Wednesday, March 18, 2015

Growth, integration and investments in community needs are on the horizon

By Rik Ganderton, Interim President and CEO 

CEO's Message and introduction to 'The Blue Book'  
RVHS Operating and Capital Plan 2015/2016  

My thanks to all staff, physicians, midwives and volunteers for continuing to grow and integrate high quality services for our communities at Rouge Valley Health System (RVHS) during the previous fiscal year. Every year brings a mix of the predictable challenges, but also some new ones.  

In 2014/15, our teams managed through several difficult issues including: Ebola preparedness; accommodating 27 residents who lost their homes due to a fire at a Whitby long-term care home; a privacy breach; a tough flu season; a strike by nurses at the Community Care Access Centre; and surges in the volume of patients presenting to our emergency departments.

Despite these challenges, Rouge Valley is in a position to initiate new and much-needed investments for our ever-growing communities of Scarborough, Ajax, Pickering, Seaton and Whitby in the 2015/2016 fiscal year and beyond. Due to fiscally responsible management that has led to year-end budget surpluses in each year since 2008, we’ve earned the enviable reputation of being able to invest in new and future hospital services.

Rouge Valley is planning to meet the future needs of the soon-be-developed Seaton community in north Pickering, which will be home to some 70,000 people in about five years. At its public board of directors’ meeting in December 2014, the Central East Local Health Integration Network (LHIN) Board of Directors endorsed our early-stage pre-capital planning submission to continue planning in order to meet Seaton’s future needs. 

The Central East LHIN also endorsed two other significant early-stage pre-capital submissions: 
Redevelopment of Rouge Valley Ajax and Pickering (RVAP) hospital campus, which has already surpassed the 60,000 annual emergency department visits it was expanded for in 2011; 
Renovation of emergency department facilities at Rouge Valley Centenary (RVC), which community demand has significantly outpaced during the last 20 years. RVC receives more than 66,000 emergency visits a year in a space built for 20,000 visits.
We are also planning related extensive redevelopment at RVC in: surgery; inpatient units; ambulatory services; and diagnostics. 

Our pre-capital planning submission assumes that during the next 20 years, significant redevelopment of existing hospital capacity at RVC will be required to meet the healthcare needs of residents residing in the Scarborough cluster of the Central East LHIN. Planning data suggests a requirement for 1,100 to 1,200 beds by the year 2031. An opportunity exists to renovate, reconfigure and add capacity to the existing inpatient units at the RVC campus. This would bring the total bed complement to 550-plus beds, in an attempt to minimize the necessity for the entire replacement (e.g. new facilities) of all the hospital sites within the Scarborough cluster. (This assumes that one hospital in the range of 500-600 beds would then meet roughly one-half of the 1,100 to 1,200 bed requirements for the Scarborough cluster, exclusive of any repurposing of physical buildings required to support the delivery of ambulatory care services.) 


One of our greatest strengths is our willingness and ability to work with other healthcare providers to create accessible and connected care for patients and their families. 

Thanks to new funding from the Central East LHIN earlier this year, Rouge Valley was able to transfer funds for a new full-time nurse to work with mental health patients in the community.

The new full-time nursing position at Durham Mental Health Services (DMHS) is now integrated with Rouge Valley’s Assertive Community Treatment Team (ACTT) in its Stepped Care service. The program helps people live in the community while receiving mental health care, without having to come to a busy emergency department. 

The latest initiative between RVHS and DMHS builds on their recent history of collaboration. Since 2011, RVHS transfers $200,000 a year to DMHS toward staffing a community crisis location in Ajax, again allowing people to be treated in the community rather than having to come to the hospital. DMHS also has a full-time staff member at RVC’s emergency department in our hospital-to-home program. 

Our regional cardiac care program also continues to be a beacon to others of integration potential as it exemplifies what can be done for patients accessing specialized care, such as Code STEMI, throughout Scarborough and Durham. The program also offers its regional cardiovascular rehabilitation and secondary prevention service now to Kawartha Lakes, as well as in Scarborough and Durham. 

The February 2009 Central East LHIN Hospital Clinical Services Plan identified the need for integrated cardiac rehabilitation services using a “hub and spoke” service delivery model, with common standards to establish local access to consistent, high quality services. In 2011, RVHS and Lakeridge Health (LH) submitted a Regional Cardiovascular Rehabilitation and Secondary Prevention Voluntary Integration Proposal using a hub and spoke model, with RVHS being the hub and LH the first spoke. The Central East LHIN approved $1 million of incremental funding, which enabled the following: 
A) Integration of the existing programs at RVHS and LH; and 
B) Harmonized referral criteria with centralized referral. There are now nine satellite sites across Scarborough, Durham & Kawartha Lakes. 
In December 2014, the Central East LHIN approved $1 million of funding toward the expansion of the cardiovascular rehabilitation program and establishment of the heart function management program, to serve additional patients, provide additional sites, and enhance support for patients with heart failure.

