Monday, January 28, 2008

Town Hall Q&A

By Rik Ganderton
President and CEO
Rouge Valley Health System

Good day to you all.

It was my pleasure to present the latest information on the Peer Review Process and the RVHS approach to it in Town Halls this week.

That presentation is available here for your reference.

Thank you for your many insightful questions. I think, this month, I will share your questions from each of our Town Halls at RVAP and RVC on Jan. 23 and 24, along with the answers that we gave.

Here’s a sample of questions asked and answered:

Q1 - Is the Birthing Centre going ahead?
Yes, the Birthing and Newborn Centre is going ahead, as are our other two major capital projects--the redevelopment of RVAP and the Mental Health Supportive Housing Project.

Q2 - How about having a lottery to raise funds, like at Princess Margaret Hospital?
(Reply from Chad Hanna, RVHS Foundation President and CEO) The Foundation was involved in a car lottery that was not raising enough money to continue. The Board is always reviewing opportunities to raise funds, including our recently launched Cash Cow staff lottery.

Q3 - What will happen with our regional paediatric program?
Our regional paediatric program is unfortunately not funded as a regional program. Our pacemaker program and cardiac rehabilitation programs, among others, are also not fully funded. We have not determined any specific plan for these or other programs at this time. We are working with the Central East LHIN to determine how best to deliver these services within the region.

Q4 - How does our financial status compare with that of other hospitals?
Our working capital deficit is the worst in the province, I'm sorry to say. Years of overspending have put us here and now we must balance our budget and live within our means. Part of the issue is that we have, over the last several years, taken on programs that we are not funded for, and part of it is that we have not operated as efficiently as we could have and need to.

Q5 - The CE LHIN commented in the newspaper (The Scarborough Mirror) recently that staffing levels might be affected as part of implementing the Peer Review. When are you going to start implementing that?
We don't have that plan developed yet. We have already done the analysis on this. Now we are working (as a senior executive, medical leadership and Board team) to determine how we implement the changes we need. Staffing levels are going to be affected since 80% of our expenses are related to staffing. In order to scale our spending back to live within our means, we will have to look for staffing reductions perhaps as early as April. All collective agreement provisions will be adhered to for unionized staff members. We are committed to minimizing any involuntary departures and will treat staff as fairly as we can.

Q6 - Has the Peer Review team noticed we have a lot of empty space (at RVC)?
The Peer Review team didn't specifically comment on it. But this is a huge strategic asset for us going forward. It's a real opportunity for us four or five years out. We've got all this capacity. It will be easier for the CE LHIN to make use of our capacity than it would be to build a new hospital or expand other hospitals in the Central East area. We recently made use of our capacity in accommodating Lakeridge Health patients displaced by a fire last July at its Whitby site. But our capacity also extends to the 25 acres of land we have at each of our hospital campuses. We've got some short-term pain to go through. But our long-term future at this organization is very bright.

Q7 – Do we have enough patients to sustain the rehab unit?

Q8 – What if funding was pulled (for the rehab unit)?
I don’t have an answer on that right now. But I don’t see us closing down any program in the short-term. Those sorts of decisions can’t be made by one hospital in isolation. That kind of decision would be made with the CE LHIN after a great deal of discussion and planning.

Q9 – Have you sent our RVHS plan to the CE LHIN yet?
Not yet. We have submitted reports on our successful initiatives such as Agency Free and on revenue enhancement (examples - preferred accommodations, increased parking rates.) RVHS’ implementation plan will go before our own Board of Directors and then to the CE LHIN Board of Directors before the end of March.

Q10 – In your presentation you talked about maximizing the use of beds. Where will that occur?
I anticipate increasing bed capacity in the short term within the Department of Medicine at both hospital campuses. This will mean at least a reallocation from other services. However we must not lose sight of our key planning parameter – we will maintain our volumes in 2008/2009 at the same levels as in 2007/2008. We will use our resources, including beds, to do this more efficiently

Q11 – Aren’t you just robbing Peter to pay Paul?
If you want to put it that way, yes. We have to figure out how to balance our resources more effectively. The organization has to be appropriately resourced and programs must perform at benchmark efficiency levels. We will not be taking on any other services or programs unless we are funded for them, including wait time initiatives. We will live within our means.

