Friday, December 31, 2010

Happy New Year: Looking forward to more successes in 2011

By Rik Ganderton, President and CEO

Hello everyone and happy New Year to all!

Thank you to everyone for your dedication to our patients and all your hard work in 2010. The year marked another huge step in our progress to becoming the best community hospital in Canada. We again served and treated more patients than in the previous year.

Our emergency departments (ED) at both hospital campuses — Rouge Valley Ajax and Pickering (RVAP) in west Durham and Rouge Valley Centenary (RVC) in east Toronto — saw and treated record numbers of patients during the year. In fact, December was a record month for both sites. Thanks to all of you — whether in the ED, on an inpatient unit or providing support services — who showed up for work over the holiday season and contributed to managing this record patient load.

From a quality perspective, we maintained or improved our record of making Rouge as safe as possible for our patients, families and staff. We are still challenged to ensure that our hand hygiene habits are the best in the industry, and I look forward to relentlessly pursuing this goal with you in 2011!

Operationally, we had another successful year, and we anticipate — on a financial-year basis — that we will again achieve our budgeted surplus. This will mark the third year in a row of success in managing to a surplus, and will bring to a successful close our three-year deficit elimination plan. Achieving surpluses allows us to reinvest in our facilities and equipment that have been so neglected for so many years (see our previous blog on this). Behind the scenes we have completed major, multi-million dollar replacements of our boilers (at RVC), while more obvious items for frontline staff include new monitors and infusion pumps. At RVAP, our major redevelopment is almost complete and we have opened the new complex continuing care unit; the ED has been open for more than a year; and the new ambulatory care area, lab and diagnostic imaging space are in use.

People development is core to our success. We have been able to invest significantly in training and developing our people. We continue to invest in the Late Career Nursing Initiative, we are expanding our investment in training of frontline nurses and other clinicians, and we continue to provide training for our managers in the use and deployment of Lean tools (read how Lean helps our patients). We have also run a very successful (and ongoing) program for our managers and leaders, called Advanced Leadership Foundations (ALF). This program is aimed at equipping all our managers with the skills and competencies needed to lead our organization. (Read about the ALF program in one of earlier blog posts).

Operating efficiently and delivering on what we commit to also means growing credibility with our funders (the Central East Local Health Integration Network — and through them, the Ministry of Health and Long-Term Care). This translates into real and tangible benefits for our patients, our communities and our staff. Examples include new funding for 20 new transitional restorative care beds at RVAP (read more about this new unit in our December 2010 Echo newsletter), as well as the recent announcement of operational funding for a new MRI at RVAP as well (see news release from CE LHIN). At RVC, we have enjoyed significant funding increases for the Birthing and Newborn Centre; for additional surgical volumes in a variety of specialties; for additional MRI operational funding; for a new coronary care unit bed; and support for the very successful implementation of Code STEMI program, which fast-tracks emergency care for people who experience a heart attack in our communities (learn more about Code STEMI). In fact, as I write this, I am sure there are lots more successes — they are just too numerous to recall!!

I fully expect 2011 to be as busy and successful as 2010. We will publish our new strategic plan early in the new year, and we will be starting an ambitious major capital plan which will see us, amongst other things, replace the Siemens catheterization lab and install a third cath lab so that we can meet our regional commitments to cardiac EP. We will also try to do some visible sprucing up of our facilities, including a "lick of paint" here and there to make the place look better!

Of course, we will continue to drive innovation and operational excellence so that we can continue to benefit our communities, make RVHS a place where all of us are proud to work, and allow us to invest in our people so that we can be the best.

Again thank you all for a tremendous year in 2010, and I look forward to an even more success in 2011.

I wish you all a healthy, happy, safe and successful 2011.

Regards to all!

Monday, December 13, 2010

Reinvesting $2 million in our hospital - Thanks to staff and doctors’ teamwork

By Rik Ganderton, President and CEO

Rouge Valley knows how to close a calendar year on a high note.

In fact, I’d say this is a trend – thanks to not only hard work, but also smart work by our staff, physicians and volunteers.

In the three years since we introduced our Deficit Elimination Plan and then Lean, we have gone from the hospital that “couldn’t” improve, to the hospital that “could” and does improve for its patients – everyday.

Following-up on a blog by my colleague – John Aldis, vice-president of corporate services and chief financial officer – Rouge Valley Health System finds itself in the enviable position of generating modest surpluses. As John said, “Efficiency is contagious.”

As a result, we have some very real reinvestments to make in our existing hospital services and facilities at both campuses.

So the Christmas, Hanukkah and happy holiday gift that our staff and physician team at Rouge Valley have delivered to our patients and community comes in two big packages. This is on top of the $650,000 in recently approved additional capital investments that John talked about.

Gift number one –
$1 million for 2010-11 Approved One-Time Expenditures

Our strong year-to-date financial performance has generated $1 million, which we have decided to invest in 24 important one-time items this fiscal year, including:
• Education and training for staff in critical care, emergency department, diagnostic imaging, labs, paediatrics/neonatal intensive care unit (NICU), labour and delivery, and biomedical engineering;
• Various minor repairs, renovations, and upgrades to hospital facilities;
• Stereotactic (surgical) biopsy supplies;
• Emergency department patient navigator role, for four months;
• And more.

Gift number two –
$1.09 million for 2011-12 Approved Budget Reinvestments

There is also $1.09 million in service reinvestments budgeted for the 2011-12 fiscal year that will go toward additional staff resources in key areas:
• Five medical short stay beds at Rouge Valley Centenary;
• Intensive care unit staffing;
• Pharmacy staffing to support medication reconciliation;
• New manager of quality, who will support implementation of requirements of the Excellent Care for All Act;
• Information technology project management; and
• Patient services representative staffing.

As the year 2010 comes to a close, I want to thank all staff, physicians and volunteers for putting our hospital in such good shape for the New Year and into 2012.

Thursday, November 18, 2010

Restoring comfort and health, one bed at a time

By Rik Ganderton,
RVHS President and CEO

A bed is synonymous with comfort. When you’re sick it can be crucially important to restoring your health.

For whatever reason you find yourself as a patient in the hospital, you will probably be using a bed. The Rouge Valley Centenary Buy a Bed campaign is our challenge to restore comfort and health, one bed at a time as we replace older beds in the hospital.

Replacement beds have been identified as a high-priority need for many departments in the hospital. Beds cost about $5,000 each. Medical beds play a vital role in patient recovery, and in wound and injury prevention. The specialized mattress and frame in a medical bed is built for a lot of use. Special features include patient position monitors and in-bed scales to reduce both patient and caregiver injuries. These elements make them much more expensive than household beds.

The goal of the campaign is to purchase 100 beds during the next two years. This is an achievable goal and we are already well on our way with 45 beds purchased.

