The problem with focusing on Success Matrixes is that frequently what you are successful at is shooting yourself in the foot.

Success Matrixes are also much better, it is often far easier, to count a positive – the number of heart attack victims you kept alive – than it is a negative – the number of people you didn’t have to save from  a heart attack.

Yet the actions to achieve the negative – no heart attack – are often far less costly than it is to achieve the positive – saving someone having a heart attack.

Given the tightening budget and financial realities of municipalities, provinces and even the federal government we need to begin to actively cultivate the fiscal savings to be found in the negative.

Unfortunately for our pocketbooks and services such as healthcare we are obsessed with success and therefore success matrixes, No matter the cost, no matter the consequences.

There is a bonus to be earned if hospitals get a patient treated and out the same day. If the patient has to return a day or two later,,,,   …another bonus to be earned. If the outcome of this efficient treatment is that the patient ends up in intensive care for 50 or 100 days………..

The cost of a few days in hospital begins to look like a real bargain and an extremely wise financial investment.

How could you know she was going to end up in intensive care? She had to keep returning for treatment, she was homeless,,,,   …it isn’t rocket science to predict that at some point she would require extended – and expensive – medical care. Unless you were betting on her death saving you treatment costs.

Financial reality is that we are in an era of tightening, finances and the resources our dollars will purchase.

And that is the vital point that is missed. It is not the dollars, but the resources the dollars will purchase that we need to focus on. The fact we are spending more dollars is of no use if those dollars purchase less resources.

With costs that rise by double digits healthcare is being hammered by the more dollars, less resources reality of rising costs.

No level of irrational demands or wilful denial by citizens will change the reality that you cannot have unlimited healthcare without paying for it. In fact the major fiscal problem faced by Canadians is that we chose to give ourselves free healthcare and chose, instead of paying for our healthcare, to borrow the money to pay for healthcare and to stick our children [those kids with their totally out of line sense of entitlement] with the bill.

No amount of rationalization, self justification or burying heads in the sand will change this reality.

If we don’t want our healthcare system to become: in theory we have healthcare, in reality…….

We need to shift our focus from more exotic and costly ways to treat health problems to the far more cost efficient and effective avoiding of health problems that require expensive interventions.

Or set priorities of what [and who?] will get treated and if it [you?] isn’t a priority…Well…….you can’t make an omelette without breaking a few eggs.

To be successful in changing the focus of healthcare to prevention we need to be able to measure the negative. A challenge complicated by our first by the post, winner – losers, success matrixes attitudes.

For example. Fraser Health has a program that has a doctor having office hours at the Abbotsford Salvation Army, The fact that he is there has allowed me – I do not have/have not been able to find a family doctor so the doctor’s presence has allowed me to get a referral to the diabetes clinic, adjust my medications based on blood test results and regular blood tests to monitor my diabetes on an ongoing basis.

Un-managed diabetes results in numerous health problems requiring treatments of varying costs. Avoiding those costs more than covers the cost of the program to have a doctor hold office hours one afternoon a week at the Salvation Army. Now add up the costs saved for all the other people who have access to a doctor at the Salvation Army and the program saves Fraser Health far more than the program itself costs.

But we are not use to evaluating programs whose value lies not in what they accomplish but in what they prevent or avoid.

We had better learn how – and quickly.