The Waterloo Wellington Local Health Integration Network (LHIN) has directed the boards of Wellington County’s two hospital corporations to amalgamate by Nov. 30.
While the Groves Memorial Community Hospital board of directors is supportive of the plan, North Wellington Health Care (NWHC) chair Tom Sullivan says the northern board needs to retain its autonomy and rural identity.
Groves in Fergus and NWHC, which operates hospitals in Palmerston and Mount Forest, already share CEO Jerome Quenneville as well as a senior management team and about 20 staff members, explained LHIN senior director of health system integration Gloria Cardoso at the Aug. 13 LHIN board meeting.
An issue with the renewal of Quenneville’s contract was a driving force behind a dispute between the two boards, Cardoso said at the meeting. Another factor was “how best to move forward with opportunities to strengthen the health services” in Wellington.
She added the dispute led to the LHIN’s involvement and its subsequent directive on amalgamation.
“Over the past eight months there has been a disagreement between North Wellington and Groves Community Hospital and has resulted in their partnership becoming fractured and dysfunctional,” Cardoso continued.
“This conflict is getting in the way of the hospital boards finding new and creative ways to address local resident needs and positively contribute to the achievement of the 2013 Rural (Wellington) Health Services Integration Plan.”
Two years ago, a rural working group laid out the steps necessary for an integrated model of care.
Various health care representatives in Wellington County, including Groves and NWHC, signed a memorandum stating their commitment to following those steps.
However, Cardoso said the actions committed to in the 2013 integration plan haven’t yet been realized.
During the LHIN meeting last week, Cardoso presented a summery of over 300 pages of a briefing note made available to the public on the LHIN’s website prior to the meeting.
“As health service governors and leaders we share an unwavering commitment to act in the best interest of residents’ health and well-being and to lead a high quality integrated health system,” she began.
“Specifically this note provides recommendations … to bring to an end the conflict between these boards which we believe is putting our design and implementation of an integrated health system at risk.”
The LHIN stepped in because the two boards were not able to resolve their differences over nine months.
“To be clear this is a governance issue and the collapse of the alliance poses a risk to the future of integrated care in rural Wellington,” Cardoso explained
Dale Small, vice chair of the LHIN board, expressed disappointment in the two hospital boards.
“One thing I would like to reiterate is it’s disappointing from my perspective that the two boards have not been able to come together over the last nine months to resolve a number of issues and challenges that they had,” he said.
However, despite the recommendation to integrate the board of governors, Cardoso made it clear the LHIN wasn’t planning to close Palmerston, Louise Marshall or Groves hospitals.
“Nor do we have the authority to do that,” she said.
The LHIN hired Mark Rochon, a long-time health care executive with the consulting firm KPMG, to facilitate the amalgamation.
Through previous interviews Rochon, “identified there’s a disproportionate amount of energy being consumed by the challenges facing the governors,” Cardoso said.
“There’s a lack of trust between the parties and the actions are not in keeping with governance best practice and there’s concern that capital projects are at risk as a consequence of the dispute between the parties.”
All three of the hospitals are currently undergoing construction projects.
“One in Palmerston with primary care, one in Fergus which is a new build, and one in Mount Forest Louise Marshall which is an emergency department and ambulatory care space,” explained LHIN CEO Bruce Lauckner.
“They’re all in past the initial planning stages and well into development and design.”
The concern stems from the loss of partnerships. If the health care alliance in Wellington County dissolves, service providers for various treatments, such as the Canadian Mental Health Association, may choose a different alliance and Wellington County residents may not receive the services they need in their community, Lauckner explained.
“We’re crystal clear that the board approved those capital projects based on the rural plan, which we didn’t create – input from the residents of Wellington, all of the providers in Wellington provided that integrated plan – and that’s why we would be concerned if any of these partners decided to leave that partnership and not participate in that, because we want our residents, in all those communities, to have access to care, services as close to home as possible,” he said.
If one of the members of the alliance were to leave it would be a “huge red flag” he said.
Lauckner said an amalgamation of the Groves and NWHC boards would provide a solution to the competition for the attention of the CEO and his team. He added a single board would understand the needs and areas of priority in all three hospitals.
