Tuesday, December 22, 2009

President’s Blog: SWOT analysis of 2009

To staff, physicians, volunteers

By Rik Ganderton, President and CEO

It has neither been the best of times nor the worst of times, to re-phrase a Charles Dickens line.

We have lived and worked through the greatest global recession in living memory, yet with this backdrop Rouge Valley has really found its footing as a patient-centred hospital relentlessly focused on improving the quality of care it delivers. We have dealt with many challenges in the last year and overcome them. Our staff, senior management team, physicians and volunteers have increasingly been working as a strong, cohesive team.

I will summarize some of our highlights of 2009 as successes, weaknesses, opportunities and threats to RVHS. As a reminder, we have all determined that our Vision is “to be the best at what we do.” And we have taken many strides towards that Vision this year.

Here are some of my thoughts on how Rouge Valley has fared in 2009.


We have had many, but here are a few top-of-mind ones.
• Our focus on quality yielded our hospital’s three-year accreditation. The surveyors found that our Strategic Plan-On-A-Page was among the best implemented and best known that they had seen and they spotlighted our Passport to Patient Safety training sessions as exemplary.
• The Central East Local Health Integration Network (CE LHIN) named our cardiac care program as a regional centre for the 401 corridor, recognizing years of ongoing patient care excellence.
• The opening of our new diagnostic imaging, fracture clinic and emergency department at Rouge Valley Ajax and Pickering (RVAP), which went live at 4 a.m. on Nov. 30, 2009, was a great success for us all and especially for our community. (See the photo of our first patient at this link.
• We are being recognized for our ongoing application of Lean management and methods by the CE LHIN and the broader industry. Some fine examples of Lean results by the Rouge Team include –
o Improved patient flow and discharge planning for patients at both of our hospital campuses.
o Faster turnaround times achieved for patients’ lab test results at both campuses.
o Shorter waits for our patients in emergency and shorter ambulance offload times at Rouge Valley Centenary (RVC).
• The new Birthing and Newborn Centre at RVC recently celebrated its first full year of delivering babies. Staff at the new centre have also led the way in implementing electronic documentation, which has improved the quality and accuracy of charting and improved processes for all staff using the system.
• We have received notification of first-year operating funding for both the Birthing and Newborn Centre at RVC and the RVAP Emergency. This will mean that we will be able to start to train and hire staff to support these new expansions in the new year.

We do have these as well, but fewer than we used to! We are better at managing them. Among our weaknesses are:
• Complacency – This is always a risk, but one that we are training ourselves away from with increasing Lean initiatives and successes of 2009 and 2008 to build on.
• Losing focus – We must relentlessly focus on improving the quality of care we deliver and we must continue to manage our operating costs diligently and carefully.
• Accountability for results is a mindset that we continue to develop. This includes greater transparency, staff empowerment and improved information for decision-making all supported by our Lean philosophy.
• Crisis management often dominates the time of our leadership team. Through Lean management we will shift our focus from fire-fighting to strategy and innovation.
Remember that every weakness is in fact, an opportunity for us to improve!

This is my favourite category.
• Our first opportunity is to continue building on our expertise in Lean management. This will be increasingly important as we continue to drive the quality agenda while managing through the inevitable effects of the recession. We will continue to develop our skills by integrating Lean training and education into our Management and Leadership competency development program called Advanced Leadership Foundations.
• Increased marketing of our regional centres of excellence in cardiac care and mental health. We will start to develop plans for the broader marketing of our services and strengthening our brand to one that represents the highest quality of care.
• Improving conservable days – meaning getting our patients home sooner. The reasons to reduce conservable days are simple and vital: timely discharges are good for patients as they recover better at home; it lowers their risk of infection; it makes beds available sooner to patients waiting in the emergency department; and it lowers costs to the hospital.
• MRI at RVAP. We are actively building our case to get ministry approval to have Magnetic Resonance Imaging services at RVAP. This is supported strongly by our hospital Board of Directors and is a priority item within our CE LHIN. Our RVHS Foundation is also ready to take on the challenge of fundraising for this vital equipment.
• Additional medical beds at RVAP. We are also actively working with the CE LHIN to add more medical beds at our RVAP campus to meet the demands of our growing community, improve access to critical care beds in Durham and to make the most of our new redevelopment space for the community.
• Continued practice of our ARC (Accountability, Respect and Caring) training. In short, let’s live our values every day: Responsive, respectful and caring to our patients, colleagues and community.

