RVHS Blog

Why breastfeeding is best for your baby

2011-11-22T11:02:00.005-05:00

By Dr. Karen Chang, Chief of Paediatrics, Rouge Valley Centenary

It’s no secret that breastfeeding is widely considered the recommended method of choice to feed infants by leading organizations like the Canadian Paediatric Society, the American Association of Paediatricians and the World Health Organization (WHO).

It’s recommended that mothers try to breast feed their babies for a minimum of six months. It’s even better for the baby if they can continue for longer than that.

Advantages

The advantages of breastfeeding are too numerous to mention in their entirety, but some of them include:

It’s a great way for mothers and babies to bond;
Babies who are breastfed continue to receive antibodies via breast milk. This helps to prevent the baby from developing diseases and infections.
Reduces a baby’s chances of developing atopic dermatitis, including eczema;
Breastfeeding helps to decrease instances of Sudden Infant Death Syndrome (SIDS);
Decreasing an infant’s chance of developing allergies;
It’s most easily absorbed by the baby’s stomach;
Breast-fed babies are rarely constipated compared to babies fed with formula;
It’s always at the right temperature;
Decreases necrotizing enterocolitis, a severe inflammatory disease that affects at-risk premature infants and newborns;
And finally, it's convenient and inexpensive.

Many breastfeeding moms can also attest to how breastfeeding has helped them to lose weight because of all the calories they’re giving to the baby. It’s also known to help contract the uterus back to its normal size.

Challenges

While the benefits of breastfeeding are numerous, it’s no easy task. For many women and their babies, breastfeeding can be a challenge – far from the image that many mothers have of immediately mastering this task. Remember that this is a learned activity, many mothers and babies don’t get it on their first try.

Some babies don’t latch on right away, while some mothers experience pain when they are breastfeeding. Many mothers are delayed in getting their milk, which can be a challenge. And once you and your baby finally master breastfeeding, it can also be a challenge to wean the baby off of the breast and transition to formula.

Remember that help is available, and if you’re having difficulty breastfeeding, you don’t need to go through it alone.

Breastfeeding Support

But remember that there are supports available. Many hospitals, including Rouge Valley Health System, recognize the nutritional benefits of breastfeeding. As a result, they have provided supports such as lactation consultants, who help to teach breastfeeding mothers how to breast feed and assist them through any challenges they may be experiencing.

Our lactation consultants see patients, both in hospital and on an outpatient basis. They also run daily breastfeeding classes for mothers in the hospital, as well as provide education for staff. Our Lactation Consultants will also begin to see patients in our Newborn Follow-up Clinic at Rouge Valley Centenary.

Our Lactation Consultants can be reached at:
* Rouge Valley Ajax and Pickering: 905-683-2320 ext. 1597
* Rouge Valley Centenary: 416-284-8131 ext. 4530

Toronto Public Health and Durham Region Public Health also offer breastfeeding clinics in the community.

If you’re experiencing difficulty breastfeeding, you can speak with your paediatrician, or take advantage of the many breastfeeding supports and resources currently available, both in your community and online.

RVHS Resources

· Rouge Valley Health System Breastfeeding Clinics:
-Rouge Valley Ajax and Pickering, 905-683-2320 ext. 1597;
-Rouge Valley Centenary, 416-284-8131 ext. 4530.

· Rouge Valley Health System Maternal Newborn Program http://www.rougevalley.ca/maternal-newborn-care

Community Resources

· Toronto Public Health: http://www.toronto.ca/health/breastfeeding/index.htm

· Durham Region Public Health Breastfeeding Resources: http://www.durham.ca/print.asp?nr=/departments/health/family_health/parenting/bf/bf_resources.htm&setFooter=/includes/health/healthFooterBF.inc

· La Leche League Canada - http://www.lllc.ca/

· Breastfeeding Inc. from Dr. Jack Newman - http://www.breastfeedinginc.ca/

Fiscal responsibility is good for patient care

2011-11-21T08:42:00.003-05:00

Operational Sustainability Plan is about maintaining and improving our ability
to invest in patient needs in our hospital

By John Aldis, Vice-President,

Corporate & Post Acute Services, and Chief Financial Officer, RVHS

Our hospital is investing in the current and long-term health care needs of our communities in west Durham and east Toronto.

This of course, is what we should be doing. But it’s important to remember that our organization has not always reinvested in direct patient care, replaced equipment or maintained facilities at the level required. So we are still playing catch up.

The fact that we now can, and are, investing in our hospital is the result of clear financial plans supporting our Strategic Plan-On-A-Page, collaboration and teamwork, and a “can do” culture of accountability we have cultivated over the last three to four years.

In that time, Rouge Valley Health System (RVHS) has moved from having zero cash on hand and being stalled on investment – for even basic needs such as boilers and roofing – to generating the operating surpluses that we so desperately need to maintain facilities and invest in current and future patient needs.

Fiscal 2011/12 marks the first year of our Operational Sustainability Plan (OSP), the logical evolution of our successful Deficit Elimination Plan (DEP), which lived up to its name and was successfully completed in March 2011. The OSP will help guide us through the next three years; building on the platform we built with our DEP. In alignment with our Strategic Plan On-A-Page and our Patient Declaration of Values, the OSP will allow RVHS to increase our regular annual investment in capital needs and fund additional major capital items, including big ticket medical and diagnostic equipment, information systems, and facilities infrastructure.

- But what does that mean for patients? -

An example of what this means to patients, is the accelerated purchase of our new Magnetic Resonance Imaging (MRI) scanner at Rouge Valley Ajax and Pickering hospital campus. We were able to fund the MRI upfront, while the RVHS Foundation collects on the pledges from its tremendous fundraising campaign over the next few years. Without the cash reserves we have accumulated over the last three years and stronger working capital position, our patients and their families would have waited longer for in-hospital MRI in their community.

The OSP will allow us to continue to invest in new equipment, technology, and our facilities, as well as expand our services to care for more patients, as our communities continue to grow in east Toronto, Pickering, Ajax and Whitby.

There are always risks and challenges, especially in these financially constrained times. But we are taking a proactive approach to financial risk management, as part of our OSP. The plan has specific risk mitigation plans built in and gives us the ability to adjust and protect our financial stability if actual events are worse than we planned, or invest even more if events turn out to be more favorable.

Our critical success factors are:

· Reaching for the top – that is, achieving top-quartile performance in the many areas in which we are measured provincially. We will achieve this by benchmarking against the best in all that we do, such as: minimizing infection rates, reducing wait times, improving patient outcomes, and finding ways to reduce our costs through continuous Lean-based performance improvements;

· Further ingraining Lean as our management philosophy and approach to innovation and constant improvement for patients;

· Enhancing and sustaining our revenue streams, such as parking, retail operations, outpatient diagnostic and other revenues, and better access to insurance-covered private rooms; and

· Anticipating risks through proactive financial management and fiscal accountability – to make sure our patients continue to get the highest value for their tax dollars.

For more on the OSP, take a look at my presentation to hospital leaders at both hospital sites in September and October at our Leadership Forum.

- Major Capital Plan -

Complementing the Operational Sustainability Plan is our three-year Major Capital Plan (MCP). This plan provides a road map for our major capital investments between 2011 and 2014.

The MCP selection process, carried out as a team with all areas of the hospital, identified 83 items worth about $57.3 million. Of that, already 37 items worth about $20 million have been approved by our management and Board of Directors, including:

· Cardiac catheterization lab replacement;

· Intensive care unit patient central monitoring equipment;

· Mental health unit renovations;

· Information technology infrastructure; and

· 27 facilities infrastructure repairs/replacements.

Our ability to continue to invest in more items on our Major Capital Plan is directly linked to our success in implementing the Operational Sustainability Plan. We have outperformed our Deficit Elimination Plan over the last three years working as one team, inspired and involved. I have no doubt we will execute our Operational Sustainability Plan with the same zeal.

My Personal Business Commitments are tied to quality improvement

2011-11-04T10:08:00.008-04:00

My Personal Business Commitments are tied to quality improvement

Public blog to staff and physicians / By Rik Ganderton, President and CEO, RVHS

Focus matters.

All of the improvements we have made for patients at Rouge Valley Health System in recent years are driven by our focus on achieving specific goals. It is our standard work to set annual personal business commitments (PBCs) to define that focus.

My 2011/12 personal business commitments show how we will achieve our Quality ImprovementPlan (QIP) and our three-year Strategic Plan-On-A-Page.

My PBCs set out the direction for all other team members, vice-presidents, directors and everyone throughout the hospital. Think of the PBCs as our high-level work plan for this fiscal year and a set of steps toward achieving our longer-term strategic plan.

Connecting our PBCs to the QIP also aligns us with key provincial government legislation. The QIP stems directly from the province’s Excellent Care for All Act. So the QIP offers a roadmap to implementing improvements to our patients’ experience.

At Rouge Valley, we have committed to an ambitious set of goals to improve the patient experience. These are aligned with our Strategic Plan-On-A-Page and the four strategic dimensions embedded in it:

Access to Care;
Service Excellence;
Team Engagement; and
Fiscal Responsibility.

Please read the MS Excel spreadsheet of the RVHS Executive 2011–12 Personal Business Commitments for me and the entire senior management team. You’ll see how each dimension leads to a set of measurements that we will deliver and track our achievements against. (View the members of senior management team and the roles that they play at our hospital.)

Each commitment is connected to weightings – the relative importance of each item – so the items with the greatest weighting will receive our greatest focus. To view my goals and weightings just click on my tab in the document.

You’ll see that we are all committed to measuring our performance against four heavily weighted metrics: the hospital standardized mortality ratio; achieving a top notch emergency department patient length of stay for our admitted patients; meeting our financial targets of generating a surplus so that we can reinvest in infrastructure and equipment; and staff satisfaction, to support our team of employees and physicians in improving patient care.

The PBCs hold me, and us, accountable to:

Delivering high quality health care;
Creating a positive patient experience;
Ensuring that we are responsive and accountable to the public; and
Being transparent about it.

These PBCs start the chain of accountability to move us further along on our journey of operational and cultural transformation, which we started in 2007-2008.

We continue to use Lean as our management philosophy and framework for continuous improvement. It is the philosophy and tool kit that enable us to implement the PBCs. It is our expectation that every department and program use our many Lean tools or techniques. These tools and techniques include value stream analysis, process mapping, Kaizen events, standard work, reorganizing the work environment (6S), A3 problem-solving, process control boards, Kamishibai (visual management auditing mechanisms) and more.

In my next blog I will talk about how we are bringing a consistent strategic alignment throughout the organization and one of the specific techniques we are using to do this – the Gemba walk.

A survivor story.

2011-11-01T16:47:00.002-04:00

(As part of our Patient Appreciation Day, we present this personal blog.)

By Tracy Paterson, Vice President, RVHS Foundation and breast cancer survivor

A few years ago, I never imagined I’d be writing a blog about being a breast cancer survivor. But here I am doing just that.

This December marks three years since I had my mastectomy. I sure didn’t expect that, at age 45, after finding a lump in my breast, and after a mammography and ultrasound revealed that it was highly suspicious for breast cancer, that I’d soon have to have my breast removed. I had none of the typical risk factors for breast cancer, and I’m the first one in my family and among my friends to have a diagnosis.

It certainly was strange being on the receiving end of patient care at the place where I went to work every day. But I had faith in my colleagues, and I was also fortunate to be treated in my community hospital, so that I could be close to my husband, daughters, friends and colleagues.

I remember thinking before my surgery about all the equipment that I would typically point out to potential donors during hospital tours. Who knew that I would one day be using it?

