Monday, December 22, 2014

2014 Year-end Board Chair & CEO Message

Message from Board Chair Joan Wideman and President & CEO Rik Ganderton
December 22, 2014

As we enter the holiday season, I want to thank each of you, on behalf of the Board of Directors, for your ongoing work of delivering outstanding care to our communities. It has been another busy and exciting year for Rouge Valley Health System (RVHS).

Our CEO, Rik Ganderton will end almost eight years of successful leadership on Dec. 31. The Board has again been able to prevail on Rik to not cut the ties completely, and he will continue to provide strategic leadership advice and guidance to the senior team and the board on strategic matters until the new CEO arrives. Michele James has agreed to continue as acting CEO while Rik continues to support RVHS remotely. Michele will continue to have day-to-day operational responsibility. The Board is grateful to Rik for his visionary leadership and the turnaround of RVHS over the last eight years. He is leaving the organization in a much better and stronger state than when he joined in January 2007. It is our intention to celebrate Rik’s leadership and success at RVHS at an event in the spring, and you will see more information on this in the New Year. 

As you are aware, we have been conducting a search for Rik's replacement. We are very pleased with the number and quality of the candidates that have stepped forward. We have held initial screening interviews with 17 candidates and then selected a short list of seven for in-depth interviews with the selection committee (Board Executive Committee, plus Dr. Joanne Ma as President of the Medical Staff Society.) We now have a shortlist of three absolutely outstanding candidates, and we intend to make our final selection quickly. It is our hope that the new CEO will be on the job by the end of March.

While there have been many exciting events in the last year, the potential merger discussions and work with The Scarborough Hospital (TSH) took much time and effort from your Board, physician leadership, senior management team and many others. I want to thank every one of you for your tireless dedication and the countless extra hours of effort. While the merger did not proceed in March, we continue to believe strongly that it is the right thing for our patients and the local health care system. We continue to work with TSH on several integrations at the program level and are hopeful that at some point this opportunity can be brought back to the table for the benefit of our communities.

Perhaps one of the most important roles of the Board of Directors is to set the Mission, Vision, Values and Strategic Direction of the organization. We are now in the process of renewing our current 2011 – 2014 Strategic Plan. To this end, we have created a Board-led Strategic Planning and Branding committee with representation from the Board; physician leaders and front line doctors; union leaders; managers; community advisory group members and front line staff. There is also an Operations committee, which includes an even broader representation. These committees will be very active along with the new CEO as we re-examine our Mission, Vision and Values and renew our strategic direction. A key component of the process is understanding what our existing brand is and what the gap may be to the brand that we want (brand is not about name but about how our patients see us and think of us). We see the strategic plan and the brand as being inextricably linked and that our strategies must drive us towards brand improvement.

Looking into the future, we are sure 2015 will be another exciting year for Rouge Valley. We will have a new CEO to lead us into the future. We will continue to work with our health system partners to integrate our services and break down silos for the benefit of our patients. We continue to look at new opportunities and priority projects to enhance our services to our community. We may again look at organizational changes and opportunities such as mergers, whether these are vertical (up or down stream providers) or horizontal with other hospitals.

What we know for sure is that the health system is continuing to transform and that we want to be and will be a leader in that transformation. We will also continue to focus on our patients by ensuring they are at the centre of all of our decision making.

On behalf of the RVHS Board of Directors, I wish you and your families a joyous Christmas season, and best wishes for a safe, healthy and successful 2015 year!

Joan M. Wideman
Chair, Board of Directors
Rouge Valley Health System

I echo Joan’s thanks to the team. It has been a year of tremendous effort from every one of you, and I thank you all for your energy and commitment to making Rouge “the best at what we do.” As with any look back, there have been a number of highs and lows. It was clearly a low point when the merger did not proceed given the benefits we saw and frankly the effort that the teams from both Rouge and TSH put in to the project. We remain committed to integration and continue to work with TSH to integrate services for our patients. We also continue to work with our other health system partners and continue to further integrate services for the benefit of our communities.

There have also been many successes in 2014 that we should be proud of and celebrate. The most recent is the response to the Fairview Lodge fire. Along with our other health system partners, we were able to react and accommodate some 200 residents across the system — of which Rouge Valley took 27. Our health system partners were also able to find new temporary homes for these residents within two weeks of the fire — a remarkable achievement given the shortage of long-term care capacity.

