The cure

Prince Edward County Memorial Hospital is the best community hospital in Ontario, according to its patients. That is now an established fact. Folks here have known it all along. Now everyone does. It cannot be denied nor diminished. It cannot be dismissed as “sitebased protectionism” as Scott Rowand described this community’s fierce loyalty to its hospital in 2006.

It is useful, I think, to go back to Rowand on this momentous occasion.

Rowand was handpicked by then Health Minister George Smitherman to sort out the dysfunction at Quinte Health Care eight years after four hospitals in Picton, Trenton, Bancroft and Belleville had been forced into an ill-conceived corporate marriage.

Rowand’s prescription, ambitiously titled New beginnings: An assessment of governance and related matters at Quinte Health Care Corporation, became the bible that has guided the hospital corporation through its various contortions since then.

In Prince Edward County, Rowand found a community that clung irrationally to its beloved community hospital, as well as staff and physicians unwilling to compromise (read: gracefully absorb the eradication of services, resources and staff) for the greater good of the corporation.

“Tough choices will need to be made,” wrote Rowand ominously. “The citizen of the communities served by QHC must also understand and accept that changes to the health care delivery system they have enjoyed in the past are inevitable.” (Italics added).

It is what this community has heard for a decade or more. “Don’t you know health care is changing? Don’t you understand that health care provided to your parents isn’t relevant in this day and age? Why can’t you see that the pressures of demography, technology and the cost of the human skills are driving services out of the community and into factory hospitals?

Centralization became the cureall to health care funding woes. The promise of centralization was that it would eliminate duplication and make leaner, more responsive ,healing factories.

It didn’t work. Instead it made administrative layers fatter and more expensive. Managers had more to oversee, so they needed higher pay, bigger staff and more stuff in general. Meanwhile costs continued to escalate uncontrollably.

This trend was already evident in 2004.

After a rather raucous meeting with hospital members in 2006 I stayed behind to pose questions to then chief administrators Bruce Laughton and Scott Rowand. It was clear in our conversation that neither were burdened by doubt or second thoughts that the singular solution to reining in costs was to increasingly centralize hospital services. There was, in their minds, only one way forward. Progress meant coring out community hospitals and diverting resources spent there toward larger centralized hospitals—hospitals that could churn out higher volumes–presumably at a lower cost per unit. This was the modern way.

It would be hard, but the uninformed folks in Prince Edward County would simply have to get over it.

Finally I asked them, “What if you are wrong? What if your prescription takes us down the wrong path?”

Rowand’s response was succinct, though crude. “Shit happens,” said the health minister’s appointee, shrugging his shoulders.

The research is clear and abundant: when patients feel good about their care, they do better and their outcomes improve. It is also clear from this recent research that people feel better about smaller hospitals such as ours in Picton.

Isn’t that all there is? Isn’t that what medicine and health care is about? Making people feel better and mending broken bodies and tending to illness in order to improve their outcome? To realize their full potential? To live a long and healthy life? Isn’t that what health care is?

According to the NRCC report: “These hospitals may have leading practices in place from which others may wish to learn.”

This is surely the goal of this report. This is why this research was done. Perhaps the Ontario Hospital Association, as the sponsors of this research, will want to learn from this report. Though I fear it will be a generation before those guiding health care policy and administering our hospitals understand and accept the evidence staring them in the face.

Folks in Prince Edward County and other rural centres understand what their communities need. They also know how to make do with the resources available to them, far better than earnest folks sitting in offices far away from this community. Prince Edward County Memorial Hospital has had a long history of serving its community well and managing it’s finances prudently. It is why the folks in this community have fought so hard to preserve and protect their community hospital.

The cure for health care in Ontario, it turns out, was right here in Prince Edward County. So the next time QHC feels the squeeze on its finances, it would well advised to learn from the best community hospital in the province—rather than continue to slash it to bits.

rick@wellingtontimes.ca