Only when the voice of the community is heard can we move forward ~ former MAHC directors

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In this commentary on the future of acute care hospital services in Muskoka, we will take you on a journey back, through the history of the issue of a single site new hospital vs maintaining the existing two hospital sites – recently referred to as the “Elephant in the Room” issue. We will wrap up with some important questions.

MAHC Pre-Capital Stage

The journey begins in 2012 with work on MAHC’s “Pre-Capital Submission”. Three years later, the MAHC board made a recommendation to single site acute care services in a “centrally located” site, based on a hospital steering committee recommendation. This decision went against what most in the community wanted, leading to significant backlash in many Muskoka  and area communities including campaigns, civic protests, a Hospital Retention Committee, and direct engagement with the Minister of Health (medical practitioner’s letter, municipal leader meetings). The “Elephant” is born.

LHIN (Local Healthcare Integration Network) Taskforce

By the fall of 2015, in direct response to the community backlash, North Simcoe Muskoka LHIN Chair Bob Morton initiated a task force, bringing together municipal leaders and stakeholders with MAHC leaders to achieve a resolution to community concerns and break the impasse. One thought was to find savings within the broader Muskoka healthcare expenditures (via consolidations, reorganizations, etc.) that could target the long-term financial sustainability of MAHC and other key local needs. The task force deliberated for six months, establishing good dialogue and ideas between the various health service providers. However, it was unable to resolve the Elephant in the Room issue. The LHIN Chair recommended that a new group be formed, with broad stakeholder representation, and the Muskoka and Area Health System Transformation (MAHST) project was born.

MAHST Project

In the Summer of 2016, with Ministry blessing and funding, and significant Town, District, LHIN and MAHC resources, MAHST launched with a mandate to research, analyze and recommend how healthcare services might change to better integrate and optimize the health care system in Muskoka and area. Its future state target was set to 2022, with a number of ambitious goals, in particular, applying resulting savings to identified top priority healthcare service gaps including hospital financial sustainability.

Early in the project, Community Health Links organizations (members from a range of health service providers) took a lead role. Some very good work and innovative ideas flowed. However, as additional healthcare players were added, original timelines expanded, and the original project Terms of Reference shifted – the hospital’s role and its future moved outside their circle of primary focus.

By the early summer of 2017, some (including MAHC’s Board Chair) questioned if quantifiable savings could be found. Perhaps expectations that MAHST would be able to make sufficient progress in addressing system-wide integration challenges spanning the spectrum of siloed health care service organizations was unrealistic. Such a wide scope is likely better addressed at the provincial level. Importantly, the “Elephant in the Room” issue was pushed down the road. We note some good progress was made, centering mostly around primary care enhancements and improved patient system navigation.

One recommendation was to create a new Sub-LHIN organizational layer to oversee the entities below it, which raised alarm bells for some people. Examination of past provincial decisions that create new layers of administration shows that they only lead to increased bureaucracy, resulting in more cost and slower decision-making. Skeptics will conclude that new layers of bureaucracy shield politicians or Ministries from direct accountability, and often coming at the expense of front line service delivery.

The LHIN board of directors received the MAHST first year report, and provided direction to continue collaboration with MAHST members, but apparently did not extend funding into 2017/18 (as per the public record). In an October 17 article, the LHIN CEO addressed the MAHST topic and potential change to healthcare delivery in Muskoka, however without reference to the LHIN board’s decision on funding, leaving questions about MAHST’s future.

MAHC Capital Plan Development Task Force

Meanwhile, in mid-2017 the Ministry of Health provided MAHC an additional $1 million of dedicated funding (mostly for consulting costs), launching Stage 1 of the capital planning for the hospital. The decision around the hospital future comes full circle, and lands back where it started five years ago – with the MAHC Board. Shortly following a mid-August launch, the initial goal of completion by year-end 2017, shifts out to mid-2018.

To learn from this journey, these important questions are raised:

  • Are we confident that MAHC gets it right, and is the ‘we know best’ thinking reflected in past decisions gone? We note: The large 25-person task force has an oddly heavy MAHC footprint, when compared to other key community areas representation.
  • Why did MAHST decision makers push the hospital “Elephant” issue down the road, and why was its past chair appointed vice-chair of the new task force?
  • When will the full results from the recently concluded (flawed, as per our past article) online hospital survey be released? We note that a previous survey from MAHC’s pre-capital planning process was not widely shared.
  • Will the evaluation criteria that matters most to the community about future hospital model options be appropriately weighted, or will it be swamped by a long list of lower priority factors? We note the prior pre-capital planning process used 21 equally weighted scoring criteria, which skewed the results.
  • How can we be assured that model design/costing work, created using the same consultants, is correct, and without any bias?
  • Do we really want so many health tax dollars spent on additional administrative overhead, seemingly endless planning, task forces and consultant’s fees rather than invested in improving frontline patient services?
  • Are Muskoka tax payers aware that the board’s previously recommended option for a single site new hospital will dramatically increase their taxes, as the community cost share will likely reach well over $50 million, when all costs are factored in? We believe, in contrast, the two existing acute care sites, incrementally upgraded, and gradually evolved to changing Ministry standards, will lead to lower costs and a smaller tax burden.

Finally, maybe the Elephant in the Room issue is at hand, once the voice of the community is clearly heard and respected. Only then can we fully move forward with the important work of resolving the inadequate hospital funding and funding formula problems (that sits behind the service reductions and aging infrastructure issues) and improving on what we already have. This would begin to build some confidence in our hospitals’ future!

Authored by – Dave Wilkin, (former) MAHC director, retired bank & IT executive and Ross Maund, (former) MAHC director, career health services corporate executive

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1 Comment

  1. Thank you, gentlemen, for providing this detailed chronology of the Muskoka Hospital(s) conundrum. Especially important are the questions which you posed. No less a luminary than John Carver has posited that the ideal size for a board is seven directors. Standing committees and ad hoc committees (with a board chair, but open to all community members) should be performing research, composing and analyzing survey results, writing reports for board consumption, etc. With a more manageable board size, decisions rather than too many wasteful discussions should predominate.

    It is to be hoped that the majority of Muskokans read your thoughtful article, and have an informed opinion.

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