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Improving Access to Care

A series of ideas to stem the bleeding in our healthcare system

HIGHLIGHTS

  • Emergency Measures
  • Retain with Respect
  • Send a Signal
  • Kicking the Training Plan
  • Call for Backup
  • All Aboard!

Emergency Measures

ER closures are becoming a far too regular occurrence, and the emergency departments that are open often have increasing wait times, ambulance offload issues, and more. Emergency services need to be addressed, at a minimum there needs to be a band-aid solution to reassure scared New Brunswickers that when they are experiencing a critical health situation, they will be supported and cared for despite the challenges facing the system.

With so many New Brunswickers unable to access timely care because they are waiting for a primary care provider or struggling to quickly get an appointment with their doctors, emergency rooms have become the backstop for too many people creating unreasonable wait times and crippling demands on staff.

There is consensus among healthcare professionals that the rapid establishment of multidisciplinary care centres could relieve some of the pressure on emergency rooms. It is important that these centers be staffed by a mixed team of health professionals and are accessible both during the day and after hours. This could be started as a pilot project to accelerate the implementation. To have the most impact possible, areas where the need for health services is greatest and the wait list for a primary care provider is the longest should be targeted when establishing multi-disciplinary care centers. A shift toward the multi-disciplinary team model is recommended for strengthening community health care in the long term, so any investments made today will continue to pay off in the future.

Other initiatives that could significantly improve the situation in emergency rooms include revising the 10-year-old funding model for emergency rooms, increasing funding to support after-hours community care, as well as training and hiring allied health workers who can expand health care professionals’ capacity.

Retain with Respect

We must stop asking healthcare workers to increase their workloads out of the goodness of their hearts. They have been stretched and strained like never before over the past few pandemic years. Healthcare professionals are saying that they do not feel respected by management, that there is no recognition of their home life and personal needs, and that they are continually being asked to sacrifice vacation, add shifts, work longer, and do more. Investing in New Brunswick’s healthcare professionals will support retention, and the Government has the financial capacity to do so as they have demonstrated with back-to-back surpluses and the availability of federal funds designated for healthcare.

Concerns were raised about the request that some healthcare professionals be redeployed to other hospitals without receiving extra compensation. This shows a lack of respect towards the employees who are being asked to make personal sacrifices due to a lack of human resources. While hospitals across the province struggle with capacity, there is merit in scheduling and redeploying staff from a hospital with greater capacity, but should be incentivized through additional compensation. Offering a redeployment payment demonstrates respect for the professionals, increases the likelihood that people volunteer to be redeployed and addresses patient needs.

Send a Signal

The Premier and members of his team should tour the colleges and universities in the province to hand-deliver a personal letter, promising them a Guaranteed Full-time, Permanent Job to each student studying in a nursing program when they graduate.

This same commitment should be made to everyone studying to be a paramedic, doctor, personal support worker, or any other health care profession in which we are currently experiencing or projecting a shortage. Neighboring provinces have already taken a similar approach which has left New Brunswick nursing students are feeling undervalued. They need to know they are wanted in the New Brunswick health system, and they need to hear it from the top. Graduates are leaving the province because no one recruited them, this needs to stop.

A targeted tuition relief program focused on where there need is most dire would also encourage students to consider studying in healthcare. Going to New Brunswick high schools and promoting guaranteed employment and reduced tuition costs will surely drive enrollment into the programs aligned with our critical labour shortages.

In addition, re-training into an in-demand health career should be made as easy as possible. Under the current model, a paramedic who wants to become an Advanced Care Paramedic would need to take a year off without pay and cover the cost of the course, which is not possible for many people. Introducing tuition relief and potentially cost of living allowances to make upgrading skills in critical areas a viable option for mid-career professionals could be another way of addressing critical shortages.

Kickstart the Training Plan

Doctors and nurses take a long time to train, it’s the reality of the profession. In some high-skilled specialized fields, a student starting school today means the system gains a health professional a decade from now, but the time to start is still now. In the meantime, there must be partnerships created immediately with all relevant organizations to focus on the recruitment of international doctors, nurses, and other healthcare professionals and find ways to accelerate their entry into our workforce.