When I awoke from surgery, there was a Christmas tree in my room decorated by my friends. It was a touching gesture, given how crummy it feels to be in the hospital over the holidays. When you’re faced with a critical illness, you’re not the only one dealing with your diagnosis and treatment. Your family and friends are affected too.

For the next year, I underwent my chemotherapy and radiation treatments just like the many patients who visit the chemo clinic at Rouge Valley Centenary. Having regular chemo sessions became a new, but weird, kind of normal. The chemo centre was very busy, and inevitably over the long hours of treatment, you’d strike up friendships with those sitting next to you. Some people are really outgoing and forthright about their disease. Others are more reserved. Scared, really.

This part of my treatment was rough, though. The chemo cocktail of drugs prescribed for me left me feeling weak and tired. Plus, I lost all my hair, including the hair on my head, nose hairs, eyebrows and eyelashes. Boy did I miss my eyelashes! You never think about how important they are until the soap you use to wash your face runs into your eyes and they begin to burn.

However, I’m fortunate that during that time, my fantastic colleagues were so supportive, and that my job allowed me to work from home or to come into the office when I was feeling up to it. If I was working in the office, the other staff members were careful not to come in if they weren’t feeling well, and were sympathetic when I was feeling under the weather.

And let me tell you, you really think about how important hand hygiene is when simple hand washing can make a difference to your health and well-being.

Cancer is different for everyone. No two stories are the same. What I experienced three years ago may be completely different from what someone else experiences today. But know that it is possible to survive it. I’m a walking example of that.

During my treatment, I remember my two daughters looking up statistics on the internet and, after seeing the high survival rates for cancer, decided I was going to be just fine. It turns out that they were right.

Today, although I’m at risk for reoccurrence, I only need a follow-up MRI once a year.

I’m hesitant to say that things always happen for a reason, but maybe it’s true to some degree. Three years after my mastectomy, we now have a brand new, state-of-the-art MRI at Rouge Valley Ajax and Pickering. Having this quality of treatment available to our patients, and right in our community, is significant. It means that our patients no longer need to travel outside of west Durham to receive this kind of care, which many of us can appreciate.

Waiting for a diagnosis or treatment is incredibly scary and stressful. And bringing down wait times and ensuring that life-saving equipment and services are available closer to home now are even more meaningful to me.

When I’m giving a tour to a donor of one of our hospital campuses and I pass by patients waiting in the lobby looking a little nervous, I wonder what they’re thinking. Especially since I was once in their shoes. I’m so very grateful to those compassionate, warm and knowledgeable health care professionals who saved my life three Christmases ago.

This Christmas, once again, I’ll be holding my breath a little. Hoping and praying that my MRI scans stay clear. And I’ll also be crossing my fingers for all those worried-looking people who I see in the lobby.

Ontario Breast Screening Program opens door for younger women at high risk for breast cancer

2011-08-31T17:07:00.000-04:00

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

Cancer Care Ontario has recently announced the expansion of the Ontario Breast Screening Program (OBSP) to include screening for women aged 30 to 69, who are at high risk for breast cancer. The funding, which went into effect July 1, 2011, provides younger women at higher risk for developing breast cancer with annual mammograms and magnetic resonance imaging (MRI) scans.

Prior to the announcement, only women 50 and over were eligible for OBSP mammography screening. Early detection can significantly improve the chances of survival once diagnosed with breast cancer. This new development is great news for women under 50 who are at high risk for breast cancer.

The OBSP was formed in 1990 primarily for screening and allowed patients to receive a mammogram without obtaining a requisition from their family physician. In effect, they refer themselves, making the service more accessible for many women. It provided an environment with quality of care assurance, Canadian Association of Radiologists (CAR) accreditation and standardized reports and reminders. The breast screening clinic’s system navigator also helps to facilitate and guide the patients through urgent surgical and cancer care referrals.

The general screening OBSP population includes women 50 years of age and older, who have no acute breast symptoms or problems, no implants, no personal history of breast cancer, and have not had a mammogram in the past 11 months.

The newly-expanded high risk program will be available initially at certain sites called OBSP Assessment Centres with a family doctor or nurse practitioner referral only. A genetic assessment can be arranged for certain gene mutations such as BRCA1and BRCA2, which can be seen in first degree relatives such as mother, sister or child.

Rouge Valley Centenary is currently in the process of becoming such a centre, with Rouge Valley Ajax & Pickering expected to follow in the near future. The centres will feature state-of-the-art radiologic equipment and services, while surgical and oncologic departments will be available to breast patients. Our new system navigator, Channie Mak is on hand to help guide patients through difficult and complex breast issues.

Approximately 34,000 women in Ontario are at high risk of developing breast cancer. It is expected that the stringent screening process with MRI and mammography will detect an additional 17 cancers a year for every 1,000 women screened.

For most women, genetic screening assessments will be needed to determine whether or not they are at high-risk for breast cancer. However, high-risk factors include:

Women who are known to be carriers of the BRCA1 or BRCA2 gene mutation;
Women with a first degree relative that is a known carrier of the BRCA gene mutation carrier;
Women with strong family history in first and second degree relatives with breast and ovarian cancer;
Patients who have had chest irradiation for cancer prior to 30 years of age.

Speak with your physician for more information on genetic testing.

Women at high risk have a 25 per cent or greater lifetime risk of developing breast cancer. In other words, their risk is two to five times higher than most other women. Many of these breast cancers detected in younger women are more aggressive than those seen at a later age.

Finding breast cancer early means:

A better chance of treating and curing the cancer successfully;
A lesser chance that the cancer will spread;
More treatment options.

Currently the five-year survival rate for breast cancer in Ontario is 88 per cent. Mammography is still considered the screening tool of choice. Both Rouge Valley Centenary and Rouge Valley Ajax Pickering’s breast clinics feature new low-dose full-field digital mammography units, as well the capability to perform stereotactic and ultrasound guided breast biopsies. This means that our patients have access to the highest standard of breast screening care, right in their own community.

Remember that prevention and early detection are key to living a long life. If you're not sure about what screening test to arrange, or how frequently you should be screened, you can have your questions answered by a short Cancer Care Ontario self screening on- line tool here or ask your family physician.

And learn more about Rouge Valley’s mammography program here.

Re-investing in our hospital

2011-07-25T17:28:00.004-04:00

By John Aldis, vice-president, corporate and post-acute services, chief financial officer, Rouge Valley Health System

As reported in the treasurer’s report at the Rouge Valley Health System (RVHS) 13th Annual General Meeting of Members, held on June 28, it has been another very successful year for us. Fiscal 2010–2011, the third and final year of the hospital’s deficit elimination plan has been our best yet. RVHS achieved an operating surplus of $8.9 million, which was $3.7 million better than planned.

Overall hospital revenues increased by 4.1%, while our operating costs climbed 2.6% compared to the previous year.

Driving our success this past year has been exceptional revenue performance and our continued focus on operating efficiencies and cost containment through our Lean management philosophy. As part of our operating plan, RVHS put a major focus on revenue enhancement this past year.

In addition to securing additional post-construction operating funds for new space and expanded programs as part of our Rouge Valley Ajax and Pickering (RVAP) redevelopment, the hospital received bonus funding for achieving wait time improvement targets in our emergency departments at both sites. And we attracted additional funding during the year for performing more CT and MRI scans, more surgical procedures targeted by the government for reduced wait times, and more priority program cardiac procedures than we had planned. Finally, the hospital also secured new funding from the Central East Local Health Integration Network to open a 20-bed transitional restorative care program at RVAP.

We have already re-invested some of our financial surplus directly into patient care. Approximately $1.3 million was spent on various quality of care improvement initiatives, staff education and training, as well as new furniture, equipment, and mattresses that will help reduce the risk and spread of hospital infections. In addition, RVHS will use part of last year’s surplus in the current year to accelerate investment in major capital equipment and renew our aging facilities’ infrastructure.

While our capital needs far exceed available funding, the hospital was able to invest close to $74 million in capital this year—most of which was related to completion of the RVAP redevelopment.

Fundraising is critical to our hospital’s financial well-being, and 2010–11 was no exception. The RVHS Foundation donated and transferred $687,000 to the hospital this year in support of much-needed capital purchases. Thank you to all donors, volunteers and Foundation staff.

We continue to make the most of every dollar raised by aligning the Foundation’s fundraising goals and efforts with the strategic priorities of the hospital.

Rouge Valley’s working capital deficit continued to improve and ended the year at $31 million. Improved cash flow and prudent cash management has enabled RVHS to build up cash reserves through the year, reducing short-term borrowing needs and reliance on debt to fund minor capital expenditures.

Rouge Valley continues to be a very busy place. This year, the hospital treated approximately 29,000 inpatients, provided 52,000 mental health, rehab and complex continuing care patient days, and registered 109,000 patient visits across our two emergency departments. On the outpatient side, we had 190,000 clinic visits and performed 16,500 day surgery cases.

Thank you to our staff, who have done such a tremendous job in meeting the health care needs of the growing and aging populations of our east Toronto and west Durham communities.

Protecting your skin is key to enjoying your summer

2011-06-14T08:39:00.002-04:00

By Dr. Mansour Bendago, Division Head of Plastic Surgery, Rouge Valley Health System

Seeing the beautiful sunshine and feeling those warm rays on our skin is a welcome change from the cold harsh winter, and long wet spring. But in order to get the most out of the summer season, it’s important that we always make protecting our skin a priority.

Not protecting your skin can make it more susceptible to ultra violet (UV) damage, which can result in skin cancer. And this is possible whether your skin is light or dark. You even need sun protection when the skies are overcast.

Preventing Skin Damage

Skin is divided into six categories, ranging from one (no pigmentation) to six (very dark). People whose skin ranges between one and three are more susceptible to skin damage from the sun, although those with darker skin are not exempt.

What you need to protect your skin

Take great care in protecting your skin from sun’s harsh UV rays, especially areas that are typically more exposed to the sun, like the face, shoulders, arms, and legs, especially below the knees. You should use a sun screen that is sun protection factor (SPF) 30 or greater. Wear a hat with a brim to give your face added UV protection. Be sure to wear sunglasses that offer UV protection.

Sunscreen is a must for children above six months of age. And because their eye tissue is delicate and their pupils are larger, their eyes are more susceptible to UV damage than adults. So they should wear sunglasses when they’re outside. Wearing a hat can help to protect their face and eyes.

Adults and children alike should also keep themselves hydrated by drinking water, especially when they’re out in the sun.

Melanoma – What to Look For

One of the reasons we should take great care in our skin is to prevent melanoma, a very aggressive form of skin cancer. Here are some signs to look for:

- Moles become asymmetrical in appearance, where one half is unlike the other;

- Their normally well-defined borders become irregular in appearance;

- The colour of mole starts to change;

- Itchiness or bleeding of the mole;

- The mole appears like an ulcer or a scar.

If you notice these types of changes, contact your physician immediately.

So while you go out and enjoy your summer, please remember to always protect your body’s largest organ – your skin!

............ .........
Related news -

Read an article about port-wine stain and how Rouge Valley is treating children with this serious skin condition. Rouge Valley is one of only two hospitals in Ontario, which treats this condition.

Physician Interview: Prevalence of heart disease in black community

2011-05-24T16:40:00.002-04:00

View the full video interview on Rouge Valley’s YouTube channel.

Cardiologist Dr. Paul Galiwango is the medical manager of cardiac imaging at Rouge Valley Health System (RVHS). Here he discusses his particular interest and insights on the issue of heart disease and hypertension faced by the black community.

