Four years after the amalgamation of nine separate district health authorities into one centralized organization known as the Nova Scotia Health Authority, the responsibility and the money for running hospitals and health programs will shift to senior managers in four zones — North, South, Eastern, and Western. The oversight for ensuring consistency and planning will stay with the Nova Scotia Health Authority.
“The intent is to focus on devolving operational responsibility to the zones while maintaining a provincial focus on standards and program development,” said Janet Davidson during a public meeting of the Nova Scotia Health Authority Board of Directors in Dartmouth yesterday. Davidson, a nurse and former deputy health minister in Alberta, has been acting CEO of the health bureaucracy since the other Janet — Janet Knox — retired in August.
Davidson told the board the decision to de-centralize decision making was in response to feedback from physicians and the public and her realization that “all zones are not the same” and could improve service if they had more authority.
“What it does is give zones the budget and the accountability to make some local decisions about issues and concerns and deal with them directly. We’ve heard there is undue process and bureaucracy. For example, if there is a chip in the tile of the floor in the front lobby of a hospital, fix it. You no longer need to make a request of corporate office to do it.”
Davidson added the change is being made in consultation with the incoming CEO, Dr. Brendan Carr, a native of Sydney River who takes the helm of the Health Authority December 16.
Asked by journalists if the province shouldn’t have realized that too much control and bureaucracy was being consolidated in Halifax before approving the amalgamation of the former District Health Authorities, Davidson had this reply:
This is a sea-change: going from nine authorities to one. I don’t think you can contemplate everything that could happen. If you look across the country, there’s not one province that regionalized that has stayed with that structure. They’ve had to make some adjustments based on the experiences they had.
The senior health administrator and breast cancer survivor who also chairs the Board of the Canadian Institute for Health Information, Davidson said work is underway for the changeover to take effect by April 1, 2020.
One billion dollars of annual spending will be divvied up. Each of the four zones will be run by a vice-president who must live in the local area. The three vice-president positions that were axed last week along with one vacancy for a senior vice-president means there will be no change in the total number of vice-presidents (11) earning more than $200,000 annually.
Meanwhile, the board of directors did not appear impressed with a report from staff that showed little improvement in the wait times for patients showing up at emergency rooms or the time to off-load ambulances at five major hospitals where the Department of Health issued a directive last June.
One target is for 90% of ambulances to transfer their patients and leave the ER after 30 minutes. That’s not being met at any of the five regional hospitals where performance is being monitored.
| Percentage of Ambulance Patients Off-loaded within 30 minutes (Oct. 2019) | |
|---|---|
| Cape Breton Regional Hospital | 48% |
| Colchester East Hants Health Centre | 52% |
| Dartmouth General Hospital | 40% |
| QEII Halifax Infirmary site | 23% |
| Valley Regional Hospital | 69% |
“We haven’t moved the needle at all,” worried board member John Rogers, a retired manager from the Stewart McKelvey law firm.
The same five regional hospitals are struggling to meet another target which states 12 hours should be the maximum wait for 90% of people admitted as an in-patient after arriving at the Emergency Department. The percentages for October, 2019 indicate there are still bottlenecks in the system.
| Emergency Dept. Length-of- Stay Less Than 12 Hrs for Admitted Patients | |
|---|---|
| Cape Breton Regional Hospital | 50% |
| Colchester East Hants Health Centre | 48% |
| Dartmouth General Hospital | 37% |
| QEII Infirmary site | 60% |
| Valley Regional Hospital | 68% |
“You can’t move people out of Emergency into the hospital if there is no bed available,” said Janet Davidson. “And you can’t make a bed available in some cases unless there is a bed available out in the community. There are large number of people in acute-care beds who don’t need to be in those beds. I’m not seeing they don’t need care; they do need care. But I think there is a requirement for more long-term care and community care.”
Initiatives continue at the Health Authority to recruit and retain more doctors. Year-to-date statistics suggest the province is treading water with demand continuing to outpace supply. Eighty-four new doctors started this year compared to 90 for the same time period last year. But the 84 doesn’t include an additional 23 doctors who have signed to come practice here in the next 12 months.
Dr. Nicole Boutilier, the vice-president of Medicine, said the NSHA has hired a recruitment consultant to work exclusively with residents and student doctors at the Dalhousie Medical School to boost the percentage of medical grads (currently 50%) who choose to practice in the province following graduation. The province has also hired KPMG to come up with a human resources strategy to keep more physicians from leaving for greener pastures. The 2% yearly pay raises for doctors announced yesterday and doubling the financial incentive for family doctors willing to work in rural areas may help.
“The intent is to focus on devolving operational responsibility to the zones while maintaining a provincial focus on standards and program development,”
Isn’t that why we have the Provincial Dept of Heath? At what point are the overlap, duplication and excessive admin load going to be addressed?
Until we see 35% less admin personnel in the system as a whole we might wish to consider being more cautious in our optimism. That does not mean we need to fire people. It means we need to redeploy anyone with clinical skills to work at least 20% of their time in a patient contact role. It means that we need to decide if a function belongs in the NSHA or the Province and strive to eliminate duplication.
We had demonstrably too much admin overhead going into this mess… and given that we have the same number of VPs and once again have people holding the same titles and/or job descriptions at both the NSHA and the Province, I fear that real progress will be elusive.
The province’s own blue-ribbon committee on health reform in 1994 wrote that “centralized control serves to make the system rigid, inflexible, and unresponsive to regional health needs.” So if the architects of the current system had bothered to read any of the province’s own reports on governance models, then yes, they should have known precisely what the consequences of amalgamation would be.