There must be better and faster ways to allow well-trained international colleagues to come work here. Canadian training programs are struggling to produce enough graduates to meet demand and there are highly qualified healthcare professionals around the world looking to come to Canada, New Brunswick must step up, convince them to come here, and make the process as simple as possible. It’s not an aspiration, it’s a necessity.

In addition, increasing the number of seats in the nursing programs and the number of medical residency positions in New Brunswick could happen right away. Collaborating with institutions, colleges, and associations to explore the options of accelerated or shorter-term programs is encouraged as it could provide ready-to-deploy resources more rapidly than current programs. The public colleges in New Brunswick are full of great ideas on how to equip more allied health professionals, like personal support workers, to get into the workforce right now. There needs to be a more collaborative approach between Government and the institutions to address this issue.

There is also merit in incentivizing nurses who are retired or close to mentor young nurses who are just starting their careers, and who would benefit from their decades of experience. Such a program would help increase the number of nurses currently in the system while supporting the new nurses who are thrown into a system facing significant challenges.

Call for Backup

The healthcare system is in crisis and anyone who is able to help should be called upon. While being careful not to create conflict between communities, there is merit in introducing a healthcare recruitment package for communities to promote their regions to doctors, nurses, and other in-demand healthcare professionals. These packages would include financial support to ensure communities of all sizes have the ability to create programs to recruit healthcare professionals and ensure a level playing field.

If communities want to create local, tailored pitches to recruit new doctors or nurses, they should be able to do so. These programs would be community-oriented and would focus on welcoming and facilitating community integration with a variety of partners, including but not limited to local realtors, local businesses, and local restaurants. Each community has their own strengths and are able to promote themselves better than a provincial group ever could. Government’s role in this model would be to support them in their efforts while leveraging their help in our all-hands-on-deck recruitment process.

All Aboard!

Creating an office of health staff recruitment and retention with leads from Horizon, Vitalité, and the Department of Health, as well as experienced professional recruiters who know how to land good candidates, would significantly strengthen the province’s recruitment efforts and send a clear message that it is taken seriously. 

The leads from Horizon, Vitalité and Health would support a team of motivated recruitment professionals who are incentivized to attract and secure new hires, and would support the reduction of red-tape in the hiring process in collaboration with professional associations and labour representatives. The office would also manage a provincial workforce strategy to address the skills and demographic gaps in the health system workforce. This would be done in partnership with associations, societies and groups, to allow better insight into retirements, practice closures, and other trends that impact the recruitment forecast.

This team would be transparent, publishing quarterly, data-driven report cards outlining how many positions are vacant, and of which type; how many have been filled in the last quarter; how many candidates were sourced for each vacancy, how many candidates are advancing through the pipeline, and the best recruitment suggestions they received from staff, and more. They’d focus on tasks like replacing New Brunswick’s archaic health professional recruitment website and making sure every person who contacts the recruitment team gets a response within a reasonable delay, preferably within 24 hours.

All Aboard!

This series of ideas is the product of several meetings with health worker unions and professional groups. The consensus is that the province must be goal-oriented in their approach, focusing on these three things in acute and primary care:

1) how to retain healthcare staff,
2) how to reduce emergency room wait times; and
3) how to provide primary care for everyone on the waitlist

To be clear, this is about listening to paramedics, nurses and nurse practitioners, home care workers, physicians, and other health care professionals who all have serious staffing problems and ideas to fix them. What is causing professionals to exit the healthcare workforce? How can the labour force help to bring about bold changes to how healthcare workers are treated? The people on the ground are in the best position to identify the root of the issues plaguing the system.

These recommendations are not all encompassing, and other avenues such as expanding teambased care options and increasing scopes of practice should also be considered. There needs to be a look at improving how organizations run, what role technology can play in improving the delivery of services for both patients and healthcare professionals, and how can collaboration and sharing of resources can improve the way services are delivered. How can the process to free up beds and/or treatment rooms be improved to make it faster? Can there be a streamlined discharge processes to the same effect? With the use of data and process improvements can make hospitals much more efficient.

The ideas are focused on speed and success, they can be implemented quickly and affordably, and send a strong signal to the sector that recruitment, retention, and emergency care matters to New Brunswickers. The health system needs less knee-jerk reactions to healthcare crises and more steady, sincere commitments to addressing problems at the root causes. This is just a start, but illustrates what changes are being requested by healthcare staff and organizations who are looking for hope.

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