The CEO of the Peterborough Regional Health Centre appeared before the Central East LHIN January 26 to give an update on the controversial “Hospital Improvement Plan” (HIP).
While much of his last presentation dealt with financials, the expectation was that this visit was going to be more about the impact of the HIP on quality of care at the hospital.
CEO Ken Tremblay presented what was the worst-kept secret: Peterborough was going to end the year $5 million in deficit despite small surpluses in the last two months of 2010. Much of this deficit was associated with one-time restructuring costs, he said.
The community has been concerned that cuts at the hospital are impacting on quality of care.
Peterborough scored 110 on their Hospital Standardzied Mortality Ratio – an indicator that preventable deaths are about 10 per cent above average (score of 100).
The HSMR compares the actual number of deaths in a hospital with the average Canadian experience, after adjusting for several factors that may affect in-hospital mortality rates, such as the age, sex, diagnosis and admission status of patients. The ratio provides a starting point to assess mortality rates and identify areas for improvement to help reduce hospital deaths.
Tremblay failed to spend much time on quality issues, suggesting the data was up on the hospital’s web site.
In fact, the PRHC “performance dashboard” has considerable red on it – an indicator that the hospital has not improved its performance towards established targets. As an interesting footnote, there is no colour indicator on the dashboard to show where performance had actually declined. The hospital is showing poor performance on a series of indicators ranging from length of stay and alternate level of care occupancy to hand washing and rates of MRSA and C. Difficile.
A year after the HIP was introduced the hospital is still in the process of layoff. To date 145 full-time equivalent positions have been deleted through early retirement, voluntary exits, transfers and natural attrition. 19 FTE layoffs have been accepted, while 17 FTE layoffs had to be rescinded. There are 38 FTE layoffs still in process.
Tremblay acknowledged the irony that this was taking place against a backdrop where the hospital was struggling to recruit part-time workers and some specialized positions.
One of the difficulties the hospital has is recruiting when staff morale is low. Its online presentation shows that only 29.9 per cent of PRHC’s staff responded positively to five composite questions that make up something called the “Organizational Commitment Composite.” The average of hospitals using this tool scores at 55.1 per cent.
Tremblay said he did have success in reducing overtime by 62 per cent and absenteeism was down to an average of 10 days per year. This he credited to the hospital’s wellness program.
Community groups have alleged that patients are being discharged from the hospital before they are ready. The online quality survey has no data on 30-day repeat visits to the hospital.
Tremblay did say they closed 20 beds last October.
Tremblay appeared irritated about a letter in the Peterborough Examiner stating $24 million in funding was clawed back in 2010, and a further $14 million in 2009. Tremblay said the hospital had not earned the money and had to give it back. “Clawback would be an incorrect term,” he said.
After Tremblay had left, acting LHIN CEO Paul Barker was critical of other LHINs for advocating financial bailouts before the hospitals had gotten their house in order.
“We have been consistent in our message to find ways to be more efficient with as little impact on care as possible,” he said. “We have always gotten all the way there on our own.”
He said Peterborough had not been underfunded, but had “not been operating in a proper way.”
Claiming he was speaking personally, he criticized the province for giving the Niagara Health System $15 million last year only to come back to projected deficits for this year and next.
He said hospitals in the Central East LHIN accepted their responsibility and were mindful of risks to quality.
Barker said that when the Minister of Health recently toured Peterborough Regional, she said “this is a place we want to make investments.”’
Tremblay is next to appear before the LHIN in April.
OPSEU Diablogue 
As a worker at PRHC I can tell you that there is no wellness program in place, as suggested by Mr. Tremblay to be the reason for reduction in absenteeism and overtime. Staff have criticized Senior Management for enforcing a disciplinary attendance management program (staff will come to work sick to avoid being placed on program) while having no wellness program to try and change the poisoned environment in which we find ourselves working every day. Vague efforts to appear interested in developing a Wellness program have fluttered and now disappeared. The manager assigned this task has been promoted to a new portfolio. Overtime has been reduced by not replacing the first sick call (remaining staff then work short and carry heavier workload). Tremblay refers to his success of reducing OT as “reducing the gravy”. Staff cannot perform their duties effectively when they are racing around trying to cover two positions. Quality of patient care IS effected. Morale is at an all time low – who would have thought it could get worse, but it has.