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.

Hospital Care For Our Future Generations

An exciting initiative to envision and plan Hospital Care for Our Future Generations is underway at Muskoka Algonquin Healthcare. We started this planning late last year with our staff and physicians from both clinical and non-clinical areas. To date we have had more than 150 staff, physicians and community members leading this conversation, facilitated by planning experts. And late in May we brought our progress to our communities in a series of information sessions. Very soon we look forward to engaging our communities once again when we will be able to show you some options for how hospital care in Muskoka could look in the future.

What is Hospital Care for Our Future Generations? It’s simply that – exploring the types of programs and services that MAHC will provide in the future for your children and your children’s children. Like many hospital facilities built decades ago, our buildings are getting old and their infrastructure is limiting. Research and technology are improving how patients are treated and are changing the way that hospitals provide care. All of this, and other variables like workload data, the catchment area we serve, projected population growth, disease prevalence and travel distances, have been considered as we develop the options and consider the risks and benefits of different models. As part of Master Planning, all potential models must be explored and we would imagine that our community would also expect nothing less.

So in 2012 we started into the Ministry of Health’s capital planning process, a process that all hospitals in Ontario have to go through if they want to sell, lease or redevelop their land or buildings. We know this process is long and requires several ministry approvals along the way. We also know it is important to start planning early so we are in the Ministry’s queue for development projects. And on top of all of this we know that community support is key to any plan moving forward, so I encourage you to get involved. Not only will this work shape the future of hospital care in our communities, but it will also immediately provide a context for our infrastructure renewal planning

Step 1 - in the fall of 2012, MAHC filed a Pre-Capital assessment with the North Simcoe Muskoka LHIN and the Ministry of Health and Long-Term Care, and is now moving toward completing a Stage 1 submission.

Step 2 - Our next step is to develop what the Ministry calls a Master Program. It reflects our facilities’ present and future clinical service role within our communities. It outlines current and projected future programs and services, workload, staffing, and departmental space requirements by site. This work to develop a draft Master Program has been undertaken over the past several months through a series of planning team meetings at the hospitals.

Step 3 - I am excited to announce that over the summer months we will be working on the Master Plan stage to determine the potential space needs based on the proposed programs and services. As part of this stage, experts are evaluating the condition and potential use of our buildings, which will help to define our long-term development strategies over a 20-year timeframe to support the future delivery of health services as described in the Master Program. Internally, early this summer we will be holding a series of three integrated workshops with a variety of stakeholders, including architectural services, functional programming, hospital staff (clinical and support), and community representatives. The work that comes from these sessions will help inform the various models that we intend to bring to our communities in interactive sessions in late August. Please stay tuned to our website for more details.

By the end of 2014 we hope to bring a draft Master Program/Master Plan to the Board of Directors for approval, but it’s important to remember that the document is fluid and will continue to evolve as health care here in Muskoka evolves. This is certainly an exciting time at Muskoka Algonquin Healthcare and I hope you too are excited about what the future could hold.

The Value of Volunteers - Priceless!

There is a contingent of workers at our hospitals who put in countless hours and don’t take home a cent for their time. You can find them fundraising in the community and supporting patient care in nearly every area of our hospitals. Easily recognized by their green smocks and big smiles, our hospital auxiliary volunteers are hard-working and caring individuals dedicated to supporting local hospital care.

Volunteering is about giving back. Volunteering means working with others to make a meaningful contribution to a better community. At Muskoka Algonquin Healthcare, we are fortunate to have the South Muskoka Memorial Hospital Auxiliary and the Huntsville Hospital Auxiliary supporting our community hospitals in Bracebridge and Huntsville. These Auxilians assist patients, staff and visitors, promote awareness in the community, and raise money to help purchase much-needed equipment. It is thanks to support like this that we are able to realize our vision of Outstanding Care that is People Focused and make continued investments in the hospitals that improve patient care.

As a hospital administrator, every time I hear about all the work our volunteers are doing and the dollars they are fundraising, I am humbled – humbled by their generosity, commitment and contagious enthusiasm. Each of our volunteers has a story to tell, each of them comes from a different background with different life experiences, but yet they all have one thing in common – and that is their willingness to give of their time in support of the hospitals.

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 improve patient care at MAHC.

The value of volunteering is something money can never measure and our Auxiliary members are simply priceless.

Home First – A Patient-Centered Approach to Continuous Care

Muskoka Algonquin Healthcare embraces the home first philosophy and the ability for patients to receive continuous care in the comfort of their home.

Home – it’s a familiar place of comfort, warmth and security filled with memories and personal belongings. Just thinking about it soothes the soul and makes us feel better when we are unwell. So creating a concept where patients continue to recover at home with support services in place, after they are well enough to leave the hospital, is a patient-centered approach to providing continuous care. It’s why we at Muskoka Algonquin Healthcare support the home first philosophy – a component of the government’s Aging at Home Strategy and a significant shift in health care thinking to transition patients from hospital to home more quickly.

Often times, seniors are waiting in hospitals no longer needing acute care services and potentially moving to long-term care homes with health care needs that could be safely met in the comfort of their own homes with proper support. Hospitals are a place to receive acute care and to support you through serious, complex health concerns. When you are ill or injured, MAHC is here to provide you with safe, excellent care as long as you need it. Our goal is to get you well enough, and make sure in partnership with the Community Care Access Centre you have the right supports, to help you get back home where you are more comfortable and will recover more quickly in familiar surroundings, with the support of family and friends and away from diseases and other risk factors. 

At MAHC, we are committed to ensuring that patients, and especially seniors, receive the right care in the right place at the right time. In partnership with physicians, nurses and community health agencies such as the North Simcoe Muskoka CCAC, we are supporting patients and their caregivers in making informed decisions about their care. We want to help them understand why choosing home first may be the best option.

Why Home First? It’s simple. When given a choice, most seniors prefer to be at home than in a hospital. Outcomes are better when patients recuperate at home with appropriate supports, away from the inherent risks of hospitals, including risk of infection, pressure ulcers, falls and isolation. Once a patient’s acute health needs have been met in hospital, home is the best place for them to recover.

There are many good reasons to go home to recover: the familiar surroundings and overall comfort of your own home, being able to set your own schedule and make your own meals, sleep in your own bed and maintain the independence of doing more things for yourself in a normalized routine. Our community also benefits from your decision to choose home first. Our hospitals need to have beds available for patients with serious health concerns and having beds available will mean shorter wait times in our emergency rooms.

If you are admitted to hospital, planning for discharge is discussed from the beginning. The health care team works with you and your family to discuss what services are needed to support a transition back to home. The services are coordinated and referrals to community health agencies are made. Once at home, patients and their families can discuss long-term options and make decisions about any ongoing care needs.

We recognize that home first is not for every patient depending on their individual medical needs and physical capabilities. Our priority is our patient’s acute care needs and we are excited to embrace the home first philosophy and provide our patients with continuous care in the comfort of their home.

Watch a patient testimonial from the North Simcoe Muskoka CCAC or find out more at www.mahc.ca.