November 29

Twelve joined us for all or part of the time for this ASK Salt Spring gathering that welcomed Erin Price-Lindstrom, Site Director of Lady Minto Hospital (LMH). After Erin’s Territorial Acknowledgement, she was asked what “excited and delighted” her. Since it had been nearly two years since she last joined us in early 2023 (see https://saltspringexchange.com/2023/04/10/ask-salt-spring-with-the-new-site-director-of-lady-minto-hospital-erin-price-lindstrom/), she had lots to tell us:

• Having been in her position for just over two years, she now has a far better idea of what to expect and has tremendously valued the opportunity to witness the growth and adaptability of the LMH team through a significant period of change and transition. 
• Despite this enhanced experience, these years have been uniquely challenging due to the change and transition that the LMH team has navigated, including the launch of our new Emergency Department (ER). Erin is thrilled that it is now welcoming patients after several challenges throughout the construction of the approximately $14 million project. 
• As many of us have experienced, building on an island brings unique supply and labour challenges. Adding to these issues were the complex and highly technical requirements of our Emergency Room (ER). 
• To further complicate Erin’s life, the same day our new ER opened, she and her husband purchased a home, embarking on a fun, yet complicated, renovation project. 

Erin spoke briefly about the professional route that brought her to her position as Site Director. She originally moved to Salt Spring with her husband and family in 2015 as a midwife, having served families in a range of communities across BC since 2007. (https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/midwives). Loving her satisfying, but perpetually on-call role as Salt Spring’s only midwife, her years in that role also allowed her to see first hand the sustainability challenges faced by rural health care providers, as well as the overwhelming resource and housing challenges facing our young Salt Spring families. 

Her on-call responsibilities, added to those of her husband, then a Paramedic and Paid on Call firefighter, and her role as the mother of four eventually spurred Erin towards a more predictable schedule. She completed her master’s degree in health leadership and accepted a job in the Population Public Health Division of the BC Ministry of Health shortly before the start of the COVID pandemic in early 2020. What an education working there when policy and service changes were imperative and immediate! Later we learned that COVID was a serious test of our healthcare system and that our health system continues to face challenges from the pandemic.

When Erin heard about the position at Lady Minto Hospital, she threw her hat into the pool, never expecting the whirlwind process that resulted in a job offer within days. While she loved her time in midwifery and at the Ministry, coming to work again at Lady Minto was like coming home for her. 

Erin reminded us that the completion of our new ER is a big win for the Salt Spring community, requiring decades of work, generous funding from locals as well as agencies, and the tenacious will to make it happen. Projects of this magnitude do not happen overnight but require patience, partnerships, and persistence. 

Only tangentially involved in the building of our new ER, a large part of Erin’s job has focused on leading the clinical, operational transition of services, including overseeing implementation of the new LMH staffing model required by the separation of emergency services and in-patient care. The increased funding needed for this staffing change has been secured from Island Health.

The major challenge ahead for Erin’s team is, like most rural and remote communities, recruitment and retention of the whole range of required healthcare and support workers needed. Nursing vacancies have been challenging but rates are improving. Although permanent staff is preferable, Lady Minto Hospital, like all other rural and remote hospitals in BC, employs a wide range of temporary healthcare workers, including nurses and care aides. 

Recently, working with Go Health (https://www.gohealthbc.ca/) has been very helpful. Go Health is a provincial model designed to support remote and rural hospitals with publicly funded travel nursing support including nurses’ accommodation and travel costs. While these efforts have made a big difference with Lady Minto’s nurse staffing challenges, supporting this ever-changing cadre of nurses adds a large additional workload to Erin and her team’s already full days.

Over the past few years, we have seen a decline in our physician base for ER staffing. This has forced Lady Minto Hospital to rely heavily on physician locums. This experience is consistent with many other similar communities throughout BC and Canada. Although LMH is supported by a rotating pool of about 50 locum physicians, Salt Spring competes with sites all across the province to entice them here. 

When asked whether our new ER could have to close for periods due to staff shortages like many other hospitals throughout the province, Erin agreed that small sites do face this challenge but there are plans and processes in place to do everything possible to prevent temporary closures. While our ER has not yet had to shut down due to staff shortages, Erin told us that last summer required heroic physician efforts and operational leadership to maintain services.

A continued priority remains focused on recruiting and retaining staff to LMH, including physicians, nursing, allied health, and support service staff. Too often, qualified staff will apply, interview, and be accepted only to go elsewhere due to housing and cost of living barriers: Too many find that moving to Salt Spring is difficult and that another community better meets their needs. 

Predictably, finding housing is the biggest deterrent to moving here. Over the past few years, Lady Minto Hospital has been relatively successful leasing homes within walking distance for travel nurses, doctors, and other temporary personnel. Lease agreements with homeowners are in place for several suites and accommodations, but Erin is always looking for centrally located homes offering two and, even better, three bedrooms within walking distance of the hospital.

A participant asked if there was room on the Lady Minto Hospital property to build housing. Erin replied that using hospital land for housing would be tricky if not impossible. Even though our hospital is making huge efforts to find housing for its casual and temporary personnel, Erin reminded us that securing affordable, work-force housing, along with affordable housing for families and seniors, is an island-wide problem that requires an island-wide solution. She urged us to move away from siloed thinking to work together to solve our cross-sector housing crisis. The conversation turned briefly to consider partnering to advocate for funding for the Kings Lane 50-unit project, the perfect location for Lady Minto staff. 

While housing is the biggest challenge, Erin spoke briefly about other recruitment challenges. Salt Spring needs to compete to attract workers. Are we doing enough to market ourselves? Do we stand out as an attractive option when qualified workers are evaluating communities? Do we even have a marketing strategy lauding our amenities to needed workers? What about a website? Interestingly, our Chamber of Commerce has also identified this marketing effort as a top priority if Salt Spring is to compete successfully for the workers and business owners we need. Would Island Health be willing to contribute to an island-wide marketing effort? Erin saw promising possibilities for funding and partnership were we to work together with the local Medical Staff Association and the LMH Foundation on such a recruitment strategy.

A participant asked whether Lady Minto Hospital is set up to deal with emergency mental health incidents. Erin responded that our hospital is a designated site under the Mental Health Act (https://www2.gov.bc.ca/gov/content/health/managing-your-health/mental-health-substance-use/mental-health-act). It is equipped to safely stabilize patients when indicated and arrange transport to a higher level of care, likely at the Royal Jubilee Hospital in Victoria.

As our time together was coming to a close, Erin spoke briefly about the recent Ministry approval of a Primary Care Network (PCN) service plan (https://divisionsbc.ca/north-shore/what-primary-care-network). Another example of a big win achieved by collaboration among multiple groups, specifically Island Health and local physician and community groups, this service plan aims to increase patient support, offering patients a co-located network of healthcare providers offering a range of primary care services. While many decisions have yet to be made, the personnel funding for our PCN has been approved–another reason for Salt Springers to celebrate!

As 1:00 had already arrived, we bid farewell to Erin, glad of her promise to come back to ASK Salt Spring with a panel of health professionals this spring. We expressed our appreciation for her tenacity in the face of challenges, successful navigation of the opening and staffing of our new ER, honesty about ongoing issues, and willingness to partner to find the solutions Salt Spring needs. (Thank-you, Erin!)