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February 12, 2019
Standing Committees
Meeting summary: 

Legislative Chamber
Province House
1726 Hollis Street
Nova Scotia Health Authority
Janet Knox – President and CEO
Mr. Tim Guest – VP Integrated Services
Accreditation Canada 2017 Report on Nova Scotia Health Authority

Meeting topics: 

















Tuesday, February 12, 2019





Accreditation Canada 2017 Report on NSHA





Printed and Published by Nova Scotia Hansard Reporting Services









Mr. Gordon Wilson (Chairman)

Ms. Suzanne Lohnes-Croft (Vice-Chairman)

Mr. Keith Irving

Mr. Ben Jessome

Ms. Rafah DiCostanzo

Ms. Karla MacFarlane

Ms. Barbara Adams

Ms. Susan Leblanc

Ms. Tammy Martin



[Mr. Hugh MacKay replaced Mr. Gordon Wilson]

[Hon. Leo Glavine replaced Mr. Keith Irving]

[Mr. Bill Horne replaced Mr. Ben Jessome]



In Attendance:


Ms. Judy Kavanagh

Legislative Committee Clerk


Mr. Gordon Hebb

Chief Legislative Counsel





Nova Scotia Health Authority


Ms. Janet Knox - President and CEO

Mr. Tim Guest - VP, Integrated Services

Mr. Colin Stevenson - VP, Health Services and Quality & System Performance

Dr. Mark Taylor - Interim VP, Medicine









1:00 P.M.



Mr. Gordon Wilson



Ms. Suzanne Lohnes-Croft


            MS. SUZANNE LOHNES CROFT (Chairman): Order. I call this meeting of the Health Committee to order. This is the Standing Committee on Health. I am Suzanne Lohnes-Croft, vice-chairman of the committee, filling in as chairman. Today, we welcome witnesses from the Nova Scotia Health Authority to discuss the Accreditation Canada 2017 Report on the Nova Scotia Health Authority.


            I would like to remind members to turn off their phones or put them on vibrate. Note the locations of the exits, which I have been looking for. They are only in the gallery. Those of us on the main floor here will just exit through the front doors. We’ll go out the back door and meet in the Grand Parade should there be an emergency.


            The current seating arrangements are arranged so that Legislative TV can pick up your microphone. Also, please wait to be addressed by the Chair so that we can make sure your microphone is on. I will ask committee members to introduce themselves. We have a few substitutes, and we welcome them to the committee today.


            [The committee members and witnesses introduced themselves.]


            MADAM CHAIRMAN: Our topic today is the Accreditation Canada 2017 Report on the Nova Scotia Health Authority. I will ask for opening statements. Ms. Knox.




            MS. JANET KNOX: Good afternoon and thank you. I welcome the opportunity to be here with you along with my colleagues who have just been introduced.


            In October 2017, a team of 30 surveyors and one patient surveyor from Accreditation Canada visited the Nova Scotia Health Authority. They spent time in our hospitals, facilities, and community placements across the province observing and talking with employees, physicians, volunteers, patients, learners, clients of our community programs, families, and community partners. This occurred through structured meetings and through their site visit and assessment process.


            The visit was part of Accreditation Canada’s peer review process, which helps health care organizations like ours assess the services they provide to their patients and clients based on national standards of quality service. It is a snapshot at a point in time of how well an organization is doing its work. It provides an opportunity for us to test what we are doing well and where we need to improve. The overall accreditation process is based on a combination of self-assessment, compliance with national standards and required organizational practices, and the development and implementation of quality improvement plans and activities.


            This was the Nova Scotia Health Authority’s first organization-wide survey, after transitioning from nine to one Health Authority. It was an incredibly valuable experience for our organization. We learned a great deal.


            The surveyors visited 53 sites from Yarmouth to Sydney and everywhere in between, assessing the organization on 28 evidence-based, system-wide, and service excellence standard sets. In total, they reviewed 4,014 quality and safety criteria in areas ranging from governance and leadership to risk management, infection prevention and control, and medication management.


            Overall, we met 92.9 per cent of the criteria and were granted “accredited with report” status. That meant that we had succeeded in meeting the fundamental requirements of the accreditation program, but still had more work to do. We have since completed all the necessary requirements, and in November 2018 received notice that we have maintained our full accreditation status.


            Given that this was our first province-wide survey and that we were only in our third year as an organization, we were pleased with the decision and felt that we had met the goals we had set for ourselves as an organization at the beginning of this important process.


We wanted to focus on consolidating and standardizing our practices so that we could enhance quality and outcomes, to identify best practices and help spread them across the province, to ensure that we had the right foundation for the alignment of policies and clinical practice, and to identify areas for improvement. We saw this as an excellent opportunity to highlight our progress as a provincial organization and to gain valuable insight as we moved forward. The feedback we received from our surveyors and from within the organization has indicated that we are on the right path.


            The accreditation process is not intended to be an end to improvement activities. It is a point in an improvement journey. The survey team helped us to identify or confirm areas that we needed to focus upon. These included the process of transferring patient information between units and departments when a patient moves through the system, our patient identification practices, our medication reconciliation process, our falls and suicide prevention strategies, and our management of patient flow. The report also noted a need to enhance focus on people, pace, and resiliency; continue to reduce variation across the organization; strengthen public and community partnerships; address building and infrastructure challenges we face; and advance our health services planning - all things which we had been working diligently on.


            We know we have more work to do, that is a constant in health care, and we are using the information provided by the Accreditation Canada process to help us move our quality improvement efforts forward.


            At the same time, I want to say we’re very proud of our teams and what they have accomplished and what they do every single day for the people of this province. The accreditors noted many strengths, including the commitment of our staff, physicians, and volunteers, and a strong and committed leadership team, as well as meaningful patient and family engagement. They also acknowledged the diverse, experienced, competency-based board of directors who met 100 per cent of their governance standards.


            The surveyors told us that we have much to be proud of, including the enormous progress since the creation of the Nova Scotia Health Authority, a demonstrated commitment to our work by all the people they met, and a solid vision for the future of health and wellness for this province. Despite the challenges we are facing in our health system, we can’t lose sight of the tremendous efforts and commitment of our teams every day as they meet people in this province, to provide them high-quality care, and to ensure safety and service.


            The organization was also recognized at that time for five leading practices, which are essentially innovative solutions to improve quality. A leading practice is determined by the National Health Standards Organization, which is affiliated with Accreditation Canada. The teams that were recognized at the time of our accreditation were:


1. The Dartmouth General Hospital pressure ulcer team;

2. A client-centred wait-list management model for ambulatory care;

3. An ambulatory medication reconciliation process for our renal program;

4. A Seniors’ LINCS Walk ‘n’ Roll program; and

5. Our Patient Stories initiative.


This is just some of the great work that is happening every single day throughout our organization.


            We value the accreditation process as it provides a road map for our ongoing quality improvement efforts and it helps ensure we continue to develop as a quality- focused organization with consistency in the delivery of care across the organization.


The accreditation process provides us with an opportunity for self-reflection, learning, and improvement.


I’ll finish with the words of our colleagues from Lakeridge Health in Oshawa, because they serve as an important reminder to us every day: “We are not working on meeting accreditation standards because the surveyors are coming tomorrow. We are working on meeting accreditation standards because our patients are here today.” - and they’re important to them.


            Thank you very much. We look forward to the conversation.


            MADAM CHAIRMAN: We will now open the floor to questions, starting with Ms. MacFarlane for 20 minutes.


            MS. KARLA MACFARLANE: Thank you so much again for being here. Thank you for all the work that you have accomplished to date. Thank you for recognizing that there is still ongoing necessary work that needs to be addressed as well.


            Going forward, I’m wondering if you can explain the governance functioning tool and what exactly it was used for and how it was administered. We know that there might have been a questionnaire, but who did the questionnaire go to? Who completed it? Was it sent out to Nova Scotians? Did the board themselves complete it? I’m wondering if you could start with that, please.


            MS. KNOX: I’ll start, and Colin Stevenson, who leads our accreditation process, may want to add something to it.


            I did say in the opening remarks that it’s a self-reflection and a self-evaluation. The governance functioning tool is a tool that’s developed by the Health Standards Association and Accreditation Canada based on best governance practices. It’s a set of standards that describes how a governing body should work. In our organization, we use those standards to develop our teams.


            We would have been aware of those standards working with the board actually from before the board began their responsibility for the Nova Scotia Health Authority in their first retreat. It’s part of their education.


            The process of accreditation, though, that tool is administered through a portal we have, a website. Our board members then go in to our site that is loaded from Accreditation Canada, and they individually assess their own performance and describe the work that they do. That goes to Accreditation Canada. It’s not a group exercise. Individual board members have to do the assessment tool. That’s one thing, the governance functioning tool.


            To determine whether you meet the standards, then there’s a process. When the surveyors come in, two or three surveyors meet with the board and go through an interview process where they ask them to talk about their work and give examples to demonstrate that they’re meeting the standards.


            It’s a two-part process, a self-reflection on a questionnaire that goes to Accreditation Canada - not to us - and then an interview with the surveyors.


            Is there anything you would like to add, Colin?


            MADAM CHAIRMAN: Mr. Stevenson.


            MR. COLIN STEVENSON: The governance functioning tool is one instrument in the sense of the pre-assessment that is done by the organization. The other thing that would be submitted to the surveyors in advance of their visit would be documentation that’s required by the organization to prove or to demonstrate compliance with the specific standards that they’re being tested on. Both the governance functioning tool as well as us documenting as an organization, from a board perspective, how they have complied with the required standards - that would be provided to the surveyors in advance. Then when they come onsite and survey, they’re looking to verify and ensure that the information provided is correct and accurate.


            MS. MACFARLANE: I know in 2015, Accreditation Canada’s assessment of the IWK Health Centre indicated: “New board members receive an extensive orientation which includes the code of conduct, conflict of interest policy and the ethical framework for decision making.” I know that similar language was also used in this report that we are discussing. My question is, are you confident that NSHA will not necessarily experience the same failure of board governance as the IWK has?


