Sheila O'Brien
"Virtually every sector has had to consider restructuring at some point, but the difference in health care is that the demand on our system is increasing, the supply of workers is shrinking and rising costs add enormous pressures," Sheila O'Brien, UHN's EVP of People, Culture and Community, writes in an op-ed piece which was originally published in the Globe and Mail. (Photo: Courtesy Sheila O'Brien)

By Sheila O'Brien


Canada's health care system has come perilously close to collapsing several times over the past two years, and we are not out of the woods yet. We have had to take drastic measures to keep Emergency Departments open. Widespread surgery cancellations and delayed treatments have eroded the trust Canadians have in their health system. COVID-19 has exacerbated this crisis, but it did not cause it. We are at a tipping point and must act decisively – now.

This crisis is systemic, acute and very complex. The World Health Organization says worldwide demand for health care workers is expected to double to 80 million by 2030 with a global shortfall of 18 million. In Canada, we are currently short tens of thousands of nurses and there are no hopeful signs on the horizon. Nurses are leaving the profession in droves, citing burnout, exhaustion and moral distress. Many fear that they can't practice safely because of staff shortages. If more leave, then there will be even fewer people to carry the load, and an increase in overtime work will only exacerbate burnout. It's a vicious cycle, and it is unsustainable.

So, what can we do? To start, we have to stop the bleeding. We must retain and restore the nurses we have. We must reimagine the provision of care in ways that meet our high standards, but also prevent nurses from working the same kinds of exhausting shifts. Unions must be our partners in creating these solutions; we need the most creative and innovative ideas available.

And then we have to find more nurses – but where? There's no ready supply in Canada and we don't have the training capacity to enroll the thousands of students we need to graduate to fill in the gap. And, we are losing the wisdom of our experienced nurses who are retiring after seeing us through the early part of this pandemic.

We also can't steal our way out of this. Several provinces have launched aggressive recruiting campaigns to lure health care workers to other parts of the country, but beggar thy neighbour has never been a winning strategy. Let's all keep the workers we have, treat them spectacularly and engage them in the process of changing the current system. Additionally, we should all be looking in our own backyards: In 2020, Statistics Canada reported that nearly half of all immigrants with an education in health care were underutilized for their skill set or underemployed, with many unable to get their foreign credentials recognized.

'We should start with the idea that there is no bad idea'

We also can't give up on finding new people. International recruiting is a hot topic, but we have a moral obligation to preserve the capacity of health care systems in the rest of the world. We need to look in places where there has been a conscious effort to train health care workers to supply other markets and develop pipelines for these people to make their way to Canada in an orderly and well-thought-out process.

According to the United Nations, 89 million people are currently living in desperate circumstances in refugee camps. There may be untold numbers of highly skilled health care workers among them. If federal and provincial governments, unions and professional organizations created pathways to Canada for refugees with training in health care and provided adequate support for these newcomers, we could bolster our system with more workers at a time when they're badly needed. Several Latin American countries, including Mexico, Colombia and Peru, provided a model for implementing this type of program in 2020, when they called on skilled refugees to assist with their coronavirus response.

I joined the University Health Network in January, 2021, after a 40-year career in the global energy industry. In health care, I've been reminded of previous experiences working in systems in crisis. The oil-and-gas sector is constantly moving through boom-and-bust cycles, and it has adapted and designed itself around these patterns. When commodity prices plummet, layoffs follow, but the energy sector has learned how to navigate this to the best of its ability, setting the stage for valued employees to potentially return at the next rotation.

Virtually every sector has had to consider restructuring at some point, but the difference in health care is that the demand on our system is increasing, the supply of workers is shrinking and rising costs add enormous pressures. Still, with our system in crisis, we need to look beyond the traditional tools used to fix our problems and see what other sectors can offer for inspiration. We should start with the idea that there is no bad idea – let's ask the big "what if" questions, and be resourceful.

This is a big task, but it has a huge reward, and Canada has a robust record of responding well to crises. As the old adage says: fortune favours the bold.


Sheila O'Brien, CM, is Executive Vice President of People, Culture and Community, UHN.

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