Dr. Jude Kornelsen is looking to change the way health authorities in B.C. operate in rural settings.
The co-director of the Centre for Rural Health Research at UBC has completed a number of studies looking at ways to improve rural health care, and found that many people in rural communities have lost trust in their health authorities.
“So many people wrote back and said that they do not have engagement with the health authority anymore. They cannot figure out who to talk to when they have suggestions or solutions,” Kornelsen said about a 2020-2021 study she led.
The Northern Health Authority has faced sharp criticism on Prince Rupert’s social media channels, as recent closures to the city’s emergency room has created a deep sense of frustration among many residents.
Kornelsen said she understands the challenges facing health authorities – which she said are “between a rock and a hard place” – but argued that the systems they have put in place have been a major cause of the issues they face today.
“Obviously, they don’t want closures,” she said.
“But it’s a product of how we’ve set up the system right now and our lack of attention to midwifery, but also to nurses.”
Bringing back hospital boards was an idea Kornelsen heard frequently. The boards consisted of members of the community who were not in the health-care field, but were still able to communicate to important decision-makers in the field.
“These local community members had a direct pipeline to the ministry, where they could say, ‘This is what’s happening in our community. This is what we think we need and these are the solutions we’ve come to.’ So a lot of people in the survey said, ‘Why don’t we go back to regional health boards?’”
While Kornelsen said bringing back hospital boards may not be viable, bringing back more direct lines of communication will improve the relationships between communities and B.C.’s health authorities.
“We need way more transparency in reporting and decision-making so decisions don’t just come from above and nobody understands why,” she said.
“I’m not necessarily criticizing the decisions that are made, the health authorities have reasons for the decisions they make. In the communities, we just don’t know what they are.”
Kornelsen found the COVID pandemic made the disconnect between communities and health authorities even more profound, when health authorities had to make rapid decisions, which led to a lack of consultation with communities.
“That alienation and frustration due to lack of engagement in health planning and decision-making really erupted during COVID, and it was precipitated by some of the public health mandates we had.
“But then just exacerbated because we weren’t doing public forums. The decision-makers weren’t doing any outreach.
“So it became really evident that we have to understand this gap between rural community-oriented voice in policy and decision making and what its uptake is in health planning at both regional levels, but also provincial.”
B.C.’s health authorities have faced backlash for their perceived over-bureaucratic operation methods. At a March Prince Rupert city council meeting, Coun. Barry Cunningham argued Northern Health needed “less desks and more beds,” a sentiment Kornelsen said she has frequently encountered.
“When we did interviews with community leaders, they said that was their biggest issue, trying to fight through their bureaucracy to get things to happen, all of the red tape they had to go through,” she said.
“For example, to open a primary care clinic in their community, the health authority bureaucracy was crippling.”
Northern Health has implemented numerous incentives in recruitment efforts for healthcare staff.
But Kornelsen said more emphasis needs to be placed on ensuring medical staff are not “siloed” into separate groups, but work as one cohesive unit where physicians are aided by specialists.
“Physicians can’t and shouldn’t be doing everything,” Kornelsen said.
“You can’t just put a group of people together and say, ‘There we go, we’ve got a team.’ It doesn’t work like that. You have to do team development.”
She said there have been improvements in team-based care in B.C., although there is still more work to be done.
“We’re not getting to the heart of the problem, which is making sure that health care providers that go to rural communities feel very well supported,” Kornelsen said.
“What we have in essence is a situation where people are daunted about going and practicing in a low-resource environment, in a small hospital where they don’t have immediate access to all the sub-specialties that exist in Vancouver.
“That’s a daunting proposition, especially if somebody is new to practice. Because I’ve never met anybody who’s willing to be in a situation where they believe a patient could be better served in a different environment.”
According to Kornelsen, nurses she spoke to appreciated even the smallest demonstrations of gratitude from their employers, such as a free lunch once a month.
“They kept going on about ‘oh my gosh, we felt so valued, so respected to be invited to a free lunch this month.’ That is not difficult. That is not hard to do.”
