In Conversation with Dr. Kwadwo Kyeremanteng: On Cost-effective and Compassionate Healthcare
Within medicine, palliative and critical care are important components near the end of a patient’s journey. Providing treatment that considers the patient’s goals but that’s also justified based on the prognosis is a difficult balance. How do healthcare leaders and health systems provide cost-effective and supportive care when the treatment itself is expensive and difficult?
This challenge became even more perplexing with the onset of COVID-19 which negatively affected ICU capacities and the ability to deliver high quality care. Furthermore, the pandemic has also highlighted gaps in various areas including elderly care and access issues within low socioeconomic communities.
In our closing entry of UTIHI’s Speaker Series, we had the honour of hearing from Dr. Kwadwo Kyeremanteng as he tackles these issues as a palliative and intensive care physician at the Ottawa Hospital. We’ll learn more about Dr. Kyeremanteng’s journey into the field, why he formed the Resource Optimization Network, and how his Solving Healthcare Podcast provides an accessible platform that covers important healthcare topics with a focus on cost-effectiveness, justice, and dignity. Furthermore, we’ll learn about the amazing initiatives that emerged from his podcast including a medical mentorship program for black youth and Bridges Over Barriers.
Please enjoy the final interview of UTIHI’s Speaker Series!
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Dr. Kwadwo Kyeremanteng is a critical care and palliative care physician at The Ottawa Hospital. Dr. Kyeremanteng cares for the sickest of the sick patients in the intensive care unit (ICU). As a researcher, he is interested in using ICU resources more efficiently and improving access to palliative care in the ICU. To help do this, he founded the Resource Optimization Network, a multidisciplinary research group working to reduce health spending in this area without compromising care. In September 2019 Dr. Kyeremanteng launched his ever-growing podcast “Solving Healthcare with Kwadwo Kyeremanteng” these podcasts feature interviews and discussions on the topic of improving healthcare delivery in Canada. Underpinned by the values of cost-effectiveness, dignity, and justice, these podcasts will challenge the status quo, leaving no stone unturned as we explore gaps, assumptions, and different perspectives in the pursuit of finding solutions to problems in Canada’s healthcare system.
Can you tell us a bit about yourself including your journey into palliative and critical care?
My journey into medicine started off with my pediatrician. I had childhood asthma and the impact he had on creating a calm, confident environment whenever he walked into the room – I thought was just incredible, and I wanted to be able to create that for my patients.
The reason I went into critical care was due to an elective I completed as a medical student at Foothills Medical Centre. I knew it was for me the second I entered. The teamwork, the constant learning, the fact that you didn't know what was coming through the door and that you’d have to be on your toes. Not only did you need to have the technical skills but also the soft skills like communication and leadership to lead and navigate your team through tough times. It was just meant for me - I love the fact that you don't know what every day is going to be like, and each day is a unique one.
Regarding palliative care, I had a mentor – Dr. John Sealey, who was similar to my pediatrician. The second he would enter a room; everything would calm down and he would put his hand on the patient’s arm, and it helped them realize that they can get through this tough time. It's an incredible experience being with family during such a tragic time in people’s lives. But it's also a privilege to be able to have that amazing connection that happens at the end of life. That's what brought me into it. Also, within critical care, I think one of the most important aspects of it is communication, especially near end of life in which those palliative care skills come into play.
What does your vision of a cost-effective healthcare system with dignity and justice look like?
I think with a lot of the steps for equity and access to high quality care- the more cost effective we are, the better our ability to provide that high quality care is. I think there's a lot of waste within our current health care system, whether that’s healthcare delivery or the fact that we overtreat many conditions. In my world, we often provide care to ICU patients that do not benefit. So, I think if we have that lens, we can ask: are we providing justified care towards our citizens? Even that question alone can lead to a more cost-effective strategy.
What is the Resource Optimization Network (RON) and its overall mission?
Essentially the Resource Optimization Network provides strategies to create a more sustainable health care system that maintains or improves quality of care. This is a group that we formed in 2016/2017. It’s comprised of people from different specialties and disciplines including physicians, nurses, health economists, pharmacists, and even members from business management schools. We want to have that lens, that diversity, and that perspective on ways we can optimize resources and provide better care.
How was the Resource Optimization Network formed and what was your motivation when launching this?
The Resource Optimization Network was formed because one day, I just decided to do it. I decided to make a call and say “Hey! This is what our vision is. Who wants to be a part of it?” and almost everybody that was approached said yes to joining. The motivation came from what I saw first-hand on the bedside. When I saw patients getting suboptimal care because of healthcare cuts – it provided real motivation to look at ways we can make our dollars stretch and provide better care for our patients.
When I saw patients getting suboptimal care because of healthcare cuts – it provided real motivation to look at ways we can make our dollars stretch and provide better care for our patients
What are some interesting findings in the realm of healthcare efficiencies that RON was able to identify and/or implement?
