David Diamond, CEO of Acute Care Alberta, told reporters at a health care system capacity update in Edmonton on Thursday that his department is in step with the provincial government as heavy strain on the hospital system is addressed.--CP FILE PHOTO
zmason@medicinehatnews.com
One of the recurring questions raised by health-care professionals and critics since the province initiated its system-wide refocusing is who is responsible for operational control.
Prior to the refocusing, Alberta Health Services was the singular agency overseeing all aspects of health-care delivery. Since responsibilities were divided between four health ministries and the previous geographic zones were transitioned to new regional corridors under the system, health-care providers and analysts have been unsure whether a singular entity retains the power to co-ordinate province-wide response.
“Well first, there is no one person who runs a $28-billion complex, integrated health-care system,” Minister of Hospital and Surgical Services Matt Jones said at a press conference Thursday.
“Acute Care Alberta, government ministries and departments and other agencies like Assisted Living Alberta and service providers like AHS, Covenant and Lamont all work together on a daily co-ordinated basis to provide care to Albertans. So there is province-wide co-ordination.”
David Diamond, interim CEO of ACA, told reporters his agency could assume authority over all the disparate parts of a given catchment area or corridor. He says to this point, ACA has not deemed it necessary to seize that kind of operational control.
Diamond says ACA has been engaged in the province-wide response to current levels of strain in the health-care system as a collaborative partner, not as an overseeing authority.
He says daily co-ordination meetings take place between ACA, AHS, Covenant Health, ALA and other relevant partners, and that ACA takes a leadership position in these conversations. But it appears that leadership is, for the time being, informal.
Diamond says there is still power at his disposal to take further control over operations if necessary, but he doesn’t foresee his agency taking the reins.
In an op-ed Jan. 9, which subsequently garnered the support of 300 physicians across the province, two Edmonton physicians called on the province to implement a number of measures to relieve strain on the hospital system.
One measure was integrated load levelling, which they argue has been lost in the system refocusing and which they identify as a root cause of the current crisis. They suggest load levelling must be managed by an entity with authority over all service providers in a corridor or catchment area.
“I do want to respond to that – I’ve seen in the media, folks have talked about this piece that’s missing from our response this year that they’ve seen in Alberta in previous years, and that’s not actually missing,” said David Diamond, interim CEO of ACA.
Brian Wirzba, president of the Alberta Medical Association, says it’s not AMA’s stance that those structures and measures are missing. Rather, he says those mechanisms simply aren’t working as well as they used to.
“What we’re suggesting is not that it’s disappeared, but from a frontline worker perspective, we’re not seeing it run as efficiently as our previous experience was maybe two to three years ago.”
Wirzba, also a practicing internal medicine physician in Edmonton, said that during the peak of the current surge over the holidays, a patient was hospitalized in an Edmonton ICU.
When the patient no longer required intensive care, doctors tried to transfer him back to Wetaskiwin. Ultimately, the process took five days, by which time the patient was sufficiently healthy to be discharged altogether.
“That would have been smoother and quicker in the past, and we would have received reports on a daily basis of where this person was in the queue. That seems to be lacking.”
Roadblocks obstructing effective discharge predate the system refocusing, Wirzba says. But part of the problem is fractured communication, which he says has gotten notably worse since the refocusing.
“You heard at the press conference, the buck still stops with ACA – but does it really? Because if the challenge is getting patients out to long-term care, how do they communicate?”
Wirzba says the refocusing hasn’t helped matters, and wasn’t endorsed by any physicians he’s consulted. While he said he was encouraged to hear ACA is engaging in daily co-ordination meetings, he says little information from those meetings is finding its way to the front lines.
“It doesn’t have to be everybody on the front line, but to the hospital leadership groups, the zone leaders for emergency medicine and general internal medicine. I can tell you those zone leads are not really kept in the loop with what’s happening at the ACA.”
He says health professionals would benefit from clearer directives from the ACA about minimum requirements for service providers, the measures being implemented to manage challenges, and who it is health professionals can report to.
Wirzba says many of the issues faced in urban hospitals now are longstanding. It’s been years since he can recall patients being admitted directly to ward in Edmonton.
“I will blame the last 10 different administrations for not taking the bull by the horns and fixing it. I’ve told two of the current ministers, we’re just waiting for a government to take some ownership and start fixing it.”
Still, Wirzba was heartened by Thursday’s press conference and the efforts to improve communication it represented.
“It was great to have them present at that news conference yesterday. The minister took accountability for things, and I’ve not heard a minister say that for a long time.”
Wirzba agrees with Jones that no special powers are necessary to begin implementing changes that can help relieve pressure on the straining system.
“They have all of those powers already. We’re asking that they use them.”
If Thursday’s statements do represent any kind of new willingness to engage with what doctors across the province are calling a crisis – a word government officials stopped short of employing – Wirzba says he hopes this time, the government takes some professional advice.
“It’s for sure a crisis. You can use different terms, but we need to fix it. And I don’t want them to fix it unilaterally, because I don’t have the confidence that it’ll work. We’re just asking that they work with us.”
