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Why We Need to End Hallway Medicine

Why We Need to End Hallway Medicine

On October 3rd, the Ontario government announced the formation of the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, and I was asked to join this council. Dr. Ruben Devlin, who serves as a special advisor to the premier on healthcare, has been named the chair of the council, and he will be leading a group of ten individuals who bring various expertise from across the health professional sectors. Together, we will advise the government on ways in which patient care could be improved, and we will develop and recommend strategic priorities that could guide the government’s efforts to make the system more efficient.

Hallway medicine has been a systemic problem in our healthcare system for a while now. When hospitals do not have the capacity to provide appropriate beds to all of their patients, nurses and physicians end up treating patients in hallways and other spaces that are far less than ideal. In these circumstances, patients lack the privacy and resources that they deserve, and it is difficult for healthcare providers to do their best work. More important, it’s a barometer and reflection of some fundamental stresses (and flaws) in our system. This problem has deep roots and hallway medicine will not easily be solved. Some of these roots can be traced to issues outside of hospitals, including our systems of complex continuing care, home care and long-term care. But even more profound, it is likely that many of these issues trace to the ways in which we deal with more fundamental issues – determinants of health, like poverty, homelessness and many other social inequities.  Despite the challenges, forming this council marks a promising step in the right direction.

I am excited to be working with my colleagues on this council because I believe that there is much work that could be done to improve healthcare for people in Ontario. Hallway medicine is certainly one of the larger problems we face, but it is by no means the only one. There are complex challenges in our healthcare system that will require broad vision, creative thinking, and dogged determination to solve. As Dean of the Faculty of Health Sciences, I see on a daily basis both the strengths and weaknesses of our system, and I am optimistic that this council will develop ideas that can intensify the former and mitigate the latter.

My colleagues on this council come to it with a wealth of experience that I am confident will be used to help us generate meaningful insights into the problems facing our healthcare system. No less important, I believe that we are all coming to the council with an open mind and a willingness to listen and collaborate. And I believe that the government is willing to do the same as well.  

 

The full list of members of the council is as follows:

  • Rueben Devlin, Special Advisor and Chair
  • Adalsteinn Brown, Professor and Dean, Dalla Lana School of Public Health at the University of Toronto
  • Connie Clerici, CEO, Closing the Gap Healthcare
  • Barb Collins, President and CEO, Humber River Hospital
  • Michael Decter, President and CEO, LDIC Inc.
  • Peter Harris, Barrister and Solicitor
  • Gillian Kernaghan, President and CEO, St. Joseph’s Health Care London
  • Jack Kitts, President and CEO, The Ottawa Hospital
  • Kimberly Moran, CEO, Children's Mental Health Ontario
  • David Murray, Executive Director, Northwest Health Alliance
  • Richard Reznick, Dean, Faculty of Health Sciences at Queens University
  • Shirlee Sharkey, President and CEO, Saint Elizabeth Health
     

I am eager to work with all of them, and I look forward to updating the readers of this blog on our efforts as they develop.

In the meantime, have you been affected by hallway medicine in some way? What factors do you think should be taken into account by the council? Please share your thoughts or experiences in the comments below or, better yet, please stop by the Macklem House – my door is always open.

 

 

J H Coyle [Q Meds]

Wed, 10/17/2018 - 16:03

Reading the list of people involved in this project - - The list is composed of a vast majority of people who are not involved in the day to day battle of hallway medicine - - Thus it is doomed to failure - as the bureaucrats - by the time that they have become entrenched in their offices HAVE lost all realization of what the physicians - nurses - etc. endure each day - let alone have any real knowledge from a patients point of view or the relatives seeing their loved ones treated in the hallway of a hospital - - JIM - -

J H Coyle [Q Meds]

Dear Dr. Coyle

Thanks for your comment. While I appreciate your perspective, I would suggest that many of us did indeed spend the better part of our careers at the goal face. On a personal level, I will draw on my 30 years of surgical practice to help inform our deliberations.