[1:15 p.m.]


            MS. KNOX: I feel very proud of our board and the work that they’ve done in terms of really looking at best practices. I can’t comment on another organization. We can only talk about our own organization. What we have is a board that has built education, in terms of best practices, into the work that they do, so there’s educational programming for the board, both at a retreat, one-day kind of session every once or twice a year, but also education at their board meetings. We have all of the kinds of policies that you’re talking about in terms of conflict of interest, ethics, framework, and all of that work.


            We look to places like Accreditation Canada to come in and help us say, is there something else that we should be doing? But we don’t just stop there. It’s the same as our entire organization. We’re constantly reviewing best practices in terms of governance and working with our board to say, what are the kinds of things that we need to do differently?


            It’s a constant level of improvement. I can say, as the CEO of our organization, I feel very supported by the board in the quest for constant improvement.


            MS. MACFARLANE: Accreditation Canada raised concerns though with the absence of exit interviews. We all know that there are a number of doctors that I’m aware of that never had an exit interview, along with other allied health care professionals. What steps are you taking to correct this situation that has been addressed in this report?


            MS. KNOX: Exit interviews are very important, and so our Human Resources Department has been helping us develop the process to do that. I agree, whenever Accreditation Canada came in in 2017, we were not at the place we needed to be. Would I say we are where we need to be right now? No, we are constantly improving that, but it’s very important to have an opportunity and to have people to have exit interviews in a way that they feel they can say what they need to say. We’re developing that process to be very careful about that - so not an exit interview with the person that you used to work with, a separate person.


            MS. MACFARLANE: Who actually will conduct the exit interview?


            MS. KNOX: It will be different, depending on which group it is. It may be that we have to use some external support to our organization, or it may be that we have a group in our Human Resources Department that will do them for different departments.


            MS. MACFARLANE: I know we had a doctor in Pictou West exit and received a thank you note once he was in Ontario a year later, thanking him for his services - a whole year later. What exactly is the intention to have these exit interviews, and at this point have any been conducted at all, and what is the information that you have gathered to this point that can help enhance retaining these physicians and health care professionals to remain in Nova Scotia? What are you finding out?


            MS. KNOX: One of the things that we found out is the issue in terms of recruitment - when physicians came on board, how fast or how challenging it has been for them when they came. I talked to a physician the other day who still remembers seven years ago when he came into this province and how long it took him to get his licence, to really understand some of the work that he had to do to set up his practice.


            Even hearing from people who have been with us for some time, when they decide that they need to move on, they have something to share. One of the things that helps, we have a Recruitment and Retention Advisory Committee that we put together around physician recruitment and retention, and we have all the stakeholders that could possibly, we think, have some input - so they’re talking into recruitment, but also into retention.


            We had different conversations over the last three years with the College of Physicians and Surgeons, Doctors Nova Scotia, Dalhousie Medical School, and our own folks internally at the Nova Scotia Health Authority. We all need to do things differently. That is the value, I agree with you 100 per cent, in hearing the experiences of our people, their lived experience in our organization. Even if they’re prior to this organization, we really need to take the opportunity for enhanced improvement of these processes.


            MS. MACFARLANE: Did the Health Authority conduct an exit interview with Dr. Jeannie MacGillivray from St. Martha’s Regional Hospital in Antigonish after she resigned?


            MS. KNOX: I would not like to talk about individual situations. I’m very aware of the privacy rules, so I cannot talk about individual situations.


            MS. MACFARLANE: As far as we know, and in speaking with Dr. MacGillivray, there has not been an exit interview. Could it happen later on, perhaps, if it hasn’t happened at this point?


            MS. KNOX: An exit interview can happen at any time, absolutely.


            MS. MACFARLANE: The report also states: “The organization is encouraged to conduct regular performance reviews for all staff, to contribute to their development and skills. It does not appear that performance reviews are being undertaken systematically across the organization.” Therefore, there’s a lot of inconsistency across this province. I’m wondering if the NSHA has decided to conduct or develop performance reviews for all staff across the province.


            MS. KNOX: I’ll start, and Colin Stevenson could help with our process, because I think your question is: how do we take what we have been told in the accreditation survey and build a plan?


            In terms of performance appraisals, when we became the Nova Scotia Health Authority, we had nine organizations. That meant there were nine different ways, in fact, maybe even different beliefs around performance appraisals, as an example of one of the strategies. We have had to develop our model in terms of what we believe, in terms of constant development for our staff. We have developed a leadership framework that guides that work.


            We now have a whole performance plan that describes, beginning with job descriptions, an individual’s job description and how you help them grow and develop in their role. There are expectations for when performance appraisals should be done, and there are specific guidelines on how to do that. A performance appraisal also includes, at that time, a growth plan for the individual. This is a big challenge across the country in terms of how many people actually see performance appraisals. We have looked at different models.


            A full performance appraisal needs to happen every second year, but at least every year there needs to be contact with that employee and their manager to discuss what’s happening in the workplace, how they feel about their role, and what things they want to do to grow and develop. If you ask me, are we at 100 per cent? Absolutely not. I can tell you I get a report annually for the people who report directly to me about who has had a performance appraisal - it should say 100 per cent; mine does - and when those were happening, with a note of when the next one is expected to happen. I have to document that it has happened, and the report has to go to the HR file.


            We have the program in place now, and we are working hard to make sure that people get the support. It really is about creating the environment where people are getting feedback in their workplace. That goes a very long way. We have a lot of work to do across this country because our scopes of manager to staff can sometimes be large, and we have to look at different ways to be able to accomplish that.


            MR. STEVENSON: Maybe just to add - Janet mentioned at the start in the sense of our process and approach, when there is an improvement area that has been identified through the process, some of that actually starts as part of our own self-assessment, understanding whether or not we ourselves are feeling we’re fully compliant with what the requirements are within the standards. Each individual team that has responsibility for that particular standard area would establish or develop their own action plan, so that they’re identifying what steps they need to take, and then within our organization have accountability to report on the progress that they’re making within that.


            If you look specifically at performance improvement or performance development plans within manager positions or staff, there was a process that was in place and in development at the time of our survey. Since then, we have done a further evaluation and assessment, and received feedback from our staff and leaders from across the organization. I’ve recently implemented a change to that process to try to better meet the feedback we received from the surveyors.


            MS. MACFARLANE: I have one more question and then I’ll pass it over to my colleague. I noticed that Accreditation Canada did observe that NSHA does not have a central work order system. I have often heard people going in to have tests done and then something breaks down. It’s very concerning because then it’s delayed and often I think we even have to reach out to other provinces to have individuals come in and fix the system.


            I’m wondering if there has been any development on this request to improve the system and if there is any standardized work order system being developed as we speak.


            MR. STEVENSON: There has been some progress associated with that. When they talk about the work order system, they’re talking about the ability for individuals in any facility, site, or service across the organization to be able to identify that they need maintenance work done. It could be something that’s happening within the facility in the sense of the walls, the floors, the lights, the electrical, the plumbing, or a specific piece of equipment. Really, the intention is to try to understand the complexity associated with what’s in your space, and that you have the ability to submit some requests.


            There has been some progress. It’s still in development and it’s not necessarily a single system, but we have looked at and started to build in the approach to consolidate that within each of our four management zones.


            In addition, there is a consolidator or single organization-wide approach to being able to assess risk associated with equipment purchase or repair as well as our infrastructure so that we can identify major initiatives or projects, as well as minor shifts or changes, and that they get targeted to the right funding source, are selected based on an identified list of criteria, and there is interdisciplinary participation - folks from different disciplines and across the organization that can contribute towards the setting of those priorities.


            MADAM CHAIRMAN: Ms. Adams, with less than two minutes.


            MS. BARBARA ADAMS: I guess I’ll start with asking a numbers question. Thank you for the graphic that you gave us. Can you tell me how many people are sitting in an acute care bed that are actually waiting for a long-term care bed?


            MADAM CHAIRMAN: Mr. Guest.


            MR. TIM GUEST: I can’t give you an exact number right off the top of my head. Certainly we could give it to you after. It fluctuates, but at any given day we would have about 136 people across the province that are either approved and waiting or in the process to be looking towards - not necessarily just long-term care, it could be long-term care, it could be DCS housing, it could be some support service in between, but give or take on any given day, that’s kind of the number that we would have that would need a service other than hospital care that would be in a bed.


            MS. ADAMS: My understanding is that the estimate is higher than that, and at times like last week, the husband of one of my constituents was moved from the Dartmouth General, where he had been waiting for four months, over to the VG to a transitional care bed on the third floor, which is not a transitional care unit. He’s now sitting in a place that is not designed for him, and there’s no sense of how long he’s going to be there. How many acute care beds have been converted to transitional type care beds?


            MR. GUEST: We would have some designated beds in facilities from across the province. I wouldn’t say that we necessarily designated them as transitional care, but what we try to do is coordinate care of individuals who have those needs in the common place. Generally, they have some similar needs, and their care can take a little bit longer. It also allows us to adjust the team.


I can give you an example. We have space that has been designated in the Central Zone for individuals who are in a transitional period. We have beds, as an example, in Middleton for that. We have beds at the Aberdeen in New Glasgow that have that function. There’s a variety of them across the province. We ebb and flow them as we need.


[1:30 p.m.]


            MADAM CHAIRMAN: Order. Time has lapsed for the Progressive Conservative caucus. We’ll move on to the NDP, Ms. Martin for 20 minutes.


            MS. TAMMY MARTIN: Thank you for your presentation. The accreditation report indicates that there is some unmet required organizational practice around client flow in emergency rooms. Can you please explain, in layman’s terms, what that means?


            MR. GUEST: When the surveyors came, what they did is, they went through our facilities, quite a number of them. They looked at a lot of our processes. They looked at how well we’re transitioning people through.


            When some of our client flow processes don’t work as well, they result in things like - which I’m sure you know - overcrowded emergency departments and ambulance off-load issues. They looked at some of the things that we were doing in comparison to the standards and they actually gave us some really good feedback. We have done some really good initiatives with the implementation of our patient flow system, as an example. We have fairly robust data that identifies what some of our common challenges are. I think they also gave us some really good feedback about things that they thought we needed to continue to do.


