A DECAF report: Growing pains or systemic problems at new CV hospital?

A DECAF report: Growing pains or systemic problems at new CV hospital?

This is the first article about problems surfacing at the new Comox Valley Hospital. Future articles will look at issues arising from the planning process, the change in culture and how the lack of residential care beds in the Comox Valley has contributed to these problems.

 

UPDATE: This article has been updated to correct the estimated cost of the new hospital originally reported as $350 million. And also to correct that VIHA does not lease the building from Tandem Health, which manages the facility, but that it pays a monthly management fee, and that while St. Joseph’s General Hospital was frequently overcapacity it was not on the hospital’s last day due to an intentional effort to reduce the number of patients prior to the move.

 

The new $331.7 million Comox Valley Hospital, which sits atop Ryan Road hill on 13.3 acres, looks like a shiny symbol of regional progress and modernity.

But inside the three-month old building, the working environment is not as pretty.

Questionable decisions and compromises made during the planning process have created operational inefficiencies that, when combined with a dramatic change in management culture, have caused a decline in staff morale during the hospital’s first three months of operation.

And yet, not all staff and physicians have had exclusively “unfavorable experiences” at the new hospital.

Our sources say they generally recognize the hospital’s many improvements over St. Joseph’s General Hospital; among them, more comfortable patient rooms, a quieter and brighter environment, leading edge technology and uncluttered hallways. And, it’s new.

But during a two-month investigation, involving nearly two dozen interviews, Decafnation has learned there are concerns about some operations at the new hospital and whether the facility is sufficient to service a growing and aging Comox Valley population for very long.

Our sources say they are not just unhappy about their personal working conditions. They are distressed over the failure of Vancouver Island Health Authority to staff the hospital sufficiently and the excessive amount of money being spent on overtime.

The hospital has been significantly overcapacity since it opened, as St. Joseph’s frequently was during its last years of operation. Yet, CVH was designed and budgeted (staffed) as if it would never have more than the projected number of inpatients.

It appears that planning teams did not take into account the increased size of the hospital and the advance to single patient rooms in the units and the Intensive Care Unit when the budget and staffing levels were set. Those changes require even more staff given the same workload, our sources say.

Overcapacity has caused, among other issues, the cancellation of at least two surgeries, a temporary shut-down of the emergency room and forced VIHA to use areas of the hospital that it had not planned to open for years.

And that appears to have increased the stress felt by many hospital employees, from food service workers to clerical staff to nurses.

Staff say they are frustrated that the hospital’s technology has them “locked down,” making them unable to help out different departments during peak periods, as they used to do at St. Joseph’s. They have concerns about patient care, and are disillusioned by what they see as a lost opportunity to have built a better facility for the community.

And they’re angry that management has not listened carefully enough to front-line workers, or addressed the issues they have raised, in some cases going back years into the planning process.

Almost everyone spoke on conditions of anonymity because they fear retribution from VIHA management.

One support staff member described the CVH working environment as worse than the “toxic” atmosphere reported at Nanaimo Regional General Hospital by an independent analysis in November.

FURTHER READING: Culture at Nanaimo hospital is “toxic,” report

“Every day, I meet someone crying in a hallway,” said the source, who is a current CVH employee. “We’d be worse than Nanaimo (hospital). I’d say 90 percent of staff are unhappy with the new hospital.”

VIHA and local elected officials have a different point of  view.

Stressing the positives

Charlie Cornfield, of Campbell River and chair of the Comox Strathcona Regional Hospital District, which has no operational responsibility for CVH, but funds 40 percent of hospital capital costs, said the new hospital “is as good as it gets.”

“It’s quite reasonable with a project of the size and complexity of CVH to have hiccups,” he said. “It could take years to work these out. Give the system a chance.” 

MORE INFO: Comox Stathcona Regional Hospital District

Dr. Jeff Beselt, VIHA’s Executive Medical Director for Geography 1, which includes Campbell River, Courtenay, Comox and Mount Waddington/Strathcona, said workers in other island hospitals are envious of the newsness and cutting edge technology and other features at CVH.

“We have an amazing hospital that we can grow into for decades,” he said. “We have to learn how to use what we have. It’s a long journey.”
Beselt chose not to characterize staff morale as good or bad.

“It varies on who you speak with,” he said. “It takes some people longer to adapt … the process was exhilarating and draining at the same time, for all of us.”

Beselt said the hospital has done non-compulsory “pulse check surveys” to measure staff morale, but would not disclose their results. And he emphasized that “staff well-being is very important to us.”