Richard Reznick

Richard.reznick@queensu.ca

Fred Mather (Meds '79)

Wed, 10/17/2018 - 21:27

There does not appear to be significant representation from the long term care (LTC) sector. Former Dean David Walker already did a report on Alternative Level of Care (ALC) patients. Placement of ALC patients backs up the systems causing sick, acute patients to be cared for in the hallways. Most of these patients are waiting for LTC. An addition 30,000 new beds are promised to be added to the current nearly 77,000. Hospitals need to be working with the LTC sector to assure the most effective use of these beds.

Fred Mather (Meds '79)

I certainly agree with you that the ALC problem is an enormous part of the issue. And addition of course are many issues out in the community, including complex continuing care, homecare, and long-term care. Of course it’s certainly true that there may be deeper roots, such as homelessness, poverty, and addictions and mental health issues, and many other social determinants of health.

Richard Reznick

Richard.reznick@queensu.ca

James Stone Meds'84

Thu, 10/18/2018 - 16:05

I completely agree with Dr. Coyle. A blue ribbon panel with no real first hand experience or current experience of this problem is extremely unlikely to provide the insight and innovative thinking that might contribute to a long term solution. I worked in 2 community hospitals in Ontario as a general internist almost 30 years ago. One of the hospitals routinely had patients in the ER hallways. The other had just built a 24 patient, 24 hour assessment unit attached to the ER. They solved their own problems. WTF. What to figure? It's actually not rocket science. Just follow the money.

James Stone Meds'84

Thanks Dr. Stone,

I appreciate that many of us on the panel have taken on senior administrative leadership positions. But for many of us, that has followed many decades in direct contact with patients.

That said, I am confident that during our deliberations we will take great care to have significant engagement with current day practitioners.

This will not be a theoretical exercise, I’m confident it will be a practical one.

Richard

Richard.reznick@queensu.ca

Garry L. Willard Queen's Meds'63

Tue, 10/23/2018 - 19:31

Richard,
You have an amazing group of people to work with in helping to address this serious issue.
However, may I be so bold as to suggest the addition of a few individuals working at the coal face or in the trenches.
Consider adding two Chiefs of Surgery, Medicine, Obstetrics-Gynecology and Paediatrics currently involved in direct patient care ... one from an urban centre and the other from a rural community hospital to add to the perspective. Fortunately there appears to be representation already from public and mental health advocates.
Should the Council make up seem too cumbersome, the clinical group could function as a sub committee at least.
I wish you success.
Garry. L. Willard MD FRCS(C) FRCS(Edinburgh) FACS FICS

Garry L. Willard Queen's Meds'63

Thank you for your input and your encouragement, Garry. I will take your suggestions under advisement. In the meantime, though, I'm confident that a number of us on the committee have quite a lot of collective experience in the trenches of patient care to inform our deliberations. We will also take great care to engage with current practitioners to make sure our understandings of all issue are up to date.

Richard Reznick

Denise Mosco Nursing Science '89

Thu, 10/25/2018 - 13:20

I have been a Registered Nurse for over 29 years now and have worked in mostly acute care hospital settings. I have been working on an in-patient mental health unit for the past 15 years. We have several ALC clients due to placement issues in the community,families being unable to care for their loved ones etc. The government set up RAI (Resident Assessment Indicators) many years ago for several types of hospital settings. The "quarterly" statistics generated from these assessments,as I understand, were to help the 'powers that be' learn where funding is needed in the health care system. I'm not sure how much money has been spent on those positions in the government and in hospital settings, but I'm sure the money could be better spent on staffing emergency departments and in patient units with more nursing staff who could help their patients reach their recovery goals and be discharged sooner. This in turn would free up beds to help the 'hallway medicine' situation. Completing RAI assessments at admission/discharge of every admitted patient has been a time consuming task for nurses for far too long, with little results seen in my humble opinion.

Denise Mosco Nursing Science '89

Thank you very much for sharing your thoughts, Denise. It is very helpful for me to know the views of a wide range of practitioners. I am going to keep your experiences in mind as I work with the council. 

Richard Reznick

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