The only constant is change was the message at the Huron Perth Healthcare Alliance (HPHA) annual meeting last Tuesday.
And change will be coming to the alliance within the next year — including at St. Marys Memorial Hospital.
HPHA CEO Andrew Williams spoke extensively about how the alliance will operate its four sites, something he admitted “was a little out of the norm at an annual meeting.”
The HPHA’s plans for the future are known as Vision 2013; a five-year process to strengthen the alliance, as well “as maintain four viable sites,” Williams explained.
Due to a shift in demographics — namely, the aging Baby Boomer population, coupled with a smaller population of those age 25 to 34 (who will be filling staffing positions in the next decade or so) — the Alliance has started the process of reviewing how it provides healthcare at all of its sites.
The process isn’t financially driven, Williams added, as the HPHA is operating on a balanced budget for the next fiscal year.
“The status quo is not an option,” he told attendees. “But we have to have a willingness to change our assumptions on how we define a hospital — we’re not what we were even 15 or 20 years ago.”
Williams assured that there will be no hospital closures as a result of the review.
“There’s anxiety, though — people are invested in rural healthcare,” he said.
He also assured that “no decisions have been made; we have to go through a process” in determining how the sites’ evolutions will take place.
In the short term, Vision 2013 “is specifically going to focus on the St. Marys (emergency) site,” Williams noted, explaining that staffing, proximity to other emergency rooms, and hours versus demand will be weighed.
A key question in the process, Williams said, will be “are we using the resources in a way that brings the most value to the healthcare system?”
When asked by the Journal Argus if the St. Marys Memorial emergency room hours could be cut back from 24 to 12 or even 16 hours, HPHA board chair Leslie Showers responded that “that is probably the way we will be going to match our physician shortage and nurse shortage.”
Across the four HPHA sites, he explained, “the vast majority of ER visits are not true ‘emergencies’ that you’ve got to see a physician right away.” Figures for the past year for emergency visits across the site, provided by the HPHA, show that out of a total of 54,519 ER visits across the alliance, 39,999 occur between  7 a.m. and 7 p.m., with almost 27,000 of those being able to wait at least an hour or two for care.
The HPHA numbers reflect the ER stats at St. Marys Memorial. Of a total of 9,319 visits over the past year, 7,018 took place between 7 a.m. and 7 p.m., with 6,708 being able to wait between 30 and 120 minutes to see a physician. Sixty-six per cent could wait 60 minutes before seeing a physician.
Showers says that “Emergency room coverage is one of the important points of our vision... our main goal is recruitment and retention for the future.” She explained that the board has been consulting with physicians and local advisory committees for the past few months, and that “we’re not proposing anything we don’t think will work.”
Showers recalls when, two-and-a-half years ago, she got a call on a Saturday night from Williams, saying that the St. Marys Memorial emergency room would have to close the next day because there was no one to staff it.
While the ER did remain open due to last-minute intervention by then-Minister of Health George Smitherman, Showers says that this isn’t the way to provide healthcare.
“We don’t want to react,” she says. “That’s not the best way to offer healthcare — our physicians need quality of life, and to ignore that is not to work effectively.”
This summer, Williams told the Journal Argus after the board meeting, there are a few physician shifts that need coverage, and nursing shifts are tentatively covered.
A secondary focus for St. Marys comes as a result of possibly creating “centres of specialty” at Clinton Public and Stratford General hospitals. Clinton would focus on day surgeries (such as cataracts), while Stratford would focus on “enhanced” acute care.
As a result, St. Marys Memorial and Seaforth Community hospitals would offer more rehabilitative beds, as well as beds for those who are waiting for  a space in a long-term care facility, or who can’t go home for other reasons, such as waiting for homecare.
‘We’d be increasing the bed numbers in St. Marys and in Seaforth,” Williams said. St. Marys Memorial currently has 15 acute care beds and five complex continuing care beds.
Speaking to the Journal Argus after the meeting, Williams said that the 15 rehab beds in Stratford that will likely be split between St. Marys and Seaforth.
But how to best staff these beds — and all four sites — is a big piece of the Vision 2013 puzzle. Williams explained that reducing duplication — or “quadfrication” as he called it — of services is part of the plan. Instead of having services available at all sites, serving fewer people, it is more attractive, for recruitment purposes, to centralize some of these services at one, or two, locations.
“There is a disconnect between the needs smaller hospitals (such as all four HPHA sites) are looking for, and what people are coming out of school with,” Williams said, explaining that many people entering the healthcare field are looking to specialize in one area; rural hospitals, by nature, require staff with more broad-based experience.
Vision 2013 also addresses “gaps” in HPHA service. One such gap is the creation of dedicated child and adolescent mental health beds; currently, patients must go to hospitals in London or Kitchener for a bed.
Secondly, the HPHA will also begin the long process of acquiring a magnetic resonance imaging machine (MRI), which, it is hoped, will also attract new staff to the alliance.
“The whole reason to change is to try to strengthen our system, to make better use of our facilities,” Williams added. “You always make a worse decision when you’re reacting to change instead of being proactive.”
Starting in mid-July and continuing to the end of September, HPHA staff will be gathering input from the public, as well as from partners such as EMS teams, on what should be done.
“We want anyone who has an opinion to be able to participate,” Williams said, noting that there will be public forums, as well as more private ways for people to offer opinions, such as via online surveys.
Showers add that “we want to engage the community (in these discussions) — it’s a very positive step forward, once people understand the reality of the issues at hand.”
It is the HPHA board’s hope to have an implementation plan ready by the end of this year. The plan will still have to be approved by the Southwest Local Healthcare Integration Network (LHIN); changes in service could be made by spring, 2010, Williams told the Journal Argus.