            We had variable processes across the province when we were merged into one organization, different priorities with how we moved individuals. As an example, some of the previous district health authorities would take individuals out of their emergency department into vacant beds, maybe first, and others might take them from somewhere else. We really needed to coordinate our approach so that we were all rowing the boat in the same direction. That’s largely what the process of that was.


            MS. MARTIN: That’s actually a good segue into my next question. It has been about a year since the paramedics union started their campaign on Code Critical. Since January, there have been 113 Code Critical incidents, and I’ll table that document. There were 113 incidents just since January. I’m just basically looking for a yes or no - are you familiar with these numbers and/or the program?


            MR. GUEST: I am aware of their initiative. The numbers, no, I have not seen them directly. I’m certainly aware of the fact that they’re tracking them, yes.


            MS. MARTIN: You may also know that there were 336 incidents of units being out of service in October, 274 in November, and 379 in December. That’s a total of 989 incidents in the province where ambulances were out of service.


            Paramedics are saying that the Code Critical incidents are related to off-load pressures in the emergency departments. When EDs are overwhelmed, paramedics can’t transfer their patients into the care of the hospital and end up stuck in ambulance bays. The more ambulances that get stuck in bays, the fewer ambulances that are in service.


            The accreditation report also identifies the backlog of alternate level of care, or ALC, patients as part of what’s stressing the emergency rooms. Surge capacity in emergency rooms is also influenced by flu season. According to the report, “In most settings, it is a direct consequence of too many alternate level of care patients and limited opportunities to place these patients.” That’s on Page 111 of the accreditation report.


            If you could, please explain to me what the limited opportunities are to place these patients. Would it be fair for us to conclude that there is a lack of ALC and/or long-term care beds? Would it also be fair for us to conclude that we need a significant investment in long-term care in order to start to resolve these issues from Code Critical to lack of beds in emergency room overcrowding?


            MR. GUEST: There are a number of questions there and hopefully I will catch them all. Certainly, you’re right - when you look at emergency department overcrowding and the ambulance off-load issue, very much they’re a symptom of a larger system problem. That really is that we have challenges with pressures on the in-patient beds, which put pressure downstream.


            Up until now, the emergency departments across the province and EHS have largely been a buffer that has allowed the system to kind of cope with that situation. That ability to buffer has been tighter and tighter, and it’s really requiring us to take more urgent action.


            I would say that there are a multitude of options that are available as solutions. Certainly, long-term care beds are one of them - I would not say they’re the only one. There are significant numbers of individuals who are in hospitals that need care in a different setting. It’s not necessarily long-term care that they need. It could be that they need antibiotics two or three times a day and there isn’t enough home care in that community in order for them to be at home, as an example. It could mean that maybe they have a complex wound that needs to be changed, but there might not be sufficient resources in the community they reside to be able to access it.


            We also have individuals that are in beds simply because they live in a community that doesn’t have transportation resources that if they didn’t have it, they wouldn’t be able to come into the facility for a community-based service.


            There are all kinds of examples of how I think the hospital system has become the catch-all for gaps in the social safety net. There are multiple options and opportunities that we could look at that would make a difference.


            MS. MARTIN: Thank you for that.


            MADAM CHAIRMAN: Did all your questions get answered?


            MS. MARTIN: I’m sure - I may revisit something. What happens then when a patient is medically discharged, but remains in a hospital bed because the community doesn’t have the required service or there’s a lack of home care or support or whatever?


            Last year, we found that 20 per cent of our acute care beds were being taken up in these situations - one particular lady in my riding. What is the process there?


            MR. GUEST: I think there are a couple of processes that we have available to us. Certainly, we can look at being able to utilize other facilities where maybe there would be less demand. In your community, as an example, some of the smaller sites like New Waterford, Glace Bay - sometimes there are opportunities to be able to use those that maybe have less pressure on the beds.


            We have the ability to work with community partners for complex clients to be able to put additional services in place, maybe from the Department of Community Services or home care. We can request additional approvals for extra services that might not normally be available, as examples to try to get those individuals home.


            MS. MARTIN: What is the process then if they remain, because as we know, there are wait times for home care, there are wait times for long-term care. As well, there are many instances where there are patients in emergency rooms who are waiting for placement. What happens to those people? In one particular instance, she waited close to a year. What is the process? What happens then?


            MR. GUEST: If we’re not able to put in place a plan that would meet a client’s needs in the community, what could happen is, they may need to remain in one of our facilities. Our goal is to try to put them in the location that meets their needs in the best way we can. In doing that, we try to maximize our resources so that the facilities that might have additional demand on them, like the Regional Hospital as an example, we try to not use them as our first option, because that has a significant impact on access for individuals who would actually have a higher acuity and have a care need that’s more in line with the service offering in those facilities.


            MS. MARTIN: The report also talked about the amount of time it takes for staff to move through the system to other positions or to be hired using the Success Factors system. Am I to understand that these positions, these chronic vacancies that we have in many hospitals across the province could be filled more efficiently using some other process?


            MR. GUEST: I would say that with the implementation of that system, we have had some growing pains. We have had some process challenges, and they have been related to individuals learning how to use it and maybe to some challenges with the system being a little cumbersome at the beginning. We have certainly worked with our IT colleagues to tweak the system as we have found challenges with it. To be brutally honest, there are some efficiencies that we could glean from tightening that up.


            We do have some situations where we have had vacancies for prolonged periods of time while it has gone through those processes. Our Human Resources Department has narrowed that gap down. But as a clinician on the operational side of the organization, there certainly are times that I hear from our managers that that could get better.


            MS. MARTIN: Would it be fair to say that this is having a significant impact on the emergency room overcrowding crisis that, quite frankly, we’re seeing in emergency rooms across the province?


            MR. GUEST: No. Certainly, I would say there are times when it could be a contributing factor, but I would say that the reality is there is just as much of a chance that there could be individuals that we actually can’t recruit into the vacancy in the first place. That would be more of a contributing factor, and that would be geographical in nature. We have some locations in the province where we do have a challenge right now recruiting into. Yarmouth is a really good example of that. Sydney has been an example in the past of where we have had to be much more creative with how we staff some of those specialty areas. I wouldn’t say that the technology for how we post is the issue as much as maybe the availability of the individuals to recruit.


            MS. KNOX: I just wanted to add some information - this is a great question that you’re asking. When we began as the Nova Scotia Health Authority, we had 50 collective agreements. We now have four, so that has changed some of the issue in terms of posting and time frame.


            The other thing is that we have one Health Authority with 23,400-some staff, and 80 per cent of our positions are filled from within. I remember a young man who was 35 years old and said he had been waiting to go home to Amherst. The job became available, and he left Halifax and went home to Amherst. That takes some time and adds time to our posting.


            They’re all staying in Nova Scotia, and we’re helping them find their place to be. I just wanted to tell you that it is really challenging, though, from the perspective of trying to fill that position that we need right now that’s vacant, but we want Nova Scotians to have their place to work. I just wanted to tell you that. It’s one of the realities that we live with.


            MS. MARTIN: To be brutally honest, I was part of the bargaining committee for not the 50 collective agreements for the province but for the unions. It was never as cumbersome as it seems to be now.


            To revisit the issue about exit interviews, specifically talking about Cape Breton and the lack of senior management and senior leadership in that area, talking about Dr. Meghan Keating, who has resigned her senior leadership position but kept her family doctor, Dr. Stephanie Langley, who is the lead for the Northside General Hospital, and Dr. Carol Critchley. I’m wondering - because from where I sit, there seems to be a pattern, especially when it comes to Cape Breton - I would like to know, what is the NSHA doing to resolve the crisis? Are you talking to the specific doctors who have abandoned their position because of the lack of support?


[1:45 p.m.]


            I realize that you may cite privacy issues, but these three doctors have been very public, saying that without the support needed in Cape Breton, they have resigned their senior leadership positions. Have you spoken to them and investigated, and what are you doing to fix this?


            MS. KNOX: Many of our folks have spoken to them and continue to speak to all of our physicians who are in leadership positions. We have more than 175 physicians who are in leadership positions around this province. We do have turnover in our organization of about 2,000 people a year. There are 24,000 people so we know that there will be turnover. What we hope is that when people leave positions, we find out what was important to them so we can learn from that.


            We are doing some work with Doctors Nova Scotia and others around physician leadership and leadership development, so I think that perhaps Dr. Taylor can offer some comment in terms of some of the things that we’re doing. We do have a lot of physician leaders in this province who are working really hard, and we have had turnover in other of those positions as well. They are really challenging positions for clinicians who maintain a clinical load as well.


I take your point, they’re really important people. They’ve done really good work and we thank them for their work, and we have to respect if it’s not the role that they want to have at this time. It’s really encouraging to us though when they stay and continue to be very focused on their patients. Perhaps we could ask Dr. Taylor to talk about our work on leadership development.




DR. MARK TAYLOR: We have a number of initiatives under way. Most recently there was an event in Truro a couple of weeks ago. The initiative was started by Doctors Nova Scotia, and all five organizations - the Nova Scotia Health Authority, the IWK, Doctors Nova Scotia, the Department of Health and Wellness, and Dalhousie University - all brought together physician leaders from all of those organizations. There were 54 physician leaders. It was a very exciting evening and a really positive event, and everybody is really interested in moving forward together to resolve all of the issues that we face.


We’re also working on the possibility of establishing a section within Doctors Nova Scotia of physician leaders as a section of Doctors Nova Scotia. We have in the Central Zone, where I am, a group of individuals who are employees working on physician leadership development. We’re putting together a tool to be used throughout the province that will help us with assessing the capacity of physician leaders.


We’re also working with the Medical Council of Canada bringing forward - just to get back to a point raised earlier about performance appraisal. This will be used on physicians throughout the province. A pilot project is starting on that in the very near future throughout both the NSHA and the IWK working together on assessing physician performance. We have a very large number of enthusiastic and dedicated physician leaders, and I work with them every day of my life.


