Reinventing the Wheel – More on Health Standards Organization

By Marvin Ross

Back in November, I wrote a very critical blog about the Health Standards Organizations and their attempt to find a psychiatrist to finish a draft standard on mental health services in Canada. Their efforts had previously been criticized by Susan Inman in the Huffington Post. She then wrote in the Tyee that with these new standards, those with severe mental illness will wind up getting even worse care than they do now.

The president of the Canadian Psychiatric Association (CPA) also complained to them as did another psychiatrist in a blog on the CPA site. All the criticisms are linked in my blog.

That blog did get a number of comments that were also critical of them. One reader in the US stated:

“I got a headache trying to understand what the HSO was, what is it’s authority, and what is it’s driving source of funding and philosophy. Standards of care and accreditation should be a governmental or professional organizational function. The HSO is an enigma.”

Another Canadian reader stated:

Unfortunately, Accreditation Canada https://accreditation.ca/ appears to have SUBCONTRACTED the development of new standards to HSO — which appears to be part of some larger, multinational organization of mysterious origins. In any case, their shoddy work and obvious ignorance is astounding. (When I completed HSO feedback form on draft mental health standards, it asked for my zip code)

 

There was also a reply from Health Standards which can also be seen at the end of that original blog. I did not think it made much sense so I attempted to find their media person but got caught in their voice mail hell and hung up when I could find no human operator. I still have no idea who that person is but I did send an e-mail to them November 17. They responded via twitter on November 19 that they had my e-mail and were preparing answers. On December 12, I reminded them that they had not responded This is what I asked below in bold marked with a Q, their responses sent to me on December 17 marked with an R. My editorial comments to their answers are in italics starting with My comment. Despite my correspondence with them, no one has ever given me their name. The e-mail was not signed and came from “communications”. A robot? A secretary? The person who delivers coffee? I have no idea.

Q. What are the requirements for your committees?

R. The Mental Health and Addiction Technical Committee is made up of 16 voting members and three advisors and will soon include a psychiatrist as a voting member.

Worth highlighting are the two co-chairs of the committee:

Rita Notarandrea, MHSc, CHE, is currently the CEO of the Canadian Centre on Substance Abuse and Addiction and has held several roles during the 21 years she worked at the Royal Ottawa Hospital (Mental Health Care & Research), including 13 years as the COO.

Ed Mantler, Registered Psychiatric Nurse, MSC, is the Vice President of Programs and Priorities at the Mental Health Commission of Canada.

You can see the rest of the committee members on page II of the draft standard at http://healthstandards.org/files/Mental-Health-EN-PR-2018.pdf.

My Comment: Ms Notarandrea has been with substance abuse for many years and when she was with the Royal Ottawa Hospital (a psychiatric facility) she was the chief operating officer and left in 2005. Not, in my opinion, sterling qualities for this role as it does not appear that she has clinical experience.

Mr Mantler is with the Mental Health Commission of Canada which is an organization that I have severely criticized for years. His main focus, it seems, is on reducing stigma and promoting mental health first aid. Again, efforts that I have written critically about for a number of years. Prior to that, he was CEO of physician recruitment in Saskatchewan and senior operating officer at the University of Alberta Hospital. Physician recruitment and operations of a hospital are not clinical roles in mental health.

Both of those agencies were part of an extensive re-evaluation on the usefulness of their role by Health Canada and both were deemed to be expendable. The Globe and Mail reported that “it is also clear that, in all the scenarios, three organizations come out big losers: the Mental Health Commission of Canada, the Canadian Partnership Against Cancer and the Canadian Centre on Substance Abuse and Addiction.”

Q Who are the general interest members and what committee criteria do they posses.

R You can find information on HSO Technical Committees here: https://healthstandards.org/standards/technical-committees/. There is an infographic about halfway down the page that explains the composition and defines each group. If you haven’t already, you can also learn more about the standards development process on this page: https://healthstandards.org/standards/development-process/.

Technical Committee Requirements

Technical Committee members apply on our website at www.healthstandards.org. They find out about us through social media, our partners, existing relationships, conferences, and targeted outreach that we conduct.