One of our most exciting initiatives has been the new bed map. This has been a unique and innovative approach to managing the continuum of care for our patients. We have changed from the approach of moving patients to where the care is to moving care to where the patient is — a totally patient-centric philosophy. While this sounds simple, it is one of the most complex and far-reaching change initiatives Rouge has ever undertaken. It has impacted virtually every aspect of our care delivery processes. I am well aware that many of you have put in hundreds of hours of effort to make this change work, and I know that it has been very challenging on occasion. It will continue to be a challenge as we adjust our care processes to the new approach, but rest assured, it is making a positive difference for our patients (and for our staff). For instance, we are now physically moving patients far less often. This is much safer for patients as it reduces the risk of handoff errors. It also reduces the infection risk as we are not regularly changing the environment that a patient experiences. It is also a better patient experience as the care comes to the patient and the patient is not physically moved multiple times during his or her stay. It also reduces workload for staff, such as housekeeping (less cleaning), portering (fewer moves) and nursing (fewer moves and handoffs).

No look back at 2014 can be complete without the response to the Ebola threat, a deadly disease that arose again in West Africa on a huge scale and which for a time threatened to spread globally. Our domestic and local response required herculean efforts, and as with most similar situations, there was a modicum of confusion and wheel spinning before the new processes and procedures kicked in as a routine. The threat now seems to have diminished substantially, but ongoing vigilance is required to ensure there is no re-emergence of this or other similar threats. I wish to thank everyone for their unstinting efforts to ensure the safety of our staff and patients.

On an activity basis, we continue to experience growth in volumes and/or the complexity of the patients we are treating. We continue to see periodic surges in activity throughout the year and are currently experiencing yet another surge. This latest one seems to be driven by the spiking flu season, which is expected to peak over the Christmas and New Year’s holidays. Its impact is increased because of the reduced long-term care capacity caused by the Fairview fire and now the impact of respiratory and enteric outbreaks in several nursing homes, which means they are closed to admissions. We will as usual weather this ‘storm,’ but it will require your patience and continued dedication to serving our patients in the best way we can.

Rouge continues to develop the scope and volume of services we provide. Our regional cardiovascular rehabilitation program has continued to expand and now covers much of the Central East Local Health Integration Network. It is recognized for its innovation and it is considered as a model for the province. Its efficacy will be subject to a research study lead by Institute for Clinical Evaluative Services (ICES), which is very exciting for the program. Also leading the way in innovation and improving benefits for our patients is our surgical program. Examples here include the introduction of GreenLightTM lasers for prostate surgery, greatly increasing the success of these procedures and greatly reducing patient discomfort and recovery. Our orthopaedic program continues with its innovative ”prehab” approach for major joint replacements and we are starting to work with our primary care colleagues in both hip, knee and shoulders to introduce care pathways that span the typical silos. We continue to recruit new physicians and build our bench strength for service delivery, and we welcome the 15 new doctors who joined us in the last year. There is no doubt that the effective relationships between the Board, management and medical staff is a true differentiator for Rouge.

Last but not least, I must mention the affiliation agreement with the University of Toronto, which was signed in the fall. This agreement will help us to attract new physicians and other clinical staff and offers and exciting partnership with U of T - Scarborough Campus. While definitive mutual directions have not been set, we are exploring opportunities in sports medicine, brain imaging and mental health with our colleagues at the Scarborough campus.

This is also my last annual message as CEO of Rouge. It has been a pleasure to serve as your CEO, and I look back with pride at all of the accomplishments that each of you, and Rouge as an organization, have enjoyed in the last almost eight years. You should have great pride in the organization you work for and the things you do every day to serve our patients and be the best at what we do. I wish you all health, happiness and success in the years to come and I hope that our paths may cross again in the future. Thank you.
Rik Ganderton
President & CEO
Rouge Valley Health System

Friday, November 28, 2014

Facing Prostate Surgery

Below the Moustache blog series

Dr. Arthur Grabowski, Urologist

Patients with prostate cancer facing surgery are naturally apprehensive. Not only are they usually concerned with how the procedure will go, the extent of pain involved and the time it will take for them to recover, they also worry about long-term side effects. 

In this blog, I hope to alleviate some of these concerns by providing a detailed account of what patients can expect to experience.

Let’s begin with the actual surgery itself.