MS. MARTIN: Sadly, the words I heard in your response were “excited” and “Central Zone.” I didn’t hear Cape Breton. I didn’t hear about the bleeding of leadership doctors in Cape Breton that are leaving, and I didn’t hear the reason why. Many doctors - and this was a public call-in show where Ms. Knox spoke and said how involved the doctors were with the announcement of the closures. In fact, Dr. Keating called and said, no, actually you misspoke and that wasn’t the case.


When we’re faced with doctor after doctor after doctor leaving the senior leadership roles in Cape Breton specifically and they’re telling us publicly why - because there is a lack of support in the Eastern Zone - I’m not hearing “excited” when I talk to doctors in Cape Breton. I’m hearing “fearful,” I’m hearing “scared.” What are we doing to keep them? We’re not supporting them. We’re doing everything opposite from what I hear from the doctors. What you are saying and what I am hearing are, sadly, two completely different stories. I would like to know specifically, what is the problem?


            MADAM CHAIRMAN: Order. Time has elapsed for the NDP. We will move to the Liberal caucus. Mr. MacKay.


            MR. HUGH MACKAY: Dr. Taylor, I think you should be given an opportunity to answer my colleague’s question. I would be very interested in hearing your response to the situation in Cape Breton.


            DR. TAYLOR: I do know those specific position leaders who have stepped down have been spoken to by a number of my colleagues. I don’t have specific responsibility for Cape Breton in my interim VP role. Dr. Nicole Boutilier has that responsibility. I know she has been working very closely with the physicians there. Dr. Dale Miller is the interim Eastern Zone executive medical director. I speak to him at least once a week, and I know he’s working very hard to help to resolve the situations there as well.


I know there are a number of physicians there working with the Cape Breton regional redevelopment project. There are a number of people who are doing their very best to improve the situation.


            MR. MACKAY: Ms. Knox, did you want to add anything to that perhaps?


            MS. KNOX: Certainly, thank you. I hear your concern and we want to have an environment where our physicians, employees, and volunteers feel that they can be engaged.


            Perhaps the Cape Breton redevelopment project is one of the ones where I can tell you that I see on a weekly basis the meetings that they have. All of the planning teams are co-led by a physician and one other leader. They’re doing wonderful work in terms of doing what we call functional planning, planning for what services will be provided in those four facilities that will, together, become an integrated plan for service delivery for the Cape Breton Regional Municipality.


            You probably have seen that we have one piece of that work that we have to add to, and that’s having a patient-public advisory committee - our work that we do in terms of planning to complement our physicians and nurses and other practitioners. That team is to have public representatives present and part of the work. We recently connected with the foundations there so that they will become part of that plan. It’s to say that our leaders need to be together in these interdisciplinary teams that include the patients and the public to really bring about the best work.


That’s a change in many parts of our province, and it’s a work in process, but we’re very pleased with the engagement of physicians in Cape Breton in terms of this work. I’m encouraged by the interest and willingness - somebody described to me the other day that they were in the ICU, and people were marking out the square footage of the new ICU room, and you could feel the excitement in the team.


            We acknowledge the challenges that people are talking about and the fear that change brings about. One of the things that I always say is that we need to work with our people and encourage and support them in taking on the leadership roles and doing the work. It’s hard to be out there in a leadership position for many people because you are the centre of attention, so that’s a bit of a challenge. I’m very encouraged by where we are and the engagement. Some people are quietly being engaged and being part of the work in a way that’s important to them, and I think that’s fine. I think we have to find everybody’s place.


            MR. MACKAY: Thank you both. I would like to commend and compliment my colleagues for their questions. I think they have done a good job of raising some of the concerns, perhaps, that Nova Scotians have.


I would like to go back to the accreditation program and the fact that you met 92.9 per cent of the criteria. Obviously, there are things being done correctly, a lot of things being done correctly. You alluded to the fact that there’s always room for improvement. I’m wondering if you could perhaps walk through a little more of the continuous process improvement within NSHA.


            MS. KNOX: Thank you. I’m happy to hear you acknowledge that we made 92.9 per cent of the criteria. I would like to say that we very much were not surprised by the outcomes because the nine previous organizations were very focused on quality improvement and very focused on the accreditation process. We came with a culture of nine different ways that quality improvement was important. I wanted to say that because that puts us in a very different position than we might have been in. I am going to ask Colin Stevenson, who is our vice-president responsible for quality and system performance, to walk us through how we use the process and what we do when we get this report. I think that’s what you’re asking me.


            MR. MACKAY: Yes, please.


            MS. KNOX: The real value of the report is that we use it, and we are able to show how we have used it. I think Mr. Stevenson can help.


            MR. STEVENSON: I think Janet alluded earlier to the fact that the actual survey itself and accreditation process is not intended to ever be a point in time or the end to the quality journey. It really is an opportunity for us to receive and take advantage of some external eyes and help us understand how we’re doing as an organization and help to set the course for us as we move forward.


The accreditation, if we look at it from a cycle perspective, really is looked at as a cycle, approximately four years in duration. Really, it starts within our organization with understanding our own internal quality structure and the teams and the people that we bring together and how we engage people within the organization to understand how we’re doing and where opportunities for improvement are. We do use some of the Accreditation Canada instruments. By instruments, I mean things like work-life pulse surveys. We ask our employees how they feel about working within the organization. We use a patient safety culture survey, so again, we can ask employees, learners, volunteers, physicians, and leaders within the organization whether or not there is a culture of quality and safety within the organization.


We already talked about the governance functioning tool, and then understanding the standards themselves and whether or not we’re actually compliant with that. That’s all part of our own internal assessment process.


We have, within the organization, been building - and more established now than what we would have been even two years ago - a structure where we actually have interdisciplinary teams established within each of our program areas for the purpose of overseeing quality and patient safety within that respective team, generally established, provincial in nature, with representation from across the province in different disciplines. Those provincial structures would have local teams, either within a zone or within a site, to focus on standards, how they’re doing assessment and improvement. Really, those are permanent structures that are established within the organization. They’re not established just for accreditation or survey but are really intended for that ongoing assessment of the work that they’re doing and how they actually can identify priorities and improve.


The survey process itself takes the work that those teams do, their understanding of how they’re doing as an organization, and then, as we mentioned earlier, gives that separate set of eyes, those 30 surveyors from across Canada, for us the first time having a patient surveyor to bring the perspective of the patient to the system and have conversations around whether or not we truly have that patient and client focus in the work that we do. Through that internal assessment and the work of the external surveyors, we identify our areas of focus and our priorities. The other 7 per cent of areas that we need to focus on as an organization, some of those required organizational practices, and the survey results themselves, those the teams take. They develop action plans for the work that they’re going to intend to set out and accomplish over the coming years. Then really, it’s execution of that. That continues to be monitored within each of those teams.


[2:00 p.m.]


The work that we also do allows for the communication of that work up through to a provincial oversight group and to our quality and safety committee of the board so that our governance structure of the organization really has the ability to understand whether or not the organization continues to pursue the highest quality. That’s just a little bit in the sense of the work that we do from a monitoring perspective.


            I just want to say it’s also important for us to focus on the celebration of that. Each year we have a quality summit where teams, clinicians, leaders, and physicians from across the organization have the ability to share with their colleagues and share across the organization success that they have had, because in addition to understanding local success is understanding how we can spread that. Each year, they look at what they’re proud of and share that with their colleagues as an opportunity for us to celebrate the good work that’s being done.



            MR. MACKAY: We heard a previous comment in regard to community partnerships. I guess it was in the context of housing and finding partners in communities to help with housing. We do hear about what’s happening in local communities for amalgamation. I’m wondering if you could speak to what you’re doing as far as community partnerships across a broad range of topics for the NSHA.


            MS. KNOX: I’ll start, and my colleagues will chime in. Our goal here is that we set standards as an organization so that where services are provided - it should not matter where you live. The same standard has to apply everywhere. That’s one thing.


            Then those need to be implemented at the local level. The community partnerships need to happen at the local level with site leaders in the facility and with program leaders that are offering a service. It might be that a mental health program in a local community partners with an NGO that offers mentoring to clients - I’m making that up. That would be an example. I’m not going to talk about a specific.


            Who are the partners in the community that really are important to supporting the people that we support? It really is by starting to understand what is our community? What are the assets in the community? Who can come around a question that we have in terms of how to support a group of people? We all come together.


            I’ll give you an example. When we started as the Nova Scotia Health Authority, one of the things that was a big challenge for us was access to home care and long-term care. With the home support in particular, there were two parts of the province that were really challenging. We brought together in one part of the province all the players that could contribute to that, including what’s now the Nova Scotia Health Authority, and said, let’s talk about the people that we jointly serve and what services we have to offer them. That probably means that we all have to change some of the things that we’re doing, including the Nova Scotia Health Authority. Together, they came up with a solution for how to help people access support in the community quicker and faster and more comprehensively, and we’re able to start moving that across the province.


            Our goal is at the organizational level, so at the senior management team, we work with Doctors Nova Scotia, the 22 regulated colleges, all the universities, and the municipalities. It depends on what the issue is and what part of the organization. As we roll down into where the action happens, or roll out in our province, those community partnerships are really important - so the site leader in Shelburne working with local leaders in that community about the things that we need to do to make that place the best place it can be for the people of that community.


That’s our focus. We expect that our leaders get to identify who are the people they need to work with and find ways to do that. Our job as an organization is to create our skill and our imperative and the expectation that we walk with Nova Scotians. We work with Nova Scotians. We’re one part of the solution of the social fabric of this province. The health system - we have to see ourselves as one part of what needs to happen in this province to make it the very best place to support people.


            MR. MACKAY: Thank you, Ms. Knox. I believe my colleague, the member for Clayton Park West has a question she’d like to ask.


            MADAM CHAIRMAN: Ms. DiCostanzo.


