HOSPITALS, · and shift resources to direct patient care both within and outside hospitals. As a...

HSRC

Better

HOSPITALS,. . . . . . . . . . . . . . .

Better

HEALTH CARE. . . . . . . . . . . . . . .

for the

FUTURE. . . . . . . . . . . . . . .

Summary Report on Hospital Restructuring

1996-1999

HEALTH SERVICES RESTRUCTURING COMMISSION

April 1999

http://www.health.gov.on.ca/hsrc/bettere/home.html [6/17/2004 9:54:05 AM]

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HSRC

April 1999

The Honourable Elizabeth WitmerOntario Minister of Health

Dear Minister:

It is my pleasure to submit to you a report summarizing the hospital restructuring phase of the Health Services Restructuring Commission's (HSRC) mandate. We eleven volunteer commissioners carried out this work from April 1996 to March 1999. We expect the following outcomes of hospital restructuring to be in place by 2003:

● Urban hospitals will be consolidated into larger organizations on fewer sites, resulting in higher quality services delivered more cost-effectively, while preserving accessibility to the people served

● Rural and northern hospitals will organize themselves into networks to preserve accessibility and improve cost-effectiveness and quality of care

● Some patients now accommodated in hospital acute care beds will have ready access to home care, long-term care, rehabilitation, mental health and sub-acute care services that better meet their needs

● The capacity of specialized services will be significantly increased, including MRIs, hip and knee replacements, cardiac surgery and radiation therapy for cancer patients

● Hospital buildings will be renewed and many new community-based facilities will be created, especially long-term care facilities

We are pleased to have hospital restructuring behind us. It was necessary work and we are confident that our design for change offers a realistic, made-in-Ontario way to improve hospital and health care for the future. Until the end of our mandate in March 2000, we will prepare advice to you on ways to achieve greater coordination among all of the many contributors to the health services system in Ontario.

Yours sincerely,

http://www.health.gov.on.ca/hsrc/bettere/1.html (1 of 2) [6/17/2004 9:54:20 AM]

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HSRC

DUNCAN G. SINCLAIR, ChairHealth Services Restructuring Commission


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HSRC

Why restructure hospitals?

Between 1989 and 1995, 11,000 hospital beds were closed while hospital funding increased by over 20 per cent. Yet none of Ontario's 250 hospital sites was consolidated. This bed decrease has been likened to the closing of 30 medium-sized hospitals - a poor analogy, since hospital beds and wards, not buildings, were closed. But the empty beds and in some cases, empty wards and floors still needed heating, lighting and maintenance.

In April 1996, the government gave the HSRC the enormous challenge of restructuring hospitals. The goal was to improve the services they provide while eliminating duplication and unused space. Since then, hospital restructuring has created anxiety among health care professionals, hospital staff and the general public. Naturally, people are attached to the hospitals in their communities. Hospitals are where most of their children are born, where personal and family emergencies are dealt with, and where their last days are often spent.

Hospital restructuring was needed due to changes in the way health care is provided today as compared to the past. Evolution in technology and health care practices that result in better and more appropriate treatments have changed the way we use hospital services. A much smaller percentage of people needing care are hospitalized today, and those who are hospitalized spend less time there than in the past. This is the result of a shift to day surgery, out-patient and ambulatory care, advances in drug therapy, the availability of home treatments and many other factors.

As a consequence of this evolution in hospital care, new needs arose for different services increased home care, community mental health and long-term care. Hospitals also needed to provide different services than in the past, including sub-acute care, more rehabilitation, as well as more specialized services including MRIs, hip and knee replacements and cardiac surgery. While the need increased for other vital services, resources were being used to maintain hospital surplus capacity. In some cases, these other needs remained unmet.


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HSRC


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HSRC

Hospital restructuring has never been about saving money. It is about preserving hospital services AND expanding the availability of out-of-hospital services to offer a range of health care services that is more accessible, of high quality and affordable. Accessible means preserving the availability of all health services. High quality means services that are safe and of benefit to patients. Affordable means achieving the greatest possible amount of care for our spending at a cost that is reasonable.

Implementing the HSRC's decisions about services in hospitals and outside hospitals require the province to invest more money than the total estimated operating savings in order to carry out effective restructuring.

