by Barb Biley
For over five years all the events leading up to the opening of the new Comox Valley hospital, from the planning, to the choosing of the location, to the construction, the negotiations to transfer staff from St. Joseph’s to the new hospital, have been ‘top secret’ with only occasional rumours to suggest that all was not well.
There have been many opportunities for VIHA staff and planners to answer questions from the community and hospital workers and to listen to concerns of workers, including the ‘information sessions’ with representatives of VIHA and of the “private partners” who financed, designed and built the hospitals and are responsible for building maintenance and housekeeping.
It was very frustrating for workers to be told that they did not know what they were talking about when they pointed out that on the hospital floor plan there was no Health Record department – “not needed”, they were told. It was nerve-wracking to be told that although the hospital was larger and processes more complex, most departments would operate with the same number of staff that we had at St. Joseph’s. “How is that possible?”, we asked. Seven fewer beds in Psychiatry? Not a problem. There will be fewer patients because VIHA is investing in community resources for addiction treatment. Really? Where? And the very best – “there will be enough residential care beds and home care services when the hospitals open that there will be no people in hospital beds waiting for residential care.”
Luckily, that has all come to an end. Now the truth is starting to come out and it is a great relief. Now that the overcapacity, understaffing, and problems resulting from the flawed planning process are becoming public there is an opportunity to address them.
For the last two years workers at St. Joseph’s had been hoping that their work lives would improve at the new Comox Valley hospital. Those who got some advance orientation were encouraged and felt their input was valued. But in the end VIHA seems to have had a pathological resistance to any contribution from anyone who actually does the work of providing care to patients.
There is a cure for that. It starts with acknowledging that the most reliable information comes from those who do the work and they are also the source of solutions, not administrators or board members or politicians. Having acknowledged that simplest of facts, steps can be taken to activate both the knowledge and the problem-solving skills of those who do the work.
Not everyone working at the new hospitals feels the same but the experience of a significant number in both the Campbell River and Comox Valley hospitals is not positive. For the workers who came from St. Joseph’s the challenges are greater in that they have a new employer and a new hierarchy over them. In both hospitals there is the challenge of new buildings, new procedures, and insufficient training for the changeover.
From an organization that was relatively small and self-contained where many workers felt devalued and belittled, workers from St. Joseph’s have now joined what seems like a massive bureaucracy where we feel more devalued, more belittled, and disposable. This is not because health care workers have big egos. This is because our job is to look after people who are sick or injured or anxious or stressing over a loved one, and VIHA’s specialty seems to be putting obstacles in our path so that it is impossible for us to do our jobs to the best of our ability and to provide the best care we can.
When I ask visitors, patients, and workers at the hospital or people who have friends who work in the hospital what their impression is, both in Comox Valley and in Campbell River, the first comment is usually that they see no “team work”. Our inability, even sometimes sitting side by side in public view, to be able to step in and help when needed by a co-worker, is a source of immense frustration. Lack of cross training and rigid VIHA procedures mean that clerical staff, particularly those at the front desk and Emergency who used to be able to pitch in to help one another can no longer do so. Nurses used to be able to assist one another from one unit to another but now each unit is completely closed off from others so that collaboration is gone too. Our employer either does not understand that this is bad for patients and bad for workers who do not want to be idle while the person next to them is overwhelmed, or our employer thinks that this is a good thing. Either way it’s a problem.
St. Joseph’s was smaller, self-contained, without the massive, remote and top heavy VIHA management structure and without the complexity of being a P3 where the private partner which owns the building calls the shots on signage and lighting and other things that should be an easy fix.
An interesting and disheartening feature of the design of the new hospitals is that neither has a cafeteria, which discourages workers in different departments from mingling and talking to one another. The far too small staff rooms that do exist seem to be designed to discourage any contact between workers and actually even encourage conflict between workers.
Many VIHA representatives say patients, visitors, doctors, support workers, nurses and others who are raising concerns about patient safety, about the danger of injuries to workers because of lack of mirrors in the hallways or anti-ergonomic work stations, or the danger to patients from understaffing and overcapacity are “resistant to change”. First of all, that is false. Change is a constant in health care and health care workers are more accustomed to change than most. This is a gross misidentification of the problem. I would suggest that the problem lies with the VIHA bureaucracy which is entirely aloof from the reality of the delivery of health care in a hospital. Warnings from VIHA and St. Joseph’s personnel that were “consulted” during the planning process were ignored. Problems identified in the pre-occupancy risk assessment conducted by VIHA and WorkSafe BC have not been addressed. Problems identified during the “orientation” period by staff who were brought in to tour the buildings and those who were trained in conducting those tours who became more familiar with the buildings and work flow, have not been addressed.
Kudos to the investigative reporting by the local website Decafnation for ending the silence about what is going on at the Comox Valley hospital. I hope that more people will share their experiences and proposals for improvements. If you haven’t seen the series of articles I recommend that you do at www.decafnation.net.
A final point. No one should think that this is an “internal matter” that concerns only those who work at the hospital. It is far from that. In their great wisdom and over the objections of many, it was determined that a 153 bed hospital was sufficient to meet the needs of the growing population of the Comox Valley, so a 153 bed hospital was built. But, based on a logic that does not take human need or reality into account, the operating funds were provided for only 120 beds (this number is iffy as different numbers have been given at different times, 120 being one of them. The highest number I have seen as “funded beds” is 129), which, we were told, was plenty and the full capacity of the hospital, 153 beds, was targeted for 2025.
Reality check: The Comox Valley hospital is “overcapacity” virtually all the time and has had patient counts (admitted patients) as high as 168. It’s our hospital (or will be in 30 years when the private “partner” delivers it to VIHA) so as residents of the Comox Valley we should be demanding from VIHA and the Ministry of Health that adequate funding be provided to meet the actual, not imaginary, need. And that includes an immediate increase in the number of residential care beds. On the day that there were 168 admitted patients 46 of those patients were designated ALC, or Alternate Level of Care, which means that an acute care bed was not the appropriate care for them but there was no residential care bed for them or the supports were not available for them to be discharged.
The Regional Hospital District (i.e. the residents of the Comox Valley and Campbell River) pays 40% of the cost of the new hospitals. The province (i.e. everyone in the province) pays the other 60%.
The good news, you ask? Everyone knows what needs to be done and it does not take a rocket scientist to do it. It takes funding and the cooperation of VIHA management with the people who deliver health care. And it will take public pressure to make that happen.