'Institutional betrayal': CMA digs deep into the healthcare worker crisis

The crisis facing Canadian healthcare workers was on stark display in the third and final instalment of the Canadian Medical Association’s Health Summit Series: Bold Choices. This virtual session, on Feb. 22, focussed on healthcare workers. “There was not a time in my training when I would have anticipated the state of the healthcare system today,” said Dr. Marcia Anderson, a physician and Indigenous health advocate in Winnipeg, who has been in practice for 15 years. “A pandemic? You can kind of anticipate. We had SARS when I was a resident . . . but the health workforce situation right now is not something that I anticipated.” “Moral injury: this is something that’s plaguing our healthcare providers,” said Dr. Sarah Hanafi, a resident physician in Montreal on the panel. Dr. Hanafi said she’s working on her Royal College exams now and, of course, learning about evidence-based things but finding in the healthcare system as it stands today her patients don’t always have access to what evidence-based medicine would say are needed such as even psychotherapy. “It’s very hard when we have to reconcile our knowledge, our passion for caring with our feelings of helplessness, and having to apologize on behalf of this system,” she said. Dr. Anderson nodded. “You mentioned moral injury ... and I’ve heard this term described in a talk as ‘institutional betrayal.’” She argued that a key thing that is needed is re-establishing trust between healthcare workers and policymakers. “(There’s) been a feeling like we’re working against our government partners, instead of for a shared purpose. . . . I’ve certainly felt that at times, and I know that I’m not alone in feeling like that.” Dr. Hanafi said: “As people go through training, we have a lot of emphasis now on training about advocacy, equity and justice.” But she said she’s finding as she enters the healthcare system it seems to want to see doctors as just providers of a clinical role. “Once we enter our institutions, we’re shown that . . . when you do try to speak truth to power, it’s not valued.” Read: Should doctors campaign more with nurses and others for national licences? The cause of the current crisis for healthcare workers is multifactorial but at core, noted Dr. Kevin Smith, president and CEO, University Health Network in Toronto, “it is a very challenging world where we are increasingly faced with demand that outstrips supply.” He said he’s very concerned about the current environment. “Perhaps it’s the world of Twitter and social media but a time of civility—where we actually debated ideas about what we wanted from our healthcare system in a respectful way—seems more elusive than ever.” Dr. Smith said he worries about our ability to solve our problems in the healthcare system unless we recommit to civility, respect, and dignity in our discussions. “Governments are always talking about costs but it’s really just not necessarily about throwing more money at something,” said Sara Fung, a registered nurse and health podcaster in Toronto. “It’s about using resources wisely. Quality care doesn’t necessarily have to equate to more costs.” Fung said she thinks Canadians aren’t always aware of the struggles that healthcare workers face. “We (nurses) have dealt with legislation that cap’s wages, and sometimes the public might think that it’s about the money. But it’s about the respect that we deserve.” She added: “If you ask any nurse what they’re really looking for it is safe patient ratios.” Fung said about the state of the crisis: “I don’t know if we’ve hit the bottom yet.” Solutions? For one of his questions, moderator Dr. Alika Lafontaine, Canadian Medical Association president, asked about solutions to the healthcare worker crisis that can be applied in the short term. “First talk about retention before (recruiting),” said Dr. Smith. We “have a skilled workforce. How do you keep them there? I think unquestionably we have to listen (deeply) to what’s making the quality of work-life (poor), particularly of nurses, but across the disciplines.” Dr. Smith added that we need to look at where maximizing scope of practice can benefit quality of work-life as well as quality of care and caring. “When we look at other systems in the world, and look at extenders, we know that we cannot educate or immigrate our way out of the shortage of healthcare providers,” said Dr. Smith. “We unquestionably will have to look at different models of care, different extenders of care (and) the application of technology” that do such things as support monitoring systems to boost homecare. “Every patient we talk to (in hospital) says ‘my greatest desire is to go home with functionality.’” Dr. Hanafi added that improving the efficiency of our digital tools needs to be a top priority. “They can do wonders to improve our workflow and reduce our administrative loads,” she said, “(but) right now for a single impatient encounter I have to open five to six different clinical applications just to complete one appointment.” (But she noted that where she trained in Alberta there was a “fabulous model” for health IT.) Dr. Anderson said one solution for the challenges facing healthcare is to prioritize looking at funding models and moving away from fee-for-service to team-based care. She and others on the panel also talked about the need to make the healthcare system work for groups of Canadians who have been marginalized. She cited a World Health Organization document where “one of the key principles is that you have to centre (care for) those who are furthest behind first.”

'Institutional betrayal': CMA digs deep into the healthcare worker crisis

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