Hospital Director: Healthcare Should Create Value, Not Profit

Following a year of trouble, marked by extended strike actions, recent reports from Landspítalinn Háskólasjúkrahús (the National University Hospital) are anything but reassuring. After the January resolution of Iceland’s first ever doctor strike, delayed operations were further postponed as nurses along with various other healthcare professionals went on strike this spring, further straining the already taxed healthcare system.

Today, the situation looks dire, as inpatients are routinely housed in hallways, equipment rooms, and cafeterias, and the waitlist for certain operations is nearing the two-year mark. To learn more, we reached out to Landspítalinn director Páll Matthíasson, PhD; here is what he had to say about the past twelve months.

What are your experiences of running the hospital this past year? How have you scaled back?
All services offered at Landspítalinn are important, but some can be rescheduled and postponed, and that’s what we’ve done. This has led to longer surgical waitlists, cutbacks on daily services and outpatient appointments, and extended hospital stays.

What effect have the BHM and nurse strikes this spring and summer had on the hospital?
Due to reductions in work hours and several staff members taking unpaid leave, you could say that the economic effects have been positive. That being said, the goal of a hospital is not to have an operating profit, but to create value in the form of the increased health of the nation. It is clear that long waiting periods come at a considerable cost, and it is vital to address them as soon as possible.

Generally speaking, the effect has been very negative, whether directly assessing service for critical patients or the effects on staff morale. It will take time to make up the extended waitlists, and we expect special funding from Alþingi to tackle this large project.

Following failed negotiations, numerous nurses resigned from their posts in protest. What effect has this had on the hospital’s operations? How many additional nurses does the hospital need in order to adequately perform all of its roles?
Most of the nurses that resigned returned to their jobs, which was very important to us. We’re talking about experienced nurses, the kind you don’t find everywhere. It’s been shown in similar cases that about 10-20% of those that resign do not return, and that’s been our experience. The hospital estimates that we need to fill at least 100 more full-time positions to run the hospital properly.

Last year you expressed concern that the doctor’s strike would eat up the additional funds allocated to the hospital. Did the nurse and BHM strikes have this effect?
The latter strikes prevented us from tackling the long waitlists that had built up during the doctor strike, extending them even further. The short-term effects of the strikes have been a reduction in payroll expenses and temporary operations. The long-term effects are waste caused by us being unable to fully utilise the staff and facilities at hand.

It costs more to tackle waitlists that form on top of the day-to-day demand for service, in addition to the inconvenience and possible harm that patients can be subject to. We’ve evaluated that the cost for shortening the delays on joint-replacement and cataract surgeries due to the strikes is about 900 million ISK. You could say that substantial expenses have been delayed due to the strikes, but they will catch up to us sooner than later.

Last year you discussed plans to build a new state-of-the-art hospital that would cut costs and improve productivity—have there been any developments in this matter?
We broke ground for the patient hotel—the first phase of the new hospital— in November, and construction has begun. Alongside that, the final designs for the treatment centre, which will consolidate emergency services under one roof, are being completed. This is one of the healthcare sector’s most urgent safety concerns for the immediate future, and it cannot be delayed any further.

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See Also:

Iceland’s Universal Healthcare: (Still) On Thin Ice
One year ago, Iceland’s lauded universal healthcare system seemed to be teetering off the edge. Doctors’ wages had stagnated after the economic crash, and following a bout of failed negotiations, they went on strike for the first time ever. While they coordinated their actions to avoid endangering patients’ lives, the doctors’ message was clear: if demands were not met, they would seek employment elsewhere.

Iceland’s University Hospital: The Director Speaks
Throughout the whole healthcare debacle, one man has consistently remained focused on the big picture: the National University Hospital of Iceland (LSH) director Dr. Páll Matthíasson, PhD. Educated as a psychiatrist, Páll worked in London, England, from 1997-2007 before returning to Iceland, where he served as a senior physician before becoming the Chief Psychiatry Executive at LSH in 2009—and director at the end of 2013. Despite the tremendous pressure he faces with the ongoing strike, Páll still finds time to sit down with me in his office to discuss LSH and the future of medicine in Iceland.