Myths and facts about the HSRC

The HSRC's work has been the subject of criticism during the first phase of its mandate. Here are some of the popular myths and the corresponding facts:

MYTH: The HSRC was created to reduce the number of health care beds, especially in hospitals.

FACT: In the years preceding the creation of the HSRC, thousands of hospital beds were closed while hospital funding increased. The HSRC sought ways to make better use of hospital space and shift resources to direct patient care both within and outside hospitals. As a result, the HSRC's decisions will lead to a net increase of over 12,000 health care beds in hospitals and long-term care facilities.

MYTH: The HSRC only worked on closing hospitals.

FACT: In every community review, the HSRC made decisions based on the growing need for


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HSRC

hospital and other health care services in the years to come. Providing hospital care in the Emergency rooms will have enhanced capacity to treat an expected 17 per cent increase in cases.


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HSRC

most efficient way possible can and will lead to more care - even at fewer hospital sites. In addition, the HSRC produced the first-ever guidelines on reinvestments in long-term care, home care, and mental health to provide some hospital services in appropriate alternate settings.

MYTH: Current emergency room crowding and ambulances on redirect are the result of HSRC decisions to close hospitals, which has reduced capacity to provide emergency care.

FACT: Emergency room crowding is a longstanding, complex problem that will take time to solve and which has no one easy solution. During the flu season in particular, sick people cannot be admitted to hospital because many patients already there have nowhere else to go, despite the fact that some of them can be cared for appropriately in a long-term care facility or at home with proper help. As a result, emergency rooms become backlogged. Rebalancing hospital and non-hospital services to increase capacity to treat patients in all health care settings is the fundamental solution to this recurring problem. This rebalancing will result from carrying out HSRC decisions and recommendations, which include expanding the capacity of hospital emergency rooms to care for more patients.

MYTH: Restructuring means sick people will either leave hospital sooner than they should or be denied hospital care in the first place.

FACT: Overall health system capacity to treat patients will increase by one-third as a result of restructuring. To meet growing needs, hospitals can treat more patients by incorporating current health care developments, concentrating resources on the types of care they provide best and operating more efficiently.

MYTH: The HSRC was inflexible, did not listen, and ignored local opinions and solutions.

FACT: HSRC reviews were based on studies carried out by District Health Councils and always included two periods for community comment. Local solutions were used whenever possible. In Windsor, Sarnia and Parry Sound, the HSRC's design is consistent with plans developed locally. In other cases - including Ottawa, Sault Ste. Marie, Hamilton and Pembroke - the HSRC adapted its decisions to accommodate local solutions suggested through public input.

MYTH: The HSRC is closing psychiatric hospitals and people who need their services will be left on their own, potentially ending up homeless.

FACT: The HSRC insists that no patient be moved from a psychiatric hospital until appropriate services in community settings are available. This follows Ministry of Health policies developed in 1993 to


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HSRC

shift most mental health services to community settings. All psychiatric hospital savings will be redirected to other mental health services that maintain people in the setting that best meets their needs. The HSRC has recommended the appointment of local representatives to regional Mental Health Implementation Task Forces to oversee this transition.

MYTH: To the HSRC, a hospital is a hospital. Small rural and northern hospitals are analyzed with the same criteria as large urban hospitals.


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HSRC

FACT: The HSRC recognized that rural and northern hospitals would have to be considered differently from urban hospitals, primarily because accessibility is an entirely different challenge. Creating rural and northern hospital networks recognizes these different circumstances.

Ontarians enjoy a very high standard of hospital care and will continue to need it. Yet today, there is a pressing need for a better balance of all types of services - in our homes, in home-like environments such as long-term care facilities, and in hospitals. Improving the balance based on the strengths of all links in the health care chain is the goal of the HSRC.

