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Achieving excellence, sustainability key drivers in Hospital Improvement Plan

Posted Jul 17th, 2008

Niagara, ON: A Hospital Improvement Plan (HIP) that provides a framework to enhance quality of hospital care across the region, balancing financial pressures, the needs of Niagara's aging population and the challenges of the ongoing shortage of doctors, nurses and other health professionals, was released today by the Niagara Health System (NHS).

The NHS was directed by the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) to develop the HIP after it was unable to balance its budget for the year ended March 31, 2008. The NHS ended the last fiscal year with a $17.9 million deficit on a $370 million budget. A budget deficit is projected for the current fiscal year.

"It is clear that the current situation cannot be sustained and not just because of the financial deficit .The status quo is no longer sustainable nor is it optimal. We have and into the future will continue to have very real challenges with being able to attract and retain the right number and right kind of healthcare professionals – doctors, nurses, and allied health providers – to operate the current model with the level of care that patients demand and professionals want to provide. The HIP addresses all those issues while improving care in Niagara, " Mrs. Betty-Lou Souter, Chair of the NHS Board of Trustees said.

On May 30, 2008, the NHS was directed by the HNHB LHIN to prepare a HIP by July 15, 2008 that:

  • Ensures the necessary expertise and resources are available to provide accessible, quality healthcare for the citizens of Niagara;
  • Identifies current and future hospital based services by site;
  • Establishes timeframes and specific targets for each year of the HIP;
  • Links the proposed strategies of the HIP and the public interest; and
  • Achieves a balanced operating budget by 2011/12.

The 311 page HIP is a patient-focused, five year Plan that:

  • Puts quality in patient care first;
  • Builds on the strengths of the NHS to ensure the necessary expertise and resources are available to provide accessible, timely and equitable healthcare for the citizens of Niagara;
  • Responds to the changing healthcare needs of people in the Niagara region;
  • Is based on best practices;
  • Is financially viable and makes the best use of our doctors, nurses and healthcare providers;
  • Will improve the quality of work life, teaching, and learning for our doctors, nurses and healthcare providers;
  • Will help attract the next generation of doctors, nurses and healthcare providers to the region; and,
  • Achieves a budget surplus of $1.5 million in 2012/13.

"The HIP speaks to a vision and a future that are proactive, thoughtful and demonstrative of the passion and commitment of our clinical leaders to transform hospital-based care in Niagara," said NHS Chief of Staff Dr. Bill Shragge. "The HIP takes what we know today about the health of our population and the trends in the health sector, and it makes conscious decisions based on best practices about the organization of hospital services to best meet the needs of our population in the future."

The HIP incorporated feedback from NHS staff, physicians, volunteers and members of the public, all of whom were asked through a consultation process to provide input on better ways to deliver quality care to the Niagara community and make better use of resources.

"This is a significant milestone since the formation of NHS in March 2000," says NHS President and CEO Debbie Sevenpifer. "The HIP provides a vision which is the next step in the evolution of hospital care and the broader health system in Niagara. Many of the changes identified in the HIP are consistent with the health-care transformation taking place across the health sector in Ontario and Canada."

The HIP responds to well-documented challenges facing the NHS, the community of Niagara and the country at large: an aging population, an aging workforce, decreasing population wellness and more chronic disease, a need to enhance patient and staff safety, increasing patient/consumer expectations, demands for a better quality of work-life, rising health-care costs, and poor integration of care particularly related to health-care information sharing.

"Healthcare usage increases with age. The HIP focuses on dealing with the future needs of our aging population," Dr. Shragge said. "Another significant challenge we face is that one in three Niagarans has diabetes, asthma, heart disease or other chronic conditions. The HIP responds to this increasing prevalence of chronic disease in Niagara."

Among the key principles used to formulate the HIP:

  • Every NHS site has a role that contributes to the overall healthcare of Niagara and at the same time recognizes the health-care needs of the local community's population that are in keeping with delivering high quality and safe patient care;
  • A number of "enablers" are essential to realizing the vision for change. These include a significantly improved medical and non-medical transportation system throughout Niagara and more services in the community to deliver non-acute care services like supportive housing and primary care.

The HIP supports moving from a provider focus to a patient focus and speaks to a system that can adapt to patients' needs across the broader health-care system. The HIP identifies significant changes to the way NHS delivers patient care services into the future.

The vision outlined in the HIP includes:

  • The creation of Centres of Excellence to provide new and/or enhanced specialty care in the areas of Oncology; Cardiac Catheterization; Stroke; Women's and Children's Health; Mental Health; Addictions; Diabetes; Nephrology; Surgical Care (Dental, General Surgery and Endoscopy, Gynecology, Orthopedics; Otolaryngology, Ophthalmology, Plastics, Thoracic, Urology, Vascular).
  • A refocus of Emergency Department services at the Port Colborne and Douglas Memorial sites to Prompt Care Centres and then over time to an enhanced Primary Care service as an integral part of a Community Health Centre;
  • The introduction of slow-paced recovery/rehabilitation for patients with complex medical needs; supporting people to transition home with support or to an alternate, more appropriate care environment. These centres of excellence would be located at the Port Colborne and Douglas Memorial sites; and
  • An increased focus on chronic disease prevention and management.

The manner in which healthcare is provided in hospital has significantly changed in past decades due to advances in technology, drug therapies, and other developments. The pace of change shows no sign of slowing, and many positive opportunities can be realized for hospital care in Niagara through change, according to Dr. Shragge.

"We recognize that not everyone will agree with the vision in the HIP or any others that bring about significant change," Mrs. Souter said. "Our entire community has a vested interest in healthcare, and we are committed to continuing to work with our staff, physicians, volunteers and with the public, to reach our common goal of better healthcare for all Niagarans."

Building on the input already received by the NHS during the development of the HIP, the next phase of the process will include consultation with doctors, staff, volunteers and members of the general public on the HIP. The public is encouraged to provide feedback beginning the afternoon of July 17 through a NHS website at — through the Your Input section designed specifically for community consultation. An electronic copy of the HIP and video presentations are also available on the website. In addition, the HIP will be available in printed form for viewing at any NHS Site Administration Office.

The NHS submitted the HIP to the HNHB LHIN on July 15, 2008.

"We look forward to the feedback from the LHIN and its Advisor as they complete the review of our submission and we work together to finalize and approve the best Plan for improving quality and access for Niagara residents and to provide sustainable healthcare for the future," Mrs. Souter said.

To view the full report please click on the Your Input link located in the green box at the top of the page.

Niagara Health System