Threats are essentially the reverse of our opportunities, which I’ve just highlighted but there are some other significant threats that I need to talk about:
• Not achieving our Deficit Elimination Plan (DEP), which is entering its third and final year. We must achieve our annual financial targets, as we set out to do in March 2008, if we are going to meet our balanced budget responsibilities. We remain committed to our goals and will begin implementation of the third year of the plan in early January 2010. This will include further position reductions, but we will again minimize the number of involuntary exits through several redeployment strategies including the placement of staff into new positions created through the funding for the Birthing and Newborn Centre at RVC and the RVAP redevelopment. We must meet our DEP targets if we are to generate the cash we need to replace aging equipment and aging infrastructure, which you all deal with every day. We also have to be prepared to deal with the uncertainties in funding that may materialize next year. I will issue a blog on this early in the new year as well as hold Town Halls for broader discussion with staff, physicians and volunteers.
• Funding challenges. We’re certainly not alone in this boat. But we are better positioned, if we achieve our Deficit Elimination Plan, to respond to this threat. The Province, like all levels of government, has been severely constrained by the recession of 2008/09. Economic growth and catch up will take several years. It is possible that we will not receive the usual two per cent inflationary increase to our base funding next year, or potentially the year after. This will obviously mean that further cost containment, beyond the DEP, will be necessary if this scenario materializes. We are in fact planning for various funding scenarios (0%, 1% and 2 % increases) as instructed by the Joint OHA/LHIN H-SAA Steering Committee. However, it is important to understand that no decisions have yet been taken by government. Again I will let you know in the new year as this situation becomes clearer.
• As mentioned above, we have aging and previously neglected equipment and facilities, which will continue to require appropriate replacement and maintenance. We are factoring this in to our corporate plans. Clearly, part of the solution is the continued generation of operating surpluses to allow us to reinvest in our equipment and facilities. Without this reinvestment, keeping the lights on and continuing to provide high quality care will be difficult!

I thank you for your teamwork, your energy, spirit and collective wisdom during 2009.
Undoubtedly 2010 will be yet another year of challenge for our industry and RVHS. As a team we are stronger and better prepared to meet these challenges and the quality of care we are delivering is improving every day thanks to all of your efforts.

I wish you both health and happiness in 2010. All the best to you, your family and RVHS in the new year.

Thursday, October 8, 2009

Returning home sooner: Good for patients and for the hospital

By Dr. Romas Stas, Associate Chief of Staff

The term conservable days is an internal hospital expression that probably means nothing to our patients and their families. Yet, reducing the number of conservable days has an enormous impact on their health and well-being.

Conservable days are the number of days patients remain in hospital past the benchmark average length of stay. (We benchmark, or compare, ourselves to the best performing hospitals to improve our patient care.)

Rouge Valley Health System is working with its physicians and staff to reduce our hospital’s number of conservable days. If we focus on this aspect of patient care, we can greatly improve the flow of patients through the hospital, thereby easing bed pressures and reaping the benefits of efficiency.

There are several benefits of timely patient discharge, including the following:

* Lower risk of infection;
* Improved patient recovery, allowing patients to recover in familiar surroundings with family;
* Reduced costs to the hospital, allowing the hospital to reinvest in new equipment and new technologies, thereby improving quality of care.

Let’s all work together for the benefit of our patients. Remember, there is no such thing as a good conservable day unless it has been eliminated.

Here are a few reminders on how to reduce conservable days, from Michele Jordan, RVHS vice-president and chief transformation officer.

Thursday, September 24, 2009

Preliminary accreditation results outstanding!

By: Rik Ganderton
President and CEO RVHS
To: All staff, physicians and volunteers of RVHS

Congratulations and a big thank you!

