Shifting Advocacy to Action: Co-Creating Care with Clearwater

In 2022, Dr. Helmcken Memorial Hospital in Clearwater found itself facing the same severe staff shortages endemic across the health care system. Health care and social assistance job vacancies were almost double of those just two years earlier, at the start of the pandemic. 

Job vacancies were exacerbated by challenges unique to the hospital and to the town of Clearwater. These included a staffing model that was not functioning well, and a severe shortage of affordable housing. Within a six-month period, between April and September 2022, emergency department services were interrupted close to 60 times. 

The Interior Health (IH) operational team, with support from Communications and Engagement, recognized that a solution lay not just in updating the staffing model, but by engaging broadly with the small community of just over 2,300. 

The Clinical Operations and Professional Practice Office teams engaged with community partners to promote awareness of the staffing challenges. Their goal was to gain input from the community and partners to co-create solutions to attract staff to the community of Clearwater, and to hire and retain staff at the hospital. Increasing access to sustainable emergency health care was a priority for everyone. 

“Rural hospitals are used to thinking outside the box to get things done,” says Trish Sullivan, an emergency department nurse. “Interior Health and the community of Clearwater and surrounding areas worked with our hospital to brainstorm and implement ideas and practices to help ease our staffing issues. By changing our registered nurse (RN) rotations dramatically – splitting the lines into emergency room-specific and ward-specific roles – we were able to hire non-ER trained RNs into ward positions. Most importantly, the ER and hospital could remain open as we trained ward nurses for ER roles.” 

The impact of these collective efforts are demonstrated in the outcomes and results to date. Since implementing these co-developed solutions, the hospital has had to suspend emergency department services only once. 

The IH leadership team reached out to the community to gather feedback. By deepening organizational partnerships, addressing the housing shortage, reframing the staffing model for nurses within the hospital, and engaging physicians, the team was able to co-create solutions for staffing, recruitment and retention.  

Interior Health worked closely with organizational partners such as BC Emergency Health Services (BCEHS) Clearwater, the Rural and Remote Division of Family Practice, as well as First Nations partners to understand the community needs, and offer short-term solutions while the model was being reframed. This included increased paramedic coverage in the region while the emergency department was experiencing closures. 

To address the housing shortage for health care providers, residents joined in to support health care staff by offering suites and rental units at fair market value for visiting nurses or physicians. In January 2023, IH rented a six-bedroom, fully furnished house for short-term accommodation for staff who come to work in Clearwater and may want to stay. 

By working with local nurses and the BC Nurses’ Union, IH effectively collaborated to explore and reframe new models of nursing rotations. The posting and hiring processes were ramped up and expedited to bring nurses into the community quickly. 

And, IH leadership worked alongside the Rural and Remote Division of Family Practice team to ensure that physicians were engaged and felt welcomed in the community. The town now has 4.5 full-time equivalent doctors, just short of the five it needs. 

“The initiatives were successful in great part due to the feedback from our staff and our community members. Everyone’s ability to act quickly and professionally allowed staff to feel heard and valued,” says Kristy Culbert, Acute/ER program leader. “Staff feel they are set up to provide safe care to patients – having nurses available 24 hours a day is critical in providing optimal care to patients. These changes reflect the needs of the nursing staff and the community members who use these services daily.” 

You can count Clearwater Mayor Merlin Blackwell as among the happiest about the stabilization of services. He says it wouldn’t have happened without taking a collaborative approach to the work – with the community as a key collaborator. 

“2022 was a hard summer for health care in Clearwater (with) so many closures, but it was also a hopeful time thanks to the hard work of everyone at Dr. Helmcken Memorial. Staff, local managers, and IH leaders worked together on a plan to keep our Emergency Department doors open,” he says. “It required everyone to be brave and to trust the plan would work. It also took buy in from the community as there were going to be more closures while the plan was being implemented.   

“Myself and Clearwater Council were more than happy to get the message out that the community needed be patient with hospital staff and trust that the end of closures was coming, to ask residents to find housing for new recruits and to get the word out through media that Clearwater was a great place for health professionals to live, work and play. We went from 60 plus closures in one year, to only one or two in the year and a half since then. Congratulations to everyone involved.”