I am excited about this campaign, since it is something that everyone is able to easily identify with. The response of the community has been tremendous and we are so thankful for this support. I am also very proud of staff members at Rouge Valley Centenary, who have demonstrated their incredible support of the campaign.

We currently have 67 staff members who have enrolled in payroll deduction and those who have made outright donations. I personally support this campaign, of course.

There are many ways to support the campaign as an individual, or as a group, including sports teams and as colleagues at work. You can help restore comfort and health, one bed at a time. To find out more on this campaign, please visit the RVHS Foundation's Buy-A-Bed web page.

Tuesday, November 2, 2010

Almost 5,500 Ontario doctors using eHealth records: minister -

Monday, November 1, 2010

Effective budgeting and management by all means more money for patient needs

$650,000 more now available for equipment!

By John Aldis,
Corporate Services
and Chief Financial Officer

Efficiency is contagious.

Our directors and managers, and their teams, have kept the Capital Equipment Planning Committee updated as to the status of medical and related equipment needs and purchases from our approved capital list. Regular monitoring and management of our capital list of approved equipment needs allows us to maximize investment of our limited resources for our patients and communities.

Aligning personal business commitments, the strategic plan, our Lean philosophy and a concentrated focus on efficiency from all departments – including finance, of course – is paying off for the patients of our hospital. This focus has spread at all levels of our management structure and among our staff teams.

Now, let me skip to the good news: The Capital Equipment Planning Committee (CEPC) recently reallocated approximately $650,000 of “freed up” capital funds to additional items our hospital needs for patients.

Fiscal responsibility, one of our four strategic dimensions – is not simply a function of our finance department. Indeed, the better we all are at fiscal responsibility, the better positioned we are to improve in our three other strategic dimensions: service excellence; access to care; and team engagement.

There are many reasons for this recent positive development, but it all stems from the fact that our professionals at Rouge Valley Health System are becoming more efficient and better stewards of tax dollars for patient care.

The $650,000 is available because:
• Approved capital expenditures from 2008/09 and 2009/10 were completed under budget;
• A number of items were deemed to be no longer necessary;
• Through closer collaboration between the RVHS Foundation and CEPC, some items on our capital list have been funded through the foundation’s efforts to direct donor giving to specific items

- So who is CEPC and what are the results? -

The group is comprised of managers, directors and vice-presidents representing our program and service areas at both hospital campuses.

The CEPC has been a very productive and cohesive team, reallocating funds mid-year using a criteria based framework. In fact, there was unanimous agreement by the team on where to reallocate the funds to address key needs, such as buying new:
• Dedicated equipment, such as vital signs monitors, in isolation rooms;
• Portable vital sign monitor in the children’s program;
• A defibrillator in the surgical program;
• Medication carts;
• Two ventilators;
• A chemistry analyzer;
• And more.

I’d like to thank the members of our Capital Equipment Planning Committee, our finance team and all our hospital staff for their engagement in this and other corporate initiatives.

Optimizing our limited resources throughout our hospital supports better patient care everyday. This efficiency bug is one contagion we want to continue spreading.

Thursday, October 28, 2010

How digital technology can mean better care

By Michelle Jones (shown), and Betty Walker, Charge Technologists, Rouge Valley Health System Diagnostic Imaging

Some very exciting things are happening in our Diagnostic Imaging departments at both of our hospital campuses (Rouge Valley Centenary and Rouge Valley Ajax & Pickering). We are so proud to announce that our Breast Screening Clinics at both of our hospital campuses now feature state-of-the-art digital mammography machines. We’re quite privileged and very proud that we can feature this cutting edge technology. This digital equipment can cost up to four times more than film mammography, making it too expensive for many smaller clinics to have in their facilities.

Why is that important? Well, there are a number of different reasons why this so significant for us and all of our patients:

* This improved technology improves our chances of finding breast cancer. Digital imaging is better for women under the age of 50, or young women with denser breasts. Digital technology makes it easier for us to spot breast cancer in these women. Earlier detection and improved treatment can help to save more lives.

* Remember when you would take a photo using film, and wait for days for it to be developed, just to realize that the picture didn’t turn out properly? Well, just like your digital camera where you can quickly preview your photos, when a technologist takes an image of the breast, we’re able to see much sooner if we need to retake the image.

* Since there is no more need for film, the images are available much sooner – usually within seconds. The radiologist can quickly access the images, as there is no longer a need to process films. This means you, the patient, can get your test results much sooner, cutting down on wait times and that anxiety you experience while you wait.

* Since the images can be stored electronically, there’s no need to carry around huge bulky envelopes of film to take to your physician. The images can usually be sent electronically or saved to a CD that you can easily bring to your physician.

* At RVHS, many of our physicians are connected to our Picture Archiving and Communicating System (PACS), allowing digital images to be transferred to them within minutes. So if you had an appointment for a mammogram the same day as your appointment with your physician, it could be ready by the time you see your physician.

* Last but not least, digital imaging requires less radiation than film imaging. This means that we’re giving up to a 50 per cent reduction in dose.

Overall, this new technology means that we’re able to provide our patients with the highest standard of care, something that each staff member, physician and volunteer at RVHS is committed to.
For appointments in our breast imaging centres and all other diagnostic tests, contact our central booking line at 416-281-7299 or toll-free at 1-866-752-6989. Currently, most services require a referral from your family physician. We are currently in the processing of becoming a part of the Ontario Breast Screening Program (OBSP), which will allow patients over 50 to receive a mammogram without a requisition from their family physician.

Learn more about our Diagnostic Imaging program by visiting

Wednesday, October 27, 2010

Early detection of breast cancer can save your life....

Thursday, October 21, 2010

Putting meat on the bones of strategic planning

By Rik Ganderton
President and CEO

We’re getting there!

Thanks to your participation in our strategic planning process since last April, we are now able to start putting some meat on the bones of our new strategic plan.

My thanks to all who’ve taken part so far, including staff, physicians, volunteers, community members and political leaders for your thoughts and input on our questions, surveys and many presentations.

All of this input and information was used to produce a comprehensive Current State Analysis Report. The full report and an executive summary are available on our strategic planning web page.

The report examined our current environment in terms of our:
• Programs and services;
• Patient profile;
• Workforce;
• Infrastructure;
• Approach to quality, transformation and organizational culture;
• Community Demographics;
• Inventory of providers in Central East Local Health Integration Network (CE LHIN);
• Provincial and LHIN priorities;
• Internal and external stakeholder feedback; and
• Key trends likely to impact our organization.

