Greg Ottenbreit, minister responsible for Rural and Remote Health, cut the ribbon Thursday to officially mark the opening of the Canora Health and Wellness Centre. The ribbon was held by MLA Ken Krawetz, Sunrise CEO Suann Laurent, Lawrence Chomos (Sunrise Health Region board chair) and Mayor Gina Rakochy.
An idea conceived more than five years ago, the celebration marked the dream coming to fruition in its final form. The collaborative emergency centre (CEC) model went into operation in July of 2014, but this was a celebration to mark the grand opening of all the services now offered under one roof.
The CEC is essentially the emergency room of the hospital which is staffed by doctors from 8 a.m. to 8 p.m. For the next 12 hours, the emergency room is run by registered nurses, a paramedic and a direct link to a STARS doctor in Regina or Saskatoon. The Canora Health and Wellness Centre replaces the former Canora Medical Clinic, allowing doctors, the nurse practitioner and various therapists and specialists to work from under the same roof – all in the name of improved efficiency.
While the Health and Wellness Centre operates under the same roof as the hospital, its administration structure is different. While Jennifer Richardson is the manager of the hospital, management of the Health and Wellness Centre is the responsibility of Mary-Jean Vogel, Sunrise’s manager of Primary Health Care-Rural. A Sunrise pamphlet describes the primary health care team as part of a broader, closely connected network of health professionals that includes, but is not limited to doctors, nurse practitioners, mental health and addictions services, occupational and physical therapists, chronic disease consultants, public health, home care and dietitians.
Speaker after speaker took note that when Sunrise and Canora began to move in this direction, it was in an effort to make 24-hour emergency health care a sustainable service in the community. Previously Canora had to often suffer the consequences of being on emergency room bypass because of a lack of physician coverage. Having emergency room coverage was deemed over taxing on the local doctors which limited the appeal of doctors setting up a practice in the community. Since the CEC model was launched in July of 2014 the hospital has not been on emergency bypass even once.
The model works, said Laurent. Not only will it help recruit physicians, it is welcomed by the physicians because each is afforded more personal free time. For clients, it better serves them not only because of the convenience of having all the services under one roof, but access to the primary health care team is extended; 8 a.m. to 8 p.m. weekdays and from 8:30 a.m. to 5 p.m. on weekends.
“Canora Health and Wellness Centre is a great example of patient-centred care,” Ottenbreit said. “It provides a ‘one stop shop’ for patients, where they can receive stable, timely access to health services in the community. Our government is pleased to support this model of care that enhances the patient experience while improving work-life balance for our excellent health care providers.”
Dr. Hamed Afshari, the latest doctor to join the primary health care team, said he was impressed with the design and how well it serves patients with the emergency department, lab and X-ray departments all being so close.
”As a member of the primary health care team, I can offer my patients more options for appointment times and, because the CEC takes over in the evening, I am able to spend more time with my family. It is a very good system and one that attracted me to Canora.”
“We are very pleased with how well the CEC model of care is working in Canora,” Laurent said. “Since the CEC model was implemented, there have been no emergency department service interruptions, and primary health care appointments are more accessible with longer weekday hours and weekend appointment times available.”
“Thank you to the community for the support and to the health region and health care providers for their leadership and hard work to make this happen,” Krawetz said. “This new centre is a wonderful example of how great ideas and partnerships benefit residents and help keep Saskatchewan strong.”
In making reference to statements made by other speakers referring to the genesis of the CEC model first being conceived in 2010 at a conference in Regina at which former mayor Terry Dennis accompanied Laurent to learn about the Nova Scotia CEC model, Krawetz said the idea came even earlier. As first ministers, Premier Brad Wall and Premier Robert Ghiz of Prince Edward Island were tasked with the job of coming up with new methods of making rural health care sustainable. It was through their work that the Nova Scotia CEC model was identified as a possible solution for rural Saskatchewan. The government planned for five CECs to be set up in rural Saskatchewan and Canora’s was the third to be offered as a pilot project.
