University Health Network CEO Kevin Smith talks health care privatization, Bill 7 and medicine’s ‘unsung heroes’
Despite the challenges facing Ontario’s health care system more than two years into the COVID-19 pandemic, the president and CEO of Toronto’s largest hospital network remains remarkably optimistic.
“It’s been a very, very trying time,” says Kevin Smith, president and CEO of the University Health Network. “Obviously the nursing shortage has been at the forefront of this discussion.”
But UHN emerges from the first two years of the pandemic in a decent financial position thanks to help from the provincial government, Smith says. “They’ve made us whole throughout COVID,” Smith says. “We didn’t have to worry as much about losing funding.”
Toronto General and Toronto Western Hospital, along with the Princess Margaret Cancer Centre, the Toronto Rehabilitation Institute and the Michener Institute of Education all form the University Health Network. Like a university spread across multiple campuses, each of these facilities operates under the same management team, with Smith at the helm.
Strengthening the province’s health system will not be easy. Ontarians are worried about the possibility of an increasingly privatized system, and Queen’s Park’s attempt to free up hospital beds – Bill 7 – will allow the transfer of elderly hospitalized patients to care homes nurses that they have not chosen.
But Smith believes there is a way for UHN and the Canadian healthcare system as a whole to move forward despite the many lasting obstacles of COVID. He spoke to the Nursing Agencies Star, how the two University Health Network foundations have responded during the pandemic, and his thoughts on the privatization of health care debate:
I’m sure you have a lot of worries in mind. What keeps you up at night that people outside the healthcare system might not understand?
I think my biggest worry is a double-edged sword. How can we get people who need care what they need in a timely manner? A number of multi-organ transplant patients who 10 years ago would not have survived are now living vibrant lives thanks to University Health Network programs. They are among the best results in the world. It’s fantastic.
But at the same time, we’re creating this huge population of patients who will need very specialized care for the rest of their lives. Historically, we have not built such a system. People had shorter life expectancies and did not have as many comorbid illnesses. How will we manage to continue to care for these people, while meeting the needs of new patients and not generating enough medical graduates to do the job?
Where do you look for inspiration to solve these problems?
I find comfort in talking with colleagues. I hosted Gianrico Farrugia, the CEO of the Mayo Clinic, last week. We are both on the list of top 10 hospitals in the world. I was comforted by the fact that the problems Gianrico and his colleagues are facing are identical to ours. They have a different financing system. They have different issues around equity and access. But when it comes to the challenges of running a health system and caring for people, there is no difference.
Do they have the same problems with hiring nurses?
They absolutely do. We also both find that while nurses are willing to stay in the clinical workforce, many suggest they want to work in a less clinically intensive environment. And then, of course, there are a large number of clinic staff who prefer to work in an agency world where they have more control over their schedules.
This is by no means unique to Canada. I can’t get you to a perfect health care system anywhere in the world, and I wish I could. There are trade-offs, and Canada has made trade-off choices in different ways. We have some of the best results in the world, which is great. The problems we have are similar to those of other G7 and G15 countries in terms of access, quality and cost of health care.
Is there anything else UHN can do to hire and retain nurses permanently without using agencies?
I think so. We have set up a working group to focus on these big health care issues with human resources, particularly in nursing. I had a meeting with our leadership team who work with our ethics professionals to ask where we can legitimately recruit nurses without harming the health status of places that might be in worse shape than Canada. There are jurisdictions around the world that overproduce nurses for export – Cuba would be one environment.
We actively engage in international recruitment and work with the Canadian government to expedite applications. We actively seek out refugee environments where those who are trained as nurses can be quickly treated as refugees and then assessed according to North American standards of practice. At the same time, we are also considering expanding some of the regulated providers. What are nurses still doing so that others who are less well trained and less qualified than nurses can be trained to do it?
And then last, but certainly not least, it’s a very exciting time in healthcare to think about technology, digital health, artificial intelligence and home care. If we could get patients treated for what historically could have been treated in hospital, that means we can do more in an acute care setting.
Much has been said in Ontario about the possibility of greater privatization of health care. This seems to worry a lot of people. Does this worry you?
That doesn’t worry me as much as the words “universal accessibility”. Thirty percent of our system has been in private hands for a very long time — dental care, eye care, drugs, parts of the long-term care system. I think the clarification that would take a lot of the sting out of this debate would be the words, “You will not suffer because of your economic situation in terms of access.
I know there are those who believe very, very strongly that if there is a profit margin in a business, it should be put back into the system. I’m a little more optimistic about it. If someone can provide exceptional service, very good results, high quality work, and can do it within a private structure while respecting universal accessibility, I am ready to experiment with that.
Do you think people should be forced to move to a CHSLD away from their family, according to Bill 7?
Ideally, no. If they have to because of limited access to acute care services – that there are people who really need to be in those beds and their outcome will be compromised if they don’t receive care – so I think we need to look at other solutions. I don’t think any system says you can stay in a place with very limited capacity, even if you no longer need those people’s services, while others who need them can’t access them. .
Hospital foundations have received many donations during the COVID-19 pandemic. Should UHN rely on its foundations for funding?
Our foundations have been absolutely outstanding, there is no doubt about that. One of the biggest things they were able to do was offer resources for hotel rooms when employees were sick or for people who were really struggling to get around. Many generous donors got involved.
But I have to say the government has really met our needs economically during COVID. They were very easy to work with. We got the things we needed funded. Obviously this is going to get more difficult as we return to more normal times, especially as we have a staffing shortage and our nursing colleagues have been very clear about their expectations for significant increases through collective bargaining. They are important at a time when inflation and other pressures make it difficult for the government to think about tax increases.
Our two foundations, UHN Foundation and Princess Margaret Cancer Foundation, raise approximately $250 million annually. It is their investment that allows us to invest in research and innovation, scholarship, education and training. We are not funded any differently than other hospitals when it comes to clinical care. So if we enjoy having one of the top five cancer centers in the world, it’s our foundations that help us do that.
There are a lot of catch-up effects of the pandemic still happening – trauma, long COVID, addiction issues. When do you think you will get back to normal as a hospital? Do you expect to deal with these persistent issues for years or decades?
I think we are on our way to more normalcy. Remember that we are still facing capacity issues. We were often operating at 110 or 120% before the pandemic. We are now approaching 100% occupancy. I think the big change is that we have a new disease. It’s not a disease that goes away, and we haven’t scaled our system to accommodate COVID, long COVID, and the aftermath of COVID. We’ve seen monkeypox lately, and I think most of us think the risks of antibiotic use and infectious diseases are higher on the list of risks than they give it credit for. were once.
As a result of COVID, we were living in a changed world. This will open the doors to new professions and new opportunities. This will — I hope — open the door to reconsider where and how we deliver care. But it will also challenge, in Canada and around the world, the financing of an already very expensive health care system. I think it will also help us think about what patient-centered care looks like and what clients want from us as a system.
Health care is not isolated from broader societal developments. It’s fairly new for us in healthcare to deal with uncivil patients frequently. Incivility towards healthcare workers is at an all-time high, at a time when they are wondering if they want to continue in the profession. This is one of my main concerns. How do we bring stability back and forth – to our patients and from our patients, and create a high quality working environment for the people we need to keep in the profession? They feel quite overwhelmed.
This interview has been edited for length and clarity.
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