Embracing family presence at the bedside

Research shows that family, friends, and other support members play an important role in the patient’s hospital experience to improve patient safety and comfort, medical and psychological well-being, and the healing and recovery process.

Recognizing that family members are essential members of the health care team, we have worked over the past year to replace our “Visiting Hours Policy” with a Family Presence Policy that welcomes family members at the patient’s bedside 24 hours a day, 7 days a week.

The concept of removing prescribed visiting hours through a Family Presence Policy is growing in popularity across North America, and this month we are joining that growing movement and building on our vision to provide patient- and family-centered care.

So why is MAHC implementing a Family Presence Policy? Quite simply to put patients and families first. We know that a loved one’s presence makes a positive impact on the physical and emotional recovery of patients and supports the best possible health outcomes for the patient.

However, we cannot open the floodgates without a few guidelines to ensure safety for everyone impacted by this positive change. Our Family Presence Policy takes a common-sense and collaborative approach to visiting. This means there will still be guidelines or parameters around visiting, for safety reasons.

Our patients will define who “family” is to them. Family is not necessarily a legal entity but rather whoever the patient tells us they consider as their family and how they will be involved in care, care planning and decision-making.

Timing of visits will be determined according to the patient’s preference and in collaboration with the interprofessional team. We must remember that sick people need rest, so while there are no specified visiting hours, we like to respect that overnight hours are quiet time. We may restrict the number of visitors to acknowledge the needs, comfort and privacy of our patients in shared semi-private and ward rooms if the visit is too disruptive to another patient’s sleep and/or care or treatment.  Visiting may also be interrupted due to private patient care, infectious outbreaks, or other unforeseen situations.

Tips for Visiting

• We ask that families and other visitors come to the desk or nursing station of the patient’s care area before entering the patient’s room. This ensures visitors are not interrupting care processes that are private. 
• Children under 14 years of age are welcome and must be supervised at all times during the visit by an adult who is not the patient.
• Family members visiting during overnight hours between 10 p.m. and 6 a.m. are required to receive temporary “Visitor” identification from Patient Registration. If the visit is planned ahead of time, advance notice to the hospital’s Switchboard with the estimated time of arrival is appreciated.
• As always, we ask that people do not visit if they feel unwell in any way, but especially if they have a cough, fever, respiratory infection or diarrhea or if they have been in contact with anyone who has an infectious disease.
• Be respectful. Disruptive behaviour is not tolerated at MAHC.

The Family Presence Policy was led by our Patient- and Family-Centered Care Steering Committee and involved community consultation that helped us to better understand the benefits and barriers to removing visiting hours. Please feel free to talk with us about our new policy, and any special requests that you have. We will do our best to meet your needs, while ensuring the safety of all our patients in a restful, healing and safe environment.

Concerns Raised with Pre-Capital Submission

In 2012, the Muskoka Algonquin Healthcare (MAHC) Board of Directors set a strategic objective to develop a long-range facilities and clinical services plan. The planning goal was to ensure that MAHC could continue to sustain and deliver the very best health care to Muskoka residents in the years ahead. After two years of careful data gathering and analysis involving many stakeholders and following significant community engagement, the Board unanimously endorsed the One Hospital model, centrally located for the year 2030 and beyond.

Our Pre-Capital Submission was submitted to the North Simcoe Muskoka Local Health Integration Network for review on August 7, 2015. Through the month of September we worked collaboratively with staff at the LHIN to revise the Part A to incorporate their input and feedback based on their analysis of the projected demand on two North Simcoe Muskoka regional programs: Complex Continuing Care and Acute Integrated Stroke Rehab. Part A of the Pre-Capital Submission is our future plan for programs and services that MAHC will provide in the next 5, 10 and 20 years planning horizons. The Part A was revised to incorporate changes to the bed projections for the future and is posted on MAHC’s website.