            MS. RAFAH DICOSTANZO: I really wanted to bring the collaborative care - collaborative care to me, because I’ve worked in the refugee clinic for about a year and a half, is an amazing thing that we’re bringing - how important and how it works so well when the doctors and nurses and dieticians are all working together. The volume of patients that they saw was amazing to me. If you wanted your own doctor and the situation can wait, you made an appointment for long term. But if you had something urgent, another doctor, the system was there.


The whole idea of collaborative care - I was just so impressed with it. I go to a doctor that is an amazing doctor. His father was a doctor. His son is a doctor but is refusing to take his - and I’m slowly talking to him about collaborative care and how well that is working, and I know he’s going that route as well.


I just want to know, how does accreditation - what did they do and what were the results? Did they check on collaborative care and the future of collaborative care, and what would be the result in how accreditation would work - the relationship between the two?


MS. KNOX: The relationship between . . .


MS. DICOSTANZO: Did they look at collaborative care? What’s the percentage? How well are we doing? How well are we going forward with collaborative care? Sorry, I wasn’t clear.


MS. KNOX: I’ll start in terms of - ambulatory care and primary care are part of the accreditation standards. We can only take the surveyors in places where we can say that the Nova Scotia Health Authority is there and we are part of the offering. It wouldn’t be looking at all primary care in the province because physicians are independent and so some would have independent offices. They were very encouraging of the work that we were doing in looking at primary health care.


We have also brought in other groups from across the country to work with us in looking at collaborative primary health care. We have been working with seven other provinces in Canada, looking at some of our models and developing some evaluation of what we’re trying to achieve there. That has been very helpful and supported by the Canadian Foundation for Healthcare Improvement. They were just here yesterday having a chat with us about the work that we can do.


I would say our journey with collaborative family practice care in this province has really taken off in terms of physicians being - when we started, we put out expressions of interest because we need to work with people who want to move forward, and we had 14 people respond. The second time we put out a request for interest, we had more than 300 physicians respond.


We’re now working with more than 70 groups - they’re not full on teams yet, but groups around the province. We’ve gotten to that place where nurse practitioners love to work in these environments. Family practice nurses are finding new roles for them within these environments and on some of our teams, we’ve included social workers or nutritionists.


We’re in a state of development across the province. I was down in Digby one day with a community group and talking to patients, and this one man was describing for me the change in his thinking about - he’s my age probably, and he has a long-term health problem. He said having a team and other professionals - he loved his primary care provider and still does, but he really talked about the focus on health and wellness and seeing other professionals, and making him think about his own role in looking after his health.


That is the goal we want to get to, that all Nova Scotians have support from primary care providers that will help us stay focused on how we live healthy, live well, and contribute to our own health, and when we need help with that, we have a variety of expertise to offer.


            The last comment I would like to say that you described in your experience is that we’re valuing all professionals’ contributions. What we have learned is that . . .


            MADAM CHAIRMAN: Order. Time has elapsed. We’ll move on to the PC caucus, Ms. Adams for 14 minutes.


            MS. ADAMS: One of the topics that was highlighted by Accreditation Canada was patient flow, so I want to go back to bed flow. We were talking about the number of people who are sitting in acute care beds waiting for long-term care. We have a range of somewhere between 178 and 20 per cent of acute care beds, so around 700. But according to the Nova Scotia Health Authority website, there’s about 1,107 people waiting for long-term care beds from home. These are people that continuing care has deemed needing long-term care, and there’s insufficient home care to keep them home.


            We’re roughly somewhere around 1,500 to almost 2,000 people, and there are only 7,800 long-term care beds. Do you believe that our system would work better if we had more long-term care beds so that people sitting in very expensive acute care beds were not having to stay there and were, in fact, placed in appropriate long-term care facilities?


            MS. KNOX: I’ll start, and I think Mr. Guest will probably pick that up. If our continuing care leaders were here with us, they would say we need to imagine new ways of supporting people in their home and also in facilities, so we wouldn’t go directly to we need more long-term care beds. More long-term care beds is probably part of the solution, but really looking at where other places around the world have focused on how we help us to age in our place and to move gently into support.


            There may be different kinds of opportunities that we could create together. In this province, we have home care and facility care. How we help people transition between the two is a discussion that we need to have and look at options.


We do have an aging population, and what we’re finding - I was just listening to our leader in the province, who is leading our seniors program and talking about when he went around the province and talked to seniors. Seniors were saying to him, don’t assume that we immediately want to go to long-term care. Assume that we want support to live well in our community.


            What are the things that we need to do? Sometimes it’s a transportation strategy to get to a meeting place of seniors every Monday, Wednesday, and Friday, because isolation is really the issue and the challenge. I would say that there’s a menu of options that we need to develop together across sectors of our support.


            MR. GUEST: Certainly, we have communities within the province that are more pressured than others. I would say that we need a multi-faceted approach to the issue. I think it would be a missed opportunity if we only focused on long-term care beds as a potential solution. One of the things that we do know is that without options, some individuals choose to be assessed for long-term care early - we do have individuals who are going through the assessment for long-term care who have never even had home care before. I think there are certainly ways that we can support individuals if there were more options for them. We do have some communities within the province where we have pressure with long-term care beds as well.


            MS. ADAMS: I appreciate what both of you said. Ms. Knox, you said that more long-term care beds may be part of the solution, and you just said that we could probably support more people in the community if we had more resources, but we don’t at the current funding level.


            I’m going to maintain that these 1,500 people have already been deemed to not be able to stay in their home, or they wouldn’t be on a long-term care wait-list. In fact, if they don’t have home care, they’re not even eligible to be on the long-term care wait-list so they’re not on the list. They used to be allowed to be on the list, but they’re not allowed on the list unless they’re accepting home care. I have a constituent right now where he’s providing the home care and they haven’t accepted government-funded home care, but they won’t even consider assessing her for long-term care unless they either abandon her and then they’ll take her into the care of the province.


[2:15 p.m.]


I’m going to maintain that there are almost 2,000 people out there. There isn’t sufficient home care because you have determined that continuing care has said these people cannot manage at home. That’s why so many of them are taking up acute care beds, which is why there are so many people backed up in the emergency department.


One of the other things I am aware of - because I did work for the health authority for 18 years and I was part of the accreditation process at the Nova Scotia Environmental Health Centre, so I appreciate how hard everybody works to make sure that the policies and procedures are in place, but what it really always boils down to is what is the exact experience of the patients and the staff.


One of the things that I am struggling to understand is why there is a 2,000- personnel turnover every year? That’s 10 per cent, as you mentioned, which is staggering to me. I am assuming with all that many people turning over, we could have quite a number - that was the number you quoted me - that there could be a very simple exit interview computer system. Everybody who leaves fills out an online computer system form - you can accumulate all of the data that you need, so I’m going to suggest that might be an option.


One of the issues I have though is with respect to the Success Factors program, that the managers have said it has created a very lengthy process for hiring and can be very challenging. I’m going to use an example in my own constituency. Sixteen months ago, Minister Delorey gave me the funding for a clinical nurse practitioner for Eastern Passage. It took us eight or so months to find a location, which is Ocean View Manor.


If you go on the Nova Scotia Health Authority website right now under job vacancies, you will not see that position listed, so I’m at a loss as to how my community is going to get a clinical nurse practitioner if the position isn’t advertised on the website. We were also given permission to have a family doctor and there has been absolutely nothing there.


If we can’t even post one position that I’ve been talking about in the Legislature, I’m not sure how the Success Factors system is working to fill all of those vacancies. I’m just wondering if you can explain to me how many vacancies we have right now, and since there are 2,000 that turn over every year, how has that changed - better or worse - since before amalgamation?


MADAM CHAIRMAN: There was a lot there. Vacancies for?


MS. ADAMS: Job vacancies. We say there’s a 2,000 turnover every year, which creates a lot of work and expense of rehiring and training people. How does that compare to before we amalgamated?


MS. KNOX: I don’t have that number, but we do know that one of the things I would want to say to you is remember I told you that 80 per cent of our positions are filled from within, so that 2,000 can count people moving around our organization, but we can get that information for you.


We do know - I just can’t recall it off the top of my head because we see it quarterly; we have a report. We are no different than the rest of the country and we’re not really significantly different, I don’t think, than before the amalgamation.


MS. ADAMS: It would be good to know that information. One of the other things, having worked with the staff for many years, their safety is of importance to me as well. Of course, one of the issues is they’re feeling overworked because if there are staffing vacancies, then they’re the ones carrying the burden.


One of the things that I found out recently is that the Human Rights Commission has advised us that about 65 per cent of the complaints that they get are from an employer failing to accommodate somebody with a physical or mental illness. That’s a huge percentage of the Human Rights Commission’s work. When I asked who the top employers were that the complaints were about - and, of course, you would expect that they would be larger employers - the Nova Scotia Health Authority was number one; the provincial government was number two; and the municipal government was number three.


I guess what I’m wondering is, where we’re a health authority, we would be the ideal employer to provide duty to accommodate because we would have all the people and knowledge. I’m wondering if you can answer that for me, because we want to provide protection for our staff and we certainly want to keep them employed as long as possible.


            MS. KNOX: Safety of our people has to be job one because if we don’t provide a safe environment, we can’t provide safe care, so that is very important to us. The issue of accommodation is also very important, and we are on a journey to educate all of our managers to really understand accommodation. In years past, it probably was a very limited kind of view in terms of that’s your job and the accommodation has to be around your job. We’re taking a very different view in how we help people come back to the workplace. We have 23,000 jobs and the size of our organization now makes it easier - it’s never easy, but it should be possible - for us to make accommodations.


            So, thank you, it is something that’s very important to us, and it requires a whole changing of culture, changing of education of your managers, and creating that kind of welcoming environment.


            I’ll give you an example. One of the things that we’ve done to change the environment, how we see people, is really to bring in the Mental Health Commission of Canada and across our organization to do workshops to educate all of us about what it’s like to have a mental illness, how you recognize that in your colleagues, and how we create a kind of environment where we’re supportive and welcoming. So, thank you very much for that question. It’s very important.


            MS. ADAMS: I would encourage you to meet with the Human Rights Commission because I know they’ve created an online initiative as well. I think that’s a really good start.


