NHS Comments on the OHC Report
- Date of Issue: Summer 2010
PREAMBLE: The Niagara Health System’s (NHS) primary mandate is to provide community hospital services to the 434,000 residents of the Region of Niagara. NHS is one hospital comprised of seven sites with a workforce of 4,300 employees, more than 600 members of medical staff and more than 1,100 volunteers. On an annual basis the hospital serves approximately 192,000 patients through its Emergency Departments and Urgent Care Centres, performs more than 54,000 in patient and out patient surgeries, as well as nearly 30,000 in-patient admissions. As a hospital the NHS, abides by provincial healthcare policy and legislation and works collaboratively with the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) and the Ministry of Health and Long Term Care.
The Niagara Health System has undergone and is continuing to under go a series of significant changes in the way the hospital delivers health care services. These changes are outlined in the Hospital Improvement Plan (HIP) which was approved in January 2009 by the HNHB LHIN for implementation. Niagara Health is currently in its second year of a four year implementation of the HIP changes.
The May 17th 2010 Ontario Health Coalition Report makes a number of statements about the Niagara Health System, healthcare changes and hospital performance which the Niagara Health System comments on in the following summary.
NIAGARA HEALTH COMMENTS ON KEY THEMES CONTAINED IN THE OHC REPORT
PUBLIC DIALOGUE: Niagara Health appreciates and upholds the principle that healthcare is important to everyone and public debate is fundamental to improving it. The Ontario Healthcare Coalition and its local chapters have been catalysts for public dialogue on healthcare matters – locally, provincially and nationally. This is all very positive. Ensuring that Ontarians have access to quality health care is everyone’s goal. What’s at issue is what that means and how we get there.
The Niagara Health System’s goal and desire is to work constructively with communities and their elected members in the best interests of the patients and families served by our multi-site hospital.
While public dialogue is a vital element to community well being, everyone has an obligation to ensure commentary is truthful and accurate. Misinformation continues to circulate in the community that the Port Colborne Site and Douglas Memorial Site are closed or will be closed. This is simply not true. Niagara Health is committed to the Douglas Memorial and Port Colborne Sites. We continue to offer inpatient and outpatient services at both these sites and are working in partnership with other health care agencies as well as the local municipalities and the HNHB LHIN to identify appropriate new and expanded services. Work is underway by the NHS to expand the number of outpatient clinics at these two sites to better care for the health conditions of people resident in these two communities, such as High Blood Pressure, Congestive Heart Failure, and more.
OHC CALLS FOR INVESTIGATOR: Although the OHC report calls for an Investigator to turn back the clock, it should be noted that this action does not change the realities that hospitals – including the Niagara Health System - face. The Hospital Improvement Plan changes that were outlined just two years ago stem from evidence-based challenges with quality and resources – that includes having enough doctors and nurses and other health providers, modern medical equipment and facilities. The changes outlined in the HIP are fundamental to providing quality care.
All aspects of NHS’s operations have been reviewed compared to industry best practice guidelines. Since amalgamation in 2000, the NHS has demonstrated its operations are efficiently run. The NHS is performing better than its peer hospitals with respect to the operating costs per patient that are set by the MOHLTC.
FINANCIAL SUSTAINABILITY: The NHS now has an annual operating budget of $406 million which includes an additional $14 million in annual base funding from the HNHB LHIN and the MOHLTC that began with this 2010-2011 fiscal year. The hospital had up to this fiscal year a longstanding base funding shortfall, which has existed since the system was formed in 2000. This additional funding along with the cost savings achieved through the HIP helps the hospital get to a point of financial stability. This new increased level of funding for our hospitals will benefit people throughout the Niagara Region by helping to ensure that the Niagara Health System has the resources it needs to serve Niagara residents.
Now that the hospital is properly resourced, we can begin to free up funds to reinvest in patient care equipment and medical technology we need to keep pace with the advancements in patient care. Niagara Health is most appreciative of this funding increase and thanks the MOHLTC and HNHB LHIN for this important investment.
PATIENT STORIES: Niagara Health’s desire and goal is for every patient and their family to have a positive experience. At times where we fall short of this goal, we want to hear from patients and their loved ones so that we can follow-up and address those areas where our team can do better. Compassion, Professionalism and Respect are our hospital’s core values and our expectation is that every member of our team lives up these values in their interactions with all. We ask patients and families to let us know when we can do better. Feedback in the form of compliments and/or concerns will assist us to reinforce our efforts to provide quality care. It ensures that areas of improvement are identified and quality assurance initiatives are acted upon. We ask our patients and their families to share their compliments and/or concerns with our Patient Relations Specialist Natalie Foster. Natalie is located at Ontario Street Site and can be reached at 905-378-4647, extension 44423 or by e-mail Natalie.Foster@niagarahealth.on.ca.
THE NORTHERN AND RURAL HEALTHCARE PANEL: Niagara Health supports the work of the Government of Ontario’s panel of experts who as the Northern and Rural Healthcare Panel are studying and making recommendations on the role of small and rural hospitals. Similarly to how the NHS developed the Hospital Improvement Plan, the rural northern panel is developing their recommendations on the best practices that are evidence-based. The government’s Rural and Northern Health Care Panel was convened in 2009 to highlight current programs and services targeting northern and rural communities, identify rural and northern Ontario's unique health care challenges and recommend steps the government can take to improve access to health care in rural and northern Ontario using existing resources.
Niagara Health believes the establishment of the Panel demonstrates the government’s commitment to addressing the unique and diverse needs of these communities, and towards developing a well-informed small, rural and northern health strategy. The panel’s full membership represents a broad range of stakeholders and health care professionals who will draw on their experiences working in rural and northern areas of Ontario. Innovative models of care delivery will allow for rural and northern hospitals and other health care providers, such as CCACs, primary care providers, community agencies, paramedics, public health, and regional and provincial hospitals to work in partnerships with one another, enabled through information technology (e-health and telemedicine).
