Strategic Plan Refresh Presentation

to the

Central East Local Health Integration Network

Wednesday, March 27, 2013 Marla Fryers

Executive Vice President, Clinical Operations

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GOAL - To assure the Central East LHIN Board that:

• due diligence was adhered to in the

Strategic Plan Refresh (SPR) process.

• engagement of internal and external stakeholders was robust, inclusive and transparent.

The Scarborough Hospital

The General Campus

The Birchmount Campus

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4

Hospital Standardized Mortality Ratio (HSMR)

12

8

12

7

94

91

84

83

11

5

11

0

98

84

81

82

12

3

11

9

95

88

83

83

0

20

40

60

80

100

120

140

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 (Q1-Q2)

General Birchmount TSH Target

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Vaginal Birth After Cesarean (2011/12 rate per 100 c-sections)

4.7

4 7

.23

7.9

8

7.9

9

8.7

7

9.4

9.7

11

.09

11

.68

11

.69

12

.04

14

.29

16

.14

16

.43

18

.56

18

.93

20

.48

21

.73

26

.18

26

.67

0

5

10

15

20

25

30

Hospital Community-Large

Calculation of 2013-14 Operating Plan Reduction Target

Budget Change from 2012/13 to 2013/14 ($000s)

2012/13 Carry=forward 46 estimate

REVENUE

MOHLTC 891 estimate

Other Revenue 291 estimate

SUBTOTAL REVENUE 1,182

EXPENSES

OPERATING EXPENSES

Salaries, wages and benefits (7,433)

Supplies and other non-compensation expenses (4,323)

Capital - equipment leasing expense ($6.0 million)* (811)

ONE-TIME EXPENSES

Severances (2,600) estimate

Strategic Plan Refresh – renovations and moves (1,800) estimate

SUBTOTAL EXPENSES (16,967)

TOTAL REDUCTION TARGET (15,739)

* Total capital equipment purchase = $6.0 from TSH Operations + $2.0 Foundation

5% reduction to 2012/13 budget allocated to Clinical Operations; 6% assigned to all other Divisions at VP level

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Operating Plan Timeline, including SPR

24-Jul-12

• Request for

Services (RFS)

for Strategic

Plan Refresh

(SPR) issued

06-Jun-12

PIC Meeting

• Request by

members to define

process for 2013/14

budget reductions

other than “across

the board” cuts

18-Jun-12

CAC Meeting

• Initial assumptions

re 2013/14

Operating Plan

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

23-Aug-12

• Hay Group

selected as

successful RFS

respondent

04-Sep-12

• First meeting of

Strategic Plan

Refresh

Steering

Committee

06-Sep-12

PIC

• Strategic Plan

Refresh launch

01-Nov-12

PIC

19-Nov-12

CAC Meeting

• Operating Plan

Update

04-Oct-12

PIC

Oct-12

• Internal and

external

consultation

commences

06-Dec-12

PIC

10-Jan-13

PIC

6-Feb-13

• Hay Report

released

5-Mar-13

Board of Directors

Meeting

Strategic Plan

Refreshy related

resolutions

18-Mar-13

Community Advisory

Council Meeting 7

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TSH Executive Team

TSH Administrative

Leaders

TSH Chiefs/Medical Directors

Performance Improvement

Committee

TSH Committee Structure to support Strategic Plan Refresh

Community Engagement Process

• Two phase process – over six months

• Phase 1: September 2012 – January 2013 • Focus: to inform and obtain input from internal and external

stakeholders about changes to provincial hospital funding formulas and the impact on TSH operating budgets

• Phase 2: February 4 – 28, 2013 • Focus: to inform and obtain input on Board decisions required to

address changes resulting from the funding formula and support the delivery of high-quality and safe care

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Phase 1 • Draft decision-making criteria posted TSH web site, received

1,400 hits

• @issue, 2,500 copies distributed internally and externally

• Online survey

• Community Presentations

• Online communications (intranet, website, eNewsletter and social media, including blog, Twitter, Facebook)

• Town Hall meetings (internal stakeholders)

• Visioning sessions

• Advertising

• Media relations

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Phase 1 Key Findings

• Phase 1 Report posted to hospital’s website

• General awareness of financial situation facing provincial healthcare system and TSH and reluctant acceptance of the need for change.

• The decision to keep emergency departments open at both campuses is applauded by community groups

• Distance and travel times between the two campuses are not an over-riding consideration

“Clearly there is some duplication of services

in Scarborough that could be minimized to save money and improve patient care.

Focus on those areas first.” (on line survey response)

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Phase 2 • 2 Online surveys

• Focus Groups

• Executive Interviews

• Community Information Sessions

• Presentations

• Town Hall Meetings

• Program / Department Meetings

• Mall and Hospital Information Displays

• Online streaming video synchronized with PowerPoint

• @issue, 2,500 copies distributed internally and externally

• Online communications (intranet, website, eNewsletter and social media:

Twitter, Facebook) • Media relations

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Phase 2 • Final Report posted to hospital’s website

“Looks like the right thing to do, we have no concerns on behalf of our clients. We support you, hope you can

get it done this time.” (Community agency leader)

“I think it should be focused on one campus. TSH should create a specialty in

one area. Women’s and children’s health is a very different kind of care. Everyone in this community has the view that Sick Kids is best. But it is a

long way to go. If you can’t go there, it’s good to have a specialty here. If I know Scarborough has a pediatric emergency doc, I’ll go there.”

