On July 24th, the Executive of the South Island MSA sent a letter to Kathy MacNeill, President and CEO of Island Health. Below is a copy of the letter, as well as the response.
Dear Kathy,
On behalf of the South Island Medical Staff Association, we are writing as partners to Island Health. The current fiscal reality is incredibly challenging for the heath authority and affects everyone working in or accessing care from its facilities. As partners, we want to support Island Health’s efforts to reduce costs, improve efficiencies, and ensure the organization’s return to financial viability.
The layoffs that began a few weeks ago affect everyone. Given our unique position of being credentialed to practice at Island Health, we feel we have the responsibility to speak up for others who are employed by the health authority. Our aim is to try to ensure that the cutbacks are applied as fairly as possible; that layoffs are kept to a minimum; and that the leaner health authority is poised to move forward with a strong, supportive, and unified culture:
- Acknowledge the problem. The pain of these cuts must be recognized for us to work together to make the necessary sacrifices. “Better Care, Better Value” fails to acknowledge this. For those being laid off, being told their dismissal will result in better care must be especially painful.
- Offer transparency. So far, layoffs have been done quietly without public announcements. Some who have been laid off may prefer to have privacy. However, we are also hearing from people where the abruptness and lack of acknowledgement for the good work that they had done is increasing the sense of shame around losing their jobs. Those remaining need a chance to honour their departing colleagues and also be provided with information about how the necessary services will survive without their valued team members.
- Share the underlying strategy. We have been told that the layoffs are part of a restructuring plan. However, no details of the new structure have been revealed. This makes the cutbacks, perhaps unfairly, appear random and at times unjust. Understanding the rationale behind the decisions will help build trust with those who continue to serve in Island Health.
- Ensure input into cutback decisions. As far as we can determine, decisions about personnel and other cutbacks have been made from the top down. However, those closer to direct patient care have valuable opinions on what clinical programs are essential and which leaders are worthy of being followed. These opinions need to be heard. Physicians are keen observers of the health care environments in which they work and are well placed to support changes in the delivery of care that improve the safety and efficacy of medicine.
- Think differently. Explore alternatives to full layoffs such as hybrid clinical/ leadership positions and job sharing, especially for nurses. Support physician ClinDoc use at all Island Health sites to smooth patient visits and transfers. Reap the benefits of physician-led engagement and QI projects that have been shown to reduce costs, smooth inefficiencies, and improve patient care (examples below). Identify and reduce unnecessary, internally-defined barriers (details below).
- Demonstrate a sense of shared sacrifice. Senior Executive needs to communicate how sacrifices are being borne by all levels of the organization.
In your email of June 4, 2025, you shared that the Health Authority is looking for strong ideas that “accelerate a value-driven mindset, shift resources from administration to frontline care, or improve existing clinical services without additional spending.”
Through FE-funded engagement projects, members of the South Island MSA have been at the forefront of physician-led value mindset innovation since 2016. Successful, replicable projects that could be rolled out at other Island sites include:
Decrease wait times and overall costs by bringing care closer to patients
- A compassionate approach to detecting and treating skin cancer among the institutionalized elderly
- Adult Psychiatry Services and Behavioural Supports in LTC
- LTC Wound Care
- Point of Care Ultrasound
- Pulmonary Function Test Lab Service Improvement
Reduce Length of Stay and number of visits by improving on-site services
- Breast Surgery ERAS and regional anaesthesia project
- Development of the Victoria Enhanced Recovery Arthroplasty (VERA) program
- Pediatric Complex Care
- Urgent Pediatric Access Clinic
Reduce medication and device costs through targeted action
- Climate Conscious Deprescribing Initiative
- Penicillin Allergy Delabeling in Pregnancy
- Rapid Delabelling of antibiotic allergy among children
- Reducing Pharmaceutical Costs in ER
- Saving on Downstream Costs in Implantable Loop Recorder Monitoring Through Reducing False Positive Alerts
- Worksafe BC Re-allocation in ER
Embed efficiencies into clinical care through interdisciplinary work
- Designing a Multi-Disciplinary Clinic at the BCCA
- Development of a Complex Comorbidities Clinic
- Enhancing Specialist Care for Patients with Decompensated Liver Disease
- ERCP Service Improvement and Follow-up
- Integration of General Internal Medicine into the Cardiology unit
- Paracentesis Process Improvement
- South Island Integrated Breast Cancer Care Program
Reduce hospital visits and re-admissions through improved patient support
- ER Discharge Resources
- Presurgical Resilience Optimization Project (PROP)
- Surgeries for Disadvantaged Patients
Reduce Island Health-imposed barriers to change
- Another project investigated the possibility of a ‘gainsharing’ initiative to inspire physicians to identify and implement cost-savings activities within their own departments, with an added incentive: a portion of the cost-savings would be reallocated to the department to fund future quality improvement initiatives. The multidisciplinary project team identified several ‘easy wins’ for this type of cost-savings, such as reducing the number of inappropriate lab tests in the ER, in line with the Choosing Wisely Initiative. Despite this promising beginning, this initiative struggled to gain traction with Island Health leadership, in part due to logistical complications associated with the transfer of funds from one operational account to another based on the evidence of cost-savings.
- Although the KnowledgeExchange is now closed, members of the South Island MSA have numerous low-effort, high-impact, “strong ideas.” However, they don’t know who to speak with or how to bring these ideas to fruition. As an example, neurosurgeons perform Burr Hole Procedures to relieve pressure on the brain. Currently, the procedure packs contain 25 instruments. According to a South Island physician, only three instruments are actually needed for the procedure. When they have spoken with Island Health personnel to try to change the procedure packs, they’ve been told that a change simply isn’t possible.
This is just a short list of many high-impact, low-cost ways to reduce spend, from a single Medical Staff Association. With 10 other MSAs across the region, there is an Island’s worth of medical staff-led passion, innovation, and quality improvement waiting to be tapped into. We encourage you to not only consider the suggestions listed, but also to reach out to the other MSAs. They know their sites, communities, and patients best.
Public funding is at the heart of healthcare. We hope that the push for efficiency and savings continues beyond the current fiscal realities and becomes an integral, regular part of Island Health’s responsible practice. For now, and in the future, we look forward to working collaboratively with Island Health to ensure the wellbeing of our shared clinical work and workplace culture.
Sincerely,
The Executive of the South Island MSA
July 28, 2025
Dear Executive of the South Island Medical Staff Association,
Thank you for your letter of July 24th. I truly appreciate the South Island Medical Staff Association’s continued partnership and commitment to reducing spend and improving efficiency. Your thoughtful ideas, constructive feedback, and focus on high impact, low-cost opportunities are both valued and timely. They will meaningfully contribute to and help shape the Better Care, Better Value work we have underway.
As a next step, I will be reviewing your letter and suggestions with our executive leadership team. Once we’ve had the opportunity to reflect and discuss them together, Marko Peljhan, Vice President, Acute Clinical Operations & Provincial Programs, and Dr. Ben Williams, Vice President, Medicine, Quality, Research & Chief Medical Officer will be in touch.
I am grateful for the South Island Medical Staff Association’s ongoing collaboration, leadership, and partnership in this important work.
Sincerely,
Kathy MacNeill