Q: What is hypertension?
A: Hypertension is high blood pressure. The heart pumps blood into vessels; and if the pressure is too high, the heart has to work harder to pump blood. Over the long term, it leads to damage of the lining of the vessels, and increases the chances of blood clots, strokes, and blood vessels bursting. There are usually no symptoms, which is why it’s important for patients to visit their physician regularly, so that we can try to detect it at that silent stage—before it wreaks any damage.

Q: Why are blacks more susceptible to hypertension, heart failure and stroke?
A: We certainly know that hypertension affects the black community more disproportionately. We see an increase in frequency, and we see it at younger ages. In addition to that, hypertension is often more resistant to treatment on patients in the black community. And it seems to have a particularly malignant vascular effect in terms of organ damage to the heart, kidneys, and brain. Why we see that is still a subject of fierce debate. I think it is multi-factorial. There are some genetic studies that suggest there are some unique aspects in the way the kidneys handle the sodium load, which makes blacks more sensitive to salt. And salt affects the cause of high blood pressure—so we call it sodium-sensitive hypertension. And then there are also some lifestyle issues. For example, if you look to the American south, there tend to be some very high-sodium diets, and high prevalence of obesity. So this also contributes to the hypertension rates.

Q: Why do stroke and heart failure tend to present so young in blacks?
A: It certainly seems to be linked to the prevalence of hypertension coming at a younger age. There was a large study that came out last year that looked at a very diverse group–whites, blacks, Hispanics–and followed them for 20 years. What they found was the prevalence of heart failure at a young age (younger than 50 years old) was about 20 times higher in blacks than in the non-black participants. And the lion’s share of that contributed to hypertension. Researchers saw that for every 10 millimetre increase in blood pressure in a black person in their 20s, you double the risk for heart failure in their 40s. It’s sobering, but what’s encouraging is that it’s a treatable condition.

Q: When you see black patients, how do you treat them? What sort of programs do you put them on? Is it particularly unique?
A: In any patient who I see with hypertension, I treat aggressively. Hypertension is silent, and it’s easy for it to progress without the patient even realizing it. With black patients, there are some nuances—we do know that they respond differently to certain classes of drugs that are commonly used for hypertension, like ACE Inhibitors, Beta Blockers. Data has suggested that medications such as these may be less effective in the black population. So I would tend to stay away from those, at least at first, and go to more effective drugs like Calcium Channel Blockers and Diacide Diuretics.
I also really underscore the importance for everyone—particularly in the black population—of trying to avoid salt in their diet. People often recoil at that suggestion at first, but you do find that with time, the palate adapts, and you get used to it. There’s just so much sodium already in packaged foods, it’s best to try and cut out salt anywhere you can. I recommend just not adding it to table food, or when you’re cooking. In fact, I’ve learned to cut salt out of my own diet.

Q: What do we do at Rouge Valley to treat this population?
A: The cardiologists at Rouge Valley are all very cognizant of these issues, and can aggressively manage heart hypertension in all patients, and know what to do when they see anyone approach. We have a very diverse community in Toronto and Durham—blacks, South Asians, Asians, etc.—so we deal with everyone appropriately. But I’d also emphasize that the cardiac rehab program is an excellent one, and it gives all the patients the tools they need to live a healthier lifestyle—and aids in helping them to abandon some of the more harmful habits, like smoking, or a high-sodium diet. So we also refer a lot of our patients to that program.
It’s important for physicians who are treating black patients whose hypertension has gotten quite difficult to treat, not to give up and refer those patients on to a specialist for evaluation. It’s possible that the medication might need to be tweaked, or replaced. A lot of times, it’s a bit frustrating to have a patient on medication for a while, and their blood pressure isn’t coming down. But if that’s the case, they really should be referred on. You can get there, but you just have to persist.

Fiscal responsibility means a dividend in patient care

2011-05-13T15:33:00.000-04:00

By John Aldis
Vice-President Corporate and Post-Acute Services,
Chief Financial Officer

As we close the books on our successful three-year Deficit Elimination Plan (DEP), I’m pleased to report that the hospital continues to optimize spending of public funds on quality patient care.
The plan ended officially on March 31, 2011, and has set the foundation for the hospital to start making meaningful reinvestments in patient programs and services, continuous quality improvements, and new equipment that benefits our patients and staff.

Years of not balancing its books had put Rouge Valley Health System (RVHS) in a situation where it could not afford to maintain and renew its facilities and equipment. The hospital was essentially bankrupt. We had no surplus cash, we covered payroll through our line of credit, and the bank would not lend us any more money. Three years later, our collective efforts have paid off for patients and the hospital.

Our plan was not just about a financial turnaround. It was about balancing financial responsibility with access to services and quality improvement. We have maintained our DEP commitment by providing the same or greater access to quality care for our patients and community. In fact, we now see more patients than we did in 2007–08 before the DEP started.

Our success has truly been a team victory for the patients of our communities in east Toronto and west Durham. Staff, managers, physicians, and volunteers across our organization have pulled together to do more and better with less. We started by comparing ourselves to how the best hospitals were providing quality care with lower infection rates, lower return rates, and shorter wait times. They were doing all this and spending less per patient. Three years later, Rouge Valley is among the leaders in our peer group for quality and fiscal responsibility. We are delivering higher quality care, as measured by the province, while making the most of our funds for our patients.

We also embarked on a long-term transformation journey using a Lean management philosophy and teamwork after a platform for success had been established by our DEP.

Now, after years of chronic deficits, we have been spending within our means since 2008–09 generating surpluses, and becoming more efficient and effective each year. While our operating results for 2010–11 are not yet finalized, we have surpassed our budgeted bottom line of $5.2 million. This means we have money to allocate to operational priorities (e.g., programs and services such as pharmacy services, a short stay unit, and critical care staff training) and invest in new equipment (e.g., equipment for cardiac catheterization, surgery, and patient mobility) and maintenance for our hospital campus buildings, which were built in 1967 (Rouge Valley Centenary) and 1964 (Rouge Valley Ajax and Pickering). With our improved cash flow, we can also borrow for big ticket items that we have been unable to tackle for years.

The ongoing maintenance needs include rather unexciting, but crucial things such as a new boiler, new roofing systems, as well as fire, electrical and water system upgrades. We can’t go out and fundraise for these items. It just isn’t something people would be attracted to in a campaign. We also have major capital equipment needs like catheterization labs, central patient monitoring systems, and information technology.

Being fiscally responsible and generating surpluses is the best way to ensure we have the facilities and equipment to be the best at what we do. Joint capital planning with the RVHS Foundation over the last three years is also helping focus the Foundation’s fundraising efforts on the hospital’s priorities such as an MRI scanner for our Rouge Valley Ajax and Pickering campus, diagnostic equipment, and new medical beds at our Rouge Valley Centenary campus.

Our DEP was just the beginning. A new three-year financial plan is being developed to support our recently refreshed Strategic Plan On-A-Page. I look forward to sharing this plan with you in the summer and continuing to build on our success over the next three years.

I congratulate all staff, management, physicians, board members and volunteers for this outstanding achievement. We are reinvesting in the future for our patients and communities thanks to you.

Our team is ready to make the plan work for patients

2011-04-14T12:11:00.001-04:00

By Rik Ganderton,

President and CEO

Thanks to staff, physicians, volunteers and the community our new Strategic Plan On-A-Page is done. Our 2011 – 2014 Strategic Plan was developed with robust participation from all interested stakeholders.

The content of the final strategic plan was created as a result of information collected during almost a year of consultations with community members, political leaders, RVHS Board members, the Community Advisory Group, staff, physicians and volunteers.

Now what?

Now we must put this exciting plan to work for our patients and their families. Our team has proven itself adept at leading and implementing change so I have great confidence in our ability to put this plan into action quickly and effectively.

As a next step there are 19 program and service teams that are creating their own specific strategic sub-plans fully aligned to deliver on the hospital’s corporate plan. Work on this will be ongoing throughout the spring with our sub-plans to be completed by early June.

We currently have teams visiting each department on all shifts sharing the strategic plan and the draft Patient Declaration of Values with front-line staff. Thank you to our staff involved and those participating. The response has already been very positive.

RVHS’ Strategic Plan On-A-Page is again on one page. It’s concise, clear and easily communicated so that we can all focus on the three main strategic directions:

* We will focus on what is important to our patients;

* We will help to build a system of care that meets the needs of our community;

* We will strengthen our organization to be the best at what we do.

The essential question each of us must answer individually, in our teams, our departments or our areas of the hospital, is:

How do I personally, and as a part of my team, ensure that our patients and their families see that we are delivering on our strategic commitments?

To put it another way: How do we each walk our talk?

Everyone is asked to keep each sub-plan to one page. This is no easy feat. But I remind everyone that you have done a lot of great work in the last four years. Delivering this new plan is a continuation of your successes for our patients and our community.

I know we can deliver this new plan because, quite simply, we are a dedicated team always planning, managing and working to be the best at what we do for our patients and their families.

To read our RVHS Strategic Plan On-A-Page 2011-2014 please visit

http://www.rougevalley.ca/strategic_plan .

The Sunshine List continues to grow

2011-03-15T09:33:00.002-04:00

By Rik Ganderton, President and CEO

It’s still a few weeks before the annual Sunshine List is published by the Ministry of Finance. We will be publishing the Rouge Valley Health System (RVHS) list on our website concurrently with the official release by the Ministry of Finance on March 31, 2011. Our list will also have comparative information dating back to 2007.

The number of professionals employed by RVHS — at its two hospital campuses and mental health sites — earning more than $100,000 a year has increased from 46 people in 2007 to 142 in 2010.

View our list of RVHS staff who have appeared on the Sunshine List since 2007.

This is not surprising. Over the years, our list -- and that of all hospitals -- has grown to include more management and more union members in nursing and allied health professions.

The reason for this is not related to huge salary increases, but rather that the threshold figure of $100,000 has not been adjusted for inflation. It has remained at the 1996 level as set by the government at that time. Meanwhile, the inflation rate during the past 15 years has averaged about 2.5 per cent a year. Given inflationary increases, someone earning $71,000 in 1996, would now be earning $100,000. Put another way, earning $100,000 in 1996, is equivalent to making about $140,000 in 2010.

More and more unionized employees, who comprise the majority of employees at many hospitals, are now also the majority of those making more than the $100,000 threshold. In 2007, 17 per cent of our unionized employees were represented on the list. In 2010, the percentage of unionized staff earning over $100,000 increased to 58 per cent.

Most doctors, by the way, are not shown on our list because they are not hospital employees. Rather, doctors are independent contractors who bill the Ontario Health Insurance Plan (OHIP) on a fee-for-service basis.

For more on the rationale of the Sunshine List, please visit the Ontario Ministry of Finance’s website at www.fin.gov.on.ca/en/publications/salarydisclosure/2011.

Please feel free to leave us any comments to this blog on this site or through emails to communityrelations@rougevalley.ca. Thank you.

Thailand's 'Lean' Hospitals

2011-01-31T13:39:00.001-05:00

Bangkok Blog #6 – Friday, January 28, 2011

By Michele Jordan, VP Quality Improvement and Transformation, RVHS

There are five Thailand hospitals that participated in the first phase of the Lean demonstration project. We visited three of them this week. The other two are somewhat far from Bangkok so it was more cost-effective to have their representatives come and present to us.

We started by hearing two case study presentations by physician leaders at the Songklanagarind Hospital. Songklangarind is an 860 bed university teaching hospital with a very advanced Health Information System (HIS). They have made very impressive progress and have a really good grasp of how to apply Lean tools.

