Looking at the Past to Shape the Future
Dr. Noralou Roos, Professor in the Faculty of Medicine and a founding director of the Manitoba Centre for Health Policy
The Repository at MCHP can tell us a lot about what keeps Manitobans healthy and how well our social and health care systems are working. Research from the Centre has influenced health policy in a number of ways over the years. During these unusual times I am reminded of a study (led by Professor Verena Menec) that we did in the late 1990’s.
Hospitals were struggling to find enough beds for patients, people were receiving care in the hallways. Newspaper stories vividly described the plight of patients waiting for beds, and nurses and physicians publicly expressed their frustration with the state of the Winnipeg hospital system, as reflected in comments like “There is an atmosphere of almost desperation on the wards” and “Dignity and privacy are guaranteed to patients, and yet there is a deafening silence when clear-cut transgressions of this code of ethics take place day after day” (Winnipeg Free Press, March, 1998).
Several committees had formed to investigate the problem and many theories had been put forward. A team of us at MCHP were asked by Manitoba Health to look into potential causes of this hospital bed crisis. We had noticed a pattern of seasonal overcrowding of hospitals, as reported in the media. This gave us an idea to try and figure out how occupancy rates at Winnipeg hospitals changed over the years and how this related to what the media was reporting. A programmer figured out how to calculate the number of people in Winnipeg hospitals every day of the year. We tracked the number and type of cases in hospital (broken legs, heart attacks, surgery etc.) during the times the media was reporting the bed shortages to try and figure out what could be causing the crises.
We and others were surprised to learn that bed crises occurred regardless of the number of beds in the system. Periods of high pressure during the winter months were apparent before 1991/92 when there were about 700 more beds in the system than in 1997/98, and in many subsequent years. We concluded that high pressure periods therefore can be expected to recur regardless of the absolute number of beds in the system.
The increase in emergent/urgent medical patients in hospital during the winter months was due to influenza-associated illnesses (pneumonia and influenza and other respiratory conditions). We concluded that influenza-associated illnesses were largely responsible for high pressure periods.
The flu creates an acute problem because you get a rapid increase in people who are very sick and need health care. This rapid increase in people needing health care services wasn’t limited to only hospital beds, there was also increased pressures in emergency rooms and physicians’ offices, the bed crises was just most obvious.
We recommended that overcrowding in hospitals could be reduced through measures like coordinated bed management strategies and a flu vaccine program, particularly targeting the elderly and those at risk. The findings from this study have been credited by both the Ontario and British Columbia governments for justifying their expanded flu immunization efforts too.
Prior to the research, not much was known about the high pressure periods and how we could better prepare the health care system to meet the needs of Manitobans.
As Manitoba flattens and reverses the COVID-19 curve, data are being created that can teach us a lot about our health care system, the pressures it was put under and health of Manitobans during a pandemic. The MCHP Repository will likely give many opportunities for understanding how the COVID-19 pandemic affected the system – what worked and what didn’t and how to take important steps towards system recovery.
Dr. Noralou Roos
Professor in the Faculty of Medicine at the University of Manitoba and a founding director of the Manitoba Centre for Health Policy