Tuesday, 2 June 2020

Planning a gradual and cautious ramp-up for resuming hospital services

Our everyday lives have changed dramatically with the COVID-19 global pandemic and the same is true for hospital operations. Over the past two months, Muskoka Algonquin Healthcare (MAHC) has been nimble to implementing service changes to do our part to contain community transmission of COVID-19, to preserve critical resources for when they are most needed, and most importantly to keep our patients, staff and physicians safe. 

To ensure hospitals in Ontario had enough beds to care for a surge of COVID-19 patients, scheduled, non-urgent surgeries and procedures were paused in mid-March. Visitor restrictions were implemented, and our hospital auxiliary members stepped away from their volunteering duties. We put in place screening measures and made infrastructure changes to be able to expand our limited number of private rooms to meet isolation precautions for a highly infectious virus. Though it may have seemed that scaling back services meant less activity in the hospitals, our teams were implementing and adjusting to doing different things, or at a minimum doing things differently. Every function changed in one way or another. It was not business as usual for our staff, and I am exceptionally proud of every member of our team for their hard work, dedication and courage during an incredibly unprecedented and extraordinary time.
Redeployed Diagnostic Imaging staff spend time "spring cleaning",
 safely purging thousands of imaging films that no longer
have to be stored under health information retention rules.
As the Province of Ontario takes steps to reopen the economy, the health care world is also assessing its readiness and preparing plans for a gradual and cautious reopening process. This will not happen with the flip of a switch, nor will it be a one-size-fits-all ramp-up plan. We all must recognize the pandemic continues while we co-exist with COVID-19, safety precautions will continue for some time, and there will be a new normal for all of us.
Hospitals and their regional partners are figuring out together where, when and how scheduled care can safely resume for waiting patients. We appreciate the frustration and angst that delays in care have caused, and we too want to provide care as soon as possible. Regardless, our top priority is to make sure everyone will be safe when they return to the hospitals, and this includes making more changes that will protect against the spread of the virus, like respecting the ongoing need for physical distancing and other public health measures. Recovery planning is not just about restoring what we had the way it was, but also about rethinking and redesigning how we provide care in the future to reduce safety risks, embrace virtual care, and remain ready to respond to unexpected COVID-19 surges.
The government, which must approve our plan, has set out strict criteria that must be met before hospitals can resume elective surgeries. For example: the number of COVID-19 cases in the region must be manageable; hospitals must ensure they have enough protective equipment, medication, staff and community-based services to care for recovering patients; and we can’t start to ramp-up if our inpatient occupancy rate is above 85 per cent.
This message reinforces that health care has changed dramatically over the past two months, resuming services will take weeks not days and hospital operations will look very different as we move forward. At the appropriate time, patients will be contacted by the hospital or their physician’s office to advise them when their procedure will be scheduled. And in the meantime we encourage everyone to continue with self-isolation precautions to reduce the risk of exposure to COVID-19, continue to flatten the curve and avoid the potential for a second wave. Stay updated as the situation at MAHC changes by visiting www.mahc.ca/COVID-19/

Monday, 27 April 2020

MAHC Board’s Message to Our Communities

Phil Matthews
This blog prepared by Phil Matthews, Chair of the MAHC Board of Directors

As Chair of Muskoka Algonquin Healthcare’s Board of Directors, I am so impressed and humbled by the efforts of our health care teams in combatting COVID-19. During this crisis, the Board has been kept up to date on the pandemic preparations and status at the hospitals and has moved to virtual meetings like so many of you. Even while physically distant from the hospitals, we are well aware of the exceptional efforts being made by all members of the MAHC team. 

Although we have never experienced anything quite like COVID-19, MAHC has successfully adapted to the changing  circumstances every day. From the Pandemic Incident Command Team planning the details to the staff and physicians skillfully executing them, we have the utmost confidence in the hospitals’ pandemic preparedness. 

By every account our teams across our two sites along with our community partners have pulled together remarkably in the face of very challenging times. Examples are varied and many but include activities such as preparing spaces in the hospitals designated for COVID care that we hope will never be filled with patients, frequent simulations and scenario planning to ensure all details are accounted for, and collaboratively setting up and operating the Assessment Centres. To date, we have been fortunate to have seen very few cases in our hospitals. But if MAHC were to see a sudden surge of COVID-19 patients requiring hospital care, I know they are very well prepared. On behalf of all the Directors, I want to again say a most sincere thank you to all of the staff and physicians and commend you for your compassionate care and your courage during COVID. 