Dr. Rungsun Bhurayanantachai discussed how Lean was used to improve flow in the chemotherapy program. Problems included: long waits to get an available bed; patients turning up at hospital for admission without adequate prep, unnecessarily long lengths of stay, too much time spent on documentation and lack of a team approach. A few of the many Lean solutions they put in place to alleviate all of these problems included:

• Completing patient documentation and the medical order before admission- patient asked to do the medical condition checklist before they come to the hospital; order written and saved in the computer system to be activated when the patient is admitted; when patient arrives on day of admission they go directly to the ward.

• Implemented an “e-Kanban” system – pharmacy sends an alert through the computer system to let the ward know that the chemo drug is ready for pick up.

• Visual controls - a sticker is placed on the chemo bag to mark when there is 3 hours left for chemo administration; this gives the doctor 3 hours to complete the discharge summary; when the last bottle of chemo has been put up, the nurse puts a sign on the door to alert housekeeping that discharge will be today and when the patient leaves the room they are asked to turn the sign around to the other side which indicates that the room is ready to be cleaned.

The one-year results of the combination of these actions are:

• A reduction in length of stay for chemotherapy from 72.3 hours to 53 hours;

• An increase in bed utilization (i.e. the number of patients per bed per week) from 2.3 to 3.2;

• An increase in patient satisfaction scores from 3.2 to 4.6;

• Staff satisfaction increased for all indicators related to work speed, work process and team work.

Dr. Nipat Aui-aree, a Neuro-Opthamologist, discussed how load leveling principles were applied to the Bolulinum Eye Clinic. This clinic uses botox injections to treat people experiencing involuntary facial spasms. Before the Lean initiative, it was not unusual for patients to arrive at 8am even though the clinic did not open until 1pm. After applying Lean, turnaround has been reduced from 333 minutes (5.5 hours) to only 50 minutes. The number of steps in the process has been reduced from 15 to 11. Patient satisfaction is up from 2.77 out of 4 to 3.5 out of 4 and continues to rise.

Next we heard about the progress being made at the Suratthani Hospital, an 800-bed facility that sees 2,000 outpatients and 150 admissions per day. Dr. Suwicha Saringkarnpoonperm described the interesting approach the hospital is using to promote Lean. They are using the concept of “Dr. Lean”. They launched their process by visiting all departments of the hospital and using value stream mapping, spaghetti diagrams and genchi genbutsu to ‘diagnose’ problems. The 7 wastes are described as ‘symptoms’. The various Lean improvement tools are described as ‘drugs’ for treating the symptoms. They do 3 to 5 corporate projects per year. Their first corporate initiative was aimed at streamlining and leveling flow in the outpatient department. The improvements they implemented based on Lean Thinking included:

• Set up satellite units with general practices and well-trained nurses

• Set up call centre (a non-medical team) for management of the consulting system

• Set up an improved appointment management process and better communication with the GP and the patient

As a result, their outpatient process time has dropped from 5 hours to 2 hours and 40 minutes.

In the afternoon, we had a lengthy discussion with the international delegates on their learnings from the conference and each delegate had to describe one-specific action they will taken when they return home to advance Lean in their country. We also discussed how to get started with Lean. Professor Philip Choo and I shared the lessons we have learned in our individual hospitals.

Today was the final day of the conference. The week went by very quickly and it was somewhat sad to see it all come to an end. There was a lot of picture taking and exchanging of gifts. I gave each of the delegates a Rouge Valley pen and they were all very appreciative. We have all vowed to stay in touch so I’m looking forward to being part of this dynamic international network. Bangkok was a great host city for this conference and the organizers did an outstanding job.

Lean requires leadership buy in, support

2011-01-28T08:42:00.007-05:00

Bangkok Blog#5 – Written on Thursday, January 27, 2011
By Michele Jordan, VP Quality Improvement and Transformation, RVHS

Today was another busy but very educational day. Again we set off from the hotel before 7am for a hospital site visit. (One thing I’ve learned is that you don’t want to get stuck in Bangkok’s rush hour traffic.)

We spent the day at the Siriraj Hospital. Before describing some of the hospital’s many, many Lean initiatives you cannot talk about Siriraj without mentioning two things – its size and its history. Siriraj is huge! It is a sprawling ‘empire’ consisting of 74 buildings. They have about 3,000 beds, 1200 physicians, approximately 8,000 nurses and about 4,000 other staff. They have 24 medical departments, a cardiac centre, the medical education technology centre and 8 paramedical schools. Their enormous medical library is the most amazing any of us on the tour had ever seen. The hospital is currently in the midst of a major redevelopment project that would see them expand even further on their current site as they seek to become the Centre of Excellence in southeast Asia. Siriraj Hospital is situated right on river and the views from most buildings are spectacular. Because of the traffic situation, water ambulances are common.

In terms of its rich history, Siriraj is the oldest hospital in Thailand. It was established in 1888. The official opening was presided over by King Chulalongkorn. The hospital is named after his young son, Prince Siriraj, who died of dysentery while the hospital was being built. The hospital has always received strong support from Thailand’s royal family. The father of the current King was a Harvard-educated doctor and his original medical school notebooks are displayed in the hospital library. Interestingly, Siriraj is currently the residence of the much beloved King of Thailand. He is in his 80s and has been hospitalized there for over a year. Each day hundreds of loyal subjects and busloads of school children come to the hospital to pray for the King. You can imagine the implications that having a King as an inpatient has for hospital security!

My day at Siriraj went something like this – official picture taking in the courtyard, formal presentation by hospital leaders on their Lean journey, two hour press conference for myself and the two experts from Singapore, lunch, tours of a few departments (the oncology unit, the trauma unit, the lactation clinic and postpartum area), discussion of what we saw, dinner with select hospital leaders and finally after-dinner presentations by Dr. Choo and myself on Lean leadership. We left the hospital at 9pm!

Several things impressed me about Siriraj:
·         Their leadership team is strongly committed to Lean. This was demonstrated in many ways including the promotion of our visit as part of the Lean in Healthcare conference (there were posters everywhere), the arrangement of a press conference just to talk about Lean, and at least four physician leaders gave us detailed presentations on Lean initiatives in which they are involved. Like RVHS, Siriraj has a strategic plan-on-the-page and a strong set of core values that they have actually set to music.
·         Understanding of Lean is spreading throughout the hospital and improvement ideas have tended to come from the frontline. On every unit we visited, nurses in traditional white dresses, white shoes and starched white caps were able to explain in detail the Lean principles and tools that they have chosen to apply to their areas – everything from process control boards, to Kanban systems, to visual management and some of the best 6S results I have ever seen. One nurse was asked where she learned the Lean techniques she has applied to reorganize her supply room. She replied that she learned these techniques from her own research using books and the internet.
·         They have incredible discipline. Like everywhere else, staff report that changing mindsets was tough at first but having made changes they are able to sustain them. Everything is kept up-to-date. When asked whether they have trouble getting nurses to maintain the discharge board, one head nurse replied ‘no, it is what we do as nurses’.
·         Their data collection is rigorous. For every Lean initiative they presented, there was good baseline and future state data. They have solid statistics to back up their successes.
·         They are fostering a healthy workplace for innovation. They have recently launched a program called ‘R2R’(Routine to Research). They are de-mystifying the concept of research as something only for scholars and showing how research and innovation can be part of everyone’s role. This was very evident in the breastfeeding program. Breastfeeding is a centre of excellence for Siriraj and they are leaders in breastfeeding research. Five nurses and 2 practical nurses see 60 mothers a day in the lactation clinic. Nurses that work in this program are encouraged to be very creative. They walked us through the various types of breastfeeding-friendly hospital gowns they have designed, the breastfeeding pillows they have created for both comfort and infection control purposes, the Madonna jacket (unofficially known as the “Lady Gaga Jacket” -- see the photo) they designed to teach expecting mothers how to breastfeed and the application of Lean principles to create a reliable system for storage of breastmilk.
·         They have invested in internal resources to support their Lean implementation. They have a “Utilization Management/Lean Office” that is very similar to our TMO. Six nurses spend 80% of their time in this Office coaching staff on how to make improvements. They also offer 3 levels Lean training – Lean Basic, Lean Supervisor and Lean Manager.

Siriraj has too many Lean initiatives underway to describe each one but here are a few highlights of their achievements:
·         By reorganizing their model of nursing care using Lean’s cell concept, they have reduced average length of stay from 8 days to 4 or 5 days in less than 2 years. It took 6 months to implement the changes. Nurses meet once per week to discuss how to improve quality.
·         They have done a lot of work on end of shift handover rounds and reduced the time this takes from 45-60 minutes down to 15-30 minutes. Now, nurses and doctors round together. Nursing satisfaction has increased significantly for all indicators tracked including a sense of harmony on the team and feeling respected by doctors.
·         Patient satisfaction has increased to 95%!
·         They have used Lean in their clinics and reduced outpatient turnaround time by 35%. They actually see 65% of outpatients earlier than their booked appointment time.
·         Given the vast size of the Siriraj campus, transporting lab specimens is time consuming. By applying Lean to this process they reduced the staff required from 13 people to 1 person! Of course, there were no layoffs, and the staff time saved has simply been redeployed to meet other important patient needs.

The amount of positive change this large institution has been able to achieve in a relatively short period of time is quite phenomenal.

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Read Bangkok Blog#4

Less waiting as a result of Lean around the world

2011-01-28T08:24:00.006-05:00

Bangkok Blog#4 – Written on Wednesday, January 26, 2011

By Michele Jordan, VP Quality Improvement and Transformation, RVHS

Sawadee Ka! (That means ‘hello’ in Thai. Actually Sawadee means hello and ‘ka’ is added because I’m a female). The Thai people are so friendly and welcoming that I’m starting to feel like a local. I can see why they call Thailand ‘the land of smiles’.

Day 3 of the conference was a fantastic experience. We visited two hospitals to see their Lean improvements. First stop was the Saohai Hospital . This is a small, rural hospital located about 90 minutes outside of Bangkok so we boarded our convoy of vans around 6:30am. The hospital has 30 beds and an occupancy rate of 82%. They serve an average of 280 outpatients daily. There are 3 doctors, 2 dentists, 3 pharmacists, 48 nurses, 4 medical technicians and 100 supporting staff. The hospital is a beautiful open-air facility that resembles a spa more than an institution. This is not a far-fetched comparison because the hospital offers a blend of modern medicine and alternative medicine including massage, acupuncture, infrared sauna, music therapy, 'past life regression' and more.

As we disembarked from the van we were greeted by several hospital staff who presented each of us with a beautiful bracelet made of flowers. We proceeded to a large auditorium where, to our surprise, we were treated to a local dance performance. This was followed by a formal presentation on the hospital’s Lean initiatives.   Like all of the demonstration projects, Saohai began their Lean journey in mid/late 2008. For a small facility they have made tremendous progress. One of their projects focused on reducing the waiting time in their outpatient diabetes mellitus clinic. They implemented visual management, a 6S, an A3 and a series of kaizen events. The biggest change they put in place was to work with the 13 Primary Care Units (PCUs) in the community to reassign roles. Before Lean, patients arrived at the hospital clinic very early in the morning so they could have their blood taken before seeing the doctor. Now, patients are asked to go their local PCU the day before their clinic appointment to have their blood taken by the PCU. For many patients this reduced the travel distance significantly and meant they didn’t have to come as early to their clinic appointment. Skype is used for communication between the PCUs and the hospital clinic if needed. When one considers that the 13 PCUs are completely separate from the hospital, this is a huge system integration achievement. Here are some of the results of this initiative:
·         Reduced total Turnaround time in the clinic from 258 min to 196 min (59% improvement)
·         Reduced waiting time for consultation with the doctor from 72 min to 30 min (58% improvement)
·         Increased patient satisfaction rate from 81% to 91%

They have also used Lean techniques to educate and empower patients to use self-care. After lunch, more dancing and group picture we boarded the van for our second stop – the Saint Louis Hospital in Bangkok . The two hospitals are in stark contrast to one another.

