Category Archives: Hospitals

“If I compare the situation right now to the one several years ago, there are the same number of beds and the same number of patients but fewer staff. This means that we have to work nights/weekends. It is so difficult to claim for overtime, I just end up working for free. All work, no recognition – it just gets to you after a while.”

– focus group participant in a recent study on role overload.

Role overload means feeling that you have too much to do and not enough time in which to do it.

Role overload has been linked to increased levels of anxiety, fatigue, burnout, depression and emotional and physiological stress and to decreased satisfaction with family and work.

A recent WSIB-funded study by three business professors sheds new light on the impact of underfunding on the hospital workplace.

“The Etiology and Reduction of Role Overload in Canada’s Health Care Sector” interviewed workers at four Ottawa hospitals. In addition, 1400 workers filled out in-depth surveys – the majority (84 per cent) were female. The majority of Allied health professionals and technical staff were members of OPSEU. Authored by Dr. Linda Duxbury (Carleton University), Dr. Christopher Higgins (University of Western Ontario) and Dr. Sean Lyons (Univeristy of Guelph), the 213-page report looks at causes and possible solutions to role overload.

Looking at previous studies, the authors note that compared to other professions, health professionals have the lowest level of trust in their employers, lowest level of commitment to their employers, the lowest ratings of workplace communications, the least influence on workplace decisions and least supportive and healthy workplaces.

One study notes the “quality of work life among health care workers has deteriorated to the point where it is impeding the capacity of the system to recruit and retain the staff needed to provide effective patient care.”

Canadians in health occupations miss more work due to illness or disability than other occupations. A CMA survey indicated nearly half of Canadian physicians were in an advanced state of burnout.

The reasons for workload were many, including the most obvious – staff shortages.

Despite the government’s emphasis on multi-disciplinary teams, health care workers pointed out this contributed to the sense of overwork given the time needed to coordinate, schedule, and communicate. The focus groups highlighted the need for constant repeating and rehashing of issues. They also noted that there was a lack of training in how to work in teams.

Workers also complained they could never get away from work – requests for vacation and lieu days were often denied, while taking sick time often meant coming back to even more work. People complained there was no coverage for lunch or breaks.

With hospitals required to provide a greater data stream, front line workers spoke about the demand for documentation has increased over the last several years while time to complete it had decreased.

“The documentation has to be done – for due diligence, for professional standards, for administration – but there is no time in the day for it,” said one focus group participant. “I often end up doing it on my own time, and resenting it. I did not go into this profession to be a secretary.”

Seemingly contradictory, the hospital workers suggested that there was not enough communications and too much communications. Lack of transparency led them to feeling harassed and under pressure. On the other hand, they also felt bombarded by messages, making it difficult to distinguish what was important.

Other contributors included the lack of training and training time, too few resources, the high expectation of patients and their families, the requirement to wear too many hats, the unpredictability of their jobs and the feeling that work was never finished.

Managers were stressed by a lack of job security, particularly after leaving a unionized environment.

One manager told the study: “I spent too much of my time selling and implementing new changes – there is no time to evaluate the change and quite honestly, find it hard to convince others that this is the right thing to do when I am not convinced myself – but I have no choice.”

Management were the group with the highest level of turnover – only 44 per cent of managers had been in their jobs longer than five years.

Para-Medical/Allied health suggested that this group was the most impacted by lack of resources.

Physicians said resources allocated for the government’s wait times strategy actually meant patients outside of those priority areas had to wait longer. They said physicians in private clinics were taking the “easy” patients, leaving physicians working in the hospitals with more complex patients.

Respondents made three suggestions to personally cope with overload – make sure you have some downtime, have positive interactions with colleagues, and set life priorities, not just work priorities.

The suggestion for their hospitals was more varied: provide adequate support, respect and recognize the work they do, provide adequate rewards, allow time to regroup and socialize with colleagues, improve the leadership and culture, improve communication, fix/improve infrastructure, and provide more resources.