Health care after restructuring

Taken as a whole, the HSRC's work will bring about two types of significant positive changes.First, an expanded range and amount of health services will be available after restructuring. Second, hospitals will work more closely together and with other health service providers on behalf of patients and the people they serve.

http://www.health.gov.on.ca/hsrc/bettere/5.html [6/17/2004 9:55:03 AM]

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HSRC

Expanded services

Today, many patients who receive treatment in hospitals can be treated in other settings that better meet their needs. For instance, in 1996-97, 2,100 acute care hospital beds, or almost ten per cent of Ontario's total, were used by patients who would have been better cared for in home care, a long-term care facility, or a rehabilitation hospital bed. Clearly, this is an inefficient use of a costly resource needed by acutely ill people. In addition, emergency rooms become backlogged and closed temporarily when hospital beds are occupied by patients who are past their acute illness but have nowhere else to go. The HSRC believes the solution to current problems is to ensure an appropriate balance of health care services a balance that matches health services with people's needs. Accordingly, the HSRC has recommended a $1.2 billion annual reinvestment in health services. This funding will:

● increase the overall capacity to care for patients in urban centres by over one-third. This expansion includes hospital beds, long-term care beds and home care visits

● lead to the following changes across Ontario

❍ 17,000 more beds in nursing homes and homes for the aged

❍ 25,000 more long-term care places in community settings

❍ 80,000 more patients helped to continue recovering from an acute care hospital stay at home

❍ 1,600 new sub-acute care beds in hospitals created


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HSRC

"The difficult task undertaken by the HSRC over the past three years has set the stage for an effective and efficient health care system in Ontario. The result is that our frail elderly citizens, who require long- term care, will have better access to the care they require and will be living their life in a way that promotes dignity and independence."

VIDA VAITONISExecutive Director

Ontario Nursing Home Association


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❍ 1,200 more hospital rehabilitation beds

❍ mental health services shifted from psychiatric hospitals to community settings

● provide more specialized services in hospitals, including

❍ 19 more MRI machines

❍ 5,000 more hip and knee replacements each year

Greater coordination

The results of implementing HSRC decisions and recommendations include:

● more and better coordination between

❍ urban hospitals as a result of amalgamations and shared decision-making

❍ rural and remote hospitals within their networks and with the referral centres with which they work

❍ hospitals, home care and long-term care services

● smooth coordination of care between hospitals and community-based organizations for people with mental illnesses or conditions

● the creation of networks to coordinate the local, regional or provincial provision of rehabilitation, children's, women's, and French-language services

Transition to rebalanced health care


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HSRC

Ontario has entered a transition period in hospital restructuring a period in which people will see a significant shift in where they receive services, including some hospital services. In some cases, hospital programs will move sites. Doctors, nurses and other staff may also move to different hospital sites, with any staff movement occurring in a way that treats everyone fairly.


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HSRC

When restructuring is complete, its success will be measured by the extent to which Ontarians have access to an integrated system of accessible, affordable, high-quality health services. To achieve that success -- and to build a true health care system the government must do three things:

● Establish and fund alternatives to acute, psychiatric and chronic hospital services in out-of-hospital settings. Only then can the capacity of hospitals be safely reduced

● Reinvest more than the expected savings from hospital restructuring in these alternative health services that better meet patient needs, including expanded rehabilitation and sub-acute care in hospitals as well as services outside hospitals

● Invest in building improvements to ensure hospitals are built and equipped to provide high-quality care according to the best current health care practices

The HSRC believes that total spending on health services must increase to meet the needs of our growing and aging population. In the short term, hospital consolidations and operating efficiencies will result in significant savings. But all these savings and indeed, additional resources must be directed to meet new needs, many of them outside hospitals. When Ontarians need treatment, they should be able to receive it in the setting that most appropriately meets their needs and allows them to retain as much independence as possible - whether that setting is at home, in supportive housing, a long-term care facility or a hospital. This is the direction in which health care is evolving in Ontario, Canada and the developed world. The government must work together with everyone who provides health services to carry out this transition to a genuine, well-balanced health care system that takes full advantage of all recent health care developments.