If a radical prostatectomy is required, it is because a surgeon believes he or she can remove the localized tumour completely. This type of surgery is generally recommended for patients who are younger, in good health and have prostate cancer that requires treatment. The surgeon accesses the area either through a single incision or a few small incisions in the abdomen. Using delicate surgical instruments, the surgeon then removes the prostate gland and some of the surrounding tissue. This is an added measure to ensure the whole area is free of cancer cells.

The procedure takes approximately two to four hours, depending on the extent and type of surgery. When a patient wakes up following the surgery, he will have a catheter to empty his bladder and a small tube in his abdomen to help drain any fluid that may accumulate. He can expect to stay in hospital after surgery for two to three days. He is discharged home with the catheter, which stays in for 10 to 14 days to allow healing of the connection between the bladder and the urinary passage.

Now let’s look at what happens during recovery and any possible side effects.

For the next couple of weeks he may notice some blood in his urine. This is normal and will ease off on its own as the surgical site heals. There will be some pain, as with most surgeries, but it can be managed well with medications both in the hospital and once the patient is home. Each patient and his surgery is different. For example, some may need follow-up radiation if the cancer has spread beyond the confines of the prostate.

Long-term side effects also vary with each patient. Incontinence, the involuntary loss of urine, occurs in about two to seven percent of patients and can vary in degree from mild to bothersome. Erectile dysfunction occurs in about 40 to 50 per cent of patients depending on a patient's age, type of surgery and pre-operative erectile status. Again, these have varying levels of severity and can often improve with time.

Here at Rouge Valley Health System, we understand the anxiousness that patients may be feeling. That’s why we have a patient-centric model that guides how we care for patients before, during and after surgery. We want patients to have the best experience possible throughout their prostate cancer care journey. Our surgeons work with a number of other sub-specialists and healthcare providers to ensure we address all the health needs of patients. Often this means a team approach, which can bring together oncologists, counsellors and even home care professionals.

Rouge Valley urologists are ‘hands on’ in patients’ care well beyond the surgical suite. This is how we provide the best outcomes for patients in Durham and Scarborough.

Monday, November 17, 2014

Partners play vital role for patients with prostate disease

Below the Moustache blog series  

Dr. Zachary Klinghoffer, urologist 
Rouge Valley Centenary

In sickness as in health, significant others play a key role in recognizing and helping their partners cope with illness, especially true when prostate problems arise. Often it’s the sleep-deprived partners who question why trips to the bathroom several times each night have become the new norm and encourage their partner to visit their family physician to discover the reason for the change in pattern.

Sleep isn’t always the only thing interrupted. Because the prostate contributes to a man’s sexual wellbeing, physical changes to the prostate can trigger emotional responses amongst couples. When a man is diagnosed with prostatitis, benign prostatic hyperplasia (BPH) or prostate cancer, the degree to which it affects his partner is proportional to the level of intimacy the couple shares. Partners, like the men themselves, can feel a sense of loss when sexual activity declines so it’s important for couples to remain open and supportive with each other during diagnosis and treatment.

Changes in a couple’s relationship may depend on the severity of disease and the length of treatment required. In many cases, sexual side effects are minimal and short term. Conditions such as BPH can have a wide range of symptoms and can be treated with medication or surgery.  Thanks to the generosity of our donors, the RVHS Foundation was able to contribute $250,000 to enhancing our men's health program, including a new surgical laser at each campus to treat BPH through a minimally invasive procedure. 

The GreenLightTM laser, a type of photoselective vaporization, can eliminate prostate tissue that blocks the urinary tract while sealing blood vessels to minimize blood loss. This new treatment – often performed as a day surgery procedure and available now at each Rouge Valley hospital campus - reduces a patient’s risk and recovery time, so he can get back to the business of living life to the fullest much faster.

Treatment for prostate cancer can be more demanding and require a longer recovery period. In these cases, couples may benefit from relationship counselling if there are long-term sexual side effects. Open communication can help a couple remain emotionally intimate.

Illness or injury never solely affects a man; health issues also affect the people closest to him. It is important for partners, family members and friends to recognize the vital role they play in helping the men in their lives recognize, treat and recover from men’s health issues.

Related links -- 

Wednesday, November 12, 2014

‘Mo’ Food for Thought

Below the Moustache blog series focusing on men’s health

By Dr. Greg Trottier, urologist, 
Rouge Valley Centenary

Maintaining good prostate health may be as close as your refrigerator. There’s evidence to show a link between certain naturally occurring food compounds and health benefits for the prostate, the walnut-sized gland responsible for the male reproductive system.