HIP CHANGES TO EMERGENCY DEPARTMENTS AT DOUGLAS MEMORIAL AND PORT COLBORNE SITES TO 24 hour a day / 7 days a week URGENT CARE CENTRES: There are a number of comments contained in the OHC Report about Niagara Health’s Emergency Department and Urgent Care services. Niagara Health feels it is important to provide the following clarifications.
With respect to Emergency Rooms, it is important to remember that not all ERs are the same. We refer to them as ERs but they do not all provide the same level of service. Today, the gold standard in terms of services accessible to an ER physician include CT, MRI, and access to surgeons/internists. These services were not available at the Fort Erie or Port Colborne EDs prior to conversion. Prior to the conversion, often times patients would arrive on their own or via ambulance and then often had to be transported out to another ED who had access to these services, which caused a delay in their treatment.
The conversions to Urgent Care Centres at our Port Colborne Site and our Douglas Memorial Site in Fort Erie were driven by quality of care issues. More simply put, the change to Urgent Care is intended to improve patient access to the right site, for the right care and on a more timely basis. Over 95% of the patients that used to go the EDs at Port and Fort continue to access great care at the UCCs – patient satisfaction is high and wait times lower than in our EDs; for the 5% - the sicker patients – they are now taken directly to a 24/7 ED which have the equipment/health care professionals required. Patients with serious conditions should always receive their care at the most appropriate full-service ER, not necessarily the closest ER. Stroke patients for example in Niagara have always bypassed the closest ER and taken directly via ambulance to our Regional stroke centre in Niagara Falls.
A comprehensive public education program has been in place by NHS to inform residents of these two communities about the availability of their local 24/7 Urgent Care services. This effort has helped restore patient visits to the levels experienced prior to the change to Urgent Care.
CHANGE IN HEALTHCARE: The OHC Report is silent on the context of change in healthcare. Niagara Health believes that change – no matter what the context –is difficult. And certainly change in healthcare is very stressful. Through the Hospital Improvement Plan, we’ve experienced the most significant reconfiguration of patient care services that has ever occurred in Niagara. When the HIP transformation is complete, the roles for our hospital’s sites will be different
The concept of hospitals being the provider of the majority of healthcare needs is indeed a thing of the past as hospitals and other care providers reinvent themselves. It just isn’t possible anymore given the increasing demand for care and associated costs; medical advances in the way care is provided; changes in technology; a national shortage of doctors, nurses and healthcare professionals that shows no signs of abating; and other trends in healthcare. Every hospital has to take all of these realities into consideration in order to provide people with the best possible care, not only today in 2010 but in the future.
The acute care hospital of the future will look and be very different from the acute care hospital of today. We will see the emergence of more and more technology-dependent services. Advancements in diagnostics such as MRI and computerized tomography will bring faster service for patients, quicker turnaround times for diagnosis and shorter stays for patients in hospital. More effective drug treatments and therapies will shorten in-hospital stays for patients. Advanced surgical capability will mean more procedures will be performed on an outpatient basis than ever before. Emphasis will be on keeping people healthy with more care being provided in the community. Evidence-based decision making and standardized treatment and the increased use of research will become the norm in health-care.
Hospital facilities and equipment we need to care for patients are rapidly aging at a time when advancements in medical technology, therapies and equipment are advancing. Yet health-care technology and equipment is extremely expensive. Demands on services and the costs of new technologies, drugs and techniques are all increasing, so we must make the best use of all our resources – people, buildings, equipment and dollars and focus on our core business which is delivering quality care.
Going forward Niagara Health must make the best use of our valuable resources – people, financial, facility, technology and equipment – in order for us to deliver the best care possible for the residents of Niagara into the future. We also have to look to the broader community, to shift reliance off of acute care services for those services that are best provided to patients in non-institutional settings like community health centres and community clinics. Investments in community services are vital to enable our hospital to focus on its core business of providing acute care. Health-care is about more than hospitals.
Our entire community has a vested interest in health-care in Niagara, and by working together, we can overcome the barriers and take the next steps in the evolution of NHS services, programs and sites. Our common goal is better health and better health-care for the people of Niagara, now and in the future.
UNDERSTANDING THE HOSPITAL IMPROVEMENT PLAN: The OHC Report while it references elements of the HIP, it does not speak to the full context of the plan. Niagara Health is of the view that to brace for population health needs ten years from now, we need to prepare today. In very simple terms that’s what the HIP is enabling us to do. Niagara is not alone in this transition or evolution. Some would say we are in fact ahead of the curve.
The HIP is aimed at reorganizing hospital services across our system to ensure the sustainability of quality health services. It balances resources available to us now and into the future, including doctors, nurses and other healthcare professionals, finances, facilities and equipment. The HIP is a plan for the Niagara Health System and the patients the hospital serves. It is based on the health-care needs of the residents of Niagara and the challenges and resources of the NHS to deliver that care.
Implementing the patient care changes that were outlined in the HIP is our key focus through to 2014.Through the HIP, we have made number of changes made that will see patients from across Niagara having to go to new locations for specialized care and service. There are different scenarios across the system where patients who live in Fort Erie or Port Colborne now will travel to Welland, St. Catharines or Niagara Falls for specialized services or where residents from St. Catharines may need to travel to Niagara Falls or Welland.
The manner in which hospitals provide health-care has significantly changed in past decades and the pace of change shows no sign of slowing. While change is often feared and unwelcome, there are many positive opportunities that can be realized through change.
LEARN MORE: Niagara Health welcomes you to learn more about the hospital, our people, our services and the HIP. Read more at www.niagarahealth.on.ca