COLUMN: Occupy BGH

Opinion Feb 27, 2017 by John Bradford Brant News

Any reference to an “occupy" movement brings images of large and loud crowds, anger and angst, and tents and tension from the average citizen.

There is an occupy movement groundswell here in our own Brant Community Healthcare System, minus the tents.

On the surface, it appears to be a co-ordinated effort with doctors and medical staff, employees and patients. And the opposition could be the CEO or senior administration, the Local Health Integration Network, the Minister of Health or the whole provincial Health Ministry.

Underneath, it is far more convoluted and disparate. Many feel discontented but none agree about the wave that carries them all.

A detailed letter was sent to the Minister of Health, Dr. Eric Hoskins, from Dr. Arash Zohoor, who represents the Brantford Hospital Medical Staff Association.

This advocacy group are bylawed with an executive and staff membership of about 150 full and part-time medical professionals who meet to discuss various issues around quality of care and the practice of medicine locally.

They report to senior administration and the board of governors as non-voting members through the medical advisory committee chaired by the chief of staff, Dr. Christopher O’Brien.

I interviewed several doctors including Dr. O’Brien and Dr. Zohoor, although the latter was given a direction a few days ago by his membership to not discuss his role or the issues in general with the media.

His letter was sent in December 2016 to the Minister, but bypassed the LHIN and the Brant Community Healthcare System.

Some feel his articulation of the issues is not fully substantiated or factually detailed and in some cases represent five-year-old issues already dealt with.

The association doesn’t meet regularly and claim to have taken concerns to senior management and the board of governors through the Medical Advisory Committee for discussion.

There is another professional group called the Brantford Medical Association, chaired by Dr. John Hadley, which represents the needs of all 350-plus doctors. Several other doctors interviewed have suggested they were not consulted about the letter.

Regardless, some are not happy and want the province to solve the perceived problems. Problems with overcrowding in the emergency room, working conditions, administrative decision-making and lack of patient support services. They are also understandably upset about the caps on income and the claw backs of fees for service rates.

But who should they be mad at?

There are the Ministry of Health and the LHIN as government decision-makers. The LHIN, although designed as a local advocate for regional health care, has sometimes been referred to as the "oven mitts,” since they take "hot stuff" off the ministry's plate or send the "hot stuff" to the ministry from local caregivers.

This recent letter bypassed them, forcing the ministry to follow up back to the LHIN.

The LHIN discussed the issue in an open meeting with publicly published minutes in January and recommended back to the ministry that an “investigator" be assigned to dig into the allegations.

In an interview with Dr. Zohoor, he alluded to his understanding that an investigator has already been selected by the Ministry of Health but not publicly announced. On Monday, it was announced by the BCHS that Dr. Tim Rutledge, the CEO of North York General Hospital, had been appointed as an investigator.

Rutledge will conduct a review over several months, following up on concerns regarding operational reviews and plans.

“We are grateful to have Dr. Rutledge review our current situation, and he comes to us with a great reputation and wealth of experience,” BCHS CEO Jim Hornell said. “Our hospital is hopeful the investigator will help us chart an improved path forward — and help put to rest concerns of stakeholders in the process. We deeply value all the skilled professionals on our teams and continue our commitment to provide the very best care to our community.”

In this role, Dr. Rutledge will examine governance and management at the BCHS, as well as quality of care and financial matters. He will also liaise with the LHIN and other stakeholders before providing his final recommendations.

The investigator does not replace the board or leadership of the hospital. Hospital leadership will co-operate fully and assist the investigator in obtaining information.

The LHIN met with the Brant board, absent the senior administration, for clarification.

You see, if the inspector finds there are resolvable concerns, recommendations are included.

Ironically, the BCHS just completed an operational review at the board of governors level before Christmas, through Ernst and Young, that includes a variety of recommendations.

If, on the other hand, the place is toxic and the safety and welfare of patients and staff is in dire straits, as Dr. Zohoor suggested, then a “supervisor" could be assigned from the province to take over as CEO, and perhaps even the board of governors, too.