While the Board has the utmost confidence in our MAHC team, as a community we can still help them help us. First and foremost, please heed the government’s insistence about the importance of continued physical distancing. Please take care of yourselves – both emotionally and physically. If you have symptoms, please seek testing through either of the Muskoka Assessment Centres (more information can be found at www.mahc.ca/COVID-19/). Please remember to wash your hands frequently and thoroughly. Preparations for COVID-19 come with a cost to securing the necessary supplies and equipment to increase our capacity to care for critically ill patients. We are forever grateful for all of our communities’ support for our two hospital foundations and, especially in such trying times, we hope you are able in some way to continue with that absolutely critical support.

Thank you for doing your part, for standing by our side, for helping your hospital through various much appreciated donations, and helping your fellow community members.

Tuesday, 7 April 2020

Another Message to Our Communities About COVID-19

Since my first COVID-19 blog on March 25, I’m pleased to share another update with our communities from Muskoka Algonquin Healthcare. In the past week and a half, our emergency planning has continued to evolve to a greater level of preparedness for an influx of patients from COVID-19. We are taking the advice of public health very seriously that community spread is occurring, and we remind everyone of the importance of staying home and physical distancing from others. It is the only way to protect ourselves and each other, and limit the potential of overwhelming the hospitals during the pandemic. Our teams across both sites stay at work for you and we remind you how critical it is to stay at home for them, with the exception of essential trips for groceries, takeout food, or medications – and only if you are feeling well. Be sure to keep washing your hands! 
Like every Ontario hospital, MAHC will struggle with the patient surge that is anticipated still to come due to COVID-19. As a smaller community hospital we have limited personnel and limited space. Health care practitioners fill many roles in our communities and we are monitoring the wellness of the hospital workforce and recognize the potential for burning out these hardworking providers in every facet of health careOur teams are doing everything they can to provide excellent care for patients with medical needs unrelated to COVID-19, while responding with a dynamic pandemic plan. If COVID-19 becomes very prevalent in Muskoka, we have to remember how being able and healthy to go to work can impact many essential service workers. Please, please, stay at home.
There is no question the population in Muskoka has grown in the last few weeks. MAHC will always serve whoever comes through our doors to the best of our ability whether they live here 12 months of the year, operate a business, cottage here or are visiting our region. We all like to call Muskoka home, and we are all in this together. More than ever we must be kind, stop drawing lines, and support and respect each other. Our hospital foundations are blessed by the generosity of numerous donors, seasonal residents too, who make hospital care better for everyone.
With the concern and potential impact of community spread, MAHC has done a lot of work to put in place additional measures at Muskoka’s two hospitals including:
  • We have ensured robust infection control isolation precautions are practiced diligently everywhere at all times. Regardless of where potential or confirmed COVID-19 patients are, various practices are in place to protect against cross-contamination of any infection.
  • We are following guidelines for mask use and other personal protective equipment (PPE) and implementing directives that reduce the risk of potential transmission from anyone who could be carrying the virus but do not show symptoms.
  • We continue to monitor and react to a provincially-challenged supply chain of personal protective equipment. We’ve launched a community donations process through the leadership of our Huntsville Hospital and South Muskoka Hospital Foundations. We are so grateful to everyone for their overwhelming support of gifted masks, gowns and gloves, and hand sanitizer, as well as financial support through donations. Information about this streamlined process and what we are in need of most is on our website for anyone who can help.
  • We have worked collaboratively with our health care partners to open two assessment centres – one in Bracebridge and one in Huntsville. These centres are by appointment only Monday to Friday. Learn more about the process for getting an appointment at a centre if you think you have COVID-19.
  • We continue to work closely with our partners, and Home and Community Care to move patients to appropriate environments, which also been effective to reduce the number of admitted patients in each of our sites.
  • By moving quickly on difficult decisions to cancel elective surgeries, we have also been able to free up hospital beds should the wave come. In the days ahead, our Operating Rooms will be used for emergency surgeries only as we continue to align with updated provincial direction to ramp down services even more.
  • We have finalized our pandemic plan for a surge in critical care needs. This type of planning guides both mitigation and response and follows a phased approach that looks to maximize capacity at both campuses and identify and prepare appropriate spaces to manage COVID patients effectively according to infection control guidelines.
  • Teams are looking at innovative ways to change flows in the Emergency Dept. to create separate streams to serve COVID and non-COVID patient needs to protect the safety of all.
  • Our clinicians are modelling optimal care for COVID patients through simulations across both sites.
  • And providers are exploring virtual care options both in hospital and in community primary care so those who are ill have alternative means to get the care they need without leaving their homes.
Provincial and Ministry directives are changing rapidly as new information and statistics become available and are reviewed daily and by our Pandemic Command Team. Our staff and physicians remain committed to COVID containment and compassionate care. I am grateful every day for their courage and their hard work during these very difficult and often stressful times. On their behalf, I would also like to share some thanks to everyone who keeps us in their thoughts and prayers. 
MAHC has been very fortunate to be on the receiving end of donated masks, gowns and gloves, and hand sanitizer as well as financial support through donations, tokens of appreciation that have been dropped off, cards of thanks and well wishes on our social media posts, last week’s sirens of support from our fellow first responders, and grab-and-go prepared food for our teams from businesses that have worked with our Foundations. Countless community partners and friends have offered supplies, accommodations, other assistance and support, while donors continue to support and believe in our hospitals. This is the true meaning of community, and together, we will get through this. 
Please rest assured your Muskoka hospitals are committed to acting in the best interests of preparedness for our greater communities. We know this will be a long haul that will persist for weeks to months, but we also know someday this will be over. Take care of yourselves and your families. Be diligent with physical distancing. Stay healthy and stay safe!

