Questioning Island Health Care Model

Today I was up in Question Period and I called on the Minister of Health, Terry Lake, to protect Vancouver Island patients by insisting that Island Health release its evidence in support of their new controversial patient care model. I also called on the Minister to initiate an independent review of the model.

Island Health’s controversial new patient care model, titled Care Delivery Model Redesign (CDMR), will be implemented at Victoria General and Royal Jubilee Hospitals on April 23, 2014. Under CDMR Island Health would cut 100 baseline nursing positions and replace them with 95 baseline Health Care Aid positions. Whereas Registered Nurses have a 4-year bachelor’s degree, Health Care Aids have up to 6 months of training.

Here is the question I asked:

On April 23, Island Health will implement a new patient care model—Care Delivery Model Redesign (otherwise known as CDMR) — at Victoria General and Royal Jubilee Hospitals. In their CDMR Fact Sheet, Island Health claims that the model will lead to “improved quality and patient safety”. Island Health claims the model is based on evidence but has yet to make their evidence publicly available. An internal surveys show that 88% of nurses working under CDMR at Nanaimo Regional Hospital would not feel comfortable having a family member cared for on their unit. And last week I held a town forum on CDMR that raised a number of additional concerns.

As a publicly-funded body, Island Health has an obligation to be accountable to British Columbians.

Will the Minister of Health step in to insist that Island Health release its evidence for public scrutiny?

Answer from The Honourable Terry Lake, Minister of Health
(Hansard Blues extract)

Hon. T. Lake: Thank you to the member for Oak Bay–Gordon Head for the question. I had mentioned that I’ve had an opportunity to travel around the province and meet a lot of the people who care for our patients in all kinds of settings. I think members on both sides of the House agree on the tremendous work that nurses and other health care professionals do for British Columbians.

It’s about appropriateness of care — the right care, the right provider, at the right place, right time, with the right resources. This is an effort on behalf of Island Health to ensure that we have those five Rs in place. This patient care model is to wrap services around the patient, which in some cases is appropriate in some situations. Some wards, where there are more personal care duties, are where you can use other professionals to aid the highly-trained nurses, who can then spend more time doing patient care plans.

This was a result of a study done by Island Health. It’s about providing the right care to the right patient at the right time with better outcomes. That is the goal, and that is what I believe will be happening, at the end of the day, with this new model.

Here is my supplemental question:

The research is clear. Increasing the Nurse to Patient ratio beyond 1 to 4—as will happen under CDMR—leads to higher mortality rates and higher morbidity rates. Just last week, a study of more than 400,000 patients in 300 hospitals across Europe published in the prestigious medical journal Lancet found that increasing a nurses’ workload by even 1 patient, increased the mortality rate by 7%.

There’s also substantive research to suggest that increased nursing levels:

• reduce length of hospital stays
• reduce the rate of adverse events;
• reduce nurse turnover rates.

All of these are actually cost savings measures.

This is why jurisdictions like California have responded to the evidence and legislated nurse-staffing ratios. CDMR goes against this research.

Honourable Speaker, The Minister of Health has a responsibility to protect patients.

Will the Minister step in to protect patients by insisting that Island Health release its evidence for public scrutiny and by initiating an independent review of the program?

Answer from The Honourable Terry Lake, Minister of Health
(Hansard Blues extract)

Hon. T. Lake: I mentioned in my first answer that it’s the appropriateness that’s important. We must be led by evidence. The member is quoting from a study in the Lancet that looked at surgical patients, not medical patients, not rehabilitation patients — surgical patients.

In that particular instance it may not be appropriate to move away from the one-to-one type of nursing model that is in place for surgical patients that are being looked after, after a surgery. However, for rehabilitation, the use of health care aides, along with LPNs and led by RNs, is a much more efficient system, allowing nurses to do the job that they are highly trained to do.

That is the appropriate situation, and that is the intent of looking at new and better ways of caring for our patients in the hospital system of British Columbia.

……………….

Last week I held a public Town Hall on CDMR with representatives from the Association of Registered Nurses of BC, the BC Nurses Union, the UVic School of Nursing and the UVic Nursing Students Society. Island Health was invited but unfortunately declined to participate.

As a publicly-funded body, Island Health has an obligation to be accountable to British Columbians. As Minister of Health, Mr. Lake has a responsibility to protect patient safety. There is enough credible research out there to raise serious questions about the controversial patient care model. That is why I have called on the Minister to insist that Island Health release its evidence for public scrutiny and to initiate an independent review of the model.

Sources:

Nurse Staffing and Financial Outcomes http://ww.w.massnurses.org/files/file/Legislation-and-Politics/3_08CE_NurseStaff.pdf

Improving Nurse-to-Patient Staffing Ratios as a Cost-Effective Safety Intervention: http://vwvw.massnurses.org/files/file/Legislation-and-Politics/Cost_Effectiveness_Study.pdf

The Association of Registered Nurse Staffing Levels and Patient Outcomes: http://www.ona.org.3pdns.korax.net/documents/File/pdf/KaneRNStaffingPatientOutcomesMedCare.pdf

State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction: http://innovations.ahrq.gov/content.aspx?id=3708

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study: http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673613626318.pdf

 California Nursing Staff Level Regulations: http://www.cdph.ca.gov/services/DPOPP/regs/Documents/R-37-01_Regulation_Text.pdf