PRHCVision2014_UpdatedFINAL

PRHC Vision 2014Engaging. Planning. Inspiring.

Strategic Plan Summary 2011-2014

Driving the Road to ExcellenceNavigating a Successful Course Correction

Foreword

To suggest that our journey over the past 3 years has been stimulating, empowering, and of course chal-lenging would fall well short of a complete representation of what the 3,200 professionals, hospital sup-

port personnel and volunteers have experienced over the life of our transformative 2011-14 strategic plan. In the foreword of that plan we reported that our communities and stakeholders wanted us to “deliver strong regional leadership and eff ective collaboration across the health care continuum”. They challenged us to:

As you will read in subsequent pages, we’ve made enormous strides in the ambitious strategic priorities we set for ourselves. Although there may have been a distinct, demonstrable beginning for some of these priorities, for many there is no end, today’s measures for excellence, quality, safety and performance are tomorrow’s standard baseline.

We’ve come a long way! We are proud of the dedicated, professional, and caring men and women who make up the PRHC team. We are grateful to our partners, the PRHC Foundation and our communities who have stuck by us through diffi cult times, supported our eff orts, and contributed immeasurably to our success. Together, we have proven that we are resilient, determined and focused on the health and well-being of the patients of Peterborough and surrounding areas.

The road ahead will not be without its hazards and minor course corrections – healthcare has never been for the faint of heart. However, together the team at PRHC, our communities and our partners will thrive as we do our part in making Peterborough a great and healthy place to live.

We look forward to navigating the journey ahead!

Alan Wotherspoon John Connolly Ken Tremblay Chair - Board of Directors Chair – Board Planning Committee President & CEO

Be Provide Be

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Overview Patients and communities receive high quality, safe care at the Peterborough Regional Health Centre from our 2,000 professional, caring staff , and benefi t from the additional care and support of over 360 physicians and 600 volunteers. PRHC off ers acute, sub-acute, inpatient and outpatient care through a variety of community and regional services. The hospital serves over 300,000 people across Peterborough, Haliburton, Northumber-land, and Kawartha Lakes Counties. Regional programs serve up to 600,000 people within the Central East Local Integration Network.

The Peterborough Regional Health Centre has evolved from a more community hospital model through legacy hospital sites (Peterborough Civic Hospital and St. Joseph’s Hospital), each with 100 years of proud, caring, compassionate history. The new Regional Health Centre’s vision and design were built on a platform of regional specialization while maintaining care close to home. Over the course of the past decade, strategic plans have evolved to acknowledge changing local needs & populations, foci, and evolving face of healthcare delivery.

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Executive SummaryThe Plan

PRHC’s 2011-14 Strategic Plan was developed at a time of significant upheaval and uncertainty at the Regional Health Centre – following years of fiscal and operational performance shortcomings. Its development was condensed due to the financial and performance imperatives facing the organization following an external, provincial Peer Review in 2010. It was determined at the time that the existing Vision, Mission, and Values were sufficiently robust and relevant to guide the organization while substantive and valuable internal and external (public, stakeholder) input would be sought to develop new Strategic Directions to better focus the organization through needed performance improvements.

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Accomplishments, Adjustments & Ongoing Initiatives

Through focus, un-relenting determination, talent and will power, PRHC has substantially met and even surpassed the strategic directions it set out in the 2011-14 Strategic Plan such that:

ü A cascade of progressively deepening, operating defi cits has been reversed – bringing PRHC into fi scal balance for the past 4 fi scal years (since 2012/13).ü Access, Quality, Safety have been enhanced – meeting or exceeding provincial targets. ü New regional programs have been attracted to Peterborough:

ê Cancer - Radiationê Complex Diabetes Careê Strokeê Vascular Surgery (incl. Endovascular Aneurysm Repair) serving over 600,000 people in the Central

East LHINê Cardiac Care (angioplasty)

ü Existing programs have been expanded and/or enhanced:ê Mental Healthê Respiratoryê Neurologyê Minimally Invasive Surgery

ü Improved Staff and Physician Engagement scores, supporting the recruitment of new, highly sought-after professionals and specialists.

