Talking About Our RVHS Strategic Plan 2015-18 Blog Series — Part 1: Our Vision

By Fred Clifford, Chair, RVHS Board of Directors

Presenting the hospital's new Vision Statement
at the Strategic Plan unveiling event, held on
July 7, 2015 at Rouge Valley Ajax and
Pickering hospital campus.

On June 23, Rouge Valley Health System introduced our new Vision Statement, as part of our 2015-18 Strategic Plan. The plan was approved that morning at our Board of Directors meeting, and shared for a first time publicly that afternoon at the Annual General Meeting of Members.

The new Vision Statement of the Strategic Plan represents Rouge Valley’s ongoing work as a leader in quality patient care for our communities.

Our new Vision Statement is Together – the best at what we do.

This statement builds upon Rouge Valley’s previous vision statement with the simple, but powerful, addition of one word: Together.

If you were to look up the word “together” in a dictionary (or these days, you may be more likely to Google it online), you would find a few meanings, such as:

– A group or collection in one place as a whole; 

– In proximity, contact, connection with others; 

– Simultaneously, in agreement or harmony.

All of this — whole, connection, harmony — is what we are so proudly stating about the kind of hospital we will be with our community. Our Vision Statement means that we will be the best at what we do:

– Together — With our patients and families to best meet their needs; 

– Together — As a team of staff, doctors, and volunteers;

– Together — As a system working with other healthcare providers, local partners and government to deliver services for patients and their families.

There’s one more meaning for “together” that I really like. It’s a little more colloquial, but is fitting as we embark upon this new Strategic Plan — and that meaning is: confident, organized, able to use your abilities to achieve what you set out to do. As in, “Rouge Valley is a very together community hospital.” Health care is changing, and we are ready to help shape that change.

With our Strategic Plan and our vision to be the best, we have set an ambitious course for the next three years. We know we can accomplish this, but we understand that it is only possible if all of us — healthcare team, patients and family, and health and community partners — are actively collaborating, partnering, getting engaged and being there for each other. I look forward to us achieving this together.

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Download a copy of Rouge Valley’s new Strategic Plan 2015-18. To learn more about the strategic planning process that led to the new plan, please visit www.rougevalley.ca/strategic-plan.

Growth, integration and investments in community needs are on the horizon

By Rik Ganderton, Interim President and CEO 

CEO's Message and introduction to 'The Blue Book'  
RVHS Operating and Capital Plan 2015/2016  

My thanks to all staff, physicians, midwives and volunteers for continuing to grow and integrate high quality services for our communities at Rouge Valley Health System (RVHS) during the previous fiscal year. Every year brings a mix of the predictable challenges, but also some new ones.  

In 2014/15, our teams managed through several difficult issues including: Ebola preparedness; accommodating 27 residents who lost their homes due to a fire at a Whitby long-term care home; a privacy breach; a tough flu season; a strike by nurses at the Community Care Access Centre; and surges in the volume of patients presenting to our emergency departments.

Despite these challenges, Rouge Valley is in a position to initiate new and much-needed investments for our ever-growing communities of Scarborough, Ajax, Pickering, Seaton and Whitby in the 2015/2016 fiscal year and beyond. Due to fiscally responsible management that has led to year-end budget surpluses in each year since 2008, we’ve earned the enviable reputation of being able to invest in new and future hospital services.

Rouge Valley is planning to meet the future needs of the soon-be-developed Seaton community in north Pickering, which will be home to some 70,000 people in about five years. At its public board of directors’ meeting in December 2014, the Central East Local Health Integration Network (LHIN) Board of Directors endorsed our early-stage pre-capital planning submission to continue planning in order to meet Seaton’s future needs. 

The Central East LHIN also endorsed two other significant early-stage pre-capital submissions: 

• Redevelopment of Rouge Valley Ajax and Pickering (RVAP) hospital campus, which has already surpassed the 60,000 annual emergency department visits it was expanded for in 2011; 

• Renovation of emergency department facilities at Rouge Valley Centenary (RVC), which community demand has significantly outpaced during the last 20 years. RVC receives more than 66,000 emergency visits a year in a space built for 20,000 visits.

We are also planning related extensive redevelopment at RVC in: surgery; inpatient units; ambulatory services; and diagnostics. 

