Tuesday, March 11, 2014

Exciting and challenging year ahead: CEO’s Message 2014/15

(RVHS publishes its Operating and Capital Plan, nicknamed the "Blue Book", each year on its public website. Here’s the CEO’s introduction of the Blue Book for 2014/15.)   

By Rik Ganderton
President and CEO, RVHS 

Next year promises to be every bit as challenging and exciting as this year has been for Rouge Valley Health System (RVHS).

My CEO message for our "Blue Book" is about three key opportunities and challenges for us in the year ahead, namely:
  • Quality patient care;
  • Fiscal responsibly; and
  • How the proposed merger with The Scarborough Hospital will help us better address these challenges as one larger hospital corporation.

There has been continued improvement and great potential to do even better in the quality of the care we provide as we look into, and beyond, the coming year.

Our team successes by staff, physicians, midwives and volunteers have set a solid platform from which to work. From a quality perspective, we have maintained or improved our record of making Rouge Valley as safe as possible for our patients over the last year.

We have 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 success. 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. To top it all off, we have been accredited with the highest rating (2012-16), exemplary standing, by Accreditation Canada.

In 2013/14, we also started on an ambitious agenda to put patients first where care is provided throughout Rouge Valley. Our bed mapping initiative will better align patient demand with budgeted beds, allow us to provide multiple levels of care in one place so patients needn’t be transferred to other areas, reduce wait times for admitted patients in our ED, and help us respond better to variations in demand. The new bed map is all about improving patient outcomes and getting them home sooner to their families.

Quality patient care is also about how that care is delivered every day.  In keeping with our Lean philosophy of respect for people, Rouge Valley implemented a comprehensive customer service-training program for all staff, volunteers and physicians in 2013. Based on the Cleveland Clinic’s Communicate with HEART program, we adapted the curriculum for use in our hospital and delivered the first phase, START with HEART, to more than 95 per cent of our staff, 80 per cent of our volunteers and 16 per cent of our physicians. The remainder of our team will receive START training in 2014, plus we will roll out our second phase, Respond with HEART and a supplementary program for leaders called Coach with HEART, beginning in February 2014. Patients are already telling us they notice the difference.

Fiscal Responsibility

As the 2013/14 fiscal year comes to a close, we expect to far exceed our budgeted operating surplus for the year. While this is a very good thing, the reality is we will achieve a very healthy bottom line because of some unusual, one-time items, which are not related to our ongoing core operations.
The major one-time items driving our surplus this past year are: 
  • Post Construction Operating Plan funding – During the year, the Ministry of Health reconciled funding we received in 2009/10 and 2010/11 related to our Rouge Valley Ajax and Pickering (RVAP) redevelopment and Rouge Valley Centenary (RVC) Birthing Centre.  As a result we got to keep more of this funding than we had estimated based on the volumes we had achieved in those years at each site.
  • Plexxus – Early in the year, Rouge Valley and the other 10 member hospitals of Plexxus, our shared supply chain services organization, negotiated a new business model. The new model is very favorable to our hospital and allows us to keep a much greater share of savings from Plexxus-managed supply and service contracts.
  • Rebates, revenues, and incremental funding – Over the course of the year, RVHS has received various unexpected and unbudgeted one-time rebates and revenues. We also received incremental funding to support certain services, including two additional beds at RVC ICU, cancer surgery procedures beyond our base funding, and magnetic resonance imaging (MRI) hours.
Apart from the ICU funding, which will continue, these unusual items are hiding the fact that we are exceeding our budgeted expenses in many of our programs and departments.  We know that our current run rate is not sustainable and that we will not generate a surplus next year if we do not address it.  We also recognize that the volume of services we are delivering continues to go up and we anticipate that under the new funding formula, we will eventually get some credit for these volumes through funding increases.

So, we have worked very hard this past year to design and implement two key strategic initiatives – the new bed map and the staff resource team – which will help us become more efficient and effective in the care we provide.  Through these initiatives, we will: better match our resources to patient needs; integrate acute with post-acute care; eliminate the waste of unnecessary patient moves and off-service patients; and reduce overtime and agency use, which negatively impact quality and our bottom line.  Working together to refine and adapt to the new bed map and integrated model of care, as well as fully utilizing the staff resource team, are keys to our success in the coming year.  Becoming more efficient, while improving the patient experience and quality of care we deliver, remains our mantra by necessity.

As I do every year, I’d like to emphasize that we need operating surpluses in order to:
  • Maintain and upgrade our facilities infrastructure, which was cash starved over many years of operating deficits before we implemented the deficit elimination plan (2008-11);
  • Fund our capital equipment needs. Our three-year capital lists, excluding facilities items, includes $37.8 million in front line patient care equipment, clinical support equipment, diagnostic imaging, and information systems, which are vital to the safe and efficient functioning of our hospital and the achievement of our strategic directions;
  • Rebuild our working capital. Our hospital’s working capital deficit continues to be one of the worst in the province. This is because while we have generated cash from operating surpluses over the last few years, we have been investing most of it back into the organization. Capital and operational reinvestment will continue to take priority over the next year while managing our working capital deficit, which is a concern to our funders at the Central East Local Health Integration Network and the Ministry of Health and Long-Term Care.
I am confident that we can, and will, become better and more efficient, as always.  But we are hitting the wall on what we can achieve as Rouge Valley Health System alone.

Proposed merger

A proposed merger with The Scarborough Hospital has been in the analysis, stakeholder engagement and planning stages since March 27, 2013. The proposed merger offers a significant opportunity to provide greater access to services, improve quality, attract more physician sub-specialists and make much better use of our limited tax dollars.

The challenges facing Rouge Valley and The Scarborough Hospital exist with or without a merger of the four hospital campuses of both corporations. A merger will make us more resilient to change as one larger hospital corporation serving Scarborough and west Durham. The final approval to merge rests with the Minister of Health and Long-Term Care.

We have positioned Rouge Valley for success, despite the many challenges we have faced this past year, and as you will read in our Blue Book, we will continue to do so in 2014/15.

My thanks to all Board members, staff, physicians, midwives and volunteers for their strong commitment to continually improving quality of care and the patient experience.