Thank you to all staff, physicians and volunteers! The work you do everyday at Rouge Valley lives up to our vision to be the best at what we do. I want to thank everyone involved in the Accreditation Canada survey that was completed Wednesday. The preliminary report presented yesterday to staff, physicians and volunteers, by the surveyors, was extremely positive and one that we should take great pride in. I want to thank you not only for the tremendous efforts by all related to the rigorous accreditation process, but also for the patient-focused work and improvements you have all actively driven forward at Rouge Valley Health System. The Accreditation Canada surveyors noticed. More importantly, our patients are noticing.

The surveyors’ report shined an external light on the progress and top-notch work you all perform.

We will get official notification of formal accreditation status in 10 days time. Overall, we believe our results are outstanding and we should all be extremely proud of the accomplishments we have made as a team.

There are several opportunities for improvement, which we welcome and will act upon. What makes even the opportunities for improvement so telling about the quality of work you all do, is that you are already addressing most of the issues. In fact, many of you, actually identified the opportunities for the surveyors.

We were commended for many activities and processes.
· Of the 1,700 Quality Criteria/Dimensions applicable to RVHS we met 1,636 or 96.5% - this is fantastic!
· One of our approaches to patient safety, our Passport to Safety, has been identified and will be recommended to Accreditation Canada as a leading practice and national benchmark. Our three senior management team members, who have experience as accreditation surveyors, tell me they have rarely seen organizations where this has happened before. While the report is not approved yet, even a recommendation like this is outstanding!
· Strategic Plan-on-a-Page and everyone’s, including external stakeholders, knowledge of and active implementation of it was cited in the report.
· The Personal Business Commitments process stood out for the surveyors.
· Our use of Lean in our ongoing transformation of patient care quality improvement and hospital services.
· Our Quality and Risk Framework and our commitment to quality, plus staff and patient safety were highlighted as strength.
· Our communications processes and community relationships were also listed as strengths.
· Financial controls and our balanced budget plan impressed the surveyors.
· Pandemic planning and code policies and procedures were also strengths.
· Patient focus in ambulatory care was noted as was our focus on patient flow in emergency.
· Our attention to emerging health needs in paediatrics was noted as a strength.
· Improved turnaround time for reports in diagnostic imaging was cited.

I could go on and on, so please read the presentation by the surveyors themselves.

The presentation is posted on our intranet as a PDF, accessible internally for staff, physicians and volunteers, only.

This significant external validation of your work says more than anything about your daily commitment to our patients, to our hospital, to our community and to our team.

Be proud Rouge Valley. You’ve earned it.

Tuesday, September 22, 2009

Thank you and stay the course!

A joint Blog by RVHS Board Chair Janet Ecker and President/CEO Rik Ganderton
- To all staff, physicians, volunteers of RVHS


If we had to pick one word that describes what has been achieved by the Rouge Valley team, then that would be the word.

Making progress is no small feat in the constantly challenging healthcare environment.
Thank you for your commitment to driving progress at our community hospital. It has been, is and will continue to be, a team effort.

As we move through the period of leadership transition, the Board wants our staff, physicians and volunteers to know that we fully support continuing on the road of transformation, accountability and quality focus that we have started on.
President and CEO Rik Ganderton and Chief of Staff Naresh Mohan are completing their terms in their respective positions. Both are staying on until the searches for their replacements are complete.

The RVHS Board of Directors wants everyone to know that it is totally committed to the transformative direction that you as staff, physicians and volunteers have been implementing with such success. The board is looking for new leaders to build on those successes; leaders who will continue our focus on quality, constant improvement and accountability.

Thank you for earning our achievements through your active participation in transformation initiatives and teamwork.
As you know, we have made progress on the key measures aligned with our Strategic Plan – www.rougevalley.ca/strat_plan.pdf.

• The designation this year by the Central East Local Health Integration Network (CE LHIN) of Rouge Valley Cardiology as the regional centre for the 401 corridor was an important recognition and reaffirmation for us. The designation set out in the Hospital Clinical Services Plan also supports our Strategic Plan, which selected cardiac care as one of our centres of excellence.

• Quality patient care is another area of progress, as evidenced by our published quality indicators. Continued focus by our staff and physicians is demonstrating success – www.rougevalley.ca/indicators.