Our pre-capital planning submission assumes that during the next 20 years, significant redevelopment of existing hospital capacity at RVC will be required to meet the healthcare needs of residents residing in the Scarborough cluster of the Central East LHIN. Planning data suggests a requirement for 1,100 to 1,200 beds by the year 2031. An opportunity exists to renovate, reconfigure and add capacity to the existing inpatient units at the RVC campus. This would bring the total bed complement to 550-plus beds, in an attempt to minimize the necessity for the entire replacement (e.g. new facilities) of all the hospital sites within the Scarborough cluster. (This assumes that one hospital in the range of 500-600 beds would then meet roughly one-half of the 1,100 to 1,200 bed requirements for the Scarborough cluster, exclusive of any repurposing of physical buildings required to support the delivery of ambulatory care services.) 

Integrations

One of our greatest strengths is our willingness and ability to work with other healthcare providers to create accessible and connected care for patients and their families. 

Thanks to new funding from the Central East LHIN earlier this year, Rouge Valley was able to transfer funds for a new full-time nurse to work with mental health patients in the community.

The new full-time nursing position at Durham Mental Health Services (DMHS) is now integrated with Rouge Valley’s Assertive Community Treatment Team (ACTT) in its Stepped Care service. The program helps people live in the community while receiving mental health care, without having to come to a busy emergency department. 

The latest initiative between RVHS and DMHS builds on their recent history of collaboration. Since 2011, RVHS transfers $200,000 a year to DMHS toward staffing a community crisis location in Ajax, again allowing people to be treated in the community rather than having to come to the hospital. DMHS also has a full-time staff member at RVC’s emergency department in our hospital-to-home program. 

Our regional cardiac care program also continues to be a beacon to others of integration potential as it exemplifies what can be done for patients accessing specialized care, such as Code STEMI, throughout Scarborough and Durham. The program also offers its regional cardiovascular rehabilitation and secondary prevention service now to Kawartha Lakes, as well as in Scarborough and Durham. 

The February 2009 Central East LHIN Hospital Clinical Services Plan identified the need for integrated cardiac rehabilitation services using a “hub and spoke” service delivery model, with common standards to establish local access to consistent, high quality services. In 2011, RVHS and Lakeridge Health (LH) submitted a Regional Cardiovascular Rehabilitation and Secondary Prevention Voluntary Integration Proposal using a hub and spoke model, with RVHS being the hub and LH the first spoke. The Central East LHIN approved $1 million of incremental funding, which enabled the following: 

A) Integration of the existing programs at RVHS and LH; and 

B) Harmonized referral criteria with centralized referral. There are now nine satellite sites across Scarborough, Durham & Kawartha Lakes. 

In December 2014, the Central East LHIN approved $1 million of funding toward the expansion of the cardiovascular rehabilitation program and establishment of the heart function management program, to serve additional patients, provide additional sites, and enhance support for patients with heart failure.

Setting the stage 

In the previous fiscal year, we set the stage for more growth and modernization of several patient care services. 

With the support of the RVHS Foundation, our surgical program has introduced GreenLightTM lasers for prostate surgery, greatly increasing the success of these procedures and minimizing patient discomfort and recovery time. The Cancer service has implemented the Prostate Diagnostic Assessment Unit to help men get faster diagnosis and treatment for prostate cancer. It is a multidisciplinary clinic staffed by urologists, radiation oncologists, medical oncologists, and a nurse navigator. The aim is to shorten the wait times for consultation and time to biopsy, pathology results, and treatment.

We have also recently set the stage for keeping wait times below three months for orthopaedic surgical patients (hips, knees, shoulders).  We’ve set a 90-day target from the time patients are referred to the day they have their surgical procedure done.  With proper funding, orthopaedic patients can get access to assessment and surgical or non-surgical treatment in 90 days or less. This is less than half the provincial target time from referral by a family doctor to the patient receiving the surgery in medically suitable cases. 

We have also developed and implemented a standardized process for hip and knee replacement and shoulder care that provides an improved patient/provider experience, lower system cost with high quality outcomes, and lower wait times for patients overall.

Our orthopaedic program continues with its innovative “prehab” approach for major joint replacements. We are also starting to work with our primary care colleagues in hip, knee and shoulders to introduce care pathways that span the typical silos. 

We continue to grow and develop our Women’s and Children’s program.  In 2014, we launched an extensive marketing campaign to promote this program. Since 2011, our Rouge Valley Centenary site has been a designated level 2C facility for maternal and neonatal care and is currently the only facility in Scarborough with the authorization to deliver and manage newborns as young as 30 weeks gestation.  To support our commitment to developing specialized expertise, we have opened a Maternal Fetal Medicine (MFM) clinic so that mothers at risk can access this service in their home community.  

