Question to Alberta Health Services

 

Hi there,

I have a few questions about the recent announcement that obstetrics will be closing in Banff in March of this year. If you are unable to answer the questions perhaps you could kindly direct me to where I could find the information.

1. Of the 80 community members that helped to devise this plan how many were Banff residents?
2. What research was cited to demonstrated that 46 births was too low of a number for staff to retain their skills? Does this research provide an optimum number of births to have staff retain skills?
3. How many complaints were there from patients feeling that the care the received in the Banff hospital’s obstetrics department was lacking?
4. How many staff raised concerns that they felt they were losing their skills due to a small number of births this year?
5. Is the fact that there seem to be too many obstetricians in Canmore a concern to Alberta Health services? It would seem to me that the doctors in Canmore on average would be overseeing fewer births each per year than the one docotor in Banff and therefore at risk of losing their skills. (using 46 births in Banff versus 300 divided among 7 doctors in Canmore)

Thank you so much for taking the time to answer these quest

ANSWER from Alberta Health Services :

Hi Kristen,
Please find below a response to your email inquiring about the recent announcement about the shift in programs/services between the Banff Mineral Springs Hospital and Canmore General Hospital.   We hope that the response will help you understand some of the complexities involved in decisions around a shift in services.
Regarding community consultations that took place, invitations were extended to organizations and individuals to ensure there was broad based representation from the Bow Valley.
Covenant Health – Banff Mineral Springs Hospital extended invitations to 67 individuals who had connections with our community, the Mineral Springs Hospital and the geographic we serve.  Of those, 42 were residents of Banff.
Alberta Health Services extended invitations to 62 individuals who had connections with Canmore and the geographic area served by Canmore.  It is important to note that planning was not limited to individual communities but took a broader context to health service planning.  The attached document and links provide a more extensive description of the methodology used will assist you in your understanding of the process utilized.  These are public documents posted on the Alberta Health Services website.
Regarding research cited to demonstrate numbers of births to maintain competency; there is no definitive research that we are aware of.   Having said that, facilities need to always take a critical look at patient safety when the number of deliveries per year declines.  The impact of declining numbers of deliveries (for example, deliveries per year less than 100) has more of a profound impact on nursing as the probability of a nurse having exposure and experience to a delivery and maternal child care is reduced when you have declining numbers of deliveries.   Obstetrics is a specialty area of nursing and requires advanced practice skills to ensure competency and confidence in the birthing process.
The decision to shift services is not based on complaints.  There are many women and families who have had a great birthing experience at the Mineral Springs Hospital.  The challenge on a daily basis is to ensure adequate staffing to manage obstetrical cases.   Staff regularly voice concerns about feeling competent and confident about managing obstetrical cases.   On numerous occasions where staff have refused to be involved in deliveries or requested that a more senior nurse or the Manager of the unit come in (often after working a full shift) to assist or manage the case.   Recruiting RNs trained in obstetrics has also been a challenge as well as finding nurses who are willing to work in Banff as they know it is a requirement that they learn and develop this skill base.
It is not a concern that there are seven Family Practice Physicians willing to practice obstetrics in the Bow Valley.  Fortunately there is a group that have established a low risk clinic where they can offer Bow Valley families this service. The issue of competence and safety is not an issue for physicians (in Banff or Canmore) but is an issue for nursing.   Canmore deliveries will exceed 300 deliveries per year so there will be ample opportunity for nursing staff at the Canmore Hospital to gain the practice and competency level they require to ensure safe quality care.   There are not too many Family Practice physicians in Canmore.  The Bow Valley is very fortunate to have eight Family Practice physicians (seven in Canmore and one in Banff) with an interest in practicing in the area of obstetrics.  It is important to note that the one Family Practice physician who delivers babies in Banff will be able to continue her practice in Canmore once the services shifts to the Canmore Hospital at the end of March.
We trust that you will find this information helpful in understanding the decisions made to support quality and safety of maternal child care.
Thank you for your inquiry.
Valerian Nyaga
Project Coordinator ,
Alberta Health Services
Suite 1220, Standard Life Building
10405 Jasper Avenue,  Edmonton, AB T5J 3E4
Phone: (780) 643-4640, Cell: 780 952 2052  Fax: (780) 643-4559

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4 thoughts on “Question to Alberta Health Services

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  2. Dear all,

    I have had a chance to review the minutes from the planning committees and the responses from Alberta Health Services.