            On Page 35 of the accreditation report under Physical Environment, it talks about the fact that there is a deficiency of about $85 million just for the urgent infrastructure needs for all of the buildings around the province. Some of the items listed above that - 3.2, 3.6, 3.7, and 3.9 - centre around air quality and “Rooms where surgical and invasive procedures are performed have at least 20 complete air exchanges per hour.” These are unmet criteria.


            Given the fact that we had the Camp Hill issues 20 to 25 years ago, I’m wondering why we would have these kinds of issues now and if they’ve been addressed since this accreditation report was published.


            MR. STEVENSON: Thanks for that question, and yes it was within our surgical program, there were a couple of areas which were identified as not meeting what would be considered as high-priority criteria at the time of the survey. It reflected the need to ensure that there was ongoing monitoring of air quality within an operating suite or an adjacent area. I believe there were two specific areas that were identified at the time of the survey.


            Since then, there has been a monitoring system in place within each of those areas. An operating procedure and guideline has been established to ensure that there is regular monitoring/auditing associated with that work. Also identified is starting to do some assessment for a more long-term solution associated with that particular problem - not just within those sites, but within other areas as well. What that requires is more of an internal monitoring system hardwired into a computer system.


            There have been immediate actions taken and the response back from the Accreditation Canada body was that we met the requirements associated with that to ensure that there was regular monitoring of those particular areas.


            MS. ADAMS: Very quickly, I wonder since you had submitted the necessary requirements to Accreditation Canada in December and received notice that you received your status, is there documentation that’s available to the public of what you submitted to them and what their report back to you was?


            MR. STEVENSON: At this time, the submission was actually just directed to Accreditation Canada through our portal, so we haven’t actually posted that publicly. But we’ll be looking at how we can actually post that in a way which is available and easily accessible.


            MADAM CHAIRMAN: Order. The time has elapsed. We will move on to the NDP caucus for 14 minutes - Ms. Leblanc.


            MS. SUSAN LEBLANC: Speaking of information available on websites, the NSHA and the former district health authorities used to publish strategic indicator reports every month that contained a good level of data about how things were going within all of the different systems.


In 2017, the NSHA published on the website: “As of January 2017, publication of the monthly Strategic Indicators Report (SIR) has been discontinued. To align with new strategic priorities and to better meet the needs of provincial programs of care, the SIR is being replaced with alternate meso-level indicator reports.” It goes on from there.


            Can you give me an example of some of these alternate meso-level indicator reports, and are those being made available to the public?


            MR. STEVENSON: When we look at our performance framework, there would be macro, the highest level for an organization or system; meso, which would be sort of the operation of a particular program across the system; and micro, which would be direct operations, for example, at a site. We did make a shift in the change of our reporting to be more reflective of particular goals or priorities within a particular year.


            What we were seeing and hearing when we asked others around the type of information that we were providing at a very system level often takes years to see shift or change. The high end or the macro indicators didn’t necessarily have as much meaning from a public perspective. What we were paying attention to within the organization and ensuring that we were demonstrating our accountability both within the organization and publicly was, what is it that we set out to do within that particular year and how would we report on that?


            An example would be as it relates to the implementation of collaborative practices. That was a priority established within the Province of Nova Scotia, and we had a part to play within that. What was important is for us to be able to disclose the progress that we’re making as it relates to that. So, still within our public site, you would be able to find both a status report and an indicator report as it relates to key priority areas for the organization. That would include primary health care, mental health and addictions, and orthopaedic wait times, for example.


            MS. LEBLANC: There are other things that we can also see in the public realm of the website. We can see reporting on hand hygiene, C. difficile, MRSA infections, and a few other communicable disease-associated numbers, but some things that we haven’t been able to find are the following: wait times from triage to admission in the emergency department, wait times from triage to physician in the emergency department, wait times for priority interventions, and percentage of patients who left the emergency department without being seen. I just want to talk for a second about that because I’m particularly troubled by that one.


            This morning in the Star Metro, there was an article about a woman who presented at the emergency department having had a heart attack at age 40, but she was about to be released because there was nothing that came up on the EKG. Just as she was leaving, they called her back in and they had received her blood work and of course it showed that, yes, she had the - I forget the hormone you see there. I’m not going to waste my time looking for the name of it. They knew she’d had a heart attack, and obviously very troubling, very scary that she was on the way out the door.


            I actually presented at the emergency room the other day with abdominal pains and they checked me with an EKG. I didn’t even know until I read that article that I was showing symptoms as a woman in her 40s of having a heart attack. I have another friend who presented the other day who was actually sent home without having blood work. She had an EKG done and there was nothing that showed up, and so they sent her home without the blood work. It was a very busy day that she was there. She was there for six or so hours, and she ended up going home because her symptoms had subsided and she left, but now she knows - after speaking to friends who are in the health care profession - that she could very well have had a heart attack and she is waiting now for blood work to find out.


            Also, I will say that the day I was there I almost left, but when I said I’m leaving, they said you’re next, and I said, okay, I’ll stay - after several hours. My point is that people are leaving the ER department without getting complete assessments, and that suggests that things are wrong in the system.


            This is all circling back to the critical indicators and without those, and not being able to monitor these things, I’m concerned that we can’t get a clearer picture of what’s going on. I’m wondering if you agree with that statement.


[2:30 p.m.]


            MR. GUEST: Certainly, all of the items that you’ve asked, we do track, and we do actually monitor those and could provide you with the results of those. The emergency department program of care is new to me and so I’m not entirely sure why we haven’t made a decision to post those results, but I don’t see why we can’t. There are things that we’re actively working on and so we certainly could provide you some specifics after.


            MS. LEBLANC: That’s great. Can I take that as a commitment that those will go back up online and be available to the public?


            MR. STEVENSON: I’ll confirm and verify this - it may not be readily understood when you look at some of our priority areas, but one of the priority areas would have been under patient flow, which we certainly talked about a little bit this afternoon. Under that particular priority area, we do include some of the emergency department measures and indicators. So, by CTAS score - by assessment score - we do indicate percentage of patients that are seen within national standards. We are reporting our times or percentage of patients seen by CTAS score from a provincial perspective, and I think we’re targeting some of our main emergency departments where there has been more attention from a flow perspective.


            That should be posted and available. It’s under our patient flow, which sort of wraps up a number of different performance areas.


            MS. LEBLANC: Just to be clear, that number would be how we’re doing in comparison with across the country. Is that what you mean? I just don’t understand exactly what those numbers would be.


            MR. STEVENSON: What we’re using would be a national standard associated with a triage level.


            MS. LEBLANC: We’re hitting the national standard.


            MR. STEVENSON: And what the expectations are of a patient within that level being seen, within what time frame, and then what percentage of patients we are seeing within that national standard.


            MS. LEBLANC: I liked your answer better. I would rather see very clearly reports on a monthly basis of all the things that I’ve listed, especially the percentage of patients who are leaving - for all of the reasons I’ve already stated. I strongly encourage you to do that. I would really appreciate it.


            I want to switch gears for a second. When the accreditation report came back in 2017, a press release from the NSHA noted that the infrastructure and resource challenges had been identified as an area of concern, which you’ve already spoken about for a few minutes, but when I read that it sounded to me like simply that there isn’t enough money going to the health care system to meet the needs of the care delivery and health promotion. I’m wondering if somebody could comment on that.


            MS. KNOX: What we would say is that we have a system that was designed - I think I read that this morning, somebody else was writing about this - designed in the 1960s, a hospital-based system, and we are still basically functioning that way. We are changing with making the foundation in Nova Scotia to be primary family practice collaborative teams in your local community to be the foundation of our health system. We have stated that and are moving very diligently towards that.


            We still have a hospital system that for 956,000 people we have these sites all around our province that were designed many years ago, so we’re not sure exactly if we have enough money to run the system to go forward. What we would say is we probably will be very challenged if we try to run it the same way that was designed in the 1960s to meet the needs of our population now.


In 1960, we had a young population, very rural, very active - all of those things. I grew up on a farm in the 1960s and it’s a very different population that we have now, so we need to do things differently and pay attention to making every dollar count for an outcome for our population.


Some of the work that we’re doing in terms of the Cape Breton Regional Municipality redevelopment is transformation of the entire system - all of the services that we provide in that locale and really paying attention to how we use our resources. That’s an example of the kind of work that we need to do across Nova Scotia.


MS. LEBLANC: You say you’re not sure if you have enough money to fund the system as it stands now. I understand that there are changes being made, but when can you be sure that there is enough money? Do you have to wait for the transformational process or are you able to comment on whether or not there is simply enough funding to do the things that are being done now and this year, for instance?


            MS. KNOX: What I’m saying - I’m talking about into the future if we stayed where we are and look at how much it costs. We have old buildings that need a lot of retrofit. We need a lot of money for equipment. Is that equipment all in the right place?


            I would be uncertain if you asked me now if we can sustain this. I would suggest we cannot sustain it, so that’s why I’m saying I can’t tell you I’m confident that we have enough money. What I’m saying to you though is I’m confident that we can change the system that will suit the people of Nova Scotia, and we can do it in a way that maximizes our resources, and together we plan in five-year increments, I believe, a budget that will support that. I am confident that we can do that in this province. We have to be willing to do that.


            MS. LEBLANC: One of the other measures that was reported on in the SIR was the percentage of approved funding requests for infrastructure, clinical equipment, and equipment. Can you tell us about where the target levels are for those types of requests now, and are there targets for those areas?


            MS. KNOX: You’re asking about targets for equipment? I couldn’t hear everything you said. Targets for equipment?


            MS. LEBLANC: Infrastructure and clinical equipment.


            MS. KNOX: We have done a facility assessment. We know how much money it would cost to bring all of our facilities in Nova Scotia up to the standard that we would expect - hundreds and hundreds of millions of dollars. We can get you that information.


            We also know we have an assessment of the capital equipment, the medical equipment that we need, and we know that we have a great need for investment in those areas. Each year we get an allocation. The allocation doesn’t meet our need.


