Last week, Dr. Del Dhanoa, a radiologist from Northern Ontario, asked some questions that I decided to answer as another blog since they continue the series I have been working on. The questions also spark further debate about whether the Minister of Health and Long Term Care has completely explained his vision of health care in Ontario, given the degree of change being undertaken in Bill 41.
This is the first question:
“What are your thoughts about Hospital CEOs and Boards? Will they eventually go by the wayside like British Columbia because the LHINs (and Minister) have much more direct control over Hospitals with Bill 41? A Hospital Board Director told me that she/he was ready to hand in his/her resignation after reading Bill 210/41. They feel like they no longer serve a purpose and, after all, their time is largely volunteer based.”
I served on the Board of my hospital when I was the President of the Medical Staff. What is most impressive about hospital boards is how deeply they draw into the fabric of the community in which they are located. My main clinical appointment is at the Royal Ottawa Mental Health Centre, a psychiatric hospital in Ottawa. The members of our hospital Board of Trustees include prominent local lawyers, very senior civil servants, patient advocates – all very busy people who volunteer their time to ensure that the citizens of Ottawa have access to the best possible mental health care. They are all volunteers and commit a significant amount of time to the work of the hospital. They have a vision for how the community can best be served that is grounded in the reality of the advantages and disadvantages of living in the national capital and its region. Bill 41 would add another lens to that vision and, unfortunately, it seems to be a lens that could override some of the most important decisions they make.
In the narrative leading up to his question, Dr. Dhanoa mentions the reaction of one of his hospital’s Board Directors. My husband had served on the board of a local Ottawa hospital and he too believes Bill 41 as an interference that that was unneeded. He spoke of the fact that every new directive or initiative from government just added time to board and committee meetings since one often had to work patient needs and priorities around them. For example, governments have had many interventions over the years to improve wait times, as if doctors and hospitals were not already working hard to do this. Really, does the Minister believe we are trying to increase wait times? Or decrease access? Doctors and hospital boards hear concerns directly from patients and can tailor a local response to their concerns.
Here is Dr. Dhanoa’s second point:
“The language in Bill 41 is pretty clear. The Minister can act to change Hospital mandates in the “public interest” and this includes activities that decrease Hospital length of stay. As you know, LOS is the basic currency describing the activities in hospitals: from the Emergency Department to the wards, to the lab and the medical imaging department. Everything in hospitals is based on LOS.
So, really, Bill 41 gives the Minister a lot of power to change the way medicine is practiced in all of Ontario’s Hospitals to meet the LOS metric. While on the outside that sounds great, I have many reservations on how that will play out in Ontario especially when physician input is ignored.”
I think that Dr. Dhanoa makes his own point very well and underlines how important it is for physicians to sit on and participate in their hospital boards because it is one important way in which we have input into how health care is delivered. Having said this, it was the decision of Premier Wynne’s predecessor to stop physicians from having a vote on hospital boards under the changes the Liberal government made to the Public Hospital Act in 2010. Doctors realized then that their input was being marginalized by the Liberal government in Ontario.
The problem with ignoring the input of doctors is that we spend all day every day working to integrate patients’ health care. Integration is the goal of Bill 41. Why ignore the concerns of those who actually understand how this might be achieved?