Tuesday, December 22, 2009

President’s Blog: SWOT analysis of 2009

To staff, physicians, volunteers

By Rik Ganderton, President and CEO

It has neither been the best of times nor the worst of times, to re-phrase a Charles Dickens line.

We have lived and worked through the greatest global recession in living memory, yet with this backdrop Rouge Valley has really found its footing as a patient-centred hospital relentlessly focused on improving the quality of care it delivers. We have dealt with many challenges in the last year and overcome them. Our staff, senior management team, physicians and volunteers have increasingly been working as a strong, cohesive team.

I will summarize some of our highlights of 2009 as successes, weaknesses, opportunities and threats to RVHS. As a reminder, we have all determined that our Vision is “to be the best at what we do.” And we have taken many strides towards that Vision this year.

Here are some of my thoughts on how Rouge Valley has fared in 2009.


We have had many, but here are a few top-of-mind ones.
• Our focus on quality yielded our hospital’s three-year accreditation. The surveyors found that our Strategic Plan-On-A-Page was among the best implemented and best known that they had seen and they spotlighted our Passport to Patient Safety training sessions as exemplary.
• The Central East Local Health Integration Network (CE LHIN) named our cardiac care program as a regional centre for the 401 corridor, recognizing years of ongoing patient care excellence.
• The opening of our new diagnostic imaging, fracture clinic and emergency department at Rouge Valley Ajax and Pickering (RVAP), which went live at 4 a.m. on Nov. 30, 2009, was a great success for us all and especially for our community. (See the photo of our first patient at this link.
• We are being recognized for our ongoing application of Lean management and methods by the CE LHIN and the broader industry. Some fine examples of Lean results by the Rouge Team include –
o Improved patient flow and discharge planning for patients at both of our hospital campuses.
o Faster turnaround times achieved for patients’ lab test results at both campuses.
o Shorter waits for our patients in emergency and shorter ambulance offload times at Rouge Valley Centenary (RVC).
• The new Birthing and Newborn Centre at RVC recently celebrated its first full year of delivering babies. Staff at the new centre have also led the way in implementing electronic documentation, which has improved the quality and accuracy of charting and improved processes for all staff using the system.
• We have received notification of first-year operating funding for both the Birthing and Newborn Centre at RVC and the RVAP Emergency. This will mean that we will be able to start to train and hire staff to support these new expansions in the new year.

We do have these as well, but fewer than we used to! We are better at managing them. Among our weaknesses are:
• Complacency – This is always a risk, but one that we are training ourselves away from with increasing Lean initiatives and successes of 2009 and 2008 to build on.
• Losing focus – We must relentlessly focus on improving the quality of care we deliver and we must continue to manage our operating costs diligently and carefully.
• Accountability for results is a mindset that we continue to develop. This includes greater transparency, staff empowerment and improved information for decision-making all supported by our Lean philosophy.
• Crisis management often dominates the time of our leadership team. Through Lean management we will shift our focus from fire-fighting to strategy and innovation.
Remember that every weakness is in fact, an opportunity for us to improve!

This is my favourite category.
• Our first opportunity is to continue building on our expertise in Lean management. This will be increasingly important as we continue to drive the quality agenda while managing through the inevitable effects of the recession. We will continue to develop our skills by integrating Lean training and education into our Management and Leadership competency development program called Advanced Leadership Foundations.
• Increased marketing of our regional centres of excellence in cardiac care and mental health. We will start to develop plans for the broader marketing of our services and strengthening our brand to one that represents the highest quality of care.
• Improving conservable days – meaning getting our patients home sooner. The reasons to reduce conservable days are simple and vital: timely discharges are good for patients as they recover better at home; it lowers their risk of infection; it makes beds available sooner to patients waiting in the emergency department; and it lowers costs to the hospital.
• MRI at RVAP. We are actively building our case to get ministry approval to have Magnetic Resonance Imaging services at RVAP. This is supported strongly by our hospital Board of Directors and is a priority item within our CE LHIN. Our RVHS Foundation is also ready to take on the challenge of fundraising for this vital equipment.
• Additional medical beds at RVAP. We are also actively working with the CE LHIN to add more medical beds at our RVAP campus to meet the demands of our growing community, improve access to critical care beds in Durham and to make the most of our new redevelopment space for the community.
• Continued practice of our ARC (Accountability, Respect and Caring) training. In short, let’s live our values every day: Responsive, respectful and caring to our patients, colleagues and community.

Threats are essentially the reverse of our opportunities, which I’ve just highlighted but there are some other significant threats that I need to talk about:
• Not achieving our Deficit Elimination Plan (DEP), which is entering its third and final year. We must achieve our annual financial targets, as we set out to do in March 2008, if we are going to meet our balanced budget responsibilities. We remain committed to our goals and will begin implementation of the third year of the plan in early January 2010. This will include further position reductions, but we will again minimize the number of involuntary exits through several redeployment strategies including the placement of staff into new positions created through the funding for the Birthing and Newborn Centre at RVC and the RVAP redevelopment. We must meet our DEP targets if we are to generate the cash we need to replace aging equipment and aging infrastructure, which you all deal with every day. We also have to be prepared to deal with the uncertainties in funding that may materialize next year. I will issue a blog on this early in the new year as well as hold Town Halls for broader discussion with staff, physicians and volunteers.
• Funding challenges. We’re certainly not alone in this boat. But we are better positioned, if we achieve our Deficit Elimination Plan, to respond to this threat. The Province, like all levels of government, has been severely constrained by the recession of 2008/09. Economic growth and catch up will take several years. It is possible that we will not receive the usual two per cent inflationary increase to our base funding next year, or potentially the year after. This will obviously mean that further cost containment, beyond the DEP, will be necessary if this scenario materializes. We are in fact planning for various funding scenarios (0%, 1% and 2 % increases) as instructed by the Joint OHA/LHIN H-SAA Steering Committee. However, it is important to understand that no decisions have yet been taken by government. Again I will let you know in the new year as this situation becomes clearer.
• As mentioned above, we have aging and previously neglected equipment and facilities, which will continue to require appropriate replacement and maintenance. We are factoring this in to our corporate plans. Clearly, part of the solution is the continued generation of operating surpluses to allow us to reinvest in our equipment and facilities. Without this reinvestment, keeping the lights on and continuing to provide high quality care will be difficult!

I thank you for your teamwork, your energy, spirit and collective wisdom during 2009.
Undoubtedly 2010 will be yet another year of challenge for our industry and RVHS. As a team we are stronger and better prepared to meet these challenges and the quality of care we are delivering is improving every day thanks to all of your efforts.

I wish you both health and happiness in 2010. All the best to you, your family and RVHS in the new year.