From the desk of Dr. Michael Gardam, Health PEI CEO
Hi everybody,
I want to talk about change today, but I want to start by acknowledging a mistake I made in a recent interview regarding the PCH ICU transition. I said that the ICU at PCH frequently transferred the sickest patients to QEH ICU. While that might sometimes happen I now understand that transfers occur mostly because of capacity issues. The last thing I want is to mischaracterize your work or imply a lack of skills. I apologize for this.
The recent changes to the PCH critical care services that were shared with you all last week have been a major topic of discussion for the past couple of days. These are big changes, and not changes anyone wants, especially not like this. Yet, we move forward for the sake of patient care with the best plan we can design given our resources.
Being in this situation is a clear indicator that the old critical care model at PCH is no longer viable – one of the main reasons the doctors wanted change was because of having to cover the ICU frequently. I believe that simply recruiting internists to work under the existing model will likely result in the same outcome. We need a new plan for the future at PCH that works long-term, as an important part of a provincial critical care strategy. Similarly, we need to figure out more sustainable models for anaesthesia and other specialties so we can stop the rotating crises.
Some people are demanding that plan now, asking what it should look like, how many internists should work there, and when it will be in place.
We are not going to make up a quick, artificial plan – we have a history of doing that in the province and quick fixes to complex challenges rarely work out and then we are back in crisis. We need much more input from people first, and the future of critical care at PCH will depend on the ability to recruit ICU-trained physicians for the program and the needs of the population.
What we do know is we need to hire more internists, including ICU-trained intensivists, critical care nurses, respiratory therapists and more to ensure a provincial critical care program is one where all staff are supported and the service is sustainable. That is our goal.
As we move toward that goal, we will need to ask questions: what does the future look like for a provincial ICU program? We need more internists at PCH but what role should they play there and possibly in other facilities and should other facility-based doctors spend time at PCH? How do we use the critical care beds we have at PCH and QEH most efficiently, in a way where everybody is happy at work and doesn’t burn out our internal medicine doctors?
The PCH changes have stressed the part of our system that cares for the sickest Islanders. It’s been hard on staff at PCH, QEH, and team members across the system who are doing their best to adjust and meet the needs of patients. Thank you to all of you who have been impacted by and are responding to this change.
CHANGE
A good friend of mine once worked for one of the big consulting firms in the US and told me a story where they were all given T-shirts that said: “Change is Good……you first!”
I have always loved that anecdote because it tells it exactly like it is. When I first came to PEI, I was bombarded with messages like “Health PEI needs to change”, our “system needs to change”, and “we can’t keep going the way things are.” All true statements, yet, getting to a better place is hard. It is so difficult in fact, that I sometimes feel one would have to be crazy to try to make change and that probably explains why many problems have not been tackled in the past.
Health PEI has made many, many changes over the past two years, most of which have gone unnoticed because they were about streamlining and improving processes. We can now hire faster, we can move money in our budget to take advantage of opportunities, we are finding clinical space like never before, and we are communicating better. Of course, we are not done yet, but clear progress is being made.
Clinical programs are another matter. I believe there is widespread agreement that we are critically short-staffed, people are burned out after a long pandemic, and the PEI population explosion has made things even more challenging. I also believe there is widespread agreement that we need to change how we deliver care on the Island. The devil, as they say, is in the details.
Since taking this role, we have moved from crisis to crisis—today I likened it to chain smoking where we light one crisis with the previous crisis. This is no way to run a healthcare system.
If we can put aside the rivalry, the history, and the anger, what can we come up with? How do we move beyond what I have been hearing lately: “They need to get their act together” and “Health PEI doesn’t support us”?
Because we need to act now, together, for Islanders.
OUR BURNING PLATFORM POINT
We are at a point now where we have a so-called “burning platform”—a description that comes from an oil rig fire where the workers had no choice but to make a decision—die in the fire or take a chance and jump into the ocean.
Here’s our burning platform: We do not have enough staff to keep doing things the way we have always done them, and Islanders still need care. It is that simple, and that scary, as we have no choice but to make meaningful change.
My experience over the past 6 months though has also shown me that while almost everybody wants change, they usually want someone else to do it. How do I know this? From the volume of emails I have received and meetings I have attended for different programs, where the proffered solution is often to get someone else to change. This is a bit like wishing for a third option on a burning platform where someone puts out the fire on the oil rig. This is understandable and this is human nature, pure and simple.
Sadly, a caravan of healthcare workers is not about to cross the bridge to come to our rescue. And yet Islanders need healthcare.
One of our big initiatives is to get our different facilities and programs to act as one system. Historically, there have been significant differences in practice across the island which is a holdover from when we had multiple health authorities and everybody did their own thing from a very regional perspective.
For example, some long-term care facilities have more staff working for the same number and type of clients than others. Different wards have different staffing ratios, despite similar patients. Physician staffing can be wildly different across the island for similar activities. By continuing this system, we are not sharing the load equally, and it continues to feed a lack of trust between facilities and programs. We are far too small to be competing with each other.
We resist change in different ways such as delaying and hoping it goes away, being easily affronted and posting on social media, calling the media or leaking internal documents, calling politicians, threatening to quit, or yelling at leadership. Yet the platform still burns and such negativity makes it harder for us to recruit, which is the main way we will get out of the mess we are in.
The only way Health PEI is going to get better (something we all want!), is if we all get engaged in what the future of Island healthcare might look like, beyond our local regions, programs and institutions.
We need us to change and Islanders desperately need us to change. We are focusing on making decisions that are data-driven and evidence-based, supporting our staff by sharing the load as equally as we can, and providing the most care possible to the most people.
Some of you may read this note and become even more angry. That is not my intent. I understand how difficult change is and we have no choice at this point in Health PEI’s history, but to change and work towards a common purpose.
All islanders, no matter where they live or what hospital is in their region, are depending on us to care for them.
Michael
Please send questions, comments, or submissions for these notes to emclean@gov.pe.ca, subject line “Notes for Michael”.