Saint Louis is a non-profit, private general hospital that is run by the Sisters of Saint Paul de Chartres. The 500-bed facility is extremely modern and includes escalators, a new state of the art cardiac clinic and a large board room with computer terminals and microphones at every seat.

The hospital leadership is strongly committed to Lean. They said that they chose Lean because it fits well with their vision – ‘to be a leader of hope in health care and health promotion’. Their first Lean project was focused on improving the cardiology outpatient care process. Improvements include: setting up a schedule to phone patients 3 days after their visit, streamlining the process for preparing the medical record, creating a handover sheet for the patient’s next clinic/service, using visual controls and standard work. The biggest change was renovating the entire clinic based on Lean’s cell concept. The cell concept requires co-locating all the services that are part of the patient’s value stream in one area to reduce walking for the patient/family. They also have several large screen monitors that display who and how many patients are waiting for each doctor at any given time.   These changes have resulted in a 23% reduction in the waiting time for doctor consultation (from 43 min to 33 min); a 20% reduction in total patient turnaround time (from 186 min to 149 min), improved patient satisfaction and improved staff satisfaction.

This hospital also used Lean to improve the non-emergency patients care process in the ED. An analysis of ED volumes by time of day found that the peak period is between 4pm to 10pm (just like at RVHS) so the team focused their efforts on this time period. They set up a new flow for patients who need only medical treatment and set up a new medical treatment room near the ED. Patients who just require a wound dressing and are not first time patients are seen and treated by a nurse. Cycle time and takt time calculations have been used to establish a process control board that lays out the timing for each step in the dressing change process. They introduced lots of visual management and standard work is posted in the department. An x-ray alert card has been created to communicate when x-ray results are ready. This hospital has empowered and trained nurses to function independently. They can order x-rays before the doctor has seen the patient to reduce waiting time. As a result of all these changes they have improved ED turnaround time by 69% - from 96 minutes to 30 minutes!

Saint Louis Hospital has a clear plan for where they wish to go with Lean. They have a ‘Lean Council’ and invest in training. They are introducing a ‘unit optimization’ program whereby each unit will be asked to identify 3 priority problems they need to fix and they will pick one problem to work on. There will be awards for the best performing teams.

All in all, this was a very interesting day. Both hospitals – one large and one small- have made very impressive progress and seem motivated to stick with Lean for the long term.

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Presenting Lean - Insights from Singapore hospitals and RVHS

2011-01-25T15:13:00.000-05:00

Bangkok Blog#3 – Written on Tuesday, January 25, 2011

Michele Jordan
VP Quality Improvement and Transformation

The format for Day 2 of Seminar on Regional Sharing on Lean in Health Care was a little different than Day 1. The first day was a small gathering of about 25 invited delegates from across Asia. The second day was open to the public, and there were approximately 250 participants from health care organizations in the local Bangkok area.

There was a poster exhibit with several hospitals promoting their Lean achievements. A range of clinical areas were covered, including cardiac outpatient care processes, chemotherapy for solid organ tumours, breastfeeding and surgery. I was very impressed with the work of a team at the King Chulilongkorn hospital that applied Lean to improve operating room utilization for colorectal surgery. In just one year, this hospital was able to increase OR utilization from 44% to 74% while also reducing cancellations from 35% to 10%!

The formal part of the conference included two speakers that I had been anxiously looking forward to meeting – Dr. Kelvin Loh and Dr. Philip Choo.

Dr. Kelvin Loh (MBBS, MBA) is the CEO of the Mount Elizabeth Hospital in Singapore. After introducing Lean in some Singapore hospitals, he was hired as the expert consultant for the five-hospital Lean demonstration project in Thailand. He talked about value stream mapping, sustaining the gains and spread. Dr. Loh promotes the concept of a combined ‘top down and bottom up approach’ to Lean implementation – something worth exploring at RVHS. Value stream mapping in Asia is more oriented to patient groups or specific procedures (e.g. total knee replacement). The VSM crosses clinical departments. Dr. Loh recommends that hospitals have three levels of coordination to support their value stream improvements:

A ‘VSM Driver’ who owns the value stream that is being mapped -- i.e. someone who owns total knee replacement;
A few process owners for departments that fall within the value stream (e.g. nursing, physiotherapy); and
An overall coordinating Lean Council or Quality Council that keeps track of all VSM projects and prioritizes activity.

Dr. Loh ended his talk with a few thought provoking ideas to use Lean to improve processes. For example, load leveling in outpatient clinics to eliminate what he calls the ‘morning tsunami’ that is so common in hospital clinics. He suggests scheduling non-fasting patients and those who live close to the hospital in the afternoon rather than have everyone come in the morning. He also challenged the notion of all departments running clinics and rounding at the same time. He suggests a model where clinic space could be shared between medicine and orthopaedics for example. Orthopaedics would use the clinic in the morning and do their inpatient rounding in the afternoon. Medicine would use the clinic in the afternoon and do their inpatient rounding in the morning. He also recommended one-stop shopping for patients, much like what we have introduced in our pre-op clinics at RVHS.

Professor Philip Choo, CEO of the Tan Tock Seng Hospital in Singapore is one of the strongest advocates for Lean I have ever met. He has visited hospitals all over the world, learning how they have approached Lean. His presentation was entitled, “Leadership at all levels - A Key Success Factor in Lean Paradigm Shift”. He shared some very insightful information on requirements for cultural change, the role of leadership and seven competencies of effective leaders. I had the opportunity to speak with Dr. Choo over lunch, where we compared notes on our efforts to improve the discharge process and our application of EDD (estimated date of discharge). In Dr. Choo’s hospital, the most responsible physician must identify the EDD for the patient within 24 hours of admission. They must communicate it to the clinical team and write it on the discharge whiteboard on the unit. If a doctor does not identify an EDD, Dr. Choo is informed and takes it up with the chief of the department and the individual doctor – he notes that no doctor want to experience this twice. His hospital has made dozens of excellent improvements since starting Lean in 2007. For example, cataract surgery is now booked as a 15-minute procedure with high-quality outcomes.

After hearing Drs. Loh and Choo speak, I told them how excellent their presentations were and that my only complaint was that they had left very little for me to say because our tools and strategies are so similar.

In the afternoon, I had the opportunity to give a one-hour presentation. I covered:

Lean in the Canadian health care system
Application of Lean at RVHS
Lessons Learned

Everyone at RVHS should be very proud to know how impressed the audience was with our progress. I have already had two people express interest in coming to Canada to visit us.

The day ended with a two-hour panel discussion in which I took part. We focused on how to sustain Lean and took questions from the audience.

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Benefits of Lean similar at hospitals around the world

2011-01-24T12:35:00.003-05:00

Bangkok Blog#2 – Written on Monday, January 24, 2011

Michele Jordan
VP Quality Improvement and Transformation

Today was the official start to the Seminar on Regional Sharing on Lean in Health Care. There are about 25 participants sponsored by the Asian Productivity Organization (APO). I am in awe of the rich diversity. Participants represent 15 Asian countries: Cambodia, China, India, Indonesia, Iran, Japan, Korea Malaysia, Mongolia, Nepal, Pakistan, Philippines, Singapore, Thailand and Vietnam. Each country had to submit a ‘country paper’ describing their health care system and the status of Lean in the health care sector. I have to read all 15 of them before the end of the week.

Most countries are in their infancy where Lean is concerned but they all see the potential for Lean to improve their health care systems and are anxious to learn more. The health care challenges faced in Asia are similar to what we face in Canada – quality concerns (i.e. wanting to use more evidence-based practice; need to minimize adverse events), lack of standardization, patient satisfaction, meeting growing public expectations, trying to reduce length of stay and insufficient money to do all the things we want to do.

In Asia, many hospitals are run by doctors who serve as both practicing physicians and CEOs. Most of the participants at the conference are doctors and all of the speakers today were doctors.

The first presenter was Dr. Anuwat Supachutikul, Chief Executive Officer, Healthcare Accreditation Institute who set the tone for the day by providing an Overview Application of Lean Thinking to Healthcare. I think it is absolutely brilliant that Thailand’s Healthcare Accreditation Institute had the foresight to invest in Lean and sponsor demonstration projects in several hospitals. They clearly see the link between Lean and quality!

Next Dr. Cherdchai Nopmaneejumruslers, Assistant Dean in Quality Development, Siriraj Hospital gave an introduction to the theory of Lean touching on topics such as value vs waste, the ‘House of Lean’ (similar to our ‘House of Rouge’), common Lean tools, operational excellence, value stream mapping and visual management. He also talked about error rates and adverse events. Did you know that the rate of preventable deaths in hospitals is comparable to the error rate for airline baggage handlers? Dr. Cherdchai is a respirologist who trained in Canada at (U of T, McMaster and UHN). He is the only one I came across so far who can relate to the frigid temperatures in Canada in January.

The third speaker was Asst. Prof. Dr. Roengsak Leetanaporn, Director, Songklanagarind Hospital. He gave a series of small lectures on specific aspects of Lean thinking including: Benefits of Continuous Flow, Cycle Time, Takt Time, Cell Concept, Batching, Workload Leveling, Error Proofing and A3 problem solving. For each topic, he gave an example from his hospital. His hospital currently has 300 Lean projects on the go of varying size and complexity!

One of the most interactive and enjoyable parts of the day was a Patient Simulation Exercise organized by Dr. Cherdchai and his team from Siriraj Hospital. It was a fun exercise similar to ones we have used at RVHS but using Lego. At the end of the exercise we showed how improving processes (without increasing staff or space) could lead to more patients being seen, better quality (reduced defects), improved cost-effectiveness and improved morale. The results made true believers out of everyone in the room, especially the doctors. (Look for this exercise at Rouge Valley in the coming months!!)

Two things struck me about Day 1 of the conference. First, the similarities in Lean implementation between the Thailand hospitals and Rouge Valley. Like us, they are using 6S, A3 thinking, surgical safety checklists, standard order sets, value stream analysis and kaizen events. Their discharge planning whiteboards, complete with “EDD” look exactly like ours! They have even surpassed us in some areas. For example, they have implemented Kanban systems for inventory management.

The other thing that impressed me immensely is that we sat in a room for an entire day and talked about the benefits of Lean. Yet no one ever mentioned cost-cutting – only improving quality and ‘making patients happier’. No matter what part of the world you live in, that is what Lean is all about.

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Read Bangkok Blog#3

From Rouge with Lean

2011-01-24T10:16:00.007-05:00

Bangkok Blog#1 - Written on Sunday, Jan. 23, 2011
By Michele Jordan
VP Quality Improvement and Transformation, RVHS

When we started our Lean journey at RVHS who would thought that a mere two years later, people half way around the world would be interested in hearing our story. Yet here I am in Bangkok where I’ve been invited to speak at the Seminar on Regional Sharing on Lean in Health Care.

So how did this come about? In late November I received a telephone call from an individual who works in the Modernization Branch of the Ontario government. He said that he had heard me speak about Rouge Valley and Lean at a conference in Toronto several months prior. The Ontario government has links with governments in many other countries and he has been doing some work with the Asian Productivity Organization (APO). The APO has existed for 50 years. They have promoted Lean in the manufacturing sector for many years but recently decided to explore the potential to deploy Lean widely in the service sector, including health care. He said the APO was holding a conference on Lean in hospitals and the organization would be interested in having a Canadian speaker. He recommended me and with the support of our CEO, I was pleased to accept the invitation. All expenses are completely covered by the APO so there is no cost to the hospital for participating in this wonderful educational event.