• We are living within our means, as mandated by the province. We had an excellent first fiscal year of our three-year Deficit Elimination Plan. We maintained service volumes and improved quality while generating a small surplus. Although we are hitting some challenges in the first quarter results of this, the second fiscal year, we know we can succeed by applying greater focus on funded health services, as highlighted in our Town Halls in September.
We need to continue to improve our quality of care and our financial position by improving our management of volumes and case mix, by eliminating conservable days, following the new standardized clinical pathways and eliminating waste through the aggressive use of Lean principles. By doing this we can:
-Generate sufficient surpluses to enhance our core services, as we identified in our Strategic Plan;
-Cover unfunded inflation costs;
-Address capital needs; and
-Pay down our working capital deficit and long-term debt.
All of this will help us sustain and improve the healthcare we provide to our patients.

• Transformation of processes for delivering services to patients has been a success, as evidenced by:
-Improved patient flow and discharge planning for our patients at both campuses;
-Faster turn around time for lab test results for our patients at both campuses;
-Improved emergency department discharges at Rouge Valley Centenary, where 83.3 per cent of ambulatory patients are now discharged in less than three hours (among the lowest of discharge times in Toronto).

• Commitment to our vision to be the best at what we do, evidenced throughout Rouge Valley Health System in the improving care provided everyday. This commitment also comes through in the Personal Business Commitments starting with the CEO’s Personal Business Commitments, aligned throughout senior management. (www.rougevalley.ca/business_committments_rganderton_09_10.pdf/)

• Leadership. Rouge Valley Health System is increasingly seen as a leader in quality, accountability, and in our application of Lean as part of our ongoing transformation journey.

We really can’t stress enough that these successes, and many others, are the direct result of your daily attention to providing the best healthcare experience for our patients and their families.

So as we face funding challenges in the near future, and work to get patients home sooner (reducing conservable days) we ask you all to focus your plans and daily efforts for our hospital and our patients.

Thank you and stay the course!

Monday, September 21, 2009

Skills survey for pandemic planning

President's Blog by Rik Ganderton

We have developed a Pandemic Inventory of Skills Survey to aid in the roll out of our pandemic plan. This survey will allow us to capture employees’ skills sets and list how they can benefit the hospital during a pandemic.

We would use this information to optimize our available human resources and ensure patient-centered care. With the urgency surrounding preparation for the fall and a resurgence of H1N1, it is imperative that all full-time and part-time employees complete this survey. The survey is available from today (Sept. 21) to Oct. 5, 2009, which is when all surveys must be complete.

Here’s the link to the survey (for staff and physicians only).

If you do not have an Outlook email address at RVHS, please fill out the intranet form, print it, then give it to your manager/supervisor/delegate. I ask all managers and directors to ensure the surveys are completed by all staff.

I thank you for your support as Rouge Valley takes this proactive and measured approach to pandemic planning. Thanks, as always, for supporting the Rouge Valley team.”

** For more information on H1N1, please visit our website H1N1 section.

Wednesday, April 15, 2009

Sustaining the gains

President's Blog - Rik Ganderton

We’ve had many Kaizen events and Lean-related improvements to bring better and faster care to our patients. Now the key to success for Rouge Valley is sustainment.

So far it has been a very rewarding process to improve ourselves. We have started to change:

The quality of patient care;
lab turn-around times;
patient discharge planning;
the organization, tidiness and flow of the emergency department;
electricity usage;
ambulance offload time;
and more.

And sustaining all of these changes is what I want to stress to you all today.

Our progress in improving Rouge Valley’s quality of patient care, overall efficiency and fiscal health has been tremendous. Now, not only do we have to tackle similar challenges in more areas and departments of the hospital—but we have to make sure we sustain the ones we have already started.

Please remind yourselves, your co-workers and your colleagues of the new processes that have been established. Use the visual management that has been designed as a part of your new processes to make sure you keep doing them. Engrain these improvements in the way you now work everyday. Remember, you created the successes so far—it is up to you and all of us to sustain them. Relentless focus is key.

Financial road to success

Rouge Valley is now entering a period where we should be able to sustain another area of success—a balanced budget. For many months now, Rouge Valley’s leaders and staff have been able to focus the spending of our budget on what is most important for patients. This rigorous fiscal management is translating into not only a balanced run rate—spending no more than we receive from the LHIN—but to small surpluses.

