Tuesday, November 22, 2011

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.

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.
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
·         La Leche League Canada - http://www.lllc.ca/
·         Breastfeeding Inc. from Dr. Jack Newman - http://www.breastfeedinginc.ca/

Monday, November 21, 2011

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.  

Friday, November 4, 2011

My Personal Business Commitments are tied to quality improvement

My Personal Business Commitments are tied to quality improvement
Public blog to staff and physicians / By Rik Ganderton, President and CEO, RVHS

Focus matters.
All of the improvements we have made for patients at Rouge Valley Health System in recent years are driven by our focus on achieving specific goals. It is our standard work to set annual personal business commitments (PBCs) to define that focus.

My 2011/12 personal business commitments show how we will achieve our Quality ImprovementPlan (QIP) and our three-year Strategic Plan-On-A-Page.

My PBCs set out the direction for all other team members, vice-presidents, directors and everyone throughout the hospital. Think of the PBCs as our high-level work plan for this fiscal year and a set of steps toward achieving our longer-term strategic plan.

Connecting our PBCs to the QIP also aligns us with key provincial government legislation. The QIP stems directly from the province’s Excellent Care for All Act. So the QIP offers a roadmap to implementing improvements to our patients’ experience.

At Rouge Valley, we have committed to an ambitious set of goals to improve the patient experience. These are aligned with our Strategic Plan-On-A-Page and the four strategic dimensions embedded in it: 
  1. Access to Care;
  2. Service Excellence;
  3. Team Engagement; and
  4. Fiscal Responsibility.

Please read the MS Excel spreadsheet of the RVHS Executive 2011–12 Personal Business Commitments for me and the entire senior management team. You’ll see how each dimension leads to a set of measurements that we will deliver and track our achievements against. (View the members of senior management team and the roles that they play at our hospital.) 

Each commitment is connected to weightings – the relative importance of each item – so the items with the greatest weighting will receive our greatest focus. To view my goals and weightings just click on my tab in the document.

You’ll see that we are all committed to measuring our performance against four heavily weighted metrics: the hospital standardized mortality ratio; achieving a top notch emergency department patient length of stay for our admitted patients; meeting our financial targets of generating a surplus so that we can reinvest in infrastructure and equipment; and staff satisfaction, to support our team of employees and physicians in improving patient care.

The PBCs hold me, and us, accountable to:
  • Delivering high quality health care;
  • Creating a positive patient experience;
  • Ensuring that we are responsive and accountable to the public; and
  • Being transparent about it.

These PBCs start the chain of accountability to move us further along on our journey of operational and cultural transformation, which we started in 2007-2008.  

We continue to use Lean as our management philosophy and framework for continuous improvement. It is the philosophy and tool kit that enable us to implement the PBCs. It is our expectation that every department and program use our many Lean tools or techniques. These tools and techniques include value stream analysis, process mapping,  Kaizen events, standard work, reorganizing the work environment (6S), A3 problem-solving, process control boards, Kamishibai (visual management auditing mechanisms) and more.

In my next blog I will talk about how we are bringing a consistent strategic alignment throughout the organization and one of the specific techniques we are using to do this – the Gemba walk.

Tuesday, November 1, 2011

A survivor story.

(As part of our Patient Appreciation Day, we present this personal blog.)
By Tracy Paterson, Vice President, RVHS Foundation and breast cancer survivor

A few years ago, I never imagined I’d be writing a blog about being a breast cancer survivor. But here I am doing just that.

This December marks three years since I had my mastectomy. I sure didn’t expect that, at age 45, after finding a lump in my breast, and after a mammography and ultrasound revealed that it was highly suspicious for breast cancer, that I’d soon have to have my breast removed. I had none of the typical risk factors for breast cancer, and I’m the first one in my family and among my friends to have a diagnosis.

It certainly was strange being on the receiving end of patient care at the place where I went to work every day. But I had faith in my colleagues, and I was also fortunate to be treated in my community hospital, so that I could be close to my husband, daughters, friends and colleagues.

I remember thinking before my surgery about all the equipment that I would typically point out to potential donors during hospital tours.  Who knew that I would one day be using it?

When I awoke from surgery, there was a Christmas tree in my room decorated by my friends. It was a touching gesture, given how crummy it feels to be in the hospital over the holidays. When you’re faced with a critical illness, you’re not the only one dealing with your diagnosis and treatment. Your family and friends are affected too.

