The Comox Valley Hospital is not only a new building, inside there’s a brand new management culture and procedures that some say takes a step backward in patient care and staff morale.

This is the third in a series of articles about problems surfacing at the new Comox Valley Hospital. Previous articles have examined staff morale and how the hospital was designed and planned. A future article will look at how the lack of residential care beds in the Comox Valley has contributed to these issues.

UPDATE: This article has been updated to clarify that Tandem Health manages the north Island hospitals and receives a monthly fee for the service and that the Campbell River hospital has been managed by VIHA only since the health authority’s creation in 2001, not since the opening of the 60-year facility.

Most people have been faced with dramatic changes in their working or personal lives, and how well each individual adapts to that change depends on a variety of unique circumstances.

For long-time employees of St. Joseph’s General Hospital, the transition to the new Comox Valley Hospital operated by the Vancouver Island Health Authority (VIHA) has presented a triad of difficult changes, including a less flexible management style and some systems that are less efficient and effective.

So, after the first three-and-a-half months of operation, a two-month investigation by Decafnation has learned the changes have pushed staff morale down to a new low.

First, St. Joseph’s was run like a small, independent local business. It won the 2013 Chamber of Commerce award for Business of the Year.

FURTHER READING: Annual Chamber of Commerce awards; Culture of fear, bullying at VIHA Nanaimo hospital

St. Joseph’s building was physically small. People worked in close proximity. The systems and procedures allowed people to move around among departments, helping colleagues as needed.

These things created a tight bond and camaraderie among employees that doesn’t exist at the much larger CVH operated by the multi-jurisdictional VIHA, according to our sources.

Second, St. Joseph’s was a publicly funded hospital operated autonomously by local management and a board of directors. The new CVH is a public-private partnership operated by VIHA in a building managed by the private sector, which receives a monthly fee for the service.

Third, while St. Joseph’s was by no means a laggard in medical and systems technology, the new hospital has brought more technology to the workplace.

Dr. Jeff Beselt, Island Health’s Executive Medical Director for Geography 1, which includes Campbell River, Courtenay, Comox and Mount Waddington/Strathcona said VIHA understands that it takes some people longer to adapt to change.

“We all miss that closeness,” said Beselt, who worked in the region for several years before the change. “I recognize that some people are really hurting.”

He said VIHA has blended its ways of doing things with St. Joseph’s procedures to create the best quality patient care, and to support staff through the change.

“But this is the new system (procedures and technology at CVH),” he said. “This is the future; the old system is over. We’re just part-way on that journey.”

But some of those new systems have reduced efficiency, affected patient care and battered staff morale.

Patient care issues

Medications — Physicians and nurses have told Decafnation that new technology has resulted in some patients getting their medications late. For some on strict regimes, such as those in severe pain, this is a critical issue.

The new automated medication dispensing technology is designed to reduce errors, which Beselt said occurs more often in hospitals than people are aware.

The system restricts nurses from dispensing medication for more than one patient at a time, which makes the process take longer, but staffing has not increased.

“Adding more checks and balances requires more people … but it improves patient care,” he said.

Colonoscopies — The new hospital is doing fewer colonoscopies than were done at St. Joseph’s. Beselt estimated about 20 percent fewer, though sources estimated the reduction as high as 50 percent.

Beselt said the drop is due to introducing the Provincial Infection Control Network standards, which VIHA uses at all of its acute care sites.

“These stringent requirements extend the reprocessing time of the rooms, scopes and other associated equipment between patients to ensure the highest standard for patient safety.” he said.

Microbiology laboratory — St. Joseph’s Hospital employed staff and equipment to do microbiology analysis in its laboratory in order to provide physicians with timely results before deciding on patient treatment options.

It was a medical service that a local hospital could decide to provide, but one that VIHA decided to centralize. There is no microbiology lab at CVH or the new Campbell River Hospital. All samples are sent to the microbiology lab in Victoria.

Yet smaller hospitals in other B.C. health authorities have retained their microbiology labs. Both Cranbrook, which operates 73 acute care beds, and Fort St. John, which has 55 acute care beds, have microbiology labs.

There are 248 potential acute care beds between Campbell River and Comox Valley hospitals.

