As a public sector union we are often left to speak for those who can’t. Members often face reprisals and discipline from their employer if they speak publicly about problems in public service delivery for which they have first-hand expert knowledge.
When they feel they cannot speak out, we all lose as both funders and users of these services.
Badly run organizations often go hand-in-hand with a culture of fear among employees. This was a lesson learned at Windsor’s Hotel Dieu hospital, where a dysfunctional staff culture led to major issues and incidents around quality of care for patients.
Supervisor Ken Deane (now the CEO) specifically noted that among management there was a culture of “fear of reprisal for speaking up” at Windsor Hotel Dieu. Just imagine what it would be like to be a front line worker.
The irony of such workplaces is not lost on us amid all the talk about empowering front line workers through such continuous quality improvement processes as Lean. It also calls into question the government’s commitment to transparency and accountability when front line staff are effectively gagged.
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.