How much of a factor is underfunding to the working relationships within a public hospital? What is the impact of resulting cuts on the public’s perception and trust?
In July Ken Deane’s final report was submitted to Health Minister Deb Matthews. Deane was appointed supervisor for the Windsor Hotel-Dieu Grace Hospital after a series of public incidents that shook the community’s confidence. His report was made public a month later.
Deane sums up the so-called “difficult” period the hospital went through. Those issues include “a tragic murder/suicide; medical errors, and pathology mistakes that resulted in an investigation into surgery and pathology; an external review of cardiology; fraud in the finance department; termination of a vice-president and a related $6.3 million lawsuit against the hospital and specific staff; ministry announcement that it will appoint a provincial Supervisor; removal of the Board Chair by the sponsoring organization; and a subsequent resignation of a Board member.”
While Deane casts the usual blame on the dysfunctional relationships between the leadership of the hospital and the constant conflict within the organization, he does highlight financial stresses that may not rest entirely with the hospital.
Deane makes a particular plea to the Erie St. Clair LHIN noting the hospital provides substantial specialized regional services without accompanying compensation. Deane notes that the hospital has the highest “acute specialization index” (ASI) among Ontario community hospitals and 11th highest overall in the province. The ASI measures the per cent of hospital inpatient activity that is identified for specialized services or programs. Deane also identifies HDGH as having the highest resource intensity weight (RIW) of any community hospital in the province. The RIW measures the relative expected cost to care for a patient, suggesting a very high intensity level. While the new provincial funding formula does take these measures into consideration, Deane notes these issues have been identified to both the LHIN and the Ministry of Health for redress.
Deane was successful in increasing the hospital’s base funding, a balm that often gets applied to hospitals under supervision, although a new provincial base funding freeze may lead to cuts to outpatient clinics. A clinical services review is presently underway at the hospital as part of its overall action plan. Hotel Dieu Grace enters the latest round of austerity presently carrying a working capital deficit of $14.2 million.
The supervisor’s report notes that when the hospital underwent a risk analysis in 2008, that the hospital received high marks for new technology, Lean processes, and leading edge medical treatment, but it did not have enough “high touch,” a suggestion that years of underfunding may be responsible for eroding direct bedside care.
Deane did reverse two irritants, one to patients and the other to retiring staff. Among previous budget cuts were cuts to “patient nourishments” on inpatient units. Dean reinstituted the food in addition to cancelling a charge to hospital retirees who were forced to pay $50 to process the paperwork for their post-retirement benefits.
Deane also eliminated a number of management positions, including a vice-president for clinical support services.
Of interest to labour, Deane has instituted bi-monthly meetings with union leadership in an effort to rebuild relationships with front line staff. He has also introduced something called a charter of rights for employees, physicians and volunteers.
The supervisor’s report underlines how dysfunctional HDGH became by quoting a 2010 external review of cardiology, which states “the members of the review team have never seen a working relationship this concerning in any other health care institution.” The review specifically notes that such conflict began “as a discussion between individuals over use of hospital resources.”
There is no question that hospitals across Ontario are bracing themselves against the coming austerity. There are likely few who believe that this year’s funding freeze will be a one-time event, the province openly setting its austerity goals to take us through much of the remaining decade. The provincial budget already laid out plans to scale back overall funding increases over the next three years. Home care and long-term care seem the likely recipients of any new money, and even that appears to be extremely limited. If hospitals are starting this year at zero, what will it look like when overall funding increases dip below 2 per cent by 2014?
One doesn’t have to look hard to read between the lines in Deane’s reports. The question is, how does it get better when hospital staff will be pitted against each other amid year after year of coming scarcity? HDGH may not be the only hospital that degenerates into internal conflict, challenging the ability of a demoralized hospital staff to deliver ever-challenging services.