Thread by @BlackwellMerlin

A thread 🧵Things I've learned about keeping your Emergency Department - and Hospital- open in BC in the time of a nationwide shortage of Nurses and Doctors. /1

The Background. In late 2021 through to September of 2022, our smalltown hospital -Dr. helmcken Memorial- saw over 70 "diversions" aka closures of the Emergency Department. In the spring of 2022, my council and I started to get involved in trying to turn this around. /2

by the first week of Sept 2022 we stopped having closures... we went something like 12 months without another one, but have experienced 7 in the last 2 months. this means we have to go hard again. Here are a few lessons learned, some the hard way. /3

Lesson 1. Don't go negative. Your gut reaction will be to start angerly demanding action, to call hospital / health authority managers on the carpet and demand they do better. You will want to vent this in the press, in your council meeting, in your community. I wouldn't. /4

Here's why. The staff at the hospital take your negativity personally - as a criticism of them. This includes the nurses and doctors you desperately need to retain. They, thank god, are not political animals like us. I was fortunate to have a staffer tell me this early on. /5

Lesson 2 is more of lesson 1... if your council is negative, if key community members are negative, you might as well stop trying. I had a senior member of the health authority confirm this. Everybody in the system with the ability to change things goes into defense mode. /6

If health authority(HA) management is in defensive mode, they aren't going to act quickly or boldly. I/council switched from "I demand you fix it" to " What can we do to help this get solved". This created an atmosphere of trust. Then the HA was brave enough to try changes./7

Lesson 3. You need to know what the actual problem is. "We have a shortages of nurses" is not the problem. "Why do we have a shortage of Nurses?". Ask that, get honest and often blunt answers. IF you are cycling through staff, you likely have a problem in the workplace. /8

The problem in the workplace is causing you not to attract or retain nurses. Often it's as simple as poor shift schedules that no one wants to do. Sometimes it's a staff vs staff or a staff vs management conflict. Bullying, lateral violence, inflexibility to change, etc. /9

Which leads to Lesson 4. Be open to change, and have the backs of the managers who make it. We had an overnight on call shift that was unfair to the nurses who got it. We needed the schedule changed. That resulted in 2 weeks of night ER closures. I stood up and sold that./10

2 weeks later and a few cooperative nurses who now felt listened to, we were out of crisis. Sometimes its way tougher than that, sometimes it means managers remove bullies or people acting as roadblocks from your hospital team. That leads to short term pain, but you need to./11

Lesson 5. If you demand 1 thing of our Hosp Auth, make it that they send in an out of area HR person who can do and evaluation of your hospital, but can do it by gaining the trust of the staff there. We had this. Guy came in, 6 staff talked the 1st day, 20 the second-Trust./12

You are not going to get anywhere unless outside management has a full understanding of all the problems, and then sends someone in who can pull the trigger on changes. No change, no solution. Cycle of hire/loss continues. /13

Lesson 6. Gestures are important. One of my council works with Dr's as her day job. She asked if we could hold a "Mayors Dinner" for the doctors, especially the new ones. Okay? Because it's respectful.. and with foreign Dr's, sometimes culturally significant. /14

Invite your MLA/MP. Them showing up to meet Dr's shows they care about the situation. It makes everything suddenly more personal. Other types of gestures are appropriate for staff. Treat baskets, public thanks.. but acknowledge all staff/nurses, not just the new ones. /15

Lesson 7. If you do have to take on the HA or the Health Minister, do it by having an argument they can't dismiss. I spoke at UBCM right after BC's Health Minister. In that speech I wasn't very critical of anyone. I went through our history, our current issues, and a plan./16

if you spell out all the reasons you need to stay open, the possible solutions, the community supports that are ready to rally to help, the efforts you are making to attract healthcare workers... there's really no defense by ministry against trying to help you. /17

Lesson 8. This is a team effort. Hugely important. You need to rally the community for housing, donations to the hospital auxiliary for equipment, welcome committees, comforts for long term Locums and temp nurses. EG my council/townsfolks showed up to help a new Dr move in./18

BUT.. you need to acknowledge that team. Recognize and promote people, businesses, and organizations that bring help to the table. One of my councillors is a master of gestures... a couple leased their house to the Hospital for long term for locum/new staff housing. /19

Lesson 9. You never really win, the work is never over. We had a very long stretch with no closures, but here we are with a new series of closures. Time to look under the hood, let staff know you are aware and paying attention, ask how you can help solve new issues. /20

Often it will be a reoccurrence of an old issue. Start making calls. Start talking about the things that are needed to help publicly. You did it once, you can do it again. This is a long game. Just getting enough nurses into the Canadian system will take years. Keep hope. /21

And lastly, for now, lesson 10. Celebrate your victories, but give credit where it is truly due. Our current Hospital Administrator and her team are award winning. The create a workplace culture worth joining. Nothing's perfect, but they are a team, and they own it. /22

Here's some awesomeness about them from Health Quality BC.../24 healthqualitybc.ca/quality-awards…

There's more -power in numbers- talk to others in crisis. Gaby Wickstrom, Lori Ackerman, Ange Qualizza and others... we formed a Rural Mayors Health Caucus to work together. I speak to other communities in crisis, often quietly. BUT.. I always start with "Be Positive". /FIN

We need 2 nurses to be out of diversions, 4 to be stable, 6 we will be basically fully staffed. Our hospital team is doing this now with awesome nurses from other hospitals, agency nurses and locums. A local high school grad just joined the nursing team. We can solve it.