What affects access to health care in our hospitals?

A clinician, educator and planner weigh in

Accessing health care and the multitude of factors affecting fast access were the topics served up at the Connecting to Health Care luncheon October 19, the latest event in a series of information sessions presented by the University Hospitals Kingston Foundation and sponsored by Bell Canada.

Speaking to 60 invited guests, Dr. John McCans, medical director for the joint medicine program at Hotel Dieu Hospital and Kingston General Hospital, acknowledged bottlenecks—some to be expected, some not—as patients flow through our hospitals for elective and emergency health care. 

“It’s a system of checks and balances that aims to meet the needs and requirements of our patients,” explained McCans.

Elective procedure patients—for example, those having hip replacement or cataract surgery—may be slowed down by the availability of particular diagnostic services or by how physicians manage their wait lists. 

“As well, what a patient perceives as delays in testing may actually be carefully built-in steps to the diagnostic process,” said McCans.

On the Emergency side, patients can experience delays because more acute cases must take precedence or because beds are not immediately available. 

“An ER patient may be temporarily stalled in moving to a floor because we reserve some beds for elective surgeries,” said the physician.  “Certain delays are essential to the system.

“That said, we know we need to do some tweaking to get rid of unnecessary bottlenecks—a good example is the use of acute care beds by long-term care patients.”

For Sandra Carleton, vice-president, Human Resources at Providence Care, access to good health care translates into retaining hospital staff at a time of huge transformational change—the result of demographic shifts, fiscal challenges and fast-paced technological advances.

“Our strategic priority now should be retention—keeping excellent staff who can provide exceptional care,” she said. 

Carleton explained that hospitals are under more than fiscal pressure these days.  In terms of human resources, they are challenged by shortages in some professions (e.g., nursing), higher turnover of staff due to the retirement of baby boomers, and difficulties in recruiting people into management roles.

In her experience, staff are eager to upgrade their clinical and technical skills, develop leadership capacity and make the most of educational opportunities. 

In concrete terms, she said, that means providing educational bursaries, creating mentorship and coaching programs, and supporting internally-driven leadership programs.

Our hospitals need to focus on investing in staff, said Carleton. “If you create a quality workplace and develop people’s capacity to contribute to that workplace, then you get results.”

From a bricks-and-mortar perspective, access to care will get a big boost thanks to the unprecedented redevelopment projects underway in Kingston’s hospitals, said Ted Darby, Vice-President of Planning and Facilities for Hotel Dieu, KGH and Providence Care.

“We’re building and expanding our hospitals at a time when patients and staff expect and need facilities to stay in step with the rapidly changing field of health care,” he explained.

For instance, evolving standards in health care now call for more private rooms to address infection control issues and new technologies for information management, diagnostic testing and treatment can demand special dedicated space. 

And, as real-world classrooms for the next generation of health care professionals, our hospitals have to provide the right physical environment for learning.

“We also have new standards around accessibility for patients,” said Darby, “as well as many more safety regulations and standards for energy efficiency.”

Darby was enthusiastic about the progress of hospital redevelopment, noting the KGH project is on schedule.  Forty-two per cent of the project is complete; the new pediatric unit opens in December and a new inpatient mental health unit will be in place by next summer. 

Meanwhile, Hotel Dieu is well along in the planning stages for a retrofit of 21,500 square feet and new development of 25,000 square feet, while Providence Care is planning for a new 355,000 square-foot hospital on its King West site.

“Our facilities are a critical tool in providing patients with access to quality health care,” said Darby. 

“We’re very excited about all of this redevelopment because it will bring a new level of efficiency to our hospitals and that will benefit patients and staff alike across all three organizations.”