Called nutraceuticals, these extracts, derived from natural food products, can be consumed as part of your regular diet or as a dietary supplement. Just remember, supplements are no replacement for a good diet.

Vitamin D and fruits and vegetables rich in antioxidants prevent free radicals from forming, keeping cancer cells at bay. For example, it is generally accepted that lycopene, the compound that gives foods such as tomatoes and sweet red peppers their brilliant red pigment, as an antioxidant minimizes the risk of cancer and other diseases.

In some studies, isoflavones, present in soy products such as tofu or edamame, have also offered protection against both prostate and breast cancers, and are considered a healthy alternative to red meat.

While Movember allows us to focus on foods that benefit men below the belt, we recommend you regularly manage your portions so your belt doesn’t need loosening after meals. Following the Canada Food Guide is a good start as it will help you control your weight, which is important since being overweight is a contributing factor for developing prostate cancer. As a rule: more vegetables, less meat.

Our goal is to keep your prostate, urinary tract and love life all functioning well. Small changes to your diet can yield huge benefits. Consider my FARM formula when making prostate-healthy food choices:
Fresh is always best — organic if possible; fish as a first choice
Antioxidant fruits and vegetables
Red pigment in foods, like tomatoes — that’s what to look for
Moderate portions; keep meat to a minimum

Recipe: Dr. Greg Trottier’s Below the Moustache Prostate-Healthy ‘Mo’rinara Sauce

This sauce is rich in lycopenes, natural compounds that promote prostate health. It’s also really easy to prepare, which makes it good any day of the week.

12 to 14 ripe plum tomatoes chopped, blanched with the skin removed (or two large cans of diced tomatoes)

1 – 5 oz can of tomato paste
1 red pepper, chopped finely
1 medium onion, chopped finely
4 to 5 garlic cloves, minced
3 tablespoons fresh basil
2 tablespoons fresh oregano
1 to 2 bay leaves
½ teaspoon of chili peppers
½ cup red wine (optional; substitute with chicken or vegetable broth if desired)
1 tablespoon honey
3 tablespoons of olive oil

½ cup bread crumbs
½ cup fresh parmesan cheese
½ teaspoon flax seed
Garlic salt to taste
1 tablespoon olive oil

Heat onions and red peppers with the olive oil in a large pan. Add chopped garlic and stir regularly. Add tomatoes, then paste. Chop the fresh herbs and add to pan. Cook over medium heat for 30 minutes.  Stir in red wine, honey and season with chili peppers. Cook for an additional 30 minutes.

Blend together the bread crumbs, parmesan cheese, flax seed and garlic salt in a bowl. Heat olive oil in a pan. Add bread crumb combination to lightly toast for five minutes. When brown and slightly crispy, remove from heat.

Serve sauce over your favourite pasta. Sprinkle topping to add flavour and texture. Serve with chicken breast or fish, green salad with pomegranate garnish and cherry tomato pesto bruschetta.

What foods are rich in lycopene? 

  • Tomatoes
  • Watermelon
  • Pomegranate
  • Guava
  • Papaya
  • Mango
  • Purple cabbage
  • Sweet red peppers 

Read Below the moustache: Early detection of prostate cancer can save lives

Tuesday, November 4, 2014

Below the moustache: Early detection of prostate cancer can save lives

Rouge Valley Health System’s urologists to men: focus below the moustache

By Dr. Jeffrey Spodek, Chief of Urology,
Rouge Valley Health System 

Men’s health is the focus in November, thanks to the international prostate awareness movement that has affectionately renamed the month Movember.  My fellow Rouge Valley Health System urologists and I would like to remind everyone that while it’s fun to change up their look with a bit of facial hair, it’s more important to focus on what is way, way below the moustache.

Prostate cancer is insidious because there are usually few symptoms in the early stages. That’s because the prostate is situated deep within the pelvis so it can get bigger before any symptoms become evident. In the absence of symptoms, men assume all is well. Of the 23,600 Ontario men diagnosed with prostate cancer in 2014, about one-quarter (6,000) will die from the disease , largely because it was not diagnosed early enough.

Early detection gives patients a better chance of beating the disease that has become one of Canada’s leading health concerns for men. While Rouge Valley urologists are well equipped to perform the required prostate cancer surgery and treatment, our primary goal as health care professionals, is to help stop cancer before it reaches the advanced stages.

