At The Rotary Club of Picton’s weekly Tuesday meeting at the Yacht Club, Stacey Daub, CEO of Quinte Health Care (QHC) spoke to the club of current struggles and areas of focus.
From a shortage of practitioners and nurses, to how people are using hospitals as a substitution for other things, Daub tried to cover a little bit of everything.
“You hear on a day-to-day basis in the newspaper there’s a shortage of physicians, there are shortages of nurses,” Daub said. “It’s interesting for me because I meet lots of other industry leaders, everybody from people who run Tim Hortons to people who run hotels, airbnbs, restaurants and this whole phenomenon of not having enough people for the industry that your in is very common but there are some very unique reasons behind that in healthcare.”
Daub pointed out that especially during the time of the pandemic, QHC systems became very overwhelmed very quickly.
“Our system became very overwhelmed very quickly,” stated Daub. “And yes it happened in other parts of the world but the way Ontario and some parts of Canada became very overwhelmed, really gave us some insight and some ideas of some of the things we need to focus on so that we don’t have to have that same experience. Essentially for any healthcare system in the world.”
Touching on decision making, Daub added that she has served in many different governments including Conservative, NDP and Liberals and doesn’t think any of them have gotten it right.
“I don’t stand before you with any particular opinion on any of our political parties but what I can say is healthcare, in particular in Ontario and in Canada is really very politicized,” Daub said. “And it really follows a very short term political tenure in terms of decision making. So decisions are often made, with a newly elected government, decisions are often made for the next couple of years to kind of quickly implement things and then smooth things out for the next two years till you get to the next election. And for something as complicated as healthcare systems that are changing dramatically, those two-four year cycles just aren’t enough to look further ahead.”
Daub then shared some stats as she thinks its important to give people a bit of perspective.
“In Ontario we operate about 2,300 ICU beds,” stated Daub. “Our neighbours just to the south, New York state, they operate 34,869 beds. Now some of you might say, well their population is bigger 14 million in Ontario to 19 million in New York state but in fact if you look at that calculation, they operate and have been in operation 10 times the amount of ICU beds. For their system to be able to respond to the pandemic was very different then ours.”
Daub continued on with a few other examples.
“Ontario operates the fewest per capita hospital beds, not only anywhere in Canada, but also in the entire world,” Daub said. “So there is a very big difference, for example, in Canada we operate about one bed per 400 residence, where as in France they have about one bed per 150 residence. And if you add that up, I think we did the equivalent to Germany, and if the system worked like Germany in Canada you would have about 25,000 more hospital beds.”
Over all, hospitals have been operating over capacity. In QHC alone, for the past few years have been operating anywhere from 100-120 per cent capacity.
“If any of you run businesses to actually operate that with no kind of buffer, is very challenging,” said Daub. “And in fact universally they kind of accepted ideas that hospital systems should run at about 85 per cent capacity so that you have that ability to be able to flex during catastrophes, large fires or other types of illnesses, so thats one really significant issue is that we had never planned long term capacity because its not just hospitals, many of our other community partners such as primary care, home care, longterm care, you really have to think about the long run and start thinking about looking at capacity everything from schooling people to setup programs and so on.”
Another formidable challenge for QHC is that there hasn’t been a lot of investment in systems around hospitals, in turn the hospitals on a day-to-day basis become a failsafe for the system in a substitution for other things.
“In any given day in Ontario there are about 6,000 people who are sitting in hospitals who don’t need to be in hospitals, they should be somewhere else,” Daub stated. “They could be home, they could be perhaps in a hospice, they could be needing a longterm care but they actually can’t move out so they remain. There are many, many other areas where the hospital is really playing a substitution role and the one that breaks my heart the most is mental health in children. We’ve seen about a 300 per cent increase in the number of visits for children who have mental health issues. Quite honestly when you come to an emergency department, emergency physicians and nurses are trained to treat and release. They don’t have a lot of mental health training so its been a really difficult thing to see this population who really needs support and help coming to a system that wasn’t designed to actually support any of them.”
Daub added that the most illustrated substitution role within QHC for her would have to be the increase in medicine beds.
“If you just go back to 2019 just before the pandemic,” said Daub. “We were operating on any given day about 118 medicine beds, so that average number of people who were sitting in medicine beds on an average day. And currently today we are operating 200 beds filled on an average day. And so for us thats about a 76 per cent increase and that is really hard to keep pace at. Often even if there weren’t health human resource recruitment issues as big as they are in Canada, to grow our staff to accommodate for 76 per cent more patients within a two year period has been really, really challenging for the teams and individuals.”
Daub added why this background is necessary.
“So a lot of this background is only to illustrate that these issues are quite pervasive and quite challenging,” Daub said. “And if anything, if there is a silver lining from the pandemic, it has really helped us to think very differently about how we play and build our systems.”