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HSRC


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HSRC

Renovating hospitals

Hospitals will remain vital components of an increasingly integrated health care system. Consolidating and modernizing them makes sense to eliminate duplication and use space in fewer buildings to provide better patient care. Between 1996 and 1999, the HSRC directed that 33 public hospital sites no longer be used as hospitals, as well as recommending to the Minister of Health that six psychiatric hospital sites and six private hospital sites be closed. Some of these buildings will continue to have a role in health care. For instance, Pembroke Civic has become a senior's residence. Women's College, North York Branson and the Queensway sites in Toronto, as well as the Riverside site in Ottawa, will be converted into ambulatory care centres. The Doctors Hospital and Salvation Army Toronto Grace sites in Toronto will be rebuilt as nursing homes. To a greater or lesser extent, all the hospitals the HSRC examined over the past three years need renovation. The HSRC recommended over $2 billion in renovations so that hospital services will meet peoples' needs more closely. This investment is an essential element to create a more appropriate balance of health services, and ultimately, a health care system that is worthy of the name. When the renovations are complete, hospitals will be better able to offer the range of services that meets growing needs and reflects current health care practices. For instance, these renovations will expand capacity so hospitals can handle 17 per cent more emergency room visits and 18 per cent more ambulatory care visits.

http://www.health.gov.on.ca/hsrc/bettere/9.html [6/17/2004 9:55:37 AM]

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HSRC

The HSRC also recognized the increasing need for cancer and cardiac services. As the population continues to grow and grow older demand will rise. Accordingly, the HSRC has called for the construction of four new regional cancer centres, a cancer treatment satellite site, and a new cardiac surgery centre.

Coordinating hospital care

A consistent theme of the HSRC has been to identify ways for health care practitioners to work together more effectively. Independence must give way to interdependence - not just among hospitals, but among all those who provide health services. Cooperation today is an investment in better health services tomorrow. The HSRC has sought to ensure greater collaboration among hospitals through a number of approaches. For example, the HSRC has called for 14 amalgamations involving 44 hospital organizations. In the interest of patients, HSRC decisions have united hospitals in Niagara, Ottawa, Toronto, the Greater Toronto Area and Sudbury. In Hastings and Prince Edward Counties, one hospital now operates on two urban and two rural sites, sharing expertise, staff and equipment. Fourteen Joint Executive Committees have been established, in which two or more hospitals join forces to serve their communities through shared decision-making. In Sault Ste. Marie, the Sault Area Hospitals will form a Joint Executive Committee with the Group Health Centre, the city's other major health service provider, which offers a wide range of medical services to 40,000 local residents. The HSRC also created 18 rural and northern hospital networks to strengthen the working


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HSRC

"The restructuring of health care systems was long overdue in Ontario and drastic change is only accomplished by strong external forces. That was the role of the HSRC and they accomplished it."

CARL WHITEPresident and CEO

St. Joseph's Care GroupThunder Bay


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HSRC

relationships of their member hospitals, promoting the increased cooperation that leads to better and more cost-effective patient care. Common policies among network members will help them recruit the health professionals their communities need, often urgently. At the same time, closer collaboration will make patient referrals to specialized services faster and easier. The HSRC has created six networks to coordinate specific hospital services at the local, regional and provincial levels. There are networks for both rehabilitation and children's health services in Ottawa and Toronto. In eastern Ontario, another network seeks to improve services in French while the Women's Health Council works to improve women's health services throughout Ontario.

An easier to use health care system

The HSRC intends to promote greater colla-boration among all who provide health services by finding ways for the many disconnected parts and people to work together to provide better patient care. The goal is to help Ontario move closer to realizing the ideal of a seamless health care system. For many patients, accessing health services can be a difficult path, fraught with obstacles and barriers, gaps, cracks and potential pitfalls. This should not be the case, especially in a $30 billion system, of which we spend $19 billion in public money, on which so many vulnerable people depend. It makes sense to speak of a person's central nervous, respiratory or digestive systems


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HSRC


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http://www.health.gov.on.ca/hsrc/bettere/12.html

or to describe a building's heating, air conditioning or plumbing systems. In a system, the various parts must work together as a whole. Unfortunately, in health care, we have many types of services but no system to coordinate the parts. We must correct that and create a genuine health services system to meet the needs of the people of Ontario into the 21st century. Certainly, a true health care system is attainable. Patients will be served better with everyone working together to accomplish desired results. The HSRC is working on several projects to further this goal, including:

● Helping a small number of interested communities to find made-in-Ontario ways of improving coordination among health service providers, and identifying specific steps to improve the quality of patient care

