That was then. This is now - 50 years at Group Health CentreTuesday, December 10, 2013 by: Bob Mihell
Three leaders at Sault Ste. Marie’s Group Health Centre agree that the outpatient medical facility with about 71,000 patients is steering the right course as it heads toward its 51st year of operation.
Grant Walsh, new president and chief executive officer of GHC, stressed during an exclusive Soo Today interview Dec. 3 that eliminating a pesky fiscal debt that plagued GHC, and balancing the budget, has created stability for the primary health care organization as it plans its future.
Walsh was hired in 2012 as GHC’s interim CEO to eliminate a projected $1.7 million deficit for that fiscal year. He did that by cutting some programs and jobs.
Those decisions did not sit well with everyone at the time, including the leaders of the Canadian Union of Public Employees, who represent the majority of staff at the GHC.
That was then. This is now.
Tom Bonell, a longstanding community member on the GHC Board of Directors, said that since Walsh was hired in 2012, there has been a “dramatic turnaround” in the quality of health care being delivered.
He attributed the improvements in part to the new governance model put in place, and the new contract with the Province.
“In the twelve years I’ve been on the Board, I can say in the last two years the Health Centre has stepped up tremendously compared to what we were in the last ten years or so,” Bonell said. “Sault Ste. Marie is getting better health care now than they’ve had in a very long time.”
Melinda Genys, interim president of Canadian Union of Public Employees Local 894, said that communication has improved and there is a better “rapport” between about 210 CUPE members and GHC senior management.
That was not the case in March 2012 when Walsh arrived, she said. “He implemented changes very quickly. We had no notice of those changes, therefore, the repercussions were program closures, layoffs, and people bumping into other jobs.”
Currently, Genys said CUPE employees remained cautiously optimistic there would be no further cuts to programing or staff at the GHC. She said the union has been told by GHC management there are no intentions to make further cuts to either.
She said there was some trepidation around the potential affect on jobs of the new $11 million high tech electronic medical records system set to begin early in 2014.
“It will be a wonderful system, and our number one goal as union members is to provide for patient care,” Genys said. “However, there is some concern if the new system will result in job losses.”
Walsh highlighted last week that the new electronic medical record system, scheduled to come online Feb. 24, would make GHC the first community health centre in Canada to have the advanced system.
He said medical records would be available to GHC patients online in a user friendly way, but also to physicians anywhere GHC patients may be.
The paperless system also would allow patients to book appointments and receive reminders online.
The $11 million expenditure included a $3.3 million grant from Canada Health Infoway, Walsh said. The remainder came from cash reserves and through borrowing.
“We made a major expenditure in having one of the best, most responsive medical record systems that exist,” Walsh said. “We would not have been able to do that, had we not made ourselves sustainable first.”
Walsh added that balancing the budget did require some cuts to programs offered by GHC. He emphasized, however, that the health centre continues to provide 19 programs to patients in the community, and has no plans for further reductions.
“No more departments have been reduced, because we see these programs as very important to this community, and they will continue,” Walsh said last week. “Have there been efficiency improvements? Yes. Are they done? Never, because we are in the continuous quality improvement business.”
Genys (CUPE) indicated in an email that programs that were eliminated include: communication and speech disorders; counseling services; vision and eye (an ophthalmologist remains); smoking cessation; communications department; clinical research; and audiology.
She added that there were reductions to staff in diagnostic imaging and chiropody.
Walsh said the criteria used during the restructuring review process in 2012 included asking several questions. Is the service available elsewhere in the community? Is the program funded by the Ministry of Health, and can it make or lose money?
“If the service is readily available in the community, and is not funded by the [MOH], then there is no need for us to have it in our portfolio of services,” he said.
Walsh had admitted in 2012 that cutting the communications, language and speech disorders program at GHC was a particularly difficult decision because many of its patients were children. However, he said then those patients could be provided for through several organizations in the Sault.
Walsh repeated last week his message that language and speech disorder programs offered in the community lack focus and coordination, in part because their funding is coming from different ministries of the provincial government.
GHC Board member Bonell added, “The language and speech disorder program is a perfect example of a program we tried to carry that, quite frankly, kept us in deficit for years because we could not get funding for it. We had the expertise to do the job; we didn’t have the money. Therefore it’s gone back to the organization that does have the money.”
Asked if GHC still can offer “one stop” medical services to all its patients, Walsh acknowledged that likely has changed because of the economic realities.
He noted, however, that the GHC now has 81 physicians and specialists. The total includes seven new doctors with an eighth scheduled to begin practice in Jan. 2014.
