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  • Writer's pictureDr. Sandor Demeter

Lack of Accountability in Health Care

Health care leaders need to be held responsible, and accountable, for both the good and poor outcomes of their policy decisions.

Unfortunately, this is generally not possible as the system tends to diffuse accountability to the point where it is impossible to identify who is accountable for what. There is also the tendency to “circle the wagons” and deflect blame when things go awry.

This feeds into the health care cliché that “loyalty trumps competency”, progressively more so the higher up you go in leadership (tongue firmly planted in cheek).

While acknowledging that this is an unfair broad stroke assertion it speaks to “packaged” messages from the health care system which generally do not allow for critical reflection of past decisions as they relate to the here and now.

MB is still feeling the after-shocks of recent health care system changes, not the least of which is related to acute care capacity.

On August 24, 2021 MB ratcheted up COVID preventive measures in response to an anticipated fourth “wave” largely driven by the “delta” variant.

Dr. Jazz Atwal, Manitoba's Deputy Chief Provincial Public Health Officer, presented modeling data which included a worst case scenario where our ICUs could be overrun, again, within two months of a fourth wave (Manitoba ICUs could be overwhelmed during 4th wave without more vaccinations, modelling suggests).

It is interesting to note that no senior health care leader, policy maker or majority government politician questioned whether the inability to manage increased acute care demand, also called surge capacity, may be related to our painful and prolonged health care transformation journey which started in 2017– aka “Healing the Health Care System”.

The fact that no other province had to send over 50 patients out of the province for ICU care should lead to sober reflection of whether the system is better, or worse, now. Many individual health care providers have stuck their necks out and shared their angst related to staffing shortages and burn out (staff shortages, burnout).

It could have been worse as MB did not experience the normal yearly influenza surge this year which would have compounded the stress COVID put on the system.

Overwhelming our ICUs is not just a COVID issue; it is also a consequence of poor decision making and a prolonged agonizing rollout of the changes to our health care system.

Another example is related to a recent unfortunate death of a patient in the Saint Boniface emergency and subsequent temporary rerouting of some patients to other emergency departments (Hallway cardiac death at SBGH).

When you have reduced the number of emergency departments down to three partially shutting down one ER puts significant stress on the remaining two sites (e.g., HSC and Grace Hospital).

Shared Health’s response to the SBGH incident is telling; more so in what it does not discuss:

While emergency room wait times are often one of the most visible indicators of stress on the health-care system for patients, Shared Health chief nursing officer Lanette Siragusa said it signals a bigger issue for health officials.

"Emergency is not the problem, quite honestly," Siragusa told Global News.

"Emergency is like the canary in the coal mine."

Both St. Boniface and Health Sciences Centre are dealing with significant nursing shortages but Siragusa said the ER often has a bottleneck problem trying to get patients admitted who need beds in other areas of the hospital.

"It's a process issue and there's not really one silver bullet that fixes it, but it is something that we definitely have to work together as a system to respond and support our emergency departments," she said.

She said it is not just a one-unit or one-hospital problem but instead one that is systemic.

"The problem is the flow into the inpatient beds up in the hospitals. There's the inpatient beds and also the outflow out of the hospital."

Siragusa said it was an issue pre-COVID-19 that was being worked on but was pushed to the back burner while dealing with the virus.

"We were working on access block and then we all got diverted with COVID and the pandemic. So we need to go back to the core efforts of making sure that there's patient flow, making sure people are in the right place to get the care they need," she said. (Brittany Greenslade Global News 2021-08-17)

There is no acknowledgment that some of the less than ideal “healing our health care system” changes resulted in a “cut to the bone” health care system with very little room to accommodate increased demand due to reduced staffing and “bricks and mortar” capacity.

Siragusa’s message is framed in the standard government media release fashion of:

· We are aware of the issue (e.g., strain on the acute care system)

· That we are monitoring the issue (e.g., we are working on solutions)

· People will be safe (e.g., we will fix this)

The sad news is that it would be career limiting for any senior health official to acknowledge serious flaws in how we “fixed” the health care system or how these decisions were implemented.

Unfortunately we live in a corporate “group think” bubble world.

There needs to be “safe” environment for health care leaders to candidly, and transparently, discuss the implication of past decisions and to make recommendations to change course when necessary.

Otherwise, the appearance is that they are trapped in a “loyalty” bubble and face career peril if they don’t drink the party line “Kool-Aid”.

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