Wednesday, 25 March 2020

Message to our Communities About COVID-19

This has been a difficult, unprecedented and extraordinary time for everyone. I would like to express my confidence in all members of the Muskoka Algonquin Healthcare (MAHC) team and share my utmost gratitude to all of our staff and physicians for their dedication to hospital care for our communities. We assure our communities that both hospital sites have measures in place to protect the health of our patients, staff and physicians. While things may be done differently during this time, please know that our team remains dedicated to treating everyone with care and respect. Some of the steps we have taken to ensure everyone’s safety include:
  • Initiating an emergency response to a pandemic plan, which includes daily command team meetings to ensure we are up to date on public health recommendations and Ministry of Health directives.
  • Screening everyone who enters the hospitals for travel history and symptoms of illness. 
  • Limiting all visitors with the exception of visits for compassionate reasons, including palliative circumstances.
  • Postponing non-urgent, elective surgeries. Affected patients are being contacted directly and will be rebooked as soon as it is safe to do so.
  • Reducing, suspending or relocating some hospital services in order to create capacity for an influx in the potential acute care needs during the COVID-19 pandemic.
  • Contacting patients directly to cancel most non-urgent, scheduled outpatient procedures and clinic appointments. Appointments will be rebooked as soon as it is safe to do so. Urgent procedures and appointments will continue.
  • Enhancing infection prevention and control protocols and managing supply needs and monitoring supply levels to ensure preparedness while protecting everyone in our buildings.
  • Working collaboratively with our partners to open community assessment centres in Bracebridge and Huntsville.
  • Sharing information both internally and externally as the situation changes.
If you have a loved one being cared for in our hospitals, please rest assured they will continue to receive high-quality, safe and compassionate care by our providers who are working hard to make their experience is the best it can be during these challenging times.  
We would like to also send out words of thanks:
  • To our team members for their unwavering commitment to patient care and to keeping our facilities clean, maintained and safe.
  • To our patients and families for their patience and understanding while daily routines are interrupted and we strive to continue to deliver essential treatment and care.
  • To our Foundation teams, and their donors for continuing to believe in our hospitals and offering support and words of encouragement. Now is a great time for giving donations to the Huntsville Hospital Foundation and South Muskoka Hospital Foundation.
  • To individuals, businesses and groups that are showing their appreciation and support by reaching out to offer various ways to help. We are feeling the love and we are grateful for every heartwarming offer. We are working through a process to ensure that gifted supplies are appropriate for hospital use and the best way to receive these. Please do not bring items to the hospitals unannounced. For a variety of reasons, we cannot accept gifts of prepared food and encourage you to think of others in our community who need that support.
  • To our health care partners and municipal leaders for working together with us.
We implore everyone to continue social distancing, which is critical to slowing the spread of COVID-19. Choose knowledge over fear. Please remember to be kind and support each other, especially our most vulnerable. 
MAHC continues to monitor new information on a daily basis  and is committed to informing the community of updates on our website at www.mahc.ca/COVID-19/. During these challenging times, we appreciate your continued support and understanding. 
Together, as a team and as a community, we can get through this. Stay safe and be well.