ü Accreditation with Commendation.ü Implementation of Lean improvement systems to drive value, eliminate waste – improving fi nancial,

operational, quality and safety performance.

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Environment

Like many jurisdictions, through Local Health Integration Networks the funder (Ministry of Health and Long-term Care) has become increasingly sophisticated and prescriptive in the areas of volume management, quality & safety standards, and procedure-based funding – to name a few. The stewardship and enforcement of these standards is primarily accomplished through the use of legally enforceable Hospital Services Accountability Agreements (with sanctions & penalties for non-compliance), legislation, and quasi-external oversight organizations (e.g. Health Quality Ontario, Cancer Care Ontario).

In addition to these levers, fl at-lined hospital funding and sizable funding increases to community-based providers have been used eff ectively by government to focus the role of hospitals to acute care services - in favour of eff ective but less expensive community-based organizations.

ProcessThe plan incorporated input from the community, hospital staff , health care providers and community agencies. The planning process included:

• A broad framework to encapsulate the current and future complex environment – informing discussion, foci and options • Forums to hear and listen to our partner and stakeholder voices • Frequent and refl ective planning workshops • Planning Retreat with the Board, medical and administrative leadership, partner hospitals and stake holders

2011-2014 Strategic Plan Development

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Goals & Accomplishments

Strategic Plan Summary 2011-2014

Driving the Road to ExcellenceNavigating a Successful Course Correction

PRHC Vision 2014Engaging. Planning. Inspiring.

In partnership with the Central East Regional Cancer program and Durham Regional Cancer Centre at Lakeridge Health, PRHC off ers Cancer care services including chemotherapy and radiation therapy closer to home. The new addition of radiation therapy in 2013 allows patients to receive state of the art care supported by physician and allied health professional experts for breast and prostate cancer as well as palliative care.

PRHC’s Cancer Program DetailsPRHC delivered almost 6,000 chemotherapy treat-ments and provided over 12,000 consultation appointments 2013-2014 fi scal year.PRHC’s Cancer Care Program has grown by 85% over the last 5 years.650 cancer related surgeries were performed at PRHC between 2011 and 2012.513 patients received colorectal FOBT and Colo-noscopy screening at PRHC in 2011 and 2012.7,800 patients visited PRHC’s Breast Assessment Centre for OBSP Screenings in 2011.In summer 2013, the fi rst patient received radia-tion treatment at the new Norm and Jessie Dysart Radiation Centre.

Key Accomplishmentsü Radiation Therapy Centre implemented at PRHC -

First treatment, July 2013.ü Implementation of Ambulatory Oncology Fall

Prevention Program - September 2013.

What We’re Working On• Implementation of Diagnostic Assessment Programs including breast, colorectal and pros-

tate (target implementation over the next year).• Implementation of a Psychosocial Oncology Program clinic design.• Implementation of processes and infrastructure

to support quality based funding which commences in the 2014-2015 fi scal year.• Implementation of local Multidisciplinary Case

Conferences target date May 2014.

Ambitions• Implementation of CCO ISAAC platform (an alternative method to collect patient symptom information). Target completion within the 2014-2015 fi scal year.

Cancer

Page 7For full details of strategic initiatives see Appendix.

Key Accomplishmentsü Established prioritization guidelines by procedure

and re-scheduling criteria for emergent cases in Interventional Radiology.

ü Established PICC (Peripherally Inserted Central Catheter) line service.

ü Cross-train staff in diff erent DI modalities.ü Implemented recommendations from the CT/

Oncology rapid improvement event to improve timely access.

What We’re Working On• Support of the Medicine Review and program to

assist in improving length of stay results.• Implementation of CT/Oncology rapid improvement (LEAN) event.

Ambitions• To continue to provide safe, eff ective, effi cient

and timely care using state-of-the-art imaging equipment with highly trained professional staff .