There have been supervisors in the past in Sarnia, Niagara, and Peterborough, as examples, but never in Brant.

As a matter of fact, the Brant Community Healthcare System has been nationally accredited for decades.

Yes, they know they have issues, but they also have defined strategies to resolve them already acceptable to the ministry.

Dr. Zohoor wants to be clear on the record that there are many at all levels of the hospital that are champions and committed to patient-first care. He also is confident that an investigator — an expert in Ontario health-care systems and procedures — would provide an outside set of eyes and be a valuable asset to bring clarity and resolution.

So, what has changed?

The past funding model was a single pot of dollars based on the number of beds and activities like specialized surgical procedures, with almost all capital expenditures the responsibility of the local community — not the ministry.

Now, they have a three-part model: 40 per cent allocated as quality-based procedures like knees, hips and cataracts; 30 per cent for health-based allocation such as number of patients and the level of their acuity; and a 30 per cent global fund for everything else, including a list of 11 mandates from the LHIN that must be accomplished.

It is understandable that if an emergency room was built originally for 20,000 patient visits annually, and now gets 60,000 visits, everyone — from staff to patients — are unhappy.

These kinds of changes take millions of dollars but the funding envelope for capital expenses from the province only allows about $500,000 annually.

What has also changed for docs is the role for direct care in the hospital.

It used to be that all doctors were credentialed to use the hospital in return for helping with strategic planning and administrative meetings. Now, less than 50 per cent of doctors in Brantford apply for credentials, opting to serve from their clinics instead.

But that means patients come in as “orphans" and the hospital has to supply hospitalists to be their primary caregivers.

These folks are like subcontractors who do their own OHIP billing, but salaries are topped up 35 per cent by the hospital to compensate for any income loss not being in their own clinics. And this has changed because now they are being asked to negotiate common contracts so there is no discrepancy in expectations between them.

Some don’t necessarily see that as helpful to them, as their previous contracts were satisfactory.

In addition, they may get assigned to particular sections of the hospital — referred to as geo-rounds — to offer familiar and consistent care for patients at significant administrative savings, even if the practitioner would rather hop about to a variety of departments.

Staff see the changes, hear the medical complaints and, as expected, tend to side with their front-line colleagues. But they have concerns too.

There are hundreds of registered nurses, but the ministry has allowed more personal support workers to do several of their functions at lesser pay. Nurses feel this provincial decision is an assault on their professionalism and many came through the ranks for years, often from other institutions that reacted to their identities in different ways. They see strategic structural changes in managing and leadership that are a reality of cost savings given the shrinking funding envelope.

On one occasion, 13 senior administrators were downsized as cost savings so that money could be diverted to hiring 27 front-line staff for added patient care. One could only imagine the anxiety those moves induced.

Patients want to know they are going to be taken care of. If they are assigned to a bed in a hallway they are very angry.

It could be because many rooms are locked up with seniors with complex needs because the nursing home they came from doesn’t have the level of staff to accommodate their care anymore and refuses to take them back until they are well. Or reductions in evening staff mean less visits to each patient. Or with a shortage of family physicians and few urgent care clinics, non-emergency cases are showing up at the front door.

And then there is simply the reality on the ground that, to some extent, the system is broken, the funding is inadequate and a wholesale change is in order.

Who is at fault for all this?

The feds determine health dollar transfers and national standards of care. The province dictates mandates and funding. The LHIN advocates between the province and the institutions. The administration and boards govern the operations. And the patient has a high level of expectation to meet their needs.

We all cherish our health care and we have every right to complain. But if you don’t know who is directly at fault, it is easy to pick on the one directly in front of you.

Take your "occupy BGH" attitude with pride, but focus on seeking resolution not devolution. Remember that negotiation is just about developing relationships, agreeing on acceptable outcomes and determining the process to get there.

More communication is critical. Already in Brantford over the past few weeks, staff, doctors, administration and board members have been huddling together to open more lines of communication.

Sometimes it just takes a letter to get everyone’s attention.

So, let’s look for a made-in-Brant solution.

