Get moving for better health

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

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

(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

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!