We take the following into account when selecting Technical Committee members:

1.Professional/clinical experience as it relates to the scope of the standard

2 Acceptance of agreement with of the role of the patient as a partner in care and a member of the care team

3.Knowledge of standards and familiarity with accreditation

4.Relevant committee/extracurricular participation

5.Unique experience/perspective or contribution that relates to the standard’s topic

6.Commitment and anticipated level of engagement in the technical committee

7.A balance of positions within the health system (for example national versus provincial, acute care, and primary/community-based services)

  1. Balanced representation from a geographic perspective (remote, rural, and urban)

Q Who are the policy makers, how big is the committee and how were they solicited and/or accepted?

My comment:  This does not seem to have been answered unless it is part of the answer to the previous question

Q What is a product user?

My comment: This also does not seem to be answered

Q. You statedUnlike clinical practice guidelines, our standards follow the patient journey through the system by including elements of population health to plan services and identify health inequities, chronic disease prevention and management”

What does this mean? How do you prevent chronic diseases like schizophrenia or bipolar disorder?

My comment  Not answered

Q. You are a not for profit so could you send me your last financial statement?

R Our financial information is made available to the public on Canada Revenue Agency’s website: https://apps.cra-arc.gc.ca/ebci/haip/srch/t3010form23-eng.action?b=852490200RR0001&fpe=2017-12-31.

Unlike many other non-profits, HSO do not receive funds from public entities outside of fees for services performed.

My Comment The stated aim of HSO from their financial reporting is the promotion and protection of health. I am not sure what that means other than maybe they are protecting our health and promoting it. How do they do that?

Their main activity is to provide the international health sector community with leading edge accreditation, education and advisory services to improve health care and patient safety. I am not sure how that translates into programs

To accomplish all this, HSO has 10 full time employees all earning over $120,000 a year and one earning over $350,000. There are also 13 part time employees earning a total of about $142,000. Total salaries comes to a little over $2 million. Total revenue is $4.8 million with Total non tax-receipted revenue from all sources outside Canada (government and non-government) of $1.4 million. Total revenue from sale of goods and services (except to any level of government in Canada) is $3.4 million. Total expenditures are $5.6 million with $1.3 million going to professional and consulting fees.

Q Why do you charge $100 for standards?

R Except in the rare case when another organization works with us to sponsor a standard, we cover 100% of the cost of developing our standards. This cost is recuperated through the sale and licensing of our standards. This model is used by many other Canadian and International Standards Development Organizations, including the CSA Group and ISO.

Q Health Quality Ontario just brought out guidelines/standards for the treatment of schizophrenia and they list all members of the committee. Many of them I know either personally or by reputation and it is a very competent group. Why are your standards needed?

R Clinical practice guidelines focus on a specific illness – for example, schizophrenia – and recommend things like assessment tools, medications, and treatment options. HQO standards provide clinical practice guidelines, specific to Ontario.

HSO quality and safety standards can be applied across Canada and, in many cases, internationally. They focus on providing the best possible patient journey rather than focusing on how to treat a specific illness. This includes topics such as: accessibility and safety of services; health promotion and disease prevention; awareness and early detection of illnesses, including initiation of treatment and continuity of care during transitions in service; and engaging clients and families in service design. HSO standards are based on the HSO Quality Framework, which consists of eight quality dimensions that all play a part in providing safe, high quality care. For more information on the HSO Quality Framework, see page XII of the draft standard.

Both types of documents have a place in the health system. HSO quality and safety standards are intended to be used along with clinical practice guidelines and health care providers’ professional and regulatory requirements; they do not replace or duplicate them.

My Comment I do have to say that in my opinion their rationale for what they are doing is gibberish. When you suffer from an illness, you want the best possible treatment developed using appropriate evidence and recommended by those who actually treat. Those are what clinical practice guidelines are whether we are talking about schizophrenia, hypertension, stroke or whatever. Those are guidelines that apply to everyone everywhere.

The Health Quality Ontario guidelines which they dismiss as being relevant only for Ontario is an absurd contention. Clinical practice guidelines do not know geographic or political boundaries and should not.

Health Standards focuses on “best possible patient journey”. Well, if you or a loved one face a health problem, the best patient journey is to receive timely diagnosis and timely treatment using the best modalities that we have. What else is there or am I missing something?

As always they mention disease prevention and would that not be wonderful if we could prevent many of the illnesses that plague us – cancer, mental illness, whatever. But the truth of the matter is that we cannot prevent unless we know what the cause is. That is certainly the case with most serious mental illnesses. How will their efforts prevent someone from developing schizophrenia or bipolar disorder?