Leveraging the expertise of our large complement of paediatric subspecialists and our close relationship with SickKids, we continue to expand our paediatric clinics to provide our community with access to paediatric specialty care close to home. 

Last year we introduced a new paediatric constipation clinic bringing the number of paediatric clinics to 17. In 2015, we will benefit from ‘twin’ family lounges generously donated and built by Ronald McDonald House – the first time they have ever implemented two lounges in one hospital at the same time.

Enhanced physiotherapy services were introduced last year at both of our hospital campuses for high-risk inpatients, especially the frail elderly, during the winter months. Additionally, the 2015/16 operating plan includes a significant budget investment of $400K for increased allied health services for weekend and vacation coverage.

One of our newest initiatives is helping to reduce readmission rates for patients once they are discharged from hospital. Studies have shown that inadequate support following discharge home contributes to a longer hospital stay, higher risk of negative health outcomes, and readmissions. Our Care After The Care in Hospital (CATCH) program is designed to fix that. It works to improve patient flow connecting physicians, nurses and rehabilitation therapists to work together to help reduce the patient’s chances of being readmitted for the same medical issue. Patients are referred to CATCH when they are discharged from hospital so they can manage their care at home without a setback forcing them to return to hospital.

 

Surpluses are vital 

Maintaining our ability to reinvest in our facilities, equipment and services is key to meeting community needs so we can grow with them. As we look to future growth and integration opportunities, it is important to maintain our resolve to generate annual operating surpluses. 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 successful deficit elimination plan (2008-11); 

• Fund our capital equipment needs. Our annual capital list, excluding facilities items, includes $17 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 achievement of our strategic directions; in 2015 we will acquire a new MRI and two new CTs as well as other types of new equipment; and 

• Fund future strategic growth initiatives. 

Capital and operational reinvestment will continue to take priority during the next fiscal year. However, sustaining this level of financial performance promises to be increasingly challenging as growth in volumes, in particular our emergency department visits, puts pressure on our bed capacity and cost structure. As emergency visits grow, our admissions grow. This can necessitate the opening of unbudgeted inpatient bed capacity.  

Managing volume growth in an efficient and effective manner will be a critical success factor for RVHS in the 2015/2016 fiscal year. We strongly believe that good quality costs less and continue our relentless focus on quality to support not only high quality care, but also fiscal responsibility. Our hospital has sustained its commitment to Lean thinking for over six years.  We continue to reap the benefits of this approach to continuous quality improvement, which underpins our 2015/16 Quality Improvement Plan.

We can proudly say that our track record is strong and sustained at Rouge Valley. Let’s make sure that we stay focused and aligned as a team. 

My thanks to all involved in the creation of this year’s Blue Book. All the best to the entire Rouge Valley team as plans and actions take shape this year and into the future. 

2014 Year-end Board Chair & CEO Message

Message from Board Chair Joan Wideman and President & CEO Rik Ganderton

December 22, 2014

As we enter the holiday season, I want to thank each of you, on behalf of the Board of Directors, for your ongoing work of delivering outstanding care to our communities. It has been another busy and exciting year for Rouge Valley Health System (RVHS).

Our CEO, Rik Ganderton will end almost eight years of successful leadership on Dec. 31. The Board has again been able to prevail on Rik to not cut the ties completely, and he will continue to provide strategic leadership advice and guidance to the senior team and the board on strategic matters until the new CEO arrives. Michele James has agreed to continue as acting CEO while Rik continues to support RVHS remotely. Michele will continue to have day-to-day operational responsibility. The Board is grateful to Rik for his visionary leadership and the turnaround of RVHS over the last eight years. He is leaving the organization in a much better and stronger state than when he joined in January 2007. It is our intention to celebrate Rik’s leadership and success at RVHS at an event in the spring, and you will see more information on this in the New Year. 

As you are aware, we have been conducting a search for Rik's replacement. We are very pleased with the number and quality of the candidates that have stepped forward. We have held initial screening interviews with 17 candidates and then selected a short list of seven for in-depth interviews with the selection committee (Board Executive Committee, plus Dr. Joanne Ma as President of the Medical Staff Society.) We now have a shortlist of three absolutely outstanding candidates, and we intend to make our final selection quickly. It is our hope that the new CEO will be on the job by the end of March.