The conference runs from Monday, January 24th to Friday January 28th. The first two days are a standard conference format with some of the best Lean experts in Asia scheduled to speak. The next two days will consist of site visits to three hospitals in Bangkok that have been participating in Lean since 2008. Lean was introduced into these hospitals as a demonstration project sponsored by Thailand’s hospital accreditation body and by the APO. I will have a chance to see the improvements these hospitals have made and contribute to an evaluation of their progress. From the advanced reading materials I received it looks like all hospitals have made impressive progress.

I will speak at the conference on Tuesday afternoon and Thursday night. The week promises to be very busy and a great educational opportunity. I will update this blog daily to ensure that interested individuals at Rouge can share in the learnings. So stay tuned.

Read Bangkok Blog#2
Read Bangkok Blog#3

Happy New Year: Looking forward to more successes in 2011

2010-12-31T10:50:00.000-05:00

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!

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

2010-12-13T17:10:00.000-05:00

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.

Restoring comfort and health, one bed at a time

2010-11-18T13:57:00.000-05:00

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.

2010-11-02T12:08:00.001-04:00

Almost 5,500 Ontario doctors using eHealth records: minister - thestar.com http://ping.fm/iGxAy

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

2010-11-01T12:09:00.000-04:00

$650,000 more now available for equipment!

By John Aldis,
Vice-President,
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.

How digital technology can mean better care

2010-10-28T12:57:00.000-04:00

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 www.rougevalley.ca/di.

2010-10-27T09:36:00.001-04:00

Early detection of breast cancer can save your life.... http://fb.me/L6VQhQV0

Putting meat on the bones of strategic planning

2010-10-21T16:35:00.000-04:00

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.)

We agree with the government & AG

2010-10-20T12:32:00.000-04:00

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.

2010-10-19T18:21:00.001-04:00

Things are shaping up nicely at RV Ajax & Pickering hospital campus! http://ping.fm/hEYvA

Why early detection is the best way to beat breast cancer

2010-10-18T16:11:00.000-04:00

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.

2010-10-18T12:30:00.001-04:00

We're back in the black: http://ping.fm/LPSNM

2010-10-15T15:35:00.001-04:00

Want to help improve a person's health, for a living? Here's an excellent place to start: http://ping.fm/mJAUv

MRI: Why an Image is Everything to our community

2010-10-07T08:38:00.000-04:00

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)

Personal Business Commitments are all about working as a team

2010-09-21T08:44:00.000-04:00

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.

ROUGE VALLEY FIRST WITH SMALLER AND IMPROVED DEFIBRILLATORS

2010-08-17T13:30:00.000-04:00

ROUGE VALLEY FIRST WITH SMALLER AND IMPROVED DEFIBRILLATORS

Why Lean works for patients at Rouge Valley

2010-08-03T14:57:00.000-04:00

-- And how it can work at your hospital

By Rik Ganderton
President and CEO
RVHS
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.

Working together to create leaders in health care

2010-07-30T10:24:00.000-04:00

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.

President’s Blog: Time to map our future

2010-07-06T10:01:00.000-04:00

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

President’s Blog: Thank you Darrell

2010-06-22T13:05:00.000-04:00

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

Chemo Clinic: Quality care closer to home

2010-06-11T08:46:00.000-04:00

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!

Senior management team gets “real” through Gemba Walks

2010-04-07T20:02:00.000-04:00

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.

Regards,
Rik

Senior Management Team changes

2010-03-31T08:54:00.000-04:00

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

Going beyond Peer Review Report recommendations

2010-03-08T15:44:00.000-05:00

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.

MRI

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.

Fight heart disease with heart healthy foods

2010-02-17T13:09:00.000-05:00

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.

President’s Blog: SWOT analysis of 2009

2009-12-22T10:05:00.000-05:00

To staff, physicians, volunteers

By Rik Ganderton, President and CEO

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

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

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

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

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

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

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

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

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

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

Returning home sooner: Good for patients and for the hospital

2009-10-08T10:20:00.000-04:00

By Dr. Romas Stas, Associate Chief of Staff

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

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

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

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

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

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

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

Preliminary accreditation results outstanding!

2009-09-24T12:33:00.000-04:00

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

Congratulations and a big thank you!

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

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

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

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

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

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

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

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

Be proud Rouge Valley. You’ve earned it.

Thank you and stay the course!

2009-09-22T10:06:00.000-04:00

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

Progress.

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you and stay the course!

Skills survey for pandemic planning

2009-09-21T11:30:00.000-04:00

President's Blog by Rik Ganderton

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

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

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

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

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

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

Sustaining the gains

2009-04-15T12:34:00.000-04:00

President's Blog - Rik Ganderton

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

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

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

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

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

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

Financial road to success

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

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

Thanks to you

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

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

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

Transformation themes

Let’s all stay focused on our transformation themes:

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

Community Outreach

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

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

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

President’s Blog - Clinical Services Plan (CSP)

2009-02-25T15:23:00.000-05:00

By Rik Ganderton - President and CEO, RVHS

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

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

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

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

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

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

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

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

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

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

Get moving for better health

2009-02-24T13:35:00.000-05:00

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

By Dr. Amir Janmohamed / Rouge Valley Cardiologist

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

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

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

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

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

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

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

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

Real progress, but must stay the course

2009-02-03T10:07:00.000-05:00

By Rik Ganderton
President & CEO, RVHS

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

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

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

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

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

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

President's New Year's message

2009-01-06T08:26:00.000-05:00

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

Hello everyone,

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

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

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

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

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

Remember our four focus areas:

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

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

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

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

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

Rik Ganderton, President and CEO

Update: Birthing Centre / Town Halls / Mental Health / Socials

2008-12-04T14:33:00.000-05:00

By Rik Ganderton President and CEO

I have a few pieces of news to update you on today.

* Town Halls
First, sorry it's been so long since we've had a Town Hall. Scheduling of various meetings has got in the way. We will resume our regular monthly staff-physician-volunteer Town Halls on Thursday, Dec. 18 at each hospital campus:
- 9:30 a.m. at RVC's Dr. Bruce Johnston Conference Room; and
- 2 p.m. at RVAP's Conference Rooms B and C.

* Birthing and Newborn Centre at RVC
My congratulations to our RVHS Foundation team for their successful events on November 20 when volunteers were thanked for their tremendous $1 million support for the new centre and an evening event at which key donors and supporters were recognized. I would also like to acknowledge the work of the whole Women's and Children's Program team for all their efforts in making the new Birthing Centre a reality. While all have worked tirelessly I would especially like to thank
· Julie Goldstein, Program Director (now with the TMO)
· Sue Fyfe, Program Director
· Penny Katz, Manager, Perinatal
· Sheri Ferkl, Manager, Paediatrics
· Rose Owen, Clinical Practice Leader
· Debbie MacInnes, Clinical Practice Leader
· Debbie Lopresti, Resource Nurse, Perinatal
· Kim Eeuwes, Resource Nurse, NICU
· Amer Syed, Manager, Respiratory Therapy
· Dan Flood, Purchasing
· Nicki Modeste, Purchasing
· Rick Gowrie, Senior Director
· Ed Carroll, Manager - Plant Admin, Projects
· Martin Green, Manager, Security
· Siamak Sadr, Director
· Teresa Alzner, Resource Nurse, Paediatrics
· Kim Kaizer, Clinical Practice Leader, RVAP
· Mary Ellen Stevenson, Manager, RVAP

We look forward to having the official grand opening of the centre early in the 2009 and subject to the availability of government leaders. We'll announce the date as soon as possible.
It is indeed a beautiful facility which we can be proud of.

* Mental Health improvements
Our implementation of the plan announced in March continues to move forward.
Rouge Valley also continues to look for opportunities presented by the improved mental health service model.
We have asked the Central East LHIN (in June 2008) to fund the hospital for 29 additional acute care medical beds to go into the space being vacated as part of our improved model of care. It is our intention to house 22 of these beds on RVAP's 3 West, if they are funded.
We desperately need this medical bed capacity to improve the flow of patients through our emergency department. Durham region has some of the lowest rates of admission to inpatient medical beds in the province. When compared to other centres it appears we are substantially under resourced in terms of inpatient acute medicine bed capacity.
We'll let you know when we have an answer from the Central East LHIN on our request.

* Rouge Holiday Socials
I hope to see you at our annual Rouge Holiday Socials for all staff, physicians, board members, and volunteers.
The socials are:
- Dec. 15, 2-4 p.m. at RVAP’s Conference Rooms B and C. Plus we'll have a traveling minstrel and holiday food going floor to floor from 7:30 p.m. to 9:30 p.m.
- Dec. 16, 2-4 p.m.. at RVC's Dr. Bruce Johnston Room. Plus we'll have a traveling minstrel and holiday food going floor to floor from 7:30 p.m. to 9:30 p.m.
This is purely an end of the year social event. I'll put way my projector and PowerPoint. Please come and enjoy some good food, good music and equally good conversation!

Prevent the flu in you and in patients! / New Echo

2008-10-31T12:10:00.000-04:00

By Rik Ganderton - President & CEO
I'm pleased once again to get my flu shot and encourage us all to do so.
To get his year's campaign going, you'll see that many managers and Board members have already rolled up their sleeves to encourage everyone at Rouge to get their shot. This is the best way to prevent us from getting sick with the flu and to prevent spreading it to our patients.
Thank you all for rolling up your sleeves starting next week at flu shot clinics for staff, physicians and volunteers at Rouge Valley. It's your personal decision, but please do consider getting it for your health and for that of our patients.
And my thanks to RN Amanda Fyfe for making it so painless!
...

President's Blog
By Rik Ganderton - President and CEO
Oct. 31, 2008

Even the Echo is transforming ...

Welcome to our new echo.

More than simply a smartly re-designed magazine, echo is now serving a wider audience — reverberating and spreading the good word about the new Rouge, which all of you are so busy transforming.
echo will continue to be a newsletter for staff-physicians-volunteers. But now it will also serve as a community magazine, mailed six times a year (electronically and by post) to health care partners, political leaders and more than 350 community organizations in east Toronto and west Durham.

Please have a good read through this issue and send any comments to Public Affairs and Community Relations Director David Brazeau at dbrazeau@rougevalley.ca. As with everything we do at Rouge, we want it to be the best – reflecting your tremendous ongoing work to constantly improve patient care!

In this issue, we continue to focus on the transformation that is well underway at both Rouge Valley hospital campuses. At our Oct. 1 Transformation Celebration Town Hall, we showcased the successes of our first four kaizen event teams. This was an opportunity for team leaders to showcase the positive changes their teams achieved for patients and for each other. We take an inside look at these kaizen events in our cover story, but I would like to highlight some of the biggest achievements here and offer my own “thank you” to all of our kaizen team members.

RVAP Emergency Department 5S
Clinical Practice Leader Tina Shoemaker showed us how the Rouge Valley Ajax and Pickering emergency department organized itself more efficiently for patient care, by making these key changes:
Cleaned and organized the working environment;
Conducted daily 5S audits (sort, set in order, scrub/shine, standardize and sustain); and
Ongoing monitoring of sustainability.
I want to underline this: sustainability is the key to all kaizen event successes! We must be vigilant in maintaining the truly terrific changes you have made.

RVAP Emergency Department Lab TAT
Senior Technologist Renee Liscio demonstrated how this team improved turn-around time (TAT) for blood and urine specimens. The key changes achieved for our patients were:
Visual management system for specimen pick up was established;
A back-up system was set up to inform our patient services reps that pickup was required; and
Standard work was established for all staff involved.