The provincial government contributed $775,000 toward the renovation at the Canora Hospital and is providing $375,000 in annual funding to support the operation of the CEC in Canora, said Ottenbreit. He had a lot of praise for the Town of Canora, several surrounding municipalities and the local health foundation which is working hard to fulfill a goal of providing additional funding of approximately $200,000 to cover primary health clinic equipment, furniture and other expenses. In total, the project cost more than $1 million.
“The Town of Canora has long promised a lifestyle focused on strong family values that are centred around small town living with great education, wide recreation opportunities and the very best possible health care,” said Mayor Gina Rakochy. “The Health and Wellness Centre is a testament to one of those pillars.”
Canora is the third fully implemented CEC in Saskatchewan, said Ottenbreit. CECs help provide access to stable, reliable health services and alleviate emergency service disruptions often experienced by rural communities. It is a model that will be emulated by other communities in which CECs will be set up.
Between Laurent and Sandy Tokaruk, who was the master of ceremonies, many thank-you’s and words of congratulations were extended to numerous team leaders and individuals who all contributed to the design of the facility and in making the transition work. Given special mention were Terry Dennis and Karen Wishlow of Canora who served as client representatives to provide input from the perspective of the clients who will be using the facility.
Ottenbreit paid special compliments to Ken Krawetz who he described as a strong advocate who ensured that the Health Ministry was paying attention and willing to provide the government’s support to the project.
He described the newly integrated facility model as a legacy for generations to come.
Implementing a new model of health care is always a challenge, but in Canora there was a strong team that worked diligently to come up with a shared vision. And what is always the case, is that it takes a strong commitment from the front line staff to lead the community through what can be a difficult transition period.
Tokaruk introduced Derek Keller, Sunrise’s director of EMS/Medical Services, who had the task of designing the treatment model for the CEC’s night hours, and Mary-Jean Vogel, manager of Primary Health Care-Rural, who worked with the front line workers to make sure the flow of the new facility was open to constant improvements. Vogel stated that the system is working because there is less use of emergency services at the hospital.
In making the closing remarks, Lawrence Chomos, the Sunrise board chair, noted that the delivery of health care had to change. What worked decades earlier is no longer working and is no longer sustainable.
“This new model is a model for the future,” Chomos said.
After the formal program, public tours of the facility were given for the rest of the afternoon.
TeriLynn VanParys, the Primary Health Project manager, was the main tour guide, pointing out the main components of the Health and Wellness Centre.
Beyond the reception area, the Centre has eight examination rooms. All are essentially designed the same with the exception that one is specially designed for bariatric patients and another is connected to the therapies room.
A lot of thought went into design going as far as offering “high-low” desks/tables – work tables that can have their height easily changed to accommodate whether the doctor is standing or sitting, she said. The rooms are all equipped with “high-low” examination tables.
VanParys pointed out how the rooms are stocked using the “Kanban System” which will result in much greater efficiencies. Essentially, when shelves are stocked, a two-bin system is used and both are initially filled with a fixed quantity of supplies. When one bin is empty, it is moved behind the full bin and a card is flipped on the bin to signal to the supply managers that it needs to be re-stocked. The system promises reduced cycle counting, which means less non-value activity in the supply chain department.
The Centre has a “specimen room” which is touted as a much better way of handling specimens collected from patients, VanParys said. In previous doctor clinics, the physicians and staff were happy just to have a sink available nearby.
The “Team Hub” room (also called a consultation room) with eight work stations is the heart of the “smart” communication system and digital filing system used throughout the facility, she said. Physicians and other staff can use their key cards to gain access anywhere in the facility for seamless communication and digital filing.
The multi-purpose room is the biggest space in the Centre, but it can also be divided into two rooms by means of a folding wall, she said. The room is equipped for various therapies and it is where the Telehealth access is located. When the wall is removed, it can be used for meetings and conferences.
A lot of thought was put into the flow in the facility, VanParys said. It was designed to be separate from the hospital and emergency areas, but it also offers doctors direct access to the trauma area (rather than having them walk all the way around).
There have already been adjustments made for patient/staff flow and it is an area that will likely constantly be improved, she said.