On October 26, the LHIN Board of Directors endorsed Part A and directed the LHIN to facilitate further engagement between MAHC and the local municipalities to support enhanced awareness and endorsement for the proposed health service delivery model (one hospital) in the future. This engagement will be facilitated by LHIN Board Chair Robert Morton in the next two months and will involve representatives from MAHC and the local mayors and the District of Muskoka. We know that community support for the proposed future model is important to moving any potential capital redevelopment project through the Ministry of Health and Long-Term Care’s process. We are optimistic that these sessions with our elected officials will help them better understand the rationale for the Board-approved future direction to pursue one hospital and garner their support and the support of our communities at large.

At the same time, some of the area municipalities have raised concerns about the approach we used for our Community Information Sessions, as well as access to service in the future, the evaluation criteria utilized, and land use planning legislation and policies. I felt the need to address these concerns in my blog and explain our position.

Community Engagement

MAHC wanted an engagement approach with our community that would facilitate meaningful conversations, feedback and interaction with those directly involved in the planning such as the consultants, architects, Board members, physicians, committee members and administration. To that end, directly following the formal presentation, community attendees were encouraged to move through a variety of information posters and to stations set up for each of the models under consideration where they could engage one-on-one with the planning team members. Having directly participated at one of the stations and by observing the activity in the room, there was clearly a richness and depth to the conversations that wouldn’t have been possible using the standard microphone in the centre of the room approach where people line up to pose their questions or make their observations. This approach was validated by the very positive feedback we received from many community members with respect to the information shared, the format in which it was presented, and their access to those directly involved in the project. We were able to directly involve more people through this approach.

Access

The Board has acknowledged that access to services was one of the most common concerns raised within the 350 pieces of written feedback and other feedback that was received. The Board has made a strong commitment to being an active partner in local transportation initiatives and health integration efforts like the Muskoka Health Link and the Health Hubs to help improve access to care. In addition, there are several initiatives occurring municipally that will help improve access to all areas of Muskoka. Both the Towns of Bracebridge and Huntsville are working on their own transit strategies and the District of Muskoka has identified transit and the Highway 11 Corridor Bus system as a strategic priority. With these important initiatives underway and by working together as partners, MAHC is confident that transportation access can be improved not only for access to health care but for access to all services that Muskoka has to offer.  

Travel Times

Access to health care is more than just travel times. One of the primary considerations in MAHC’s planning work was to ensure the preferred model was one that would be sustainable for future generations, thus preserving current services. Sustainability and access to services was a risk to some of the models considered because those models did not allow for critical mass and efficiencies. Not achieving critical mass and efficiencies of some services currently available at one, or both sites, risks the availability of these services locally in the future, which could reduce access to care.

Evaluation Criteria

The criteria developed to assess the various models under consideration were based on several factors including Ministry criteria, advice from planning consultants, feedback from the working groups and an analysis by the Ad-Hoc Steering Committee that guided this work. The intent of the criteria was to provide decision-makers with an objective tool to compare and contrast the various options. It included several different categories, one of which was community support and perspective. The criteria helped eliminate some of the unfavourable redevelopment options early in the process that had the least support, such as the Ambulatory/Acute model initially considered. True to our commitment to a transparent and open process, the criteria that would be used to evaluate the models was broadly shared throughout the planning process and public information sessions.

Land Use Planning

Our knowledge and expertise is in health care service planning, not in land use planning and as a result we understood the importance of working closely with our Municipal and District partners. To that end, MAHC met with representatives of the District of Muskoka on several occasions. These meetings included the District Chair, the Commissioner of Engineering and Public Works, the Commissioner of Community Services, the Commissioner of Planning and Economic Development, the Commissioner of Finance and Corporate Services, the Chief Administrative Officer, and other District planning staff and engineers. The District of Muskoka and Emergency Medical Services team assisted with mapping and modeling and was consulted regarding the potential impact of one hospital. Generally, it was acknowledged that a single site model located somewhere between the two existing sites would pose challenges, but no initial deal breakers were identified in our meetings. It would be preferable that any services required for one hospital could build upon existing investments in infrastructure, such as water and sewer services. Preliminary costing by the District in their September 2015 report supports the fact that there is capacity in the system to do so.

