'Confidence is lost': Report on health-care overhaul finds major problems

A revealing look into the overhaul of Winnipeg's health-care system found staff at risk of burnout, no ongoing assessment of whether the revamp is even working, and surgeons threatening to walk out if Concordia's ER had been replaced with a walk-in clinic.

The report that convinced the Manitoba government last month to transition the emergency department at the northeast Winnipeg hospital into an urgent care centre was made public on Monday.

The findings of Dr. David Peachey show more egregious failings of the overhaul than the province previously let on.

His report exposes major human resource issues, from nurses encountering "unknown levels of stress" to "deep-seated unhappiness" among emergency department workers, and ER staff resigning because of the uncertainty at Concordia and Seven Oaks General Hospital.

'Confidence has been lost'

Peachey wrote that while there is consensus among health-care workers for an overhaul, there's widespread concern about the timeline.

"Overall, confidence has been lost" in Phase 2 of the revamp, reads the report, written by the consultant the province hired to assess the hospital reorganization plan, which started in 2017 based largely on his advice.

"The underpinning flaw has been stressed repeatedly as the absence of a timely risk assessment. There is general concern that there is inadequate capacity to care for inpatients after the acute phase of an admission, resulting in challenges in bed access and weak turnover data," it reads.

The report, however, notes the exception to overhaul support is the Manitoba Nurses Union and the 17 nurses who spoke with Peachey.

The nurses' concerns, Peachey wrote, are "exacerbated by a mixture of unpredictability and under-resourcing that have been fall-outs from consolidation." Some feared going to work because they'd have to work overtime, he said.

The report adds it is "entirely predictable that the quality of nursing care to patients is and will be compromised."

Manitoba Nurses' Union President Darlene Jackson said she feels vindicated by the report's findings, but is disappointed by the lack of suggested solutions.

"My biggest concern is even though this report highlights those issues ... there's absolutely no solution to any of these challenges," said Jackson.

The report recommends that nurses be involved in the assessment process going forward, but Jackson said nobody has extended an olive branch yet. 

Health Minister Cameron Friesen says the government isn't shying away from the problems being exposed. Regular assessments will be conducted going forward.

"We published the report because we don't have anything to hide," he said.

"I can tell you today: it's not the same system as the one that Dr. David Peachey first scrutinized again five weeks ago."

The plan to consolidate emergency care in Winnipeg from six locations to three locations was designed to cut wait times and find efficiencies.

Phase 2 of the revamp included shuttering Concordia's ER earlier this month and converting the emergency room at Seven Oaks Hospital into an urgent care centre this September.

Plan needed a check-in: Peachey 

Peachey recommended that both emergency departments become urgent care centres. 

His report explains that assessments of the health-care revamp should have been happening regularly.

He recommended putting most of the consolidation on hold, aside from the conversion of two emergency departments, so that "repair and restore" activities could take shape.

It's telling of the government that it wasn't keeping tabs, NDP Leader Wab Kinew argued.

The issue is "not that the government wasn't in the know; the issue is that the government had an obligation to make itself aware," he said.

Peachey found many human resource challenges as Concordia Hospital prepared to close its ER: Physicians becoming disengaged as they prepared their exit, the early resignations of respiratory therapists jeopardizing patient safety, and a destabilized emergency department caused by multiple resignations that resulted in high vacancies and overwhelmed staff.

It was believed frustration over the hospital's conversion was because people's concerns weren't being heard, Peachey wrote.

Beyond Concordia, he explained the sustainability of Seven Oaks' ER is at risk because of emergency department staff seeking other work.

He noted the "previously negligible" wait list for cardiac surgery has grown to around 100 patients, mainly because of a lack of cardiac nurse specialists and an inability to fill overtime hours.

In the midst of consolidation, the volume of emergency department patients has increased at Victoria General Hospital and Grace Hospital, Peachey wrote. Both facilities have struggled with nurse staffing.

The ER at St. Boniface Hospital is struggling to cope with an increase in patients, but hasn't seen a corresponding increase in funding, nor a patient flow strategy nor a regional risk assessment, Peachey wrote.