“The amazing thing in the Sault before my time, there was a serious need for more family physicians,” Walsh said. “There aren’t many orphaned patients in the Sault now.”
He said that the seven new family physicians do not have “full patient rosters” yet, “so we are very interested in all the patients in town who do not have doctors. They can register with Health Connect and get a doctor with us.”
Walsh said with five to seven physicians projected to retire in the next few years, there continues to be a need to recruit more physicians and key specialists to the city.
“But we now have 71,000 patients, and last year [GHC] had 330,000 visits, and 81 doctors who are part of our group,” he said. “We have 350 employees here, and we provide 19 programs of services beyond the doctors. So one stop shopping, no; but a whole lot of shopping, yes.”
Genys said that GHC has shifted its focus from a multidisciplinary program centre more toward primary care. She said that probably has not pleased all GHC patients.
“It has moved from providing a lot of services to fewer, but [GHC] still offers speciality programs and units, including a walk-in clinic now,” she said. “All in all, they have added seven new physicians, and we are hoping that job opportunities for CUPE [members] will increase because of the new patients coming to the GHC.”
Genys stressed too that CUPE members were “engaged in the change”, and looked forward to the future at the health centre.
Soo Today was unable to find out if GHC patients have an advisory council or group representing their interests, but Walsh and Bonell agreed patient care and satisfaction remained a top priority at the health centre.
Bonell said that wait-times at the GHC depend partly on how physicians run their independent practices. He pointed out that some doctors are engaged in research or serving patients elsewhere in the community.
“I’d say overall patient satisfaction is higher now than it has been in years,” he said. “Most patients can get in in a timely manner, especially when there is some serious medical problem.”
While Walsh said that balancing the budget and creating economic stability was a key priority in 2012-13 for GHC, he said management and staff continue to explore ways to expand and improve health care.
One such initiative, assisted by a Northern Ontario Heritage Fund grant, was the retrofit of part of the former Optometry Dept. so physicians at GHC can work with intern students from the Northern Ontario School of Medicine. Walsh said one of the expectations of the new agreement with NOSM is that some of those training doctors would choose to practice in the Sault after graduation.
Early this summer, GHC took over ownership of the East Street Medical Centre, and have moved some of its programs and staff to the downtown location.
They include the Employee Assistance Program; Occupational Health; HIV Aids/Hep C Unit; and dermatology and cardiology specialists. Walsh said the building is almost filled with room possibly for one more doctor or nurse practitioner.
Walsh said the decision to move some services downtown also reflected a shift in thinking by senior management and the Board of Directors.
“In thinking about the long-term future, we’ve thought about creating a medical centre close to the hospital that would accommodate all the physicians,” he said. “Over time, we’ve come to believe this community would be better served by spreading our services out. Right now, the specialists need to go toward the hospital, but spreading out family physicians seems like a good idea.”
Walsh said that one area of the community that appears to be poorly served is the West side of town.
He said GHC is very interested in working with the community group created by the Soup Kitchen who want to create a community health and education centre in that core area.
“We want to have some contact with Tony Martin and his group, to determine what is the best location for a clinic on the West side, and how can we do that,” Walsh said. “The Soup Kitchen certainly provides a wonderful service in the area, but they’re not in the primary care business, we are. We would love to join hands with them to bring health services to that area if we can find a location that works.”
Walsh said GHC also is consulting with Algoma Public Health to ensure that APH’s role in prevention and GHC’s role as primary care providers in the community are working together without duplication.
Walsh said the GHC is very interested in working too with Batchewana and Garden River First Nations to see how GHC can help with their primary care needs. “The message we want to convey to them is that if there is anything we can do to help or contribute we want to tie in.”
Walsh identified several areas that the GHC recognizes as key health concerns. He said there is a drastic need for improved health care for the elderly, the poor, and individuals with mental health or addiction problems in our community.
Walsh also took time to reflect back on the tremendous contribution made by steelworkers that led to the opening of the GHC in 1963.
“I think you are aware that 50 years ago when this concept was created by the Steelworkers it was one of a kind. To a large degree it is still one of a kind,” Walsh said. “Steelworkers encouraged six to seven thousand people to contribute $135 each to the creation of this entity. We still feel a close affinity to the Steelworkers. They are the legacy of the Group Health Centre and they did wonderful things.”
Walsh concluded that it has been “an incredible honour” for the GHC to serve this community for 50 years.
“I believe we are on the threshold of expanding services to the community, and we’re thinking strategically about where the services ought to be located and what the needs are,” he said. “We are ready, willing and able to respond to those needs by developing programs and expanding services appropriately.”
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