By Sheri Monk

Jim Hornell, CEO of Cypress Health Region, granted The Badger an interview in response to last week’s article about a former hospital manager’s concerns with the system.
“I just want to say that I have no intention of getting into a point-by-point rebuttal of a disgruntled manager who has chosen to resign. Some of these issues and some of the points she raised highlight some issues that are quite common in healthcare across the country,” said Hornell. “I’m happy to try and make a comment or two on some of those, but we normally don’t make comments about disgruntled employees and get into that in the media.”
The ex-employee – Maureen George – served as health services manager at Maple Creek Hospital until November of 2009. She had worked for the region since February of the same year. In an exclusive interview, George cited poor leadership, a hostile relationship with her supervisor, a lack of support, little direction for how to handle hospital closures and a centralized approach to regional healthcare as primary reasons for her departure.
George also claimed that the region views the Maple Creek Hospital as a difficult facility to work with and Hornell doesn’t disagree with her on that point.
“That’s been the case for us certainly because we’ve been maligned in the media and I mean, you and I have had our discussions about that in terms of whether we’re fairly treated there or not and that has stirred up people. The challenges of regionalization – that has been difficult. People have not seemed to have accepted the idea. All I hear people say is, ‘In Swift Current, in Swift Current’. I mean we’ve got two leaders in Maple Creek that work in leadership positions in our health region, that work outside of Maple Creek, but choose to live in Maple Creek. We see it as a region, and unfortunately people tend to throw up this boogeyman of Swift Current. But we have a regional headquarters in Swift Current that was chosen years ago and no, some people haven’t gotten over it.”
Hornell says money can be saved by streamlining some services, such as maintenence. Yet, he says, some staff in rural areas are still clinging to the autonomy each hospital used to have. He cited an incident a couple of years ago surrounding improper sterilization at one of the region’s hospitals.
“Some of the practises were not up to provincial standards. I mean in some cases, we had to go out and practically wrestle the autoclaves out of some of our facilties.”
Sterilization is now done at Swift Current and supplies and instruments are delivered to outlying facilities.
Regionalization occurred in Saskatchewan in 2005. Alberta went to just one region last year.
“If we can’t see ourselves acting as a region now, how are people going to feel if we’re one region in Saskatchewan, everything run out of Regina or Saskatoon? There are some communities that fight and fight to the point it takes longer for them to grieve and get over it and then say, ‘How are we going to make this system work?’ and some may never get over it until the next round of regionalization, whenever that may come. And that’s always a great fear. If the system is bad now in people’s perception, if we can’t be seen to be making this system work, then boy…” Hornell trailed off. “I think regionalization is preferable. It takes a while to make that happen, but if you don’t regionalize your services, you have individual communities running their healthcare services in ways that don’t necessarily have the best practises, the latest standards. You don’t have the economies of scale in terms of best use of your resources.”
Hornell also said Swift Current is not capable of offering all services and because of the population, will likely always have to ship patients out for specialties like neurology.
“So even Swift Current is not immune from the idea that bigger population areas have access to a broader range of services,” Hornell said, also acknowledging the hospital at Medicine Hat is fortunately in close proximity to this health region.
Hornell says concerns over temporary disruptions of services (hospital closures) are a common symptom of a national problem, but one which was relatively new for the health region at the time.
“There’s no cookie-cutter approach to that Sheri, and we’ve been feeling our way through each and every one of them to see if we have our bases covered, if we make sure that we have the proper regulatory requirements covered. We’re bound by what different professionals can and can’t do under certain circumstances,
he explained.
George cited a lack of direction as to how on-duty nurses should treat patients who walk through hospital doors during a service disruption.
“There’s some things nurses cannot do if there’s not a doctor physically present or if there’s particular orders from a doctor. And also there’s things that EMS staff can do. There’s things that doctors can do. All of that has to come into play, plus the idea of what the public expectations are. If you’ve got a sign on the highway saying you have a hospital open, then you have to make sure you have certain things in place. So as we go through these diversions, which of course none of us want and look forward to, we have to work through processes and sometimes in healthcare there’s not full agreement. And as you know, there are a number of different professional groups and their interests come into play here,” explained Hornell.