- Key findings –

Here are some of the key findings from the Current State Analysis Report.
• We are facing significant growth in the 905 area.
• Patient mix is changing – average age of patients is getting older and have higher levels of acuity and dependency; greater cultural diversity reflective of the catchment area. Scarborough and Durham are becoming more similar from a diversity perspective.
• There is a new normal when it comes to clinical service delivery. The number of inpatients has declined; the vast majority of surgical and diagnostic procedures can now be done on an outpatient basis; throughout the hospital sector, inpatient length of stay has decreased and occupancy rates have increased; alternate level of care (ALC) days are a system issue that create flow challenges for the hospital; there is more transfer activity between hospitals and RVHS is seeing an increase in the patients transferred in to our hospital from other places, particularly for circulatory system conditions.
• Our efforts to align with industry benchmarks have resulted in a higher occupancy rate and a lower average length of stay. But our readmission rates have also declined suggesting that we are making improvements to patient flow without sacrificing quality.
• We need to focus on the patient experience and be cognizant of how the community measures the patient experience; consumer expectations are changing and patients are much better informed on health issues than in the past.
• Regional integration is a priority for the LHIN and health system partners; we need strategies to pick up the pace, maintain momentum and make tangible change; there are many untapped opportunities for regional collaboration – both clinical and non-clinical.
• Emergency department (ED) wait times and ALC management are top priorities at the provincial level and also challenge our ability to provide smooth patient flow.
• There are opportunities to repatriate some of our catchment area residents, who are seeking services at other hospitals; the flow of patients in our catchment area is to the west and RVHS partnerships are in the east.
• Relationships with family physicians in the community are essential and can be improved through better communication mechanisms and easier access.
• Our human resources are our greatest asset; our people share a strong commitment to quality; we need to watch morale levels of staff and physicians.
• Our workforce is aging and we must implement strategies to manage the forecasted potential retirements.
• Operational and cultural transformation are taking shape and yielding tangible improvements; this is an ongoing journey and key to reaping the benefits of increased emphasis on pay for performance.
• The hospital is on the road to financial recovery, but keeping pace with infrastructure maintenance/repairs and advances in technology is an ongoing financial challenge.
• The planning environment is complex with many trends that will impact our hospital, including a provincial election in the fall of 2011.

The current state report findings put us in good shape heading into our strategic planning retreat last weekend. Thanks to the keen engagement of our Board; MAC (medical advisory committee); senior management team; directors; and members of the Strategic Plan Steering Committee, it’s my pleasure to report to you that we now have a new set of draft strategic directions.

- More consultation –

Consultation on the draft directions will begin shortly, in meetings and venues such as, but not limited to:
• RVHS Board meetings – open to the public;
• Meetings of our Community Advisory Group – volunteers who advise the board;
• Community outreach meetings – which we do throughout the year at meetings of service clubs, health care partners, municipal councils and many others;
• Leadership Forum – for management;
• MAC and/or Medical Staff Society meetings – for doctors;
• Town Halls – for all staff, physicians and volunteers; and
Strategic planning web page – for the public.

I look forward to our next blog update on this evolving process. Stay tuned and thanks for your participation.

(- For background, you could read my previous blog on this from July 6, 2010.)

Wednesday, October 20, 2010

We agree with the government & AG

By Rik Ganderton
President & CEO, RVHS

Rouge Valley fully supports the government’s position and the findings of the Auditor General’s (AG) Report. Rouge Valley no longer uses a lobbyist, as a result of a board decision taken some weeks ago.

As part of the overall transformation of RVHS since 2007 we have taken many steps to improve controls and monitoring in the procurement area including controls over the use of consultants. This included revisions of our policies in 2008 following an external audit that we commissioned and subsequently adopting the Broader Public Sector Policy Guidelines, effective April 2010. We have implemented procurement practices and controls ahead of this present interest in consultants and procurement.

We will continue to pro-actively improve our stewardship of tax dollars to offer the best health care to our communities. We welcome the government’s action on these matters and fully support the directions taken.

* View the AG's Report.

Tuesday, October 19, 2010

Things are shaping up nicely at RV Ajax & Pickering hospital campus!

Monday, October 18, 2010

Why early detection is the best way to beat breast cancer

By Dr. Yun Yee Chow, Radiologist, Rouge Valley Health System (RVHS)

Knowing when you should have a mammogram could save your life.
According to the World Health Organization (WHO), breast cancer is the most common cancer found in women. One in nine women will be afflicted with breast cancer at some point in her lifetime. And let’s not forget that one percent of breast cancer cases actually occur in men.

October is Breast Cancer Awareness Month, a great opportunity to increase our own awareness about this disease and to learn more about what we can do to reduce our risk of developing it.

The Canadian Association of Radiologists (CAR) recommends that women begin receiving breast screening, usually a mammogram, at age 40, and annually until age 49. Women can be screened every two years if they are between 50 – 69 years of age, unless there is a family history of breast cancer, or if they are receiving hormone replacement therapy. If they are in good health, women should continue to receive regular screenings after age 70.

Despite the increased diagnosis rate of breast cancer, more people are surviving. In 2005, mortality rates dropped to 24% from 32% in 1986. Half of this reduction can be attributed to early screening, and the rest to adjuvant treatment – therapy using drug or radiation after cancer surgery. So, early detection in the prevention and treatment of the disease is key, especially if cancer is detected during a screening.

Remember that lifestyle factors can also play an important role in your risk of developing breast cancer. Here are some of the things you can do to decrease your risk:
• Incorporate a healthier diet into your lifestyle;
• Exercise regularly;
• Maintain a healthy body weight, since estrogen produced from fat can increase the development of breast cancer;
• If you’re a smoker, consider quitting;
• Watch your alcohol consumption, as it has become a well-established risk factor for breast cancer in women.

In addition to self breast examination, you should have a yearly check up with your family physician. They can also give you a full physical exam and review of your medical and family history. Your doctor can give you a requisition for a mammogram, or you can simply head over to an Ontario Breast Screening Centre. In 2011, RVHS will be affiliated with the Ontario Breast Screening Program (OBSP) at both of our hospital campuses (Rouge Valley Centenary and Rouge Valley Ajax & Pickering), and will feature Ontario Breast Screening Centres where patients can receive mammograms without a referral.

With the range of state-of-the-art diagnostic testing available at Rouge Valley Health System, including breast screening, quality preventive care is available right in your community. Both of our state-of-the-art Breast Imaging Centres, located at both of our hospital campuses, feature fully digital mammography machines that are able to provide a lower radiation dose to detect abnormalities in the breast tissue, often before they can be felt by the patient. Other imaging modalities include breast ultrasounds and breast MRIs. Minimally invasive breast biopsies are performed using ultrasound guidance, at the bedside, or by mammographically-guided stereotactic breast biopsy.

For appointments in our breast imaging centres and all other diagnostic tests, contact our central booking line at 416-281-7299 or toll-free at 1-866-752-6989. Most services require a referral from your family physician.
We're back in the black:

Friday, October 15, 2010

Want to help improve a person's health, for a living? Here's an excellent place to start:

Thursday, October 7, 2010

MRI: Why an Image is Everything to our community

By Rik Ganderton,
President and CEO

Durham Region has one of the fastest growing populations in Canada, with approximately 600,000 residents and a forecast population of around one million people by 2031 (1).