The more surpluses we can continue to generate, the more we can invest in the maintenance and upkeep of our facilities and the upgrading our capital equipment.

Thanks to you

Rouge Valley’s previous years of spending more than it received in funding meant that there was no money left to do proper maintenance. Well, no more. As you have heard me and other senior managers say at our staff Town Hall meetings—it is because of you, our team, that we are now in position to start to do maintenance of our hospital facilities and catch up on the neglect of the past.

In case, I haven’t said it enough: Thank you to all Rouge Valley staff, physicians and volunteers for helping to put us on the right track. There’s still many more improvements to be done, but we are going in the right direction.

We are becoming an organization focused on constant improvement. The more results we can see and measure—with respect to our quality of care, the visible and not-so-visible look of our facilities, and our financial health—the more we can live up to our vision to be the best at what we do.

Transformation themes

Let’s all stay focused on our transformation themes:

Patients first—the best patient/family experience
Earn our reputation as the best everyday
No waste
One team, inspired and involved

Community Outreach

We continue to tour the countryside, so to speak, bringing our community outreach presentations to municipal councils, service clubs and community groups in east Toronto and west Durham. This is all part of our effort to communicate openly and improve understanding of what it takes to become the best at what we do. (You can view and download copies of our past presentations at www.rougevalley.ca/community_outreach).

If you know of community organizations that would like to know more about the hospital and its improvement journey, please let me know.

As always, keep up your commitment and enthusiasm for improvement. We couldn’t do it with you.

Wednesday, February 25, 2009

President’s Blog - Clinical Services Plan (CSP)

By Rik Ganderton - President and CEO, RVHS

Tuesday, the Board of Directors of Rouge Valley Health System received information on the Hospital Clinical Services Plan. The information was presented by Central East Local Health Integration Network (CE LHIN) Board Chair Foster Loucks and CSP Project Manager Susan Plewes.

The full plan was released on February 17th when it was presented to the CE LHIN Board of Directors.

The plan represents the first phase and the initial steps towards "One Acute Care Network" which is defined as;

Improved and equitable patient access to an integrated hospital system that provides the highest quality of care across the Central East LHIN.

The plan covers five program areas (Cardiac, Mental Health, Maternal Child Youth, Thoracic Surgery and Vascular Surgery) as well as recommendations relating to Physician credentialing, Regional On Call coverage and central scheduling for operating rooms.

Our board fully supports the vision of "One acute Care Network" and sees the value in the direction of the recommendations contained in the CSP. We look forward to working in partnership with the LHIN and other health care providers throughout the central east area as the CSP is communicated, by the LHIN, to its partners during the next several weeks.

The Clinical Services Plan includes (amongst other things) a recommendation to make Rouge Valley the regional centre for cardiac care in Scarborough and Durham, which is both an affirmation of our existing role and confirmation of one of the hospital's strategic directions set more than 18 months ago.

The Central East LHIN presentation to our hospital board was the first of several presentations to health care providers in the Central East area, stretching from Haliburton to Peterborough, through Durham and into Scarborough.

We are examining the plan in greater detail and we are now going to consult with our internal stakeholders to understand their perspectives as part of the CE LHIN's requested feedback process.

Further details on the plan have been presented at recent Town Halls, joint Board, MAC and Management meetings and will be shared with the Leadership Forum and the Medical Staff Society during the next few weeks. Summary detail is available on the RVHS Intranet and the full report is available on the LHIN website.

Tuesday, February 24, 2009

Get moving for better health

Heart Month a great time to get up, and get moving

By Dr. Amir Janmohamed / Rouge Valley Cardiologist

February is Heart Month. And as we use this month to focus on the importance of heart health, if you’re not already incorporating ways to keep your heart healthy, there’s no better time than now to start.

Regardless of age, it’s never too late to add physical activity to your life. And making it a regular part of your life can turn out to be a lifesaver. Just 30 to 60 minutes of exercise a day can help you to dramatically lower your risk of heart disease and stroke. It can also help to control or even prevent risk factors such as high blood pressure, high cholesterol and obesity. As well, it improves your sense of well being and quality of life.

Light activities such as walking, gardening or yoga are great ways to get started. If you’re ready for more moderate activities, try brisk walking, swimming, cycling or dancing.

