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VICTORIA GAITSKELL

Running a Healthy In-plantH

ealth is one of three major factors thatranked Canada sixth of 187 countrieson the November 2011 United Nations

Human Development Index. And althoughour country’s publicly funded health-caresystem leaves room for improvement com-pared to the systems of other wealthy na-tions, 69 percent of Canadians still told a2010 Angus Reid poll they were prouder ofit than the state of our democracy. A Janu-ary 2010 report by Statistics Canada showsnearly 2-million people are employed bythe country’s health-care and social-assis-tance systems, accounting for around 10percent of national employment.

Often forgotten behind the scenes arecrucial in-plant printing operations whichproduce and secure critical documents.

In late May, I visited the in-plant opera-tion at University Health Network (UHN)in downtown Toronto to gain a better un-derstanding of this unique printing envi-ronment. UHN is one of our country’slargest treating, research and teaching hos-pitals, affiliated with the University ofToronto Faculty of Medicine. It resultedfrom a cost-saving restructuring of hospi-tals and other provincial health services,legislated by the former Progressive Con-servative government of Premier Mike Har-ris and carried out from 1996 to 2000 by anunelected Health Services RestructuringCommission. Joe Carrelas, UHN’s PrintShop Manager, who has worked for 23 yearsin the same in-plant, located inside TorontoGeneral Hospital (TGH) at 200 ElizabethStreet, saw the whole process take shapefrom the inside.

After studying offset printing at GeorgeBrown College, Carrelas began his career atTGH as a press operator, then applied for apromotion when a supervisor’s job becamevacant. Eventually he was promoted tomanager. As it turned out, TGH was one ofthe first two hospitals and the largest to beamalgamated into what eventually becameUHN. In 1986, TGH, a 400-bed facility thatbegan as a military hospital in a small shedduring the War of 1812, merged withToronto Western Hospital, a 236-bed com-munity hospital that began in a pair ofrented semi-detached houses.

“At first, when TGH merged withToronto Western, I took over running theother hospital’s print shop along withTGH’s, but eventually it was closed downand all printing was moved to TGH,” re-calls Carrelas. Together the two merged

hospitals took on the new name TheToronto Hospital.

Next, in 1998, when Princess MargaretHospital, a 130-bed, internationally recog-nized cancer treatment facility, joined theamalgamation, the hospital’s printing op-erations were consolidated in similarstages. In 1999, the new corporate entitycomprised of all three hospitals was re-named University Health Network, whichin 2011 came to include the Toronto Reha-bilition Institute. Many of the practical lo-gistics of this most recent merger are stillbeing worked out.

Organizing the networkBased on his past experiences, Carrelas saysit can take several years for staff to adjust toworking together as a network rather thanas separate hospitals. For him personally,some of the biggest challenges arose duringthe amalgamation’s two episodes of renam-ing and rebranding, each of which requiredsignificant revisions of things like nameand logo to vast amounts of printing.

Perhaps Carrelas’s greatest challengeduring and after amalgamation, however,was consolidating management of some2,000 forms that are essential to a large hos-pital’s operation. His seven staff includeone dedicated Forms Manager whose jobis to provide centralized control, coordina-tion, barcoding, and improved efficiencyfor all of UHN’s 2,000 separate forms. “Be-sides hospitals and other health-care insti-tutions, forms management is also criticalfor the insurance companies and banks,”explains Carrelas. “But it’s especially im-portant for UHN, an organization of14,000 people, to reduce duplication andthe amount of forms and paper flow.”

Besides forms, other typical printingjobs for UHN include brochures, flyers,training materials, and posters. Addition-ally, for the last 17 years, the print shop hasdone directional sign engraving, a task for-merly assigned to the hospital’s FacilitiesManagement Department.

The print shop runs a hybrid systemusing Konica Minolta toner devices plustwo offset presses, an AB Dick 385 and aMultilith 1250 for quantities of 20,000 andup, as well as a full bindery. They run EFI’sMicroPress and Digital StoreFront software

systems to preflight, distribute, and trackwork among the toner presses. For deliver-ies, the print shop has its own hospitaltruck that travels between sites twice a day.

The single item they print in largestquantities is a two-sided, lined, barcodedform, designed for medical staff to recordclinical notes whenever they see a patient,typically run in batches of 800,000. ButCarrelas says in general his customers aretending toward smaller print quantitiesand, therefore, have an increasing require-ment for toner-based printing. Variable

data printing is also in demand, especiallyfor personalized fundraising mail forUHN’s four foundations, and the HumanResources Department when it issues an-nual benefit statements to more than10,000 employees.

He says their biggest rush job consists of packages of critical information for thevoluntary board of 21 elected memberswho govern UHN. The information theyrequire often arrives at the last minute andmust be printed the same day and couri-ered to board members before their nextmeeting. “The packages aren’t easy, becausethey involve things like covers, tabs, inserts,and a mixture of colour and black andwhite, but they’re what the board needs tomake crucial decisions about the financesand running of the hospitals,” says Carrelas.

Another challenge Carrelas faces is op-erating in a limited physical space: “Spaceis a big issue for hospitals right now and itcreates a problem for us. For example, Iwould love to get large-format equipmentto print our own posters, but we don’t havethe space. We also have to receive our paperin partial shipments, because we don’t havea large amount of storage.”

