Volunteers are the Roots of Vibrant Hospitals

Volunteers are the roots of strong communities. They are also the roots of vibrant hospitals. National Volunteer Week is April 10-16, an annual celebration to acknowledge the generous contribution of our volunteers. As Volunteer Canada puts it with this year’s theme: “Just like roots are essential for trees to bloom, volunteers are essential for communities to bloom. Thanks to volunteers, our communities grow strong and resilient. Even the tiniest volunteer effort leaves a profound and lasting trace in a community, much like tree rings that appear over time.”

At Muskoka Algonquin Healthcare, we couldn’t agree more. Across the two hospitals, we are blessed to have more than 300 volunteers, easily recognizable by their green smocks and big smiles, supporting our community hospitals in Bracebridge and Huntsville through the Auxiliary to South Muskoka Memorial Hospital and the Huntsville Hospital Auxiliary.

Our volunteers are hardworking and caring individuals who are dedicated to supporting local hospital care. They assist patients, staff and visitors in nearly every area of our hospitals, promote awareness in the community, offer educational scholarship programs to both local students and hospital staff, and raise money to help purchase much-needed equipment. Their work is essential to our operation, and because of their support, we are closer to achieving our vision to provide outstanding care that is patient and family centered.

National Volunteer Week is a platform for us all to say thanks to the many volunteers who help make our hospitals stronger, and to let them know their efforts and commitment are appreciated, not only during volunteer week, but every day of the year.

To all of our volunteers, I cannot overstate your role and your contribution to safe, high-quality care. Each and every one of you makes a difference – not only to our patients needing care of one type or another, but to our Board of Directors, leadership team, staff and physicians. On behalf of all the people that come through our doors, I sincerely thank you and I hope that you feel a deep sense of satisfaction in knowing that you make enormous contributions to improving patient care at MAHC.

Natalie Bubela
Chief Executive Officer

Future Health Care Model Presented at Huntsville/Bracebridge Joint Council Meeting

Charles Forret,
Board Chair

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

The Muskoka Algonquin Healthcare Board of Directors recognizes the work that went into the proposal presented at the Huntsville/Bracebridge Special Joint Council Meeting on Monday, February 1. There has been a great deal of dialogue and commentary in the community from individuals like Ken Black, Dr. David Mathies and others demonstrating a growing understanding in the community of the potential risks and benefits of the different models that have been discussed for the future delivery of acute care.

While we understand our communities wish to preserve two acute care sites, the Board continues to believe a One-Hospital model best ensures safe, high-quality and sustainable health care for future generations. The Board is responsible for defining a long-term vision for acute care within the hospital setting, which is only one component of the concept presented by the municipalities focused on widespread health system reform. The Board also emphasizes that status quo is not an option within today’s provincial financial state and objective to transform and shift health care to more community-based care.

The model presented at the Joint Council Meeting builds on MAHC’s Centres of Focus or “Hybrid” model. There is merit to a Centres of Focus model in the shorter term as the Board feels that eliminating duplication of services and concentrating patient volumes by rationalizing services at one site is the only way to survive within today’s funding formula and ensure that programs and services we have today are retained and available in Muskoka. Movement towards a Centres of Focus type of model in the shorter term is inevitable without dramatic changes to the funding for MAHC.

The Board looks forward to further dialogue with our municipal partners, the North Simcoe Muskoka LHIN and the Capital Planning Task Force to better understand the implications of the model and if and how this model will be broadly supported by the residents and visitors in Muskoka and East Parry Sound.

The Muskoka Algonquin Healthcare Board of Directors strongly supports a more integrated local health system and coordinated patient- and family-centered care with the hospital/acute care sector as a key partner in a the region. The Board is open to working with the Hospital Retention Working Group, the municipalities and consultants behind each of the models to address specific questions to better understand the proposal and move forward on a solution that is sustainable for the future and that we all agree will provide the best quality and safe patient care for our communities.

Consultant Report is Directional

Ontario hospitals are required by law to balance their budgets on an annual basis. At Muskoka Algonquin Healthcare, this is becoming more and more challenging under the provincial funding formula for hospitals through the Ministry of Health & Long-Term Care.

Each year, MAHC prepares an operating budget for the upcoming fiscal year, and each year since 2012 that budget is prepared knowing that there will be no increase in funding to hospitals despite inflationary pressures we experience with salaries and wages, the cost of drugs and other supplies, and even heat and hydro. This is something that I refer to as deficit funding. We are expected to absorb all cost increases and produce a balanced budget. This means that for an organization the size of MAHC we have to absorb upwards of $1 million in cost increases annually or find cost-saving initiatives to allow us to balance the budget each year.

With great difficulty, MAHC has balanced the annual budget for the past five consecutive years by implementing unpopular changes. We have adjusted operations to eliminate redundancy and to match services to demand. We have reduced beds in both acute and complex continuing care. However a point is reached when there are no longer any cost-saving initiatives, and no longer any ability to absorb cost increases. It appears we have hit that wall, as many other hospitals throughout Ontario are also experiencing.

As custodians of public money, it is incumbent on us to always look for efficiencies, and to match the performance of our peer hospitals. We need to look carefully at our operations to understand what services we can continue to provide and how those services may be reconfigured so that we can live within the province’s funding formula.

So as we faced yet another budgeted deficit in the 2015-16 fiscal year, MAHC brought in an outside consultant with expertise in health care operations to take a fresh look at the efficiency of two of our care areas and recommend ways we can operate more efficiently. 

The Hay Group’s operational assessment reviewed our Surgical Services and Emergency Departments at both sites because we recognized the costs of running these two departments was higher than the funding we receive from the province to operate these services. The report includes various recommendations – some that pertain to staffing models, and others that suggest restructuring services. I want to assure you that no decisions have been made regarding the recommendations in the Hay report.

The report is directional in that it points us to areas that we can further investigate the feasibility and appropriateness of implementing the Hay recommendations to achieve cost savings. Our frontline staff and physicians in the Surgical Services and Emergency Departments are reviewing and evaluating the recommendations and investigating other strategies that may generate efficiencies. I recognize that some recommendations may be concerning. These are highly complex and difficult issues that can potentially affect our services and thus impact our patients, communities, physicians and staff. It is not our intention to create alarm in the community, but this is the harsh reality of where we are. MAHC has reached the point where service consolidation may be considered if the budget is to be balanced. Please keep in mind that consolidating services at one site or the other to concentrate volumes and maximize our efficiency is not new at MAHC. There are a number of services that for years have been available at only one of MAHC’s sites, such as urology and dialysis. There are also certain diagnostic tests that are performed at only one site because it is simply not practical to have two of every piece of equipment. Service consolidations may be small or large, but the goal is the same; to create one combined unit that is efficient and cost effective and that provides quality care. Service consolidation is not about eliminating services; it is about retaining services in Muskoka and delivering them in a different way.

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.