Thursday, January 2, 2014

Year of improving patient care is a harbinger of continued progress in 2014

Blog by RVHS President and CEO Rik Ganderton 
To the staff, physicians, midwives and volunteers at 
Rouge Valley Health System (RVHS) 

Hello everyone and Happy New Year to all. 

Thank you to everyone for your dedication to our patients and all your continued hard work in 2013. 

The year ended with the ice storm – a tough end to a year of great change at RVHS. Please accept my thanks to everyone who struggled in to work to help our patients (and their co-workers) during this very difficult and traumatic event. The RVHS team pulled through and based on feedback through the Central East Local Heath Integration Network (LHIN), appeared to handle this difficult situation as well as anyone. 

The year marked further steps in our progress to becoming the best community hospital in the country. From a quality perspective we maintained or improved our record of making Rouge as safe as possible for our patients, families and staff. We met or beat our targets for managing nosocomial infections for VRE, MRSA and C. diff. Our record for central line infections and ventilator associated pneumonias (VAP) in our intensive care units (ICU) is exemplary and we are continuing to receive visits from hospitals across the province to learn from our successes. Our ICU teams are following the Institute for Health Improvement toolkit (which is based on Lean methodology) to ensure that we have full 100 per cent process compliance. Our unblemished record for VAP was halted with one incident, but audits showed we had followed all required protocols. Our performance on hospital standardized mortality ratio continues to be excellent and amongst the best in the country. 

Thanks to the investments we made in wound management in 2012 and the ongoing focus organization wide on pressure ulcer reduction we are seeing continued improvements in both the incidence and prevalence of pressure ulcers. We will continue to strive in 2014 to achieve an incidence rate of zero for new pressure ulcers (bed sores)! We are focusing on other nursing sensitive adverse events as part of our top 10 Balance Scorecard indicators. We are investing in training an education and hope to see significant improvements in this area in 2014. 

Our hand washing habits, while appearing to be good, still require ongoing efforts by everyone. Our independent audits indicate that compliance is not as high as it could be. Please for the safety of yourselves, your patients and your colleagues WASH YOUR HANDS at each “moment.” Let’s keep our patients and co-workers safe! Remember it’s easier to wash your hands than it is to manage patients in isolation, and whole lot better for our patients. 

Despite great efforts to make the flu shot as accessible to staff as possible and an assertive advertising campaign our staff flu shot compliance was abysmal. We dropped from over 40% in 2012 to low 30% this year. This is very disappointing and provides a real opportunity for further improvement. One hundred per cent compliance is our ultimate goal. We are NOT demonstrating to our patients and their families as well as our loved ones at home that we really do care and are paying attention to ensuring their safety. Please get your flu shot particularly as we are seeing a big spike in H1N1, which is covered by the shot this year. It won’t help our publicly reported numbers BUT it will help you, our patients, co-workers and families. 

We again served and treated more patients than in the previous year. Both of our emergency departments (EDs) saw and treated record numbers of patients during 2013. Both of our EDs saw visits in the mid 60,000 each – another record year!. Despite this we have seen continued improvement in our wait times in the ED for all CTAS levels of patients including those requiring admission. While we are not yet achieving our target of never having an admitted patient waiting in the ED we have made substantial improvements. We still have a long way to go but we are definitely going in the right direction! 

Operationally we had a challenging but successful year. We have been working on our “4 Must Do Can`t Fail Projects” that have consumed tremendous energy, but hold the promise of a leap forward in performance as we bring them to completion. These are – 
* Collaborative Care – we are now rolling this out to the surgical program and continue to refine the implementation in medicine. When we consistently get this right we will reduce the impact of nursing sensitive adverse events, we will improve our patient satisfaction and improve teamwork and staff satisfaction. 
* Bed Map – this has taken a huge effort and I want to thank Cheryl Williams, Rick Gowrie and Darren Gerson for their work on this – it has been intellectually challenging and hugely complex. It offers the opportunity to significantly improve patient flow while increasing satisfaction, quality and cost effectiveness. It will be a unique and totally new approach once implemented. 
* Service Training – Our first phase of this – Start with Heart has been rolled out and implemented. We have trained more than 2500 staff and volunteers. We are already hearing and seeing the positive benefits of this from patients, families and staff. The next round Respond with Heart was started in late October. Watch for more of this in 2014. 
* Staffing Resource Team - The SRT is up and running and we are aggressively hiring new staff to the team to provide coverage for sick time and reduce overtime. We are closely monitoring overtime and are beginning to see some reductions. We are also rolling out the web bases scheduling tool and are receiving positive feedback from staff in various departments on its ease of use, flexibility and user friendliness.

We anticipate, on a financial year basis, that we will achieve our budgeted surplus. This will be the sixth year of surpluses at RVHS. We have achieved this in a period of fundamental change in how we are funded. This has driven major operational changes such as how we manage joint replacement patients amongst several others. Special recognition to the Ortho surgical program for their work on dramatically changing how they manage joint replacement patients and becoming a performance leader in the Central East LHIN, if not the province. I will also congratulate the Cardiac program for the ongoing roll out of the cardiac rehab program, which is becoming a provincial model as well as the cardiac electrophysiology (EP) team for the performance of the first atrial fibrillation procedure at RVHS. 

Achieving surpluses allows us to reinvest in our facilities and equipment that has been so neglected for so many years. Speaking of investments in capital and facilities - Major Capital Equipment milestones in the last year has been the installation of two new catheterization laboratories to replace the old labs. In addition we purchased new cardiac echo machines for both hospital campuses and have embarked upon a significant bed replacement program. The bed replacement program will continue in 2014. By the end of 2014 we will have replaced most of our old bed inventory. We have also invested heavily in new surgical equipment including new tools, towers and anesthesia machines. We have been able to buy these and many, many other pieces of equipment because we generate surpluses. 

Special thanks also go to the RVHS Foundation for their tireless efforts on fundraising support and community engagement. 

Of course, we will continue to drive innovation and operational excellence through the ongoing use of Lean so that we can continue to benefit our communities, make RVHS a place all of us are proud to work and allow us to invest in our people so that we can be the best. 

No look back at 2013 can miss the most significant event in RVHS history, which were the LHIN motions of March 27th that initiated the proposed merger activity with The Scarborough Hospital (TSH). Thousands of hours of effort by many, many people including our dedicated volunteer Board of Directors has brought us to the point where we now know that merging RVHS and TSH is the right thing to do for our patients, our communities, our staff and for the health system more broadly. We have a clear plan to take us to the finish line. We are beginning the final phases of legal and financial due diligence and are starting the preparation of the required legal agreements. We are aiming to start the new fiscal year beginning in April as a merged corporation. This will no doubt make 2014 an interesting year for RVHS and TSH! 

Again thank you all for a tremendous year in 2013. 

This is my last New Year’s message to you all as CEO. Thank you all for your hard work, support and trust over the last seven years. It has been a remarkable personal journey for me and I have enjoyed working with you all immensely. I wish you all even more success in 2014 and to meeting the challenges that you will face. 

I wish you and your families and loved ones a healthy, happy, safe and successful 2014.

Rik Ganderton 
President and Chief Executive Officer  
Rouge Valley Health System