Health Minister Adrian Dix has promised reforms at Nanaimo Regional General Hospital, following the publication of a consultant’s report that called the workplace “toxic.” The review was based on a survey of staff at the facility.
The decision by Island Health to commission such a report might be questioned. Everyone knows exactly what the frame of mind is at the hospital: Toxic. (In fairness to the present management team, the decision was made under the previous CEO.)
The question is what should be done. The troubled implementation of Island Health’s electronic-record system no doubt contributed to internal strife at the hospital. But two less conspicuous obstacles might also have played a role.
Before the introduction of health authorities in the 1990s, hospitals were largely independent fiefdoms. And senior medical staff members such as the chief of surgery and the chief of medicine had considerable influence over the running of the facility.
The creation of health authorities changed all that. Suddenly, the big decisions, such as resource allocation, were made offsite. This inevitably caused frustration at the local level and diminished the power of physicians.
It is likely similar morale problems exist at most regional hospitals in B.C.
The second obstacle is money, or more accurately, the lack of it. Between 1976 and 1991, health-care spending by Canada’s provinces grew at an average rate of 9.3 per cent annually. There was a brief period of lower increases between 1992 and 1996, but then the good times returned. Between 1997 and 2009, the annual spending lifts averaged 7.7 per cent.
But then came the recession of 2009, and suddenly the money dried up. Between 2010 and 2017, annual health spending nationwide increased by only two per cent on average, and B.C. has followed those numbers fairly closely.
These funding lifts in no way kept up with population growth, aging and inflation. And the main weight has fallen on hospitals, which in B.C. make up nearly half the health-care budget.
No wonder staff are upset. They’ve been making bricks without straw for the better part of a decade. That takes its toll on everyone, but human nature being what it is, the blame is passed up the line.
Yet managers, both in Nanaimo and at Island Health headquarters in Victoria, are not at fault in this regard. They have no control over grant allocations from the province. Neither is the provincial government to blame. The budget only recently returned to a surplus.
This is not a whitewash of management at any level. No doubt, mistakes were made.
But to place most or all of the blame on the higher-ups is to ignore the prominent part that external forces played.
In fact, what Nanaimo demonstrates is the fragile nature of all public-service programs after years of tight money. Let us hope there will be room to boost hospital funding now the budget is balanced.
But that will not, in itself, be enough. Efficiency must also be improved, and it appears there are opportunities to do so.
B.C. spends 10 per cent more on hospitals, per capita, than the Canadian average, and 20 per cent more than Ontario and Quebec.
Yet change will not happen in a workplace that remains toxic. Staff and administrators at Nanaimo Regional General Hospital must work together if they are to retain public confidence and create a livable environment.
This is more easily said than done. An atmosphere of distrust has grown up that will not dissipate overnight.
Yet we all have a stake in this, patients and caregivers alike. A way must be found to turn this situation around, and the only option is collaboration, not confrontation.
