Bermuda Hospitals Board (BHB)

A source of pride and quality care

Business View Caribbean interviews Dr. Michael Richmond, Director of The Bermuda Hospitals Board, for our focus on Excellence in Healthcare

Comprising more than 100 individual islands, with a total land mass of about 21 square miles, Bermuda sits in a relatively isolated geographic location in the Atlantic Ocean. With approximately 63,000 residents and countless visitors, there are unique challenges to delivering healthcare services.

Bermuda Hospitals Board (BHB) delivers acute care, chronic care, long-term care, learning disability, substance abuse and mental health services. It is the only provider of 24/7 healthcare services in Bermuda. Services are delivered from the King Edward VII Memorial Hospital (KEMH) Mid-Atlantic Wellness Institute (MWI) and Lamb Foggo Urgent Care Centre (LFUCC) campuses, as well as in various group home and community settings.

Business View Caribbean spoke with Dr. Michael Richmond, CEO & President of Bermuda Hospitals Board, about how BHB delivers best practices in healthcare. His insights are both enlightening and encouraging for the future.

BVC: Can you share an overview of BHB and how it fits into the big picture of Bermuda healthcare?

Dr. Richmond: “BHB offers the only 24/7 hospital services for mental health and medical care in Bermuda. Our outpatient, inpatient acute and emergency medical services are delivered from the KEMH campus, on which there are also about 100 long term care patients and a hospice. Our mental health, intellectual disability and substance use services are based at MWI, which also has numerous intellectual disability and mental group homes across Bermuda. Our evening and weekend urgent care service is delivered from the East End of the Island, across a causeway and it opens up if the causeway closes so that people in St George’s and St David’s are not cut off from medical care .

“We provide more services than might be expected for a hospital serving such a small population due to our isolation. For those services that we can’t provide, we have strong links with hospitals in North America, most specifically on the eastern seaboard and in Canada, particularly in Toronto, Ontario. We employ approximately 1800 staff, including Bermudians and guest workers on a work permit. We have a modest turnover of personnel, and we are always strongly looking to recruit from around the world to enhance our services.”

BVC: Given the global shortage of skilled workers, how challenging is the recruiting process for BHB?

Dr. Richmond: “Obviously, it’s an area that we keep a close eye on. We do well in recruitment terms in landing well-qualified, quality staff. But I think it’s fair to say that the COVID pandemic has altered the landscape and it certainly it is harder to recruit in certain categories that are in demand, such as qualified nursing staff. We have a proactive strategy of recruitment and work hard to replace guest worker staff who leave.  If we compare our vacancy rates to those experienced overseas, we are doing well, however. There still appears to be a strong appetite to continue to come to work in Bermuda, and we benefit from that.

“The workforce challenge in healthcare, however, existed before we had COVID-19. And it’s not just in nursing, it’s across the panoply of all the services and specialties, and particularly the technical services in laboratory, imaging, and pharmacy, as well. There is a global shortage of professional staff in healthcare, and we are part of that global economy. So we have to do our best to position ourselves strongly.”

Director Michael Richmond

BVC: How has BHB adapted over the last two COVID years?

Dr. Richmond, “In March of 2020, the world had a collective heart attack and had to deal with an incredible challenge to people, services and economies. Bermuda was no different. Being an island jurisdiction, the Bermuda government proactively determined quite early on about how to manage their borders in defence against this threat. The closure of our international borders in March 2020 gave us protection in terms of the footfall landing in Bermuda, and a strong testing regime was established early on – something which holds true to this day. The country went into a National Emergency lockdown for four to six weeks, which meant there were huge compromises made during the initial period of trying to hold back the tide. The barriers that were put up were effective, however, and in the first year of the pandemic we did not experience a major surge of cases in the hospital. This made a huge difference for us to be able to prepare and cope with the much bigger waves we experienced in 2021.

“At BHB, we were obviously concerned as to what might be coming our way. We did pretty well in terms of getting ahead of some of the challenges and being proactive. We were also lucky. Before the pandemic we had ordered a large stock of new beds as part of our usual lifecycle replacement programme. They arrived in May, ensuring that if we were to be overrun with very sick patients that we would have additional beds to accommodate them. In other areas we had to work very hard. We were very aggressive in trying to secure our personal protective equipment, drug and consumable pipeline and increase our reserves to ensure we had a strong path into getting all of the stocks of medication that we needed.