 

COLUMN: Occupy BGH

Provincial investigator appointed to BCHS following letter of concern to ministry

Opinion Feb 27, 2017 by John Bradford Brant News

Any reference to an “occupy" movement brings images of large and loud crowds, anger and angst, and tents and tension from the average citizen.

There is an occupy movement groundswell here in our own Brant Community Healthcare System, minus the tents.

On the surface, it appears to be a co-ordinated effort with doctors and medical staff, employees and patients. And the opposition could be the CEO or senior administration, the Local Health Integration Network, the Minister of Health or the whole provincial Health Ministry.

Underneath, it is far more convoluted and disparate. Many feel discontented but none agree about the wave that carries them all.

A detailed letter was sent to the Minister of Health, Dr. Eric Hoskins, from Dr. Arash Zohoor, who represents the Brantford Hospital Medical Staff Association.

This advocacy group are bylawed with an executive and staff membership of about 150 full and part-time medical professionals who meet to discuss various issues around quality of care and the practice of medicine locally.

They report to senior administration and the board of governors as non-voting members through the medical advisory committee chaired by the chief of staff, Dr. Christopher O’Brien.

I interviewed several doctors including Dr. O’Brien and Dr. Zohoor, although the latter was given a direction a few days ago by his membership to not discuss his role or the issues in general with the media.

His letter was sent in December 2016 to the Minister, but bypassed the LHIN and the Brant Community Healthcare System.

Some feel his articulation of the issues is not fully substantiated or factually detailed and in some cases represent five-year-old issues already dealt with.

The association doesn’t meet regularly and claim to have taken concerns to senior management and the board of governors through the Medical Advisory Committee for discussion.

There is another professional group called the Brantford Medical Association, chaired by Dr. John Hadley, which represents the needs of all 350-plus doctors. Several other doctors interviewed have suggested they were not consulted about the letter.

Regardless, some are not happy and want the province to solve the perceived problems. Problems with overcrowding in the emergency room, working conditions, administrative decision-making and lack of patient support services. They are also understandably upset about the caps on income and the claw backs of fees for service rates.

But who should they be mad at?

There are the Ministry of Health and the LHIN as government decision-makers. The LHIN, although designed as a local advocate for regional health care, has sometimes been referred to as the "oven mitts,” since they take "hot stuff" off the ministry's plate or send the "hot stuff" to the ministry from local caregivers.

This recent letter bypassed them, forcing the ministry to follow up back to the LHIN.

The LHIN discussed the issue in an open meeting with publicly published minutes in January and recommended back to the ministry that an “investigator" be assigned to dig into the allegations.

In an interview with Dr. Zohoor, he alluded to his understanding that an investigator has already been selected by the Ministry of Health but not publicly announced. On Monday, it was announced by the BCHS that Dr. Tim Rutledge, the CEO of North York General Hospital, had been appointed as an investigator.

Rutledge will conduct a review over several months, following up on concerns regarding operational reviews and plans.

“We are grateful to have Dr. Rutledge review our current situation, and he comes to us with a great reputation and wealth of experience,” BCHS CEO Jim Hornell said. “Our hospital is hopeful the investigator will help us chart an improved path forward — and help put to rest concerns of stakeholders in the process. We deeply value all the skilled professionals on our teams and continue our commitment to provide the very best care to our community.”

In this role, Dr. Rutledge will examine governance and management at the BCHS, as well as quality of care and financial matters. He will also liaise with the LHIN and other stakeholders before providing his final recommendations.

The investigator does not replace the board or leadership of the hospital. Hospital leadership will co-operate fully and assist the investigator in obtaining information.

The LHIN met with the Brant board, absent the senior administration, for clarification.

You see, if the inspector finds there are resolvable concerns, recommendations are included.

Ironically, the BCHS just completed an operational review at the board of governors level before Christmas, through Ernst and Young, that includes a variety of recommendations.

If, on the other hand, the place is toxic and the safety and welfare of patients and staff is in dire straits, as Dr. Zohoor suggested, then a “supervisor" could be assigned from the province to take over as CEO, and perhaps even the board of governors, too.

