Rouge Valley to lead more service growth and integrations

- From the RVHS AGM of Members, June 24, 2014 - Agenda Item # 4 

Rik Ganderton, President and CEO’s Report – Overview presented in the meeting  

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

We have worked very hard to design and implement new key initiatives:

Collaborative Care;  Patient Experience Training; The Staff Resource Team;  

The Lean Management System; and the The new Bed Map.  

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

Continued investments in medical equipment, facilities

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

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

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

Focus on quality patient care 

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

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

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

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

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

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

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

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

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

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

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

A Message from the CEO

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

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

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

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

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

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


Rik Ganderton
President and CEO
Rouge Valley Health System

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

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

By Rik Ganderton
President and CEO, RVHS 

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

My CEO message for our "Blue Book" is about three key opportunities and challenges for us in the year ahead, namely:

• Quality patient care;
• Fiscal responsibly; and
• How the proposed merger with The Scarborough Hospital will help us better address these challenges as one larger hospital corporation.

Quality

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

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

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

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

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

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

Fiscal Responsibility

As the 2013/14 fiscal year comes to a close, we expect to far exceed our budgeted operating surplus for the year. While this is a very good thing, the reality is we will achieve a very healthy bottom line because of some unusual, one-time items, which are not related to our ongoing core operations.
The major one-time items driving our surplus this past year are: 

• Post Construction Operating Plan funding – During the year, the Ministry of Health reconciled funding we received in 2009/10 and 2010/11 related to our Rouge Valley Ajax and Pickering (RVAP) redevelopment and Rouge Valley Centenary (RVC) Birthing Centre.  As a result we got to keep more of this funding than we had estimated based on the volumes we had achieved in those years at each site.
• Plexxus – Early in the year, Rouge Valley and the other 10 member hospitals of Plexxus, our shared supply chain services organization, negotiated a new business model. The new model is very favorable to our hospital and allows us to keep a much greater share of savings from Plexxus-managed supply and service contracts.
• Rebates, revenues, and incremental funding – Over the course of the year, RVHS has received various unexpected and unbudgeted one-time rebates and revenues. We also received incremental funding to support certain services, including two additional beds at RVC ICU, cancer surgery procedures beyond our base funding, and magnetic resonance imaging (MRI) hours.

Apart from the ICU funding, which will continue, these unusual items are hiding the fact that we are exceeding our budgeted expenses in many of our programs and departments.  We know that our current run rate is not sustainable and that we will not generate a surplus next year if we do not address it.  We also recognize that the volume of services we are delivering continues to go up and we anticipate that under the new funding formula, we will eventually get some credit for these volumes through funding increases.

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

As I do every year, I’d like to emphasize that we need operating surpluses in order to:

• Maintain and upgrade our facilities infrastructure, which was cash starved over many years of operating deficits before we implemented the deficit elimination plan (2008-11);

• Fund our capital equipment needs. Our three-year capital lists, excluding facilities items, includes $37.8 million in front line patient care equipment, clinical support equipment, diagnostic imaging, and information systems, which are vital to the safe and efficient functioning of our hospital and the achievement of our strategic directions;

• Rebuild our working capital. Our hospital’s working capital deficit continues to be one of the worst in the province. This is because while we have generated cash from operating surpluses over the last few years, we have been investing most of it back into the organization. Capital and operational reinvestment will continue to take priority over the next year while managing our working capital deficit, which is a concern to our funders at the Central East Local Health Integration Network and the Ministry of Health and Long-Term Care.

I am confident that we can, and will, become better and more efficient, as always.  But we are hitting the wall on what we can achieve as Rouge Valley Health System alone.

Proposed merger

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

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

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

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

Year of improving patient care is a harbinger of continued progress in 2014

Blog by RVHS President and CEO Rik Ganderton 
– To the staff, physicians, midwives and volunteers at 
Rouge Valley Health System (RVHS) 

Hello everyone and Happy New Year to all. 

Thank you to everyone for your dedication to our patients and all your continued hard work in 2013. 

The year ended with the ice storm – a tough end to a year of great change at RVHS. Please accept my thanks to everyone who struggled in to work to help our patients (and their co-workers) during this very difficult and traumatic event. The RVHS team pulled through and based on feedback through the Central East Local Heath Integration Network (LHIN), appeared to handle this difficult situation as well as anyone. 

The year marked further steps in our progress to becoming the best community hospital in the country. From a quality perspective we maintained or improved our record of making Rouge as safe as possible for our patients, families and staff. We met or beat our targets for managing nosocomial infections for VRE, MRSA and C. diff. Our record for central line infections and ventilator associated pneumonias (VAP) in our intensive care units (ICU) is exemplary and we are continuing to receive visits from hospitals across the province to learn from our successes. Our ICU teams are following the Institute for Health Improvement toolkit (which is based on Lean methodology) to ensure that we have full 100 per cent process compliance. Our unblemished record for VAP was halted with one incident, but audits showed we had followed all required protocols. Our performance on hospital standardized mortality ratio continues to be excellent and amongst the best in the country. 

Thanks to the investments we made in wound management in 2012 and the ongoing focus organization wide on pressure ulcer reduction we are seeing continued improvements in both the incidence and prevalence of pressure ulcers. We will continue to strive in 2014 to achieve an incidence rate of zero for new pressure ulcers (bed sores)! We are focusing on other nursing sensitive adverse events as part of our top 10 Balance Scorecard indicators. We are investing in training an education and hope to see significant improvements in this area in 2014. 