While there have been many exciting events in the last year, the potential merger discussions and work with The Scarborough Hospital (TSH) took much time and effort from your Board, physician leadership, senior management team and many others. I want to thank every one of you for your tireless dedication and the countless extra hours of effort. While the merger did not proceed in March, we continue to believe strongly that it is the right thing for our patients and the local health care system. We continue to work with TSH on several integrations at the program level and are hopeful that at some point this opportunity can be brought back to the table for the benefit of our communities.

Perhaps one of the most important roles of the Board of Directors is to set the Mission, Vision, Values and Strategic Direction of the organization. We are now in the process of renewing our current 2011 – 2014 Strategic Plan. To this end, we have created a Board-led Strategic Planning and Branding committee with representation from the Board; physician leaders and front line doctors; union leaders; managers; community advisory group members and front line staff. There is also an Operations committee, which includes an even broader representation. These committees will be very active along with the new CEO as we re-examine our Mission, Vision and Values and renew our strategic direction. A key component of the process is understanding what our existing brand is and what the gap may be to the brand that we want (brand is not about name but about how our patients see us and think of us). We see the strategic plan and the brand as being inextricably linked and that our strategies must drive us towards brand improvement.

Looking into the future, we are sure 2015 will be another exciting year for Rouge Valley. We will have a new CEO to lead us into the future. We will continue to work with our health system partners to integrate our services and break down silos for the benefit of our patients. We continue to look at new opportunities and priority projects to enhance our services to our community. We may again look at organizational changes and opportunities such as mergers, whether these are vertical (up or down stream providers) or horizontal with other hospitals.

What we know for sure is that the health system is continuing to transform and that we want to be and will be a leader in that transformation. We will also continue to focus on our patients by ensuring they are at the centre of all of our decision making.

On behalf of the RVHS Board of Directors, I wish you and your families a joyous Christmas season, and best wishes for a safe, healthy and successful 2015 year!

Joan M. Wideman

Chair, Board of Directors

Rouge Valley Health System

I echo Joan’s thanks to the team. It has been a year of tremendous effort from every one of you, and I thank you all for your energy and commitment to making Rouge “the best at what we do.” As with any look back, there have been a number of highs and lows. It was clearly a low point when the merger did not proceed given the benefits we saw and frankly the effort that the teams from both Rouge and TSH put in to the project. We remain committed to integration and continue to work with TSH to integrate services for our patients. We also continue to work with our other health system partners and continue to further integrate services for the benefit of our communities.

There have also been many successes in 2014 that we should be proud of and celebrate. The most recent is the response to the Fairview Lodge fire. Along with our other health system partners, we were able to react and accommodate some 200 residents across the system — of which Rouge Valley took 27. Our health system partners were also able to find new temporary homes for these residents within two weeks of the fire — a remarkable achievement given the shortage of long-term care capacity.

One of our most exciting initiatives has been the new bed map. This has been a unique and innovative approach to managing the continuum of care for our patients. We have changed from the approach of moving patients to where the care is to moving care to where the patient is — a totally patient-centric philosophy. While this sounds simple, it is one of the most complex and far-reaching change initiatives Rouge has ever undertaken. It has impacted virtually every aspect of our care delivery processes. I am well aware that many of you have put in hundreds of hours of effort to make this change work, and I know that it has been very challenging on occasion. It will continue to be a challenge as we adjust our care processes to the new approach, but rest assured, it is making a positive difference for our patients (and for our staff). For instance, we are now physically moving patients far less often. This is much safer for patients as it reduces the risk of handoff errors. It also reduces the infection risk as we are not regularly changing the environment that a patient experiences. It is also a better patient experience as the care comes to the patient and the patient is not physically moved multiple times during his or her stay. It also reduces workload for staff, such as housekeeping (less cleaning), portering (fewer moves) and nursing (fewer moves and handoffs).

No look back at 2014 can be complete without the response to the Ebola threat, a deadly disease that arose again in West Africa on a huge scale and which for a time threatened to spread globally. Our domestic and local response required herculean efforts, and as with most similar situations, there was a modicum of confusion and wheel spinning before the new processes and procedures kicked in as a routine. The threat now seems to have diminished substantially, but ongoing vigilance is required to ensure there is no re-emergence of this or other similar threats. I wish to thank everyone for their unstinting efforts to ensure the safety of our staff and patients.

On an activity basis, we continue to experience growth in volumes and/or the complexity of the patients we are treating. We continue to see periodic surges in activity throughout the year and are currently experiencing yet another surge. This latest one seems to be driven by the spiking flu season, which is expected to peak over the Christmas and New Year’s holidays. Its impact is increased because of the reduced long-term care capacity caused by the Fairview fire and now the impact of respiratory and enteric outbreaks in several nursing homes, which means they are closed to admissions. We will as usual weather this ‘storm,’ but it will require your patience and continued dedication to serving our patients in the best way we can.