Q12 – How are we going to address this in the community?
We have been meeting, and will continue to meet, with various community groups and healthcare providers in our area. We are working very closely with the LHIN on all our potential initiatives. We are also going to be speaking to the Collaboratives of the Central East LHIN, with each having representatives from many healthcare organizations and community members at one table. We are telling the community that we are going through this recovery process, but that we are maintaining patient volumes, as I said during my presentation. The community has also heard us say that we are maintaining both of our 24/7/365 Emergency Departments at each of our hospital campuses as well as continuing to provide access to Core Services. As you may know we have extra need in the Emergency Departments right now because two of our emergency physicians are seriously ill.

Let me close by saying: Thank you for bringing your skills and commitment to Rouge Valley Health System –and for helping us “Be the best at what we do.”

Tuesday, January 15, 2008

Rouge begins year of living within our means

By Dr. Naresh Mohan,
Chief of Staff
Rouge Valley Health System

We have started our year of change and renewed accountability at Rouge Valley Health System. Rouge is currently preparing plans to focus our two hospital campuses on Core Services, as aligned with recommendations in the Peer Review Report, which was received and accepted by the Central East Local Health Integration Network (CE LHIN) on Dec. 14, 2007.

RVHS recently held meetings with physicians, staff and volunteers to share information related to the start of this planning. In short, the hospital can no longer spend more than it receives in provincial government funding.

The CE LHIN is providing some support for RVHS, but not enough to eliminate our financial shortfalls. Not by a long shot. We will be receiving one-time funding of $5 million in 2007/08 and $3 million in 2008/09.

The message from the CE LHIN is that Rouge must solve its own problems by being fiscally accountable--living within our means. What we must do as a hospital system is eliminate our massive debt. We have a $40 million working capital deficit and another $38 million in long term debt, making us the equivalent of a family that is mortgage poor.

This constant financial issue could have quality of care implications if we do not address it. That is why 2008 will be a year of focused renewal at Rouge. We will focus on being the best at what we do.

Years of overspending and a previous lack of accountability got us here. Active accountability will get us out.

Core Services
How we deliver services at both hospital campuses will change. At the same time, we will maintain core services at both sites. This includes Labour and Delivery and 24/7/365 Emergency Departments at each campus supported by:
  • 24-hour anaesthetic coverage;
  • High dependency units (such as ICU);
  • General surgery capacity, including day surgery;
  • Community-level obstetrical and paediatric services;
  • General medical and geriatric services;
  • Some rehabilitation and mental health services;
  • Centres for diagnostics, treatment and ambulatory care.

Central East LHIN staff and board members will now support Rouge Valley's leadership as it designs a plan to address the findings of the Peer Review Report. Our plans on how to implement the Report will be submitted to the CE LHIN Board of Directors in February for its approval.

One of the important themes of our changes will be that RVHS will operate as one hospital system. All resources are corporate, meaning that they will be allocated at the discretion of leadership to maximize quality and efficiency. The "me too" attitude of our campuses, as highlighted by the Peer Reviewers, will end. We will need to deliver the best services we can in the most efficient manner, which may mean consolidated at a single site to improve quality and efficiency. Living within our means will mean much more than being fiscally balanced. It will mean that we will pool our human resources (staff and physicians) and equipment to provide gold-standard care for a given healthcare service in one place -- rather than spreading our resources more thinly across two locations.

Our hospital campuses are 20 minutes apart and therefore accessible to our communities of Whitby, Ajax, Pickering and east Toronto.

Central to our drive to be the best at what we do, Rouge Valley's renewal has begun with these themes:

  • We are and will continue to be highly skilled and dedicated;

  • We must truly become one hospital system;

  • We will no longer try to be all things to all people in healthcare. This past approach is a quality issue and a financial issue;

  • We will focus on Core Services, consistent with the CE LHIN, whom we will continue to work with in partnership;

  • We are committed to improve our processes for family physicians and their patients in their interactions with the hospital;

  • We will continue to communicate with you.

For more information on the Peer Review Report, please visit our public RVHS website page.

Attachment: Town Halls: Jan. 23-24, 2008 (96K PDF)