Our hand washing habits, while appearing to be good, still require ongoing efforts by everyone. Our independent audits indicate that compliance is not as high as it could be. Please for the safety of yourselves, your patients and your colleagues WASH YOUR HANDS at each “moment.” Let’s keep our patients and co-workers safe! Remember it’s easier to wash your hands than it is to manage patients in isolation, and whole lot better for our patients. 

Despite great efforts to make the flu shot as accessible to staff as possible and an assertive advertising campaign our staff flu shot compliance was abysmal. We dropped from over 40% in 2012 to low 30% this year. This is very disappointing and provides a real opportunity for further improvement. One hundred per cent compliance is our ultimate goal. We are NOT demonstrating to our patients and their families as well as our loved ones at home that we really do care and are paying attention to ensuring their safety. Please get your flu shot particularly as we are seeing a big spike in H1N1, which is covered by the shot this year. It won’t help our publicly reported numbers BUT it will help you, our patients, co-workers and families. 

We again served and treated more patients than in the previous year. Both of our emergency departments (EDs) saw and treated record numbers of patients during 2013. Both of our EDs saw visits in the mid 60,000 each – another record year!. Despite this we have seen continued improvement in our wait times in the ED for all CTAS levels of patients including those requiring admission. While we are not yet achieving our target of never having an admitted patient waiting in the ED we have made substantial improvements. We still have a long way to go but we are definitely going in the right direction! 

Operationally we had a challenging but successful year. We have been working on our “4 Must Do Can`t Fail Projects” that have consumed tremendous energy, but hold the promise of a leap forward in performance as we bring them to completion. These are – 

* Collaborative Care – we are now rolling this out to the surgical program and continue to refine the implementation in medicine. When we consistently get this right we will reduce the impact of nursing sensitive adverse events, we will improve our patient satisfaction and improve teamwork and staff satisfaction. 

* Bed Map – this has taken a huge effort and I want to thank Cheryl Williams, Rick Gowrie and Darren Gerson for their work on this – it has been intellectually challenging and hugely complex. It offers the opportunity to significantly improve patient flow while increasing satisfaction, quality and cost effectiveness. It will be a unique and totally new approach once implemented. 

* Service Training – Our first phase of this – Start with Heart has been rolled out and implemented. We have trained more than 2500 staff and volunteers. We are already hearing and seeing the positive benefits of this from patients, families and staff. The next round Respond with Heart was started in late October. Watch for more of this in 2014. 

* Staffing Resource Team - The SRT is up and running and we are aggressively hiring new staff to the team to provide coverage for sick time and reduce overtime. We are closely monitoring overtime and are beginning to see some reductions. We are also rolling out the web bases scheduling tool and are receiving positive feedback from staff in various departments on its ease of use, flexibility and user friendliness.

We anticipate, on a financial year basis, that we will achieve our budgeted surplus. This will be the sixth year of surpluses at RVHS. We have achieved this in a period of fundamental change in how we are funded. This has driven major operational changes such as how we manage joint replacement patients amongst several others. Special recognition to the Ortho surgical program for their work on dramatically changing how they manage joint replacement patients and becoming a performance leader in the Central East LHIN, if not the province. I will also congratulate the Cardiac program for the ongoing roll out of the cardiac rehab program, which is becoming a provincial model as well as the cardiac electrophysiology (EP) team for the performance of the first atrial fibrillation procedure at RVHS. 

Achieving surpluses allows us to reinvest in our facilities and equipment that has been so neglected for so many years. Speaking of investments in capital and facilities - Major Capital Equipment milestones in the last year has been the installation of two new catheterization laboratories to replace the old labs. In addition we purchased new cardiac echo machines for both hospital campuses and have embarked upon a significant bed replacement program. The bed replacement program will continue in 2014. By the end of 2014 we will have replaced most of our old bed inventory. We have also invested heavily in new surgical equipment including new tools, towers and anesthesia machines. We have been able to buy these and many, many other pieces of equipment because we generate surpluses. 

Special thanks also go to the RVHS Foundation for their tireless efforts on fundraising support and community engagement. 

Of course, we will continue to drive innovation and operational excellence through the ongoing use of Lean so that we can continue to benefit our communities, make RVHS a place all of us are proud to work and allow us to invest in our people so that we can be the best. 

No look back at 2013 can miss the most significant event in RVHS history, which were the LHIN motions of March 27th that initiated the proposed merger activity with The Scarborough Hospital (TSH). Thousands of hours of effort by many, many people including our dedicated volunteer Board of Directors has brought us to the point where we now know that merging RVHS and TSH is the right thing to do for our patients, our communities, our staff and for the health system more broadly. We have a clear plan to take us to the finish line. We are beginning the final phases of legal and financial due diligence and are starting the preparation of the required legal agreements. We are aiming to start the new fiscal year beginning in April as a merged corporation. This will no doubt make 2014 an interesting year for RVHS and TSH! 

Again thank you all for a tremendous year in 2013. 

This is my last New Year’s message to you all as CEO. Thank you all for your hard work, support and trust over the last seven years. It has been a remarkable personal journey for me and I have enjoyed working with you all immensely. I wish you all even more success in 2014 and to meeting the challenges that you will face. 

I wish you and your families and loved ones a healthy, happy, safe and successful 2014.

-Rik 

Rik Ganderton 
President and Chief Executive Officer  
Rouge Valley Health System