He acknowledged that supporting staff through such a dramatic change is “a hard thing to do well,” but he said VIHA is making a strong effort. And he recognizes that some people, especially those who came over from St. Joseph’s are “really hurting.”

Cultural change

Our sources also recognized that adapting to new processes and a new employer, which they say is less flexible and so far deaf to their concerns, has exacerbated the operational problems.

St. Joseph’s Hospital was smaller and run like a family or a locally-owned business. CVH is nearly three times larger (428,683 square feet versus 151,975 square feet) and is run like a large multi-jurisdictional corporation, including many layers of management.

Our sources say a major factor in the hospital’s low morale is that staff feel like they’re under a gag order, which prevents them from working through their grief to acceptance of a new workplace reality.

“We feel like we’re not allowed to say we’re unhappy or talk about things we think are being done wrong,” said one medical staff and a former St. Joe’s employee. “And senior leadership — who are probably also exhausted from this project — are not willing to listen.”

Beselt said CVH management is committed to listening. He noted that its newly-formed Quality Operations Committee brings front-line worker issues to hospital leaders.

Several sources said crying was a daily routine. A sign was once posted in a private nook of the building that read: “Crying section: 15 minute limit.” It was a reference to the number of people wanting to use the space.

P3 versus public

And, there’s another factor affecting discontent at the new hospital

St. Joseph’s was a public and denominational hospital, not directly run by VIHA. Comox Valley Hospital is a public-private partnership (P3).

FURTHER READING: North Island Hospital’s project

The P3 arrangement means that VIHA provides the operating funds for the hospital. The building itself is managed by Tandem Health — VIHA pays a monthly fee for this service to Tandem — the private partner, which is itself a consortium of companies. One of those is Honeywell, which is responsible for the building and everything from signs on the walls to safety mirrors for navigation in the hallways.

The public-private partnerships (P3) at CVH has created confusion and frustration, and intensified the amount of change for former St. Joseph’s employees.

For example, simple maintenance issues were previously resolved in-house. Now tasks like getting light bulbs redirected or dimmed are described as an exercise in futility, as hospital-employed maintenance staff has been decimated.

Private companies are responsible for maintenance on the equipment or services they provide, but are routinely slow to respond. And staff is unclear about who to call to fix problems and who is responsible.

Will all of these issues naturally work themselves out over time? Are they just hiccups, or imaginary issues conjured by former St. Joseph’s Hospital employees too set in their ways?

It’s difficult to determine which problems are simple growing pains or a natural resistance to change, which are systemic and which need immediate attention and which can wait.

But all of our sources agreed, the accumulation of scores of large and small problems has created a staff morale problem, not to mention the physical strains of overwork, working short-staffed and excessive overtime.

Next: A sampling of problems, large and small, and how the planning process went awry with errors and compromises.

Town of Comox confesses: we misspent Laing’s money

Town of Comox confesses: we misspent Laing’s money

The Town of Comox has finally confessed that it inappropriately spent funds from the Hamilton Mack Laing trust.

At its Dec. 6, 2017, meeting, the Town Council approved paying $103,000 into the trust, a sum that town staff has classified as misspent prior to 2001, plus interest those funds would have earned.

In a report to Town Council, Comox Chief Administrative Officer Richard Kanigan characterized the misuse of funds as:

“These expenditures may not have been in strict accordance with the terms of the trust, which required the town to use the funds to convert Shakesides into a museum.”

It was an understatement. Some of those expenditures included repairing the Brooklyn Creek stairs, which aren’t even located on Mack Laing’s property.

It’s the first time the town has admitted spending Laing’s trust funds improperly.

And it’s unclear whether the confession is simply posturing for an upcoming B.C. Supreme Court hearing, or a genuine acknowledgement that the town mishandled a binding trust agreement with an important literary and ornithological benefactor.

In any case, the admission makes a start toward reparations for 36 years of disrespecting the Last Wishes of one of the community’s most widely admired citizens.

But not everyone agrees the town has fully owned up to the totality of expenditures disallowed by the trust. And there are other unresolved questions about the town’s accounting and handling of the Laing trust.

These issues are raised in at least a half-dozen affidavits that oppose the town’s court application to tear down Laing’s house.

Mack Laing vs. Town of Comox

Laing was a prolific naturalist, photographer, writer, artist and noted ornithologist, whose work from the Comox waterfront since 1922 earned him worldwide recognition.

Prior to his death, Laing left his waterfront property and his second home (named Shakesides) to the town. After his death, he left the town the residue cash from his estate “for the improvement and development of my home as a natural history museum,” and to support its ongoing operation.

