Health Sciences North (HSN) has an obligation to provide the best high-quality health care to every citizen of Sudbury and Northeastern Ontario regardless of anyone's personal circumstances or station in life.
That was part of the in-depth discussion that took place this week at the hospital's annual meeting. Despite speeches from hospital directors and the financial auditor, the first 35 minutes of the meeting was all about the importance of social accountability as one of the key values at the hospital and one of the goals of HSN's five year strategic plan (2019-2024).
Emergency room physician Dr Alex Anawati hosted the discussion that included input from other leaders at HSN.
Anawati said "social accountability should be understood as a social justice concept." He said it means HSN must be accountable to society and that includes all the diverse people and communities across Northeastern Ontario. He said it also includes everyone who is marginalized and has experienced inequity.
Anawati said equity is not to be confused with equality.
"Unlike the notion of equality, equity is not about treating everyone the same. An equitable approach requires deferential treatment based on needs and redistribution of resources and different approaches to caring for people to help achieve a level playing field for everyone so that everyone has an opportunity for health gains and so that everyone has the opportunity to thrive," he said.
Anawati said this means focussing health care on some obvious directions such as caring for Indigenous people, for people with mental illness, for people who use substances and for caring for older adults.
Indigenous Health Director Deanna Jones-Keeshig said the Indigenous population is a diverse and unique group representing about 14 per cent of the population in Northeastern Ontario.
"For Indigenous peoples, social accountability is about the commitment to truth and reconciliation. HSN has made this commitment in their strategy and have only stepped into the beginning of this journey by embarking on a path forward in partnership with indigenous peoples," said Jones-Keeshig.
She said Indigenous people, for many reasons, have health disparities. Keeshig said there is a movement among Indigenous Northerners to have a collective vision of health and wellness moving into the future.
She said HSN is moving in that direction with holistic, culturally relevant and safe practices for Indigenous patients.
"Are we making progress? Yes. Can we improve services at HSN? Absolutely. We have a long road ahead and together we can support change and achieve it," said Jones-Keeshig.
Geriatrician Dr. Jo-Anne Clarke commented on the importance of caring for elderly people. Clarke said Canadians are still living with the same health-care system and not too many changes have been made, but Canadians are living so much longer.
"We have made great gains, people don't die as much," said Clarke.
She said most Canadians are now living beyond acute disease episodes that used to be fatal.
Clarke said a new situation is developing where more Canadians are developing dementia.
"Older adults, by the year 2036, will make up over 30 per cent of the total population," said Clarke.
"And as our Boomers move through, it's important to recognize that rates of dementia double every year after the age of 60. And rates of dementia are going to be doubling in the next eight years and tripling in the next 30," she said.
Clarke said this is going to mean significant adjustments to accommodate care of the elderly.
"People can go through family medicine residencies and medical school doing no geriatric rotation whatsoever. And yet every person will at one point be caring for an older adult, the possible exception of a pediatrician," she said.
Clarke said people with dementia have higher hospitalization rates, they stay longer and are more likely to get sicker.
"So we need to train teams, and to train ourselves to look at all the things that affect quality of life," Clarke told the meeting.
HSN's Regional Addictions Physician Lead Dr. Tara Leary commented the hospital is concerned by the opioid crisis and how it has impacted visits to the emergency room.
"Our emergency department visit rate is double the provincial average for opiate overdoses and opiate-related concerns. And those are stats that I think a lot of us have access to because it is widely available and widely discussed in the media," said Leary. She said the numbers are grim, but then added other surprising statistics.
"In terms of repeat visits, about 25 per cent of substance-related repeat visits in a month are around opiate use; but more, almost half are related to alcohol use. And we don't read about that a lot. It doesn't make the news in the same way. But it is the reality that we work in. And so we're faced with a population that struggles with a variety of substances," said Leary.
She said Sudbury is faced with a population that struggles with a variety of substances. And she said this shows up at every level of hospital care, whether it is inpatient services, outpatient services, whether the care is acute or elective.
Leary said this was especially evident during the COVID-19 pandemic, but added HSN rose to the challenge with the creation of a specialized Addictions Medicines Unit (AMU).
In terms of accountability, Leary said the hospital was inclusive in consulting with patients and people with lived experiences in developing policies and procedures in the AMU.
"And I think it really speaks for itself that we were recently awarded a national leading practice organization designation by Accreditation Canada. So your organization that accredits hospitals and healthcare institutions, also accredits groundbreaking and unique programs.”
Leary also told the meeting there is a lack of research on acute care addiction health care. She said HSN is facing a lot of newer situations but the team is seeing positive results in such things as 30-day revisits, more patient satisfaction and knowing that when focused care is provided to addicted patients, there is a greater chance those patients will seek similar care once they have been discharged from the hospital.
Leary said there is room to improve addiction services.
"We don't have robust outpatient services in the same way that follow-up post cardiac issues or post lung issues have evolved in the community," said Leary.
"We're not there with addiction services. And so we really do need to make sure that when they access care, we have the biggest impact that we can."
Len Gillis covers health care and mining for Sudbury.com.