Population growth also means growth within the dependent demographics of our communities. We have already seen a rise in acute care patients who need a Magnetic Resonance Imaging (MRI) scan, now considered a basic tool that every hospital needs in the diagnosis and treatment of cancer and many other diseases and health conditions.

Thankfully, there has also been significant growth in the application of MRI technology to solve clinical problems, and as an emergency tool that can make the difference between life and death.

Currently, the Rouge Valley Ajax and Pickering hospital does not have an MRI. By including an MRI in our new and expanded diagnostic imaging centre, patients who currently are on a long waiting list will be able to stay close to home.

Patients will also receive the gold standard in care from the new MRI, which offers state-of-the-art technology, producing detailed, clear images of the body with no side effects.

We are dedicated to bringing an MRI to the residents of Ajax, Pickering and Whitby through the Image is Everything Campaign, by the Rouge Valley Health System Foundation. Through campaign events, third-party fundraising and a long list of generous partnerships, we have made great progress towards that goal. However, we still need your help.

The community has supported us since our hospital was built in 1954, and we hope you will continue to support us in bringing this modern, state-of-the-art diagnostic technology closer your family, friends and neighbours in west Durham.

So please put yourself in the picture. You can help bring an MRI to your local community hospital by contacting the Foundation at 905-683-2320 x1501.

(1. Ministry of Citizenship and Immigration)

Tuesday, September 21, 2010

Personal Business Commitments are all about working as a team

By Rik Ganderton
President and CEO

We call it alignment.

But another way to describe our annual Personal Business Commitments (PBCs) is teamwork.

My PBCs set out the direction for all other team members, vice-presidents, directors and everyone throughout the hospital. As autumn begins, this is a good time of year for us to refocus on our commitments to our hospital.

As you can read in my PBCs, which we publish publicly each year, we are focused on quality and constant improvement at Rouge Valley Health System.

I’m proud to report that our Deficit Elimination Plan of 2008-11 is drawing to a successful completion during the next six months, with our promises kept – to maintain patient volumes and improve overall patient care, while ending all overspending.

The plan enabled us to jump over other equally high hurdles, through our collective ongoing implementation of the Lean management philosophy.

As CEO, I focus on challenges ahead. But allow me to pause here and reflect on the sweeping achievements you have all made for our patients. Because of your application of Lean our patients now:
• Go home sooner – as a result of improved patient flow and your discharge planning;
• Get lab and diagnostic imaging results faster, in hours rather than days;
• Wait less time for care in our emergency department;
• Walk less distance in pre-admit clinics, because our professionals now come to them;
• Cancel fewer surgeries thanks to enhanced pre-surgical screening; and
• Waste less of their time filling in forms.

The successful teamwork of the Deficit Elimination Plan and Lean initiatives have also set the platform on which we all stand today. Now our focus moves more toward our four dimensions: Access to Care; Service Excellence; Fiscal Responsibility; and Team Engagement.

The PBC process provides us all with an important checklist on those dimensions. As we check off our achievements throughout the fiscal year, we can see our individual and team goals coming to fruition for our patients.

There is something cathartic about putting a check mark next to an item on a to-do list isn’t there? Our PBCs are our team checklists. Yours will be different from mine. But all PBCs focus on the same set of objectives and targets found in mine.

You’ll also notice that the PBCs are now lined up with our overall leadership tools, as shown on the Strategic Linkage page, which directly aligns our: Mission Vision Values; Strategic Plan-On-A-Page; Transformation Themes; and Dimensions.

To further reinforce our four dimensions, we are labeling each our stories in the Echo magazine with the relevant dimension to demonstrate how everyone is working toward the same set of objectives.

By harnessing your focused efforts to constantly improve health care for our patients we will achieve our vision to be the best at what we do.

Thank you for your engagement, your creativity and your daily commitment to Rouge Valley Health System.

Tuesday, August 3, 2010

Why Lean works for patients at Rouge Valley

-- And how it can work at your hospital

By Rik Ganderton
President and CEO
This blog appears in the August 2010 issue of
The Hospital News

Constant improvements in quality patient care and the effective use of limited resources have become even more important to hospitals in the last few years.

This is something Rouge Valley Health System started tackling head on in 2007 at its two community hospital campuses, in west Durham and in east Toronto.

After introducing a three-year plan to address years of deficits, our Board, senior management team, physicians and staff needed a framework to work within to plant the seeds for a cultural shift toward:
• Relentless focus on quality patient care;
• Heightened accountability, in achieving quality targets;
• Effectiveness;
• Respect, teamwork.

- Why Lean? -

Selecting a philosophy and management framework to address these issues was a key decision. Two years ago, I chose Lean as our enterprise-wide philosophy and management approach to align all of our transformative efforts.

There were many reasons why Lean thinking became the cornerstone of our transformation strategy including that it:
• Drives operational efficiency and cultural change at the same time;
• Focuses on long-term sustainability;
• Offers a comprehensive approach to change;
• Looks at processes from the patient perspective and flow across departments;
• Involves and empowers frontline staff;
• Establishes specific metrics and targets;
• Emphasizes eliminating waste and quality improvement;
• Works quickly, with process changes beginning in days, rather than months.

- Results -

But none of this would matter if we couldn’t get results.

Using a variety of Lean tools, including kaizen events and value stream analysis, our team of front line staff and physicians has generated tangible results for patients, among them:

• Patients going home sooner thanks to improved patient flow and discharge planning at both hospital campuses;
• Improved communication with patients and families by posting regularly updated patient communication boards in patient rooms on our medical and surgical units;
• Patients and doctors getting lab and diagnostic imaging test results faster;
• Patients spending less time waiting for care in emergency at our Rouge Valley Centenary hospital campus;
• Less walking for patients visiting our pre-admit clinics, at both campuses, by having the patient stay in one place and the professionals coming to them instead;
• Enhancements to our pre-screening process for patients booked for elective surgery, resulting in fewer cancellations because the patient was unfit for surgery; and
• Fewer hand-offs and forms for patients and their families.

What has made Lean work so far, is the fact that front line nurses, allied health, cleaning staff and physicians are increasingly engaged. But why?

Doctors and staff got engaged in small groups, often in kaizen teams, to tackle specific issues. More importantly, they were also the ones who often identified problems and created the solutions. They make it work with support from the leadership team.

- Not easy -

That’s not to say Lean has been easy to implement. It has been and continues to be a challenge to grow a Lean culture. But our results during the last two years have generated growing engagement.