I would be remiss if I didn’t remind my blog readers that there are many steps and years in the process before redevelopment approval is granted by the Ministry of Health and Long-Term Care. We need to be united in our attempt to build an accessible, innovative, and technologically advanced hospital that will provide safe, high-quality health care that our communities deserve and need in this highly competitive environment where limited capital dollars are available. We are committed to working with our municipal leaders and our communities to move this plan forward for Muskoka. The opportunity for us to come together to build the very best in hospital care is not only exciting, but a guarantee of health care locally for generations to come.

Work Progressing to Finalize One Hospital Submission

Since the decision in May by the Board of Directors of Muskoka Algonquin Healthcare (MAHC) to approve one acute care hospital centrally located as the best model to deliver health care services in the future – for the year 2030 and beyond, we have been working with our consultants to complete MAHC’s Pre-Capital Submission.

Our submission needs to be based on the most up-to-date information available, and we are refreshing our data with the latest population growth projections provided by the Ministry of Finance. Long-term planning is an “ever-greening” process of our proposal to reflect the most current information available to us. The Ministry of Finance's new growth projections, provided at the end of 2014, are lower than the 2012 figures and have an impact on the size of the facility required. We intend to submit our Pre-Capital Submission to the North Simcoe Muskoka Local Health Integration Network (NSM LHIN) in August. Our submission will be presented to the LHIN's Board of Directors at their next scheduled meeting on September 28th. Once the document has been submitted to the LHIN, it will also be posted on our website.
 

The Pre-Capital Submission Form is part of the Ministry of Health and Long-Term Care’s Joint Review Framework for Early Capital Planning Stages. The Pre‐Capital is the entry point into the Ministry’s capital planning process, which moves through a total of five distinct stages. The submission is essentially a 15-page template that poses a number of questions we answer to paint a picture of MAHC’s role as a health care provider in the local health system, as well as the initiative being proposed (a future one-hospital model). The “joint review” refers to the collaborative roles that both the local LHIN and the Ministry of Health and Long-Term Care share in reviewing the submission under the framework.

The document itself includes a Part A and Part B. Part A describes all program and service elements, while Part B covers the development concept and the physical and cost elements of the proposal. The LHIN reviews the Part A submission in the context of local health system planning priorities and develops recommendations and advice for consideration by the Ministry. The focus of the LHIN is to ensure that the programs and services outlined in the capital proposal meet the needs of the local health system. We believe we have met the expectation of developing our plan in the context of the NSM LHIN’s local system plans and local planning priorities.

  

Once the LHIN has completed a review of the submission, LHIN staff will develop a recommendation for its Board of Directors with regard to its position on the Part A submission. The recommendation is either “endorsement”, “conditional endorsement” or “rejection”. If the LHIN Board endorses the Part A program and service elements, the LHIN will provide written rationale and advice to the Ministry and direct us at MAHC to submit the full Pre-Capital Submission Form (Part A and Part B) to the Ministry. The Ministry maintains responsibility for the review and approval of projects, including review of all physical and cost elements as well as program and service elements from a provincial perspective.

This review process by both levels of government could take several weeks to complete. We hope to receive Ministry approval to advance to the next stage of the process by the New Year. In the meantime, the MAHC Board of Directors is eager to begin the site selection process, a process that could take six to 12 months and will involve internal stakeholders, community members and Foundation representation. Concurrent with the Board decision, the site selection process will target a central location and will involve criteria that ensure a rigorous, structured selection process. The Board will ensure an open and competitive site selection process that is accountable and transparent. Site selection is required as part of the next phase of planning – the Stage 1 submission.

A critical priority in the coming years is the MAHC Board’s commitment to being an active partner in local transportation initiatives and health integration efforts like the Muskoka Health Link. MAHC is one piece of a system approach to care in the region. We take our role as a partner organization very seriously and want to foster collaborative relationships that improve access to appropriate care throughout our communities and that is broader than the acute care provided by MAHC.

