Wait times down, wait list for sub-acute beds up: Winnipeg health authority

Three months after closing an urgent care centre and converting one emergency department to an urgent care centre, wait times are down — unless you're waiting for a sub-acute bed.

The Winnipeg Regional Health Authority released a three-month interim evaluation of Phase 1 of the province's new health-care plan Wednesday, and the report highlights decreasing wait times and shorter stays in emergency departments.

"In the three months following the Oct. 3 changes, median wait times were 1.47 hours," reads the report, which was completed in a partnership with the George and Fay Yee Centre for Healthcare Innovation — a research partnership between the WRHA and the University of Manitoba.

"This is a 19 per cent decrease or 21-minute improvement over the same period in 2016/17.

"The median length of stay in [emergency departments] for patients admitted to hospital was 12.15 hours, down 14 per cent from last year."

The province announced major changes to Manitoba's health system in April of 2017. In October, the province closed the urgent care department at Misericordia Health Centre and converted the emergency department at the Victoria General Hospital to an urgent care centre. 

'New bottleneck in the system'

One wait list is growing, though, says the report.

"The wait list for the new sub-acute care service … continues to grow, and this appears to be creating a new bottleneck in the system."

Sub-acute care is essentially a level of care provided for someone who does not need intensive hospital acute — or urgent — care, but does need more than basic nursing care.

The report also noted that many nurses found out their positions were being deleted through the media rather than through human resources staff. 

Other highlights in the report include:

• The average length of stays for in-patients is down 4.6 per cent to 8.6 days, a number the WRHA says is equivalent to freeing up 84 beds.
• There was a significant reduction in the number of patients waiting in hospital for personal care home placement. Nine patients were awaiting placement over the last three weeks, down from an average wait list of 80 patients.
• Patient complaints remain in the expected range, although a spike in complaints did happen when the WHRA decided to stop funding outpatient physiotherapy care.
• Although 3,776 jobs were deleted, most workers found a new position. A total of 224 people were laid off, 54 per cent of whom have found a new job in the WRHA.
• A total of 2,297 nursing jobs were deleted, 70 through layoffs. All but 31 people have found a job in the WRHA.
• As of early January, 99 nursing jobs were posted.
• Grace Hospital, Health Sciences Centre and St. Boniface will see an increase of 21 to 37 per cent in patient volume as the changes continue.

Report recommendations

The report makes a total of 19 recommendations as the province continues to make health care changes in Phase 2. They include:

• Making sure people who will be affected by further changes are told as soon as possible so they can collaborate when feasible.
• Producing a clear timeline with key milestones to ensure better planning.
• Defining clear, set roles for those who are planning and implementing changes.
• Monitoring the new models of care for in-patient medicine, particularly the eligibility criteria for sub-acute and transitional care, to make sure they're inclusive and support the patient's requirements.
• Making sure "front-line staff hear about labour-adjustment changes first from internal sources rather than through the media."
• Tackling the sub-acute bed shortage by identifying "opportunities to begin transforming in-patient medicine units at Seven Oaks and Concordia [hospitals] to sub-acute care as soon as possible."

Lori Lamont, acting chief operating officer for the WRHA, said the health authority has already acknowledged many of the changes suggested in the report. She said the authority has already moved to implement some of the changes, and had already begun to implement some of the others before the report was released.

Construction timelines for improvements in St. Boniface Hospital's emergency department may be moved up, she added, "as we give further consideration to the timing of a new emergency department at that site."

"We continue to create capacity within our existing space for the time being as construction of the new emergency department at Grace Hospital wraps up and their capacity is expanded, and as sub-acute services ramp up across the system."

'Disrespected' staff validated: MGEU

"This report confirms many of things that health-care workers have been saying — that the changes and cuts are being implemented too quickly, without meaningful involvement from front-line staff, and without adequate orientation and training for care workers," said Manitoba General Employees' Union president Michelle Gawronsky.

"The report validates staff who have felt disrespected and unsupported throughout these changes. We urge the health minister to pause his plan and take seriously the problems that have already emerged."

Manitoba Nurses Union president Sandi Mowat took issue with the report's findings.

"This report is inconsistent with what we're hearing from nurses working on the front line every day," said Mowat.

"Nurses are telling us that emergency departments are often overcrowded and chaotic, patients are being treated in hallways and that acute patients are being admitted into sub-acute units. With the increase in patient volumes, security is increasingly becoming source for concern as well. We're worried safe patient care is being jeopardized," she said.

"Because of this process [of health-care system changes] there are 31 nurses laid off. This is a system that, for years, has desperately needed more nurses to care for the growing number of patients, not less. I can't see how anyone would interpret that as a success."

'We've done an awful lot': health minister

Health Minister Kelvin Goertzen said his government knew there would be disruption when implementing its changes.

"Remembering there are 40,000 employees who work in the health-care system and we're talking about a few dozen that we're having to continue to work with [to find a job] ... but in the scale of things, I think we've done an awful lot."

Goertzen said the lack of sub-acute care beds was anticipated and will be resolved when services at Seven Oaks and Concordia hospitals are fully transitioned, as has already been done at Grace Hospital.

"We simply couldn't transition all of them at once," said Goertzen.

Goertzen said the full timeline for Phase 2 of the province's health-care plan has not been completed, but he committed to releasing it within the next two months.

He also acknowledged problems with communicating changes to staff and pledged to do better.

"I recognize that communication is both difficult. It's never going to be perfect — particularly in a system this big, particularly with the amount of changes and the amount of employees we have, it's never going to be perfect — but I know it can be better."