I think the big one is what percentage of patients receive care that they wouldn't want for themselves? For example, we see a lot of patients that have a poor prognosis and somehow end up within the critical care sphere. This is an arena that provides expensive and difficult care on patients. Patients that get through this care will often have PTSD, anxiety, depression, significant physical ailments, and deconditioning. If someone is going to go through that, you really want them to be able to line up with their goals.
I'll give an example of one of our studies. This one is yet to be published but among 12 patients that were deemed by clinicians or by consenting capacity boards to be receiving futile treatment, this resulted in about $8 million in healthcare costs and 10% of ICU budgets. These patients by the way, have all passed, but when you look at patients that are receiving care that won't be able to provide their goals- that's a lot of money that's unfortunately being put in which isn't being implemented into other measures that could benefit patients, whether it's a prevention allied health test to provide supportive care and so forth.
In September 2019, you launched a podcast series called Solving Healthcare. How has this series evolved over time, especially with the onset of COVID-19 which came a few months after launch?
Yes, Solving Healthcare has evolved tremendously! In the beginning we were focusing on areas within critical care that pointed a lens on where we could be doing better from either a cost-effective approach or from a supportive care approach.
And when COVID came, we wanted to be able to give people reliable information because there's a lot of misinformation going on in communities. We were able put out a lot of content and that also led to covering some of the unintended consequences of our approaches. So, we wanted to put a lens on that as well. For example, we did a show on child maltreatment, knowing that our restrictions were having an impact on our children. The whole reason we did that was so we could actually do something about it and the shows led to great initiatives including a charity that supports children in the community called Bridges Over Barriers. Also, post-George Floyd we did a lot on systemic racism which led to a black mentor ship program that we started. Ultimately, the show has been able to do produce a lot of good.
Another community initiative that it helped launch was Feeding Our Frontline Workers. We were able to raise over $30,000 to support frontline staff in their battle with COVID-19. Also, with Bridges Over Barriers, we've raised over $100,000 to support children and their families in the community.
How has the pandemic shaped the discourse around cost-effectiveness and efficiencies in the Canadian healthcare system?
The pandemic put a huge lens on cost. There is huge spending in and around COVID and it put a real lens on where the gaps are in our healthcare system. To address these things, we need to become more cost-effective and more efficient with resources. So, how do we create more ICU capacity without breaking the bank? Thinking about creative ways to do this is important. How do we prevent people from coming into ICU? How do we use technology such as virtual health to keep patients where they are - as opposed to being transferred to different parts of the province? This has been huge in terms of the discourse and it's going to become even bigger as we work through this pandemic.
[H]ow do we create more ICU capacity without breaking the bank? [...] How do we prevent people from coming into ICU? How do we use technology such as virtual health to keep patients where they are - as opposed to being transferred to different parts of the province?
In April, you filmed a Facebook Live vaccine Q&A with a panel of experts that addressed the public’s inquiries and concerns. Why are such outreach measures important?
We need to have multiple approaches in terms of educating the public. They can hear from our health leaders, whether it's Bonnie Henry or chief medical officers; the public could hear it, read it through Twitter, they could watch videos on YouTube. We need to provide them with as many opportunities that speak to them so that they can be more educated on the topic. For example, vaccine hesitancy is an education issue which should come from a compassionate lens, not a shameful lens. To be able to provide an avenue like this to answer people’s questions is important.
Solving Healthcare has also delved into important conversations about racism in healthcare. How can mentorship programs help to combat this?
The mentorship program is important to me because a lot of our black youth, for example, don't realize that they have an opportunity. They don't even think becoming a doctor is reachable knowing that there are few black doctors in the community- in my hospital, I'm one of a few black physicians. So, there's often not that role model. There's not that goal insight because it's just not visible. To have somebody to say this is visible, these are the steps you need to do to be able to create that future for yourself is huge. And I've already seen how this is paying off for them. It’s bolstering up their CV’s and providing some experience. I think it's everything. It starts with awareness, engaging the community and mentoring them is a huge step in the right direction.
The mentorship program is important to me because a lot of our black youth, for example, don't realize that they have an opportunity. [...] To have somebody to say this is visible, these are the steps you need to do to be able to create that future for yourself is huge.
What are your hopes for Canada’s healthcare system post-pandemic?
I just hope we learn from what we've seen. So, those gaps in long term care to gaps in our lower socioeconomic areas, using data to guide our decisions and also embracing some of the innovation that has come through like virtual health. I think that's an incredible lesson we should continue to adopt. The fact that we were so agile and adaptive in terms of COVID management - I really hope that comes through post-pandemic. The huge thing is finding our gaps, doing something about it- do something about long term care, do something about our low socioeconomic communities; just supporting them as best we can and embracing some of the innovations that we've been able to create through the pandemic.