N.S. health authority CEO eyes technology changes to improve patient movement

Karen Oldfield says multiple projects are coming online this year to help improve access

Michael Gorman · CBC News ·

Karen Oldfield might not know how long she’ll be interim CEO of Nova Scotia Health, but she has a clear view of what she wants to achieve while in the job.

Oldfield was appointed to lead the provincial health authority by Premier Tim Houston five months ago. Since then, she’s toured the province talking to health-care workers and meeting with as many people as she can to learn more about the system’s inner workings and well-documented challenges.

“People have been very kind to share and teach and I just keep asking questions and it’s really amazing what you unpeel and find when you keep asking the questions,” she said in an interview Wednesday.

Following those conversations, Oldfield formed four key focus areas: work-life balance and human resources; improved technology; sustainable services in rural communities; and patient access and flow.

Pilot project to help emergency department access

Some of these will take longer to tackle than others, particularly during a pandemic that’s laid bare problems that have existed for years. Addressing staff shortages, for example, takes time because of the time needed to educate, train and recruit people.

In the short term, Oldfield has her sights set on improving patient flow and access in hospitals and using technology to do it.

Next month, the health authority will roll out a pilot program at Colchester-East Hants Health Centre in Truro that will allow people attending the emergency department to be given access to virtual meeting with an emergency physician, if appropriate.

Oldfield, who wants a similar pilot to happen at a Halifax-area hospital, is hoping the effort will ease pressure on overcrowded emergency departments. Officials won’t take long to determine whether to expand the idea to other hospitals, she said.

“It could be 30 days, it could be 45 days, it could be 60 days — it’s not going to be long,” she said.

“If we see something there [that needs addressing], then we tweak. But if it’s half-decent, it’s going.”

‘Perfection stymies progress’

This outlook embodies the approach Oldfield, a lawyer by training who was originally tapped by Houston to be his deputy minister of priorities and planning, brings to the job. She wants to hear all ideas for improving the system and, if they’re doable and make sense, she’s willing to give it a try.

“You can’t make decisions based on nothing. But if it’s reasonable, then OK. It doesn’t have to be perfect. Perfection stymies progress. And we need to get off the status quo.”

This is the approach Oldfield is taking with respect to plans for a so-called command centre to monitor bed availability and patient discharges in real time. Often, patients are left waiting in emergency departments for hours until a bed becomes available. And because the discharge process is cumbersome and disjointed, that availability isn’t always known about immediately.

The command centre is something that’s been discussed in the past, but Oldfield said she wants it to happen this year. At a minimum, she wants an early version operating soon and the kinks can be worked out along the way.

“This is realistic. Is it going to be pretty? Not necessarily. Will it need tweaks? Absolutely. But as long as we can get something up and get people acclimatized and see how powerful it can be, then I think it will really help us.”

Sustainable rural health care

Oldfield said the pandemic has proven the value of a single health authority to take a provincewide approach in dealing with major issues. But she said there needs to be flexibility to adjust as necessary depending on a certain area’s requirements and realities.

It’s this approach she’s taking with respect to rural healthcare. The province recently announced urgent treatment centres in Northside and Parrsboro, which offer same-day or next-day treatment options for people with unexpected, non-life-threatening conditions in communities that could not sustain emergency departments.

Oldfield said people deserve access to care wherever they live, but it must be delivered in a way that acknowledges the realities communities face with respect to staffing and service availability.

“It might not look the same in every place we go, but … we need to make sure that people have a path. I need to see that path.”

Being able to act quickly is at least partly a function of Oldfield’s close connection to the premier’s office, as well as the office of health-care professionals recruitment. Oldfield has regular contact with Houston, Health Minister Michelle Thompson and Dr. Kevin Orrell, CEO of the recruitment office.

“When there are fewer layers between the actual decision makers and those who are informing the decision makers, things can happen more quickly. That is happening now.”

Staff resiliency during COVID-19

While she may not have a health-care background, Oldfield said she came into her job with the experience of caring for a husband who requires regular trips to the hospital for dialysis and other treatments.

“I have lived this system for a long time. I know the technology problems,” she said.

“I know when the parking [garage] arm doesn’t go up. I know when the parking lot hasn’t been plowed … I want nothing more than to get some of this stuff fixed.”

Of all her takeaways so far while on the job, Oldfield said the resilience of staff stands out the most, particularly considering what the last two years — and especially the last six weeks — have been like.

“Not everybody’s happy everyday. Of course they’re not. It’s very scary some days. But the resilience and the tenacity and the commitment is probably one of the things that has both surprised me and energized me and enticed me the most.”