Ombudsman finds patients grapple with oft-heartless health system
Elliott says Ontarians left feeling they’re problems to be solved, moved along
Somewhere in Ontario this past year, a lonely person needed surgery to cure a painful condition. The patient had no support system, nobody to take him or her home afterward and make sure everything was OK for a few hours, as the hospital insisted. The hospital cancelled the surgery.
Yes, we can fix you. But first you’ll have to make some really good friends.
This is the most heartless story detailed in the first report from Ontario’s new health-care ombudsman, former Progressive Conservative MPP Christine Elliott, whose office has handled about 2,000 complaints in a year.
The recurring theme, Elliott reports, is poor communication: patients who aren’t told all of their options or don’t understand them; patients who aren’t handed properly from doctor to hospital to home care to nursing home; patients who feel like problems to be solved and moved along, not people to be helped and cared for.
The report says the solo patient needing surgery was one of the three-quarters of complaints the ombudsman’s office sorted out in “early resolution,” which often means a couple of phone calls. Sometimes the subject of the complaint is happier to fix the problem than the complainant expects; sometimes it takes some significant throat-clearing by the ombudsman’s people.
In this case, the ombudsman “worked as a facilitator between the hospital and patient to achieve a resolution that resulted in the re-scheduling of the surgery and an agreement that the hospital would keep the patient overnight as an in-patient,” the report says.
The report talks about a patient without private insurance who asked for a shared “ward room” in hospital but was given a semiprivate one because that’s all the hospital had available, then was billed for it (Elliott’s people got the bill cancelled). A man who’d had a stroke and was sent for complex long-term care at a hospital his wife couldn’t get to (they got him moved closer). A woman with dementia who stopped letting home-care workers in to make sure she ate and took her pills (they got the visits timed so someone she trusted could be there to ease the way).
Elliott’s stories are stripped of identifying details, even where they happened. But “transitions across health-care settings” are trouble spots in the system, wherever you go.
The single biggest category of complaints about home care is that it takes too long to start; about hospitals, it’s patients’ being discharged too early or without proper preparation. About long-term-care homes, it’s about poor care generally.
Since this is only Elliott’s first year, it’s too soon to reach sweeping conclusions. Only two of the 2,000 complaints in the past year have turned into full investigations and she expects it’ll be at least two more years before she has an idea of what systemwide problems she’ll want to address.
But she has some unsurprising early impressions.
“Overall, patients want to be treated with greater compassion and dignity and to be seen as a whole person, not just as a disease or condition,” Elliott’s report says. Instead, heavily burdened workers struggle to do the basics.
“Hospitals in particular feel pressure to discharge patients that no longer require acute care to free up capacity for other patients,” Elliott says. “At the same time, there can be long wait times for long-term care homes and a need to provide care for residents with increasingly complex needs. The home and community care sector is also under pressure to provide more care to more patients, often with complex needs. For patients with highly complex care needs, the services that they need may simply not exist.”
Hospitals in particular feel pressure to discharge patients …
Doctors, nurses and staff are rushed, so patients and their families feel rushed at the worst possible time to feel that way. Outside of emergencies, patients really want to have their diagnoses and options presented to them in writing, so after the doctor leaves they can consider their choices without relying on their memories or notes they make about things they don’t fully understand, the report says.
Most basically, they just want people in the health system to say who they are and what they do when they walk into the room. This seems simple enough but it’s genuinely tough for a tired person nearing the end of a double shift to work up the emotional energy for introductions for the 30th time that day.
The fragmentation in the health system is reflected in the ombudsman’s complaints, too, Elliott reports. Her bailiwick includes hospitals, nursing homes and home care, but not individual doctors, for instance. About 450 of the 2,000 complaints she’s handled, she’s had to just pass on to other bodies, especially the College of Physicians and Surgeons of Ontario. Another 500 have involved overlapping jurisdictions, so the ombudsman has told other regulators about them but hung onto them in part. Some of the most complicated cases have involved four other authorities.
“We will be reaching out to the colleges governing healthcare professions, the Ontario Ombudsman and other complaint bodies to explore opportunities to provide a more seamless experience for patients and caregivers with complaints about their health care,” Elliott promises.