Board Endorses One Hospital Model for 2030 and Beyond

This blog has been prepared by Charles Forret, Chair of the Board of Directors of MAHC.

Board Chair Charles Forret

The Board of Directors of Muskoka Algonquin Healthcare (MAHC) has unanimously approved one acute care hospital centrally located as the model to best deliver health care services in the future that ensures safe, high-quality care that is sustainable for future generations. This long-range direction is for the year 2030 and beyond. If the government approves this plan, in approximately 15 years there will be one hospital in Muskoka serving MAHC’s constituents. As we continue moving in this direction through several planning stages in the years ahead, both existing hospital sites will continue to operate and provide our patients with the outstanding care they expect and deserve.  

In the next 15 years our model reflects that medicine and technology will be that much more advanced. In addition, the Province of Ontario is transforming the health care system through investments in community health care, services like health hubs and nursing stations, which will change the way hospitals take care of people in the future. We believe the health care environment will be different from a systems perspective as investments continue to shift from acute care to primary care. Change can be difficult, but we need to understand and prepare for this change. 

Although I appreciate this future direction revolutionizes today’s two-hospital approach, the Board believes one hospital will give us the best model for a sustainable future. One hospital will protect the viability of services in the future by concentrating patient volumes without duplicating services or costly equipment and technology. One hospital will help us ensure the best care in a stable environment that attracts and retains physicians and sub-specialties, and offers optimal working conditions that help to recruit competent staff. One hospital is the best solution to ensure high-quality hospital care in the most sustainable way, providing the best quality of care with everything we need under one roof with flexibility for growth. A two-site model financially burdens future generations of taxpayers and could conceivably lead to reduced services and less access to care. It is simply not sustainable or consistent with Ministry of Health and Long-Term Care trends.

In pouring over the feedback shared by our community, one of the biggest concerns has been travel distances and access to health care services. The Board takes this concern very seriously. I want to assure you that MAHC is committed to being an active partner in the integration of health services in Muskoka and East Parry Sound, and in participating in the development of transportation initiatives, to find meaningful ways to improve access to care in our community over the next several years. The Board also recognizes that one new hospital centrally located may be further for some to travel to, but believes when you get there, the care will be that much better.  

In reaching this very difficult decision, we are optimistic about what the future holds for our mission to deliver best-in-class health care. But we must maintain our focus on the present. Our buildings and equipment continue to age. Fundraising for capital expenditures and programs has never been more critical than it is today. Your continued    support will help us deliver on our commitment to provide outstanding patient care today, tomorrow and in the future. On behalf of the Board, I thank you for your involvement in this planning process, for your input, and your support of this future direction.

 

For more information, please visit our Planning for the Future webpage.

 

 

Speak up about the future! Your voice will be heard

As I write this month’s blog, Muskoka Algonquin Healthcare (MAHC) has just completed three Community Information Sessions in Gravenhurst, Bracebridge and Huntsville where we presented the final models under consideration for delivering hospital care for our future generations in the year 2030 and beyond. Additional meetings are also taking place to provide information about this planning process and the final models to as many of our stakeholders as possible across Muskoka and East Parry Sound. If you were not able to join us March 23, 24 or 25, I encourage you to visit our updated webpage at www.mahc.ca/planning-for-the-future where all of the documents and posters we presented in each of the sessions, including the slide presentation, are available for review.

As much as we are striving to make data driven decisions, we know that these are highly emotional issues. It’s logical that people might fear what they don’t know, but I must emphasize that the status quo of our two hospital sites as we know them today cannot exist for many more years. That is because of many factors, such as technological advancements in health care, funding challenges in the provincial health care system with a greater emphasis on community health care, and the changing demographics and evolving needs in our communities. The petitions in the community and the rallies held on March 21 are indicative of how people care deeply about their local hospitals. Those who participated can be confident their messages are being heard locally here at MAHC, as well as at Queen’s Park. I am inspired by the public’s involvement, whether it’s through a petition, a rally, or by attending our information sessions, and am grateful that people are adding their voice to the conversation.