Diagnostic ImagingDiagnostic Imaging is an integral element to assist in diagnosis and treatment with over 115,000 tests performed each year. Services include angiography/Interventional, Nuclear Medicine, Bone Mineral Densitometry (BMD), Mammography, CT, MRI, Ultra-sound and Xrays. Radiologists from PRHC also travel to other local hospitals to support their health human resources needs.

As a regional centre, diagnostic imaging supports a number of regional programs. The busy service must also accommodate the challenges of both scheduled and emergent needs in all types of diagnostic modalities.


Key Accomplishmentsü Established hard wait time triggers for admitted

patients in ED.ü Enhanced surge protocol to help manage patient

fl ow in the department.ü Introduced post discharge surveys for ED patients

in the blue zone for patient satisfaction.ü Completed 1st experience based co-design improvement initiative. ü Focus on full-staffi ng levels, lost time incidents,

overtime and performance appraisals.ü Signifi cant improvement initiatives with Family

Health Teams (e.g. post ED visit reporting to family physician).

What We’re Working On• Measure & enhance patient experience in the ED.• Seamless transitions of information and care between the ED and (1) PRHC programs (2) community providers.

Ambitions• Improve Patient Experience through experience

based co-design eff orts.• Continue to reduce wait times.

EmergencyPRHC’s Emergency Department is very busy with over 75,000 visits per year.

In addition, signifi cant focus on ED lengths of stay have resulted in dramatic improvements, placing PRHC as 13 out of 74 best hospitals in 2013 (from 48 in 2012).


PRHC’s laboratory provides community and regional level laboratory services, performing over 1.43 million tests every year in areas such as Biochemistry, Hematology, Transfusion Medicine, Microbiology, Anatomical Pathology, Cytology, Specimen Procurement & ECG.

LaboratoryKey Accomplishmentsü Achieved Ontario Laboratory Accreditation.ü Participated in regional internal audit at Lakeridge Health.ü Regional audit performed at PRHC.ü Successfully went live with Ontario Laboratory Information System for Chemistry and Hematology.ü Full complement of pathologists.ü Signed service agreements with NHH, CMH and

RMH.ü Implemented state-of-the-art testing for

C. difficile.

What We’re Working On• Automation of Core Laboratory Testing.

Ambitions• Continue to work with partner hospitals to ensure

high quality, cost eff ective, timely access to laboratory services.


Key Accomplishmentsü Full hospitalist complementü Reduced COPD Length of Stayü Established Medical Short Stay Unitü Quality-based Procedures implementation ongoing/accelerating.ü RPN education and training to achieve full scope of practice.

What We're Working On• General Internal Medicine program & ward-based care• Integrated Stroke Unit• Geriatric Behavioural Unit• Medicine review action plan implementation• Re-establishing hospitalist ward-based care

Ambitions• ED avoidance through outpatient strategies• Improve access to Medicine program through Length of Stay improvements.• Chronic Disease management strategies (COPD, CHF) – readmission reductions.• Increase staff satisfaction through LEAN process improvement engagement and professional development.

MedicineAs with most community hospitals, the Medicine program is the largest, most complex program with a considerable scope of practice with specialists in the following departments:

• Cardiology/Catheterization Lab• Dermatology• Endocrinology• Gastroenterology• General• Geriatrics ê Hospitalist ê Intensivist ê Nephrology• Neurology• Oncology ê Physiatry• Respirology• Rheumatology

Family medicine is also included, with areas offocus such as:• Medicine – Hospitalist• Alternative Level of Care • Genetics• Palliative Care


ü Partnership in Home Response Coalition Planning Group.

ü Membership in Central East LHIN Mental Health and Addictions Network.

ü GAIN design and Behavioural Services Ontario design team membership.ü Establishment of Classroom based Day Treatment

Program for Adolescents.ü Reintroduction of Dual Diagnosis Consultation Clinic

in conjunction with Queen’s University and Tri-County Behavioural Services.

What We're Working On• Enhanced services for the treatment of patients with

concurrent disorders (mental health and addictions).• Inpatient services for youth and adolescents with

mental health issues.• Enhanced service capacity for the treatment of patients impacted by trauma.• Developing improved process for collection and reporting of standardized data and Program indicators.