As my US colleague, DJ Jaffe, wrote recently, Serious mental illness is about biology and it CAN NOT be prevented.

If Health Standards is serious about improving the patient experience then all the money they have for staff would be well used in providing more psychiatric hospital beds for those in acute phases, more community programs for those stabilized and more affordable supported housing for those trying to survive in the community. Neither the streets nor jail are suitable therapeutic venues.

 

 

5 thoughts on “Reinventing the Wheel – More on Health Standards Organization

  1. Thanks for this refresher Marvin. The bottom line is that they ignore the facts around serious psychiatric diseases. That is these patients are “patients” and not clients. They belong in medicine THEY belong in medicine and deserve to be looked after by real doctors with a specialty in psychiatry. They assume that trauma is the cause and they fluff around in “la la land” consuming huge vats of money which would be better spent on providing real medical services and follow up care. Beds and real care are needed not fluffy talk talk talk which is more often than not nonsense.

    Counting angels on the point of a pin will just evade the obvious truths about underserved ill people.

    As for patient driven care re: choices. Well that is for the birds. People with anosognosia do not know that they are ill, and therefore do not choose treatment. If they are trapped by their symptoms why would they? AND they ARE vulnerable to parasites and predators. The Quacks are out there in droves. Anything but do what is necessary is the order of the day. Kick the can down the road !

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  2. The replies from the HSO remind me of the term “obfuscation”. Here is one definition of this term:

    ‘Obfuscation is the obscuring of the intended meaning of communication by making the message difficult to understand, usually with confusing and ambiguous language. The obfuscation might be either unintentional or intentional (although intent usually is connoted), and is accomplished with circumlocution (talking around the subject), the use of jargon (technical language of a profession), and the use of an argot (in group language) of limited communicative value to outsiders’.

    The fact that you did not get the name of their media person to reply to speaks to a need for transparency required of a publicly funded organization. This blog conjures up the question about what motivations and what entity is driving this initiative which sadly mirrors other tax payer bureaucratic initiatives which I have encountered.

    For example, look at the incredibly large salaries paid to these individuals and other bureaucrats for producing recommendations and documents that probably will have no actual positive effect on the quality of lives of those with mental illness and their families in my opinion. Even the recommendations that could make a difference like the Mental Health Commission of Canada’s Family Guidelines are ignored with no reasonable explanation given.

    Here they are for your interest:
    https://www.mentalhealthcommission.ca/sites/default/files/Caregiving_MHCC_Family_Caregivers_Guidelines_ENG_0.pdf

    Families are still facing huge attitudinal barriers. And we are still getting “top down planning” regarding a situation which needs “bottom up” planning to reflect the reality of serious mental illness. Bureaucrats should LISTEN TO FAMILIES but they do not . Locally, the bureaucrats are putting our tax dollars into a Hub to address mental health crises rather than pro actively helping families on the ground.

    Members of the bureaucracy also defend reduced hospitalizations while at the same time advocating for housing for the homeless population which their actions have helped cause because people are being discharged while they are still sick because of bed shortages. This seems hypocritical.

    Thank you so much Marvin for writing this blog. It signals that we need to keep the pressure on to cut through the BS and get the mental health system that we and our loved ones deserve.

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    1. Agreed . Perhaps the most sickening thing for me is that those committees which I sat on at Queen’s Park during the NDP administration decades ago were up to same bureaucratic stuff, and pushed the non medical model for all it was worth and made damn sure that beds would go the way of the dodo.

      However you rightly point out that there has been a marked inflation in the prime movers salaries to make sure that the willing to shrink the medical system takes place. Ethics go out of the window as this process takes even firmer hold. The evidence of a failed neglectful system is all about us. Orwell’s predictions are plain to see. It just took a bit longer to come to fruition. Obfuscation, smoke and mirrors confuse the public FACT.People come down with illnesses and deserve to be allowed to call it just that “an illness”

      More should rebel against the nonsense. i will be visiting yet another elected official this month for starters.

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  3. The very last paragraph sums up the entire article I just read..My God, is this all so hard to figure out and put into action. This entire last paragraph is exactly what needs to be addressed! As long as people want to keep those high paid jobs, they will create enough mumbo jumbo policies to do so. It makes me think these people have no clear understanding of what serious mental illness is really like..I know, my son has schizophrenia.

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