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

Rouge Valley Ajax and Pickering hospital continues to provide excellent care in ice storm

Dec. 22, 2013 - 5:30 p.m.

Rouge Valley Ajax and Pickering hospital campus' regular power remains on.    Services remain open.


_________


Dec. 22, 2013 

Community update - 9:45 a.m.  

Rouge Valley Ajax and Pickering hospital campus staff and physicians have responded excellently during the ice storm the area has experienced this weekend. 

Babies were born and patients cared for as usual while the hospital was on back-up generator power overnight Saturday-Sunday. 

Regular power is back on this morning (Dec.22), with the back-up generator ready to re-engage if required. 

Rouge Valley Health System President and CEO Rik Ganderton said senior management is proud of the hospital's ongoing response in this extreme weather situation.
Rouge Valley Centenary's power remains on as normal and has not been impacted. 

The hospital will continue to provide updates on its blog, website and social media.

News media may call David Brazeau at 647-294-8885, or at dbrazeau@rougevalley.ca. 

David Brazeau

Director

Public Affairs, Community Relations and Telecommunications 

Rouge Valley Health System

647-294-8885

dbrazeau@rougevalley.ca   

www.rougevalley.ca       

Facebook/Twitter/Blogspot/Flickr/YouTube 

The best at what we do.  

CHEER up this holiday season

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By Lindsay Drysdale
Healthy Workplace Engagement Coordinator
Rouge Valley Health System

The holidays seem to sneak up on us and suddenly you’re stressing to get things done while trying to keep some semblance of balance.  It’s easy to get burned out this time of year, but with a little planning, stress can be managed.  To help you master the holiday madness, remember to CHEER up! Here are some tips on how to keep your sanity this holiday season:

1.     Create a budget. When it’s time to get your holiday shopping done, start with making a budget. Know exactly how much you plan to spend and stick to it. Create a shopping list in advance so you can avoid impulse purchases, and consider placing your shopping money and list in an envelope (tucked somewhere safe, of course) so you can keep track of your spending.

2.     (Ask for) Help. You’re only one person – you can’t expect to do everything yourself! Write a list of tasks and chores that need to be completed and divide them among your family.  Hosting a get-together? Make it a potluck!  Asking each guest to bring a dish gives you less to worry about and also eases the strain on your wallet. 

3.     Eat healthy.  It’s okay to indulge, but sometimes we use the holidays as an excuse to overdo it.  Eating in moderation is important, so have a healthy snack before you leave the house to avoid temptation later. And if you go out to eat, opt for a salad over fries, and skip dessert. When grabbing a treat, pick something with nuts for protein, or dark chocolate for antioxidants. Between all the sweets and carbohydrates, try snacking on some “super foods” like berries, rooibos or green tea, tomatoes, etc. to give your immune system the extra boost to help fend off stress and illness.

4.     Exercise. You can still make time to be active despite the cold weather and holiday madness! Grab a buddy and go for walk, take the kids skating, or try climbing the stairs twice when going between floors at work. Active living doesn’t have to mean hitting the gym; activity can be in 10-minute gaps throughout the day and planning your time in advance will help you stick to your goals. It’s also a great way to relieve stress!

5.     Relax.  Whether it’s reading a book, exercising, baking or watching a movie, do something every day that is just for you.  If you’re feeling burned out, reach out to your family or friends and ask for their support.  Their help will make it easier for you to find a few minutes to breathe. Taking time for yourself will relieve stress and keep your mental fitness in check.