Ambitions• Signifi cant reduction in repeat visits within 30 days to

the ED for mental health and addictions reasons.• Shared intake with PASE and GAIN.

A range of community and regional Mental Health and Addiction Services (MH&A) are off ered by PRHC - supported by the Central East LHIN. MH&A Services provides care that recognizes the relationship among biological, psychological and social factors that impact an individual’s mental health. The service (fi ve multi-disciplinary clinical programs) provides leadership and expertise in partnership with community partners in the assessment, stabilization and treatment of individuals and their families with serious mental health and addiction concerns.

Key Accomplishmentsü Establishment of online mental health bed registry

to enable timely access and transfer of patients across LHIN based schedule 1 and non-schedule 1 hospitals.

ü OTN access to psychiatrist improving access for people living in rural areas.ü Membership on CELHIN Chiefs of Psychiatry table and

Directors of Mental Health table to look at system planning (Mental Health ED Common Assessment Tool, Transfer protocols).

ü Provision of Annual Clinical Education Forums to enhance knowledge transfer and collaborative practice. ü First Nations Cultural Diversity training in partnership

with community stakeholders.ü Membership in the Peterborough Health Links - Mental Health and Addictions initiatives.ü Hospital to Home partnership with Canadian Mental

Health Association.Page 12

Mental Health and Addictions

For full details of strategic initiatives see Appendix.

PRHC provides over 2 million doses of medications every year. The past three years have seen signifi cant changes in the supply and use of medications to hospitals (e.g. chemotherapy under-dosing, supplier shortages) which have signifi cantly increased the workload and pressure on pharmacy staff throughout the hospital. PRHC’s pharmacy assistants were recognized for their alertness, due diligence and follow-up in the chemotherapy event, and staff have managed signifi cant supplier issues with no impact on patient care.

PharmacyKey Accomplishmentsü Pharmacy in conjunction with professional practice implemented a computerized

medication record (cMAR).ü Supported Pharmacy Assistants to attain regulated Pharmacy Technician designation.ü Implemented Pharmacy Technician ward-based

care resulting in a signifi cant reduction in order entry & turn-around times and staff satisfaction.

ü Reduction in inventory levels. What We're Working On• Active monitoring and practice/supply adjustments to pharmacy supplier shortages.• Ongoing support of Anti-microbial stewardship

program to ensure antibiotics are used effi ciently and eff ectively.

Ambitions• Continue supporting excellent clinical care

through the full implementation and refi nement of ward-based pharmacy care.


PRHC’s Regional Renal Program operates a comprehensive service in Peterborough with satellites at the Ross Memorial Hospital and Northumberland Hills Hospital.

Key Accomplishmentsü Replaced fl eet of dialysis machines, Spring 2013.ü Implemented strategies to ensure nursing full scope of practice & transition from 7 to 6 day dialysis operations.ü Enhanced and supported patient choice of Independent Dialysis Modalities, (incl. new Nurse Navigator, new triggers for patient education choices and Inter-Professional Transition Rounds. ü Implemented the Transition Unit Model (March 2014) for focused support of patients considering independent dialysis (Unit Steering Committee for Positive Change, LEAN events).ü Patient and Family Experience Council in January 2014.

ü Staff engagement and improvement (Unit Steering Committee for Positive Change, LEAN events).ü New ultrasound equipment (ultrasound guidance for needle insertions into an arterial venous fi stula (AVF) improves the patient experience and reduces the risk).ü New transonic monitor for surveillance of AVF - early detection of access dysfunction. ü Development of processes and data collection tools to ensure alignment with Quality Based Funding and ORN best practice. ü Recruitment of Patient Ambassadors - provide information and share their experiences with other patients.

What We're Working On• Improving our home dialysis rates.• Reducing the number of hemodialysis catheters.• Implementation of Renal Software in progress with target completion in Summer 2014.• Development of Nurse Core competencies for dialysis and standardization of orientation and competence reviews across Regional Program, Spring 2014.