With the demand for hospital services going up so much, it leaves quite a few vacancies across the organization.
“We are not seeing a mass exodus in our communities or across our hospitals,” said Daub. “And in fact PEC, North Hastings and Trenton which are three of our smaller hospitals compared to Belleville, their retention rates are actually pretty good and part of that reason is, is that the people who work at those hospitals are so deeply connected to their community, its their parents, its their grandparents, its their friends and neighbours who are coming in and they saw health care as a calling. What is the challenge, and its not just for nursing, primary care is another example were seeing a significant number of people leaving their jobs and family doctors and its an age old thing, its often not the money, people will talk a lot that nurses should be paid more and I don’t dispute that, but getting a dollar more is not going to change recruitment, it is the working conditions and the lifestyle and that is the harder issue.”
Some family doctors Daub has spoken with in the region just don’t know if they can do it anymore.
“Family Doctors caseloads are so large,” Daub said. “When they need to actually refer someone they can’t get them into a specialist or we can’t get mental health services. Many of our local physicians are absolute rock stars, they do hospital care, in-patient care, they help the hospice, they also do home care, they also to palliative care in the homes. They need a system around them to support them to be successful, thats what they want to do but the systems don’t always work.”
Daub then spoke on mental health and how we should think about the prevention of mental health illnesses.
“An interesting phenomenon right now, mental health, how do we think about the prevention of mental health?” asked Daub. “Loneliness. This is the one state that I find, they say loneliness is the equivalent of smoking two packs of cigarettes a day. Loneliness has the ability to increase your chances of mortality by 26 per cent. So we have to start to think about health care and more about health, the health of our citizens, the health of our population rather then just focusing on healthcare in itself. And that combination of thinking about the health and wellness of the population at the same time your thinking about having a good healthcare system is a really good mix.”
Things changing within hospitals is the role of patients/citizens.
“We went from a time when citizens were a very passive member of their health care journey where the doctor told you what was best, you kind of followed instructions, to patients becoming much more engaged and not only in their own care but also in helping us to redesign and change the way we deliver care,” Daub said. “And so we are having a very big campaign to get people much more involved. So we have great patient leaders in our emergency department and other places who are helping us redesign those services from their perspective and their minds.”
Daub added QHC is looking at innovation and technology and will be bringing in a new health information management system to replace the 25 year old system currently in place.
“Right now in Quinte Health we have an old DOS system, thats how we keep everybody’s record, those blue screens,” said Daub. “And that old system is about 25 years old and were going to be bringing in a new health information management system that really helps to support positions and nurses in their role, so how to bring best evidence. It will also provide patients to a portal so you can actually see your own blood work, you can see the results of tests, if you have a loved one and they give you permission you could look at what is happening with your loved ones discharge. Just really empowering people to be much more part of managing your health.”
QHC members went out about one year ago across all four, plus, communities to talk with locals about what was most important about the future of their hospitals.
“If we heard anything loudly and strongly, we heard that people want to have care close to home,” Daub said. “And that is a critical priority for people who live in the community. So care close to home was a number one thing we heard, the second thing that we heard very clearly was that primary care. People are quite concerned about making sure that we support increased primary care in the area, more physicians and doctors coming to our area, so we have a lot of work thinking about how we can do that in partnership with others. On the care close to home, once we launch our strategy our intent really is to vision out over the next 5-10 years. What are the programs and services we need for our local communities, and Quinte has never actually done that across the four hospitals and well we may never be doing brain surgery in our region, there are many other services we need to start to think about a longer term plan as our population grows.”
Daub added the last two areas QHC will be very focused on based on feedback is better connectivity with partners and the communities and supporting healthcare workers.
“Most of the hospitals that our teams face on a day-to-day basis are not solved within the walls of the hospital, they’re solved in partnership with our community partners,” said Daub. “So that is a really critical area. And last and perhaps not least is kind of a laser focus on supporting healthcare workers. Both to recover from covid but also supporting them through just how difficult and challenging it is. Last week I had an ICU nurse who asked to meet with me, an dI also have an open door so I said I would be happy to meet with her. She cried for a good half an hour talking about her experiences recently. And her experience really was about some really challenging things with visitors and patients and just a very frustrating public who’s in a very frustrating situation and she just wanted me to understand and appreciate what its like to work on the front lines right now. And having people like her come and talk to us for us to understand that is the only way we can think and work with them in terms of conducting improvement.”
For more information on QHC please visit https://www.qhc.on.ca/
“My commitment across all of our communities is to make sure we are present, out and engaged in our communities so you will see many of our team members coming out trying to better understand the communities and work in partnership with them,” Daub added.