One of the fatal flaws in the provincial government’s 2017-19 plan to consolidate Winnipeg’s acute care hospitals is it failed to get buy-in from front-line staff. Today, it’s paying the price for that mistake.
Emergency departments continue to bust at the seams, even as the number of COVID-19 patients admitted to hospital declines. ER wait times have hit levels not seen since at least 2014, as patients pile up, sometimes for days, awaiting a bed on a medical ward (or any other area of the hospital that will take them).
The culprit: a lack of in-patient bed capacity, which creates bottlenecks throughout hospitals and backs up in ERs.
What that really means is a severe shortage of front-line staff. There aren’t enough doctors, nurses and support staff to treat the volume of patients admitted to hospital.
A lack of acute care capacity doesn’t mean a shortage of hospital space, physical beds or equipment. Those can be acquired with relative ease. What hospitals can’t obtain overnight are trained, experienced staff. That takes time, investment and foresight.
Hospital overcrowding is not a new phenomenon. It predates the COVID-19 pandemic and Manitoba’s “healing our health system” consolidation plan, the first phase of which was implemented in October 2017. However, ER wait times have not been this bad for years; they are now longer than they were prior to consolidation.
That doesn’t surprise those working on the front lines, the vast majority of whom were neither consulted about consolidation prior to implementation, nor given the training required to take on new roles.
More than 3,000 hospital positions were deleted and reposted during the first phase of consolidation to accommodate the changes. Many staff were forced to change jobs and/or work at a different hospital with little information about their new roles.
Three months after the first phase was implemented, an interim evaluation found the vast majority of staff knew nothing about the plan until it was reported by media in April 2017.
There was a feeling among staff, “They were treated disrespectfully through the process because they often learned about changes through media, including changes to their position,” the Winnipeg Regional Health Authority report found.
A survey of hospital staff found 67 per cent did not understand how the changes would improve the system and 68 per cent said they did not feel they were adequately informed about decisions that impacted their jobs. Health-care staff, the lifeblood of any medical system, were an afterthought.
Even middle managers were initially unclear about their role in the transformation because they were left out of regional planning.
Over a year later, a second evaluation report (this time penned by Nova Scotia consultant Dr. David Peachey, whose firm proposed much of the consolidation plan three years earlier) found widespread staff burnout and a poorly executed rollout.
“Across all WRHA hospitals, nurses have been inadvertently trapped by previously unknown levels of stress, exacerbated by a mixture of unpredictability and under-resourcing that have been fallouts from consolidation,” the report found. That resulted in “compromised care and nursing distress.”
“It has reached the point where nurses can fear going to work as they may not be able to return home due to requested and mandated overtime.”
Peachey found there was “deep-seated unhappiness” in emergency departments and a lack of in-patient bed capacity to handle the volume of admitted patients. Also, much like the 2018 interim evaluation, staff were left in the dark about why changes were being made.
A year after that, the pandemic hit and hospital operations collapsed. Thousands of surgeries were cancelled to treat COVID-19 patients, hundreds of low-acuity patients were shipped out of Winnipeg, and dozens of critically ill ones were airlifted out of province.
It’s little wonder that, even as COVID-19 admissions decline, hospitals still can’t keep up with demand and patients are piling up in emergency departments.
When government treats front-line staff like widgets, it’s no surprise many choose to leave the field or why it’s so difficult to find new people to replace them.
The provincial government is learning that the hard way.
Tom has been covering Manitoba politics since the early 1990s and joined the Winnipeg Free Press news team in 2019.
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