For the next year, I underwent my chemotherapy and radiation treatments just like the many patients who visit the chemo clinic at Rouge Valley Centenary. Having regular chemo sessions became a new, but weird, kind of normal. The chemo centre was very busy, and inevitably over the long hours of treatment, you’d strike up friendships with those sitting next to you. Some people are really outgoing and forthright about their disease. Others are more reserved. Scared,  really.

This part of my treatment was rough, though. The chemo cocktail of drugs prescribed for me left me feeling weak and tired. Plus, I lost all my hair, including the hair on my head, nose hairs, eyebrows and eyelashes. Boy did I miss my eyelashes! You never think about how important they are until the soap you use to wash your face runs into your eyes and they begin to burn.  

However, I’m fortunate that during that time, my fantastic colleagues were so supportive, and that my job allowed me to work from home or to come into the office when I was feeling up to it. If I was working in the office, the other staff members were careful not to come in if they weren’t feeling well, and were sympathetic when I was feeling under the weather.

And let me tell you, you really think about how important hand hygiene is when simple hand washing can make a difference to your health and well-being.

Cancer is different for everyone. No two stories are the same. What I experienced three years ago may be completely different from what someone else experiences today. But know that it is possible to survive it. I’m a walking example of that. 

During my treatment, I remember my two daughters looking up statistics on the internet and, after seeing the high survival rates for cancer, decided I was going to be just fine. It turns out that they were right.

Today, although I’m at risk for reoccurrence, I only need a follow-up MRI once a year.

I’m hesitant to say that things always happen for a reason, but maybe it’s true to some degree. Three years after my mastectomy, we now have a brand new, state-of-the-art MRI at Rouge Valley Ajax and Pickering. Having this quality of treatment available to our patients, and right in our community, is significant. It means that our patients no longer need to travel outside of west Durham to receive this kind of care, which many of us can appreciate.

Waiting for a diagnosis or treatment is incredibly scary and stressful.  And bringing down wait times and ensuring that life-saving equipment and services are available closer to home now are even more meaningful to me.

When I’m giving a tour to a donor of one of our hospital campuses and I pass by patients waiting in the lobby looking a little nervous, I wonder what they’re thinking. Especially since I was once in their shoes. I’m so very grateful to those compassionate, warm and knowledgeable health care professionals who saved my life three Christmases ago.

This Christmas, once again, I’ll be holding my breath a little. Hoping and praying that my MRI scans stay clear. And I’ll also be crossing my fingers for all those worried-looking people who I see in the lobby.

Wednesday, August 31, 2011

Ontario Breast Screening Program opens door for younger women at high risk for breast cancer

By Dr. Yun Yee Chow, Radiologist, Rouge Valley Health System

Cancer Care Ontario has recently announced the expansion of the Ontario Breast Screening Program (OBSP) to include screening for women aged 30 to 69, who are at high risk for breast cancer. The funding, which went into effect July 1, 2011, provides younger women at higher risk for developing breast cancer with annual mammograms and magnetic resonance imaging (MRI) scans.

Prior to the announcement, only women 50 and over were eligible for OBSP mammography screening. Early detection can significantly improve the chances of survival once diagnosed with breast cancer. This new development is great news for women under 50 who are at high risk for breast cancer.

The OBSP was formed in 1990 primarily for screening and allowed patients to receive a mammogram without obtaining a requisition from their family physician. In effect, they refer themselves, making the service more accessible for many women. It provided an environment with quality of care assurance, Canadian Association of Radiologists (CAR) accreditation and standardized reports and reminders. The breast screening clinic’s system navigator also helps to facilitate and guide the patients through urgent surgical and cancer care referrals.

The general screening OBSP population includes women 50 years of age and older, who have no acute breast symptoms or problems, no implants, no personal history of breast cancer, and have not had a mammogram in the past 11 months.

The newly-expanded high risk program will be available initially at certain sites called OBSP Assessment Centres with a family doctor or nurse practitioner referral only.  A genetic assessment can be arranged for certain gene mutations such as BRCA1and BRCA2, which can be seen in first degree relatives such as mother, sister or child.

Rouge Valley Centenary is currently in the process of becoming such a centre, with Rouge Valley Ajax & Pickering expected to follow in the near future.  The centres will feature state-of-the-art radiologic equipment and services, while surgical and oncologic departments will be available to breast patients. Our new system navigator, Channie Mak is on hand to help guide patients through difficult and complex breast issues.

Approximately 34,000 women in Ontario are at high risk of developing breast cancer. It is expected that the stringent screening process with MRI and mammography will detect an additional 17 cancers a year for every 1,000 women screened.