More from this report in coming days. To download the full report, go to:

http://www.sprott.carleton.ca/news/2010/docs/complete-report.pdf

 For the Executive Summary, go to:

http://www.sprott.carleton.ca/news/2010/docs/executive-summary.pdf

Fort Erie Mayor Doug Martin fired off a letter to Ontarios health minister, Deborah Matthews, challenging recent comments she made in The Globe & Mail that the closing of the emergency room in the hospital in his municipality was undertaken to provide better health care for residents and not to save money. See: http://niagaraatlarge.com/2010/01/29/south-niagara-mayor-community-activist-take-shots-at-province-over-eroding-hospital-services/

Tired of being ignored, Welland city council has formed a committee to respond to changes at the Niagara Health System. “It’s almost like we’ve been phoning the NHS, the LHIN and the province, leaving a message and saying what we think and not getting a response,” Councillor Frank Campion told Niagara This Week. Campion said that while the hospital restructuring decisions were not theirs to make, the issue is a concern for city hall. Councillor David Alexander told the newspaper that a reduction in hospital services makes it more difficult to market the community to potential investors. Despite its highly controversial restructuring plan, the NHS has an operating deficit of more than $18 million and wait times far above provincial benchmarks.

The board of Headwaters Health Care Centre (HHCC) has decided to close down the Shelburne Hospital.  The board approved cuts of $1.8 million based on a freeze in funding come April. Twenty-two chronic care beds will move to Orangeville while four will be eliminated. In addition, HHCC is closing eight acute care beds and one pediatric bed at its Orangeville site. “It’s not about health care, it’s all about money,” Shelburne Mayor Ed Crewson told the Orangeville Banner. Dr. Ron Murphy, the only dissenting board member, said bed reductions would lead to longer wait times and potential clogging of the emergency room. The HHCC budget will now have to go to the Local Health Integration Network (LHIN) for final approval. What to do something about it? Go to www.avoidingzero.ca

Cornwall Community Hospital is the latest hospital to get additional funding to offset its deficit. The hospital has received $5 million in new funding to its annual operating budget, reducing its deficit from $8 million to $3 million. According to the Cornwall Standard-Freeholder, there is a plan to save $2.1 million by cutting eight beds and reducing the number of surgeries by 10 per cent. … The Ottawa Citizen reported on Wednesday that the Ottawa Hospital and the Queensway-Carleton Hospital have contracted with a private retirement home to provide 74 temporary beds for elderly alternate level of care (ALC) patients. The Ottawa Hospital will close 28 vacated beds as part of the process.  Retirement homes are not health care facilities. Unregulated, they are only covered under the Landlord-Tenant Act.  Last summer the Office of the Chief Coroner sent a letter to the Ontario Hospital Association cautioning hospitals of such transfers. Investigating the death of an ALC patient that had been placed in an unregulated retirement home, the Chief Coroner wrote “health care professionals should be reminded that frail elderly patients who are totally functionally dependent and have significant care needs are not appropriate for placement in the private care homes.” The Coroner said such patients should remain in a setting that is as resource intense as a licensed long term care home. …  The Ottawa Citizen also reported this week of a new study of occupational strain at four Ottawa hospitals. The study concluded that employees are overworked and suffering “unsustainable” levels of stress in a system that’s already as lean as can be. Written by Carleton University professor Linda Duxbury, the report says stress levels are making it difficult for nurses, doctors and other staff to look after patients properly. Michael Donaldson, president of OPSEU Local 464, told the Citizen You’re trying to meet these timelines identified by the ministry, and they’re on the white board in the ER: Are we up? Are we down? We’re barraged by information about how we’re doing.” The result is a steady rise in staff burnout, higher rates of sick leave, workplace injuries and medical errors. Marlene Rivier, president of Local 479 criticized a controversial absenteeism program that required sick employees to report to the hospital’s health insurer. Those who don’t, risk having their pay docked. “People feel harassed, they feel devalued, they feel they’ve become the object of suspicion,” she said.