Increasingly, we have departments coming to the senior management team wanting to start their own kaizen events, or visual management boards, or apply value stream analysis, or make use of all of these Lean tools.

This basic Lean framework can work in any hospital provided there is sustained, visible senior management involvement that the front line can see. Our senior management team does monthly transformation rounds, as a group, of various departments where Lean initiatives are in place. We listen and learn about how our staff and physicians are getting patients the care they need sooner, more safely while getting them home sooner as well.

Additionally, as CEO, I do gemba walks – a Japanese term meaning the real place. So I go to the real place of work (whether that’s the OR, the nursing unit, or the maintenance shop) to view improvements that have been made, review where each area is on meeting minimum Lean standards, and what the action plans are to get to those minimum standards.

- Standards -

Minimum Lean standards can be demonstrated through visual management, in the form of:
• Process control boards for at least one key process;
• Evidence of Pareto analysis (demonstrating how you ranked issues in order to monitor and problem solve);
• Action plans to drive process improvement;
• Performance control boards that track progress on key metrics. There should be at least one metric for each of the following dimensions: Access, Service Excellence, Financial Sustainment and Team Engagement;
• Evidence that at least one 6S has been conducted in the department in the last 12 months (6S = safety, sort, straighten, shine, standardize, sustain);
• A3 postings, may be a good means to display this evidence. (An A3 is a gap analysis tool that places an issue on one A3-size piece of paper on which team members list the reason improvement is needed, current performance, target performance, gaps, countermeasures, action plans and reflection on this. The A3s are then posted where all team members can see and update it as the plan is implemented.)

- Tremendous efforts -

The point of the gemba walks and transformational rounds by senior management is for everyone to know how important Lean teamwork is, and to personally acknowledge the tremendous ongoing efforts of our team. It’s how we, in management, show our staff that we care and that their successes matter the most.

Once that senior and middle management commitment and support is demonstrated regularly, buy-in and more success in decreasing wait times, lowering infection rates, speeding up test results and more will be achieved for patients.

Community hospitals tend to have the same types of challenges. Rouge Valley is no different in that regard. If anything, we have had more of them! Lean is working for us and it would work for you in your community hospital.

Lean Facts
* Lean is a management philosophy that focuses on the elimination of waste in various processes. It originated in Japan and is used in corporate and hospital sectors in Ontario and internationally.
* Kaizen, a Japanese word for improvement, is one method used to identify waste, and calls on a team of people to improve service to customers or workflow processes. At Rouge Valley this means putting patients first.
* Rouge Valley’s four transformation themes, driving our Lean management philosophy, are:
* Patients first – the best patient/family experience;
* Earn our reputation as the best everyday;
* No waste;
* One team, inspired and involved.

Friday, July 30, 2010

Working together to create leaders in health care

Advanced Leadership Foundations (ALF)
The ALF acronym is a catchy one, which many were quick to liken to the 1980s TV show. But there’s nothing alien about ALF to the management teams of Rouge Valley Health System (RVHS) and Lakeridge Health (LH), who have jointly rolled out the program. ALF team members, from left, are: Bill Hamilton, learning consultant, RVHS; Kathy Gooding, director, human resources, RVHS; Wanda Leach, director, human resources, LH; Darrell Sewell, joint vice-president, human resources; plus the ALF stuffies! (Absent are: Rahim Moledina, learning consultant, RVHS; Petra Bingley, learning consultant, LH; and Marguerite O’Neal, learning consultant, LH.)
Blog by Darrell Sewell
Joint Vice-President, Human Resources
Rouge Valley Health System and Lakeridge Health

Great leadership is not about any one outstanding individual. After all, how could leadership happen if there were only one person? Rather, leadership is defined by the act of working with others.

Bearing that in mind, it seems quite fitting that Rouge Valley Health System (RVHS) and Lakeridge Health (LH) have been delivering a comprehensive leadership training program to our management teams by doing just that—working together. Now at the mid-way point of the program, we can’t help but step back and take a celebratory look at what we have collectively achieved.

In January 2010, our two hospitals jointly launched the Advanced Leadership Foundations (ALF) program. This program was designed to help our over 250 managers build a strong foundation of leadership skills and to keep them on the cutting edge of leadership fundamentals within Ontario health care.

The ALF program is based on a set of 12 leadership competencies established by the Ontario Hospital Association’s Leadership Development Institute, in collaboration with the Hay Group. These competencies define the skill sets and qualities that all health care leaders in the province should have. Building on the 12 leadership competencies, RVHS and LH developed an additional 12 management competencies focused on operational knowledge. And all twenty-four competencies were the basis for the creation of the training modules that make up ALF.

Between January and June 2010 we have delivered 12 training modules—six leadership and six management competency modules. Delivering two modules per month, we started off in January with Visionary Leadership (leadership competency) and Role of the Manager (management competency) and we recently wrapped up the first half of the program in June with Business Acumen (leadership competency) and Managing Finances (management competency).

We could not have gotten this far without three important groups. First, there’s the team of staff who worked so diligently to build the curriculum for the program and coordinate its delivery. As joint vice-president of human resources for both RVHS and LH it has been an absolute pleasure to guide this initiative and participate with the following ALF Team members who have been key in putting ALF into action:

• Kathy Gooding, director, human resource, RVHS
• Rahim Moledina, learning consultant, RVHS
• Bill Hamilton, learning and media consultant, RVHS
• Wanda Leach, director, human resource, Lakeridge Health
• Marguerite O’Neal, learning consultant, Lakeridge Health
• Petra Bingley, learning and media consultant, Lakeridge Health

The second group that has been instrumental in the success of ALF is the guest presenters who have been responsible for delivering some of the core training. This group of professionals—from administrative areas of both hospitals (i.e. CEOs; human resource; finance; labour relations; occupational health, safety & wellness; decision support)—has worked closely with the ALF Team members to provide training on their particular areas of expertise. They have done an exceptional job, and we wish to thank them for their commitment to ALF and our management teams.

Finally, we need to congratulate all of the management staff, who have participated in the first six months of the program. ALF is a mandatory program for management staff and leaders, and we are happy that everyone is making the time to take part. Thank you for your commitment to your hospital, the work you do, and ultimately, to the patients we care for.

This has been an extraordinary experience for everyone involved, and it is a true success story for Rouge Valley and Lakeridge Health. The development and rollout of ALF reflects leadership at its best. It demonstrates what can be accomplished when two hospitals take the initiative to come together and make something happen. We were not discouraged by a limited budget. Rather, we used our resources wisely, and took advantage of some or most valuables assets: our expertise, our innovation, and our teamwork.

The result has been a top-quality product, which is unique in many ways. With 12 leadership modules and another 12 management modules, ALF has certainly got to be one of the most robust leadership training programs delivered within hospitals in Ontario. Matching this comprehensiveness is the program’s intensiveness. In six months, we delivered 12 training modules to more than 250 managers across two large community hospitals.

