Building capacity in Ontario’s hospitals has been a core pillar in the province’s COVID-19 response. More than three months after the provincial government declared a state of emergency, the question is, how are our hospitals holding up? How are they navigating this next — somewhat uncertain — phase in Ontario’s health care transformation plans?
In this episode, Dr. Naveed Mohammad, President and CEO of William Osler Health System, sits down with Dan Carbin to discuss system capacity, health equity, and hallway health care amidst the pressures of a global pandemic.
Dr. Naveed Mohammad was appointed President and CEO of William Osler Health System in April 2020. Osler is one of Canada’s largest community hospital systems, serving 1.3 million people living in a fast growing and culturally-diverse region. Dr. Mohammad joined Osler in 1997 as an emergency physician at Etobicoke General and has held a number of progressively senior physician leadership roles. Most previously, Dr. Mohammad was Osler’s Executive Vice-President, Quality, Medical and Academic Affairs.
Listen to the podcast episode here.
Dan Carbin: Hello everyone and thanks for listening. I’m Dan Carbin Principal from Santis Health. On today’s episode we’re chatting with Dr. Naveed Mohammad, President and CEO of William Osler Health Systems. He is joining me to discuss how hospitals are navigating and planning amidst a pandemic.
Dr. Naveed Mohammad was appointed President and CEO of William Osler Health System in April 2020. William Osler is one of Canada’s largest community hospital systems serving 1.3 million people living in a fast growing and culturally diverse region in northwest Toronto, Brampton and Peel Region. Although new to the role of CEO, he has long ties to the organization joining 23 years ago as an emergency physician at Etobicoke General. Since then he has held a number of progressively senior position leadership roles. Most recently, prior to assuming the CEO role, Dr. Mohammad was the Executive VP for Quality, Medical and Academic Affairs. Thank you for joining us Dr. Mohammad.
It is often said that crisis is the ultimate test of leadership. If that is truly the case, you really didn’t have long to settle in before being confronted with one of the greatest challenges that you’ll face as CEO. Can you share your experience of what it was like to transition into this new role at the height of the pandemic and what’s really an unprecedented time for our modern day health system?
Dr. Mohammad: When I was interviewing for the role, as the interview process progressed we started to find out what was happening in Asia with the COVID crisis. I didn’t expect the day I stepped in we would be two weeks into this crisis full blown in Canada and especially in Ontario and this part of the GTA. So the beginning wasn’t exactly what I expected, but what was really great was that Osler’s COVID-19 response was well under way at that time and being the Executive VP and a front-line emergency department physician, I was already quite steeped in our pandemic response. Working on the front-lines with the majority of my career including a lot of work as the Chief of Emergency Medicine during SARS and the H1N1 and Ebola experience gave me a lot of previous solid experience to draw from.
There were many parts that I had to quickly understand from a President and CEO level, including really knowing the details about the operations and how to do it from the leadership role that I took on. The resources that were available, not only financial, but other resources like adequate supplies of PPE, staff redeployment, virtual platforms and what was most important was being a visible leader and ensuring my Senior Leadership Team were also visible. At this time, our staff was at the height of their anxiety. There was a lot of information true and not true going back and forth about whether the pandemic was droplet contact, was it airborne? Did you need and N95 mask? Surgical mask? Face shield? So there was a lot of things we had to get used to, and lastly having to work with external partners. The community themselves, wanted to support us, but they were also quite anxious so a lot of my initial work was based on working with our front-line staff, being visible and working with key stakeholders in the community, not only to help provide them with support for us, but also to ensure they understood how the hospital operated and the new normal for now looked like.
Dan Carbin: Even setting aside COVID-19, you knew you were coming into a very challenging job, William Osler serves one of the fastest growing regions in Canada. The municipal government even before the pandemic had declared a local health care emergency due to the massive capacity needs of this growing population and this is something William Osler has dealt with over decades. Funding from the provincial government, not necessarily keeping pace with population growth. Can you reflect on the future of health services in your community and the longer term capacity planning that you’ve been engaged in as an organization over the years? How those plans are going to evolve or change because of the needs of COVID-19? How are things fundamentally over the long term going to change because of a pandemic that may last for a year?
Dr. Mohammad: You know I feel that this COVID-19 disease is going to be around for a very long time. The pandemic itself may only last for a year but the precautions that we will have to take will be longer than a year. Osler, as you stated is one of Canada’s largest and busiest community hospitals. We serve a population that is growing tremendously, is very diverse, and a population that has a very high chronic disease burden just because of the diversity and genetic make up of the population. We serve right now more than 1.3 million residents across this part of the GTA, Brampton, Peel Region and northwest Toronto and having a political landscape where the community is very proud of their hospital, but at the same time very involved in every small change that occurs in the hospital, is not anything new for me. When we opened in 2007 the new Brampton Civic Hospital, we had a lot of community pressure then and that hasn’t changed.
