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.

Reduce Your Risk for Influenza

Dr. Jan Goossens,
Chief of Staff

The flu season is beginning to ramp up across Ontario. Here in Muskoka the local health unit is reporting increased numbers of influenza cases. If you haven’t obtained your flu shot yet, it’s not too late to get immunized. This month’s blog is dedicated to that topic and has been prepared by Dr. Jan Goossens, the Chief of Staff at MAHC.

Influenza, or the seasonal flu, is a common and highly contagious infectious respiratory disease that affects the nose, throat, and lungs. Influenza viruses can change rapidly and that’s why there is a new flu shot made every year to protect against what is anticipated to be the three most prevalent circulating virus strains.

This year there was a slight change in one of the viruses covered by the vaccine, which means the virus is not quite the same as what is targeted by the vaccine. But this doesn’t mean that you should opt out of getting vaccinated this year. Past experience shows there could still be some protection against the variant strain of the virus. The original virus continues to be around and is well covered by the vaccine. As well, the vaccine protects against the H1N1 strain of flu and a strain of influenza B. If you’ve been immunized but develop the flu, the symptoms will likely be less severe.

The bottom line is the vaccine is still your best protection against influenza.

Some of the symptoms of influenza are similar to the common cold, but the flu almost always presents with a sudden onset of cough and fever. You may also feel fatigue, muscle aches, severe headache and a decreased appetite. Sometimes nausea, vomiting and diarrhea are also symptoms of the flu. The flu lasts longer and is more severe than a cold.

The Simcoe Muskoka District Health Unit is urging everyone to make sure they are immunized against the flu and we are doing the same at MAHC. We are urging all of our staff and physicians to get vaccinated. Getting the flu shot is a personal choice, but we hope you will consider it for everyone’s wellbeing. When you get the flu shot, you’re not just protecting yourself; you’re preventing the virus from spreading to the rest of your family or to co-workers, particularly those who have medical conditions.

It’s also important to remember the age old rules for protecting yourself:

• Clean your hands frequently with alcohol-based hand sanitizer or soap and water;
• Stay home if you are ill;
• Stay at least six feet away from people who are ill;
• Avoid touching your face;
• Frequently clean and disinfect commonly touched items and surfaces;
• Cough and sneeze into your sleeve, not your hands.

And don’t forget: Influenza is contagious to others for 24 hours before you feel any symptoms and for an additional five days from the onset of symptoms.
 
If you have flu-like symptoms and are at greater risk of developing complications (individuals under the age of six and over the age of 65 and those with a compromised immune system), contact a health care provider as soon as possible. See your family doctor about antiviral medication, get lots of rest, eat healthy foods and drink lots of fluids. Please avoid visiting the hospital’s Emergency Department unless your symptoms worsen. This is because many of our patients in the hospital are at greater risk of complications from the flu. They tend to be more susceptible to infection and that’s why we ask that you do not visit if you are ill with any respiratory illness.

We also want to reassure you that measures are in place to reduce the risk of exposure to the flu at the hospitals. We will be monitoring the situation in the community and are preparing for a potential increase in admissions this holiday season. If we experience an influenza outbreak at the hospitals, we will advise the community about restrictions or limitations on visiting hours.

More information about influenza is available on the Simcoe Muskoka District Health Unit's website.

MAHC is Preparing for Ebola Virus Disease

The topic of Ebola Virus Disease (EVD) is making headlines around the world and although the risk of contracting Ebola virus in Muskoka is very low, it’s important to know that your hospitals are prepared should a suspected case of Ebola arrive at our hospitals. This month’s blog is dedicated to that topic and has been prepared by Dr. Jan Goossens, the Chief of Staff at MAHC. This message was updated on November 25, 2014.

Dr. Jan Goossens
Chief of Staff

At Muskoka Algonquin Healthcare we understand there is concern in the community surrounding the Ebola Virus Disease (EVD), and the hospitals’ readiness and preparedness. We have been monitoring the situation around the world, and in the United States especially.  And, although the risk of contracting the Ebola virus in Muskoka is very low, we have put precautionary measures in place at our Emergency Departments.

I would like to assure our community that at MAHC we have infection control systems and procedures in place that are designed to limit the spread of infection and protect health care workers, patients and visitors. MAHC is working in partnership with the Simcoe Muskoka District Health Unit (SMDHU) and Ministry of Health to safeguard the public’s wellbeing. We have implemented a directive of the Chief Medical Officer of Health for managing suspect cases and we continue to receive updates and other information through the Health Unit and Public Health Ontario. We have undertaken enhanced training to ensure that staff and physicians are comfortable with procedures for putting on and taking off personal protective equipment.

Signage has been posted at all public entrances to our hospitals to help our patients and visitors to self-identify recent travel to West African countries such as Guinea, Liberia, Sierra Leone and Bamako, Mali. If they have travelled to any of these countries or have been in contact with someone who has in the past 21 days and also have symptoms of the Ebola virus such as fever, diarrhea, severe headache, muscle pain, weakness, vomiting or abdominal (stomach) pain, unexplained bleeding and/or a sore throat, they are asked to put on a mask and sanitize their hands at the entrance to the hospitals, and to proceed directly to the Triage Desk for assessment.

Please do not be alarmed if when you visit the Emergency Department the triage nurse is assessing your condition from behind a barrier. The Chief Medical Officer of Health has prescribed additional enhancements to Ebola preparedness and is requiring triage nursing staff at all Ontario hospitals to wear a gown, face shield, mask and gloves unless they are able to complete the assessment behind a suitable structural barrier. We have put appropriate structural barriers in place at both sites so that our staff do not have to wear the protective equipment.

