Monday, April 9, 2012

Rouge Valley better than average and working hard to continue improving for patients

By Rik Ganderton, President and CEO, RVHS 

The details are out on the Canadian Institute for Health Information’s (CIHI) Canadian Hospital Reporting Project – and our hospital has above average results overall.

We also have several areas that require more focus and actions to improve for patients. We view the CIHI report as an opportunity to examine our services and improve.

Data from the report showed the performances of more than 600 acute care hospitals from all provinces and territories in the country covering the fiscal years from 2007–08 to 2010–11 in 21 clinical indicators and nine financial indicators.

When looking at the four fiscal years covered in the report, our hospital fares well compared to the national and provincial averages for the 21 clinical indicators. We’re better than average on 14 of them.

Better than average

There are many examples of better than average results in the report for Rouge Valley.
·      5-Day In-Hospital Mortality Following Major Surgery – Above average. In fact, we ranked fifth of 19 Greater Toronto Area hospitals in the category, as reported by The Toronto Star.
·      28-Day Readmission After Acute Myocardial Infarction (AMI or heart attack) – As the regionally designated centre in cardiac care, we are proud of this result.
·      Use of Coronary Angiography Following Acute Myocardial Infarction (AMI) – RVHS is better than the national and provincial averages for all four years.  
·      90-Day Readmission After Hip Replacement – RVHS was worse than the national and provincial averages in 2007-08 and 2008-09, but has improved to better than the average for the last two fiscal years in this category.
·      30-Day Readmission Rate (Obstetric, Paediatric, Adult Surgical, Adult Medical and Overall) – Data for these indicators are only reported for 2009-10, in which RVHS was better than the national and provincial averages. 
·      Obstetrical Trauma for Vaginal Delivery With Instrument and in Obstetrical Trauma for Vaginal Delivery Without Instrument – RVHS is better than the national and provincial averages for all four years for both indicators.

Worse than average

There are a handful of areas listed in the report which we are reviewing and working to improve on for patients and our communities.
·      C-section Rate (Excluding Pre-Term and Multiple Gestations) and Vaginal Birth After C-Section (VBAC) Rate – RVHS is higher than the national and provincial average for all years reported for both indicators.
·      30-Day In-Hospital Mortality following Acute Myocardial Infarction (AMI) – RVHS was better than the national and provincial average in the first two years, but has become higher in the final two years reported on. We are examining the factors that contributed to this result. As the regional centre for cardiac care, we see a variety of heart attack patients in dire need of our expertise. We will take the report’s findings as a further motivation to examine how we can improve our highly specialized services for patients. Our readmission rate after AMI, for example, is better than the average in the report, so we know there are daily success stories in our cardiac program. This downturn may be tied to introducing the Code STEMI Program in February 2009, serving Scarborough; and in February 2010, fully expanded to Durham. Measures that have been implemented to improve care of AMI patients include:
-       Increased focus on clinical guidelines and order sets, medication reconciliation practices, patient and family education programs, coordination with pre- and post-hospital providers, cardiac support programs;
-       Quality improvement committees, participation in quality collaboratives; holding staff accountable for quality;
-       Communication and coordination among providers;
-       Problem solving and continuous learning;
-       Development of a cardiology focus unit with enhanced staff presence and expertise in AMI care; sustained cardiologist physician champions, empowered nurses, involved pharmacists.
·       Administrative Service as a Percent of Total Expenses – RVHS is worse than the national and provincial averages for all three years reported.
·      Cost per Weighted Case – RVHS is higher than the provincial average for all three years reported, reflecting that it is more expensive to deliver care at RVHS than the average hospital. 

As I said we’re working on all of these. I should elaborate also on the administrative service cost percentage, in which we are listed as being the worst in the province. 

In 2009/10, the most recent year for which data is available, the provincial average for administrative expense was 5.92 per cent. RVHS’ was at 8.79 per cent. There are a few reasons for this including:
·      Severance costs and early retirement incentives as part of our necessary and very well publicized Deficit Elimination Plan for 2008-2011; and
·      Insurance premium increases stemming from a fraud discovered in 2007 and an old class action lawsuit dating back to the late 1990s. These are included as administrative costs in the CIHI report, and if reduced to normalized amounts, then RVHS’ administrative costs would be in line with the Ontario provincial average.

The hospital has been steadily improving its quality of patient care and improved overall safety — which will gradually push down our insurance premiums over time.

As part of our strategic plan, improving the patient experience is our number one priority and daily mission. As our staff and physician team knows very well, we have been applying a Lean philosophy of constant improvement for patients since 2008. That is having a positive impact on patient readmission rates, wait times and quality of care in general. All of this will have a favourable impact on our insurance premiums, which are included in the percentage of administrative overhead listed in the CIHI report.

It’s important to note that our admin costs continue to drop in 2010/11 and in 2011/12, but are still high because of insurance and ongoing severance costs incurred through ongoing restructuring.

Given the new funding formulas being introduced this year, the continuous pressure to reduce costs will escalate and will continue for several years. Based on these changes I foresee that severance costs will continue as we constantly restructure to meet these challenges. By its very nature insurance will continue to be high for another several years even without any major claims as we continue to pay off the old claims.

There is so much we can learn from in the CIHI report, as in other substantive reports done on hospitals. We will focus on improving our patient care in all areas, including those in which we are worse than average and those many areas in which we are better than average.

Our goal has been, and remains, to be the best at what we do for our patients. 

(Read the entire CIHI report on its website.)