There have been supervisors in the past in Sarnia, Niagara, and Peterborough, as examples, but never in Brant.

As a matter of fact, the Brant Community Healthcare System has been nationally accredited for decades.

Yes, they know they have issues, but they also have defined strategies to resolve them already acceptable to the ministry.

Dr. Zohoor wants to be clear on the record that there are many at all levels of the hospital that are champions and committed to patient-first care. He also is confident that an investigator — an expert in Ontario health-care systems and procedures — would provide an outside set of eyes and be a valuable asset to bring clarity and resolution.

So, what has changed?

The past funding model was a single pot of dollars based on the number of beds and activities like specialized surgical procedures, with almost all capital expenditures the responsibility of the local community — not the ministry.

Now, they have a three-part model: 40 per cent allocated as quality-based procedures like knees, hips and cataracts; 30 per cent for health-based allocation such as number of patients and the level of their acuity; and a 30 per cent global fund for everything else, including a list of 11 mandates from the LHIN that must be accomplished.

It is understandable that if an emergency room was built originally for 20,000 patient visits annually, and now gets 60,000 visits, everyone — from staff to patients — are unhappy.

These kinds of changes take millions of dollars but the funding envelope for capital expenses from the province only allows about $500,000 annually.

What has also changed for docs is the role for direct care in the hospital.

It used to be that all doctors were credentialed to use the hospital in return for helping with strategic planning and administrative meetings. Now, less than 50 per cent of doctors in Brantford apply for credentials, opting to serve from their clinics instead.

But that means patients come in as “orphans" and the hospital has to supply hospitalists to be their primary caregivers.

These folks are like subcontractors who do their own OHIP billing, but salaries are topped up 35 per cent by the hospital to compensate for any income loss not being in their own clinics. And this has changed because now they are being asked to negotiate common contracts so there is no discrepancy in expectations between them.

Some don’t necessarily see that as helpful to them, as their previous contracts were satisfactory.

In addition, they may get assigned to particular sections of the hospital — referred to as geo-rounds — to offer familiar and consistent care for patients at significant administrative savings, even if the practitioner would rather hop about to a variety of departments.

Staff see the changes, hear the medical complaints and, as expected, tend to side with their front-line colleagues. But they have concerns too.

There are hundreds of registered nurses, but the ministry has allowed more personal support workers to do several of their functions at lesser pay. Nurses feel this provincial decision is an assault on their professionalism and many came through the ranks for years, often from other institutions that reacted to their identities in different ways. They see strategic structural changes in managing and leadership that are a reality of cost savings given the shrinking funding envelope.

On one occasion, 13 senior administrators were downsized as cost savings so that money could be diverted to hiring 27 front-line staff for added patient care. One could only imagine the anxiety those moves induced.

Patients want to know they are going to be taken care of. If they are assigned to a bed in a hallway they are very angry.

It could be because many rooms are locked up with seniors with complex needs because the nursing home they came from doesn’t have the level of staff to accommodate their care anymore and refuses to take them back until they are well. Or reductions in evening staff mean less visits to each patient. Or with a shortage of family physicians and few urgent care clinics, non-emergency cases are showing up at the front door.

And then there is simply the reality on the ground that, to some extent, the system is broken, the funding is inadequate and a wholesale change is in order.

Who is at fault for all this?

The feds determine health dollar transfers and national standards of care. The province dictates mandates and funding. The LHIN advocates between the province and the institutions. The administration and boards govern the operations. And the patient has a high level of expectation to meet their needs.

We all cherish our health care and we have every right to complain. But if you don’t know who is directly at fault, it is easy to pick on the one directly in front of you.

Take your "occupy BGH" attitude with pride, but focus on seeking resolution not devolution. Remember that negotiation is just about developing relationships, agreeing on acceptable outcomes and determining the process to get there.

More communication is critical. Already in Brantford over the past few weeks, staff, doctors, administration and board members have been huddling together to open more lines of communication.

Sometimes it just takes a letter to get everyone’s attention.

So, let’s look for a made-in-Brant solution.

