Friday, December 14, 2012

Next steps: How to organize “the system” for patients and communities – within our means

By Rik Ganderton, President and CEO, RVHS

We are taking the next steps in the evolution of the health care system at Rouge Valley Health System (RVHS) and as with any change process, these first few steps will be among the hardest.

We will be analyzing what services our communities need and how best to meet those health care needs within the constraints of the global and Canadian economy and the financial environment in Ontario. I outlined this context in my blog of Nov. 23, 2012.

The changes we are considering will take analysis, careful thought, creativity, open communication, consultation and expedient action to address the burning question: How do we provide the range of services that meet the greatest needs of the communities at the highest quality and in the most fiscally responsible way within our limited resources? 

We know that highest quality care doesn't always come from hospitals offering a wide array of specialized services.  We know that it costs more to try to do this because we cannot efficiently provide services that we perform only occasionally, and worse still, we cannot deliver these services at acceptable quality levels. This has been a challenge that hospitals have faced, but rarely talked about, for decades.

We know that choosing which specialties to focus our resources on will result in better outcomes, with fewer complications and fewer return visits for our patients. We also know that everyone would much prefer to have everything available in their local hospitals. So this is the balancing act we must achieve – delivering a range of services targeted at the greatest community need at the highest quality within constrained financial resources.

This is our opportunity to focus our resources to address the greatest community needs and grow the critical mass where we choose to specialize. We have already made some of these choices in previous strategic planning exercises, such as cardiac care, high risk maternal/child and advanced paediatrics. The process we will follow will identify those things that we do only occasionally or that we do not do well and we will then have to stop doing those things. 

It's our job, as health care providers, to inform our communities that attempting to be all things to all people is not good for their health, not sustainable and not affordable. In short, we want our communities, our patients, and our team, to know that that there are hard decisions ahead.

* Analysis *
We are seeking objective, expert advice to analyze and strategize on next steps that will allow us to provide an appropriate range of services to our communities.

There are two facts that are driving the analysis:
•    The hospital projects that, during the next three years, we will need to remove an estimated $30 to $45 million from our cost structure. Of this, some $15 million relates to the 2013/14 fiscal year (Year 1).  We have already identified the majority of Year 1 savings, which will include some staff reductions which were recently announced to our employees. Our focus is now on future opportunities in 2014/15 and 2015/16 fiscal years.
•    There is acknowledgement amongst our hospital Board, medical leadership and senior management that we have untapped opportunities for greater collaboration and integration across our hospital sites as well as with our colleagues in the Central East Local Health Integration Network (CE LHIN).

The hospital is seeking expert assistance to develop a plan that will address the following questions:
1.    Which services should we expand, maintain or reduce in order to provide the appropriate quality and access to acute care hospital services that the community needs?
2.    Which site or sites should host which of the hospital’s clinical programs? What are the financial opportunities and implications, if any, that reconfiguration would offer?
3.    What is the impact on health care service access in our community (west Durham and east Toronto)?
4.    What are the financial opportunities, if any, in a reconfiguration of services (what’s offered and where)?
5.    What leadership models would best support the achievement of standardized processes, quality, effectiveness and financial performance (value for our tax dollars) and at the program and service level, including implementation of any recommended changes?
6.    What is the road map for redefining the scope and size of hospital services during the next 18 to 24 months? 

The hospital expects the plan to focus on creating a stronger organization that serves the greatest needs of the east Toronto and west Durham communities, as part of an integrated delivery system within the CE LHIN. 

Specific requirements of the study are:
•    Identification of hospital core and non-core services for each clinical program;
•    Recommendations regarding service profiles and appropriate site or sites for the hospital’s clinical and support programs that will assist the hospital in meeting its operational challenges;
•    Recommendations regarding opportunities for enhancing RVHS competitive positioning under the recent and anticipated provincial funding and service model changes;
•    Recommendations for clearly articulated identities for both hospital campuses that are compelling, respond to community needs and are consistent with directions from the Ministry of Health and Long-Term Care and the Central East LHIN;
•    Recommendations that identify partnership opportunities within the Scarborough and Durham communities and the CE LHIN; 
•    Specific plans, actions and timelines that will allow the hospital to meet its operational challenges in year two and year three.

* Process *
It is the hospital’s expectation that the process used to meet these requirements will be:
•    Built on our existing Strategic Plan;
•    Evidence-based from known and valid sources;
•    Dynamic, engaging and paint a vision that is compelling for all participants;
•    Inclusive, transparent and engage the community in west Durham and east Toronto, our staff, physicians and volunteers.

Our analysis and planning make only a few assumptions, among them that community level birthing and pediatric services as well as emergency services will be maintained at each of our hospital campuses in Ajax and in east Toronto.
We are expecting to have a preliminary report in April and will be sharing this with our communities and partners at that time.

. . . 

As always your thoughts, questions and comments are welcome in this series of blogs discussing how we can provide the best care to patients within available resources.
Please either post your comments to this blog, or email us at