There are several ways physicians diagnose prostate cancer. Blood tests can show overall prostate performance and check for any abnormalities. PSA test measures the levels of prostate-specific antigen, which could be a marker for prostate cancer. One of the most effective methods – albeit, perhaps the most dreaded by our patients and the butt of many jokes – is the DRE, digital rectal examination. While a DRE may be unpleasant momentarily, our view is those few minutes could and do save lives.

One in seven Canadian men will be diagnosed with the disease, a staggering number that is expected to climb to one in four within the decade . Translated locally, this means about one-third of the surgeries my colleagues and I now perform are to treat prostate cancer, and this percentage and prevalence are increasing. We encourage men to know the risks and get in tune with their body so they can recognize even the slightest symptom.

Prostate cancer risk factors

Rouge Valley urologists encourage men to understand the risk factors of prostate cancer , which include:
Age – men 50+ are at greater risk;
Ethnicity – men of African and Caribbean descent are at higher risk;
Family history of prostate cancer;
Diet – high fat diets contribute to risk;
Weight – men who are overweight are at greater risk.

Some of these risk factors are modifiable so, as a first line of defence, we want men to work with their family doctors to maintain their health in an effort to guard against the disease.

A stiff upper lip, even if covered by a stylish ‘stache, won’t protect men against prostate cancer. Awareness and personal attention will. Rouge Valley urologists want to give all men the greatest fighting chance to live cancer free.

Next week Below the Moustache will cover prostate-friendly foods that should be part of every man’s diet.

Thursday, June 26, 2014

Rouge Valley to lead more service growth and integrations

- From the RVHS AGM of Members, June 24, 2014 - Agenda Item # 4 
Rik Ganderton, President and CEO’s Report – Overview presented in the meeting  

The last year was a tightly scheduled and very full year at Rouge Valley Health System. As you’ve read in my President’s Report, we were not short on achievements for our patients and for our communities. 

We have worked very hard to design and implement new key initiatives:
Collaborative Care;  Patient Experience Training; The Staff Resource Team;  
The Lean Management System; and the The new Bed Map.  

All of these initiatives focused on better organizing our services to always place  patients and their families at the centre of all we do.

Continued investments in medical equipment, facilities

We would not be well positioned to grow or integrate services with other health care providers, as the chair outlined in her report, if we were not in a strong financial position. I am proud to report that we are in a surplus financial position ($6.9M) for the sixth consecutive year. That means we can continue to invest in strategic programs and services, medical equipment, information technology, and maintain our hospital facilities for our communities. 

A big part of our year involved the facilitated integration process. We are significantly disappointed by the lost opportunity of the proposed merger with The Scarborough Hospital. 

Our Rouge Valley Health System Board of Directors, physician leaders and senior management resoundingly supported the proposed merger during the last year, and in our board’s final decision on March 15, 2014. 

Focus on quality patient care 

Despite the intensity of analysis, planning, stakeholder engagement and meetings – our team of staff, physicians, midwives, Board members and other volunteers kept the hospital’s focus on quality improvement for patients. 

Service growth and integration for our communities were, and remain, key in our focus.

A great example of integration occurred just a few months ago in a partnership between Rouge Valley and Durham Mental Health Services (DMHS). Rouge Valley and DMHS integrated hospital and community services to better support mental health patients in the community. Thanks to new funding from the Central East LHIN, Rouge Valley has transferred funds for a full-time nursing position at DMHS, building on our previous partnership. 

Our regional cardiac care program continued to expand and integrate with other health care providers to meet community needs and save lives from Scarborough, to Pickering, Ajax, Whitby and throughout Durham Region.

From a quality perspective, we have maintained or improved our record of making Rouge Valley as safe as possible for our patients over the previous year. My report provides the details on this. 

As if the year weren’t busy enough, Rouge Valley’s team also stepped up when the ice storm struck in late December. Our services continued as clinical staff, facilities and security staff, physicians, midwives and volunteers at both hospital campuses made sure our communities had their hospital ready for them. 

In February, Chair Joan Wideman hosted our celebration of the 60th anniversary of the Ajax and Pickering hospital campus. Leading community fundraising in Ajax and Pickering in the 1950s, 1960s and ever since, is our RVAP Auxiliary, who we thank for their unwavering volunteer support. 

I also thank all of our volunteers, our Board of Directors, and our Community Advisory Group for providing valuable advice to our Board and hospital leadership.

