Why Baffin’s health system flunked out

When the Baffin region’s health system flunked its accreditation review this past September, it did so because of a long list of failings that threaten to harm patients, demoralize staff, and create grave financial risks for the Nunavut government.

The report, by the Canadian Council on Health Services Accreditation, was finished in September 2005, but not released to the public until MLAs demanded that it be tabled in the legislative assembly.

Its purpose is to measure the quality of the Baffin’s health and social services system against national standards. The last such report, done in 2002, granted “accreditation” to the Baffin health system: a passing grade.

But this report, begun early in 2005, found that many of the council’s 2002 recommendations had been ignored and that the system got worse. The result? A failing grade: “non-accreditation.”

The council’s report suggests this is rooted in an absence of accountability, information and follow-up work.

Its report is an evaluation of the entire health system in the Baffin region. It covers 11 health centres, plus the Iqaluit hospital.

Some of the worst findings include:

* no infection control plan;
* no pain management plan;
* no disaster or emergency plans;
* no quality control or evaluations;
* no human resource plan;
* poor internal communication;
* poor communication with clients;
* no complaint mechanism for clients;
* poor health promotion;
* and poor staff morale.

The report says the Baffin health care system sometimes prescribes too much medication or the wrong kind of medication to some patients, while at the same time, dying patients often needlessly suffer during their last hours because they don’t receive the necessary painkillers.

Patients with tuberculosis have been known to wander around the hospital, putting the health of many at risk. But near-tragic mistakes and errors of judgment — called “near-misses” — aren’t tracked and patient information often goes astray.

Understaffing doesn’t help, causing frustration, absenteeism, low morale, stress, resignations, and sub-standard patient care.

Sometimes treatment is delayed, or not even started. But there’s no official channel for staff or patients to lodge a complaint when something goes wrong.

However, if curious MLAs only read the “executive summary” of the report, which Leona Aglukkaq, the health minister, tabled last week in the Nunavut legislature, they might imagine that the hospital’s failure to pass even minimum Canadian standards isn’t such a big deal and that the region’s health care is still okay.

The summary handed out to MLAs consists only of a one-page excerpt bragging about the “successes and challenges” of the regional health care system, just one page plucked from a 297-page report.

But it’s not a summary, as labeled, of the council’s actual findings. Yet it is the only document that the GN translated into Inuktitut and Innuinaqtun.

Tabled along with the “summary,” on a CD-ROM, is the complete survey in English, which is challenging reading even for a native English-speaker.

The full report makes 103 recommendations. Nine are “key repeat recommendations,” made in the 2002 report but never acted on, and 29 are new “key recommendations.”

Overall, the best part of the Baffin’s health care system seems to be good will on the part of people, the goals of the “care closer to home” policy, and the continued efforts of staff who toil in a sub-standard environment.

In preparing its report, the council visited the following sites or communicated with them via videoconference: Baffin Regional Hospital in Iqaluit, the public health centre in Hall Beach, and the community health centres in Igloolik, Arctic Bay and Resolute Bay.

The report recognizes the GN has addressed 19 of the recommendations it received after the previous survey in 2002. But the council also says that the “the majority of recommendations… have not been met.”

The report also calls for a review of leadership roles in the health system, to determine whether the hospital or the health department is in charge: “There is currently no clarity as to who is governing the region. There is also an apparent lack of communication of the issues.”

But it says the GN has managed to deliver “good services,” despite its many challenges.

In the legislature, Aglukkaq said another accreditation review will be done in 18 months. She also said the GN added 26 new jobs to the health department, has added $2 million to the department’s budget, and is making other efforts to improve the Baffin health care system.

While loss of accreditation sends up serious warning signals about the state of health care in the Baffin region, losing accreditation has few other immediate implications. Generally, medical or nursing schools do not send students to complete practicums at non-accredited institutions. In this case, however, schools with nursing students and medical residents at the hospital have decided to continue sending their students to the BHR.