The Valley of Despair - Health Care Transformation in MB
It has been almost four months since I left HSC Nuclear Medicine and over five months since I wrote my “Exit Stage-Left” article.
First, to set the record straight, and contrary to some media reports, I have not left the province and I continue to provide clinical Nuclear Medicine services at the Grace and Victoria hospitals along with teaching at the University of Manitoba, College of Medicine.
I have had time to reflect on my experiences with MB’s health care system and it is a good time for an update as we are in a prolonged, if not perpetual, “valley of despair.”
In organizational change management “101” you do not leave people, in this case health care workers (HCW), trapped in an unsettled, or “unjelled”, state as you move them along the path to the corporation’s new end state.
Some have called this unjelled state the “valley of despair” where peoples frustrations turn into depression and apathy.
This is nicely illustrated in the following “process of transition” diagram and is similar to Kübler-Ross's classic sequence of emotions after facing a significant upsetting life event, such as the loss of a loved one.
The sorry state we are in is, in large part, a consequence of the MB Government’s plans for transforming our health care system which started taking shape in 2017-2018.
Excerpts from Health System Transformation – A Blueprint for Change (MB Health 2018 press release) :
Between 2003 and 2016, health-care funding in Manitoba rose by 97 per cent. Despite these funding increases, Manitoba remains at or near the bottom of national rankings in a number of categories, including waits for emergency department services and some diagnostic tests and surgeries.
Per capita, Manitoba has more emergency departments and the second-highest health spending in the country, yet continues to struggle with poor health outcomes….
…A transformation leadership team has been established, including representatives from across the health system. Using data, leading practices and experience from other jurisdictions, the expertise of Manitoba clinicians and broad stakeholder engagement, the team is prioritizing transformation initiatives and making recommendations on governance and policy development….
In summary, despite spending a lot of money on health care Manitobans have not experienced a good return on their investment. The Government’s “Health System Transformation” was going to “Fix our Broken Healthcare System.”
It is noteworthy that those accountable for “fixing the broken health care system” were the same folks who were the senior health care leadership team responsible for managing the “broken system.” They were appointed, without the usual senior management competitive hiring process, and shuffled from WRHA to senior leadership positions in Shared Health.
There have been some changes to Shared Health's executive team and it is encouraging that after the departure of Dr. Brock Wright, former CEO of Shared Health, there was a more open and transparent competitive process to find his replacement.
Has the MB Government 2018 Health System Transformation policy made things better?
Noting that COVID has muddied the waters, the implementation of MB Health’s System Transformation plans has abjectly failed based on persistently long ER wait times, huge elective diagnostic and surgical backlogs and generally poor morale and burn out of HCW.
Based on media reports, and personal anecdotal experiences, some of consequences of this prolonged agonizing transition period have been:
Experienced HCW taking early retirement
Experienced HCW transitioning to jobs outside of hospital settings
Burn out of HCW
Growing wait times for diagnostic procedures
Growing wait times for elective surgical procedures
Continued prolonged ER wait times which have not improved from pre-transformation or pre COVID times
A growing collection of “acting” managers and administrators
An apparent “politicization” of health care experts (e.g. differing opinions between Doctors MB and the head of the MB on which metrics to use to assess the burden of delayed diagnostic and surgical procedures – CBC)
When I speak to physicians from other clinical services it appears my experiences and observations related to working at HSC Nuclear Medicine is a microcosm of the larger Shared Health/WRHA picture.
For example, there are a number of key manager vacancies in Diagnostic Imaging (DI) which have not been filled for years. The response from senior management is that the final DI organizational chart and job descriptions are not yet finalized.
To put this in perspective, the proposal for the DI program in Winnipeg (e.g. all imaging modalities - ultrasound, x-ray, MRI, CT, NM and diagnostic and therapeutic interventional) is that there will be three DI Director positions and about six DI Manager positions. The number of manager positions may be less than the current complement of DI manages meaning someone may not have a job at the end of the day.
With Shared Health having a one plus billion-dollar budget (2020) you would think there would be sufficient resources to expediently solidify the DI organizational chart, draft the Director and Manager job descriptions and implement the changes.
The following is a list of some of the DI leadership positions which have been vacated and filled in an “acting” capacity, some for over four years:
HSC Diagnostic Imaging Director (vacancy circa 2018)
HSC Director of Radiopharmacy (vacancy 2019)
HSC Director of Cyclotron Facility (vacancy circa 2020)
For the Director of Radiopharmacy and Cyclotron position an external “Winnipeg Cyclotron Facility and Central Radiopharmacy Review” final report was submitted June 11, 2020
Various DI Manager positions at HSC, VGH, GGH and SOGH
As stated before, this scenario is not unique to DI but is apparently being played out in many other Shared Health/WRHA clinical programs.
Keeping HCW staff in the transition “valley of despair” for these agonizingly prolonged periods of time is unconscionable.
On a broader scale, after years of “erosion management”, followed by intense pandemic related health services demands, our health care system is in rough shape. Unfortunately, the proposed road to recovery has not been well defined.
For example, we are nibbling around the edges of our current 160,000 plus diagnostic and procedural wait list.
I get the sense that the current Government, ideologically, can not stomach spending more money for health care services. Perhaps they are not satisfied with the “return on investment” or, more cynically, they have a very neo-liberal agenda and want to see the public system erode to support more private delivery of health care services.
What is happening at Concordia Hospital is a good example of this apparent aversion to investing in health care.
Frist, I want to go on the record that I am in favor of public support for the Arts. The Arts are the heart beats of our societal values and culture.
However, the optics of the Government providing 7.5 million dollars to the Winnipeg Ballet but expecting the Concordia Foundation to raise a matching $350,000 to construct a new operating room to reduce joint replacement wait times is bizarre, to say the least.
To be blunt, if I practiced medicine the way MB has implemented their “Health System Transformation” plan I would lose my license to practice.