In conclusion, we have become known for our relentless commitment to constant change, integration and improvement for patients. 

For that hard-earned reputation, Rouge Valley is well positioned to meet the challenges ahead and to constantly improve care for our growing communities. 

My full report and other AGM reports were posted online to our public website. Thank you all. 

Wednesday, June 4, 2014

A Message from the CEO

The following is a message to RVHS staff which we are sharing in this public blog. 

As you are aware from previous messaging and e-Echos (staff newsletter), in the past six months, Rouge Valley Centenary has been subjected to privacy breaches, in which external companies (registered education saving plan (RESP) providers/sellers) either employed or paid two former employees to use their routine computer system access to steal contact information of mothers and families. This confidential information was used, by others, to contact former patients in order to sell them RESP investments.

This is a breach of patients' privacy, hospital policy and most importantly compromises the TRUST patients place in us as healthcare providers. The hospital greatly regrets that this breach occurred and has used it to further tighten its information security controls. We have strengthened procedures for logging and monitoring access to patient contact information. We continue to say sorry to all of our patients who have been impacted by this breach.

We view this with extreme gravity. The employees involved no longer work here. Our investigation continues. The hospital continues to conduct an audit to determine whether other breaches have occurred. We have proactively contacted the 8,300 mothers and families to inform them and to apologize during the last six months. We have also contacted the Information and Privacy Commissioner and the Ontario Securities Commission, which is investigating. We have also contacted the police and will fully co-operate with their investigations.

We are determined to stop any such activity and will continue our audit and investigation. I have also informed other hospitals, the Central East LHIN and through them, the Ministry of Health and Long-Term Care of this issue.

To you, our excellent staff, physicians, midwives and volunteers, we know that this highly inappropriate behaviour does not characterize the terrific work you do for patients every day. If you see or are aware of any such questionable activity, it is your duty and responsibility to bring this to the attention of Management. You may do this by speaking confidentially to your Manager, Director or VP; or you may call or speak to me directly, or you may use the Anonymous Confidential Report Line. 

Rik Ganderton
President and CEO
Rouge Valley Health System

Tuesday, March 11, 2014

Exciting and challenging year ahead: CEO’s Message 2014/15

(RVHS publishes its Operating and Capital Plan, nicknamed the "Blue Book", each year on its public website. Here’s the CEO’s introduction of the Blue Book for 2014/15.)   

By Rik Ganderton
President and CEO, RVHS 

Next year promises to be every bit as challenging and exciting as this year has been for Rouge Valley Health System (RVHS).

My CEO message for our "Blue Book" is about three key opportunities and challenges for us in the year ahead, namely:
  • Quality patient care;
  • Fiscal responsibly; and
  • How the proposed merger with The Scarborough Hospital will help us better address these challenges as one larger hospital corporation.

There has been continued improvement and great potential to do even better in the quality of the care we provide as we look into, and beyond, the coming year.

Our team successes by staff, physicians, midwives and volunteers have set a solid platform from which to work. From a quality perspective, we have maintained or improved our record of making Rouge Valley as safe as possible for our patients over the last year.

We have met or beat our targets for managing nosocomial infections for VRE, MRSA and C. diff.
Our record for central line infections and ventilator associated pneumonias (VAP) in our intensive care units (ICU) is exemplary and we are continuing to receive visits from hospitals across the province to learn from our success. Our ICU teams are following the Institute for Health Improvement toolkit (which is based on Lean methodology) to ensure that we have full 100 per cent process compliance. Our unblemished record for VAP was halted with one incident, but audits showed we had followed all required protocols.

Our performance on hospital standardized mortality ratio continues to be excellent and amongst the best in the country. To top it all off, we have been accredited with the highest rating (2012-16), exemplary standing, by Accreditation Canada.

In 2013/14, we also started on an ambitious agenda to put patients first where care is provided throughout Rouge Valley. Our bed mapping initiative will better align patient demand with budgeted beds, allow us to provide multiple levels of care in one place so patients needn’t be transferred to other areas, reduce wait times for admitted patients in our ED, and help us respond better to variations in demand. The new bed map is all about improving patient outcomes and getting them home sooner to their families.