Just prior to last November’s Ontario Hospital Association Conference, OHA CEO Tom Closson called for hospitals to be placed under Freedom of Information legislation.

Ontario is the only province that excludes its publicly-funded hospitals from such scrutiny.

Addressing the OHA, newly minted health minister Deborah Matthews saluted Closson for taking the initative.

“The people of Ontario expect both a strong health care system, and fiscal responsibility. And it’s our job to provide both,” she said. “One part of restoring that trust is being transparent and how we’re spending and what we’re doing. It’s about showing Ontarians that we’re achieving and being honest about our shortcomings.”

Matthews said that with Closson’s leadership at the OHA, Ontario will be able to restore trust and regain public confidence in the health system.

Enter the Friends of the Ajax/Pickering Hospital. The Friends are a diverse community-based group that advocates on behalf of its local hospital in West Durham.

In 2008 the Rouge Valley Health System board decided to move all inpatient mental health beds from the Ajax-Pickering Hospital to the Scarborough Centenary Hospital. The plan had been kept under wraps until the Rouge board approved it, and within three days, the Central East LHIN had rubber stamped the move without any community consultation or input.

While the Rouge Valley Board has continually argued that consolidation of mental health beds at Scarborough Centenary was part of their deficit reduction plan, the Friends have always doubted whether there were any costs savings to be had.

Not only did Rouge have to renovate Centenary to accommodate the transfer, but a brand new state-of-the-art psychiatric intensive care unit at Ajax-Pickering would be abandoned as part of the process.

Last year the Friends decided to ask for the information on costs related to the transfer from Rouge Valley. They received a letter back from former Tory cabinet minister Janet Ecker, Chair of Rouge’s Board. In it she said the Board’s finance committee met and considered the Friends request.

“The committee has advised me that RVHS follows financial disclosure practices that are generally consistent with the industry and in compliance with statutory reporting requirements,” Ecker wrote. “Based on the above, the committee has concluded and advised me that disclosure of the highly detailed information requested in your letter would be inconsistent with the hospital’s disclosure practices and those of the hospital industry.”

The Friends have since sent in a Freedom of Information request, and been told the information they seek is unavailable. They are appealing.

If the OHA and the Ministry of Health were serious about this, they would give the Friends the information they seek and make disclosure a priority.

It’s time for the OHA and the Ministry to open up the hospitals to disclosure, not just talk about openness and transparency.

At first it looked like a re-run of 2007’s fight to save mental health services at Lakeridge Health in East Durham. Without dedicated funding, Lakeridge’s mental health services stood between the hospital and its legal obligation to balance its budget.

January 19 the Central East LHIN confirmed their decision to deny Lakeridge the ability to cut these services, stating new funding had been found.

Shortly after the decision, a memo was sent to staff at Lakeridge stating the LHIN had contributed another $4.1 million to the hospital’s base funding. The hospital said it was also expecting additional growth funding to bridge its remaining funding gap. For the first time since amalgamation, Lakeridge is likely to balance its budget.

The additional funding marks an important victory for the community. OPSEU had been part of effort to save Lakeridge’s mental health services.

In 2007 the Ministry had given a clear directive for hospitals to divest themselves of mental health programs that weren’t already receiving dedicated funding from the Ministry.

To its credit, the Central East LHIN stepped in at the time and refused to let Lakeridge divest these services, putting the LHIN at odds with the Ministry.

In November of 2009 Lakeridge presented before the LHIN their deficit reduction strategy. However, they said they could not cut further without putting programs at risk, including mental health, outpatient physiotherapy, the day hospital and a respiratory rehabilitation program. The hospital expressed its desire to maintain these services.

Lakeridge will now amalgamate its respiratory rehabilitation, day hospital, and outpatient physiotherapy at a new Lakeridge Centre of Excellence for Rehabilitation Services to be located in the Whitby hospital site this fall.