A new building is often seen as a solution for the updated delivery of health care.
It’s true they usually reduce energy costs. If designed correctly and collaboratively, they can also contribute to higher operational efficiency.
Ontario invested heavily in new hospital buildings under former Premier Dalton McGuinty. At one point we counted about 100 major hospital infrastructure projects in the works – about a third developed as public-private partnerships.
Many of these buildings are now open or will be shortly. After moving in, administrators and staff are discovering the shortcomings that often aren’t evident in the planning stage.
One of them is Waypoint Centre for Mental Health Care in Penetanguishene. Waypoint moved both medium and maximum security units into its new $474 million building in May.
The only high security forensic hospital in Ontario, it has had an almost flawless record in preventing maximum security elopements over its long history – the last escape was about 40 years ago.
The new building has been open for less than four months and already a maximum security patient has been able to elope, traversing three chain link fences to make his escape. He has since been returned to hospital, but now many questions are being asked about security at the new building. That includes questions posed by staff who feel more vulnerable as new health and safety issues take a back seat to other priorities.
The Atrium building appears to be modelled on a series of new mental health facilities popping up across the province. Some have been quite good – including the new Southwest Centre for Forensic Mental Health Care in St. Thomas. Built with much input from the union local, St. Thomas is generally considered successful in its design – not that there haven’t been problems or unanticipated issues.
Just because a building design works in one place doesn’t mean it will work everywhere. Waypoint is not like the other mental health facilities, foremost because its patients are not like the others. When a patient is disruptive and other facilities can no longer cope, they often send him to Waypoint (there are no women in the maximum security unit).
Nor has Waypoint paid particular attention or sought extensive input from front line staff in the design. That’s a shame.
Several of the new patient rooms have already been trashed by their occupants at Waypoint, the debris used as a weapon against staff trying to restore calm. It seems self-evident that more input and thought should have been placed into the design of these rooms.
The design of the new facility gives much more freedom of movement to the patients – as it should – however neither the staffing levels nor training has kept pace with the requirements and risks of this new environment.
Waypoint is not going to rebuild its new building.
The fact that it is a P3 makes new physical adjustments that much more difficult to negotiate. Any material changes get multiplied by the long-term costs and slowed by the negotiation process.
The Royal Ottawa Mental Health Centre experienced elopements from its new exercise yard in 2006 after it was found that initial security was also insufficient. That resulted in protracted negotiations between the hospital and the P3 consortium over who was responsible for paying for the fix.
Waypoint has promised the community that high security elopements will not happen again. They have also promised a “full investigation by Waypoint officials” into the incident.
That investigation should include significant input from front line staff and its findings made public.
Health and safety concerns are not necessarily linked exclusively to the new building.
Last November the Ministry of Labour issued 10 orders to the hospital to reduce the risk of workplace violence. That’s six months before the move to the new building.
The more discretionary approach the hospital is taking to disclosure of incidents that impact the workplace frustrates Waypoint’s unionized employees. If the hospital wishes to foster trust, it should make transparency its mantra.
A new building is always a challenge. Waypoint could do much better in navigating issues in these early days.
Correction: In our interview with CBC Radio early this morning, we said that the elopement was for two days. In fact we have since been told the patient was found and returned to the hospital in less than two hours on Saturday night.