Scarborough: The first and last VP of Patient Experience

John Wright, The Scarborough Hospital’s (TSH) former CEO once proudly told staff that they were among the first in Canada to have a Vice-President of Patient Experience. While there is much rhetoric around patient-centered care, it appears the Scarborough Hospital was at least trying to walk the talk.

TSH may have been among the first in Ontario to establish such a position. It is also among the first to eliminate such a position.

One of the first projects that VP undertook was a revamping of the food served to patients at the hospital. As we reported last week, the TSH had engaged a consulting chef and invested in equipment to be able to serve patients fresh local foods. Now that project, like the former VP who spawned it, appears to be on the way out according to a discussion paper generated by a merger committee between the TSH and Rouge Valley Health System.

We get it that money is tight.

The two hospitals admit that together they need to find $28 million next year to weather an ongoing freeze in base funding to hospitals. This is not a one-time event, but a long road of deliberate fiscal restraint. The amount needed could be even higher should the two hospitals decide to make a recommendation to formally merge. Mergers generally do not save money. They cost more.

TSH has gone through recent community battles over potential changes to services. It is one of the reason merger discussions are leaving out any issues around location of service delivery, however, that “elephant in the room” is getting increasingly difficult to avoid as working committees try to determine what a merged or “integrated” hospital might look like.

The demographics around such a merger are particularly sensitive. It is one of the most diverse multicultural areas in the GTA. It is where many new immigrants first arrive – the 2006 Census indicated 57 per cent of the area’s residents were born in another country. Poverty in Toronto is also moving east. Eight of 13 priority Toronto neighborhoods identified by the United Way are in Scarborough.

Poverty is the key social determinant of health, yet there seems to be insufficient acknowledgement of Scarborough’s struggles in the provincial funding formula for these hospitals.

While the two hospitals appear to be putting a happy face on the process they are presently undergoing, nobody believes this exercise is solely about improving quality. The $28 million shortfall is the real driving force – otherwise why else would the hospitals be even willing to entertain blowing up a much heralded food services initiative?

Maybe the two hospitals should really walk the talk this time. That means putting aside issues of budget while the community participates in the process to best determine how their present and future health needs can be met.

Every health policy analyst will tell you that quality is the most cost-effective way of designing a health system. That should be the starting point.

The hospitals should be prepared to come up with a list of health needs the community requires, cost that list and determine how best to deliver it. Only then should it compare that outcome to what the province is willing to fund. The public policy decisions become much clearer in that scenario – which changes are driven by quality, and which changes are driven by a decision to slowly defund public hospitals?

Scarborough is rich political ground for the ruling Ontario Liberals, but that base of support is eroding. The MPPs in this area should be challenged to explain why the provincial funding formula is working against the high needs communities these hospitals serve. They should also explain where and how residents can access care if it is coming out of the hospital.

The hospital needs to integrate itself into a plan that will address the social determinants of health in this community. That includes addressing income inequality and growing poverty.

The mantra of the Wynne government is community-based delivery, but what does that really mean? When outpatient clinics are closed at the hospital, are they really being replaced? Is the new location for those clinics accessible to patients who may be challenged by issues of transportation? Are they considering who may be working two or three jobs and have little time to locate and travel to a more remote location to access the same care? Are these community clinics more likely to charge user fees for all or part of a service? Will these smaller community clinics have the resources to deal with issues around language and culture?

We know that real incomes have also been declining in this community. Many Scarborough residents work at these hospitals. The hospitals are among the biggest and best employers in the community. When these good jobs are lost, what does it do for the local economy of nearby neighborhoods? When jobs are transferred to smaller community-based agencies, what happens to wages and benefits?

We would invite you to ask these kinds of questions as TSH/Rouge holds two upcoming telephone town hall meetings. You do need to sign up in advance (click here). The first town hall is on September 24 at 7:10 pm, the other October 8 at 7:05 pm. We’ll also be there and report on what we hear.