I don’t believe Brampton was in a health care emergency as of October of last year, we’ve been in a health care emergency for a number of years, maybe more than 10 years. Our pressures are quite real as we continue to grow. We are at times called the epicentre of hallway medicine and probably everyone has hallway patients, but our city council and our community stakeholders make sure that the province knows that we have hallway patients. But at the same time, we have outperformed many hospitals on indicators such as ALC, emergency department wait times and other indicators that you may think maybe lagging because of our pressures. We’ve already been hit hard by COVID-19 in Peel Region and north Etobicoke but we need to look at all aspects of health care and infrastructure in this region. Our virtual care delivery program has now been accelerated and we are looking to bring even more modern virtual care aspects into the work we’re doing.
What is really important is that we haven’t stopped the push into what we want to do in terms of the redevelopment of the health care infrastructure in this region. We continue to talk to the Ministry about our cancer care program and what we’re going to do with our Peel Memorial Centre for Health and Wellness Centre in terms of adding more post-acute beds and mental health beds, and perhaps creating our 14-hour urgent care centre into a 24-hour centre. Now we’ve been planning that pre-COVID but we will have to pivot a bit because there are new guidelines coming in that says you can’t have more than two patients in one room when you’re admitting a person. We have in our oversights a large number of general ward rooms where we usually put four patients and if we’re going to go to two patients a room it’s really going to cut into our capacity. To mitigate that we will have to continue to work with the Ministry and with our community on a different type of hospital infrastructure.
We truly believe that integration is going to be the answer for a seamless health care system. We were one of the locations that was awarded an Ontario Health Team and we continue to work with our primary care providers, our specialists, our home health care services, Peel Public Health, Etobicoke Public Health, our long-term care homes and many other partners in the community to continue to a path of integration. If we can do that then we can certainly reduce the pressures not only on the hospitals but on every resource in the community. Those are the things we continue to work on as we get better at managing COVID and getting used to the new normal, those are the key aspects we will continue to push on to really build a modern health care infrastructure in this region.
Dan Carbin: One of the criticisms of the provincial government response to COVID-19, which is easier in hindsight, is that perhaps too much policy attention was placed on hospitals in the early stage of the crisis. Ensuring that hospitals had adequate PPE, ensuring that there was capacity within the hospital to deal with the surge in the ICU, really informed by the horrific experiences that we saw in Italy and a few other places. But those critics would argue that perhaps there wasn’t enough attention to long-term care, in leveraging the community sector and that runs counter to what many governments, have tried to deliver an integrated system.
Dr. Mohammad: I am not one of the people that is of the opinion that the Ministry didn’t handle this the right way. I think what we have to understand is that our siloed health care system has existed for a very long time and those of us that have worked in the front-lines, that have worked as emergency physicians that see these patients for the first time, knew very well that there were gaps or lack of resources in our long-term care sector, in our health sector and even in a lot of our community health care resources. Certainly we know that in the Etobicoke/Brampton region, I think it exists in most of Ontario and most of Canada.
What COVID-19 did was bring inefficiencies to the surface for everyone else to see. I think putting the onus on the hospitals really was the only way the Ministry could have gone, because that is where infrastructure existed. The hospitals were the centres that opened our assessment centres to begin with. Public health or a lot of our community resources were not able to open testing centres and put large numbers of people through those testing centres. If you look at Osler, we are now close to 60,000 patients tested through our assessment centres. The crisis started in March and only in the last three weeks has Public Health been able to create the pop-up centres going from place to place in the makeshift testing bus from community centre to community centre. But I don’t blame Public Health for that, I just feel that this what they were resourced with thats how long it took them. That’s why hospitals became key players. We were quite concerned that as we focused on testing, nursing homes or long-term care homes we were going to be taking away some of the focus and resources so we had to be really careful.
Dan Carbin: On Ontario Health Teams, can you talk about how even during the pandemic William Osler has worked with its community partners, in the community sector, community care, in primary care and also in long-term care? Osler has been asked to step in as the active management to improve infection control in long-term care in Vaughan. What have you learned in this experience and those ties to your community partners, and how do you build on those as you emerge from this first wave of COVID-19?
Dr. Mohammad: We had a number of homes in our region and our peer hospitals, Humber River and Trillium Health Partners faced the same issues. We worked together on it, where a number of homes were in difficulty in our region and a number of homes were in what we call red status or outbreak and we all did our part. Osler did assessments in more than 20 homes to provide advice on infection prevention and control, to transfer some of those patients into Osler just to be able to cohort patients in that home in a safe manner. While we were doing that work we were one of the hospitals that was assigned the task of managing one of the long-term care homes in Vaughan, just north of Toronto, as we took over the management of Woodbridge Vista in the last two weeks. We have been working on a management plan with Sienna who owns the home. It’s been a really collaborative two-way relationship that we have built with them and I think that there will be some great things coming out of that.
