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Debrief: Town Hall on Island Health’s new Patient care Model

Last night I held a public Town Hall on Island Health’s new Patient Care Model. According to Island Health, the new model (titled Care Delivery Model Redesign, or CDMR), will shift from a nurse-centered approach to a team-centered approach that will see an increased role for health care aids. Under the model, Island Health will be cutting 100 baseline nursing positions in 21 units at the Royal Jubilee and Victoria General Hospitals and replacing these positions with 95 new baseline Health Care Aid position.

According to Island Health the model (titled Care Delivery Model Redesign, or CDMR) will address strains on the health care system while increasing the care time a patient receives. However, critics have argued that it could put patients at risk as nurses are replaced with health care aids that are inadequately trained for their new role.

Many constituents wrote me with their concerns about the patient care model. In response, I met with key stakeholders including Island Health, the BC Nurses Union and the College of Registered Nurses of British Columbia.

What became clear is that while Island Health states that the new patient care model is evidence-based, they have yet to release their evidence for public review. Meanwhile, health care research clearly suggests that the new model could have significant implications on the quality of care a patient receives.

The purpose of the town hall was to bring together the different perspectives so that we could become informed about this change to our health care system.

I was pleased that our panel could include:

  • Dr. Noreen Frisch, Professor and Director of the UVic School of Nursing
  • Dr. Paddy Rodney, Board Member of the Association of Registered Nurses of BC and Professor at the UBC School of Nursing
  • Adriane Gear, South Island Co-Chair at the BC Nurses Union
  • Sara Shorten, Representative of the UVic Nursing Student Society

Island Health was invited but unfortunately chose not to participate.

In December, I wrote to Dr. Brendan Carr, President and CEO of Island Health and requested that further implementation of the new patient care model be paused until comprehensive, independent and publically-available evaluations can be completed. I also requested that key stakeholders, such as BC’s Registered Nurses and Licensed Practical Nurses be further involved in these evaluations and in developing any plans involving the realignment of care teams.

I will continue to voice these concerns in the coming weeks and encourage constituents to raise their voices as well.


  1. Cath-
    June 24, 2014 at 1:16 pm

    I appreciate your synopsis of the CDMR issue and for your desire to raise public awareness of the lack of evidence for this model. I am a graduate student doing research examining nurses’ work. The “original” research that CDMR is apparently grounded on is of particular interest to me, yet I cannot find the author or the study published anywhere. Does anyone know where I can find it?

    It must be published because VIHA has written on their website:

    “How we collected information about staff activities
    We tracked and recorded health care provider tasks through a process Function Analysis.

    Data was collected on 18 (33%) of Island Health’s 54 acute care units and seven units in other BC health authorities.

    980 staff members were observed during their normal work routines, up to 24 hours a day, seven days a week.

    More than 1.3 million observations across 3,100 shifts were analyzed along with patient data.”

    These are very important observations and data!!!! Why not publish it so we all know How the CDMR folks came to make the drastic changes they did??!!! It is important work!

    • June 24, 2014 at 7:56 pm

      Hello Cath, I asked Island Health for the evidence that supports CDMR and have not received it. I know that nurses were tracked to see where they were spending their time. But I have no idea how that translated into the CDMR model and what evidence (if any) there is to suggest this will improve rather than hinder patient care.

  2. March 2, 2014 at 5:37 pm

    For those interested in the CDMR issue, there is a new study just published in the journal Lancet that make it pretty clear:

    “Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths.”


  3. March 2, 2014 at 10:28 am

    I would like to thank everyone who attended the Town Hall on February 27th. Andrew talked about the importance of learning together, and I think the event made some good progress in moving forward…The voices from the public who were there, point of care nurses, students, BCNU, UVic, and the ARNBC all helped to surface the complexity and the urgency of the questions around CDMR.

    And thank you, Andrew and team members, for a great experience in healthy democratic dialogue!

    • March 2, 2014 at 5:36 pm

      Thank you for coming Paddy. Your contributions were greatly appreciated.

  4. Celia Stocker-
    March 1, 2014 at 10:31 am

    Hello Andrew,
    FINALLY a voice of wisdom. You have every reason to be concerned. In these days of short critical stays in hospital now is not the time to save money by cutting trained nursing staff. Very scary.

    It is well researched and documented that good solid care at the beginning of a hospital visit cuts the length of hospital stay and the amount of re-admissions. This care is not done by care aids, it requires well trained and qualified Registered Nurses. You get what you pay for. AND pay eventually for what you are not willing to pay up front for!

    We are headed down a very slippery path.

    Please keep the pressure on. Thank you

  5. robbar-
    February 28, 2014 at 11:18 pm

    Thank you the summary
    What I find disturbing is as you say ‘ where is the evidence’ as this looks like more of a cost saving measure when you have reduced positions for nurses. Making nurses as more admin has no sense.
    Main concern is we have spent years trying to increase training of new nurses and then place in our Health system. This approach means our young people will go to other provinces and countries. Indirectly even our operating room staffing will suffer and patients will wait longer.

  6. Beth-
    February 28, 2014 at 6:08 pm

    I think your protests. comments, complaints are about 6 years to late! Where were you when CDMR was first brought forth and when the planning started???? Getting involved now is kind if like protesting a bomb after it’s already been detonated! To little and really to late! Nice try!

    • February 28, 2014 at 6:38 pm

      Hello Beth, thank you for your comment. In fact CDMR was only introduced in Nanaimo General in September 2013. It is planned for Vic General and Jubilee in late April.

  7. Catherine Mick-
    February 28, 2014 at 5:37 pm

    Very informative meeting. Glad many younger people came out, not just the White heads! .

  8. Paula-
    February 28, 2014 at 4:01 pm

    Thank you for being willing to be the voice of reason on this very serious health care matter and I hope that everyone on Vancouver Island will stand against what VIHA is proposing. When the ratio of RN to patients go up so does patient mortality ( death rates). RN ‘s have 4 years of intense education and Care Aids six months.

  9. Jeanette Funke Furber-
    February 28, 2014 at 3:32 pm

    Thank you Andrew for organizing this town hall. I too was concerned that we did not hear from Island health, it would have been most useful to get the whole picture.

    I support your request made to the CEO in Dec, as a way to successfully resolve this major health care plan to Care delivery.

    If indeed it is about needing to save $$$, I read about innovative methods of care delivery that are doing exactly that, Most recently highlighted on the Globe and Mail, Saturday Feb 22, “Sunnybrook : We cant afford to do this” and Tuesday Feb 18, A home remedy for emergency health”

    It is time to be progressive not regressive, the model poposed it a method that was used 50 years it may have worked better then, the patients average length of stay in hospitals was weeks
    not days, in more stable conditions.