What we examined (see Focus of the audit)

Delivering health care services in Nunavut is challenging for several reasons—size of the territory, dispersion of the small population, weather, and reliance on air transportation. The territory’s 25 communities are isolated and spread across the largest territory or province in Canada.

Many of Nunavut’s health care personnel—especially nurses and physicians—are from outside the territory. Some nurses are drawn to Nunavut by the increased levels of autonomy and opportunities to perform more medical functions compared with working in southern Canada. Others also come to experience Nunavut’s Inuit culture and way of life.

This audit examined whether the Department of Health adequately managed and supported selected health care personnel who deliver services in local and regional health centres in Nunavut. We looked at orientation and training, quality assurance and continuous improvement processes, the management of safety risks facing staff in health centres, and the recruitment of health care personnel. We focused mainly on those involved in providing primary and emergency care: supervisors of health programs, community health nurses, clerk interpreters, and staff responsible for taking X-rays. We also looked at the planning and resourcing of services provided at health centres, particularly in relation to community health nurses and physicians.

Why we did this audit

This audit is important because having the right number and type of staff in health centres, with the training and tools they need to deliver health services, is essential to ensuring that residents of Nunavut receive the health services they need, when and where they need them.

What we concluded

We concluded that the Department of Health did not adequately manage and support its health care personnel to deliver services in local and regional health centres in Nunavut. It also did not adequately consider the changing needs of communities when planning the staffing of health centres. In addition, the recruitment of nurses and other health care personnel, which involves both the Department of Health and the Department of Finance, was not effective for staffing vacant positions or meeting the staffing needs of the Department of Health.

What we found

Supporting health centre personnel

Overall, we found that the Department of Health did not adequately support community health nurses and other selected health care personnel working in community health centres. The Department did not ensure that community health nurses, X-ray takers, and interpreters received the training they needed to work in isolated communities. The Department did not fully implement procedures for assuring the quality of health services and supporting the continuous improvement of its staff and service delivery. It did not adequately manage the safety risks faced by health care personnel in community health centres. We also found that the recruitment of nurses and other selected health care personnel, which is managed by the departments of Health and Finance, was not effective in staffing vacant positions within the Department of Health.

These findings are important because providing orientation and ongoing training, assessing and continuously improving the quality of services, providing a safe work environment, and recruiting staff in a timely manner all affect the Department of Health’s ability to deliver services in health centres. How these issues are managed can also affect the Department’s ability to recruit and retain nurses and other health care personnel.

• Orientation and training were not consistently delivered to nurses and other selected health centre personnel

  Recommendation. The Department of Health should ensure that appropriate orientation and training are made available on a timely basis to its health care personnel.

  Recommendation. The Department of Health should put in place systems to track and monitor whether its health care personnel have taken orientation and training in a timely manner and if licences and certifications are up to date.

• Quality assurance procedures for ensuring and improving the quality of health services were seldom implemented

  Recommendation. The Department of Health should, in collaboration with the Department of Finance, develop and implement procedures for assessing and tracking the performance of casual and agency nurses.

  Recommendation. The Department of Health should ensure that its procedures for assuring and continuously improving the quality of its health care services are implemented according to departmental policy, including those related to monthly audits of patient charts and related annual reviews, annual visits to community health centres, performance appraisals, and incident reporting. It should also put systems in place to ensure that the findings resulting from these procedures are followed up on and implemented.

  Recommendation. The Department of Health should ensure that its nursing manual is kept up to date and is well communicated to staff in health centres.

• Safety risks facing health centre personnel were not adequately managed

  Recommendation. The Department of Health should systematically track and monitor safety-related incidents and take appropriate follow-up actions to correct or mitigate safety-related risks.

  Recommendation. The Department of Health should, in collaboration with other departments, provide a safe and secure work environment for its health care personnel by implementing adequate procedures such as risk assessments and appropriate security measures. The Department should ensure that the security measures it implements are monitored, known, and working properly.

• The recruitment of permanent nurses and other health care personnel was ineffective

  Recommendation. The Department of Health should develop procedures and service standards for its recruitment and staffing actions. The Department, with the collaboration of the Department of Finance and other relevant departments, should put systems and practices in place to track and record information related to vacancies and associated staffing actions and look for opportunities to streamline the hiring process.

  Recommendation. The Department of Health and the Department of Finance should monitor the status of staffing actions and take appropriate action to reduce delays. This should include monitoring against their service standards.

  Recommendation. The Department of Finance and the Department of Health should work together to ensure that the terms and conditions of employment for health care positions are competitive, and should analyze the terms and conditions of employment in other provinces and territories when applicable.

  Recommendation. The Department of Health, in collaboration with the Department of Finance, should assess the market conditions for permanent, agency, and casual nurses; compare the results with other jurisdictions; and take appropriate actions based on this analysis to increase the competitiveness of these positions and facilitate the hiring of permanent nurses.

  Recommendation. The Department of Health should complete the implementation of the recent initiatives to improve its human resource function, periodically assess the efficiency of these initiatives, and take appropriate actions on the results of these assessments.

  Recommendation. The Department of Health should develop and implement an up-to-date nursing recruitment and retention strategy.

Planning and resourcing of health centres

Overall, we found that the Department of Health did not adequately plan the staffing of health centres. It did not adequately account for the changing health care needs of Nunavummiut. As a result, the Department did not have assurance that its health centres had the right number and mix of staff to meet demands. Though the Department recently started to look at how it delivers health care services, it did not expect to consult with Nunavummiut until it had identified options related to how it delivers health care.

This finding matters because properly staffing health centres would help ensure nurses and other personnel have a balanced workload, minimizing the need for overtime while contributing to providing quality services. It could also help improve the Department’s ability to recruit and retain health care personnel. Consulting Nunavummiut on the design and delivery of health care services would help the Department take into account Nunavummiut needs and priorities.

• The Department of Health did not adequately plan the staffing of health centres

  Recommendation. The Department of Health should continue its efforts to review and improve how it delivers services to Nunavummiut. The Department should also put in place procedures that allow it to periodically assess how it delivers services to ensure that health centres are able to meet the demographic changes and needs of communities.

  Recommendation. The Department of Health should develop and implement a human resource plan that ensures the Department has the right number and types of health care personnel needed to deliver health care services in Nunavut.

  Recommendation. The Department of Health should implement systems and practices to collect and analyze key and meaningful information on the health of Nunavummiut and the services they receive at health centres in order to better inform its planning and decision making on providing health services.

  Recommendation. The Department of Health should ensure that Nunavummiut are involved throughout its current and future reviews of how it delivers health services and programs.

Entity Responses to Recommendations

The audited entities agree with our recommendations, and have responded (see List of Recommendations).

Related Information

Report of the	Auditor General of Canada
Type of product	Performance audit
Audited entities	Department of Health (Nunavut) Department of Finance (Nunavut)
Completion date	10 January 2017
Tabling date	7 March 2017
Related audits	Reports to Nunavut Legislative Assembly

For more information

Media Relations
Telephone.: 1-888-761-5953
E-mail: infomedia@oag-bvg.gc.ca

Twitter: OAG_BVG