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.”
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.