RVC Medicine Discharge Room TAT
Physiotherapist Louie Lu shared these key turn-around time changes achieved by his kaizen team:
Discharge TAT visual management board established;
Standard work created for staff members to improve patient flow; and
Linen carts have been reorganized using the 5S principles.

RVC Medicine Discharge Process
Outpatient and Corporate Rehab Manager Karl Wong showed us how his team improved flow, coordination of discharge process on the RVC Medicine 9W unit, through these key changes:
Discharge planning visual management board was put in place;
Physician communication tool was created for patient charts; and
Signs were made to educate patients and families about discharge days and times.

Thank you to all team members and to our kaizen process owners: Program Director of Mental Health and Emergency Cheryl Williams; and Program Director of Medicine and Critical Care Margot DaCosta. I would also like to thank all staff, physicians and volunteers for working as a team, at every level of Rouge Valley, to provide the best health care experience for our patients and their families.

And to all our other readers, I hope you enjoy this first issue of the new echo and will continue to come back to these pages to learn more about how Rouge Valley is working to be the best at what we do.

Please feel free to email any questions or comments you have for me to rganderton@rougevalley.ca.

For more from the president:
internal—check out the President’s Page on the RVHS intranet site
external—visit the RVHS Blog at rvhs.blogspot.com

Rouge continues to move forward: wins second court challenge

2008-10-31T09:44:00.000-04:00

By Rik Ganderton - President and CEO

Rouge Valley has won its second legal challenge to its Deficit Elimination Plan (DEP).

The Divisional Court has recently ruled in favour of the hospital in a challenge brought forward by the provincial head office of the Ontario Nurses Association. The court ruled that the decision to approve the DEP by the Rouge Valley Board of Directors was an “internal” and "reasonable” decision.

The court accepted the hospital’s arguments that it had consulted about its plan to reduce the deficit. This summer the court also ruled in favour of the Central East LHIN and Rouge Valley in a similar challenge brought forward by OPSEU - Read our August 2008 news release.

This means we can continue to move forward in our well-publicized plan, of March 25, 2008, to fix Rouge Valley's historic financial challenges.

As we've said at leadership forums with managers and Town Halls with all staff, it is thanks to the engagement and participation of staff and physicians that Rouge Valley is now heading in a positive direction on finances and, most importantly, in transforming itself into being the best at what we do for patients.

The complete ruling is available here.

President’s Blog: My Personal Business Commitments

2008-09-08T11:09:00.000-04:00

By Rik Ganderton - President & CEO

My Personal Business Commitments (PBCs) are available here.

I am sharing my PBCs as part of my accountability to the organization. These are the major things that we as an organization have set for ourselves to do this year. They have been developed directly from the Strategic Plan on-a-Page, which set our strategic direction and is posted on our public website and internal Intranet.

As a reminder, you'll recall we've said we intend "to be the best at what we do" and that:
- We will work as a team;
- Live our values every day;
- Relentlessly focus on quality in a health workplace;
- Maintain and strengthen core services and enhance centres of excellence;
- Deliver services within the context of the Central East Local Health Integration Network, Integrated Health Service Plan and Clinical Services Plan; and
- Live within our resources.

My Personal Business Commitments have been approved by our Board of Directors. By sharing these PBCs, we at Rouge Valley are cutting a new path that you are all a big part of.

Open communications has been a key of that path since I had the pleasure of joining the Rouge team in 2007.

I’m publishing my PBCs to help provide greater clarity for us all and to help each of us understand how our varied roles contribute to achieving our strategy at Rouge Valley. By focusing on achievement of these goals we will ensure that the day to day "noise," that we all face, will not distract us from our major objectives.

I want our vice-presidents, chiefs and all physicians, directors, managers and all staff and volunteers to see the very tangible targets the Board and I have set for me and for Rouge Valley itself.

PBCs have also been set by our senior team and are being cascaded throughout the leadership organization so that we are all aligned on our goals. The management team will be sharing their PBCs with their teams. The senior team has shared their individual goals with each other so that there is clarity and understanding between us.

By publishing my PBCs, and later those of our entire management team, all staff and physicians with be better able to work toward our common vision to be the best acute care community hospital.

We will continue to work as a team, at every level of Rouge Valley, to provide the best health care experience for our patients and their families.

PBCs are the tool we will use to provide clarity to the direction we have set our selves and how we will achieve and measure our success on that journey. They also make the links across management and staff, physicians, departments, campuses and disciplines.

The development of PBC's will become and annual exercise for the whole management team so that we have clear alignment of our actions to achieve our strategic intent of being "the best at what we do."

Please feel free to email me (rganderton@rougevalley.ca) any questions or thoughts you have about my PBCs.

Implementing our plan

2008-05-15T15:47:00.000-04:00

By Rik Ganderton
President & CEO

As many of you will now be aware, OPSEU has decided to withdraw its motion for an injunction that was to be heard in Court on Friday May 16th. An application for judicial review of the process used by the CELHIN will now be heard by the Court on July 11th.

RVHS is now in a position to start implementing the Deficit Elimination Plan that was approved by our Board on March 25th. The plan is the foundation for the Hospital Services Accountability Agreement (H-SAA) that we signed with the Central East LHIN in early April.

This afternoon we provided formal notification to our various Unions regarding the restructuring. This will mean the provisions of the various collective agreements will kick in and we will start to deal with Early Retirement and Voluntary Exit Packages and subsequent (and hopefully minimal) individual notices of layoffs.

This has been a very difficult time for all our staff. We all know that we had to take these difficult but important actions. We have all been frustrated by the implementation delays forced on us over the last six weeks or so. However, we will now start implementation and the transformation of RVHS into a higher performing hospital; a hospital that we can be proud to work for, that provides the core services our communities need in a caring and efficient way and relentlessly focuses on delivering the highest quality of care.

Thank you all for your patience during this very difficult period. We have lots of work to do as we continue to develop detailed implementation plans and make the needed changes. I look forward to working with you all as we transform RVHS to be the best at what we do.

Injunction

2008-05-02T14:28:00.000-04:00

By Rik Ganderton
President and CEO

OPSEU has brought a court application seeking a Judicial Review of the Central East LHIN's process in approving the RVHS Deficit Elimination Plan, which includes the consolidation of mental health beds at Centenary. OPSEU has also served RVHS with a Notice of Motion seeking an injunction restraining it from implementing the mental health bed consolidation until the application is determined by the Court. In these circumstances, our legal counsel has advised that:

1. We should not discuss this matter publicly, while it is before the courts; and

2. We should not commence implementation until the legal matter is resolved.

We will keep you posted as to updates on this matter.

The facts on our improved Mental Health model

2008-04-30T15:09:00.000-04:00

By Rik Ganderton
President and CEO

Our improved model for mental health care at Rouge Valley Health System has received much media coverage.
But lost or buried is the fact that the new model will improve mental health care by –
• Increasing expert mental health crisis intervention services from 12 hours (8 on weekends) to 16 hours a day, seven days a week at the Ajax and Pickering Campus.
• Maintaining our outpatient services at Ajax and Pickering Campus. Outpatient Mental Health Care serves the vast majority of mental health patients
• Continuing access to all mental health services, including emergencies, through our Ajax and Pickering Campus
• Consolidating specialized Mental Health Nursing expertise for inpatient care so that more hours of nursing care will be provided to those patients who require treatment on an in-patient basis.
• Adding a further eight beds to General Medicine at the Ajax and Pickering Campus to improve patient flow and reduce wait times in our Emergency Department.
We are also exploring alternate patient care uses for the space that will be vacated in the Ajax and Pickering Campus. Among the alternate uses is the possible addition of more medical beds at our Ajax and Pickering Campus to further reduce Emergency Department Wait Times. These would require additional funding which we are discussing with the LHIN.

THE NEXT THREE YEARS
Furthermore, there has also been a considerable amount of misrepresentation by some parties as to the number and nature of jobs we must eliminate over the next three years. The facts are –
• 220 positions will go over three years: 60 at the Ajax and Pickering Campus; and 160 at the Centenary Campus.
• Of the 60 jobs at Ajax and Pickering Campus, 36 are Mental Health staff who will be re-employed at Centenary Campus; in other words they are not losing their jobs.
• Of the total positions being eliminated over the next 3 years, 72 are nursing. However, the nurses currently filling those positions will have the opportunity to move into newly funded positions such as those required for the expansion of the specialized Neonatal Intensive Care Unit (14) and the Ajax and Pickering Campus (60) as well as the other options described below.
It is our strongly held belief that almost no person will have to leave RVHS involuntarily. Our normal staff turnover rate is about five per cent a year, which represents 150 positions a year. In addition we will –
• Fill vacancies in areas not being restructured.
• Provide early retirement and voluntary exit packages in accordance with our collective agreements, which cover more than 90% of our staff.
• Provide retraining to support redeployment.
• Fill new positions created by our expansion projects.
Our three-year plan represents changes for the better. Rouge Valley will be a top performer in the healthcare system. We will deploy staff at similar levels to our best performing peers. We will improve the quality of care we deliver and reduce wait times in our Emergency Departments. We will live within the money provided to us.
We know we can do this because we have compared ourselves against other Ontario hospitals. We have seen how they treat patients more quickly, with better service quality and lower resource use than Rouge Valley. As we do this we will continue to grow our services in conjunction with the directions of the Central East Local Health Integration Network.

2008-04-23T10:13:00.000-04:00

By Rik Ganderton
President and CEO

So much to say. Firstly, my thanks and thanks from our executive team and the Board of Directors to our nurses, security, physicians and all staff involved in handling a significant incident in our Emergency Department at the Centenary campus on April 16.

We placed the Centenary Emergency Department on redirect status following the incident in which a patient seriously injured himself late that morning. Staff and physicians responded immediately to the situation and in handling the redirection of ambulances and emergency patients like the professionals they are.

OUR RECOVERY CONTINUES
We have been busy in healthcare partner and public consultations concerning our improved new model of mental health care delivery.

Much has been reported in the media. For clarity, please reference the information posted on our web site since March 25.
From the consultations, we have been able to better define issues, such as transportation of patients and families, which we will address during the next five months before our improved model of mental health care is put into place.

It’s important that our patients, families and communities—in addition to all of you—know that this model represents better access to our services by:

• Increasing crisis services from 12 to 16 hours a day, seven days a week at both campuses;
• Maintaining our outpatient services, which serves the majority of mental health patients at both campuses;
• Ensuring access to all mental health services, including emergencies, continues at each campus;
• Pooling expertise for inpatient care.
Our Rouge Valley Ajax and Pickering mental health information page has much more detail on this.

More information is available online at www.rougevalley.ca and at www.centraleastlhin.on.ca.

FUNDING
We have received funding from the provincial government as announced on April 13. That funding is not new and will not change our need to become more effective as we move up to the standards of the best community hospitals in Ontario.
We also remain focused on implementing our Deficit Elimination Plan so that we can effectively reduce our $78 million long-term debt and working capital deficit.

You’ve heard me say it many times in our Town Halls, but it’s worth repeating: we know we can perform with the best hospitals in Ontario—a top quartile performer rather than average, or worse. Rouge Valley is striving to be among the best of Ontario community acute care hospitals in both quality and effectiveness.

Having met many of you during the last year, I know we have the dedicated, high quality staff, physicians and volunteers to achieve this.”

Ministry Funding

2008-04-14T19:58:00.000-04:00

By Rik Ganderton
President and CEO
Rouge Valley Health System

On Sunday, the Ministry of Health and Long-Term Care announced a $667 million funding boost for Ontario hospitals to address new beds, more surgeries and shorter wait times.

