After a two-month long investigation, the investigator appointed by the LHIN has blasted the Chatham-Kent Health Alliance (CKHA) leadership in her final report.
Bonnie Adamson, who was tasked with leading the investigation, concluded that a supervisor should be appointed to the CKHA to “restore robust governance and administrative/clinical leadership to ensure sustainable and appropriate oversight of patient care and financial management.”
Her findings, which are detailed in the report, says the CKHA leadership and two Chatham boards have not acted in “good faith” nor have they used their best efforts to explore go forward options for reconciliation.
Failure to recognize importance of SDH Emergency Department
Adamson discussed the CKHA’s two fundamental principles driving change, which has been stated multiple times by CKHA administration and their Medical Advisory Committee: 1) Volume Drives Quality and 2) Backup Specialized Care is Critical.
“The investigation has found no evidence that would support any concerns regarding quality and safety of care at SDH Emergency Department,” Adamson wrote.
“Concerns raised regarding maintenance of clinical skills is an issue for every hospital Emergency Department regardless of volume. In other centres, the issue is consistently addressed through continuing education and an organized approach to skills maintenance.”
“The availability of increased testing and equipment at the SDH would enhance the care available. An integrated system of medical coverage between the Chatham and Wallaceburg emergency sites would promote collaboration.”
Adamson added “The PGH and SJH Boards and the CKHA leadership failed to recognize the vital role that the SDH’s Emergency Department and the physicians provide to the Wallaceburg and Walpole First Nations communities and failed to work with the SDH Board to identify an acceptable model to holistically meet the communities’ needs that balances access, fiscal and quality needs.”
CKHA’s culture of fear
Adamson described the culture of the CKHA within her report.
“The CKHA organizational culture has been frequently described by both hospital staff and medical staff to be one of fear, intimidation, distrust and an unsafe environment in which to voice their opinions without retaliation,” Adamson said in her report.
“A hierarchical and centralized decision-making management style that also lacked in transparency was also frequently described.”
Adamson touched on the three hospitals administrative organizational structure charts, dated June, 2016, “reflect a large number of leadership positions for a 200 bed community hospital.
“From the charts provided, there are approximately 50 leadership positions in total beyond the CEO position. Reduction of these positions would create significant cost savings,” Adamson wrote.
Adamson’s report states the medical leadership organizational chart indicates that there are over 20 medical administrative roles for a medical staff of 185 members, which includes medical directors and senior medical directors.
“In respect to the senior medical director role, there is an inconsistency in terms of numbers of positions versus number of job descriptions,” Adamson wrote.
“The analysis of the medical director job descriptions shows redundancy and overlap with the department chiefs and
department heads. There is no evidence of a transparent process for selection of medical directors. These appointments have caused friction and resentment in the medical staff.”
Adamson also mentioned the appointment of the Chief of Emergency Medicine, who was appointed after being interviewed by a committee with no physician from the Emergency Department.
“This has been a contentious appointment,” Adamson said.
“His schedule consists of physically being present at CKHA four days per month for 44 weeks per year for administrative duties.”
Not consistent with Rural and Northern Healthcare Framework
Adamson wrote that the CKHA’s clinical recommendation and the Chatham board’s support of the strategy, which would result in the closing of the Sydenham Emergency Department, is not consistent with the Rural and Northern Healthcare Framework.
Adamson added this also goes against the Erie-St. Clair’s Local Health Integration Network’s current expectations regarding required stakeholder engagement.
“The Boards have been complicit in administration’s long pattern of decision making regarding resource allocations that have resulted in the deterioration of SDH’s physical plant and related ability to provide the program and services to its community in accordance with the Rural and Northern Healthcare Framework principles clearly set out in the Alliance Agreement,” Adamson said.
More details about the investigation
In the process of her investigation, Adamson and her team conducted 59 interviews with more than 66 individuals both in person and on the phone.
Some individuals were interviewed more than once.
They also undertook extensive documentation reviews and facilities tours, Adamson said in her report.
HERE IS A COMPLETE COPY OF THE REPORT
Minister Hoskins says services are in jeopardy
After receiving the report from the investigator tasked with analyzing the Chatham-Kent Health Alliance, Hoskins said the delivery of healthcare services in the community are “now in jeopardy.”
Here is our full story based on Hoskins’ comments: Health Minister: ‘Hospital services are now in jeopardy’
Next steps
The Sydenham District Hospital board is set to meet tonight (Wednesday, August 17) at the Sydenham Campus.
Sheldon Parsons, chair of the SDH board, said Adamson’s report will be discussed in open session at the meeting.
The Sydenham Current will be in attendance, and will provide details and a follow-up story.
