KHSC CEO discusses provincial plans amid local backlog of 7,000 surgeries

The backlog of elective surgeries and other non-urgent procedures continues to be felt locally in Kingston and the surrounding area, with several thousand people currently on the waitlist for elective procedures within Kingston Health Sciences Centre (KHSC). While local hospitals work to clear the backlog, the provincial government’s plan to cut wait times by offering additional procedures at independent health facilities is drawing a cautious reaction from Dr. David Pichora, President and CEO of KHSC. 

As of this writing, KHSC currently has over 7,000 people on its elective surgeries waitlist, 4,000 of whom have had to wait longer than the targeted wait times put in place by the government for the various procedures. According to Dr. Pichora, the situation has been years in the making. “It’s not a new issue. Like many things, it’s been compounded and exposed by the [COVID-19] pandemic. It’s not new; we’ve been here for a while.”

Like other hospitals in the province, KHSC paused elective procedures throughout much of the pandemic, meaning people in need of hip and knee replacements and cataract surgeries had to wait an extended period of time. “We continued doing a lot of emergency and urgent surgeries… But regularly scheduled, non-emergency, non-urgent surgeries [were delayed]… Hernia repairs, elective gallbladder surgery — it’s a long list, even some kinds of cancer surgeries. Breast cancer surgeries took a real hit because screening centres in the province were closed, so patients weren’t coming in,” noted Pichora. 

Once pandemic-related restrictions on healthcare facilities were lifted, Pichora said, patient referrals to surgeons began to “drop like a stone” as the list of scheduled procedures began to pile up. “[The pandemic] compounded the flow into and through our surgical waiting list.” 

The CEO referenced other issues as well, such as staffing shortages and capacity in long-term care facilities, both of which played a role in contributing to the backlog in non-urgent procedures. “It’s not just one factor. The pandemic has compounded problems that pre-existed, and we’re working very hard to try to get back to the baseline… We’re trying to find ways to run more operating rooms or longer hours and days than we did before, but the main limit there is staffing.” 

To combat the backlog within KHSC and reduce wait times, Pichora noted that KHSC is once again operating at 100 per cent of its operating room [OR] capacity, with 40 per cent of procedures reserved for patients who have been waiting longer than the targeted wait times set by the province. 

The surgical backlog is not an issue unique to Kingston. According to a recent provincial government news release, “there are currently 206,000 people estimated to be waiting for surgical procedures” throughout Ontario. In an attempt to reduce wait times for surgeries and other procedures, Ontario recently announced a plan to expand the offerings of community surgical and diagnostic centres licensed under the Independent Health Facilities (IHF) Act, according to the provincial government.

While IHFs are nothing new in Ontario, the government recently announced plans to fund cataract surgeries, hip replacements, and knee replacements at the independent facilities, as well as magnetic resonance imaging (MRI) and computerized tomography (CT) scans. In terms of the specific role IHFs should play in reducing the surgical backlog, Dr. Pichora expressed mixed feelings. “The premier has said the status quo isn’t working and we need a shake-up, and I think that’s fairly evident. The question is, what are the options, and what are we going to try? Are we going to take some risks and be prepared that some of the things we try won’t work? Because that’s what’s likely to happen.” 

“There may be a role for IHFs,” the CEO went on. “It’s yet to be determined exactly where they fit. But most hospitals would [argue that] we could do more; all we need is more staff. Or we need the funding models to incentivize us to run longer hours and operating rooms on the weekend, assuming we’re able to get the staff to do that.”

Pichora noted that KHSC does have some experience working with independent facilities, such as its agreement with Focus Eye Centre regarding select cataract surgeries. “We have a contract with them to have them provide a certain number of our cataract surgeries every year… and it’s supported by the Ministry [of Health]. They know we’re doing it here, and they assist to make that feasible.” 

According to Pichora, KHSC continues to have oversight on the cases handled by Focus Eye Centre, which may not be the case at all facilities funded by the province. “There is some concern with hospitals that the [IHFs] are working independently of the rest of the system. They may be inclined to scoop up the low-cost, low-complexity cases and leave hospitals with a higher complexity… That may not be a good thing for the system.” 

The KHSC CEO also noted that hospitals play an important role in training the next generation of doctors and surgeons — something the contract with Focus Eye Centre allows for, but that may not occur if future funding for IHFs comes directly from the provincial government. “Our agreement with Focus enables our residents to go there and train there. Those are things that are included in our contract. There’s no assurance that would be the case if the government is funding an independent health facility directly to do the cases,” warned Pichora. 

With IHFs picking up more profitable procedures that come with a lower risk, there’s the potential that Ontario’s hospitals will be left to deal with complicated and expensive surgeries all on their own. “I think there would need to be a close eye kept on the way this is funded. [If] the [IHFs] are doing the lower cost, lower complexity cases, the funding needs to reflect that. If hospitals are doing the more complex, higher cost cases, the funding should reflect that, as well.” 

Aside from funding, another area of concern for Pichora is the impact IHFs will have on hospital staffing, which has been a significant issue within KHSC for some time. “The number one short-term issue is staffing: just recruiting, training, [and] retaining OR staff… And then, all the other folks that are involved in the surgical process… it’s a capacity issue. 

“The advantage of the [IHFs] today is that some of them exist, so they have staff and they can be contacted. So, in my view, if you want to take advantage of them, well, that’s fine, but it’s all about how the contracts are set up and how they’re partnered with and integrated with hospitals,” Pichora added. 

With the province intending to offer hip and knee replacement at IHFs, on top of cataract surgeries and MRI and CT scans, Pichora remarked on the differences between the various procedures and the need for additional clarification from the government. “There’s a lot of differences… from the resources that are required and the way they’re funded, [to] the need for overnight stays for many patients, and rehab and community care… That’s a whole different model of care that would need to be developed. Just because you’re doing cataracts today, doesn’t mean you can do hips and knees tomorrow.”

Considering the uncertainties surrounding funding and the impact IHF contracts may have on hospital staffing, Pichora said he continues to share his thoughts with representatives from the Ministry of Health. “There’s lots of work to go on. The people in the Ministry… they’re working on it. I met with them last week and gave them observations from our experience, which they were quite keen to hear about.” 

In terms of the overall net effect IHFs may have on patients within Ontario’s healthcare system, Pichora again stressed a cautious outlook. “There [are] lots of reasons why we need to reduce the waitlist down to a much more manageable level, so there needs to be more capacity in the system. IHFs, I think, are an opportunity to provide part of that solution. I don’t think it’s going to be a magic bullet that changes everything; it’s all about how it’s done.”

“How do we ensure the costs and funding are appropriate and equitable across the system? How do we ensure that patients are going to get the same quality of care wherever they go? How do we ensure that we’re able to train the next generation of nurses and surgeons and our techs? There’s lots of questions around how it’s done that really matter,” he concluded.

KHSC oversees the operations of a number of Kingston hospitals and health-care facilities, including Kingston General Hospital (KGH), Hotel Dieu Hospital (HDH), and the Cancer Centre of Southeastern Ontario.