 

COLUMN: Occupy BGH

Provincial investigator appointed to BCHS following letter of concern to ministry

Opinion Feb 27, 2017 by John Bradford Brant News

Any reference to an “occupy" movement brings images of large and loud crowds, anger and angst, and tents and tension from the average citizen.

There is an occupy movement groundswell here in our own Brant Community Healthcare System, minus the tents.

On the surface, it appears to be a co-ordinated effort with doctors and medical staff, employees and patients. And the opposition could be the CEO or senior administration, the Local Health Integration Network, the Minister of Health or the whole provincial Health Ministry.

Underneath, it is far more convoluted and disparate. Many feel discontented but none agree about the wave that carries them all.

A detailed letter was sent to the Minister of Health, Dr. Eric Hoskins, from Dr. Arash Zohoor, who represents the Brantford Hospital Medical Staff Association.

This advocacy group are bylawed with an executive and staff membership of about 150 full and part-time medical professionals who meet to discuss various issues around quality of care and the practice of medicine locally.

They report to senior administration and the board of governors as non-voting members through the medical advisory committee chaired by the chief of staff, Dr. Christopher O’Brien.

I interviewed several doctors including Dr. O’Brien and Dr. Zohoor, although the latter was given a direction a few days ago by his membership to not discuss his role or the issues in general with the media.

His letter was sent in December 2016 to the Minister, but bypassed the LHIN and the Brant Community Healthcare System.

Some feel his articulation of the issues is not fully substantiated or factually detailed and in some cases represent five-year-old issues already dealt with.

The association doesn’t meet regularly and claim to have taken concerns to senior management and the board of governors through the Medical Advisory Committee for discussion.

There is another professional group called the Brantford Medical Association, chaired by Dr. John Hadley, which represents the needs of all 350-plus doctors. Several other doctors interviewed have suggested they were not consulted about the letter.

Regardless, some are not happy and want the province to solve the perceived problems. Problems with overcrowding in the emergency room, working conditions, administrative decision-making and lack of patient support services. They are also understandably upset about the caps on income and the claw backs of fees for service rates.

But who should they be mad at?

There are the Ministry of Health and the LHIN as government decision-makers. The LHIN, although designed as a local advocate for regional health care, has sometimes been referred to as the "oven mitts,” since they take "hot stuff" off the ministry's plate or send the "hot stuff" to the ministry from local caregivers.

This recent letter bypassed them, forcing the ministry to follow up back to the LHIN.

The LHIN discussed the issue in an open meeting with publicly published minutes in January and recommended back to the ministry that an “investigator" be assigned to dig into the allegations.

In an interview with Dr. Zohoor, he alluded to his understanding that an investigator has already been selected by the Ministry of Health but not publicly announced. On Monday, it was announced by the BCHS that Dr. Tim Rutledge, the CEO of North York General Hospital, had been appointed as an investigator.

Rutledge will conduct a review over several months, following up on concerns regarding operational reviews and plans.

“We are grateful to have Dr. Rutledge review our current situation, and he comes to us with a great reputation and wealth of experience,” BCHS CEO Jim Hornell said. “Our hospital is hopeful the investigator will help us chart an improved path forward — and help put to rest concerns of stakeholders in the process. We deeply value all the skilled professionals on our teams and continue our commitment to provide the very best care to our community.”

In this role, Dr. Rutledge will examine governance and management at the BCHS, as well as quality of care and financial matters. He will also liaise with the LHIN and other stakeholders before providing his final recommendations.

The investigator does not replace the board or leadership of the hospital. Hospital leadership will co-operate fully and assist the investigator in obtaining information.

The LHIN met with the Brant board, absent the senior administration, for clarification.

You see, if the inspector finds there are resolvable concerns, recommendations are included.

Ironically, the BCHS just completed an operational review at the board of governors level before Christmas, through Ernst and Young, that includes a variety of recommendations.

If, on the other hand, the place is toxic and the safety and welfare of patients and staff is in dire straits, as Dr. Zohoor suggested, then a “supervisor" could be assigned from the province to take over as CEO, and perhaps even the board of governors, too.

