Health care in Nunavut looks dismal
Auditor's report shows staff and patient safety at risk
Michele LeTourneau
Northern News Services
Monday, March 13, 2017
IQALUIT
The Department of Health received a damning review of its health-care service delivery by the Office of the Auditor General of Canada (OAG) resulting from an audit which took place between April 1, 2014 and March 31, 2016.
But there were few surprises for Health Minister George Hickes.
"Department of Health employees were encouraged to engage in an open and frank process with the OAG. As a result, many of the report's recommendations do not come as a surprise," he stated in a news release shortly after the report was tabled in the legislative assembly March 7.
The 35-page report, which contains 17 recommendations, outlines a variety of egregious deficiencies in orientation and training for front-line workers, quality assurance procedures, safety, and recruitment and staffing. Most of these issues are long-standing, according to principal auditor James McKenzie.
"Overall, we found that the Department of Health was not giving its nurses and other health care personnel the support needed to properly care for the residents of Nunavut ," McKenzie said.
For example, the Department of Health did not deliver consistent training to its nurses and certain other personnel, such as those responsible for taking X-rays.
"Some staff members in local health centres responsible for taking X-ray images had not received training in many years," said McKenzie.
"This lack of training was highlighted in an analysis the department conducted, which indicated that 45 per cent of the X-ray images taken in certain health centres were of poor quality for diagnosing patients' conditions."
McKenzie also noted clerk interpreters, a "critical" position, received inadequate training.
"Having trained interpreters with knowledge of medical terminology is important to ensuring that health care providers and their Inuit patients who do not speak English understand each other."
Quality assurance is one of several areas where the department failed to follow its own guidelines.
"While the Department of Health had procedures for reviewing and improving the quality of health services, these procedures were seldom followed," said McKenzie.
"For example, reviews to ensure that nurses properly completed patient charts were not done as required. Patients' charts are key to capturing the results of a patient's visit, and for ensuring continuity of care."
The report details how the required monthly audits of patient charts were seldom done.
"We requested monthly chart audits of patient charts received by the director of health programs in each region for our two-year audit period for the seven communities we visited," it states.
"We received 259 (19.3 per cent) of 1,334 chart audits that were supposed to have been completed."
McKenzie noted regional directors' annual visits to community health centres were not conducted as required.
to staff and patients
In its background section, the report notes that as of Dec. 31, 2016, the department, which has 1,151 permanent positions, has a 46.6 per cent vacancy rate. Some of those vacancies are filled with temporary staff.
McKenzie stated that the department does not provide a safe environment for its staff.
"Although staff members reported threats and incidents of verbal and physical abuse, and break-ins occurred at health centres, the department is not tracking these incidents," he said.
An unsafe worksite, states the report, can result in harm to employees, create liabilities for the GN, and can affect recruitment and retention of staff.
But the department was also not tracking incidents related to patient care and, as a result "the department could not adequately analyze such incidents to identify problems and trends, address root cause, and effectively manage risks related to patient safety and quality of care," according to the report.
Examples of issues in reports the auditors did receive included dispensing inappropriate medication, providing wrong vaccine doses, and delaying the provision of care.
The report is highly critical of the staffing process, suggesting it should streamline the lengthy year-and-a-half process, and also pointedly referred to the department's lack of planning for community growth.
In June 2016, the department awarded a contract to a consultant to complete the first phase of a service redesign project, scheduled to be completed March 31, according to the report.
"We noted, however, that the department did not expect to consult with Nunavummiut until it identified options for improving how it delivered health care services," said McKenzie.
"In our opinion, early engagement is important to the success of the review."
The department received the audit recommendations prior to March 7, and in the report, both the Department of Health and the Department of Finance - which is responsible for human resources - agreed with each of the 17 recommendations.
The report also noted that for the fiscal year 2016-2017, $950,000 was earmarked to enhance training for staff that perform X-rays. In the same fiscal year, the Department of Health received approval to implement a Continuous Quality Improvement Program.
McKenzie said many of the issues described in the report and addressed in the recommendations are long-standing issues.
As McKenzie spoke with the press, Hickes stated in his release that his department has already undertaken initiatives to address challenges reported by the OAG.
McKenzie said his office will monitor developments and may perform a follow-up audit, something it has done with previous issues, such as with its follow-up report on Child and Family Services.
"We're optimistic changes will be made," said McKenzie. "Successful implementation is the key."