While physical activity can help prevent heart disease, stroke and many other conditions, remember that vigorous physical activity can be strenuous in extreme weather conditions, such as frigid cold temperatures, smog, and intense summer heat. The Heart and Stroke Foundation of Ontario recommends approaching activities such as shoveling snow in cold weather, with caution, especially if you have been diagnosed with heart disease, high blood pressure, or lead an inactive lifestyle.

Here are some tips to remember when exercising in extreme weather conditions:
• Prepare for the activity by doing a few minutes of a warm-up activity like walking, to slowly increase your heart rate;
• Take frequent breaks to prevent your body from becoming strained;
• If you need to complete an urgent task, such as clearing snow, ask family or friends for help;
• When shoveling snow, stop if you feel tired;
• Wear weather-appropriate clothing, and keep water close by to stay hydrated.

Almost anyone can benefit from a more active lifestyle. And if you have other health issues such as arthritis or osteoporosis, it can help to keep you mobile. If you have already had a heart attack, physical activity can help to prevent another one.

Of course, always consult your physician or healthcare provider before beginning any physical activity regimen.

Dr. Amir Janmohamed is a cardiologist at Rouge Valley Health System.

Tuesday, February 3, 2009

Real progress, but must stay the course

By Rik Ganderton
President & CEO, RVHS

We are making real progress in improving Rouge Valley Health System (RVHS) for our patients and all staff. I say that with caution, because RVHS is still early in our transformation journey.
Now, here comes the “but” of this message.
But, we need to ensure that our mutual focus on transformation, and the Deficit Elimination Plan, does not waiver or slip. The transformation of our culture into a hospital that is delivering top-quartile health care, safe, connected to its communities, accountable, transparent and united has only begun.
For getting our positive improvements underway, I thank all staff, physicians and volunteers for their growing engagement.

My perception is that there are “sighs of relief” starting to echo around some tables. We need to be cautious as we have not yet won the first battle and are nowhere near declaring victory in the war!
We have made positive strides as we deploy Lean methodology, but our culture has not yet changed. At best, we can say we have woken ourselves up to see what is possible and also that there is a vast amount of hard work that has to be done to deploy and sustain change for many years to come.
Use of Lean methodology is moving us toward engraining a systematic, continuous improvement approach; we are focusing our many and broad activities on reducing waste, improving care and our workplace while aligning all of our efforts to become the best at what we do for our patients.

Four Transformation Themes
We must continue to focus our efforts on our four transformation themes:
1. Patients first — providing the best patient/family experience
2. Earn our reputation as the best everyday
3. No waste
4. We are one team, inspired and involved

Deficit Elimination Plan
On the financial front, we have achieved some early successes. We had a balanced run rate (spending within our funding) in November and December. At the end of December we have a small surplus on a year to date basis.
But again, I say that with caution. We have our busiest months ahead of us. Assuming we achieve out targets (and I believe we will), we must remember that success this year is just a one-year event. It does not address the magnitude of what we have to fix and improve. As a reminder:
* We need to generate significant surpluses to -
- Maintain required infrastructure. Thanks to many years of capital starvation, our buildings, our infrastructure and our capital equipment are woefully inadequate. We have already agreed to add $3.5 million to our long-term-debt to deal with potentially catastrophic failures of boilers and roofs. These are the tip of the iceberg.
Rebuild our working capital and fund our capital needs. Our working capital deficit is $39.5 million.
- Find two to three per cent compounded efficiency every year based on shortfalls of funding increases provided by government each year. This means $5 million to $7.5 million in efficiency every year.
* In late February the Board will be presented with our 09/10 operating plan and multi-year capital plan. Operationally we have had to squeeze very hard to achieve our Hospital Service Accountability Agreement (H-SAA) committed targets to the government. Our capital needs are huge and many are vital to the safe and efficient functioning of our workplaces and the safety and standards of care for our patients.

Patient volumes
Essentially we continue to be on target in all areas for meeting our H-SAA commitments within the performance corridors, meaning we are treating the same number of patients this year as we did last. Maintaining patient volumes and improving quality of care are among the key commitments we made in our Deficit Elimination Plan, back in March of 2008.

