The Patient First Paradox: Why Saskatchewan’s 2026 Health Plan Is a Total Let Down

In this episode, Kyla offers a critique of Saskatchewan's newly released "Patient's First Healthcare Plan" and questions why health care systems insist on repeating the same failed approached decade after decade.  Drawing on comparisons to Denmark and Nova Scotia, she challenges the incremental approach to health care reform and calls for genuine system transformation.  Kyla challenges listeners to demand more from health care leaders - not just incremental improvements but bold system redesigns that measures outcomes, prioritizes prevention and ensures everyone has access to a Medical Home.

For Patient's Sake (2009)

Patient's First Health Care Plan (2026)

Transcript

Kyla Avis 0:13

Hey everyone. Thanks for tuning into what will be my first CLM podcast. What's a CLM you say? Well. It's a career limiting move, and this is potentially one of them. But I told myself when I started this podcast that I would use my position as an independent consultant to drive narratives. Others were too nervous to have publicly and rightly so. If I was working in the system, I'd probably be nervous too, but I'm not in the system, so I'm trying to fill the role of agitator. There's a saying that, you wanna rock the boat without falling out, but I've got my life jacket on and I'm fully prepared to fall out if needed, because there's too much at risk if we don't start speaking up, changing our expectations and asking for more. I wasn't planning on this podcast, but on Monday the government of Saskatchewan released a new document, the patient's first healthcare plan, and I've been reading and reflecting on it since it's release And honestly, I feel such a deep sense of disappointment if you've been following this show. You know, we're trying to talk about how we actually transform the healthcare system, but reading through this document, I couldn't shake the feeling that instead of having that kind of conversation, health system leaders just wanna double down on the status quo when what they really need is nothing less than a complete health system redesign. I am gonna be talking a lot about Saskatchewan because that's where I am and this is where this plan was launched. But I know this conversation isn't unique to Saskatchewan. What's happening here happens in other healthcare systems too. Big promises, ambitious plans, goals, targets, visions, and yet we find ourselves in a system that in many ways feels like it's getting worse, not better, and we never ask why this approach fails to work year after year, decade after decade. You see, back in 2009, we had the patient first review Commissioner's report titled For Patient's Sake, it was supposed to be Saskatchewan's Defining Review. At that time, it was considered to be a bold, honest look at a fractured system delivered in silos. It warned us. 17 years ago that simply spending more is not the solution yet. Here we are in 2026 and the government's big innovation is, let's do more surgeries. Just as a reminder, here are the promises that were made in the commissioner's report in 2009, again, 17 years ago. Improved surgical wait times, build urgent care centers. Focus on health promotion and chronic disease management using multidisciplinary teams. Improve rural remote access to diagnostics and specialist services. Strengthen system capacity for independent living. Work with First Nations and Metis organizations to improve health outcomes. Develop a provincial electronic health records so patients only have to provide their information once. Shift the Ministry of Health into a strategist, integrator, and steward role to better lead system-wide transformation. And in 2009, their plan was to empower frontline providers to work through their full scope of practice, utilizing skills of nurse practitioners, pharmacists, and other professionals to alleviate pressure on physicians. And how have we done? We've made little gains in any of these areas at scale. The little movement on many of these things aren't for a lack of trying. I know countless people who have worked tirelessly with blood, sweat, and tears to make these things happen, and yet what they face is barrier after barrier with resistance to change coming from all directions and all levels with the clear message that taking those risks and making bold steps is too politically dangerous. We need to change the system, but we can't change the system too much because it might cost us politically or financially. With every proposed change comes a no. A no from the unions? A no From the professional associations, A no from the ministry. A no from cabinet A. No from the doctors or the specialists. Because the reality is, is that we wanna make patients first. Everyone else has to move to second, third, or fourth place. And no one seems to like that. For patients to gain, someone else might have to lose, and no one wants to lose anything, especially a sense of power or control. So we remain in a state of change paralysis. That brings me to the most recent plan launched a couple days ago. This new plan talks about accelerating the pace of change, but when you look under the hood, it's almost entirely incremental. They're adding 450,000 surgeries, more acute beds and more metal detectors The 2009 report called for a New Way of Doing Business. It wanted a system that functioned as one instead. This plan gives us more pilots of team-based models. We're still piloting the idea of healthcare providers working together. Meanwhile in Nova Scotia, they've already moved past pilots to a province-wide health home model. They don't just hope for teams. They use specific metrics like exactly how many physicians, nps, and social workers you need for every 10,000 citizens to make sure that the team is robust enough to actually work. In Saskatchewan, we're celebrating 23 new nurse practitioner contracts as if we've reinvented the wheel. We're focusing on individual contracts rather than interprofessional Intersectoral Health Home