Rouge continues to develop the scope and volume of services we provide. Our regional cardiovascular rehabilitation program has continued to expand and now covers much of the Central East Local Health Integration Network. It is recognized for its innovation and it is considered as a model for the province. Its efficacy will be subject to a research study lead by Institute for Clinical Evaluative Services (ICES), which is very exciting for the program. Also leading the way in innovation and improving benefits for our patients is our surgical program. Examples here include the introduction of GreenLight^TM lasers for prostate surgery, greatly increasing the success of these procedures and greatly reducing patient discomfort and recovery. Our orthopaedic program continues with its innovative ”prehab” approach for major joint replacements and we are starting to work with our primary care colleagues in both hip, knee and shoulders to introduce care pathways that span the typical silos. We continue to recruit new physicians and build our bench strength for service delivery, and we welcome the 15 new doctors who joined us in the last year. There is no doubt that the effective relationships between the Board, management and medical staff is a true differentiator for Rouge.

Last but not least, I must mention the affiliation agreement with the University of Toronto, which was signed in the fall. This agreement will help us to attract new physicians and other clinical staff and offers and exciting partnership with U of T - Scarborough Campus. While definitive mutual directions have not been set, we are exploring opportunities in sports medicine, brain imaging and mental health with our colleagues at the Scarborough campus.

This is also my last annual message as CEO of Rouge. It has been a pleasure to serve as your CEO, and I look back with pride at all of the accomplishments that each of you, and Rouge as an organization, have enjoyed in the last almost eight years. You should have great pride in the organization you work for and the things you do every day to serve our patients and be the best at what we do. I wish you all health, happiness and success in the years to come and I hope that our paths may cross again in the future. Thank you.

  

Rik Ganderton

President & CEO

Rouge Valley Health System

Facing Prostate Surgery

Below the Moustache blog series

Dr. Arthur Grabowski, Urologist

Patients with prostate cancer facing surgery are naturally apprehensive. Not only are they usually concerned with how the procedure will go, the extent of pain involved and the time it will take for them to recover, they also worry about long-term side effects. 

In this blog, I hope to alleviate some of these concerns by providing a detailed account of what patients can expect to experience.

Let’s begin with the actual surgery itself.

If a radical prostatectomy is required, it is because a surgeon believes he or she can remove the localized tumour completely. This type of surgery is generally recommended for patients who are younger, in good health and have prostate cancer that requires treatment. The surgeon accesses the area either through a single incision or a few small incisions in the abdomen. Using delicate surgical instruments, the surgeon then removes the prostate gland and some of the surrounding tissue. This is an added measure to ensure the whole area is free of cancer cells.

The procedure takes approximately two to four hours, depending on the extent and type of surgery. When a patient wakes up following the surgery, he will have a catheter to empty his bladder and a small tube in his abdomen to help drain any fluid that may accumulate. He can expect to stay in hospital after surgery for two to three days. He is discharged home with the catheter, which stays in for 10 to 14 days to allow healing of the connection between the bladder and the urinary passage.

Now let’s look at what happens during recovery and any possible side effects.

For the next couple of weeks he may notice some blood in his urine. This is normal and will ease off on its own as the surgical site heals. There will be some pain, as with most surgeries, but it can be managed well with medications both in the hospital and once the patient is home. Each patient and his surgery is different. For example, some may need follow-up radiation if the cancer has spread beyond the confines of the prostate.

Long-term side effects also vary with each patient. Incontinence, the involuntary loss of urine, occurs in about two to seven percent of patients and can vary in degree from mild to bothersome. Erectile dysfunction occurs in about 40 to 50 per cent of patients depending on a patient's age, type of surgery and pre-operative erectile status. Again, these have varying levels of severity and can often improve with time.

Here at Rouge Valley Health System, we understand the anxiousness that patients may be feeling. That’s why we have a patient-centric model that guides how we care for patients before, during and after surgery. We want patients to have the best experience possible throughout their prostate cancer care journey. Our surgeons work with a number of other sub-specialists and healthcare providers to ensure we address all the health needs of patients. Often this means a team approach, which can bring together oncologists, counsellors and even home care professionals.

Rouge Valley urologists are ‘hands on’ in patients’ care well beyond the surgical suite. This is how we provide the best outcomes for patients in Durham and Scarborough.