(Mother, Community leader, and patient)

Birchmount Campus

• 24/7 Emergency Department

• High-tech, same-day, short-stay Surgery: • Gallbladder/Cataract/Outpatient Orthopaedics

• Mental Health Inpatient Unit

• Intensive Care Unit

• General Medicine Inpatient Unit

• Diagnostic Imaging: • CT Scan • MRI • Ultrasound • Nuclear Medicine • General x-ray

• Outpatient Clinics: • Support programs/services at Campus

A Look at the Options

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General campus • 24/7 Emergency Department • Complex – Longer-Stay Surgery: • Joint replacement, instrumental spine,

vascular , breast reconstruction

• Cancer Care Program • General Medicine Inpatient Unit • Intensive Care Unit • Diagnostic Imaging: • CT Scan

• MRI • Ultrasound

• Interventional

• Nuclear Medicine • General x-ray

• Comprehensive Breast Diagnostic Assessment Unit • Outpatient Clinics: (as an example) • Support programs/services at campus

• Chronic Kidney Disease Clinics

• Centre for Complex Diabetes Care • GAIN

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A Look at the Options

Board of Directors’ Resolutions March 5, 2013 Board Meeting

BE IT RESOLVED that the Board approves in principle the Surgical proposal. The proposal being Inpatient Complex Surgery to be sited at the General Campus, Outpatient Ambulatory Surgery sited at the Birchmount Campus, with the proviso that the Birchmount Campus shall be capable of providing emergent General Surgery. Management, through further consultation, is to bring back a safe and secure implementation plan by April 15, 2013, for approval by the Board.

BE IT RESOLVED that the Board directs Management to continue consultation to find the necessary means to ensure paediatric presence at each campus.

BE IT RESOLVED that the Board accepts Management’s recommendation to site a consolidated Maternal Newborn program at the Birchmount Campus in order to create a Centre of Excellence in Maternal Newborn and Women’s Health.

UNANIMOUSLY APPROVED 16

Next Steps - Surgery

Steering Committee formed with representation from: • Chief of Surgery • Deputy Chief of Surgery • Division Head of General Surgery • Executive Vice-President Clinical Operations • Director of Surgical Services • Director Innovation and Improvement • Communications Lead • TSH Board of Directors’ members x 2

Steering will consult with general surgeons to define problems and identify strategies to resolve problems

Report to Board on April 15

BE IT RESOLVED that the Board approves in principle the Surgical proposal. The proposal being Inpatient Complex Surgery to be sited at the General Campus, Outpatient Ambulatory Surgery sited at the Birchmount Campus, with the proviso that the Birchmount Campus shall be capable of providing emergent General Surgery. Management, through further consultation, is to bring back a safe and secure implementation plan by April 15, 2013, for approval by the Board.

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Next Steps - Paediatrics

Initial steps include: Detailed facility assessment and plan Working with Central East LHIN and Rouge Valley Health System to review

MNCC regional strategy and determine next steps

Consultation process to be determined

BE IT RESOLVED that the Board directs Management to continue consultation to find the necessary means to ensure paediatric presence at each campus.

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Next Steps - Maternal Newborn

Initial steps include: Detailed facility assessment and plan Working with Central East LHIN and Rouge Valley Health System to review

MNCC regional strategy and determine next steps Develop communication plan for pre-registered expectant mothers, referring

family physicians and other stakeholders Senior team walkabouts to clinical areas to support front line staff Comprehensive marketing plan required for future success

BE IT RESOLVED that the Board accepts Management’s recommendation to site a consolidated Maternal Newborn program at the Birchmount Campus in order to create a Centre of Excellence in Maternal Newborn and Women’s Health.

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Operating Plan Timeline 07-Mar-13

Ontario Legislative Assembly

• Agreement by Minister of Health “for

further review on the hospital's proposed

changes”

15-Mar-13

• Meeting with Central East LHIN Finance

team regarding SPR and Operating Plan

• Request by Central East LHIN to

postpone announcement of 2013-14

Operating Plan initiatives until after

Central East LHIN Board Meeting

27-Mar-13

CE LHIN Board Meeting

• TSH Strategic Plan Refresh presentation

Mar Apr Apr …

02-Apr-13

TSH Board of Directors

• Operating Plan initiatives

briefing

1st Week of April

• Union briefing

• CAC briefing

• FAC briefing

15-Apr-13

TSH Board of Directors

• general surgery implementation

plan presentation

Operating Plan

Implementation

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Risks Related to Delays in Implementation

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•Each month of delay equals 1.3 million dollars. Accumulating debt puts us

at significant risk of delivering on volumes and wait time targets and

improving our current ratio in our HSAA.

•Each additional delay causes significant moral distress to our staff,

particularly in the areas of consolidation -- MNCC and Surgical Services.

•Each additional delay allows those opposed to change to implement

additional strategies which will further divide the organization.

•Getting approval to move forward on April 2nd is already a delay equivalent

to 600K when compared to the original timeline. This translates directly into

additional staffing and nursing cuts.

Communication Forums

Medical Advisory Committee (MAC) – meets 3rd Thursday of each month

Leadership Forum – meets 2nd Thursday of each month

Performance Improvement Committee (PIC) – meets 1st Thursday of each month

Medical Staff Association (MSA)

Medical Department and Division meetings (physician meetings) – meet once per month

Program Service Group meetings (administration meetings)

Daily and weekly huddles

Hospital Town Hall Meetings

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Questions

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