Community Outreach

We continue to meet with our communities, through the many health care and community organizations in west Durham and east Toronto. Our running list of presentations is available at www.rougevalley.ca/community_outreach.
Keep up your commitment and enthusiasm for positive improvement at Rouge. We will succeed as a team. Thank you all.

Tuesday, January 6, 2009

President's New Year's message

(Originally e-mailed on Dec. 23, 2008 by Rik Ganderton)

Hello everyone,

I just wanted to thank you all for your efforts this year.

For those of you who made it to the Town Halls on December 18th (5mb PDF) you heard about some of our successes. We have gone through a lot of change this year, some of which was quite difficult, but I think we are starting to see the benefits. Our financial situation is improving although there continues to be hard work to do on this front. We are finalizing our operating plan for 2009/2010 and this will be rolled out in late February. Preliminary indications are that our H-SAA and Deficit Elimination Targets will be achieved.

In 2008 we completed both the Mental Health Supportive Housing Project and the new Birthing and Newborn Centre at RVC. Both of these were major milestones for our organization. The results of the dreadful fire at mental health supportive housing will be fixed in 2009 and it is thanks to the timely intervention of residents and RVHS staff as well as the quality of construction and workmanship that injuries and damage were minimized.

We have embraced the patient and staff safety agenda and on the patient side we are seeing improvement in our HSMR and we continue to strive to minimize our C. Diff, MRSA and VRE Hospital Acquired Infections. In the New Year we will be focusing on the roll out and public reporting of various Safer Healthcare Now! measures including Central Line Infections, Ventilator Associated Pneumonia and Medication Reconciliation. We must be relentless in our pursuit of zero harm to patients and staff. On the staff side we must continue to focus on the elimination of preventable injuries from lifts, turns and falls. All of these can be eliminated with training and individual vigilance and care. The roll out of ARC must continue so that all staff and physicians have been engaged and we must live these values with each other every day.

I also think our culture is starting to change. The introduction of LEAN, which is the new way we manage the organization going forward, is starting to be felt. We are seeing and hearing more engagement of front line staff in redesign of processes to eliminate waste. We are seeing enthusiasm and engagement at all levels of the organization. Our agenda for the further roll out of LEAN in 2009 is aggressive and many more areas of RVHS will become actively involved. Please get involved yourselves – take the training that’s offered and encourage all your staff to join in. This really is the basis of our future success.

Remember our four focus areas:

* Put patients first – provide the best patient care experience for our patients and their families;
* Earn our reputation as the best everyday;
* Eliminate waste;
* We are one team inspired and involved.

2009 will be an exciting time for us. The CE LHIN will be issuing its Acute Care Clinical Services Plan, we will embark on a Strategic Planning exercise, and we will continue to try to engage our communities using the newly recruited Community Advisory Group to the Board as well as our more traditional methods of community events and speaking to community groups. Our major building project at RVAP will see the opening of the new Emergency Department. We will have fixed the boilers at RVC and major roof leak issues at RVC and RVAP. By executing effectively on the 2009/2010 operating plan, we will generate the financial resources to start to address some of our capital equipment needs and fix up some of our buildings. This will not happen over night but we will make a good start.

From a program development side we will start the implementation of our Post Construction Operating Plans for the Birthing and Newborn Centre and the RVAP redevelopment. These plans will be negotiated with the LHIN and the MOHLTC during 2009 and we will start to see the ramp up of staffing and volumes once they are approved. We have requested that the CELHIN fund 29 additional Acute Care Medical Beds for the RVAP site which are desperately needed now and even more so with the ED expansion. We continue to work with the LHIN regarding other services and are continuing discussions on Dialysis and our role in Cancer Service Delivery. We continue to participate in the various wait time initiatives and are actively looking for opportunities to expand our services in these areas. We will continue to strengthen our role as the CELHIN 401 corridor Regional Cardiac Services Provider and our pursuit of an MRI for RVAP will go ahead unabated. We will continue to look for other opportunities to serve our communities and provide the services they need in the best way we can.

Thank you to all of you for your help and support – it has to be a team effort for us to achieve our goals so far.

I wish you and your families a safe and happy holiday season and a happy, healthy and successful New Year. Please cascade this message to staff in your areas and post on notice and information boards

Rik Ganderton, President and CEO