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

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

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

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

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

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

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

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

Prostate cancer risk factors

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

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

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

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

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.