For most women, genetic screening assessments will be needed to determine whether or not they are at high-risk for breast cancer. However, high-risk factors include:

  • Women who are known to be carriers of the BRCA1 or BRCA2 gene mutation;
  • Women with a first degree relative that is a known carrier of the BRCA gene mutation carrier;
  • Women with strong family history in first and second degree relatives with breast and ovarian cancer;
  • Patients who have had chest irradiation for cancer prior to 30 years of age.
Speak with your physician for more information on genetic testing.

Women at high risk have a 25 per cent or greater lifetime risk of developing breast cancer. In other words, their risk is two to five times higher than most other women. Many of these breast cancers detected in younger women are more aggressive than those seen at a later age.

Finding breast cancer early means:

  • A better chance of treating and curing  the cancer successfully;
  • A lesser chance that the cancer will spread;
  • More treatment options.
Currently the five-year survival rate for breast cancer in Ontario is 88 per cent. Mammography is still considered the screening tool of choice. Both Rouge Valley Centenary and Rouge Valley Ajax Pickering’s breast clinics feature new low-dose full-field digital mammography units, as well the capability to perform stereotactic and ultrasound guided breast biopsies. This means that our patients have access to the highest standard of breast screening care, right in their own community.

Remember that prevention and early detection are key to living a long life. If you're not sure about what screening test to arrange, or how frequently you should be screened, you can have your questions answered by a short Cancer Care Ontario self screening on- line tool here or ask your family physician.

And learn more about Rouge Valley’s mammography program here.

Monday, July 25, 2011

Re-investing in our hospital

By John Aldis, vice-president, corporate and post-acute services, chief financial officer, Rouge Valley Health System

As reported in the treasurer’s report at the Rouge Valley Health System (RVHS) 13th Annual General Meeting of Members, held on June 28, it has been another very successful year for us. Fiscal 2010–2011, the third and final year of the hospital’s deficit elimination plan has been our best yet. RVHS achieved an operating surplus of $8.9 million, which was $3.7 million better than planned.
Overall hospital revenues increased by 4.1%, while our operating costs climbed 2.6% compared to the previous year.

Driving our success this past year has been exceptional revenue performance and our continued focus on operating efficiencies and cost containment through our Lean management philosophy. As part of our operating plan, RVHS put a major focus on revenue enhancement this past year.

In addition to securing additional post-construction operating funds for new space and expanded programs as part of our Rouge Valley Ajax and Pickering (RVAP) redevelopment, the hospital received bonus funding for achieving wait time improvement targets in our emergency departments at both sites. And we attracted additional funding during the year for performing more CT and MRI scans, more surgical procedures targeted by the government for reduced wait times, and more priority program cardiac procedures than we had planned. Finally, the hospital also secured new funding from the Central East Local Health Integration Network to open a 20-bed transitional restorative care program at RVAP.
We have already re-invested some of our financial surplus directly into patient care. Approximately $1.3 million was spent on various quality of care improvement initiatives, staff education and training, as well as new furniture, equipment, and mattresses that will help reduce the risk and spread of hospital infections. In addition, RVHS will use part of last year’s surplus in the current year to accelerate investment in major capital equipment and renew our aging facilities’ infrastructure.

While our capital needs far exceed available funding, the hospital was able to invest close to $74 million in capital this year—most of which was related to completion of the RVAP redevelopment.
Fundraising is critical to our hospital’s financial well-being, and 2010–11 was no exception. The RVHS Foundation donated and transferred $687,000 to the hospital this year in support of much-needed capital purchases. Thank you to all donors, volunteers and Foundation staff. 

We continue to make the most of every dollar raised by aligning the Foundation’s fundraising goals and efforts with the strategic priorities of the hospital.

Rouge Valley’s working capital deficit continued to improve and ended the year at $31 million. Improved cash flow and prudent cash management has enabled RVHS to build up cash reserves through the year, reducing short-term borrowing needs and reliance on debt to fund minor capital expenditures.  
Rouge Valley continues to be a very busy place. This year, the hospital treated approximately 29,000 inpatients, provided 52,000 mental health, rehab and complex continuing care patient days, and registered 109,000 patient visits across our two emergency departments. On the outpatient side, we had 190,000 clinic visits and performed 16,500 day surgery cases.

Thank you to our staff, who have done such a tremendous job in meeting the health care needs of the growing and aging populations of our east Toronto and west Durham communities.