Ambitions• Capacity planning and “right-sizing” for Region to ensure patient access and effi ciency.• Review of Regional service delivery model and implementation of strategies to strengthen regional relationships.

Renal

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! NHH RMH PRHC Nephrology Clinics ✓ ✓! ✓!In Center Hemodialysis (HD) ✓! ✓! ✓!Pre-Dialysis Clinics ✓! ! ✓!Post-Transplant Clinics ! ! ✓!Independent Dialysis

• Peritoneal Dialysis (PD) • Home Hemodialysis

! ! ✓!

Inpatient HD and PD ! ! ✓!Critical Care including: HD, Continuous Replacement Therapy (CRRT) and Plasma Exchange (including Lakeridge patients)

! ! ✓!

Vascular Access (including Lakeridge Patients) ! ! ✓!

! NHH RMH PRHC Nephrology Clinics ✓ ✓! ✓!In Center Hemodialysis (HD) ✓! ✓! ✓!Pre-Dialysis Clinics ✓! ! ✓!Post-Transplant Clinics ! ! ✓!Independent Dialysis

• Peritoneal Dialysis (PD) • Home Hemodialysis

! ! ✓!

Inpatient HD and PD ! ! ✓!Critical Care including: HD, Continuous Replacement Therapy (CRRT) and Plasma Exchange (including Lakeridge patients)

! ! ✓!

Vascular Access (including Lakeridge Patients) ! ! ✓!

For full details of strategic initiatives see Appendix.Page 14

Key Accomplishmentsü Electronic Workload Measurement project undertaken to enable just in time collection of

workload data to improve therapy resource planning and staffi ng assignments.ü Neuro rehab clinic off ering treatment for spasticity in partnership with pharma (Allergan).ü Rehab brochure and welcome package – to enable program coordination and active engagement of families and clients towards

achievement of rehab goals. ü Development of PRHC Stroke Quality Council and

District Story Planning Committee (HKPR).ü CCC - Senior Friendly Hospital steering committee established.

What We’re Working On• Formalize our role as a high performing regional

amputee centre.• Create a “centre of excellence” within CCC through

enhancing patient experience for specialized populations other than Geriatric.

Ambitions• Ongoing development and implementation of

Senior Friendly Hospital strategy.• Planning to re-align some of the out-patient ser-

vices to optimize the therapeutic care to stroke and COPD patients (HBAM priorities).

Sub-acute care is an important component of hospital services and often bridges a patient’s journey from their acute treatment to their discharge (home, long-term care home etc…).

The key elements of this program are as follows:• Rehabilitation (Inpatient & outpatient)• Regional Stroke (designated District Stroke lead

by Ontario Stroke Network)• Functional Enhancement, Complex Continuing

Care and Interim Long-term Care

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Sub-Acute

For full details of strategic initiatives see Appendix.

PRHC’s surgical program performs a wide array of general and specialized surgical procedures. Along with specially trained nurses, respiratory therapists,and other professional and support staff , the servicehas a variety of specialists including:

• Anaesthesiology • Orthopaedics • Dentistry • Otolaryngology • General surgery • Plastics • Gynaecology • Urology • Opthamology • Vascular

SurgeryKey Accomplishmentsü Increased Vascular coverage with recruitment of 3rd Vascular surgeon and the implementation of Endovascular Aneurysm Repair (EVAR).ü Successful recruitment of a 4th Opthamologist to meet cataract wait times and volumes, introduced high effi ciency operating room days and an additional 6-8 cataract procedures within the same session time.ü Increased access to cancer services with the addition of a 5th and 6th General surgeon improving access for increased service needs such as Breast and Colorectal.ü Implemented a new bar coding system in the Operating room and in the Sterile Processing Department (SPD). ü Reduction of 50–75% of non-catalogue supplies are now scanned and the replenishment order is automatically sent electronically to the ordering system. Savings on human resources and inventory replenishment over/under stocks.ü Introduced continuous nerve block pain management, which is a big focus for Anaesthesia and they will continue to launch permanently with physician collaboration, Orthopaedics and Anaesthesia.

