Board accepts QHC plan, but wary

Quinte Health Care’s board has approved its restructuring plan in principle – but with a warning to watch for “danger signals” the cuts are too deep.
The nearly three-hour meeting at Belleville General Hospital saw an unprecedented amount of discussion between the board and senior staff.
Board members then approved their draft 2016-2017 operating plan in principle. Changes remain possible as the corporation and unions meet in December. Final approval is due in January.
The four-hospital organization had a small surplus of $301,000 as of September. But to fall in line with its expected provincial funding for the next fiscal year, the operating plan must cut $11.5 million in spending.
That has senior staff proposing the removal of 162 positions, the addition of 78 others, and a widespread shuffle of services and staff.
It’s created public fear and – as Tuesday’s meeting showed – grave concern on the cautiously-supportive board.
“Clearly the risk is going up in terms of the plan,” vice-chair Doug McGregor said.
He said staff and the board must set “red-line indicators” to halt any negative effects before they reach unacceptable levels.
“We need to make really sure, because of the amount of change, that we stay really attuned to the danger signals,” he said.
“There is not a lot of wiggle room in this plan,” said chairwoman Tricia Anderson.
“I am not saying it will go sideways, but it’s a risk,” she added.
And “risk” was the theme of the meeting, as several of the most senior administrators detailed the hazards of the restructuring.
Those risks include a “medium-level” risk of increased wait times in emergency departments, difficulty recruiting doctors and further patient-surge situations due to reductions in beds.
“I am very confident that the plan we’re putting forward has been well thought out, well-researched … and I am very comfortable that there are mitigation plans in place,” Anderson later told reporters.
“We are already seeing some of those high-risk pieces starting to be addressed before we even go into this plan.”
She said the senior leadership team has weathered other problems in the past and she is confident the team will again do so if needed.
“I’m never comfortable taking this amount of staff out of an organization,” president and chief executive officer Mary Clare Egberts said.
She said in the event of unforeseen problems, hospital leaders would have to negotiate with Ontario’s South East Local Health Integration Network, which oversees local hospitals’ funding, and hope to receive more cash.
Egberts said the network has provided past emergency funding, such as in 2014, when QHC dealt with a suspected – and later disproven – case of Ebola virus disease.
In the meantime, she said, there will be a continued focus on avoiding staff burnout.
“It has a very negative impact for our staff,” Egberts said of restructuring.
Chief financial officer Brad Harrington said the changes include the “realignment” of beds between hospitals and departments, as well as the moving of 2,250 day surgeries annually from Trenton to Belleville.
A previous QHC estimate had been for 2,400 surgeries; no explanation for the change was immediately available Tuesday.
The plan will also end duplication of certain services, such as medical equipment reprocessing, or sterilization.
Such duplication is “very much negatively impacting our performance within the funding formula” of Ontario’s health ministry, he said.
Harrington also said the plan makes “significant assumptions” about improved financial performance resulting from the changes.
Chief of staff Dr. Dick Zoutman said the October 2013 removal of beds appears to be one factor in the persistent – but not constant – surge of patients that has strained QHC. But he also noticed the surge issue is province-wide. Locally, a surge in multiple QHC units has been a problem since June.
He said QHC has data on where bottlenecks appear in the flow of patients; staff must prioritize which problems to address first.
Board member David MacKinnon of Wellington asked Zoutman if the plan was safe.
“Yes,” Zoutman said quickly and emphatically, “but we have a lot of work to do to get there”
New vice-president and chief nursing officer Kim Stephens-Woods said she is “absolutely” certain it will work.
Stephens-Woods, who’s a registered nurse, said she has worked in a model of care similar to that now being implemented locally and other hospitals have seen successes. The Ontario Nurses’ Association, however, claims otherwise and warns of worse care.
“We’ve seen a reduction in our workload grievances; we’ve seen a reduction in medication errors,” aid Stephens-Woods of benefits already seen at QHC.
Board members and others, including Zoutman, cited concerns about the ability of community organizations to shoulder the extra patient load resulting from hospital restructuring. That shift is the goal of the province, which has increased funding to the community care sector.
The board’s consensus was that those other providers, including the South East Community Care Access Centre, are not yet ready for the extra work. Watch The Intelligencer for more on the board’s discussion.
Board member Patrick Johnston – celebrated during the meeting as a new inductee of the Order of Canada – noted the large amount of work to gather public input during the draft operating plan’s creation.
“This is probably a much better plan as a result of that,” he said.
But the full effects may not be known for years.
“It does take about two years, to be honest with you, to be able to see the results, because it is a change and it is transformational,” vice-president Jeff Hohenkerk said.
“There are risks,” he said, but added, “I believe we’re doing the right thing.”
Board member Stuart Wright said he remains “in awe” of the senior leadership team’s ability to cut costs — about $36.5 million in five years — while still providing “exceptional health care.”
But Wright, who pressed staff to defend the plan, was not entirely satisfied.
“It’s the sustainability that I worry about,” he said.
The board is to deliver final approval Jan. 26 in its regular meeting at Belleville General.

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