Annual publishing of "the Sunshine List" - 2011

Rouge Valley Health System note

The Ontario government has moved up its annual posting of government employees who have earned $100,000 or more in the last year. That provincial list is being released on Friday, March 23, 2012, a week earlier than in previous years.

In alignment with the provincial posting, Rouge Valley Health System has published its list.

For more information on the annual salary disclosure, please read last year's blog by Rik Ganderton, RVHS president and CEO.

The 2011 list has grown as more union and management employees cross the $100,000 threshold set back in 1996. Please note that non-union staff salaries have been frozen for two years, with the exception of some graduated step increases in pay.

Our new list is published on our public website, via this link on our financial page. 

Quality based funding begins for hospitals

Good concept – now the hard part – doing it right

By John Aldis, vice-president, corporate and post acute services, chief financial officer, RVHS

As part of the Minister of Health’s Action Plan for Healthcare, the Ontario government is introducing health system funding reform. The new funding approach, which will be phased in starting in fiscal 2012/13, is a paradigm shift in how the government will fund and hold hospitals accountable for the services they deliver.  

Health Minister Deb Matthews recently summarized it this way: “We have to shift spending to where we get the highest value. Our funding models need to be updated, to accelerate the transition from a provider-centred funding model towards a patient-centred funding model, where funding is based on the services provided.” 

This funding reform is the most significant change in the way Ontario hospitals are funded in over 25 years.  The changes will present challenges and opportunities for hospitals which are used to a mostly fixed funding stream, with annual increases to partially offset inflation.  Over the next three years, 70 per cent of hospital funding will be variable, compared to three per cent currently, and change from year to year based on a hospital’s volume of services, level of cost efficiency, and quality of care.   This is a very dramatic change over a short period of time and has the potential to be disruptive as hospitals adjust their plans in response to funding shifts.  Some hospitals will get more money, while some may even get a funding cut.  There will be significant pressure to integrate services within and among hospitals which will impact patients, physicians and staff.  

Since details of the formula have not yet been released, the impact on individual hospitals is not yet known.  What we do know is that starting in fiscal 2012/13, 46 per cent of hospital funding will be variable, increasing to 70 per cent within three years.  Part of the variable funding will be based on the volume of key services and associated costs.  Hospitals with the capacity to provide more services, to better match demand for those services in their communities, will attract funding.  And hospitals that deliver these services most cost-effectively will also benefit under this funding method.  The rest of the variable funding will be for specific services which the Ministry will target for quality improvement and cost rationalization.  Funding for these, so called “Clinical Quality Groupings” will be provided at a set price, for a specified volume of procedures.  Hospitals that can deliver these services with high quality outcomes, at low cost, will have the opportunity to attract more revenue.  The first three Clinical Quality Groupings to be funded this way are cataracts, joints, and chronic kidney disease.

So what does this mean for RVHS?  We need to build on the good work we have begun over the last few years to enhance the quality of care, become more productive, and drive down the cost to deliver our services.  It means we have the opportunity to be rewarded financially for being a high quality, low cost provider and to grow services which our community needs.  We must redouble our efforts to deliver the highest quality care using evidence based order sets and care pathways, better understand and manage our costs, and apply our Lean approach to continually eliminate waste and become more productive.  In other words, we need to be "the best at what we do."  And in areas that we cannot, we must be prepared to divest and do so responsibly, being respectful and minimizing the impact to our patients, staff, and physicians.

RVHS has embarked on a journey of continuous, positive change over the last few years.  We have embraced change and we have outperformed.  Funding reform will challenge us all to do even better.

(For more information on quality based funding, please read the Ministry of Health and Long-Term Care’s presentation.)

Why breastfeeding is best for your baby

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

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.