Delivering the very best programs and acute care possible to the people we serve is what MAHC is all about. The public feedback we receive about the issues under consideration will help the Board of Directors make its decision this spring on the preferred model of service delivery for 2030 and beyond that will ensure we will continue to deliver the safest and very best quality health care that is sustainable in Muskoka.

Your engagement in the future planning process that we are require by the Ministry of Health and Long-Term Care to carry out, is very important to me as an administrator. I trust that those who attended our community information sessions will share the information they received from MAHC with their friends and family, and encourage them to become informed about these issues and to provide their feedback on the final models. Input may be shared through our website before April 15, 2015. Thank you for your continued participation as together we work toward a solution that will best meet the residents and visitors of Muskoka for generations to come.

We're Still Doing Our Homework on Long-Term Planning

It’s been a few months since I have blogged about Muskoka Algonquin Healthcare’s work to plan Hospital Care for our Future Generations. Mid-November, we updated our Planning for the Future webpage to share some of the feedback we received on the five different options/models that were under consideration for providing hospital services in the future. One thing that became clear from our consultation work in August and September is that one hospital in between Huntsville and Bracebridge is challenging. We have received clear guidance from the District of Muskoka about municipal servicing, which makes it more difficult to pursue the option to build one new hospital for all of Muskoka in the Port Sydney/Utterson area. We also received preliminary information from a cost estimator showing the range in size and cost of the potential redevelopment models that were on the table and the estimated 24% local share that must be borne by the community and an understanding from our Foundations of the challenges of fundraising the required local share while continuing to raise money for ongoing capital needs. On top of all of this, we have heard from residents, hospital staff and physicians about the advantages and disadvantages of the different models we were contemplating.

All of this has reinforced the need for us to undertake additional analysis and investigation into to a sixth model that blends the benefits of each model into a solution that meets the needs of the community and MAHC. Essentially, this means we are looking at one hospital model operating over two sites and exploring centres of excellence at each of our sites while also supporting sustainability, increased efficiency and reduced duplication. Back in November we also shared this in a press release to the local media to help spread the word.

So in late November and again in December, an internal working group of about 30 people (which included clinical leaders and 16 physicians including general surgeons) met to explore the art of the possible. They have suggested a variety of options that we are examining and no plans have been confirmed. Once a tangible strategy is developed, or one that we feel has some ‘legs’, we will engage our municipal leaders and our communities like we have on several occasions throughout the planning process. It is critically important to me and the Board of Directors for MAHC that the community is part of this journey and provides input that will help shape the future of care in Muskoka. We hope to have more public information sessions sometime in March, so please stay tuned and we hope you will attend.

At the same time, Health System Funding Reform, the funding formula introduced by the Ministry of Health and Long-Term Care, is putting further pressure on our ability to balance the budget, which is a legal requirement of the organization. MAHC is facing a revenue shortfall in 2014-15 as the mitigation period applied to the funding formula ends and our sites will experience the full impact of the funding formula. As well, as the Ministry shifts its investment in health care to the community our volumes are declining and are also impacting our ability to balance the budget. We need to ensure that whatever the future model of health care is in Muskoka can survive within the funding formula. We are engaging the Hay Group, a firm that is familiar with MAHC and its operations, to assess our current operations to ensure they are in line with the Ministry’s funding formula. This assessment will also help to validate and ensure that any future model of health care fits with the new funding and our costs.

I know there is some sense of concern in the community about the future of the local hospitals. I have personally answered phone calls in response to social media posts or blogs they have read, and I assure you that MAHC is committed to openly communicating with the community when we are in a position to do so. I think we have a proven track record in this regard. So, just for the record once again, before any decision is made by the Board of Directors, a plan for the future will be presented to our municipal partners for their input and to the community at large. We hope you will be part of the conversation.