            MS. LEBLANC: When we were doing our research for this meeting, we were looking into older accreditation reports from the former DHAs because we wanted to compare and contrast, but the only reports we could find were password protected, so obviously we couldn’t see them. I’m wondering if you have plans to release those older reports so that we can have a way of looking at progress over the years from accreditation to accreditation.


            MR. STEVENSON: I’ll have to look. Generally, most organizations I would have expected would have posted their previous accreditation reports publicly, so I’m not sure why, but it could be decommissioning of old websites is maybe why they’re not available. We can certainly look at that.


            I guess the one thing that I would caution - and my colleagues on either end of the table who are accreditation surveyors could probably provide some comment associated with the ability to compare and contrast. I think one thing to keep in mind is accreditation standards - we as an organization want to continue to improve, the accreditation standards continue to shift and change. You can’t always necessarily look at a previous organization’s performance and look at where we are today.


            MADAM CHAIRMAN: Order. Time has elapsed for the NDP. We will move on to the Liberal caucus with Ms. DiCostanzo.


            MS. DICOSTANZO: I’m so happy because my question was what you started to say, so you’re going to continue what you started. My question is you’re at 92.9, which is an amazing result in my opinion in how well you’re doing. I just want to compare how you’re doing compared to other provinces and how the standards are developed, and do they help you? The standard today is a certain level and another province may have found an idea or a better system of doing things, so the standard moves to a different level.


What happens with those reports and do they get upgraded constantly? Do you sit with other provinces? It is about collaboration. I’m sure what we’re having here is the same in other provinces, because I know my family is in Ontario and they’re struggling exactly the same way. How does this report compare in different provinces and where are you and how do you collaborate with other provinces?


MR. STEVENSON: I’ll be brief, but then I’ll turn to my two colleagues if they could add, because they’re both surveyors and would work on surveys in other provinces. First, I would say that we’re one of few actual provincial organizations, so the first thing in thinking about that is there are not many province-wide organizations that have gone necessarily through a survey process, so that’s one thing to keep in mind.


            The other is that you don’t actually get the results of another organization to compare to you and look at it and sort of compare from a scoring perspective. We do look at things such as our work-life pulse or our patient safety culture survey results, and look at how we compare nationally. It helps us to get a sense as to whether or not from a culture perspective or what our staff or patients may be saying from an experience side is similar or significantly different. It may give us a sense as to where we can focus, so that is an area where we would compare.


            I can say at the time of our survey when we compared to the national average that was available at that time, we were at or slightly above in some areas as it relates to the scoring - so what our patients were saying about us or what our staff were saying about working within the organization or the culture of safety. Maybe I’ll let Mark or Tim talk about their experiences as surveyors and what they see.


            DR. TAYLOR: I’ve been an accreditation surveyor for about nine years now and I’ve seen the process evolve in three different iterations, so it’s difficult to compare over time, the results, because it’s changing constantly. In fact, I just met with Accreditation Canada to work on the next version.


            I can say that generally speaking - and I think Tim would agree with me on this - most organizations that we survey meet over 90 per cent of the criteria. That’s a good thing. It means people are taking them very seriously and they use the questions of the survey to improve what’s going on in their organization. That’s constantly happening.


            You mentioned going on in different provinces - there are hundreds of surveyors all working in health care right across the country and we travel all over the place. One of the reasons that I became a surveyor was because I wanted to see what other organizations were doing. Every survey I’ve gone to in the country, and a few international, I’ve come away with something I thought that organization was doing that was really neat and I’ve left something behind that we were doing that was neat.


            A huge advantage of Accreditation Canada systems, it leads to standardization right across the country because everybody has the opportunity to see what everybody else is doing. There’s always something someone else is doing better than you’re doing, so it’s very valuable in that sense.


            MR. GUEST: I think the only thing that I would add is, I’ve been a surveyor for just about seven years and most of the surveys I’ve done have been the large, integrated health systems - the regionalized health systems. I’ve done some single hospital surveys, and in my experience, our results are largely what I’ve seen when I’ve done those. Certainly, the larger organizations that are more integrated in nature have a lot more work to do in order to meet the amounts of standards. There are certainly a lot more standards that they would be focusing on.


            If you look at Ontario as an example, they’re largely looking at facility-based hospital standards. They’re not so much incorporating the public health community-based standards that they also have to work on and improve on.


When I’m going in to do a survey in an organization, I’m not largely comparing the results of the previous one. I’m generally looking for where they have work to do. When I go in the next time, I look to see if they’ve improved on it - not really comparing the result, but more comparing their effort and activity to improve and learn from the experience that they had before.


MS. DICOSTANZO: It really is an amazing tool for the surveyors themselves to bring in new knowledge and to leave some knowledge as well. I also have another question, but I’m going to move it to my colleague, Mr. Glavine.




HON. LEO GLAVINE: It’s great to get at least one question in. I’ve usually been the recipient of many. I know my colleague, Mr. Horne, wants to have a question as well.


First of all, I’m delighted to be at the first Health Committee meeting that brings in health witnesses here to the Chamber. I know it very clearly - it may even be on the public record - I remember as a rookie MLA in 2004, looking at the budgetary outlay for Health and wondering, here I am going to the Community Services and Resources Committee meetings, why in the world wouldn’t we have a health committee? So, I’m delighted today to be part of that very first one.


[2:45 p.m.]


            There was some talk about adding extra millions of dollars to the Health and Wellness budget, but I just wanted to pass along this comment from one of Ms. Knox’s favorite doctors, cardiologist Dr. Wightman. I spoke to him on Sunday at Hearts on Ice and he said, Minister, for heaven’s sake, don’t put more into the delivery, put more in your department on the upstream work around wellness. That’s what Nova Scotians need. We have some of the worst indicators in Canada and we need to go in that direction.


            For Dr. Taylor, my question is: as a clinician, what was the strength in the accreditation that has pan-Nova Scotia good health practice, and what is a weakness that we need to work on as a system delivery?


            DR. TAYLOR: I’ll start with the second part first. I think what the accreditation survey demonstrated very clearly was the work we have to do to standardize our care. That’s not surprising, as was mentioned earlier, bringing nine organizations into one. Every one of the nine would have their own processes. I think we’ve done a lot of work, but there’s a lot of work still to be done in that area.


            In terms of the good things that were there, there were a number of very helpful and significant comments about, for example, the effectiveness of our critical care area where critical care, in fact, has gone quite a long way to standardize care. I think standardizing care is a very important concept, and there were both good and bad things about it in the accreditation report.


            MADAM CHAIRMAN: Mr. Horne.


            MR. BILL HORNE: First, I have to say that 92.9 per cent is very good, I think, with coming from where you’ve come from - from nine down to one organization to run the medical system. It must be quite pleasing to you to have had that. There must have been concerns that you might not make that, but that’s good because you can do some improvement.


            You’ve talked about a few things for patients and how they get involved in this organization to try to help improve the system. I’m just wondering if you have some extra thoughts besides the surveys that you may have done. Do you get a lot of discussions between the patients, the doctors, and the nurses, and get some of those comments?


            MS. KNOX: What I would like to say at the outset - and Mr. Stevenson will talk about our work - the lived experience of the people we serve has to be the number-one information that we use. It’s really important to understand that and to hear it openly and to hear how they can help us make things better.


I’ll ask Mr. Stevenson to talk about how our focus has been in gaining access and making our place a place where people can help us understand that.


            MR. STEVENSON: What I would offer is that really we have a committed focus to patient experience and patient engagement in care. What that means for us is not just completing experience surveys and asking patients of our system how they feel about the care they received or our facilities. We do that. We intentionally exceed what is required from Accreditation Canada and do experience surveys in five particular program areas on an annual basis.


            That’s important to us, but more so is creating opportunities for patients or family members to actually come in and participate in setting direction of the organization, in quality improvement teams and activities, and in setting and assessing policy. We are deliberately recruiting and constantly recruiting patient and family advisers. We currently have about 160 advisers on quality improvement teams and committees across the province. That is in all parts of Nova Scotia.


            It’s still not all we want. It represents about 60 per cent of the teams that we’re trying to recruit to, so there are about 80 quality improvement teams in the province that have patient/family advisers today. We also have some other advisory groups, which would have about another 50 patient or family advisers working directly within that. They show up and have a role in contributing towards policy change, communication material, educational material, assessing practices, and contributing as a voice to that.


            In our ethics processes around conversations around particular practices or disclosure, we have patient or family advisers that participate in that. Really, our encouragement in the organization and our goal is that there is nothing that a patient voice can’t provide value and contribute to, and we’re continuing to build that as an organization.


            We do have, supporting our executive team and our board, a Nova Scotia Health Authority patient-family advisory council. It has 12 representatives from across the province, so three from each of our geographical zones that really help us to look at systems issues. Any team from the organization can come forward with a question or an issue or an ask for consultation, and they provide their perspective to that. We have a requirement that we go back to them and tell them how their contribution has changed how we work.


            MADAM CHAIRMAN: Order. The time has elapsed. I’ll ask Ms. Knox for some brief closing remarks.


            MS. KNOX: Thank you for your questions. It’s very encouraging to us to be asked to come here and talk about quality and safety. I’m also very encouraged that we have talked about health and wellness and the population that we serve.


            One of the things that we didn’t have a chance to talk about is that the accreditors came in and said to me as the CEO that they were so impressed that straight across this province our team members always talked about the people they serve, what they knew about the population, and how they were trying to adjust their service delivery based on helping us be healthy and stay healthy. That was the most encouraging thing that I could have heard.


            I want to say thank you. These questions are the questions that we need to be asking. We need to be committed to being on a journey of quality improvement for the people of this province. That’s what they deserve, and we are very committed to that as the Nova Scotia Health Authority.


            Thank you for your interest. It was interesting to be here at the first committee and have you focus on quality for the people of this province. Thank you very much for that.


            MADAM CHAIRMAN: I thank you, Ms. Knox, and your team for being witnesses today. You may be excused. We have a few items of business to get on with. 


We have correspondence from the Speaker - I think you all have a copy of it - giving us permission to use the Chamber for our meetings. That is good news. That is what we had hoped for. Perhaps we will thank the Speaker for allowing us to continue in this space.