● Providing advice to the Minister of Health on specific steps to achieve greater cooperation. For instance, the HSRC will explore innovative approaches to medical practice, especially primary care, to help patients receive around-the-clock care from their doctors, nurse practitioners and others, reducing the need to use walk-in clinics or hospital emergency rooms

● Developing more policies to achieve effective hospital restructuring. The HSRC will continue work to estimate the need for services in collaboration with Ontario experts in such areas as outpatient rehabilitation, home care and community mental health


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http://www.health.gov.on.ca/hsrc/bettere/12.html

"The HSRC compelled us to institute quantum change in our roles and mandate so that we could better serve our community. The directives were aimed at addressing duplications, the need to consolidate clinical and academic programs and fostering collaboration among health care providers."

TONY DAGNONEPresident and CEO

London Health Sciences Centre


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● Providing assistance to hospitals and communities going through restructuring. The HSRC will monitor the restructuring process for delays, identify causes, and take action to get implementation back on track

● Evaluating the impact of hospital restructuring on patient care, and identifying areas for improvement by tracking indicators such ;as readmission rates, waiting lists, and the number of patients in acute care beds waiting for other types of placements

Conclusion

Establishing a well-coordinated health system to meet patient needs is an essential and achievable goal. Hospital restructuring has been an important and necessary step toward it. The HSRC has developed made-in-Ontario responses to the challenge of integrating recent health care developments into our hospital and health care system in order to develop an effective continuum of care. Carrying out HSRC decisions and recommendations in the coming years will lead to:

● more publicly funded health care beds

● increased capacity to treat patients in the most appropriate setting that meets their needs

● renovated hospitals

● increased funding for health services

The decisions the eleven volunteer Commissioners have taken over the last three years with respect to hospitals have often been difficult. The challenge of implementing them - by government, hospitals and everyone involved in health care - will be even greater. Nevertheless, all these efforts are worthwhile to achieve the goal of better hospitals and better health care for the future.

What's your view?

The Commission is working to keep Ontario's health services accessible and of high quality, as well as affordable to all. We all need to take an interest in the health of our system. Please feel free to contact us if you desire further information. We also invite your comments, suggestions and opinions. Please send them to:

Health Services Restructuring Commission


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56 Wellesley Street West, 12th FloorToronto, Ontario M5S 2G1Phone: (416) 327-5919 or 1-800-565-4453Fax: (416) 327-5689Web site: www.hsrc-crss.org


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Commission Member Profiles

Members of the Commission were chosen from across Ontario and reflect a wide range of community and health system experience. Each member has served in either volunteer or staff positions in different organizations within our health system.

Duncan Sinclair, retired Vice Principal Health Sciences and Dean of Medicine at Queen's University, is the Commission's chair. Dr. Sinclair headed the research steering committee for the Premier's Council on Health, Well-Being and Social Justice, and chaired a working group on human resources planning for the Provincial Cancer Network. He was also a member of the National Forum on Health. A long-time resident of Kingston, he retired from Queens University in June 1996.

Dr. Ruth Gallop is Professor and Associate Dean of Research at the Faculty of Nursing at the University of Toronto, where she is also cross-appointed to the Department of Psychiatry and Division of Women's Mental Health at the Faculty of Medicine. She has many years of clinical experience and writes, researches and consults widely on issues related to the provision of mental health care. She has been a member of the Advisory Board of the Psychiatric Patient Advocate Office for many years.

Shelly Jamieson is Vice President, Eastern Operations for Extendicare (Canada) Inc. Previously, she was Executive Director of the Ontario Nursing Home Association. As a partner in Envirimed Inc., she worked on diverse projects across the care continuum, from community based services to chronic care for both public and private sector clients. She is past Chair of the Ontario Health Providers Alliance, a group of 19 health sector associations committed to ensuring a viable future for the health sector in Ontario.

Dr. Maureen Law, a former Deputy Minister of the federal Department of Health and Welfare, recently held the position of Director General of Health Sciences at the International Development Research Centre in Ottawa. Dr. Law was at the Department of Health and Welfare from 1973 to 1989. She was senior adviser to the Privy Council before joining the Ottawa based International Research Centre in 1990. Dr. Law has also been Deputy Medical Officer of Health in York County and Assistant Deputy Medical Officer of Health in Carleton County. A past chair of the World Health Organization, she has a wealth of international experience, including being involved in the Global AIDS Policy Coalition and the Global Commission on Women's Health.