    First I will clarify the minutes:
    February 9th in Canmore 45 chosen people attended an engagement session-physicians, staff and elected officials-invitation only.
    Februray 16th in Banff 36 chosen people attended-invitation only.
    Of interest Barbara Shellan was the facilitator of the meetings and she is also the Director of Rural Health Calgary and administrator for the Canmore Hospital. I believe there is a conflict of interest with her position as facilitator and director and involvement with the decision to move obstetrics to Canmore.

    Top 5 Major Health Themes that arose from these meetings:
    1. Optimization of Resources and Facilities within Bow Valley Corridor
    2. Addictions/Mental Health/STI Prevention in the Bow Valley
    3 Options for Seniors/Community Housing in the Bow Valley
    4. Access to services including Affordability of Services
    5. Transportation Issues in the Bow Valley

    Between the two meeting the first theme came up with different conclusions in the minutes:
    In Banff they stated maintenance and improvement of existing services – also stated that Obstetrics was working well with excellent public health follow up. As Banff currently has 24/7 anaethesia coverage and caesarian sections. Both myself and Dr Macdonald attended the meeting in Banff and not once was it mentioned re moving maternity care to Canmore.
    In Canmore they stated centralization, consolidation of programs and services. in the minutes they stated ob/gyn critical mass-should we consolidate?

    For the fifth topic both meetings said this was an important issue- that needed to be addressed and solutions.

    As a result of these meetings 19 chosen people participated in two workshops on April 12th and 18th, 2012. I have asked for their names and have not been given them yet. They are physicians, site leaderships, AHS and Covenant Health Staff. Their job was to identify potential solutions to the 5 priority areas. it said 6 but only 5 were made?

    Partial solutions from the two workshops:
    Reorganise Facility Programs-Maximise complimentary services

    ACTION Moving gynaecology and Obstetrics exclusively to Canmore.
    Moving plastic surgery services to Banff.
    Move vascular surgery to Banff.
    Centralize endoscopy services to one site. This has not been done yet but I foresee this moving to Canmore. Loosing yet another available service in Banff.
    Keep core services at both sites. Eg Palliative care, ER ,Medicine.- OB is a core service.

    ACTION Determine capability of facilities and resources needed to support optimization of programs and services- This is also an area of concern.

    ACTION Human Resources- Investigate opportunities to combine hours in each site for increment increases. Look into feasibility of sharing staff between sites-increase professional development opportunities for staff-doctors, nurses, locum. This should be done to keep maternity care in Banff.

    They then talked about the significant challenges in planning:
    There may be a perceived loss of quality service if consolidation of certain services occurred in 1 site. ie OB– they assessed the probability of the impact to be minor.
    Would the community be concerned about this policy- Probability of impact- major-moderate
    Staffing could experience shift in role and relocate- Probability of impact – major to moderate.

    Interesting the decision was made despite not finding any solutions to the transportation problem. They probably think the bus is the solution and hence the need to train the drivers in delivering babies!!

    In August the Alpine Medical Clinic took on a new Dr who delivered babies. She was expected to be part of the OB team at the MSH. Unfortunately she had been pressurized not to provide this service in Banff as she was told that Obstetrics was closing by the end of the year. I took this to Cindy Mullherin’s attention and she stated to me that it would be the Minister of Healths decision and it had nothing to do with herself. She was not aware of it closing.
    How did Canmore know months before I was told. I was not informed till the week before Christmas-the same day as the press announcement.

    I believe this was definitely Canmore`s decision in moving the obstetrics services.

    I think that the above has also given solutions to the answers from Alberta Health Services. We have a great group of nurses that are skilled in Obstetrics at the MSH and are currently being well supported by the Nurse supervisor and our on site More OB program. This program helps to enhance their skills and without it I see a decline in the hospital skills on acute care.

    Yours,

    Dr Jane Fowke

    • From: Valerian.Nyaga@albertahealthservices.ca
      To: kristencotton@hotmail.com
      Date: Tue, 29 Jan 2013 15:35:42 -0700
      Subject: RE: Announcement that obstetrics will be closing in Banff

      Please find below a response to your second email dated January 4, 2013 re announcement that obstetrics will be closing in Banff in March of this year

      In the 3 Year Community Plan document itself it lists one action for human resources as being to investigate opportunities to combine hours in each site for increment increases and look into the feasibility of sharing staff between sites to increase professional development opportunities for staff-doctors, nurses, locum. Could this not be done to solve the problem you describe above?
      In follow-up to the report, this suggestion of combining hours in each site for increment increases was reviewed in light of the Collective Agreement and it was determined that it is not a feasible option.