But nearly 36 years later, the town has done nothing to satisfy Laing’s last wishes.

Instead, the town applied to the court last February to alter the terms of Laing’s Last Will, namely to demolish his house and use his trust fund to construct a viewing platform.

To finance the project, the town now proposes to use the $103,000 of misspent money, $75,000 previously allocated, and the balance remaining in the Laing Trust, estimated at around $70,000.

Any money left over would be placed in a reserve fund to maintain the new platform.

But to critics, such as the Mack Laing Heritage Society, the town’s $178,000 deposit into the trust is a hollow gesture because the town had already committed itself to building a viewing platform in its court filing to tear the house down.

The town appears to be simply moving the money it has promised to spend, if the court allows, from general revenue into the Laing Trust. Not so, says the town. They maintain their action was to make Laing’s trust whole.

Accounting disparities

According to several affidavits submitted to the Attorney General’s office, which is charged with defending trusts made to public institutions, the town’s calculation of misspent funds doesn’t square with its own ledger entries.

Gordon Olsen, who has filed one of those affidavits, was a friend of Laing. He says the documents he has compiled show the town is “way short of making the Laing trust whole.” But he said the details of his claim is in the AG’s hands and will ultimately be made public.

In 2016, Olsen hired a Campbell River accounting firm to review publicly available financial records of the Town of Comox. The review showed the trust fund should be worth in excess of $480,000 today. The firm used figures released by the town and used conservatively calculated interest rates.

The independent analysis suggested that if the town had immediately invested all of Laing’s bequeathed cash plus the income it derived from renting the house for 30-some years, it would have nearly a half-million dollars in the trust fund.

Olsen believes the great disparity in accounting demands a court-ordered forensic audit of the town’s financial records.

A forensic audit is a specialization within the accounting profession to determine negligence or other financial irregularities for use as evidence in court. Most major accounting firms have a forensic auditing department.

The Attorney General’s office doesn’t discuss active cases.

In response to an enquiry from Decafnation about the number and content of affidavits it has received in this case, the Ministry of Attorney General sent this statement:

“The Legal Services Branch of the Ministry of Attorney General is responsible for this case. Applications made to the B.C. Supreme Court will be decided by the Court. As this case is before the courts, we cannot comment further.”

Comox Mayor Paul Ives declined to comment for this story, referring enquiries to town staff.

 

Courtenay opens the door for private digital signs

Courtenay opens the door for private digital signs

Courtenay City Council appears to have opened the door for businesses to erect electronic message boards, despite unfavorable public opinion of digital signage.

At its Nov. 20 meeting, council defied its existing sign bylaw and approved a variance for an electronic message board for Prime Chophouse, a restaurant visible, but not accessible, from Ryan Road.

Chophouse owner Kory Wagstaff told council people have difficulty finding his restaurant, which is threatening the viability of his business. He said his location makes it a challenge to stay open for lunch and the business itself may not be sustainable without help from the city.

Wagstaff argued that digital signs are more representative of “the style of the Comox Valley.”

The current sign bylaw prohibits electronic message boards except for institutional uses. The Lewis Park Recreation Centre has one, as does St. George’s Church and Mark Isfeld High School.

Prior to 2013, the city disallowed all such signs. But the parents association at Isfeld High School lobbied council to amend its bylaw after they had raised the funds for an electronic sign.

A staff member told council that the city receives frequent requests from private businesses for electronic signs, but rejects them because during the 2013 public hearings for the Isfeld amendment, people were clearly opposed to them. Staff said people don’t like the esthetics and the added illumination of digital signs.

Council member David Frisch moved to reject the Chophouse application for a development variance permit, because “The city … sign bylaw was passed in 2013 to ensure that the character and visual appearance of our community would be maintained, and that traffic safety would not be compromised.”

Frisch’s motion was supported by councilors Doug Hillian and Rebecca Lennox.

   

But they lost the battle to Mayor Larry Jangula and councilors Erik Eriksson, Bob Wells and Mano Theos. Their support seemed to be based on the Chophouse’s support of local charities, that it’s a “great restaurant” and its location has access problems.

The most surprising support came from Councilor Eriksson, who has announced his candidacy for mayor in this fall’s elections. He had previously opposed the electronic sign at the Lewis Centre, but supported this variance application.

“I support this … it’s a great restaurant,” he said.

Eriksson later said via email that “ Lighted digital message signs are becoming more commonplace, where appropriate … I think the applicant made a good case for a variance ….”