J. Douglas Lawson is a Windsor-based lawyer and senior partner of the McTague Law Firm. Mr. Lawson has provided legal counsel to district health councils, hospitals and numerous charitable agencies and foundations, and was instrumental in facilitating the recent merger of the Metropolitan General and Windsor Western hospitals into Windsor Regional Hospital. He is a former President of the Ontario Chamber of Commerce, and founding chair of the Association of District Health Councils


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of Ontario (ADHCO). Recently, Mr. Lawson was appointed chair of the Cardiac Care Network task force commissioned to develop a report for the Minister of Health on cardiac services in Ontario.


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George Lund was Senior Vice President, East, CTV and was President and Chief Executive Officer of Baton Broadcasting Systems in Northern Ontario from 1989 to 1999. He began his career as a radio and television broadcaster in Alberta in 1958 before moving to Sudbury in 1962, where he has lived ever since. Mr. Lund served on Sudbury City Council from 1977 to 1980 and was elected chair of the Regional Municipality of Sudbury in 1980. As founding President of Science North, he was instrumental in making the science centre a major attraction in Northern Ontario. He has been on the board of Network North/Algoma Hospital for nine years and chair for five years.

Hartland M. MacDougall was a career banker with the Bank of Montreal across Canada from 1953 to 1984, the last four years as Vice-Chairman, before assuming chairmanship of Royal Trust from which he retired in 1993. He was also Deputy Chairman of London Life from 1985 to 1997. He was founding chairman of the St. Michael's Hospital Foundation, the Japan Society and Heritage Canada. He has also served as chairman of the Canada Japan Business Committee, the Council for Canadian Unity and The Duke of Edinburgh Awards International Council.

Muriel J. Parent is a francophone from Val Rita in northern Ontario where she is president and CEO of three family businesses. She has taught at both the community college and primary school level. Mrs. Parent has been involved with many social services, health care and municipal initiatives. She has served on the Board of Directors for Sensenbrenner Hospital, the Board of Management for the Cochrane District Homes for the Aged, the Board of Management for North Cochrane Children's Aid Society, and numerous community projects. Mrs. Parent also has been Reeve for the Corporation of Val Rita-Harty.

Daniel R. Ross is a London-based lawyer and partner in the legal firm of McCarthy, Tetrault, specializing in corporate, business and administrative law. He has an extensive background in the health care system. Mr. Ross was involved in the reorganization of London's Victoria and University hospitals as a member of the merger task force. Since the merger he has been a member of the hospital's executive committee, working on the restructuring and/or amalgamation of the hospital foundations and research organizations.

J. Donald Thornton has an extensive background in business, financial management and the non-profit sector. As a former executive at General Motors of Canada, he has substantial experience in re-engineering and restructuring. Mr. Thornton was on the Oshawa General Hospital board for 15 years, including serving as chair from 1989 to 1992. He has been an active member of the hospital's foundation and the Parkwood Foundation, as well as the Canadian Chamber of Commerce and the Financial Executives Institute. He is past chair of the Oshawa Harbour Commission.

Dr. Robert C. Williams is a family physician from Timmins and has served as Chief of Staff at Timmins


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and District General Hospital since 1992. Dr. Williams has been active in many professional and health care related organizations, including the Ontario Medical Association Committee on Hospitals, the Joint Planning and Policy Committee Utilization Steering Committee, and the Canadian Institute for Health Information Physician Advisory Group. He is also the co-author of a 1996 OMA document on "Physician's Role in Hospital Restructuring."

Dr. Peggy Leatt the Commission's CEO, was Professor and Chair of the Department of Health Administration of the University of Toronto, a position she has held from 1987 to 1998. A widely known and respected expert on issues related to organizational behavior and design, Dr. Leatt has written extensively on a wide range of matters relating to health policy and health services design and restructuring.


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HOSPITALS, · and shift resources to direct patient care both within and outside hospitals. As a...

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Transcript of HOSPITALS, · and shift resources to direct patient care both within and outside hospitals. As a...