The chief of surgery for central Nova Scotia Health says the new consequences for unprofessional behavior should help prevent problems from escalating and confront behavior that has plagued the division of cardiovascular surgery for more than a decade.
“I’m actually very confident in our ability to institute change,” Dr. Gail Darling said in a recent interview.
An external evaluation of the workplace is being carried out after complaints about the behavior of some surgeons, the way pupils and support staff are treated, and the lack of action by senior officials to enact change. Reviews in 2010 and 2016 identified the need for a toothy code of conduct to address behavior one of the reports described as having no place in modern medicine.
As that review work nears completion, Darling received the final report from a task force she commissioned to investigate workplace conduct and the consequences of unprofessional behavior.
Stop problems in the early stages
That document will be instituted after it goes through the necessary processes with health leadership and legal advisors, he said. In the meantime, Darling said she believes initial steps can be taken to prevent problems from escalating.
Darling said there have always been “some very drastic consequences” as needed, but the question for her is, “How do we get things closed in the early stages?”
“You know, the little incident that people gloss over. Then there’s another little incident that we gloss over. We don’t want to gloss over those more, but we really lacked a mechanism to deal with them, so now that’s in place.” said.
Darling said he accepts that some people are skeptical of the ongoing review because some things haven’t been fully addressed or changed after previous efforts. But Darling, who is also chief of surgery at Dalhousie University, said the ongoing work is unparalleled within the division of cardiac surgery.
“This has been deeper, broader, more people, with a different lens, if you will, than any review that’s been done before,” he said.
“This is a very, very different revision and we have been assured, and I am sure, that it will have teeth.”
A clinical review of the division of cardiovascular surgery was added to the work after Darling said he raised his own concerns about patient outcomes with the health authority’s acting chief executive. External reviewers also heard the same concerns, she said.
Darling, a thoracic surgeon who arrived from Ontario nine months ago, declined to comment on her concerns.
Patient outcomes are reviewed
A recent publication from the Canadian Institute for Health Information (CIHI) showed that the 30-day in-hospital mortality rate after isolated coronary artery bypass graft surgery at the Queen Elizabeth II Health Sciences Center in Halifax over the past three years is higher than the national average by a margin “statistically significant”.
The clinical review is being led by Dr. Chris Feindel, a senior cardiac surgeon at University Health Network in Toronto, and is expected to be complete, along with the rest of the review work, by the end of the month.
Oldfield told reporters Wednesday that the report will be made public without any personal or confidential matters.
change is difficult
Several people who work in the cardiac surgery division at QEII told CBC News that concerns remain about the behavior of some of their colleagues. A former head of department suing the health authority has alleged in court documents that the workplace is toxic.
Darling said there are “a multitude of reasons” why the issues identified in previous split reviews have not been fully addressed.
“Change, as you know, is hard. And some things got better, but maybe not enough. So we’re working on all of those things. I mean, I think that’s part of why I was hired as head of the department.” , was to bring someone with fresh ideas,” he said.
“I am not totally surprised that everything is not perfect and that we still have some challenges, but I would say, as a general statement, that nothing has changed or that nothing has improved. However, there is still work for sure.”