine
- Paediatrics
- Trauma & reconstruction
- Hip and Knee replacement
- Foot & Ankle
- Varying combinations of hand wrist shoulder and elbow
- A variety of orthopaedic procedure has been gathered under the heading of Sport medicine
- Growing body of orthopaedics related to Geriatric Medicine
- General orthopaedics declines as specialty orthopaedics grows
What is missing?
Some patientMSK problems get much attention, others less, and much poorly coordinated. Other related services are sequestered in different silos of care, increasing fragmentation of care
What is added?
Provincial framework includes all orthopaedic subspecialties and related disciplines( which also continue with their ongoing organizational structure). Plans and outcomes are established for all together, not one after or instead of another.
Benefits of the framework?
Subspecialties can be provided in various regions as complexities of surgeries, local capabilities and priorities are integrated. Interaction is improved with other MSK related non-surgical disciplines (Rheumatology, Physical Medicine and rehabilitation, Family Medicine, etc), other surgical specialties (Plastics, Neurosurgery) and Allied Health (Physio, OT, Chiro, etc). This framework relates directly to the ministry of health, and out of that follows a relationship with RHA’s, reducing the silo of care system which is in place.
4. Organizing bone and joint surgery includes standardization of resource distribution and evaluation of subspecialties of orthopaedics
Current system?
Surgeon participation rates vary widely, restricting access for patients. Patchy, usually informal collaborative work among subspecialists occurs, but less than is possible within a framework structure.
What is missing?
The absence of balanced surgeon participation and standardized resource allocation across subspecialties breeds discord, diminishes patient access, objective evaluation, and progressive surgeon development.
What is added?
Regional and university proceedings continue under the umbrella of an encompassing MSK/Orthopedic outline. All subspecialties are catalogued in a unified provincial structure, to be allocated in best methods and principles across five regions.
Benefits of the framework?
The government through the health ministry can achieve the goals of the CHA, and the providers are relieved of the need to continually compete.
5. MSK framework can accommodate public/private MSK care, changing the discussion from a two-tiered health care system to an integrated one-tier system
Current system?
The trumpeted one-tier system across the province where all citizens have equal access to all care of similar quality does not exist. A two-tier system in which better off and connected citizens will access more and better care faster is not prevented with the patient centred framework. Within the framework, surgeons , nurses and patients can merge in a private hospital . Deficiencies and imbalances in access and quality persist in our so-called one tier system. Many newly qualified orthopedic surgeons cannot work, as a surgeon/resource mismatch occurs nationally.
What is missing?
An open discussion of integrated care is prevented through the restricted view of a one and two tier system battle . Surgeon training programmes are decoupled from resource allocation (rationing) which is decoupled from patient needs and demands, which is decoupled from paying agencies (government).
What is added or changed?
Components of public and private care can develop within a comprehensive MSK framework. Disengaged, competing sections of the MSK system are reintegrated, and synergized.
Benefits of the framework?
Public and private elements work together, in an additive, collaborative process, instead of a subtractive competitive system.
Wait lists can be eliminated for all, as in many developed European nations.