And of course, by delivering the program jointly, we have afforded our managers with a number of opportunities to develop relationships with colleagues across the two hospitals. The training modules were offered at RVHS and Lakeridge sites in Scarborough, Ajax and Oshawa, allowing staff and presenters to learn together and from each other.

Another unique aspect of ALF is its evaluative component. At both hospitals, we have introduced Halogen Software systems to evaluate managers specifically on the leadership competencies introduced in ALF. This closes the loop on their training, and helps to ensure that managers are applying in their work what they have learned in ALF.

It has truly been a thrilling start to this program. During the summer, we have taken a pause, but ALF will get going again in the fall. Between September and March, we will complete the program with the remaining 12 competency modules. I am looking forward to the second half of this program. In fact, we have a really exciting kick off planned for September, so stay tuned!

This kind of learning isn’t just about building leaders for our two hospitals. We are creating leaders for our future health care system, and you can’t help but to want to be a part of that.

Tuesday, July 6, 2010

President’s Blog: Time to map our future

By Rik Ganderton
President & CEO

We’ve come a long way since we introduced and implemented our Plan-On-A-Page.

In the almost three years that we have been working from this strategic plan our world has changed. Changes in health care have included the tightening of available funds, largely thanks to the great recession of 2008-09, and other changes including in how we are governed, which come into effect in 2011. (Read my future blogs on topics such as the Excellent Care For All Act -- and more.)

The new strategic planning process was launched by the Board of Directors in late April. Vice-President of Quality Improvement and Transformation Michele Jordan is leading the process and working with a Strategic Planning Operations Committee and a Strategic Planning Steering Committee, which is chaired by new Board chair Jay Kaufman. The new planning process is our opportunity to renew our focus.

A strategic plan spells out where an organization wants to go, how it’s going to get there and helps us decide how and where to allocate resources. It’s a way of mapping our future. Rouge Valley has started the process of developing a new strategic plan to guide us during the next three years.

Essentially, this plan will be our corporate document that will help us skate to where the puck is going to be, rather than where it is now. Ultimately the hospital Board of Directors will approve and refine our draft of the new plan-on-a-page by January 2011.

But your input is needed to truly get this plan rolling. We don’t simply want to push this information request out, we want you to be part of this important process and to help shape the future directions of your hospital. The core information we gather for input to the process must come from you — our staff, physicians and volunteers. You know what has been working and what has not been working for our patients. Your views are vital.

So for starters, please visit our brief online public survey. (Staff, physicians and volunteers have already completed a survey.) Please click on this survey link before the end of the day on Tuesday, July 13, 2010.

We are also seeking the views of our key health system partners (e.g. other hospitals, CCAC, family physicians, long-term care homes), our Community Advisory Group, community agencies/groups, and political leaders. We are doing this through surveys, face-to-face meetings, focus groups, our electronic newsletter and publicly via social media such as blogs.

This fall, after we have analyzed all of the information and feedback collected, we will bring concepts and drafts to all staff, physicians and volunteers through our many internal forums: Town Hall; Leadership Forum; the Medical Advisory Committee; the Medical Staff Society, our two strategic planning committees and other groups.

Surveyors from Accreditation Canada last year found that we had an extraordinary number of internal and external people knowledgeable about our Strategic Plan On-A-Page. And we want even more of you in the know and actively participating this time please. For a refresher, here’s a link to our current plan as posted on our hospital’s public website.

- Rik

Tuesday, June 22, 2010

President’s Blog: Thank you Darrell

By Rik Ganderton, President and CEO, RVHS

Our senior management team and I wish continued success to Darrell Sewell, joint vice-president (VP) of human resources for Lakeridge Health and Rouge Valley Health System.

The human resources (HR) needs and complexities of each hospital corporation have grown significantly since Darrell accepted the joint role some six years ago.

Upon much personal reflection Darrell has determined that at this time he needs to focus on his growing scope of responsibility at Lakeridge Health and has decided to continue in his role as vice-president at Lakeridge full-time and to relinquish his role as VP at Rouge Valley. I can understand the increasing demands on him in this very complex joint senior executive position.

Darrell's leadership will be missed at Rouge Valley. Among the many accomplishments Darrell and his team in human resources have led and implemented at Rouge Valley are:

* ARC (Accountability, Respect and Caring) training for all staff and physicians;
* ALF (Advanced Leadership Foundations) leadership and management competency training for both Rouge Valley and Lakeridge Health, and leadership competency assessment (Halogen);
* Growing our commitment to respect, workplace violence prevention, and codes of conduct through several initiatives including ARC, Clearview Connects, revised Respect in the Workplace and Code of Conduct policies, etc. which allows any staff member or physician to identify any workplace issues confidentially;
* Communicating and implementing policies and programs to meet legislative obligations and commitments eg.) Accessibility for Ontarians Disabilities Act customer service training, Bill 168 Risk Assessments, Ontario Disabilities Act, accessibility plans, etc.;
* Ongoing management of recruitment, workforce assessment and adjustments, occupational health and safety improvements, attendance support and disability management supports, collective agreement negotiations and compliance, pay equity plans, compensation administration and the successful implementation of a payroll system (Meditech PP);
* Recognition culture established through programs like our Top of the Valley Service Excellence and Rouge Valley Spirit Days; and
* Creation of the joint HR service delivery model between Rouge Valley and Lakeridge Health, which has created many savings and efficiencies.

Darrell informed his human resources team earlier this month and wants to share his decision with the hospital at large.

He has provided us with much notice allowing me to consider how to replace this leadership position. Darrell will maintain his joint VP role at Rouge Valley until Aug. 31, 2010.

Much of the joint HR portfolio will continue to operate including the joint services provided by Gord Fitzgerald (labour and employee relations), Randy Fallis (transactional HR services ++), and some services under Occupational Health Safety and Wellness (OHSW).

However, Peter Clancy will be returning full-time to Lakeridge Health as director of OHSW, and Karen Clark will become the full-time director of OHSW at Rouge Valley, effective September 1, 2010.

Let me say it has been a pleasure to work with Darrell. His collaborative approach to complex and challenging issues has been highly valuable to Rouge Valley and me personally. I know we will continue to work with him in the Central East LHIN in his role as a vice-president at Lakeridge Health.

All the best to you Darrell. Thank you for your leadership and commitment to our hospital system.

- Rik

Friday, June 11, 2010

Chemo Clinic: Quality care closer to home

By Alastair Lamb
Director, Scarborough Joint Systemic Program
Central East Regional Cancer Program

Hello, my name is Alastair Lamb, Director, Scarborough Joint Systemic Program for the Central East Regional Cancer Program. I'd like to draw your attention to one of the gems of Rouge Valley Health System.

