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Hospital watchdog drafts 14-point plan to improve service
Saturday February 16 2008
- Brampton Guardian
A 14-point plan intended to improve patient care in the emergency department is one of several "sweeping" measures being taken to reestablish trust in this city's new hospital.
In an interview with The Guardian, provincially appointed supervisor Ken White presented an action plan aimed at fixing a mountain of issues at Brampton Civic Hospital.
The facility has been fraught with problems since it opened in October, including long emergency department wait times and issues related to staff being unfamiliar with new, state-of-the-art technology.
Difficulties at BCH began when the new facility attracted far more patients than the hospital could handle.
The influx of people into the emergency department resulted in huge backlogs, with some patients reportedly waiting more than a day to see a doctor.
Delays in getting treatment got so bad that some, notably the families of Harnek Sidhu, 52, and Amarjit Narwal, 42, accused hospital staff of contributing to their deaths. Ontario Minister of Health George Smitherman appointed White on Dec. 31 in a bid to clear up the massive public fallout that followed.
Since then, White said he has spent long hours with staff and stakeholders in a bid to figure out how to make things right.
The result is a list of measures that includes:
* A new independent panel that will review any patient concerns not satisfactorily resolved through existing WOHC processes
* An independent review of quality, patient safety, best practices and risk management
* An internal review of staffing needs
* A 14-point plan to address patient care in the emergency department
* A Patient Flow Task Force to identify the best process for moving patients more quickly and efficiently through the emergency department
* A new strategy aimed at improving communication with the community.
"To improve the quality of care we deliver, we need a strong organizational vision, we need fiscal sustainability, we need to develop guiding principles to simplify decision-making and we need to create a patient and family experience that is as close to ideal as possible," White stated in a letter to the community. "I have committed to working with staff and physicians as well as the community to achieve these goals."
The drive to restore public confidence in BCH got a real boost recently with Ontario Auditor General Jim McCarter confirming his office will review the financing model used to build the facility.
Problems at the new site have fueled an ongoing controversy over the public-private partnership (P3) model used to build the roughly $800 million hospital.
Opponents blame the P3 deal for alleged cost overruns and a shortage of beds and staff, and an independent audit may help the community get a better understanding of how the deal worked, and whether Brampton got the best possible deal.
With respect to patient care, White said William Osler Health Centre will adopt several measures to not only ensure patients get timely treatment, but staff have the proper support they need to provide that care.
For instance, WOHC will improve the triage process in the emergency department.
During the planning stages, WOHC depended on consultants to offer recommendations on how patient flow would work.
However, White conceded there was a difference between what the recommendations called for and how they actually translated on the floor.
"I don't think anybody could have imagined the complexity of a move like this," White continued. "It's amazing, they (senior planning staff) did their due diligence upfront, definitely. They had a fairly large consulting firm go through all of this and work on what the flow would look like in the new emergency department. But when you put it into action there are things that arise that you didn't necessarily expect."
For instance, White said "improving visuals" will be a major change to how staff manages patient flow.
Visibility, or staff's ability to physically see people in the waiting room, is hindered as a result of the new floor plan, and therefore impacts how quickly patients are treated.Staff is refining those processes to make them better, White said.
Dispute resolution is another area in which changes will occur.
To this point, a patient complaint could take some time before it is processed and dealt with by the proper authorities. White said the standard now would be to address problems faster.
"Because our environment is so complicated, some of these things get bogged down in process," White said. "We want to make sure that we are very agile on this and when there is an issue let's know about it today and let's deal with it today."
Natalie Mehra, director of the Ontario Health Coalition, said her organization respects the work White has been doing and the "new openness" he has brought to this process.
However, she said the health care watchdog group has some concerns with respect to White's proposed community engagement task force and the new panel being formed to address patient concerns.
An independent panel will be formed for individuals not satisfied with current WOHC dispute resolution practices.
Only, the body is comprised of physicians-- the chiefs of staff from WOHC, Credit Valley Hospital and Trillium Health Centre-- which the OHC argues still places the onus on health care professionals to police themselves.
"We strongly encourage the hospital not to create a kind of mini college of surgeons and physicians in the hospital because the responsiveness for the actual college has been a real problem for patients," Mehra said. "There are perhaps ways of doing this that would balance what the physicians will accept, in terms of their professional standards and the context in which they work, and what the community needs, in terms of openness and feeling like there is somebody there who is in their corner.
The panel could include the patient safety community of experts and academics, some of whom are physicians, whose independence and advocacy for patient concerns is well known."
With respect to creating a community engagement task force Mehra said it is important the hospital bring community representatives into the fold.
"One of the problems we've seen is hospitals often view community engagement as a kind of PR exercise," Mehra said. "It's important that the hospital involve people from the community who will not necessarily rubber stamp or agree with everything but actually represent their community."
White also noted the Ontario Ombudsman is also available to hear patient complaints. The Ombudsman's office does not typically have power over hospitals in Ontario but White's appointment as provincial supervisor has changed that.
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