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For decades, London’s two big hospitals have worked so closely together many patients likely don’t notice or care that they’re different.
Published Jun 09, 2023 • Last updated 55 minutes ago • 7 minute read
Jackie Schleifer Taylor, left; Tony Dagnone. (Free Press file photos)
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For decades, London’s two big hospitals have worked so closely together many patients likely don’t notice or care that they’re different.
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Joint research and purchasing, the free flow of doctors between them, the sharing of medical records and more, have made for a hospital network many would argue has punched above its weight for a city of London’s size, with all the acute care you expect in a major medical centre and some renowned specialties like organ transplants and upper limb surgery.
The two hospitals even briefly shared a top boss.
Now, in a seismic shift, the giant London Health Sciences Centre and the smaller St. Joseph’s Health Care London – both teaching hospitals with ties to Western University’s medical school – are going separate ways, scrapping a formal collaboration agreement and restructuring several joint ventures including their highly rated Lawson Health Research Institute, their medical research arm.
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Hospital brass insist the split – driven by LHSC under its new president, sources say – won’t end co-operation between the two health systems, and that patient care won’t be harmed.
But at least two former hospital executives in the city, along with a longtime health care critic, don’t see it that way. One is so incensed, he’s speaking out and breaking a personal vow not to criticize LHSC’s leadership since he left the hospital’s top job as its founding president in 2005.
“We’re one community, one (medical) academic centre,” said Tony Dagnone, adding the gravity of LHSC’s “adversarial” moves forced him to reconsider keeping his thoughts to himself.
“We should be competing against Toronto, not each other,” he said, referring to the major cluster of hospitals in Ontario’s largest city two hours away.
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London Health Science Centre’s Victoria Hospital. Photograph taken on Monday June 5, 2023. (Mike Hensen/The London Free Press)
In a scathing letter to LHSC’s board of directors, Dagnone slammed the “back room antics” of terminating integrated initiatives with St. Joseph’s.
“London hospitals are precious community resources. Governance should be promoting effective inter-hospital collaboration at every opportunity to garner value for money,” he wrote. “My view is that the board should prohibit management from creating self-defined organizational castles at expense of public funds.”
Dagnone is not alone.
Another high-ranking former hospital executive, whom The Free Press is not identifying because private governance information was disclosed, said breakaways in the system are no prescription for better health care in a climate where working together brings a bigger bang for the buck.
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“If you believe, as I do, that there was strength in integration, then a weakness in integration will reflect negatively in patient care,” said the former insider.
“I’m concerned. . . . If this is running down the path it has been, it’s the (hospital) board that’s supposed to stop and say, ‘Are we on the right path?’ and ‘How do we know?’” the source said.
At the heart of the LHSC-St. Joe’s split is a 2016 agreement by their boards outlining the roles and responsibilities of each. They co-operated long before that, but the 16-page deal set the broad ground rules for joint ventures and shared services from then on.
With the deal now undone, longtime collaboration on everything from electronic patient records to shared lab services and joint buying of medical supplies is threatened, some critics fear.
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St. Joseph’s board reluctantly voted last fall to end the agreement following “a number of unsuccessful attempts to engage with LHSC” after hospital brass signalled their intent to scrap the deal.
In minutes from the November meeting, St. Joseph’s board said its vote came after LHSC’s “unwillingness to continue” with the deal became clear.
The push to sever formal ties came shortly after Jackie Schleifer Taylor became LHSC’s top executive, replacing Paul Woods who was terminated in January 2020, the former executive said.
“Within weeks it became obvious that Jackie, in her mind, was targeting the integration of the hospitals . . . as detrimental to LHSC,” the source said. “The 20 to 25 years of work we had done was wrong. We had gone down the wrong road, from her perspective. She intended to take that system apart.”
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For decades, relations between the hospitals were governed by the idea that integration means better care for patients and a more efficient use of taxpayers’ dollars, the former executive said.
Ending formal ties raises questions about whether doctors and other health professionals applying for privileges still will be jointly credentialed, a single approval that allows them to practise at both hospitals and move freely between them, the source said.
“We made decisions on a citywide basis. . . . We were not trying to compete or one-up each other,” the former executive said. “I’m in no way convinced the motivation for it is to the betterment of LHSC, which is what the elevator pitch is.”