            We have hours for our morning meetings while the House is sitting. Are there any suggestions? I think we should be no later than 12:00 noon because caucuses need time to prepare, so either a 9:00 a.m. or 10:00 a.m. start. Clerk.


            MS. JUDY KAVANAGH (Legislative Committee Clerk): Legislative Television has asked that on days the House is sitting that we be out of here by 11:30 a.m.


            MADAM CHAIRMAN: So, 9:30 a.m. would be the latest start. Ms. MacFarlane.


            MS. MACFARLANE: My suggestion is 9:00 a.m.


            MADAM CHAIRMAN: Are we in agreement for a 9:00 a.m. start? Can someone make a motion so that we have that on record? Mr. Glavine.


            MR. GLAVINE: I move that the Health Committee sit at the hour of 9:00 a.m. to 11:00 a.m.


            MADAM CHAIRMAN: When the House is sitting. Ms. Leblanc, you had a piece of business.


            MS. LEBLANC: I would like to make a motion:


Whereas emergency rooms in Nova Scotia are at a breaking point; and


Whereas off-load delays and overcrowding are undermining public confidence in our health care system; and


Whereas the state of our emergency rooms is a matter of urgent, pressing debate;


I move that the Health Committee call Jeff Fraser, Operations Manager of EHS, Mike Nickerson and Donald Dixon of IUOE 727 representing paramedics, and the Deputy Minister of Health and Wellness as witnesses to an emergency meeting of the Health Committee to discuss systemic challenges to our emergency care system at a date and time determined by the chair on or before February 28, 2019.


            MADAM CHAIRMAN: There is a motion on the floor. Are there any remarks? Ms. DiCostanzo.


            MS. DICOSTANZO: We’d like to call a recess to discuss this. This is something we need to discuss between us first - five minutes.


            MADAM CHAIRMAN: Can we have a motion to extend the meeting?


MS. DICOSTANZO: All we need is two minutes.


MADAM CHAIRMAN: Are we in agreement to extend the meeting? We will recess.


            [2:56 p.m. The committee recessed.]


            [3:01 p.m. The committee reconvened.]


            MADAM CHAIRMAN: Order. Ms. DiCostanzo.


            MS. DICOSTANZO: We would like to bring in a new motion.


            MADAM CHAIRMAN: There is already a motion on the floor.


            MS. DICOSTANZO: We would like to amend the motion, sorry, and bring in the same subject that Ms. Leblanc brought in and have it for the next meeting, which is March 12th, which is our subject, but we will replace it with what she has proposed.


            MS. LEBLANC: Thank you, Ms. DiCostanzo. I appreciate that. I just want to clarify in discussion that the Liberal caucus would be giving up their topic, allowing this topic to stand and of course then allowing the other topics that have already been chosen to stand. I want to make sure we’re not messing up that schedule in any way.


            Also, we wanted to have this before February 28th, which is the day the House sits, because we wanted to make sure that we had all of the important information from those witnesses so that we have the information before the Legislature goes in, and we didn’t want to sacrifice your topic either. We think that your topic is also important. We should be having an extra meeting to discuss this. We think that we should be having two meetings a month, and so while I appreciate your goodwill, I really wish we could do this on top of the regular schedule so we’re not sacrificing any other topics.


            MS. DICOSTANZO: I believe it would be a difficult time to get everybody, and we had very short notice. If you want this subject, we feel it’s fair that we’re giving up our topic and to have it as soon as possible, which is at our next meeting, instead of everybody finding time and finding witnesses and the clerks working with this. There is another meeting on March 12th and that subject is important, and we’re happy to bring it in.


            MS. MARTIN: I think the point we’re missing here is this is an emergency meeting. Realizing that you have substitutes today, we all have other people who are available or could be available. As my colleague, Ms. Leblanc, stated, we were looking for at least two meetings per month. This health care crisis is an emergency, and I would suggest that anybody should be and would be willing to schedule time to sit and hear from these witnesses. I quoted the stats today: there have been 113 Code Critical announcements since January 7th this year, and nearly 1,000 units off the road from the months of October to December. If that is not an emergency, I do not know what is.


            MS. MACFARLANE: I see a very gracious offer being made by the Liberal caucus, and I agree; however, I believe this needs to be addressed immediately. I agree with the NDP.


            This past weekend alone, my phone was dinging constantly with HRM paramedics who I know were not getting their breaks, who were working overtime, who were spending several hours in emergency. At one point, there were 15 ambulances lined up at the QEII. This has to be addressed immediately for the PC caucus, for my colleague - we were in agreement of weekly meetings. Again, gracious that the offer was made for the next meeting. I really do believe that this needs to be addressed immediately, so I would be in favour of a meeting tomorrow, if it was accommodating to everyone.


            MS. ADAMS: I happened to be one of those people who was in the Halifax Infirmary emergency department this weekend. I received excellent care, but I also received about six apologies from the physician for having to treat me in the hallway surrounded by about 20 other people because there was nowhere to put me.


            I am grateful for the care that I received, but I am also aware of those ambulances that were backed up out the door. I think we need to move forward with having an emergency meeting on this because it is life or death.


            MS. LEBLANC: I, again, want to say I appreciate the Liberal caucus’ willingness to sacrifice their subject and I think regardless of how we do it, we need to hear from these witnesses. I’m happy to go towards a vote right now.


            MADAM CHAIRMAN: We have to vote on the amendment first. Ms. DiCostanzo.


            MS. DICOSTANZO: I just want to clarify one thing to Ms. Leblanc. We are not sacrificing our subject. We are just going to move it down to bring yours - because in your opinion, that’s more urgent. Our subject will still be there, and we would like now to do a vote as well.


            MADAM CHAIRMAN: We’re voting on the amendment, which is the offer from the Liberal caucus to give the March 12th meeting for the topic that Ms. Leblanc has brought forward. Would all those in favour of the motion please say Aye. Contrary minded, Nay.


            The motion is carried.


            The meeting will be March 12th. Mr. MacKay.


            MR. MACKAY: I have another motion I would like to make.


            MADAM CHAIRMAN: I’m sorry, excuse me - we still have to vote on the original motion, which is to have the meeting brought forward. It’s amended for March 12th. Do we need clarification? Would all those in favour of the amended motion please say Aye. Contrary minded, Nay.


            The motion is carried.


            We will move on to Mr. MacKay.


            MR. MACKAY: I would like to make a motion. I would like to add and amend the witness list for the CBRM redevelopment topic when it occurs. In addition to Ms. Paula Bond, Nova Scotia Health Authority; Mr. Brett MacDougall, Nova Scotia Health Authority Cape Breton; the Deputy Minister of Health and Wellness; and the Deputy Minister of Transportation and Infrastructure Renewal, our caucus would like to add Dr. Kevin Orrell who is the senior medical director for the CBRM redevelopment project. Dr. Orrell was appointed to this position after our agenda-setting meeting. He will be a very good addition to the current witness list, and be of great benefit to all committee members.


            In addition, the Deputy Minister of TIR may not be able to make certain meetings, as mentioned in previous correspondence to this committee. For the Cape Breton Regional redevelopment topic and the QEII redevelopment topic, we would like to amend our list to state Deputy Minister of TIR or designate.


            MADAM CHAIRMAN: There is a motion on the floor. Is there any discussion? Ms. MacFarlane.


            MS. MACFARLANE: I actually just want to clarify that the correspondence that we received from the deputy minister was, in fact, that he could not attend one meeting due to a medical appointment, I believe it said in the letter. We never received anything else that stated that future meetings were going to be an issue, so we have responded back indicating that we understand the hectic schedule and that we would be accommodating to whenever the deputy minister could find time and a conducive time and date to meet us. It’s extremely important that there’s not a substitute for the deputy minister.


            MADAM CHAIRMAN: Is there any further discussion? There’s a motion on the floor. Ms. MacFarlane.


            MS. MACFARLANE: I would like to make an amendment to that motion. In fact, I’m very pleased to hear that we are having a doctor come forward. I would at this time amend that we continue our original invitation to Dr. Jeannie MacGillivray as well.


            MADAM CHAIRMAN: There is an amendment on the floor. Is there further discussion? Ms. Martin.


            MS. MARTIN: This is on the motion, not on the amendment.


            MADAM CHAIRMAN: We’re voting on the amendment. Would all those in favour of the amendment please say Aye. Contrary minded, Nay.


            The motion is defeated.


            We are voting on Mr. MacKay’s original motion. Do you want to speak to that, Ms. Martin?


            MS. MARTIN: No, it was the amendment.


            MADAM CHAIRMAN: Would all those in favour of the motion please say Aye. Contrary minded, Nay.


            The motion is carried.


            I would like to make a suggestion that the clerk has brought forward, that if people are going to be making motions, that she have that motion previous to the meeting. It’s very confusing and difficult to run these meetings when we don’t know what we’re voting for. You’ve given some thought to it, and it’s very challenging for the clerk to be clear on what the motions are. Ms. MacFarlane.


            MS. MACFARLANE: With regard to having future meetings and with regard to understanding the protocol, I would like us to set a date and time so that we can discuss what the protocol is - there is confusion. We also have to understand that sometimes motions are made in what information was delivered in the current time. It would be hard for us to project into the future what my motion, or any other colleague of mine, would be. I just believe that we might need to have another meeting separate from our regular committee meeting so that we all have a very clear understanding of how these meetings are to unfold. I’m sure the clerk would appreciate that as well.


            MS. MARTIN: To clarify then, because I understood in the clerk’s correspondence that in order to change those who were presenting before committee it needed 100 per cent approval.


            MADAM CHAIRMAN: When we’re calling around or emailing - that way we need 100 per cent.


Seeing that there is no further business, I adjourn this first meeting of the Health Committee, and I would like to thank everyone for their respectful and collaborative approach to this committee today. I was very impressed with the mood of the Chamber and the respect to our witnesses. I hope that continues throughout the duration of this newly formed Health Committee. Thank you.


            [The committee adjourned at 3:14 p.m.]