Standard that other jurisdictions already have. I adore Jane Philpot's idea. She compares the health system to the education system. When you move to any place in this country, you are granted access to primary and secondary education. There's a school in your neighborhood or community or geographic area that you can go to, but yet with healthcare, you're on your own to figure it out. And when you can't access primary healthcare because the physicians aren't accepting new patients, you just head down to your local emergency department or urgent care center. Don't worry. We'll build more of these for you. This new plan continues to focus on volume, but is absolutely silent on quality. The government says they'll keep measuring what matters, access to care providers and access to timely surgery. But does a shorter wait time. Tell us anything about your experience of care. Did Grandma get her hip surgery within three months only to develop postoperative delirium and pneumonia and end up in a long-term care facility? Or did she go home better than No. Do we know if this surgery actually improved your quality of life? And that's what we're trying to do, right? Improve quality of life We have no mention of measures for patient reported experiences or outcomes in this plan. Do we have people working in this space who want a robust provincial reporting on patient reported outcomes and experiences? Yes. For years. And there are endless barriers to making that reality. And I'm just gonna say it because I'm in the boat and I'm rocking it pretty hard anyways. But do governments actively resist progress on reporting patient experience and outcomes because it might. Reflect poorly on them, and then they have political implications. A hundred percent. Contrast that with Denmark. In Denmark, quality is a major priority area. They don't just count procedures. They collect patient experiences through national, regional, and local surveys. They establish national quality targets and then get this, they publish the results annually so that the public can hold the system accountable. They even have an online portal where patients and staff can access benchmarking data to see how their local clinic stacks up against the best in the country. Here we're measuring the speed of a lineup, but we aren't measuring. If people in the system are actually getting better, then there's prevention or lack thereof in the 2009 report, it was actually quite visionary. It said one of the most powerful ways to build a sustainable system is to help Saskatchewan people avoid becoming patients in the first place. It called for an aggressive and targeted emphasis on health promotion because it pays dividends for a healthier population. Fast forward to 2026. Where is that aggressive emphasis? It's gone. The 2026 plan is almost entirely reactive. It emphasizes adding acute care beds and does nothing to help with the billion spent on the waste, redundancy and ineffectiveness that comes when we wait for people to get sick before we help'em, and then we have no services to get them back into the community. So they linger for weeks and months in our hospitals declining physically and mentally by the day. Again, let's look at Denmark. Their current targets are designed to incentivize a transition from hospital-based care to primary and home-based care. They have economic incentives to keep their citizens healthy and outta the hospital. In Saskatchewan, our plan is just to build bigger hospitals. Even our digital innovation feels behind. While Saskatchewan celebrates 750,000 users on a portal that shows lab results, Denmark has a unique electronic personal identifier for all citizens. Their portal is a single communication platform for every referral, every discharge, every prescription across the entire country. We're still trying to get phone calls, emails, or virtual visits while they have built a complete digital nervous system. And what's the excuse on that one? It's usually patient privacy. So listen to my upcoming episode with Terry Price, where her brother's privacy was protected, but it cost him his life. So here's the bottom line. The 2026 plan doesn't meet the moment. It's a maintenance plan at best. It's not innovative, it's not exciting, and it's not gonna solve any of the issues we face today. If we stay on this path. We'll be having the exact conversation in 17 years from now if we even have a publicly funded healthcare system left to talk about. This plan is the epitome of just keep doing what we're doing and keep getting what we're getting. We deserve an action plan that sets a goal to measure outcomes, not just volumes. We deserve a plan that shows innovative and creative approaches to keep us healthy, not just how they'll fix us when something goes wrong, and we deserve a plan where the patient's medical home is a reality for everyone, not just a pilot for a few. I created this podcast because I felt like there's not enough conversation around pushing the system for bold, innovative system redesign. We don't need to double down on the model that was built in the mid 20th century. It's 2026 for God's sake. We need to start building a system for the 21st century. Right now, it just feels like there's a deafening silence in the healthcare system. We just ask people to continue grinding away in a system that's no longer fit for purpose. And what we'll get is more burnout that comes with providing care in a system that no longer works for anyone. You deserve more from leaders as both patients and providers. You deserve a better plan. I need you to know that there are people and places in Saskatchewan, Canada and around the world who are doing things differently. They're building systems for the future. They aren't just dreams or visions. They're real practical changes that the system is making to redesign their entire approach to health and healthcare. Do we have the strength and courage to do the same, or are we just gonna add more hospital beds and metal detectors and call it a day? This is shift. See you next time.