Only Mayor Jangula addressed the key issue of whether council was opening a Pandora’s Box.

In an emailed statement to Decafnation, Jangula said, “During the meeting I commented that this was a unique problem requiring a unique solution. This is not a precedent for other electronic signs in Courtenay, and there are no plans to update the sign bylaw at this time.”

“Prime Chophouse has some unusual access problems,” Jangula said. “Council acknowledged that the lack of access off Ryan Road, which is under MoT jurisdiction, has been a challenge for this business.”

But Councilor Hillian worried about precedent.

“There’ll be no rationale for refusing any future (similar) requests,” he said.

Lennox told Decafnation, “While I have compassion for the inconvenience people have when trying to locate the entrance to The Prime Chop House, I didn’t support the resolution.

“I feel the community has been very clear about it’s hopes for modest signs without illumination​ and felt the applicant could have used a traditional sign to convey the same information,” she said.

Frisch, who moved the motion to reject the private business sign, said electronic message boards are allowed at schools, churches, rec centres and other public assembly locations.

“I believe this reflects the general will of our community and I support the idea that too much signage detracts from our natural surroundings, while providing limited benefits to our citizens,” Frisch said. “I am always open to revisit and discuss our bylaws and would consider variances as well. However, the benefits of changed and variances must be in line with our community values and must not simply be for the sole benefit of a few.”

Lennox and Frisch offered solutions other than an electronic sign for the Chophouse dilemma, but Jangula shot them down saying the sign bylaw wouldn’t permit those concepts.

But, in fact, those alternate solutions could have been permitted by a variance granted by council, which it then proceeded to grant the business owner.

 

The Decafnation lists its favorite books read during 2017

The Decafnation lists its favorite books read during 2017

On January 1 every year, the Decafnation presents its annual collective Book Report. Thanks to everyone who took the time to share short reviews of books they enjoyed during the past year. You can read last year’s Book Report here.

Mary LeeWhat on Earth am I here For? by Rick Warren. Why? To find the answer to the ultimate question.

Arzeena HamirStation 11 by Emily St. John Mandel. It’s a glimpse at a post-apocalyptic Canada

Ken AdneyHow We Got to Now: Six Innovations That Made the Modern World by Steven Johnson. And I’m currently re-reading Robert Heilbroner’s The Worldly Philosophers, which holds up as a simple introduction to economic thought (and the economists).

Brent ReidBarbarian Days: A Surfing Life by William Finnegan. In this Pulitzer Prize-winning memoir, Finnegan portrays his lifelong obsession with surfing the most challenging beaches in the world–some of them previously undiscovered. His descriptions of his fellow surfers, the code they follow, the magnificent beaches and breaks they find, and the death-defying rides they take are fascinating.

Maingon Loys — Defending Giants by Darren Frederick Speece was a pretty illuminating read. It is a history of the Redwood Wars, very useful insights. It makes a very good case exposing how conservation strategy is only transitory — somewhere human beings have to re-evaluate their priorities

Joe ScuderiMan’s Search For Meaning by Victor Frankel. It’s short but profound. Hillbilly Elegy was also excellent.

Kim SlenoA Column of Fire by Ken Follett. Read the first of this trilogy Christmas Day 1989. As a lover of history it gave me a glimpse of the past.

Jessie KerrI Was Told To Come Alone: My Journey Behind the Lines of Jihad by Souad Mekhennet. The story of a German Muslim reporter who traveled to interview several ISIS leaders. She reported for a major German daily, The Washington Post and the NY Times. Because she produced balanced stories, those leaders agreed to talk to her. Oddly, I found her stories heartening because she explores her own and other Muslim citizens’ interest in understanding the motivation behind the often violent solutions pursued by these extreme Jihadist groups. I heard her interviewed on CBC’s The Current; I knew then that I must read her book.

Jodi Le MasurierInto the Magic Shop by James Doty

Gordon MasonThe Shadow of Kilimanjaro, on foot across east Africa by Rick Ridgeway. A wonderful journey through a fascinating area in Kenya, Tsavo National Park. An incredible journey on foot from the summit of Mount Kilimanjaro to the Indian Ocean, offering a rare view of East Africa as it is today and how it once was before the inclusion of European civilization.

Dennis Crockford — All The Light We Cannot See by Anthony Doerr … wonderful description of the growing characters. And a very different writing style … flipping between the two characters every few pages … off-putting to some but I really enjoyed it.

