Cuts won’t hurt care: hospital CEO
We can ‘preserve or enhance quality’ after losing 290 positions, Kitts says
The Ottawa Hospital believes it can eliminate 290 positions in 2013-14 while preserving — and perhaps even enhancing — patient care. But the unions that represent most of its 7,700 employees are far from convinced.
The hospital announced the job cuts, which will save nearly $22 million, on Wednesday. Overall, it said, it needs to reduce expenses by $31 million to balance its $1.04-billion budget in the fiscal year starting April 1, 2013. The remaining savings will come from increased revenue and “reduced utilization and supply costs.”
The job reductions will affect the full-time equivalent of 90 nurses, 100 employees in administration and support services, and 100 other health professionals. No beds will be closed, however.
In an interview, the hospital’s president and chief executive, Dr. Jack Kitts, said the province has not yet informed the hospital of its funding increase for 2013-14. But, he said, “we’re assuming we’ll get zero per cent.”
He said that fiscal reality, coupled with growing demand from sicker patients, “mandates to us that we have to do something differently.”
About two years ago, the hospital began examining its staff mix to better match the skills of different health professionals with the needs of patients, Kitts said. Next year’s projected budget shortfall “is the catalyst to move this forward at an accelerated rate.
“We don’t believe that the way we provide service today is achieving the best in quality or the least in cost,” Kitts said.
“So we are going to change the way we deliver service,” Kitts said.
He said the hospital will watch carefully and measure the impact of the planned changes. “But we do believe we can actually preserve or enhance quality at less cost to the system.”
To develop the new service model, the hospital looked at all health providers, from registered nurses to social workers, to determine their full scope of practice. It then went through the hospital, unit by unit, to identify the needs of the “prototypical patient,” and match staff skills to needs.
Dialysis illustrates how the new model will work, Kitts said. In the hospital, registered nurses have traditionally provided dialysis to patients with kidney disease. But with improvements in technology, most dialysis clinics in the community now use lower-paid technicians rather than nurses.
“The hospital has sicker patients, so we can’t just adopt that model,” Kitts said. But the hospital will use technicians for dialysis whenever that makes sense.
“Wherever we can provide a service that doesn’t compromise quality with a less costly, less skilled worker, that’s what we’re going to do.”
But Frances Smith, head of the Ontario Nurses Association (ONA) local that represents The Ottawa Hospital’s 3,757 nurses, said nurses are already complaining that the dialysis unit is unsafe for their patients.
“They don’t believe the way the assignments are being done or the way the workload is being distributed is safe,” Smith said. With the planned changes, “it’s going to become even more difficult for those nurses.”
The hospital’s new approach will also affect patients needing endoscopies or cataract surgery.
The hospital performs 17,000 endoscopies a year. The 12,000 done at the Civic and General campuses involve sicker patients and must be done in hospital.
But the 5,000 endoscopies done at the Riverside campus are either screening tests or elective procedures done on healthy patients. Those will be shifted to community hospitals and clinics, Kitts said, where they can be done more cheaply.
“Why would The Ottawa Hospital spend the money doing what ought to be done equally well in the community for less cost?” he asked.
Kitts said clinics and community hospitals have assured him they have the capacity to absorb the endoscopy cases.
As well, demand for cataract surgery at the Riverside campus has been falling. So the hospital will save money by keeping one of its four operating rooms dark each week on average, though all patients now waiting for cataract surgery there will get it. And wait times for cataract patients will not increase because of the reduction of operating room hours, the hospital said.
But Smith said the reality is the province has cut funding for cataract surgeries. “They’re telling tertiary care centres, ‘You shouldn’t be doing cataracts because this is something that can be done much more cheaply in other facilities.”
Kitts said he’s convinced that The Ottawa Hospital can raise its game by adopting new ways to deliver services.
“If I believed that The Ottawa Hospital was tops in quality of patient care and the most cost-effective, efficient hospital in the country, then I would despair and go down to Queen’s Park and tell them we have to cut service,” he said.
“I don’t believe that we don’t have room for improvement in quality, and I don’t believe that we don’t have room for improvement in efficiency,” he said. “We are taking this opportunity to change how we deliver service with the goal of quality care at the least cost.”
Kitts acknowledged that members of the public might have trouble believing the hospital can eliminate 290 jobs without affecting patient care.
“People are going to think that this is a pretty glib thing,” he said. “I want to assure everyone that I and my team know that change is extremely difficult. But we also know that we can be better in quality and reducing costs, and therefore we have to take that opportunity.”
Smith said the hospital’s nurses share the goal of maintaining quality care. “I know nurses will work very hard to meet the needs of our patients,” she said. “But many of the nurses I speak to already feel like they’re boiled frogs.”
With layoffs in unionized support staff and paramedical professionals, Smith said, “more duties will fall to the front line nurses. There’s going to be an expectation that you’re going to do more.”
Vicki McKenna, the ONA’s first vice-president, said there’s little doubt patient care will suffer. As nurse workloads increase, research shows that morbidity and mortality rates also rise, she said.
Bruce Waller, president of the Canadian Union of Public Employees local that represents support staff at the hospital, predicted the cuts will have a “major impact” on the public.
About 120 CUPE members are affected by the job cuts, Waller said, including some registered practical nurses. He said some of his members are eager to “get a package” and retire, but others are “scared to death that they’re the ones that are affected. It’s not a good time to lose a job.”
Smith said the ONA has received layoff notices for 62 full-time nursing positions and 12 part-time positions, though 22 of those positions are currently vacant. She was hopeful that by offering buyouts and shifting nurses to vacant positions, few, if any, nurses would have to leave the hospital involuntarily.
There are currently 600 vacant positions at the hospital, including about 180 nursing positions. As a result, the hospital said “a vast majority” of the affected positions will not actually result in layoffs, though some are expected.
Kitts said the impact of the changes on staff “is very disconcerting to me,” and pledged to do everything possible to minimize it.
The hospital also faced a budget shortfall in the current fiscal year, which ends March 31, and had to find $23 million in savings. It was able to make the savings and expects to end the 2012-13 fiscal year with a balanced budget.