“We also looked at how we were going to redefine our hospital flow, and the ability to undertake elective, more routine activity was curtailed for the duration. We prioritized the critical and the emergency as a matter of course but we tried to minimize the eroding of our precious stocks to manage the unfolding scenario. This being a disease of the respiratory system, we were very cognizant that oxygen was the prime support for COVID, so we made a very early purchase of an additional backup oxygen concentrator. . We were fortunate at the time we ordered they were available, as they became a scarce resource as the pandemic unfolded. This reinforced our ability to deliver quality care in a timely manner when we did have large waves of hospitalisations. If we had delayed that a couple of months, we would probably still be waiting. We are very proud that we made the appropriate preparation.

“Like other countries around the globe, we became acutely short of personal protective equipment (PPE) across the island. What we thought were plentiful stores, were eroded very quickly. But we managed to ride that storm without any compromise. I think also that the affinity between healthcare providers in Bermuda was strengthened, whether in primary or secondary care, with government and the population.”

BVC: What would you say about BHB staff during the pandemic?

Dr. Richmond: “I am eternally grateful to a magnificent performance by our staff. They stood up to the challenge and they weren’t taken for granted. We did our absolute best through our public relations department to keep them as well informed as possible. It was a very dynamic situation: things changing day by day, introduction of new policies, leave restrictions and the like, which was a huge encumbrance on their normal lifestyle. And every man and woman did this with good grace. Also, the trade unions were instrumental in maintaining exceptionally good relationships between the management and the staff of the hospital. We’re grateful to them for the strong part they played.

“Of course, there were many anxieties among frontline staff with respect to potentially becoming a victim of the infection, and the fact that their lifestyle had been so impacted, with having to work and often homeschool their children, and struggling to do both well. Possibly the worst was the separation anxiety among staff that were from other regions, such as India, which were hit terribly hard. There were different points over the last two years that were more stressful than others, and our leadership continues to support all our staff as they deal with the struggles. Much was asked by many and much was given. I think that healthcare was seen in a good light and deserves its share of praise.”

BVC: What are the future plans for BHB?

Dr. Richmond: “In 2021, we launched a new five-year strategy for BHB taking us to 2026. Our vision is to pursue excellence through improvement to make Bermuda proud. It all revolves around the quality of care, supporting and developing our staff through our performance and collaboration to make a true and lasting impact on healthcare in Bermuda.

“We are currently  implementing BHB”s first organisation-wide electronic medical record (EMR), which is a major strategic and operational development for us. This will transform the delivery of care at BHB, helping us raise the bar on safety and quality even further. It is also a resource for the island that will give us much greater knowledge and awareness of care, and our ability to evaluate outcomes. We are closely aligned with the Ministry of Health and their intention to create a much more integrated healthcare system in Bermuda, and BHB is a pivotal partner in helping to make the system more reliable and efficient.

“Quality and safety is at the heart of all we do. The whole hospital is accredited by Accreditation Canada and we were delighted at receiving an ‘Exemplary’ categorization following their survey in 2019. Our next survey is in 2023, but in 2022 we were awarded a Stroke Distinction Award from Accreditation Canada, following an on-site survey process.  This reflects a huge amount of work to improve our stroke care, something we have worked jointly with our clinical affiliate Johns Hopkins Medicine International.

“We also have specialist accreditations with Joint Commission International in our Pathology Department, the American College of Radiology for our Mammography service, and the Commission on Accreditation of Rehabilitation Facilities (CARF) for our Substance Use service. We’re continuing to build on these achievements. . Our affiliation with Johns Hopkins is supporting improvements that will further enhance  a number of our services and we also work with the Institute of Healthcare Improvement (IHI) on our quality improvement processes.. That’s not the end of it… it’s all part and parcel of our improvement journey at Bermuda Hospitals Board.”

AT A GLANCE

The Bermuda Hospitals Board

What: A quasi-autonomous, non-government organization established to provide medical care for the people of Bermuda

Where: Paget, Devonshire, and St. George’s Bermuda

Website: www.bermudahospitals.bm