It's your Chemo Clinic.
Located on the main floor of Rouge Valley Centenary, 2867 Ellesmere Road, the clinic services the needs of residents in west Durham and east Toronto. The chemotherapy clinic is a modern outpatient clinic where patients with cancer receive chemotherapy drugs as part of their overall treatment.

Part of my job is to increase awareness of cancer care services available and to increase patient referrals to the clinic. The reason for this is simple: It provides the same level of care as chemo clinics elsewhere and is more convenient.

Currently, we have many patients being referred to cancer services at downtown facilities, some of whom could be treated at Rouge Valley. The quality of services at Rouge Valley is excellent. So we are actively promoting and encouraging physicians to refer appropriate patients to the Chemo Clinic. Head of oncology Dr. James Chiarotto and his team provide quality care, closer to home for patients.

We want physicians to know that referring their patients to the Rouge Valley Chemo Clinic will provide them with the same quality of care as they would receive
elsewhere in a more convenient and cozy setting with caring professionals, who know their patients very well. A family member or a friend is always welcome to attend with the patient.

Quality patient care is our priority, of course. The Rouge Valley Chemo Clinic is part of the Scarborough Joint Systemic Program, along with The Scarborough Hospital and the Central East Regional Cancer Program. The Rouge Valley Chemo Clinic follows the same-evidence based protocols as delivered in other cancer centres. Patients can be confident that they are receiving the best care possible regardless of where they are getting it. So, why not receive your care closer to home?

Staff members, physicians and volunteers of Rouge Valley are encouraged to spread the good word about the Chemo Clinic.

Look for more information about Rouge Valley cancer care services in future issues of the Echo and e-Echo.
For more information, please contact the Chemo Clinic at 416-281-7483, visit online or come visit
for a personal tour!

Wednesday, April 7, 2010

Senior management team gets “real” through Gemba Walks

President’s Blog: Rik Ganderton

I meet every week one-on-one with each member of the senior management team to listen, learn and ask questions about hospital issues and challenges and performance. Most of these meetings occur in an office, usually mine.

I want the senior management team to be much more visible in the organization, and to listen, learn and ask questions about hospital performance and challenges. I am changing the format of my weekly meetings from a review in my office to a weekly, structured walkabout.

In the last week of each month I will to do a full review of Quality, Operational Performance, Risk Management and other Personal Business Commitment items, (to be posted soon by the way) which will be office based.

This is a Lean management technique known as a Gemba Walk. It will allow me and members of the senior management team to review and understand key issues such as flow, wait times, quality care, safety, use of resources, continuous improvement efforts, teamwork and more.

Gemba is a Japanese term meaning the real place. These walks will support a better connection between senior management and the front line, or the real place where our patient care and related work is done everyday.

Getting out of the office and meeting with managers and staff on the floors is also in keeping with our growing Lean culture at Rouge Valley Health System.

The senior management team and I expect to learn from you and will contribute to progress in your department or area.
On the Gemba Walks I will rotate through the areas across both sites so that we visit all locations. On each Gemba Walk I want to review where each area is on meeting minimum Lean standards and what the action plans are to get to those minimum standards.

Minimum Lean standards can be demonstrated through visual management, in the form of:
• Process control boards for at least one key process;
• Evidence of Pareto analysis (demonstrating how you weighted issues in order to monitor and problem solve);
• Action plans to drive process improvement;
• Performance control boards that track progress on key metrics. There should be at least one metric for each of the following dimensions: Access, Service Excellence, Financial Sustainment and Team Engagement;
• Evidence that at least one 6S has been conducted in the department in the last 12 months (6S – safety, sort, straighten, shine, standardize, sustain);
• A3 postings, may be a good means to display this evidence.

I look forward to meeting more of you through this process.


Wednesday, March 31, 2010

Senior Management Team changes

President's Blog
Rik Ganderton

We are implementing some changes at the Senior Management Team, effective Thursday, April 1, 2010.

The purpose of these changes is to better align portfolios with the evolving needs of our hospital, our corporate objectives and enhance the strong leadership skill set of our team.

Natalie Bubela will now have the title of Vice-President Regional Programs, Program Integration and Chief Nursing Executive (CNE). As CNE Natalie will have responsibility for the ongoing development and improvement of nursing and allied health professional practice. As VP Integration, she will be responsible for advancing RVHS’ participation in the implementation of the Central East LHIN Clinical Services Plan as well as the development of new program integration and program development opportunities. As VP Regional Programs, Natalie will have ongoing operational leadership for the Cardiac, Cancer and Women’s and Children’s programs.

Sonia Peczeniuk will continue as Vice-President Clinical Support, but will also take on responsibility for the Surgical Program. She will relinquish her role as VP Medical Affairs when our new Chief of Staff starts, likely towards the end of May.

Michele Jordan will be Vice-President Quality Improvement and Transformation. Michele will continue to lead transformation and the deployment of Lean organization wide. She will also take on the role as leading the improvement of quality organization wide. This will include clinical quality, customer service and safety. Michele will also work with me to develop the next iteration of our Strategic Plan on a Page.

John Aldis will continue as Vice-President Corporate Services, but will also take on responsibility for Post Acute Care.

I would also like to welcome Cheryl Williams to the Senior Management Team as Vice-President Acute Care Services. Cheryl will have responsibility for Emergency, Medicine and Critical Care, Mental Health and Patient Flow.

There are no immediate changes to the responsibilities of Darrell Sewell, Rick Gowrie or Dave Brazeau. Dr. Naresh Mohan and Dr. Romas Stas will continue in their roles as key members of the Senior Management Team.

I ask you all to continue to support our new leadership structure and I wish each of our VPs great success in their new roles and responsibilities.

Rik Ganderton
President and CEO

Monday, March 8, 2010

Going beyond Peer Review Report recommendations

Chair’s Blog: Janet Ecker

To: The Rouge Valley team: all staff, physicians and volunteers

We did it.

Rouge Valley Health System has successfully implemented its Peer Review Report recommendations, as confirmed in a recent letter from the Central East Local Health Network (CE LHIN).

In his letter to me, CE LHIN Board of Directors Chair Foster Loucks states that Rouge Valley has met the requirements of the report, which were grouped in these categories: leadership; culture; strategy, financial; and governance. He adds, “Thank you for all of your hard work and dedication. The Rouge Valley Health System (RVHS) is to be commended for its many accomplishments.”

As chair of the RVHS Board of Directors, I wish to publicly thank and congratulate the entire Rouge Valley team – all staff, physicians, volunteers, my fellow members of the Board of Directors, the senior management team and medical leaders – on this considerable achievement.

Planning and action

Your focused planning and action in the categories identified in the Peer Review Report have put the hospital on the right track for our patients, communities and for our team. More than this, your collective focus has moved us well beyond implementation of the report.