Schleifer Taylor said LHSC’s formal agreements with St. Joe’s are reviewed every five years, and ending the deal was needed to adapt to evolving demands in Ontario’s health-care system.
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The Ford government’s move to scrap larger regional health-care administrations in favour of smaller, collaborative teams of hospitals and other partners, including in long-term and primary care, together with gaps the pandemic exposed, mean LHSC needs to work with a cross-section of other health-care providers, not just other hospitals, Schleifer Taylor said.
There’s a new focus now on partnering with similar acute-care hospitals and building closer ties with home care, long-term care and community social service agencies, she said.
Since 2018, the province that funds the system has looked upon integration as “more than just hospitals talking to one another,” she said. “All I’m doing, as the opportunities arise, is to look at the way things are today for LHSC and its commitments to our population, and align our structures and processes and people to meet those commitments.”
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St. Joseph’s Health Care London on Grosvenor Street in London. Photograph taken on Monday June 5, 2023. (Mike Hensen/The London Free Press)
Ending formal ties with St. Joe’s wasn’t unilateral on her part, Schleifer Taylor said, but backed by LHSC’s board and leaders. Nor does it mean an end to a co-operative relationship, she noted.
“We’re both trying to support each other in the execution of our mandates, which are different,” she said, adding “they’re moving forward, just as we have our path to follow, as well.”
Both Schleifer Taylor and Roy Butler, St. Joseph’s president and chief executive, said patient care won’t suffer as a result. Butler said the St. Joseph’s core mission won’t change.
He said the hospital is committed to “a high level of integrated care” in London. “We will continue to do that in partnership not only with LHSC, but with all of our community agencies.
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“The structure of that is going to look different, but that is how our community expects us to function and that is what we will deliver,” he said.
In a statement, the two hospitals said they’re making structural changes to shared ventures including: the medical affairs and information technology services division; the Healthcare Materials Management Services purchasing and inventory agency; Pathology and Laboratory Medicine Lab; and Lawson.
Their integration of electronic patient records now includes seven other regional hospitals and will continue, Schleifer Taylor said.
Butler said “the commitment is to continue to strengthen that and build on that.”
The joint agreements between LHSC and St. Joseph’s governing the lab have been extended to March 2024, Butler said. St. Joseph’s likely will still use the lab, but under a different arrangement, Butler said.
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LHSC will bow out of Healthcare Materials Management Services – which supplies London’s hospitals and 30 others in the region – in favour of a new provincial medical supply strategy that aligns with what similar acute-care hospitals are doing, Schleifer Taylor said.
The agreements governing the procurement agency – which employs about 275 people – have been extended until March 2024 and St. Joseph’s is considering its next steps, Butler said.
Each hospital will have its own medical research division, and Schleifer Taylor said there no longer will be any shared vice-presidents between the hospitals, which the agreement had covered in areas such as medical and academic affairs, internal auditing and information management.
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That’s an about-face for the hospitals, which, though separately governed, as recently as 2010 shared the same president, Cliff Nordal.
Representatives of each hospital regularly would attend the other’s board meetings.
Dagnone said LHSC has “ignored and lost the opportunity to lead Southwestern Ontario” in the pursuit of a “coherent integration of care delivery and supply-chain capacity.”
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Over the years, the two hospitals have evolved to complement, rather than compete with, each other.
LHSC runs both emergency departments in London, its birthing centre, the regional children’s hospital and an acclaimed organ transplant program, among other services.
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Among its operations, St. Joe’s has urgent care, eye and upper limb surgical programs and Parkwood Institute, a complex care centre that includes rehabilitation and veterans’ services.
One longtime health sector observer said it’s “outlandish” to undo measures that have brought the two hospitals closer together after so many years of collaboration.
“The whole point of this was to reduce costs, reduce overhead and excessive administration. That’s why we had one CEO for both hospitals. And now we’re drifting back,” said Peter Bergmanis, who chairs the London Health Coalition, a health-care advocacy group.
Londoners deserve clear answers on why dissolving the hospitals’ formal ties and joint ventures is needed, he said, calling the move a waste of resources and one he’s unconvinced won’t be felt by patients.
“We have real communication and co-operation right now, and that’s just going to go out the window,” he said. “They’ll be competing with each other for resources now.”
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