Wednesday, 4 March 2020

More is Not Always Better – Empowering Providers and Patients to Choose Wisely

Did you know that Canadians have more than one million potentially unnecessary medical tests and treatments each year? In medicine, as it is in life, more is not always better. This is the premise of the “Choosing Wisely” campaign.
Choosing Wisely Canada is a grassroots physician-led campaign that has been championed by passionate health care providers from coast-to-coast with a goal to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart choices. Tests and treatments often come with risks and harm. The goal of choosing wisely is to reduce care that is unnecessary and by doing this we ensure we are not subjecting patients to risks or harm needlessly. As well, this allows us to allocate hospital resources where they are needed and best utilized, and this too, improves patient care.
When Choosing Wisely Canada invited hospitals across Canada to join the global movement by making changes, small or large, to reduce overuse, Muskoka Algonquin Healthcare (MAHC) was keen to get involved.
In the fall, we created our Choosing Wisely Committee with physician and staff champions across both sites who began to look at options for how we at the hospitals can do our part to choose wisely and reduce unnecessary tests and treatments.
Through the leadership of the committee, MAHC has implemented five initiatives in support of reducing unnecessary tests and/or procedures, and in January achieved the Choosing Wisely Canada hospital Level 1 designation, joining the ranks of more than a dozen other hospitals across the country.
Staff display Choosing Wisely Canada Level 1 designation certificates.

Both sites received certificates acknowledging MAHC as a Level 1 Choosing Wisely Canada hospital.

These initiatives have brought about positive changes in processes such as a targeted re-evaluation of clinical order sets to ensure they are reflecting current best practices. One of the five initiatives, for example, is to require that all physician orders for daily blood work to have an end date. This helps to avoid unnecessarily repeating blood tests that may not change clinical care, but yet can cause things like hospital-acquired anemia.
There are interesting statistics that tell us that Canadians are mindful of unnecessary health care: 62% agree that there is a significant amount of unnecessary care in the health care system while 92% of Canadians believe patients need more support to know which services are really necessary for their health.
We want patients to also play a role in self-advocating and talking to their care providers about unnecessary care. It’s about education and conversations about when a particular test, treatment or procedure, may be needed and when it may not be.
I implore everyone to consider four questions that we all can be asking our care providers to ensure we are choosing wisely for our care:
1.    Do I really need this test, treatment or procedure?
2.    What are the downsides?
3.    Are there simpler, safer options?
4.    What happens if I do nothing?
We will be using posters in waiting areas and other means like our website and social media channels to spread the choosing wisely word.

