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Wonderland
I’ll try if I know all the things I used to know. Let me see: four times five is twelve, and four times six is thirteen, and four times seven is—oh dear! I shall never get to twenty at that rate!
Iam often reminded of Alice’s adventures in Wonderland when faced with the ever-more confounding rabbit hole that is Quinte Health Care (QHC). It all might be as amusing as her logic-defying story, were it not for the fact that it has entangled Prince Edward County Memorial Hospital and Trenton Memorial in this fiasco and threatened the future of these treasured community hospitals in the process.
QHC has announced it will cut 84 positions from the corporation in April. To balance its budget. Again. Six positions will be cut from PECMH, including one position that is currently vacant. On the surface it appears the Picton hospital has, in this instance, been spared a disproportionate gouging by QHC’s knife. But like Wonderland, nothing in QHC land is what it seems to be.
The fact is that PECMH has suffered so many cuts since it fell under QHC’s administration 17 years ago, that the job losses announced last week, though small, represent about 10 per cent of Picton’s workforce. Nine more years of this and PECMH will vanish entirely.
Coincidentally, or perhaps not, that is precisely how long the folks at QHC say it will take for a new hospital to be developed and built in Picton. I can envision the ribbon being cut, beaming officials relieved that this day has finally arrived. A new hospital in Picton. But sadly, no nurses. No staff. No patients. Just a shiny new, empty building— a lasting emblem of QHC’s contribution to Prince Edward County.
The unsaid, and frankly most frightening aspect of this story (if, of course, you are not among those directly affected by the job cuts) is that QHC’s problems are likely to get worse. For it must compete for a large portion of its funding each year with other hospitals. Those that perform better and more efficiently are rewarded with more money. Hospitals that lag behind their peers, like QHC, get less.
It is a way to assert real-world financial accountability upon hospital administrators and tie their success or failure in delivering hospital services efficiently directly to funding. But in this zero-sum game, the world is quickly divvied up into winners and losers. And when you find yourself on the negative side of this ledger, it becomes a monumental task to work your way back to the median.
Faced with this predicament, you essentially have two choices—launch a massive plan to right the ship or you get smaller. But a big plan means big ideas, radical thinking, comprehensive buy-in from physicians, nurses, staff, community and donors. None of these are evident within QHC today.
So you get smaller. You drop services. You cut costs. You outsource. You keep going until the unit costs of the few remaining services you provide are close to the median. Of course, both plans are long shots. The small ball approach of cutting costs (and in this setting that always translates into job losses) means that those left behind must do more. Living in fear their jobs will be next. It is hardly an atmosphere that inspires confidence and enthusiasm. Or spurs creativity and efficiency. It all becomes self-defeating.
Which plan do you suppose QHC is following?
Perhaps neither. From this vantage point, the hospital corporation is flailing—reacting with mix of desperation, denial and fake optimism each year to a predictably shrinking share of hospital funding.
To be certain, hospital administrators are in survival mode. Careers are on the line. In this maelstrom, the story can, and will, change very quickly. Villains will be cast. Scapegoats trotted out. Down will be up. Good will be bad.
There was a day when QHC officials proudly trumpeted their commitment to four strong hospitals—even when few of them believed it. But the narrative now is more muted. Circumstances have compelled a muddled line. So instead they mumble instead about four hospitals, each with an emergency room, diagnostic gear and some beds. Hardly the definition of proud community hospitals.
Sadly, even this frail definition is subject to change as QHC drifts lower relative to its peers.
I fear too many folks have resigned themselves to the bitter realization that we will not extract our hospital from QHC. And they may be right. But it seems certain to me that unless and until QHC sorts out its core operational challenges—or the funding fairy arrives—the days of a community hospital in Picton and Trenton will rapidly come to an end.
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