      Could nurses not work in both hospitals to gain the experience and skills they need? If not, why?
      Obstetrical nursing is a specialty skill that has to be used regularly in order for the nurse to keep up her expert knowledge and skill. Obtaining and maintaining these skills is not as simple as scheduling staff to work at both sites. As you are aware, deliveries (i.e. when a mother is ready to give birth) are unpredictable and sporadic. Even if staff did work at both hospitals, this would not guarantee they would gain enough experience since we can’t be sure there will always be a mother in labour or a delivery.

      Banff’s emergency room is often not fully utilized will this be the next service that Banff will lose?
      The Emergency Department at the Mineral Springs Hospital is an essential service for the community, the Banff National Park, residents of the Bow Valley Corridor and the visitor population. It is imperative that we have emergency services in Banff for the local community and the expected trauma and complex medical needs that can arise with a local population of over 8,400 and an area that has over 4 million visitors each year. While the department does experience fluctuations in activity, it is not underutilized. The staff and physicians are skilled practitioners with an average of 10,700 visits per year. The Mineral Springs Hospital also has an average of 5,700 clinic visits per year that operate out of the Emergency Department.

      Do you consider obstetrics a basic medical service?
      Obstetrics is considered a specialty service as is surgery and emergency. It is not considered a basic medical service for a community hospital.

      From the attached documents I could not ascertain how many of the 19 participants were residents of Banff. Could you provide me with this information? Also, who chose these final 19 people? Why were these people chosen specifically?
      It is important to note that the 3-year service planning was conducted in view of the “Bow Valley” and not from individual community perspectives.

      Phase 1 involved the community/stakeholder consultations. The engagement sessions included staff, physicians, elected officials and community members. It was a Level 3 engagement where AHS and Covenant Health leads worked with community and health service provider stakeholders to understand and consider concerns, needs and hopes, to exchange information and ideas.

      Phase 2 of the Provincial Framework for Community and Rural Health Service Planning involved the two workshops that were scheduled in April where 19 individuals were invited. 17 of the 19 individuals (89.5%) were from the Bow Valley Corridor. These individuals were chosen based on their role in health care delivery in the Bow Valley Corridor and their association with the top 5 priorities identified from the Bow Valley Corridor consultations (Phase 1). The intent of the workshops was to facilitate a review of the emerging themes and determine appropriate solutions for the Bow Valley Corridor. This important work led to the development of the 3 year service plan.

      Membership in Phase 2 included professionals with knowledge and expertise regarding local, program and/or Zone strategies both for future and current state. It was important to have the right people present to drill down and look at specifics that needed to be considered in view of the key priorities identified, current status, access, safety, quality, efficiencies, cost, and the provincial direction and goals of both AHS and Covenant Health.
      The 19 individuals included the following:

      1. Three representatives from Addiction and Mental Health (Zone representation and local representation)
      2. Representatives from FCSS with the Town of Banff and the Town of Canmore
      3. Representation from Banff Emergency Services
      4. Representation from Banff Emergency Services
      5. Medical Directors (Lead Physicians for the Canmore Hospital and the Banff Mineral Springs Hospital – one from each site)
      6. Medical Representative from Specialty Surgical Services
      7. Representative of Family Medicine (Banff)
      8. Representation from the Bow Valley Primary
      9. Representative of Lake Louise Medical Clinic
      10. Representative of Community Health (Public Health) – Bow Valley
      11. Representative of Home Care – Bow Valley
      12. Clinical Management staff from the Mineral Springs Hospital – 3
      13. Clinical Management staff from the Canmore General Hospital – 2

      Finally, what specific information lead the decision makers to state that delivering at the Canmore Hospital is safer for moms and babies? I have tried to research what information would lead to this conclusion and can find none.
      Competency and skill is largely dependent on having a critical mass of patients where one can gain the experience and maintain skills to practice safely. Consolidation of obstetrics in the Bow Valley Corridor has been discussed and deliberated for over two decades. With over 300 deliveries per year and growing, Canmore Hospital RNs will have the opportunity to gain and retain the expertise needed to skillfully and safely participate in labour and delivery. With a drastic decline in deliveries at the Banff Mineral Springs Hospital (51 deliveries in 2012) and only one physician practicing obstetrics, the critical mass of maternity patients is not present to be able to safely offer this program.

      We trust that you will find this information helpful in understanding the decisions made to support quality and safety of maternal child care.

      Thank you for your inquiry.

      Valerian Nyaga
      Phone: (780) 643-4640

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