Today, we answer two more staff questions, starting with one about a topic near and dear to our hearts: employee engagement.

We believe in the difference frontline and bedside staff make — we see it every day — and we take pride in the daily efforts to engage staff in developing new and better ways to provide quality care and service. But we’re hearing from staff that you’d like to be involved even more.

We’re listening, and in the spirit of engagement, we’re asking you: What are we missing?

How can we do a better job at engaging Vancouver’s staff and physicians in discussions on program changes and redesigns? In a large organization such as ours, we’re seeking your practical ideas and solutions for enhancing engagement.

Please email us your suggestions. If you have additional questions for us, we welcome them, too.

For our complete answers to today’s questions, see below.

Today’s answered questions

Q.  At the [January] Vancouver All-Staff Forum, someone asked about the consultation process that occurs prior to executing a ‘redesign’ strategy. I recall the answer proposed that it is a complex process, and involves consultation with Board of Directors, management and unions. I would like to know if the consultation process can be expanded to include frontline staff?

It sounds like there are multiple representatives from various areas, but no one is representing the clients. Or at least no one who has direct, in-depth knowledge and awareness of client experience and potential impact like frontline staff do. I believe that by including front line staff in the process, it not only would provide a more comprehensive picture of the impact of a redesign plan, but also coincide with the goal of promoting connectedness and engagement at work.

A.  It’s true — the process for undertaking complex and substantial redesign is, well, complex. To ensure clients’ and patients’ best interests remain at the centre of all decisions, the process involves number of checks and balances, and consultation with several parties. As you note, unions are part of the consultation process, and they’re at the table to represent the frontline perspective and experience. (For our previous explanation of the process, please refer to “When will the other shoe drop?”.)

But, that’s only part of the picture. Across Vancouver, frontline staff are shaping initiatives and solutions every day, whether it entails reducing falls at Banfield Pavilion, preventing c Difficile and CAUTI cases at VGH, UBCH and GF Strong, or reducing wait times in ambulatory and community care clinics. Staff are having a direct impact through their participation in working groups. Staff experience, insights and ideas are enhancing patient care and safety, and reducing costs. Take the work at Banfield by way of example. Staff at this residential care facility teamed up to prevent falls. Thanks to staff ideas and engagement, Banfield has reduced falls by more than 50% in one unit, saving residents unnecessary pain and suffering, and saving the health care system more than $866,000 in unnecessary costs.

Having said this, we have heard from a number of staff who’d like to have more input. We value frontline input, too, and we recognize that staff want to be heard, which is why we also conduct site walkabouts, conduct the Vancouver All-Staff Forum and welcome invitations to visit local teams. In a large organization such as ours, staff engagement can be a challenge, but a challenge has never stopped us before. So, we’re asking all staff and physicians for your ideas.

How can we do a better job at engaging Vancouver’s staff and physicians in discussions on program changes and redesigns? What would this look like? What are we missing? We’re seeking practical, tangible solutions on how we can engage you more than we do today. We’re listening.

Q.  Is the existing structure of VCH really the most efficient and effective model to deliver integrated innovation across a diverse health care system?

A. This is a very interesting question. While the most effective structure for delivering health care is a topic of ongoing debate across the country, a few conclusions have emerged. Linking community services with acute services on a regional basis — as we do here in B.C. — is generally believed to be the best way to optimize resources across the system.  This regional approach makes it easier to provide patients seamless care as they move from acute to community or the reverse. This structure also makes it easy to move funds between services to support shifting patient demand. Our province has had this structure for a decade, and Ontario is moving to this model from a hospital-focused structure.

Within B.C. health authorities, many are organized along program lines, meaning that the operational and funding accountabilities are organized by program — surgery, medicine, psychiatry, etc. — across multiple sites. VCH is somewhat the exception to this rule. While we have regional programs — eg:  the Regional Mental Health and Addictions Program and the Regional Cardiac Services Program — to ensure equitable access and standards of care across VCH, we’re also organized by three geographical regions or Community of Cares: Vancouver, Coastal and Richmond. Leadership and funding for each COC is held by its chief operating officers (COOs). As Vancouver COOs, we are responsible for the delivery of acute and community services within Vancouver. Particularly in times of capacity and funding constraints, the VCH senior executive team strongly prefers this model because it allows funding and resources to be more easily optimized at a site and then community level.

For example, in our current COC model, when a hospital is short medicine beds to decongest the ED, and it wants to overflow into surgical beds (How often does this happen?), it’s easier for a leader of the site/COC to make the right patient-centered decision to optimize care in the hospital. In the program model, a medicine leader would need to negotiate with the surgical leader, with neither necessarily being onsite – a much harder way to optimize care and resources.

Another advantage of the Community of Care model is the closer link between leadership and staff and physicians. As Vancouver’s COOs, we believe we’re better positioned to understand the challenges Vancouver staff and physicians face, and better able to find solutions and provide support, because we’re present and closer to where the work takes place. We also hope we can translate our proximity and knowledge to enhance the working environment, team engagement and generally help you deliver the best care.