This focus began with the Strategic Plan On-A-Page in 2007-08, which led to plans and actions on financial accountability and transforming work processes with a patients-first approach.

We are all now engaged in transforming Rouge Valley on a variety of key measures for our patients: quality care; wait times; effective use of our limited resources; and reinvestment in our facilities.

To best address the challenging recommendations of the report and engrain a culture of constant improvement, our senior management team has worked with our RVHS Board of Directors, our medical leaders, physicians, management staff and front-line staff. All of these groups have received extensive training and/or coaching in Lean management, a philosophy and method of constant improvement.

We are already recognized as leaders in the CE LHIN and beyond for our ongoing application of Lean, because of our tangible results already, including:
• Patients going home sooner thanks to improved patient flow and discharge planning at both hospital campuses;
• Patients and doctors getting lab test results faster at both hospital campuses;
• Patients spending less time waiting for care in our emergency departments, where almost 90 per cent of ambulatory patients are discharged in less than four hours;
• RVC ambulance offload times continuing to be among the lowest in Toronto. This initiative will be implemented at RVAP, now that our new emergency department is open.

I’m also proud to say that you have met and exceeded our commitment to maintain annual service volumes (at 2006-07 levels), while reducing costs to stay within budget as per the best peer hospitals in Ontario. For the fiscal year ending March 31, 2010, we will have:
• Cared for 8,500 more emergency room patients than in 2006-07;
• Delivered 400 more babies;
• Carried out 600 more surgical procedures;
• Treated 900 more weighted cases; and
• Increased mental health services in outpatient capacity and in providing more crisis services.

Among other key Lean-related improvements, as documented from March 31, 2007 to September 30, 2009, we have reduced the amount of time patients wait for:
• Cancer surgery, from 82 days to 54 days;
• Hip replacement, from 300 days to 204 days;
• Cataracts, from 339 days to 167 days; and
• Magnetic Resonance Imaging (MRI), from 128 days to 122.

Our publicly-reported quality indicators on hospital-acquired infections, Safer Healthcare Now Interventions, hand hygiene and Hospital Standardized Mortality Ratio, have all shown marked improvements during the similar period. In fact, our hospital mortality rate is the lowest in the Central East LHIN.


The Peer Review Report also recommended that RVHS defer its capital development and installation of a Magnetic Resonance Imaging scanner at Rouge Valley Ajax and Pickering hospital campus. This was the sole recommendation that we disagreed with, as we believe MRI is an essential modern diagnostic tool needed by our west Durham community. The Central East LHIN has been supportive of RVHS on this point. We will continue to work on getting an MRI at our west Durham hospital campus.

Summation: Quality and effectiveness

In short, we are all doing the best for our patients within our allocated resources – and so much better than we did before.

We all know we have more to do and are constantly challenging ourselves to innovate, eliminate waste and improve quality. Again, it’s my pleasure to congratulate our entire team on this accomplishment and encourage you all to remain focused on improving patient care. Thank you.

Wednesday, February 17, 2010

Fight heart disease with heart healthy foods

By Valerie Manbeck
Clinical Dietitian, Rouge Valley Health System

Did you know that by changing the foods you eat, you can reduce your chances of heart disease?

By introducing more heart-healthy foods into your diet, you can fight your chances of having a heart attack.

Changing the foods you eat certainly isn’t easy. However, knowing which foods to add and which to eliminate can help kick-start your way towards a heart-healthy diet.

Here are some of the top five easy tips to help you on your way to a more heart-healthy diet:

1. Limit unhealthy fats.

Limiting saturated and trans fats is linked to a decrease in blood cholesterol levels, which lowers your risk of developing heart disease. A high blood-cholesterol level can lead to plaque build-up in your arteries, increasing your risk of a heart attack.

To reduce saturated fats, try cutting down on ‘fatty’ meats like sausages or bacon, and replacing them with leaner meats. Lean meats, like poultry and fish, and low-fat dairy products such as skim or one per cent milk, are good options.

To reduce trans fats, limit foods made with shortening or partially hydrogenated vegetable oil. Instead, choose healthier fats like olive and canola oils. Nuts and seeds also contain healthier fats. But remember that all types of fat are high in calories, eating these foods in moderation is key here.

2. Choose foods with omega-3 fatty acids.

The impact that omega-3 fatty acids have on lowering your chances of heart disease are enormous. These foods can help decrease your overall risk of heart disease.

Eating ‘fatty’ fish such as, salmon, tuna, sardines, mackerel, trout, and herring at least twice a week is a great way to incorporate omega-3 fatty acids into your diet. Good sources include salmon, sardines, and herring.

3. Eat more fruits and vegetables.

A diet rich in fruits and vegetables does wonders for your waistline and helps to thwart heart disease. These two food groups are also low in calories, and full of fiber and anti-oxidants, which are keys to preventing and slowing damage to blood vessels.

Look for colourful fruits and vegetables. For example, mangos, carrots, spinach, broccoli and sweet potatoes are all good choices. Whenever possible, opt for fresh or even frozen fruits instead of fruit juices. Aim for two to three fruit servings a day, and at least four servings of vegetables each day. Try two at lunch and two at dinner, to get your vegetable servings in.

Adding fruits and vegetables to your diet isn’t as hard as you might think. Try keeping veggies like broccoli, carrots or cauliflower washed and cut up in your refrigerator. Choose recipes that feature fruits or vegetables as the main ingredient, such as fruit salads or stir-fry. And try not to cover vegetables with butter, dressings or creamy sauces, as many of these are high in fat.

4. Reduce salt.

Consuming a lot of salt can contribute to high blood pressure, a risk factor for heart disease. So, reducing your salt intake is a key part of a heart healthy diet.

The Heart & Stroke Foundation recommends that you eat less than 2,300 milligrams of sodium (one tablespoon or five mililetres of salt) a day. For those who have been diagnosed with high blood pressure (hypertension), sodium intake should be limited to 1,500 milligrams (two-thirds of a teaspoon) a day.

And while not reaching for the salt shaker is a good start, cutting back on processed foods is even more important. Much of the salt many of us eat comes from canned or processed foods, like canned soups and frozen dinners. Eating fresh foods and making your own soups and stews can help reduce your salt intake. And if you do prefer the convenience of canned foods and frozen meals, look for those with reduced sodium. Also, try other herbs and spices instead of table salt to flavour your food.

5. Go for soluble fibers.

Increasing your intake of soluble fiber is a great way to lower your blood cholesterol. Good sources of this fiber include oats, psyllium-enriched breakfast cereals (e.g. Kellogg’s All Bran Buds), ground flax seeds and citrus fruit. Adding ground flax seeds to your yogurt, apple sauce or hot cereal can be an easy way to add soluble fiber to your diet. Simply grind the seeds in a blender and stir in with a teaspoon.