Part of the trouble, he says, is that the roles different healthcare staff should play are somewhat open to interpretation. Coupled with a lack of experience in closing hospitals, Hornell said some discord was inevitable.
“There’s challenges for nurses – what can nurses do, what can LPNs do, what can EMS people do? And there’s not total agreement on that sometimes or it’s left to interpretations and things and that had to be stressful for any of our staff as well as any of our managers as we work through these processes. Like I say, we’re not experts in diverting. It’s not something we do an awful lot of. We’re doing more lately. I think we’ve refined the process so we know exactly what people can expect and we know ourselves what we can expect. But initially, there was questions all around as to what had to be covered and what could and could not happen.”
He says the region is being very proactive to ensure the skill-set of each employee is well-used, but explained that new approaches to delivering healthcare can sometimes be difficult to implement.
“We want to use all the skills we can possibly use. We want to train our LPNs so they can give meds. There’s things we can do for our nurses so they can be more advanced,” he said, adding the region has one of the highest rates of LPNs qualified to medicate. “There’s EMS. We don’t want to have our EMS sitting in the back of a building just waiting for the phone to ring when they are very trained people who could be at the front of the building welcoming people and helping more of our senior people into the hospital and hearing what their needs are and then directing them in the right way. And that creates some challenges to traditional ways of doing business.”
Hornell also admitted the traditional role of nurses’ unions have been to staunchly defend what has historically been viewed as nurses’ duties.
“Absolutely. And I think you see some of that coming into play here.”
Hornell says the health region encourages open communication, but can’t force employees to bring concerns up the chain.
“Communication is always a challenge in any organization, whether it’s your organization, a small business or a large organization like ours. And I guess that at the end of the day, you hope that you have enough processes in place. We’ll certainly look at our communication processes. It all starts off with an orientation and all of our employees get a common three-day orientation and then there’s opportunities for extra days with the different departments and directors and we even encourage managers to go to other facilities and work with more seasoned managers for a day to get a sense of how that facility would operate. Those were all in place.”
Hornell said there are regular Monday afternoons dedicated to addressing the concerns and questions of any employee within the region, as well as managers meetings every second month.
“Plus, there are opportunities for ongoing dialogue with email and things like that. There should be no manager that feels they’re left out there. There comes a point in time, where especially seasoned managers, have to take responsibility for getting answers to their questions and knowing that there are people, there is a special pecking order you go through from supervisor, to that supervisor’s supervisor and ultimately, the CEO. All those avenues are open to employees, should they choose to use them.”
Hornell also maintains he himself operates under strict, self-governed rules to be as accessible as possible.
“And at the end of the day, since I’ve been here, I’ve told everybody whether it’s the general public or that staff, that I have an open-door policy. If I’m at my desk, I answer my phone. If someone walks by and wants to meet with me, if there’s any way possible, I would.”
Hornell says since last week’s article about George, he has met with many of the region’s health services managers personally and says by and large, George’s concerns were not representative of the feelings of fellow staff.
“I’ve said that the role is a difficult role. I don’t think that others have found some of those same concerns that this individual has talked about. I’ve talked to other managers and had discussions with them as to what the state of the region is. Many people choose to stay with us. We’ve got longstanding employees who have options to go many other places. They choose to stay. Are there challenges? Yes, in any facility. But people choose to find ways to work through it or to adapt or to change.”
Leader’s health services manager also resigned recently. Hornell says both positions are still open and are currently being advertised. He says it’s a difficult role as these managers must represent the health region, the staff and the public all at the same time. He says the job requires a lot of support and while he’d like to see more managers in the system to help, that too would cause a stir.
“Would I like to see more managers put into our rural facilties? Yeah, I absolutely would. But boy the grief that would be given and even the comments now that we get that there’s too many managers in the system. And we cut the guts out of management years ago when we regionalized.”