Now we had started our Ontario Health Team work more than a year ago. We were already fully into building a health team, so we had significant relationships that had been built with primary care and with home and community care, with other long-term care homes. What that did was that during a time like this, everyone stepped up. I really do want to thank the primary care physicians in the community that did step up and help us in not only directing patients appropriately away from the hospital and those that need to be away from here, but also for stepping up and helping us in our long-term care homes going in as physicians, assessing patients, and also they provided a significant amount of help in our assessment centres in manning the assessment centres. That was just primary care physicians.
All of our other health care partners in the community were able to really build on the relationships that we had already built through our Ontario Health Team to serve this community well during the COVID crisis. In hindsight, the difficulties in COVID may actually make it easy for us to accelerate to an integrated system because of the work we have done together and what COVID has done for enhancing everyone’s desire to do virtual care. Physicians want to do virtual care now, patients want to do virtual care and we as an organization we will be putting in resources into more virtual platforms so that we can keep the hospital safe. We have to screen less patients, less traffic in the hospital and we can social distance better and a lot of patients, especially our seniors can stay at home and see their consultants without having to risk coming into an area where they may be more exposed.
Dan Carbin: British Columbia, as an example, put out a very detailed analysis of backlogs related to the COVID-19 response. They predict it is going to take a minimum of two years to get through the surgical backlog as a result of cancelling elective procedures. We’re already struggling throughout Ontario with pretty significant wait times for a number of procedures with hospitals being asked to operate at lower capacity. You talked about not being able to have four people in the room as an example of that, how do you get things back to normal to serve the non-COVID health needs of the community as the province reopens?
Dr. Mohammad: In terms of non-COVID related health care issues, we have been really clear to our community that if you need to come to the hospital, we want you to come. What we don’t want is our patients staying at home self-diagnosing and self-triaging themselves and then getting into a situation that may be more troublesome. We’ve tried to really advise our community on how safe our emergency departments are, how we have separated the path to potential COVID or infectious patients and non-infectious patients, so we are going to continue on that in terms of the general care we provide to our community. As things get warmer in the summer, as parks open up and people start to get out there and be more active, they will need the emergency department more and more and we want to make sure they understand that the hospitals are still a safe place to come.
In terms of surgery, that is a fear that we’re all living with and in Ontario, surgery and ambulatory are being allowed to open up, but in phases. We at Osler have only this week been approved to start phase one of our recovery process. Phase one means we’re going to go up to 40-50 per cent of our usual, normal capacity. Once things ease up and we continue to maintain an adequate occupancy rate and an adequate amount of PPE, we continue to have human resources, we will be able to apply for phase two. There is no hospital in Ontario that is allowed to go to phase two, but once we go to phase two which will be in the next few months we will only be up to what we call 100 per cent of our capacity or at least attempt to get there. What that means is that we still haven’t cut into the wait times that have been created over this time. It’s only in phase three that we will be able to really up our game or add resources or hours so that we can start to chip into what has been created as a backlog throughout Ontario over this time. We continue to do urgent and emergency surgery patients that came into our emergency departments, or patients that were newly diagnosed with new problems that needed to get things done. We continue to do those patients but the backlog, I agree will take at least two years to get through.
We are looking at other innovative ways of trying to expedite that. Whether its adding evening hours or weekend hours to our clinics and OR’s, finance and resources permitting, but we’re also looking at surgery centres that are available in the community. Places such as the endoscopy and colonoscopy suites that are available in the community or the plastic surgery centres in the community. We are working with our physicians and community partners to see if we can transfer some of the minor procedures there and get things done. Those are just initial discussions, but that’s the kind of out of the box thinking across the province to really move the needle on the wait times.
Dan Carbin: Do you have any parting thoughts or comments for folks in your community or staff at William Osler or others in the system?
Dr. Mohammad: I think the only thing I will say is that everyone is talking about the new normal and that is what we need to focus on. The new normal will include some more difficult situations and how to navigate through hospitals. We will feel that when we go get on a train, when we get on a long distance bus and when we get on a flight. Things will be different for everybody. Not only for staff but specifically for our patients and I just want to make sure our patients understand that each hospital in the province is doing their best to make sure that safety is paramount before anything else. We will have to continue to talk to our staff and help them understand working in this different environment is not going to be a one or two month issue.
Right now, we’re all patient and waiting to see what will happen in the fall. Will there be a wave two? But what I know for sure is that every cough and cold and flu that walks in our doors, which is very common in October, November, December and January, we will have to assume that they are infectious and we will have to isolate them, test them and it will be very different from what we’ve faced in the past. It will mean patient flow may get hampered because you will have to put patients in private rooms until you can clear them from a test and then move them to a more congregate setting. These are things that I worry about in how long can our staff cope with this and by that I mean every organization across the country. In the end I think we will get used to it. It will take a lot of work and I am hoping that Osler will continue to lead in many of the things we have led through this crisis.
Dan Carbin: Thank you again for sharing your time and perspective today and best of luck.