The first accreditation report since the merger of nine district health authorities highlights the progress the provincial organization has made, but also draws attention to long-standing challenges continuing to plague the system.

The Nova Scotia Health Authority released the document this week. The 182-page report follows intense evaluation of 54 sites across the province, judging them against national standards for more than 4,600 items.

Overall, the organization met standards for 92.9 per cent of criteria. The health authority was "accredited with report," meaning there is still work to do before receiving full accreditation. Areas that still need work include transfer of information between units and departments, falls and suicide prevention strategies and patient flow.

Tim Guest, vice-president of integrated services for the health authority, said the results are positive, but there are still things to improve.

"When you're amalgamating nine organizations into one, I don't think many people have a good understanding of how monumental that task is."

Guest said patient flow is an area that has improved across the province but continues to be a challenge in emergency departments. To that end, the health authority has recruited someone to do nothing but oversee patient flow in the central zone. A similar role at the provincial level is also being considered to ensure everyone is working together.

Many of the problems identified in the report are no surprise: challenges with recruiting (NSHA estimates there are 1,700 vacancies to fill); workers on the front lines feeling burned out and in some cases left out of the loop during rapid change and buildings continuing to crumble.

"While there is variability in the level of preventative maintenance across NSHA, the team reported that on average only 10 per cent of resources are able to be applied to preventative maintenance," reads the report.

"Facility and maintenance staff are challenged with the current volume of building and infrastructure deficiencies.… Clinical teams report that they are often required to work around infrastructure challenges to deliver quality patient care."

Health-care consultant Mary Jane Hampton said she was particularly pleased to see building conditions addressed.

"We are, in Nova Scotia, totally in the crapper when it comes to infrastructure. We need to name that and we can't duck the issue and it is inappropriate to hold the health authority alone to account for a problem it inherited."

Overall, Hampton said the report shows the merger has gone pretty well and patient quality and safety is generally good. What will be key, she said, is continued focus on taking care of and engaging front-line staff and making sure efforts to provide consistent services are based on best practices.

"At times, standardization has meant boiling things down in the name of equity so everybody is equally inconvenienced."

Guest said efforts to engage staff come down to meeting with them and listening to their concerns.

"We're looking at creating more opportunities for them to be engaged and provide more input into decisions and provide us feedback into where policy may impact their ability to work."

Guest also touted the 80 patient advisers — a number he said could grow — who are embedded on teams and councils to provide direct feedback about what's working and what needs change.

"That lens is going to be fundamental as we move forward."