Thursday, 9 January 2020

How to be a good visitor during flu season

Keeping your loved ones healthy during their hospital stay is our priority, but you can also play a role if you are planning to visit the hospital.
If you’re visiting a friend or family member or if you’re coming in for an outpatient test or procedure, it’s important to follow basic infection prevention principles – especially during flu season.
CEO using hand sanitizer to clean hands
Hand sanitizing stations are located inside
the entrances at both hospitals.
The flu is a serious respiratory disease caused by influenza viruses. It is spread by direct contact, like touching someone, and by small droplets we expel when we breathe, talk, sneeze or cough.
First and foremost, get your flu shot from your family doctor or at a local pharmacy. The best defense against the flu is getting vaccinated every year. Everyone older than six months should get a flu vaccine, and especially those who are at a higher risk of getting sick when they’re exposed to illness. Those at higher risk include people over 65 years, pregnant women, people with chronic medical conditions like asthma and diabetes, and those with compromised immune systems because of illnesses like HIV, hepatitis, and cancer.
Although most experts believe that influenza is most frequently spread by droplets, good hand hygiene can prevent up to 50% of influenza. This could be because these droplets can land on your hands or on surfaces that you have touched, and then often, and sometimes unconsciously, you touch your face.
Patients in the hospital are at a higher risk of exposure to illness, so to keep others safe it is always better not to visit patients in the hospital if you are feeling unwell. If you have flu-like symptoms like fever/chills, sore throat, body aches, fatigue, nausea and/or vomiting or diarrhea, it is especially important to stay home, avoid others and rest.
It’s also possible that you could have influenza before you feel any symptoms because the incubation period is 48 to 72 hours. That’s why good hand hygiene is really important.
Your role in helping to stop the spread of germs at the hospital starts when you first come through the door.
Use the hand sanitizing stations inside the entrances to each of our sites to clean your hands with alcohol-based hand sanitizer. Be sure to put on a mask if you have a new or worsening cough and wear it at all times in the building if you must attend the hospital.  
In health care facilities like hospitals, you should clean your hands often, especially before entering and after exiting a patient room or a care area. That’s because germs can also live on surfaces and clinical studies have shown that the influenza virus can live on hard surfaces for between two and eight hours.
Practice good respiratory etiquette by coughing or sneezing into your elbow. Avoid touching your eyes, nose, or mouth.
When we care for patients with the flu or influenza-like symptoms, our staff wears masks, gowns, and gloves. You should always talk to the nurse before entering a patient’s room, so you too are aware of what steps to take to protect yourself and others.
Like other health care facilities, Muskoka Algonquin Healthcare has policies in place to limit visitors in the event of a flu outbreak in the hospital, or even if influenza activity becomes widespread in the region.
Read the signs when you visit the hospital, check the www.mahc.ca website for updates, or call ahead for visiting restrictions.

Friday, 22 November 2019

Feedback is Your Gift to Us

CEO Natalie Bubela demonstrates the OFI tearaway
pads and deposit boxes for leaving feedback at both sites.
As the giving season draws near, I’m reminded of the gifts our communities give to us all year round that help make Muskoka Algonquin Healthcare (MAHC) better. Taking the time to share feedback about your experience as a patient or a visitor at either of our sites is a lasting contribution you can make to your local hospital that can positively affect everyone we serve.
We are always looking for ways to enrich the patient care experience, enhance processes and improve our facilities, which is why we provide a number of mechanisms for those we serve to provide feedback – positive or constructive.
Patient Satisfaction Surveys: for acute inpatient and emergency care help us identify where we are doing well and highlight where there are opportunities for quality improvement. Patients are selected at random by the National Research Corporation and we encourage you to complete this voluntary, confidential survey if you receive one in the mail. While these traditional satisfaction surveys capture the patient perspective across Ontario, we recognize that family can offer an important perspective on their loved one’s experience as well. This fall, MAHC joined the provincial roll-out of the Electronic Family Satisfaction Survey in the Intensive Care Units, which is geared to capture the family’s satisfaction with ICU care.
Comment Cards: have been introduced in some of our support services as a means of gathering in-the-moment feedback about inpatient meal service, and room cleanliness.
OFI Boxes: throughout both sites are “opportunities for improvement” (OFI) tearaway pads where you can note your comments and leave them for us in the deposit boxes.
Website: at www.mahc.ca/feedback/ compliments and concerns are easy to share with us. We also welcome feedback in writing by mail, or verbally by phone by contacting a member of Administration.
Above all else, we encourage you to be active participants in your health care. If you have a concern about your care or the care of a loved one, engage those involved around you at the point of care. Speak to one of the doctors, nurses or other care team members directly about any concerns you have. Good communication with your care providers is essential and helps to ensure the highest quality of care. If your concerns cannot be resolved with your care team, you can ask to speak to the manager or shift leader and have them help you find a resolution. You also have the option of contacting our Patient Ombudsman, either over the phone or in writing.
At MAHC, all feedback is greatly appreciated, and we take every compliment and complaint seriously. Letting us know how we are doing is the best way that you can help make MAHC better!

This fall, both ICUs joined the provincial roll-out of the Electronic Family Satisfaction Survey
where family members use iPads in the ICU to share feedback about their experience.