Patients will be asked a series of questions by the Triage nurse, such as symptoms and travel history. If they are considered a suspect case of EVD, they will be isolated in our emergency department until transferred to one of the provincially-designated treatment facilities.

Please remember that in Ontario, and all of Canada, the risk remains very low, and the public should not be worried or alarmed. There has not been a confirmed case of EVD in Canada. In fact, the risk of infection with Influenza is much greater and more likely. Influenza symptoms often mimic the early signs of Ebola and we strongly encourage everyone to get their flu shot to protect themselves. Influenza kills more people every year than Ebola has throughout history.

What You Should Know

• While the outbreak in West Africa is both devastating for those affected and a concern for international safety, the Ministry of Health and Long-Term Care is reiterating that the overall risk to Ontarians from this outbreak remains low.
• While EVD carries with it a high fatality rate, the virus itself does not spread easily from person to person. It is spread through direct contact with infected bodily fluids, not through casual contact.
• If you have recently travelled to one of the affected areas, including Guinea, Liberia, Sierra Leone and/or Bamako, Mali, you are reminded to be alert for possible symptoms of EVD.

Symptoms

• Travel history to affected area
• Fever (greater than 38.6°C or 101.5°F)
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained bleeding
• Sore throat

For additional facts about Ebola, please visit:

Simcoe Muskoka District Health Unit

Public Health Ontario

World Health Organization

What option do you like for hospital care?

What’s the best model for delivering hospital care and services 20 years from now? That is what Muskoka Algonquin Healthcare is trying to determine and you can be part of it!

It is with excitement that I write this month’s blog to update your about planning Hospital Care for Our Future Generations. My June blog outlined the purpose of completing this capital planning for the future and described the process that the Ministry of Health and Long-Term Care requires us to follow. Since that time, more work has been occurring and I’m thrilled to share where we are at in this journey and some of the options we are considering for delivering hospital care, programs and services in the future.
It is important to remember that this planning work is for the future and any changes contemplated are not going to happen tomorrow. It takes several years – 15 to 20 in fact – to go through all of the stages in the Ministry’s planning process and there are several checkpoints along the way to go back and rethink and refine our plan and assumptions as new technology comes on board or other things change in health care. The Ministry requires us to look at and explore all potential models, even if they might be unpopular. We must ensure no stone is unturned, and so together with our consultants and architects we have developed three models (which include four options in no particular order) for serving MAHC’s catchment area.

Option 1 is to construct one new acute care hospital on a single site. The existing sites and hospitals would become surplus. At this point this is a theoretical model and no site has been identified.

Options 2 & 3 are an Ambulatory Site/Acute Site model to redevelop the existing buildings on the current sites. One site would be developed as an acute hospital, and the other site developed as an ambulatory care centre with urgent care. We have modeled this as two scenarios, one with the HDMH Site as the Ambulatory Site and the SMMH Site as the Acute Care Site and another with the SMMH Site as the Ambulatory Site and the HDMH Site as the Acute Care Site. This model assumes a combination of renovating the old buildings and building new space. The Ambulatory Site would not have inpatient beds and would deliver ambulatory care services such as dialysis, chemotherapy and cancer supportive care, fracture clinic, diabetes education, diagnostic procedures, and cardio-respiratory services, for example. The Ambulatory Site would also include an urgent care centre. The Acute Care Site would house a 24-7 Emergency Department and all inpatient beds for MAHC. The key difference is that traditionally urgent care centres do not receive ambulance traffic. If a patient arrived at the urgent care centre with complex medical needs, they would be stabilized and transferred as appropriate to the acute care site or another hospital.

Option 4 is to maintain two acute care sites through a combination of renovating the old buildings and building new space. Investments would be prioritized to the higher technology areas.

There are several guiding principles that the architects are considering in the potential design of these options. Designing for health is about human experience, connection, emotion, understanding and orientation. We want to create an environment of wellness, a strong connection to our community, flexibility for future change, a positive work environment for our staff and physicians, and operational efficiency.

The three models – (one-site model; ambulatory site/acute site; two acute care sites) will be evaluated using criteria such as: affordability, ease of implementation, sustainability, travel times, capacity for future growth, compliance with municipal planning, alignment with LHIN/Ministry priorities, and others including funding capability.

The Board of Directors has a goal to receive a recommendation for a preferred model in December or January. Given the importance and complexity of this planning, we are prepared to take the time to make our Master Plan the best it can be.

Our Pre-Capital submission (which is the first step in the Ministry’s process) will then need to be revisited and submitted to the North Simcoe Muskoka LHIN and Ministry of Health and Long-Term Care with the Master Plan in September 2015.
We also know that a portion of any capital build must be borne by the community, so affordability is a serious consideration. Having said that, it can’t stop us from visioning what our future should look like. The Ministry will cover 90% of the capital cost of a new build, while the community must raise 10% and the cost of all internal furnishings, equipment, beds, etc. Because of challenges with affordability, developments could be staged and funded incrementally.

While we are planning for the future, we will continue to renew and enhance our existing facilities now through minor renovations with the strong support of our Foundations and Auxiliaries to meet evolving standards and the needs of our community.What an exciting opportunity we have to really think and plan for how health services will be delivered in the future in Muskoka! I encourage you to get involved, review the material on our website and provide your feedback. This is your opportunity to help shape the future of care in Muskoka. Feedback will be accepted until Sept. 26, 2014. Please visit our survey at www.mahc.ca/planning-for-the-future.