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Headline: Healing our health systemLetter from the region
Healing our
health system
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Réal Cloutier
Interim President and CEO
Winnipeg Regional Health Authority
Sept/Oct 2017

No matter where I go these days, all anyone wants to do is talk about health care.

That is understandable. After all, the health-care system is undergoing some major changes right now, so it only stands to reason that people want to know how patient care will be affected.

With that in mind, I'd like to use this column - my first for the new digital edition of Wave magazine - to discuss some of the changes underway and explain why I think they are needed.

The Winnipeg Regional Health Authority's blueprint for change is called Healing Our Health System. First unveiled last April, this plan paves the way for a major realignment of our hospital-based acute and sub-acute care services to better serve our patient population.

In order to achieve this realignment, we are making major changes to the way we organize and deliver patient care. The most significant of these changes involves the reorganization of emergency and urgent-care services. Currently, emergency services are available at all six city hospitals - Concordia, Victoria, Seven Oaks, St. Boniface, Grace and Health Sciences Centre Winnipeg. Over the next year or so, these services will be consolidated at three facilities - Grace, St. Boniface, and Health Sciences Centre Winnipeg. The provision of urgent-care services is also changing. Currently, we have one urgent-care centre at Misericordia Health Centre. Under our plan, this centre will be replaced by two new urgent-care centres - one at Victoria, the other at Seven Oaks. The first phase of this consolidation plan kicks in on Oct. 3, with the simultaneous opening of the urgent-care centre at Victoria and the phasing out of urgent-care services at Misericordia. The other elements of the plan, which you can read here, will be implemented in the spring and summer of 2018.

Some people have zeroed-in on these changes, suggesting they will lead to cuts in emergency services or that they are simply about saving money. But that is not the case. In fact, we expect the end result of this exercise to be shorter emergency department wait times and better care for non-emergency patients throughout the health-care system. This has been the experience in other jurisdictions that have consolidated their services.

To understand why, it helps to have a bit of background about how our health-care system has developed over the years. For as long as anyone can remember, we have tried to maintain emergency health services at all six of our city hospitals. The result is that our emergency program and the other acute services that support good emergency care have become spread too thin. This has resulted in inefficiencies and led to emergency wait times across the system that are longer than they should be.

Let me give you an example. Currently, Seven Oaks, Concordia and Victoria hospitals do not provide around-the-clock access to certain types of diagnostics tests such as CT scans and ultrasounds. That means if an emergency physician at one of these facilities believes that a patient needs such a test, that individual must either wait, sometimes as long as 12 hours, or be sent to another hospital.

Some might suggest that the answer to this problem is to staff up diagnostic imaging. But the problem is these hospitals don't have the patient volume to warrant 24-hour-a-day staffing, so all that would happen is you would end up creating more inefficiency. The better solution is to centralize staff at fewer hospitals and make sure the diagnostic imaging departments at those facilities are working at full capacity - which is what we are doing.

That we can improve emergency care by consolidating services is not just my opinion. That's also the conclusion reached by Dr. David Peachey, a consultant hired by the previous provincial government to identify ways to improve the delivery of health care.

As Peachey notes in his 233-page report, which you can read here, all of the Region's hospitals currently operate as acute-care facilities. "This means that they all have emergency departments, they all have critical-care units, and they all strive to provide the same level of acute care on the medical wards," the report says. "By doing this, the system has evolved into an expensive, unsustainable model that is failing patients and potentially could result in harm."

The report goes on to note that many of the patients in medical beds at these facilities are convalescing or waiting for a non-hospital placement. In other words, they do not need the level of care that one expects to find in an acute-care hospital. In fact, the report estimates that patients in need of acute-level care could be consolidated into three hospitals - which is what we are planning to do with the Grace, St. Boniface and Health Sciences Centre Winnipeg.

Graphic of a stethoscope

The added bonus flowing from emergency consolidation, of course, is that it will also free up acute care beds at Concordia, Victoria and Seven Oaks to be used for convalescing patients and those needing specialized services, such as mental health or sub-acute care. In the interim, we recently announced the opening of 65 new transitional care beds while we are converting hospital space. In addition, our plan also calls for the consolidation of in-patient mental health beds at Victoria, providing better access to services and raising the number of beds from 52 to 72. You can learn more about the various roles our health-care facilities will play under our plan here.

There is, of course, more to Healing Our Health System than consolidating services and re-purposing beds. In order to meet our overall goal of improving patient care and reducing wait times, we will be taking other steps as well.

For example, we are launching a new initiative called Priority Home that will make it easier to discharge seniors from hospitals to their own homes rather than a personal care home - a move that will allow people to stay in their own homes longer and think about other supported housing options if needed. In other words, the right care, at the right time, and in the right place.

We will also work to ensure we have enough capacity at our three acute-care hospitals. Construction on the new emergency department at Grace Hospital is already underway, and there are plans to expand the physical capacity of the emergency departments at St. Boniface and HSC Winnipeg. Altogether, the Region will be investing about $20 million over the next 27 months to provide the capital infrastructure needed to support all the changes contemplated in our plan.

In addition, we will continue to look at how other elements of the health-care system - family doctors, MyHealthTeams, Physician Integrated Networks and public health - can play a role in improving care and reducing the need for people to visit an emergency department in the first place. And we will also work to make the public aware of when and how to use the various primary-care options available to them, including urgent-care centres, ACCESS centres and clinics located throughout the city.

None of this is to suggest that implementing these changes will be easy. There will be challenges. But when all is said and done, I believe these changes will help us create a much stronger health-care system, one that is capable of providing effective and efficient care to those who need it most, not just today, but in the years to come. And that is something I'm happy to talk about.