June 14, 2017

Healing health care requires bold action

By Dr. Nick Hajidiacos & Dr. John Sokal

As doctors working in our health system, we offer this prescription: let’s take bold action now to establish a health system that is more responsive to the needs of our patients and that is sustainable today and into the future.

When compared to its counterparts in other parts of Canada, Winnipeg’s health-care system often comes up short in key measurements such as emergency room wait times, lengths of stay and access to diagnostics and specialty services. We also know that despite having more hospital beds, more personal-care home beds and more health-care spending than other similarly sized jurisdictions, we are still unable to meet or surpass national averages in those areas. Rather than face criticism every time these statistics come out, maybe we should look at what we need to do to attain the gold standard.

That, in essence, is what the Winnipeg Regional Health Authority’s (WRHA) Healing Our Health Care System plan is all about. It is the first system-wide initiative in a generation aimed at making our system better. As such, it represents a unique opportunity to streamline the system and to deliver better care overall, equally to everyone who needs it.

The plan is largely based on the recommendations of the Provincial Clinical and Preventive Services Planning report commissioned by the former NDP government and spearheaded by Dr. David Peachey. That report, based largely on consultations with those who work within the system, called for making fundamental and necessary changes to reduce wait times, promote access to services and ensure the sustainability of the system itself.

In the weeks since the WRHA announced its plan to heal the health-care system, some have challenged the rationale for change and questioned the need to upset the status quo.

The need for change is clear. Today, every hospital ward wants to see itself as being able to offer acute care and rehabilitation services at the same time. That’s inefficient and it spreads our diagnostic, physician, nursing and allied health resources too thinly. We’re trying to staff six acute-care sites and make them exactly the same, but they don’t all have the same specialists and they don’t all have the same services.

Too often, acutely ill patients are transferred between facilities – often multiple times – to access the resources they require. By consolidating acute care in three hospitals in Winnipeg – Health Sciences Centre, St. Boniface Hospital and Grace Hospital – we’re concentrating our expertise and person-power into three acute-care sites of excellence.

That allows us to focus our three other hospitals – Victoria, Concordia and Seven Oaks – on being sites of excellence in their new roles: rehabilitation, convalescence, mental health and transitional care.

What does that mean for patients? We believe they are going to receive better care overall, because they will be able to access the necessary resources at the right time to deal with their specific needs. By maximizing our available resources, each step in the patient’s journey is an improvement in their level of care, not a downgrade.

The health-care system in Alberta was consolidated successfully in this fashion several years ago and we’re modelling some of our methodologies on what occurred there and in other provinces.

What people may not realize is that the plan also builds on the kind of process improvements that have been implemented in Winnipeg on a smaller scale, with more recent examples being the emergency departments at both HSC and St. Boniface Hospital.

When HSC’s revamped emergency department opened in 2007, it was built to accommodate 40,000 visits per year. It’s at 62,000 now. As patient volumes grew, a minor treatment area was implemented to accommodate lower acuity patients in a separate care stream. When the 50,000-visit threshold was reached a couple of years ago, a mid-acuity stream for patients was implemented.

This method of streaming had already been proven to work in many other cities across Canada, the U.S. and the U.K. By doing this, the flow at HSC improved to the degree that it has won the Western Emergency Department Operations Conference Award for the most improved emergency department in Western Canada for the past two years.

We’re not going into this trying untested processes. We have already been testing these processes. The emergency departments at St. Boniface and Grace hospitals are already using these methods and have improved their metrics over the past year.

What’s key is that we must ensure we have the infrastructure and human resources to do this on a 24/7 basis. That is what this consolidation is all about: bringing key resources together to optimize care 24/7 in the hospital setting.

That’s why consolidating acute care into three hospitals – and having the other hospitals specialize in recovery and convalescence – holds promise.

Making these kinds of changes here and now is long overdue. The time for tinkering has passed and the philosophy of “Just build new buildings and everything will be better” hasn’t worked. Getting the job done requires new methods and innovative thinking.

We need to create a system that works and that is sustainable now and into the future. We are confident in this new system. In fact, our hope is that in two years, the only question being asked is why we didn’t do it sooner.

Dr. Nick Hajidiacos is St. Boniface Hospital’s medical manager and section head for General Internal Medicine. Dr. John Sokal is medical director of Adult Emergency at Health Sciences Centre Winnipeg.

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