In a phone interview with the Advertiser Groves board chair Howard Dobson said his board is in support of the amalgamation with NWHC.
“I think there’ll certainly be a lot of work to be done between now and Nov. 30,” he said.
“I think assuming that the amalgamation is in place after Nov. 30 that from the public’s perspective in terms of the quality of health care available I think in the first instance there won’t be any visible difference, this is all the back office stuff.
“But I think in the big picture it fits in well with both the LHIN and the province’s approach to integration.”
When asked to discuss the conflict between the Groves and NWHC boards, Dobson declined to comment, citing personnel issues that are not to be discussed in public.
Sullivan, however, said he feels NWHC is being unfairly presented as the “bad guys” in the scenario.
“I think to a large extent, North Wellington is being a little bit demonized here unfairly,” Sullivan said.
With Quenneville’s contract set to expire in March of 2016, Sullivan said NWHC “in lockstep with Groves, had agreed let the contract expire and see what was available from a CEO perspective.”
While he felt there was agreement at the executive level, Sullivan said the Groves board didn’t ratify the decision as did NWHC.
“They changed their mind, and not only that, they unilaterally hired the CEO – they hired the CEO as their sole employee beginning at the expiration of his current contract with us both.”
Sullivan said the LHIN report points out sharing of a CEO is the essence of the agreement between the two corporations and without it there is no alliance.
“We’re not in this situation because of the actions of North Wellington Health Care. That’s what’s implied in the LHIN report, but that’s not the case at all,” he said.
Although it is the key sticking point, the CEO contract is not the only point of dispute from the NWHC perspective.
“We’re concerned about the number of managers that are in our alliance,” said Sullivan, noting that a decade ago NWHC had eight managers and Groves nine.
Today, there are 12 mangers for each corporation, with 20 of the 24 working from offices at Groves in Fergus.
While LHIN officials have been careful to stress no hospital closures are being considered, Sullivan said “closure is not necessarily the main concern.”
He pointed to the example of an amalgamation between hospitals in Shelburne and Orangeville as an illustration of NWHC’s concerns.
“Now, if you speak to the people at Shelburne they’ll say that they’re just a shell today, because the vast majority of their equipment and services migrated to Orangeville.”
Sullivan said the northern board fears, “a lot of our services will migrate south and a lot of our equipment will migrate south.” As a result, he said, “our residents will travel further and the viability of our hospitals will continue to be eroded and diminished.”
While voting down an resolution to put the boards on a path to amalgamation, Sullivan said NWHC proposed an alternative of a strengthened alliance. He said NWHC would like to see the boards remain autonomous and an “alliance committee that has the teeth to make decisions” created.
The present alliance committee, he pointed out, “has no power.”
NWHC would also like to see put in place a dispute resolution mechanism that could “force parties to come to the table.” Sullivan said NWHC would also like the corporations to have separate CEOs, while continuing to share the cost of other key staff.
“The dollars and cents,” he said, “would be a wash,” except that each board “would have to step up with 50 per cent of a CEO salary.”
In NWHC’s case, Sullivan said he believes a CEO could be hired for the smaller corporation at a lower cost than the current CEO.
Sullivan also suggested NWHC might fit better into LHIN structures to the north or the west, which are more rural based, rather than the Waterloo Wellington LHIN where “the rural element of that is only about five per cent.”
Despite the disagreement, Sullivan said NWHC will work with the facilitator in the hope that its needs can be accommodated in a new structure, which could involve the strengthened alliance concept.
“A single board is not an amalgamation,” said Sullivan. “I am taking a little licence with this term because in previous reports they spoke about amalgamation. In this one they talk about a single board … we’re trying to look at this notion of one single board and we’re interpreting that to mean it could be more than just an amalgamation.”
Sullivan said the NWHC is asking local residents to support its stand by writing to their mayors, MPPs, the LHIN and the provincial health ministry to “clearly vocalize and add volume to our voice that North Wellington Health Care is not interested, and it’s not in their best interests, to have an amalgamation.
“We are rural and we want to remain rural and we need a board that advocates for rural health care in our catchment area.”
