Doppler spoke to both the Chair of the hospital board Phil Matthews and hospital CEO Natalie Bubela, following their announcement that the board had endorsed the recommendation of the Capital Plan Development Task Force for the two, acute-care hospital sites model. Below is the Q&A, some of which has been slightly edited for brevity and clarity.
It’s been a contentious ride, this whole exercise, how are you both feeling at this time?
Matthews: “I would say we’re all happy that all the contention is behind us and we’re now trying to make sure that everybody in the community’s behind where we’re going.”
Bubela: “And I would add, excited. I absolutely agree with Phil about happy but also excited because we can move forward and really begin to plan for our community.”
Natalie, you’ve always advocated for one site and you cited staffing efficiencies as one of the main reasons. Is the task force’s decision and subsequent endorsement by the board bittersweet for you?
Bubela: “No, I would say not. I think the criteria or the variables that led up to the decision at this time are very different from those that were in place back in 2015. So it’s definitely not bittersweet. I’m excited and we’re looking forward to making this work.”
Can you provide a couple of examples about what you mean when you say it’s very different?
Bubela: “Sure, so I think one of the differences for sure was around land use planning. The task force did commission a report from an external company to come in to work with our municipal focus groups and looking at the provincial guidelines around land use planning as well as municipal planning and they recommended that any hospital siting needs to be within the urban core and that a central location was really not one that they would recommend. So that’s very different from what we thought was the art of the possible back in 2015. So knowing then that the planning needs to be, for instance in a one-site model, either in Huntsville or in Bracebridge, we knew based on that information that it had two negative outcomes attached to that. One would be the possibility of losing market shares. I’ll give you an example of that, if you build a hospital in Huntsville and people had to drive to Huntsville, there’s a possibility that the people to the south might choose to go to another hospital like Orillia and vice versa, if you build in Bracebridge, that the possibility would be the people to the north, like Burk’s Falls, etc. may choose to go to North Bay. We didn’t want to lose that market share because that’s very important to us in terms of the funding formula and efficiencies, but more importantly than that, the fact that we couldn’t build in a central location had a very negative impact then on travel times and on access to hospital services and we did that analysis based on the advice that we got from our capital planning company and focus group. So again, the board and I and others were concerned that the travel times would be much longer and access would be compromised and that’s very different from what was our understanding back in 2015.”
There was a lot of talk about flexibility in the model chosen, what does that flexibility entail? Could that translate into an entirely different model in the future?
Bubela: “I’ll talk about what I think flexibility would mean, is that when you design the building in a way that is multi-purpose. So for instance a room might not be designed to only serve one function, that it would be designed in such a way that depending on what the need is it could be quickly converted and used for that purpose. Sometimes in the past, when you built, you built it specifically for a certain purpose. And so our planning in the future is to make sure that our design does not limit future use that might be different from what you originally think it might be intended for.”
Phil, was the board unanimous in its endorsement?
Matthews: “No, it was a majority decision.”
Have you gotten any input yet from staff and physicians with hospital privileges who were not on the task force?
Bubela: “I’ve been going around and speaking to all the staff to make sure that the staff heard and were aware of the support and the decision by the board and they’re just absolutely very happy staff throughout the building. They’re really looking forward to working with us as we move ahead in our planning. Some of the people that I met with today were physicians and they were equally as excited about the future and asked some good questions and understood the differences between 2015 and today, and I think were very supportive of the decision that the board has made and the recommendation that came from the task force. I think they’re really excited to get going on this and begin planning.”
What are the next steps and major challenges ahead?
Matthews: “The next steps are the consultants will take the decision and they’ll draw up their report on 1A, which is required to be submitted to the LHIN. The task force will regroup and will start working on 1B, which is where we start looking at how can we house these facilities, what kind of work do we have to do – a renovation, a build… and how do we fund it and try to get the 1B done within the next six months, so we can put the 1A and 1B in front of the LHIN and the Ministry sometime next year for their approval.”
Where will the funding come from for the task force to move onto phase 2 or phase B?
Bubela: “So the funding that we received, so that million dollars that the Capital Branch gave us that we announced, I think it was last June in 2017, was for stage 1 and stage 2 planning. So the million dollars is to cover the planning work that’s been done in A that we’ve just completed and the work that’s being done in part B and hopefully money left over that bring us into the next stage, too. It (the next stage) would be a further refinement of the model and more in-depth… where we actually do far more finite definition of each of the areas, including the number of staff that are required, the budget attached to it, supplies, volumes, all that kind of thing. So every time you go through a new stage you’re doing more and more refinement. So it’s getting more and more granular in terms of the level of detail.”
Have you reached out to the Ministry of Health yet? Of course the LHIN is aware of what’s happened – what kind of response, if any, are you getting thus far?
Bubela: “We haven’t heard any response back. We’ve kept the Ministry, the Capital Branch, and the LHIN definitely up to date. They’re aware of what the decision is. They’re not in a position to be able to comment at this point. They’re still in what they call caretaker mode, given the new government that’s come in. So they’re not in a position to be able to comment on what our verbal update to them has been and they do need to wait for a final report to come to them so they can actually have a good look at it and digest it and then raise what questions they may have.”
What do you both see as the major challenges ahead in this exercise?
Matthews: “Well, there are certain steps that the Minister of Health has laid out and two of them are making sure that we have community support behind the plan that we’ve picked and I want to make sure that we do have true community support behind us. And also the community funding of the local share is a requirement for submission, and that’s key and we have to start working on that ASAP.
Is there anything else you’d like to add?
Matthews: “I think this is a great breakthrough and we have to keep everybody positive going forward because there are 141 hospitals in Ontario and I’ll bet every one of them is sitting at the Minister’s door saying the same thing so we have to make the best case that we can to make sure that we’re number one on the list.”
Bubela: “We also want the Ministry, the Capital Branch, to recognize that the need is very high here and as a result we should jump the queue and be one of the hospitals that they look at approving and moving ahead of all the other hospitals that are in line as well and want either renovations or new builds occurring there. We’re starting to run out of room here. We’re already starting to see a sustained increase in volumes at both of our sites and we may not be able to actually last for 15 years without some changes occurring here (both sites) sooner rather than later in order to be able to look after our community. We just don’t have space in the Inn and it’s getting more constrained as each winter goes by. It used to be seasonal; I would say seven years ago when I started here there were some lulls… that’s no longer the case. Last year we ended up with 105 per cent occupancy, that was reflective of the entire year, but we had points during that year that we were occupied at 140 per cent and I think that’s the new norm, not necessarily the 140 per cent but the 105 per cent occupancy for sure, and I would anticipate this year we may be at 110 per cent or more. We need to make provisions for that and begin to plan for that in the short-term, which requires continual support from our communities too through the foundations and through our auxiliary to be able to make the necessary renovations we might need to make, as we’re waiting for the final decisions to be approved by the Ministry of Health.”
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Such important community impacting decisions should not be held in private. They need to be done in full public view, just like all levels of government operate in this country. Changes to the MAHC governance practices a must!
This, on the whole, was a very favourable and encouraging interview. In addition, on the topic of flexibility, it will be important for each site to develop its own areas of specialization. Neither hospital can afford to be all things to all people. It was also interesting to note that the decision to approve the final report was not unanimous. No recorded vote was taken (a very wise choice indeed); but note what the affect of an open Board meeting might have been.
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Now for the scary part: what exactly does our new, loose-cannon Premier have in mind for funding? As he vacations in Muskoka, we can only hope that his decision will be as self-serving as all his others to date.