What we at the BHB believe the public need to know
I am writing as I wish to strongly refute the headline in The Royal Gazette on Friday November 27, and reassure the public that the internal medicine service programme, which employs fully trained doctors (hospitalists) and medical officers, has been appropriately directed and managed. The programme has, in fact, achieved a 3 per cent cost improvement compared with the same period last year.
The Royal Gazette front-page story that ran on Friday included grave allegations about a "scam", which are wholly untrue. We are always looking to balance the needs of the service with efficiency, and in fact the internal medicine programme is running at a 3 per cent lower cost compared with the same period last year. This translates to a $86,000 cost saving compared with last year.
This has been achieved despite the incredible pressure and stress of running a hospital through a global pandemic. As we were making changes to be more efficient this year, we had set a lower budget than the year prior — before we knew about the pandemic.To date we have exceeded this budget by only 2.74 per cent. That is an incredible achievement by our professional medical staff, who have worked under great duress during such a difficult and challenging year.
I would add that, after a further review on Friday on all the times hospitalists had been asked to work unplanned extra shifts owing to an unexpected staff shortage — not just those sent to us by The Royal Gazette — we can confirm that since March there have been ten instances when there have been authorised variations to the planned schedule to ensure the highest level of patient care and safety were maintained. This is not something that happens frequently and is in response to clinical needs — certainly not an ongoing “scam” that The Royal Gazette alleges.
For accuracy of record, this does not include dates in July when there were more scheduled 12-hour shifts for the hospitalists. Although these dates were sent to the BHB to review, they were not unplanned variations to the schedule, but planned shifts to manage the workload and the pressure that was being experienced. This pressure was explained to The Royal Gazette, although they did not publish this part of our statement.
We are sharing this information in this Letter to the Editor in the hope it can be shared in full with the public who read the newspaper.
Unfortunately, while we received questions about our scheduling practices and an allegation about hospitalists returning on site to swipe in and out, at no time did the journalist make us aware that he was going to quote someone alleging this was a “scam”. He questioned the efficiency of our scheduling — a topic that we do believe is worthy of review, and we responded in good faith.
The allegations that were included in the final article, however, made an unfounded and damaging attack, not just on the hospital but on our professional medical staff, who have been working under great duress during the pandemic. Furthermore, The Royal Gazette has not published our response to the misconduct allegation, the details of the clinical pressures between April and July, and the details of the scheduling reviews that were requested by the journalist. These were provided to The Royal Gazette before they published their story, and shared again in our public statement sent on Friday in response to the article when we realised they had omitted them.
As we have said many times, we believe we can still make improvements to our efficiency, especially with scheduling. We are not perfect, but we work to improve every day. Scheduling is not a quick and easy fix, despite the claims in the article, as we must ensure the highest quality of care is maintained as changes are made. Improvements have been achieved this year, but scheduling is now in the programme of a cost-savings programme that we are undergoing with the support of KPMG, who are bringing external expertise and international benchmarks to help us.
Responses from the BHB sent to The Royal Gazette before the Friday story, but not published:
Regarding questions as to why a group of hospitalists covered four hours when a medical officer could not work a shift. We had explained that the schedules do not provide the clinical context of the number of patients and how sick they are, nor the pressures caused by the pandemic. As noted earlier the dates in July were planned 12-hour shifts, and not unplanned variations, but this explains the context as to why more senior doctors were needed:
“Through April and May we were seeing an increasing number of Covid-19 patients in the hospital, and from June through to July we experienced a significant surge in demand following the relaxation of lockdown. These patients were very unwell, some of them having delayed seeking care due to the lockdown and fears about being in hospital during the pandemic. Comparing the full month of June to July, we saw an increase from 350 admissions to 450, a month-on-month increase of about 100 people, or 29 per cent.”
Allegations about hospitalists leaving their post were reviewed. The Royal Gazette quoted allegations extensively, but did not print the response we sent to them:
“There is no evidence of the misconduct alleged by the anonymous source in the hospitalist group. Our hospitalists have specific duties of care for their cohort of patients which must be met as part of their contracts. There is professional discretion to allow hospitalists to work remotely in certain circumstances once all on-site and direct-patient care duties are attended to, although they still must respond within time frames established by the medical staff for emergent, urgent and routine requests.”
Here are more details about the scheduling review, which were not printed in full by The Royal Gazette, although they were requested:
“The BHB regularly reviews use of overtime throughout the organisation and has started work on reviewing hospitalist and medical officer schedules. This work is being undertaken in partnership with KPMG, who provide benchmarking and experience from overseas hospitals to help us find the most efficient way to provide the most effective service. Work already is well advanced for reviewing and updating schedules for nursing — our biggest professional group. Meetings started this month on schedules for medical staff, including hospitalists and medical officers.
“While this is recent work, the cost of staffing and use of overtime is a constant area of focus for the BHB, even more so as we try to respond to the financial impact of the Covid-19 pandemic. Changes to the hospitalist and medical officer schedules had been made this year as a first step to improved patient care as well as reduce double-time/overtime expenditures. This included more scheduled 12-hour shifts for the hospitalists. “
Finally, as had been included in an official response to the journalist, there is at least one on-site hospitalist at King Edward VII Memorial Hospital 24 hours a day. This was explained in more detail to the journalist — that there is a hospitalist on site overnight who oversees admissions in the Emergency Department and covers all the inpatient wards. We do not know why the journalist repeated misinformation that they are only “on call” and medical officers are on their own.
We remain, as noted in the BHB quote to The Royal Gazette, open to improving all our processes, including scheduling, to ensure we running as efficiently as possible and, despite this attack, thank all those who have been working tirelessly on the front lines of care to ensure the BHB can continue to care for all those in need through the pandemic.
MICHAEL RICHMOND MD
Chief executive and president
Bermuda Hospitals Board