While the actual amount for Rouge Valley Health System is still be to announced by the Central East Local Health Integration Network, we are pleased to receive any additional funding and thank the Ministry.

It is important to note that this additional funding does not change our financial challenge. We remain focused on implementing our Deficit Elimination Plan so that we can effectively reduce our $78 million long-term debt and working capital deficit. These additional funds will be a positive first step in getting our financial house in order so that we can better focus on the future healthcare needs of our communities in west Durham and east Toronto.

Our plan is about more than simply reducing our debts and deficit. Rouge Valley is now focusing on performing at higher standards of effectiveness, as other hospitals do. You’ve heard me say it many times in our Town Halls, but it’s worth repeating: we know we can bring ourselves to the benchmarks of the best hospitals in Ontario—a top quartile performer rather than average, or worse. Rather than aiming for the median, or average, Rouge Valley is now striving for top-quartile performance in quality and effectiveness.

Having met many of you during the last year, I know we have the dedicated, high quality staff, physicians and volunteers to achieve this.

Details of our Deficit Elimination Plan are available on the Intranet.

CE LHIN Board motion adds 30-day consultation period

2008-03-28T20:09:00.000-04:00

By Rik Ganderton
President and CEO
Rouge Valley Health System

New information has just become available from the Central East LHIN's Board meeting today, March 28.

The LHIN Board members have passed a supplementary motion, which is relevant to our Deficit Elimination Plan. Here is the wording of the Central East LHIN Board motion: "Be it resolved that the (CE LHIN) Board requires RVHS to work with the LHIN prior to the implementation of the planned consolidation of MHA (Mental Health and Addictions) services in conducting a 30 day consultation period with community stakeholders, and the general public.”

As a consequence of this, we will receive clarification from the LHIN during the next week. We will share that clarification with all of you – staff, physicians and volunteers – as soon as possible. I’m sorry we don’t have any greater detail on this yet. But I wanted to share this information with you now. We will continue to keep you informed in a timely fashion.

Our recovery continues

2008-02-08T12:04:00.000-05:00

By Rik Ganderton
President and CEO
Rouge Valley Health System

Rouge Valley’s recovery process continues to be developed. As discussed at our Town Hall meetings with you in January, our senior administration has been analyzing and developing a recovery implementation plan.

This is all part of the Peer Review process initiated by the Central East Local Health Integration Network (CE LHIN) with Rouge Valley’s full support.

Here’s an outline of how that process will work.
• Currently senior administration is developing the plan. Phase One of this plan will be to live within our means and balance our budget. We have massive debt to deal with, as I said in our Town Halls.
• Our implementation plan will be reviewed by the RVHS Board of Directors.
• The Board will then forward the approved implementation plan to the CE LHIN Board before the end of March for its approval.

During 2008 our recovery plan will go into place, providing a platform for the hospital to establish itself as the best at what we do – providing excellent, quality-focused community hospital care.

Please know that RVHS will be maintaining its 24/7/365 Emergency Departments and access to core services at both of its hospital campuses, as part of its community hospital identity.

The significant redevelopment of RVAP continues as planned. As you know, we are adding 140,000 square feet of new and renovated space to greatly enhance our emergency and related services, including cardiac diagnostics, diagnostic imaging and lab services—to name a few. Our two smaller, but important projects, at RVC also continue: the Birthing and Newborn Centre; and Mental Health Supportive Housing.

We will continue to communicate regularly. I welcome your comments and questions.

As always, thank you for your continued commitment to Rouge Valley and our patients.

Town Hall Q&A

2008-01-28T13:03:00.000-05:00

By Rik Ganderton

President and CEO

Rouge Valley Health System

Good day to you all.

It was my pleasure to present the latest information on the Peer Review Process and the RVHS approach to it in Town Halls this week.

That presentation is available here for your reference.

Thank you for your many insightful questions. I think, this month, I will share your questions from each of our Town Halls at RVAP and RVC on Jan. 23 and 24, along with the answers that we gave.

Here’s a sample of questions asked and answered:

Q1 - Is the Birthing Centre going ahead?
Yes, the Birthing and Newborn Centre is going ahead, as are our other two major capital projects--the redevelopment of RVAP and the Mental Health Supportive Housing Project.

Q2 - How about having a lottery to raise funds, like at Princess Margaret Hospital?
(Reply from Chad Hanna, RVHS Foundation President and CEO) The Foundation was involved in a car lottery that was not raising enough money to continue. The Board is always reviewing opportunities to raise funds, including our recently launched Cash Cow staff lottery.

Q3 - What will happen with our regional paediatric program?
Our regional paediatric program is unfortunately not funded as a regional program. Our pacemaker program and cardiac rehabilitation programs, among others, are also not fully funded. We have not determined any specific plan for these or other programs at this time. We are working with the Central East LHIN to determine how best to deliver these services within the region.

Q4 - How does our financial status compare with that of other hospitals?
Our working capital deficit is the worst in the province, I'm sorry to say. Years of overspending have put us here and now we must balance our budget and live within our means. Part of the issue is that we have, over the last several years, taken on programs that we are not funded for, and part of it is that we have not operated as efficiently as we could have and need to.

Q5 - The CE LHIN commented in the newspaper (The Scarborough Mirror) recently that staffing levels might be affected as part of implementing the Peer Review. When are you going to start implementing that?
We don't have that plan developed yet. We have already done the analysis on this. Now we are working (as a senior executive, medical leadership and Board team) to determine how we implement the changes we need. Staffing levels are going to be affected since 80% of our expenses are related to staffing. In order to scale our spending back to live within our means, we will have to look for staffing reductions perhaps as early as April. All collective agreement provisions will be adhered to for unionized staff members. We are committed to minimizing any involuntary departures and will treat staff as fairly as we can.

Q6 - Has the Peer Review team noticed we have a lot of empty space (at RVC)?
The Peer Review team didn't specifically comment on it. But this is a huge strategic asset for us going forward. It's a real opportunity for us four or five years out. We've got all this capacity. It will be easier for the CE LHIN to make use of our capacity than it would be to build a new hospital or expand other hospitals in the Central East area. We recently made use of our capacity in accommodating Lakeridge Health patients displaced by a fire last July at its Whitby site. But our capacity also extends to the 25 acres of land we have at each of our hospital campuses. We've got some short-term pain to go through. But our long-term future at this organization is very bright.

Q7 – Do we have enough patients to sustain the rehab unit?
Yes.

Q8 – What if funding was pulled (for the rehab unit)?
I don’t have an answer on that right now. But I don’t see us closing down any program in the short-term. Those sorts of decisions can’t be made by one hospital in isolation. That kind of decision would be made with the CE LHIN after a great deal of discussion and planning.

Q9 – Have you sent our RVHS plan to the CE LHIN yet?
Not yet. We have submitted reports on our successful initiatives such as Agency Free and on revenue enhancement (examples - preferred accommodations, increased parking rates.) RVHS’ implementation plan will go before our own Board of Directors and then to the CE LHIN Board of Directors before the end of March.

Q10 – In your presentation you talked about maximizing the use of beds. Where will that occur?
I anticipate increasing bed capacity in the short term within the Department of Medicine at both hospital campuses. This will mean at least a reallocation from other services. However we must not lose sight of our key planning parameter – we will maintain our volumes in 2008/2009 at the same levels as in 2007/2008. We will use our resources, including beds, to do this more efficiently

Q11 – Aren’t you just robbing Peter to pay Paul?
If you want to put it that way, yes. We have to figure out how to balance our resources more effectively. The organization has to be appropriately resourced and programs must perform at benchmark efficiency levels. We will not be taking on any other services or programs unless we are funded for them, including wait time initiatives. We will live within our means.

Q12 – How are we going to address this in the community?
We have been meeting, and will continue to meet, with various community groups and healthcare providers in our area. We are working very closely with the LHIN on all our potential initiatives. We are also going to be speaking to the Collaboratives of the Central East LHIN, with each having representatives from many healthcare organizations and community members at one table. We are telling the community that we are going through this recovery process, but that we are maintaining patient volumes, as I said during my presentation. The community has also heard us say that we are maintaining both of our 24/7/365 Emergency Departments at each of our hospital campuses as well as continuing to provide access to Core Services. As you may know we have extra need in the Emergency Departments right now because two of our emergency physicians are seriously ill.

Let me close by saying: Thank you for bringing your skills and commitment to Rouge Valley Health System –and for helping us “Be the best at what we do.”

Rouge begins year of living within our means

2008-01-15T14:07:00.000-05:00

By Dr. Naresh Mohan,
Chief of Staff
Rouge Valley Health System

We have started our year of change and renewed accountability at Rouge Valley Health System. Rouge is currently preparing plans to focus our two hospital campuses on Core Services, as aligned with recommendations in the Peer Review Report, which was received and accepted by the Central East Local Health Integration Network (CE LHIN) on Dec. 14, 2007.

RVHS recently held meetings with physicians, staff and volunteers to share information related to the start of this planning. In short, the hospital can no longer spend more than it receives in provincial government funding.

The CE LHIN is providing some support for RVHS, but not enough to eliminate our financial shortfalls. Not by a long shot. We will be receiving one-time funding of $5 million in 2007/08 and $3 million in 2008/09.

The message from the CE LHIN is that Rouge must solve its own problems by being fiscally accountable--living within our means. What we must do as a hospital system is eliminate our massive debt. We have a $40 million working capital deficit and another $38 million in long term debt, making us the equivalent of a family that is mortgage poor.

This constant financial issue could have quality of care implications if we do not address it. That is why 2008 will be a year of focused renewal at Rouge. We will focus on being the best at what we do.

Years of overspending and a previous lack of accountability got us here. Active accountability will get us out.

Core Services

How we deliver services at both hospital campuses will change. At the same time, we will maintain core services at both sites. This includes Labour and Delivery and 24/7/365 Emergency Departments at each campus supported by:

24-hour anaesthetic coverage;
High dependency units (such as ICU);
General surgery capacity, including day surgery;
Community-level obstetrical and paediatric services;
General medical and geriatric services;
Some rehabilitation and mental health services;
Centres for diagnostics, treatment and ambulatory care.

Central East LHIN staff and board members will now support Rouge Valley's leadership as it designs a plan to address the findings of the Peer Review Report. Our plans on how to implement the Report will be submitted to the CE LHIN Board of Directors in February for its approval.

One of the important themes of our changes will be that RVHS will operate as one hospital system. All resources are corporate, meaning that they will be allocated at the discretion of leadership to maximize quality and efficiency. The "me too" attitude of our campuses, as highlighted by the Peer Reviewers, will end. We will need to deliver the best services we can in the most efficient manner, which may mean consolidated at a single site to improve quality and efficiency. Living within our means will mean much more than being fiscally balanced. It will mean that we will pool our human resources (staff and physicians) and equipment to provide gold-standard care for a given healthcare service in one place -- rather than spreading our resources more thinly across two locations.

Our hospital campuses are 20 minutes apart and therefore accessible to our communities of Whitby, Ajax, Pickering and east Toronto.

Central to our drive to be the best at what we do, Rouge Valley's renewal has begun with these themes:

We are and will continue to be highly skilled and dedicated;

We must truly become one hospital system;

We will no longer try to be all things to all people in healthcare. This past approach is a quality issue and a financial issue;

We will focus on Core Services, consistent with the CE LHIN, whom we will continue to work with in partnership;

We are committed to improve our processes for family physicians and their patients in their interactions with the hospital;

We will continue to communicate with you.

For more information on the Peer Review Report, please visit our public RVHS website page.

Attachment: Town Halls: Jan. 23-24, 2008 (96K PDF)