He says in the last 10 years UHN’s ad-ministration has supported supplementingtheir analogue system with toner-based

Inside the University Health Network’s printing operation.

JUNE 2012 • PRINTACTION • 15

Joe Carrelas, Print Shop Manager at theUniversity Health Network.

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32 • PRINTACTION • JUNE 2012

PRINTING EQUIPMENT

equipment since the move has loweredtheir costs greatly. For toner equipmentpurchases, Carrelas needs a flexible sup-plier: “We presently have 230 copiers scat-tered throughout our organization, butwhen hospital services are reduced, someof the copiers are not needed any longer. In2001, we chose Konica Minolta out of 13different vendors because no other com-pany was willing to take back the equip-ment and release us from the contractwithout penalty on machines that were tooold and run down or that we didn’t use anymore. Konica Minolta also charged usnothing for the first six months to help uspay off penalties from a previous supplier.

“We worked with IT to update the printqueues with new drivers and to networkthe machines to make full use of theirmultifunctions as copiers, printers, faxmachines, and scanners, so both the num-ber of devices and cost per copy [at lessthan two cents] are lower than with ourformer supplier.”

Carrelas says for any equipment withdigital components, UHN’s IT depart-ment will not support any contract overthree years. “In 2013/2014, we’ll go to themarket again to see what’s out there.Going to tender is a huge process for ven-dors, but it’s worthwhile for the companiesthat are bidding, because UHN has a lotof buying power right now. In our last dealour purchasing department boughtequipment for 13 different hospitals in theGreater Toronto Area.”

Adopting new proceduresA huge move to efficiency occurred inApril 2010 when UHN adopted Web-to-print technologies. “By then 90 percent ofour work was submitted electronically viaemail attachments, or, if the files were toobig, by disks or USB flash drives. Thesedevices worked fine for staff at TGH butnot so well for staff at other locations,who had to wait up to two days for theirfiles to reach us by inter-office mail,” recounts Carrelas.

He says it took several years to build thesite and enter all the products and formsone by one on top of all their regular du-ties. Then they chose their biggest clientsto pilot-test the system for five months tohelp them tweak the system before they feltready to launch it.

Carrelas says online ordering has en-abled his shop to capture more of the workthat was formerly going outside UHN: “Inour downtown location, we are sur-rounded by competition from small store-front printers, chains, and franchises, sooffering clients a better method of submit-ting orders to us really gave us an edge.

“Within 10 months of implementingthe system, the print shop’s revenue wentup $72,000 and our volume of impressionswent up a million copies.”

Some of Carrelas’s customers still workfrom old-fashioned hard copies, so, forthese clients, he has started a free serviceof scanning their documents as PDF filesin hopes they will submit their orders on-line next time. He and his staff also striveconstantly to educate their customers inbest practices, aided by the e-learning

videos available on UHN’s Website toshow staff how to place various types oforders online.

Like a commercial business, Carrelas’soperation bills and receives payment fromits customers, although they are all internalstaff within one of the departments of eachhospital comprising UHN. “We’re only re-covering costs, not making a profit,” ex-plains Carrelas. “Our system cuts costs bymaking people responsible for theirspending and showing them the value ofwhat they print.

“Before online ordering, we loggedevery order manually on a spreadsheet,which made cost recovery slow. Donemanually, the process sometimes took twodays, but now it only takes a matter ofminutes.”

Carrelas says sometimes, owing to cut-backs, when staff leave UHN they are notreplaced. Often the results include reducedservices and longer wait times for patients.“But so far the print shop has been fortu-nate, because we haven’t suffered any lossesof staff, and we keep gaining internal cus-tomers.

“I believe one reason is that our in-plant stays relevant in serving the needs ofthe hospital. We run it like a business andkeep stats on everything we do – especiallyvolumes, which help justify the staff,equipment, service contracts, and re-sources that we have. When we divide shopcosts by number of impressions, we can seeif we’re upgrading efficiently.”

Carrelas explains that his operation triesto follow the “three Cs” of in-plant print-ers: Cost, convenience and confidentiality.

“We have to be careful of the quality ofwork we do here and upgrade our equip-ment regularly to maintain our value tothe hospital. I keep reminding our employ-ees of the importance of running the op-eration like a business, tracking costs, andkeeping a customer-friendly focus. We ei-ther do the job right or someone else willdo it for us. I’ve seen situations where fa-cility management took over in-plants ifthe service was not good.

“We perform Quality Assurance everymonth by checking the dates on which or-ders came in and went out to assess ourturnaround times. Our standard for meet-ing target deadlines is high at 98 percent,but in the last fiscal year we exceeded thestandard with 99.5 percent. We know thislevel of excellence in our service is appre-ciated from the feedback and emails ofthanks we receive from customers.”

Support from Carrelas’s print shop hasassisted the advancement of medical tech-nologies at UHN’s member hospitals,whose impressive series of world firsts in-clude single- and double-lung transplants,deep brain simulation to treat depression,the discovery of stem cells, and the inven-tion of the Cobalt machine, the technologythat allowed modern radiation therapy todevelop. In the last fiscal year, providingthis support required the print shop toprint 13-million impressions and the copyfleet to produce 4,674,000 copies for agrand total of 17,674,000 impressions. “It’sa busy place here,” he laughs.

Victoria Gaitskell is keen to exchange ideaswith readers at victoria@printaction.com

GaitskellContinued from page 15