Update On The Niagara Health System

January 25th, 2012

HNHB LHIN Office

264 Main Street East, Grimsby ON

2

Overview NHS

Mission

Working within an integrated system for a healthier Niagara

Values

• Compassion

• Professionalism

• Respect

NHS Organization Today

• Douglas Memorial Hospital Site (DMH)

• Greater Niagara General Site (GNG)

• Niagara-on-the-Lake Hospital Site (NOTL)

• Ontario Street Site (OSS)

• Port Colborne General Site (PCG)

• St. Catharines General Site (SCG)

• Welland Hospital Site (WHS)

NHS Statistics

Budget= $410 Million (app.)

Approximately 75% of budget on wages/benefits

• Employees: 4,180

• Volunteers: 1,100

• Medical Staff: 614

Patient Care Statistics (all NHS Sites)

Number of Patient Beds (as of June 2011)

• Acute (Medical, Surgical, ICU, Obstetrics, Paediatrics, Oncology, Palliative, Nephrology)….. 450 • Mental Health…………………………………………....58 • Complex Care………………………………………….201 • Total Hospital Services Beds…………………..........709 • Addiction Services (Detox and Recovery)……………………...…78 • Long TermCare…………………………………………115 • Total Beds………………………………………...........902

Patient Care Statistics (April/10- March/11)

Average Daily Admissions……………….……………....90.3

Number of: Patient Admissions……………………….…………….33,178

Births ……………………………………………………..2,747

Inpatient Surgeries ………………………….………..…8,238

Day Surgeries…………………..…………….……..….35,058 .

ER & Urgent Care Visits…………………….….....…188,299

Clinic Visits ……………………………………….…..247,513

Diagnostic Exams (X-Ray, Mammography, etc.) ………..382,912

Number of Laboratory Exams …………………….6,393,134

With a population of over 434,000, Niagara is

comprised of 12 municipalities containing mid-sized cities, towns,

rural areas and two of the busiest border entries

into Canada

NHS

Acute care facility replacing the Ontario Street and St. Catharines General sites to provide services to St. Catharines, Niagara-on-the-Lake, Thorold and surrounding area

Will provide new regional services never before available in the region Walker Family Cancer Centre Heart Investigation Unit Longer-Term Mental Health Services

Will act as the hub of regional dialysis services, supported by the permanent dialysis unit in Welland and being planned for in Niagara Falls

Our New Health-Care Complex and Walker Family Cancer Centre

Milestones and Next Steps

Construction Start • April 28, 2009

Design complete • August 24, 2010

Substantial Completion • November 26, 2012

Opening to patients • Spring, 2013

Training & Orientation

February 2012

August 2012

Equipment Install

Overall Financial Position

• Estimated 2011/12 Budget Deficit- $4.5 M

• Estimated 2012/13 Budget Deficit- $7 M

Community Engagement

• “No Niagara” • History of competitive relationships • Perception of site hospital programs prior to NHS not

based in fact • Mayors/Municipalities (12 in total) heavily engaged in

health care at a local community level

• Many external reviews and studies

Previous Board

• Reasonable skills based background;

• Alleged “recycling” of Board Chair/Vice-Chair positions;

• Perceived lack of transparency;

• Adversarial relationship with local media.

Management

• Prior CEO/COS departed;

• Interim CEO/COS positions in place;

• Almost all positions filled internally;

• High turnover at manager levels.

Physicians

• Less than clear medical structure - site v regional

• Significant “top-ups” for clinical care

• Site focus not regional

• Perceived lack of input to decisions

• Low level of standardisation

• Inadequate data re MD performance

Staff

• demoralized;

• lack of pride in NHS;

• a few “hot spots”;

• patient/family complaints on attitude and lack of caring.

Initial Diagnosis

• Multi-faceted issue with several areas of significant concern;

• retention/recruitment at all levels are impacted by current state of dysfunction;

• confusion at all levels on corporate or site autonomy and accountability;

• in some cases “success” in one community would be seen as “failure” by others;

• great deal of skepticism that a solution other than 5 full service and acute care sites will be viewed as acceptable.

Other Considerations

• FIPPA will energize the skeptics and there will be significant media attention;

• with MOHLTC Supervisor, Office of Ombudsman

involved in process; • strong consensus view in Niagara that site of new SC

hospital poorly chosen- on edge of referral population.

Work to Date

1. Consultation:

a) Meetings - staff all sites; - physician leadership all sites; - Mayors and other elected officials; - families/patients on request.

b) Dedicated NHS Supervisor email site - review and

response to approximately 800 emails from patients, families, staff, physicians, community at large.

2. Introduction of timely response system to patient/family complaints/concerns.

3. Redistribution of resources to “Hot Spots” - Infection control - ER

4. Restructuring of leadership team - 6 terminations - secondments/posting of positions

5. Communication - regular blogs from Supervisor - departmental meetings when requested - ongoing meetings with Union leadership (ONA,

SEIU, OPSEU) and non-union “Peer Group” - emphasis on care and caring

6. Review of Program Alignment

Brenda Flaherty (HHS) leading team to review prior program alignment models (including HIP) and provide recommendations

7. Support for Management - establish mentoring program with leaders from SJHS and

partner organizations; - support for time/$ for continuing education - on site training on management best practices

8. NHS Wide Culture of Transparency - improved media relations; - openness at all levels of organization - encourage feedback and constructive criticism on ways to

improve patient safety, quality and caring

Potential Options

• 2nd new site in “South” • will involve closures;

• “Divorce” and decentralize governance/management structures;

• Keep model but drive more decision making /accountability to sites.

Next Steps

• Development of options (2 - 4) for widespread consultation by Spring, 2012. ?polling

• Recommendation to Minister by Summer 2012

• Board recruitment using CBAC

• CEO Search……