An operational review of Kenora's hospital released this morning suggests some fundamental reforms.
The 74 recommendations include changes to:
- the board of directors and how the hospital is managed
- how the hospital is financed
- the relationship between medical staff and managers
BIG Health Care and their team of eight health care professionals with over 30 years experience conducted an operational review on the hospital. The review started in September 2017, and it took a close look at policies and positions within the hospital.
Lack of resources
"Overall therefore, the resources available for hospital operations have declined over the last six-years," the report concludes. "Management has responded as required with efficiency improvements and service reductions in an attempt to maintain a balanced position, while also dealing with inflationary pressures."
Wendy Cuthbert chairs the hospital board, and she says a lot of their issues relate to funding.
"You know, we'd all like to have exactly what we need to do the job for everybody, but we do the best we can within the budget we have. Obviously, even at that we run a deficit," she said this morning, in reaction to the report.
Cuthbert noted the province has agreed to a new funding model for the hospital. While this will help, Cuthbert added they'll still have work to do, in order to balance their budget.
Mark Balcaen is the outgoing president and CEO for the hospital. He was pleased to see that many areas of the hospital are working quite efficiently, and he welcomed recommendations for improving the hospital's operations.
"Some of the recommendations can be addressed quite quickly -- and will be -- others will take more time," he said.
Next steps he said were to meet with staff and get their reaction and comments. His last day after 20 years with the hospital will be at the end of June.
The hospital has a budget of just under $50 million, including more than $30 million for wages, benefits and remuneration.
Dysfunctional relationships impact patient care
The report noted the dysfunctional relationship between staff and management was having an impact on patient care.
"Unfortunately, at LWDH (Lake of the Woods District Hospital) we heard a long history of the poor relationship between administration and medical staff. The roots of this situation are beyond the scope of this review. The real issue, however, is that this poor relationship is affecting patient care at LWDH," the report noted.
On one hand, the medical staff report that they first brought their concerns to the attention of the board over eight years ago and have continued to do so. In December 2016, the concerns boiled over as medical staff passed a non-confidence motion that alleged that the hospital is not properly governed or managed arising from management efficiency decisions, as supported by the board.
However, the consultants found many board members dismissed this motion, because they felt it was precipitated and supported only by a small number of disgruntled physicians. Nursing managers uniformly indicate many nurses will not report objectionable physician behaviour, because they believe nothing will be done about it and they will suffer consequences from physicians. Some interviewees indicated that the CEO and COS (Chief of Staff) are reluctant to deal with problematic physicians for fear they will leave Kenora.
"The dysfunctional relationship between Administration and the Medical Staff is apparent to all, and negatively influences both the culture of the organization and patient care. However, despite the abundant evidence that administration and the medical staff, left alone, will not be able to solve their differences, the board has not insisted that a serious physician engagement initiative be undertaken," the report stated.
"Hospitals that thrive under difficult circumstances are uniformly characterized by dynamic, constructive and collaborative relationships between management and appointed medical staffs. Both medical staff and administration at LWDH must accept responsibility and move forward. The board must take a leadership role to ensure that this happens," the report continued.
When five family physicians left Kenora recently within a short period of time, the consultants noted the chief of staff and CEO did not initially appreciate the need for, or support, the hiring of a physician recruiter. Over time, the Kenora Area Health Care Working Group evolved into the All Nations Healthcare Group with a focus on developing a new Health Services Campus for Kenora.
"Administration must play a larger role in physician recruitment and coverage planning," the report added.
Racism a factor
Finally, report authors noted the systemic and overt racism that continues to exist in Kenora, unfortunately, is also considered to be present at LWDH.
"The impact of perceived racism to any degree is a continued sense of distrust of the hospital by members of the First Nations Community," the report says. "As such, it was reported that the preference of many members of the First Nations in the area is to travel to Winnipeg hospitals for services (rather than to Kenora), including for emergency department services, because they feel they will get better treatment (clinically and racially) in Winnipeg."
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