Island Health’s Drew Digney, MD, CCFP (EM) on Solving Healthcare’s Challenges of Demographics, Access, and Accountability

In this episode… 

Ohad speaks with Drew Digney, MD, CCFP (EM), Medical Director at Oceanside Health Centre, Island Health – Vancouver Island Health Authority. They discuss the biggest challenges facing healthcare today — demographics, access, and accountability — and what hospital administrators can do to reduce wait times and improve patient care, including better data recording and tracking. They also talk about how handheld ultrasound assists in faster decision-making and how AI will be a “game-changer” for radiology.

Topics discussed:

  • How primary care has changed with the rise in specialists and fewer generalists.
  • How reducing wait times improved care across “vertical” customers and “horizontal” patients.
  • Why an aging demographic of patients presents a challenge to healthcare systems.
  • Why hospitals need smoothing when it comes to access on different days of the week.
  • How a lack of accountability has led to healthcare having an expenditure problem.
  • Why recording and tracking good data is a solution to more accountability and less variability.
  • How handheld ultrasound improves decision-making and how AI in radiology will be a “game-changer.”

Drew Digney, MD, CCFP (EM) on the Three Biggest Challenges Facing Healthcare Today

Drew Digney, MD, CCFP (EM) is focused on finding and implementing strategies to fix hospital systems and make them run more efficiently. Starting as a family physician, Drew switched to emergency medicine and hasn’t looked back, serving at Vancouver Island Health Authority in administrative roles that have allowed him to make changes on the ground to improve patient care.

“What can we control within our four walls and with the budget that we have, and the people we have, and the beds we have, and how can we do that differently?” he asked in our newest podcast episode “We got some support to get some experts and we made some huge changes. When we cut our wait times in half, we actually did that by getting rid of beds. We looked around to see what best practice was. We put a customer focus on it.”

On a recent episode of our Healthcare Disruptors podcast, Drew talked about the three biggest challenges facing healthcare and hospital systems today — demographics, access, and accountability — and what solutions the industry needs to adopt to address these challenges.

1. Caring for an Aging Demographics

The first challenge is effectively serving an aging demographic. Not only is the population getting older, they’re living longer, which means that they’re continuing to use healthcare systems longer, too. “We put it in [to the system] and then for another 20, 30 years, we take out, and we do it by getting our knees replaced, our hips replaced, our cataracts done, having a couple of stents put in there, getting our diabetes managed, maybe ending up in the CCU, getting our stroke thrombolized, and then coming in with a bazillion meds,” he illustrates. “So all of these things conspire on the demographic side,” adding up to the need for ongoing care.

On the flip side of patient demographics are doctor demographics. Older doctors, who were trained more as generalists, are retiring and younger doctors who tend to focus more on specialties and who have different views about work-life balance are taking their spots, creating impacts as well.

2. Providing Equal Access Throughout the Week

The second challenge of access comes down to the understanding that a patient will get treated differently on a weekday than they will on a weekend. He explained that “there is really good evidence that if you come in with certain conditions on a Thursday or Friday, into an acute care hospital pretty much anywhere on the planet, you will have a different outcome than if you come in on a Monday or Tuesday. In my mind, that’s unconscionable. How do we have a system that is in its design giving different care to people on the toss of the dice as to whether it’s a Monday or Tuesday when they have their Triple-A rupture? But that is because of this thing called a weekend.”

He goes on to give an example of how one of the main hospitals in Vancouver Island has twelve physiotherapists available on a Monday to Tuesday, but only three on a Saturday or Sunday. A possible solution for this disparity is smoothing. By evenly distributing your staff so you “couldn’t tell what day of the week it was,” you’re able to provide more equal access and care to each patient.

3. Increasing Accountability with Spending and Quality of Care

The third challenge is accountability in two distinct areas. According to Drew, healthcare doesn’t have a revenue problem, it has an expenditure problem caused by a lack of accountability. “There’s a lot of duplication. We’re not really tight with how we spend our money. So that’s a big problem,” he says.

There’s also a lack of accountability in variation of practice across physicians. “We started looking at CT rates. So there was a sevenfold difference in the rate at which physicians refer out patients. Sevenfold difference. That’s enormous,” he states. “Then I started reading about … a Calgary study looking at what happened if you came in with a renal stone. One hospital had twice the rate of operative fix on that versus a conservative fix. Twice. How does that happen? So we have about a threefold difference in the rate of admission. That admission to hospital is such an important metric for patients, but also just for the whole system.”

The Solution is Data

One solution lies in better data recording, tracking, and analysis. When he started presenting data around disparities in the system, “it started a really interesting conversation about how people were practicing and looking at their practice because we get very little feedback on those kinds of metrics about our practice in comparison. I think that’s a shame. That’s something that, in this day and age, with the amount of data that’s collected and the amount of information that’s out there, that doesn’t get brought back.” This could be solved by scribing, or having someone in the room write down everything the patient is saying to record more accurate information for better tracking. AI scribing tools are evolving to offer the same benefits in tracking data and increasing productivity as well.


Knowing the major challenges to solve is the first step in creating better strategies to help improve patient care and outcomes through increased access and accountability. The next step is executing those strategies and backing them up with data.

Listen to the full interview with Drew Digney, MD, CCFP (EM) on the new season of our Healthcare Disruptors podcast.

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