Setting the stage 

In the previous fiscal year, we set the stage for more growth and modernization of several patient care services. 

With the support of the RVHS Foundation, our surgical program has introduced GreenLightTM lasers for prostate surgery, greatly increasing the success of these procedures and minimizing patient discomfort and recovery time. The Cancer service has implemented the Prostate Diagnostic Assessment Unit to help men get faster diagnosis and treatment for prostate cancer. It is a multidisciplinary clinic staffed by urologists, radiation oncologists, medical oncologists, and a nurse navigator. The aim is to shorten the wait times for consultation and time to biopsy, pathology results, and treatment.

We have also recently set the stage for keeping wait times below three months for orthopaedic surgical patients (hips, knees, shoulders).  We’ve set a 90-day target from the time patients are referred to the day they have their surgical procedure done.  With proper funding, orthopaedic patients can get access to assessment and surgical or non-surgical treatment in 90 days or less. This is less than half the provincial target time from referral by a family doctor to the patient receiving the surgery in medically suitable cases. 

We have also developed and implemented a standardized process for hip and knee replacement and shoulder care that provides an improved patient/provider experience, lower system cost with high quality outcomes, and lower wait times for patients overall.

Our orthopaedic program continues with its innovative “prehab” approach for major joint replacements. We are also starting to work with our primary care colleagues in hip, knee and shoulders to introduce care pathways that span the typical silos. 

We continue to grow and develop our Women’s and Children’s program.  In 2014, we launched an extensive marketing campaign to promote this program. Since 2011, our Rouge Valley Centenary site has been a designated level 2C facility for maternal and neonatal care and is currently the only facility in Scarborough with the authorization to deliver and manage newborns as young as 30 weeks gestation.  To support our commitment to developing specialized expertise, we have opened a Maternal Fetal Medicine (MFM) clinic so that mothers at risk can access this service in their home community.  

Leveraging the expertise of our large complement of paediatric subspecialists and our close relationship with SickKids, we continue to expand our paediatric clinics to provide our community with access to paediatric specialty care close to home. 

Last year we introduced a new paediatric constipation clinic bringing the number of paediatric clinics to 17. In 2015, we will benefit from ‘twin’ family lounges generously donated and built by Ronald McDonald House – the first time they have ever implemented two lounges in one hospital at the same time.

Enhanced physiotherapy services were introduced last year at both of our hospital campuses for high-risk inpatients, especially the frail elderly, during the winter months. Additionally, the 2015/16 operating plan includes a significant budget investment of $400K for increased allied health services for weekend and vacation coverage.

One of our newest initiatives is helping to reduce readmission rates for patients once they are discharged from hospital. Studies have shown that inadequate support following discharge home contributes to a longer hospital stay, higher risk of negative health outcomes, and readmissions. Our Care After The Care in Hospital (CATCH) program is designed to fix that. It works to improve patient flow connecting physicians, nurses and rehabilitation therapists to work together to help reduce the patient’s chances of being readmitted for the same medical issue. Patients are referred to CATCH when they are discharged from hospital so they can manage their care at home without a setback forcing them to return to hospital.
Surpluses are vital 

Maintaining our ability to reinvest in our facilities, equipment and services is key to meeting community needs so we can grow with them. As we look to future growth and integration opportunities, it is important to maintain our resolve to generate annual operating surpluses. 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 successful deficit elimination plan (2008-11); 
Fund our capital equipment needs. Our annual capital list, excluding facilities items, includes $17 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 achievement of our strategic directions; in 2015 we will acquire a new MRI and two new CTs as well as other types of new equipment; and 
Fund future strategic growth initiatives. 

Capital and operational reinvestment will continue to take priority during the next fiscal year. However, sustaining this level of financial performance promises to be increasingly challenging as growth in volumes, in particular our emergency department visits, puts pressure on our bed capacity and cost structure. As emergency visits grow, our admissions grow. This can necessitate the opening of unbudgeted inpatient bed capacity.  

Managing volume growth in an efficient and effective manner will be a critical success factor for RVHS in the 2015/2016 fiscal year. We strongly believe that good quality costs less and continue our relentless focus on quality to support not only high quality care, but also fiscal responsibility. Our hospital has sustained its commitment to Lean thinking for over six years.  We continue to reap the benefits of this approach to continuous quality improvement, which underpins our 2015/16 Quality Improvement Plan.

We can proudly say that our track record is strong and sustained at Rouge Valley. Let’s make sure that we stay focused and aligned as a team. 

My thanks to all involved in the creation of this year’s Blue Book. All the best to the entire Rouge Valley team as plans and actions take shape this year and into the future.