Wayne Bradley — Ravensong by Lee MaracleMaybe its best because I read it last, who knows? I realize that I am very late for the Lee Maracle party, but I loved Ravensong! Great writing style with good character development, and chalk full of First Nations perspectives. Written i early 1990s, I think, but with perspectives on First Nations / settler relations that are startlingly relevant today.

Bill Morrison — The Boys in the Boat by James Brown. An epic rowing story about the struggle for gold in the 1936 Berlin Olympics by an unknown Washington team.

Brad Morgan — Lincoln in the Bardo by George Saunders. A mix of American history, spirituality and allegorical surrealism out of a story about Abraham Lincoln’s grief over the death of his 11-year-old son.

Richard Schmidt — Sing, Unburied, Sing By Jesmyn Ward. A story about the love-hate tensions between races as a black woman and her children take a road trip through Mississippi to pick up her white husband from prison.

Allison Grey — Exit West by Mohsin Hamid. A wonderful love story about how place can affect the heart.

Bobbi Ellison — Manhattan Beach by Jennifer Egan. A WWII-era tale about connecting disparate stories about a father’s disappearance and the rise of a mobster and the host of larger issues this journey reveals.

John Vernon — The Future is History by Masha Gessen. Why post-Soviet Russia rejected democracy for Putin and the threat he poses.

Marcia Sorenson — Hunger by Roxane Gay. How an early-life sexual assault shaped this woman’s body image for life.

George Le MasurierThe Force by Don Winslow. Fictional but insightful peek into the shady world of “dirty” cops in the NYPD. It makes “Serpico,” “The Departed” and “Donnie Brasco” seem tame and shallow by comparison.

 

Revisiting Harry’s love affair with the clouds and stars

Revisiting Harry’s love affair with the clouds and stars

Editor’s note: Decafnation originally published this essay a year ago. For a silly version of the annual holiday letter, go here.

———–

At this season I seldom had a visitor. When the snow lay deepest, no wanderer ventured near my house for a week or a fortnight at a time, but there I lived as snug as a meadow mouse.
Thoreau in Walden

I/dropcap] once took a series of photographs of a man named Harry. In his own way, Harry modeled the life of Thoreau. He lived alone in a shack he built himself 25 years earlier, while he was slipping into legally blindness. When technology made it possible to transplant new sight into his eye sockets, Harry vowed to see the world from a different perspective.

During each subsequent Christmas season, this individualist shared the view from his perch in a letter he wrote “to the world.”

Like Thoreau at Walden, Harry drew much out of his solitude, contending that his treasures are memories tucked away in his mind “to be brought forth when the long nights become lonely, like this one.” He wrote this letter on one of those lonely nights.

“It’s Christmas time again. White ruffled curtains are sifting the moonlight. The soft yellow lights from the neighbor’s kitchen are buttering the falling snow. Yesterday’s puddles wear a grey skin of ice and our ponds have shut their eyelids on the winter cold. The evergreens are mittened with frost.”

Harry spent a lot of time with nature. He loved birds and animals. He was never an important man by the standards of status and financial success. He was a logger for a while and finished his working career as a janitor.

But he was a keen observer, a rough poet, a witty, wise old man who had a long love affair with clouds and stars.

“I stood in awe and wonder. Dawn started emerging from the womb of night, and slowly the sun was chinning itself on the horizon. Pillowed clouds, gently aired by a slight breeze, seemed like hooded friars telling their beads in the morning sun.”

Harry often turned nostalgic.

“I grew up in the days when you could buy a nickel’s worth of something, when sex education was learning to kiss without bumping noses, when buying on time meant getting there before the store closed, when health foods were whatever your mother said you’d better eat and when it cost less to educate your son that it does now to amuse his children.”

A man of little formal education, Harry spent most of his hours of solitude reading classics. He also kept up with current events and lamented the frenetic modern world.

“When I was young, we had little mental anguish, no tense nerves to frustrate the spirit. The hardships were usually resolved by a good night’s sleep. Our lives were tranquil and uncomplicated, not plagued by the traumatic turmoil or the age of the spaceship and the terrorist. We didn’t want much because we didn’t see much to want.

“The answer to the world’s problems may be in that statement.”

There was a small marsh near where he lived. He spent more time than usual before his small wood stove that year. At 80 years, it felt colder than it really was.

Harry never became pessimistic. He embraced nature as a buffer to a world he did not fully understand. Or didn’t want to. He died during his sleep some years back, probably after his nightly ritual.

“The last thing I do every night before retiring is to step out the back door and look upward.”

To continue his love affair with the clouds and the stars.