Quality patient care is also about how that care is delivered every day.  In keeping with our Lean philosophy of respect for people, Rouge Valley implemented a comprehensive customer service-training program for all staff, volunteers and physicians in 2013. Based on the Cleveland Clinic’s Communicate with HEART program, we adapted the curriculum for use in our hospital and delivered the first phase, START with HEART, to more than 95 per cent of our staff, 80 per cent of our volunteers and 16 per cent of our physicians. The remainder of our team will receive START training in 2014, plus we will roll out our second phase, Respond with HEART and a supplementary program for leaders called Coach with HEART, beginning in February 2014. Patients are already telling us they notice the difference.

Fiscal Responsibility

As the 2013/14 fiscal year comes to a close, we expect to far exceed our budgeted operating surplus for the year. While this is a very good thing, the reality is we will achieve a very healthy bottom line because of some unusual, one-time items, which are not related to our ongoing core operations.
The major one-time items driving our surplus this past year are: 
  • Post Construction Operating Plan funding – During the year, the Ministry of Health reconciled funding we received in 2009/10 and 2010/11 related to our Rouge Valley Ajax and Pickering (RVAP) redevelopment and Rouge Valley Centenary (RVC) Birthing Centre.  As a result we got to keep more of this funding than we had estimated based on the volumes we had achieved in those years at each site.
  • Plexxus – Early in the year, Rouge Valley and the other 10 member hospitals of Plexxus, our shared supply chain services organization, negotiated a new business model. The new model is very favorable to our hospital and allows us to keep a much greater share of savings from Plexxus-managed supply and service contracts.
  • Rebates, revenues, and incremental funding – Over the course of the year, RVHS has received various unexpected and unbudgeted one-time rebates and revenues. We also received incremental funding to support certain services, including two additional beds at RVC ICU, cancer surgery procedures beyond our base funding, and magnetic resonance imaging (MRI) hours.
Apart from the ICU funding, which will continue, these unusual items are hiding the fact that we are exceeding our budgeted expenses in many of our programs and departments.  We know that our current run rate is not sustainable and that we will not generate a surplus next year if we do not address it.  We also recognize that the volume of services we are delivering continues to go up and we anticipate that under the new funding formula, we will eventually get some credit for these volumes through funding increases.

So, we have worked very hard this past year to design and implement two key strategic initiatives – the new bed map and the staff resource team – which will help us become more efficient and effective in the care we provide.  Through these initiatives, we will: better match our resources to patient needs; integrate acute with post-acute care; eliminate the waste of unnecessary patient moves and off-service patients; and reduce overtime and agency use, which negatively impact quality and our bottom line.  Working together to refine and adapt to the new bed map and integrated model of care, as well as fully utilizing the staff resource team, are keys to our success in the coming year.  Becoming more efficient, while improving the patient experience and quality of care we deliver, remains our mantra by necessity.

As I do every year, I’d like to emphasize that we need operating surpluses in order to:
  • Maintain and upgrade our facilities infrastructure, which was cash starved over many years of operating deficits before we implemented the deficit elimination plan (2008-11);
  • Fund our capital equipment needs. Our three-year capital lists, excluding facilities items, includes $37.8 million in front line patient care equipment, clinical support equipment, diagnostic imaging, and information systems, which are vital to the safe and efficient functioning of our hospital and the achievement of our strategic directions;
  • Rebuild our working capital. Our hospital’s working capital deficit continues to be one of the worst in the province. This is because while we have generated cash from operating surpluses over the last few years, we have been investing most of it back into the organization. Capital and operational reinvestment will continue to take priority over the next year while managing our working capital deficit, which is a concern to our funders at the Central East Local Health Integration Network and the Ministry of Health and Long-Term Care.
I am confident that we can, and will, become better and more efficient, as always.  But we are hitting the wall on what we can achieve as Rouge Valley Health System alone.

Proposed merger

A proposed merger with The Scarborough Hospital has been in the analysis, stakeholder engagement and planning stages since March 27, 2013. The proposed merger offers a significant opportunity to provide greater access to services, improve quality, attract more physician sub-specialists and make much better use of our limited tax dollars.

The challenges facing Rouge Valley and The Scarborough Hospital exist with or without a merger of the four hospital campuses of both corporations. A merger will make us more resilient to change as one larger hospital corporation serving Scarborough and west Durham. The final approval to merge rests with the Minister of Health and Long-Term Care.

We have positioned Rouge Valley for success, despite the many challenges we have faced this past year, and as you will read in our Blue Book, we will continue to do so in 2014/15.

My thanks to all Board members, staff, physicians, midwives and volunteers for their strong commitment to continually improving quality of care and the patient experience.