Loss and recruitment of program staff

Finding

The evidence suggests that the loss of and failure to replace professional medical staff from the Variety Children's Heart Centre in 1992 and 1993 represented a serious erosion in the ability of the Pediatric Cardiac Surgery Program to continue to provide the level of service that it had previously provided.

Finding

The evidence suggests that the impact on the Pediatric Cardiac Surgery Program of the loss of medical staff in and before 1993 was not appreciated by the heads of the responsible departments.

Finding

The evidence suggests that the HSC's recruitment of a pediatric cardiac surgeon in 1993 to replace Dr. Kim Duncan was flawed.

Finding

The evidence suggests that the process of replacing Dr. George Collins as head of the Variety Children's Heart Centre following his retirement in 1993 also was flawed.

Those responsible for staff replacements in 1993 and 1994:

• were slow to begin the process of recruitment and replacement;
• took too long to find capable replacements once they did begin;
• relied on inadequate professional staff recruitment processes; and
• failed to take appropriate steps to address case load and other program issues when positions were left vacant for extended periods of time.

Two staff cardiologists had left the pediatric cardiac surgery program during 1992-93 and had not been replaced by the time of their departures. In addition, Dr. Kim Duncan, who gave notice in April of 1993 of his intention to leave the hospital in July for a position in the U.S.A., was also not replaced by the time he had left. While Duncan was under no obligation to provide any greater notice than he gave, the period of time between his notice and departure was also likely insufficient to ensure that a replacement would be in place by the time he left.

The evidence also suggests that there was confusion as to who was on the formal search committee established to find a candidate to replace Duncan. While Drs. Blanchard and Giddins testified that they believed that Dr. George Collins was a member of a search committee for the new pediatric cardiac surgeon and responsible for assessing the candidates' surgical skills, Collins testified that he did not view himself as a member of any such committee. Accordingly he had only peripheral involvement in the recruitment of Duncan's replacement.

There are no documents establishing a formal search committee and no minutes of any formal committee meetings; nor are there any criteria set out for the candidates that were sought.

Although Collins informed Dr. Agnes Bishop in April 1993 of his intention to leave the hospital at the end of October of that year, it appears that no one-including Collins-took steps to inform the other department and section heads involved in the Pediatric Cardiac Surgery Program of that resignation. Dr. Niels Giddins, the only cardiologist left after Collins, was not aware of Collins's resignation until shortly before Collins's departure.

There was also no formal committee or selection process put into place to find a replacement for Collins, nor was there a formal discussion and assessment made of the potential impact of his resignation on the program so soon after the resignation of Duncan and the other cardiologists. Although Collins gave the HSC six months notice, a permanent replacement had not been found by the time he left. Indeed, by the time the program was suspended in December 1994, a year and a half after his departure, the Children's Hospital had not yet appointed a permanent replacement.

The inability to replace medical staff by the time of their departures may speak to the need to require lengthier notice periods from those HSC staff members whose specialties are in high demand. It may also speak to the need for the hospital to put into place a better method of professional recruitment, particularly for multidisciplinary specialized programs, such as the Pediatric Cardiac Surgery Program. The hospital might have benefited, for example, from engaging the services of a professional recruitment agency.

The details of Odim's appointment, which are outlined in Chapter Five, also indicate the inadequacies of the recruitment process in place at the HSC in 1993. While his credentials appeared to be quite impressive, no one in Winnipeg actually saw him perform a surgical procedure or spoke with anyone at Boston where he had most recently trained, before offering him the position as Chief of Pediatric Cardiac Surgery. The assessment of Odim's operating-room skills appears to have been made largely on the basis of what he told them, where he had trained, what his resume revealed and comments from people who had not observed him in surgery or had had no involvement with him for three years or more. Additionally, little consideration seems to have been given to assessing his ability to work with or develop a surgical team such as was in place in Winnipeg.

Information about Odim was gathered from sources such as personal contacts, word of mouth, interviews and an assessment of paper credentials. These sources can be useful. However, when they comprise almost all the information that is used in coming to a decision as to whether or not to hire an important individual such as a surgeon, they can prove to be ineffective in determining the individual's appropriateness in a number of important areas.

The prime area, obviously, is that of surgical ability. It seems logical to think that when hiring a surgeon, one of the most important areas to investigate is that of the individual's surgical skills and ability. One can properly assume that any trained surgeon has been certified as being capable of performing the surgical procedures associated with the field of specialty for which he or she is being hired. However, such certification does not provide information on the level of skill and ability that the person brings to the position. That can best be determined by observing the candidate while he or she actually performs surgery and by interviewing those who have recently observed the candidate in surgery and have the capabilities themselves to make judgments about the level of skill of the candidate. Those at the HSC responsible for recruiting Odim did none of those things.

Had they consulted with individuals such as Dr. John Mayer, who had supervised Odim during his most recent medical training in Boston, they would have learned that, in his view, Odim was not ready for the position he undertook in Winnipeg. Armed with that knowledge, they might have reconsidered hiring him, or at the very least, been able to put into place measures to monitor and assist Odim, as well as ensure that his lack of experience and need for assistance in some technical areas did not compromise patient care.

All of this speaks to the need for the HSC to revamp the approach it takes to the recruitment and hiring of senior or specialized medical professionals such as surgeons.

Recommendation

It is recommended that: The HSC establish a medical staff recruitment process for senior or specialized positions within the hospital that has as its main priority the creation of a mechanism that results in the best possible candidate being hired or appointed. The process should include these elements:

Before the recruitment of a specialized surgeon to a staff position, personnel in related fields, such as nursing, anaesthesia and perfusion, should have input into the criteria developed for the position.

The process should be time-sensitive, and include a provision that requires that those holding senior or specialized positions within the hospital give a reasonable amount of notice to the hospital before leaving, to enable the hospital to seek and hire replacements.

The recruitment and hiring process should be overseen by a formal search committee, consisting of the head of the department doing the recruitment and such other individuals as have a related medical or administrative interest in the appointment. This should include nurses. In addition, the search committee should include members with expertise and experience in professional recruitment and hiring.

Where there is a limited pool of experienced and/or trained candidates capable of filling the position, the hospital should consider engaging the services of a personnel recruitment agency specializing in the field of professional staff recruitment.

When hiring an individual with specialized surgical skills, the department head should ensure that the candidate is observed while performing surgery before a final assessment is made.

One of the important criteria for the hiring of a surgeon must be the ability to work well in a team setting and a demonstrated understanding of surgical team concepts.