There have been supervisors in the past in Sarnia, Niagara, and Peterborough, as examples, but never in Brant.

As a matter of fact, the Brant Community Healthcare System has been nationally accredited for decades.

Yes, they know they have issues, but they also have defined strategies to resolve them already acceptable to the ministry.

Dr. Zohoor wants to be clear on the record that there are many at all levels of the hospital that are champions and committed to patient-first care. He also is confident that an investigator — an expert in Ontario health-care systems and procedures — would provide an outside set of eyes and be a valuable asset to bring clarity and resolution.

So, what has changed?

The past funding model was a single pot of dollars based on the number of beds and activities like specialized surgical procedures, with almost all capital expenditures the responsibility of the local community — not the ministry.

Now, they have a three-part model: 40 per cent allocated as quality-based procedures like knees, hips and cataracts; 30 per cent for health-based allocation such as number of patients and the level of their acuity; and a 30 per cent global fund for everything else, including a list of 11 mandates from the LHIN that must be accomplished.

It is understandable that if an emergency room was built originally for 20,000 patient visits annually, and now gets 60,000 visits, everyone — from staff to patients — are unhappy.

These kinds of changes take millions of dollars but the funding envelope for capital expenses from the province only allows about $500,000 annually.

What has also changed for docs is the role for direct care in the hospital.

It used to be that all doctors were credentialed to use the hospital in return for helping with strategic planning and administrative meetings. Now, less than 50 per cent of doctors in Brantford apply for credentials, opting to serve from their clinics instead.

But that means patients come in as “orphans" and the hospital has to supply hospitalists to be their primary caregivers.

These folks are like subcontractors who do their own OHIP billing, but salaries are topped up 35 per cent by the hospital to compensate for any income loss not being in their own clinics. And this has changed because now they are being asked to negotiate common contracts so there is no discrepancy in expectations between them.

Some don’t necessarily see that as helpful to them, as their previous contracts were satisfactory.

In addition, they may get assigned to particular sections of the hospital — referred to as geo-rounds — to offer familiar and consistent care for patients at significant administrative savings, even if the practitioner would rather hop about to a variety of departments.

Staff see the changes, hear the medical complaints and, as expected, tend to side with their front-line colleagues. But they have concerns too.

There are hundreds of registered nurses, but the ministry has allowed more personal support workers to do several of their functions at lesser pay. Nurses feel this provincial decision is an assault on their professionalism and many came through the ranks for years, often from other institutions that reacted to their identities in different ways. They see strategic structural changes in managing and leadership that are a reality of cost savings given the shrinking funding envelope.

On one occasion, 13 senior administrators were downsized as cost savings so that money could be diverted to hiring 27 front-line staff for added patient care. One could only imagine the anxiety those moves induced.

Patients want to know they are going to be taken care of. If they are assigned to a bed in a hallway they are very angry.

It could be because many rooms are locked up with seniors with complex needs because the nursing home they came from doesn’t have the level of staff to accommodate their care anymore and refuses to take them back until they are well. Or reductions in evening staff mean less visits to each patient. Or with a shortage of family physicians and few urgent care clinics, non-emergency cases are showing up at the front door.

And then there is simply the reality on the ground that, to some extent, the system is broken, the funding is inadequate and a wholesale change is in order.

Who is at fault for all this?

The feds determine health dollar transfers and national standards of care. The province dictates mandates and funding. The LHIN advocates between the province and the institutions. The administration and boards govern the operations. And the patient has a high level of expectation to meet their needs.

We all cherish our health care and we have every right to complain. But if you don’t know who is directly at fault, it is easy to pick on the one directly in front of you.

Take your "occupy BGH" attitude with pride, but focus on seeking resolution not devolution. Remember that negotiation is just about developing relationships, agreeing on acceptable outcomes and determining the process to get there.

More communication is critical. Already in Brantford over the past few weeks, staff, doctors, administration and board members have been huddling together to open more lines of communication.

Sometimes it just takes a letter to get everyone’s attention.

So, let’s look for a made-in-Brant solution.