Our medical sources could not say if relocating microbiology lab work to Victoria, lengthening the time to get results, had affected patient care. But a source said the new time lag had played a role in a recent case at Campbell River Hospital, though Decafnation was unable to confirm that information.

“Due to provincial privacy legislation, Island Health (VIHA) cannot comment on individual patients and their care,” Beselt said.

VIHA systems

Centralized staffing — Department leaders and local staffing clerks no longer arrange staffing for their areas. All staffing for Vancouver Island hospitals has been centralized in Victoria and Campbell River.

When someone calls in sick, the information goes to Victoria or Campbell River where an automated text or email is sent out to all the relevant VIHA employees asking for people to fill that person’s shift. But department leaders don’t know who might not show up for work that day and cannot make arrangements with their staff to fill the gap.

Everything has to go through the automated system. Any given staff member might get numerous automated messages every day, blowing up their phones.

But due in part to low staff morale, those vacant shifts often go unfilled, resulting in a volume of overtime uncommon at St. Joseph’s.

Front desk issues — Clerical workers at CVH only have access to portions of hospital computer systems relevant to their departments. This provides security but also prevents clerical people from helping out in other departments for which they don’t have computer access, and it’s also causing problems at the front admitting desk.

The front admitting desk was supposed to be supported by four to six universal admitting clerks who were cross trained to admit all out patient appointments. That training has not yet occurred.

There are now two or three clerks doing admitting for Ambulatory Care patients  and another two to three clerks doing admitting for Medical Imaging patients.

In the morning, the ambulatory care admitting clerks are busy, and the medical imaging clerks are not busy. In the afternoon, the medical imaging clerks are super busy and the ambulatory care clerks are standing around.

“This looks terrible to the people waiting to be called,” said a source. “They don’t understand why there are clerks standing around talking and they are being kept waiting, and in fact some will lose their appointments.”

This problem was identified at the front desk pre-occupancy risk assessment, but has not been addressed.

Our sources say doctors and numerous patients have complained about this.

Cultural issues

Bureaucracy — The transition to a more bureaucratic organization has taken a greater toll on former St. Joseph’s employees.

As one source put it, “Comox is just getting introduced to the ineffectiveness of (VIHA) whereas Campbell River staff are more aware of the futility already.”

Campbell River Hospital has been managed by VIHA since the the health authority was created in 2001.

Department leaders at St. Joseph’s had the flexibility to fine tune their operations for the greatest efficiency, which isn’t allowed by the Vancouver Island Health Authority. To make a necessary change now, they have to go to different levels and committees.

“St. Joseph’s staff were either not listened to or respected by (VIHA) from the very start of this process,” the source said, adding that CVH staff are really in a period of grief and mourning.

“Campbell River staff have lived and breathed (VIHA) and transitioning into a new privately owned building has been easier, but the buildings are just flawed in so many ways,” the source said.

FURTHER READING: VIHA fires alleged “trouble maker,” not perpetrators

No cafeteria — There’s no cafeteria at CVH where staff can meet colleagues from different departments. There is only a bright, but small bistro operated by the locally-owned Rocky Mountain Cafe in Comox.

This seems like a small thing, according to our sources, but they say it illustrates the VIHA culture of keeping people isolated in silos.

Our sources say St. Joseph’s staff expressed concerns about how this would affect the culture of the new hospital.

“Not only has the one gathering place been lost,” said a source. “The transit to and from that place also brought about a culture where everyone talks to everyone else on the way to/from the cafeteria. Short of linens? Well, just stop and talk with the staff who supply linens on the way to the cafeteria. Need to submit a last-minute payslip into payroll? Well,  just stop by and drop it off to meet the deadline on the way to lunch.”

Despite inefficiencies in some of the VIHA systems and their unfavorable effect on staff morale, VIHA has not yet taken steps to mitigate the cultural change for St. Joseph’s employees, or to acknowledge that some of the old systems might produce as good or better results.

Next: How the lack of adequate residential care beds in the Comox Valley has contributed to the stress and low morale of hospital staff, and its effect on patient care.

FURTHER READING: Hospital helipads may be unusable; Flawed planning at root of hospital’s problems; Low morale at new Comox Valley Hospital