ê Pilot study on total knee replacement patientsê Less use of Opioidsê First two months of trial reduced length of stay

by 0.5 days

Services Visits Anually(Approximately)

Pre-op Clinic 18, 200 per yearOrthopaedic Clinic

(including fractures) 13,100 per year

Inpatient(Orthopaedic, vascular, urology,

general)4, 400

Outpatient (Eyes, skin, minimally invasive surgery, cystoscopy and endoscopy)

14, 750 cases

Sterilization of Medical Devices

157, 000 items sterilized (11,

348 sterilization cycles)


ü Granted Level IIB status as the Regional Centre providing Maternal and Neonatal Care for the NE Cluster of the CELHIN.

ü Enhancement of Obstetrical Services - Compre-hensive Midwifery and Family Practice obstetrical collaborative care model.

What We’re Working On• Recent integration of Radiation Services at PRHC to support Breast Assessment Centre patients and families.• Stable funding model to support specialist care

within our NICU and Regional Paediatrics Program.• Ongoing implementation of MORE ob program.

Ambitions• To be the provider of choice

for Women's and Children's services – providing

excellent patient experience.• Further support internal

program and external community partners in

the care of Regional Level Women's and Children's Services.

This program spans a continuum of service from birth (> 1,600 annually), highly specialized neo-natal Inten-sive Care Unit (2,500 patient days), Paediatrics (200 patient days), sexual assault/violence care (~1,500/yr), Breast Assessments (~8,000/yr) and Women's Health Centre Visits (5,400/yr).

Key Accomplishmentsü 30+ fold increase in the volumes of patients seen

in the Paediatric Out Patient Clinic (POP) avoiding admissions to the hospital and reducing ED wait times.

ü Investment in Obstetrical Care Providers and Nursing Staff to implement the MORE ob Program (Managing Obstetrical Risk Eff ectively).

ü Added Regional Genetics Program to the portfolio (integrated within the Breast Assessment Centre) to enhance capacity and access and create a sustainable inter-professional

model to support the patients and families of the NE Cluster of the CELHIN.

ü Development of the CELHIN – Maternal, Neonatal and Paediatric Advisory Committee.

ü Capital Investment in new Clinical and Urodynamics technology for the program. ü Additional outreach clinics for OB/Gyne and Paediatrics.ü Development of a robust Breast Assesment Centre Community Advisory Committee.

Women’s and Children’s


Clinical and Hospital Support Services

Clinical and hospital support services are essential elements of the healthcare we provide. They ensure that this quarter billion dollar enterprise is clean, secure, has needed supplies, and the building & equipment systems run at peak performance. The teams maximize information technology, human, fi nancial and physical resources to ensure that our funders, taxpayers, are getting the best value for their hard earned money and care to our community is accessible, and of the highest quality and safety.

Thank you to our clinical and hospital support teams who make care possible at PRHC.

• Communications• Collaborative Practice• Financial Services• Strategic Supply Chain• Business Development• Environmental Services• Facilities and Grounds• Human Resources• Information and Communications Technology• Health Information• Decision Support Unit• Medical Device Reprocessing• Nutritional Services• Quality, Risk & Medical Aff airs• Transformation• Volunteer Services


Lessons Learned and Plans for the FutureGeneral ObservationsPRHC’s Strategic Plan for 2011-2014 was successful in aligning the organization during a very difficult period for the Health Centre.• Largely created appropriate and reasonable service directions and priorities • Driven focus on:

ê Strengthening existing and “earning” new regional programsê High performanceê Need for Health Human Resources Planning & Recruitment

Mission, Vision and Values Developed to:• Bring two separate organizations together• Drive building, planning & “move in” • Drive recruitment (A place for Care and Career etc…)

These components were focused on the “Come Join the Team” approaches instead of “Drive/Strive Forward” which wasn’t optionally suited to drive decisions or manage competing priorities and focus.

Strategic Priorities & Directions• Well designed & thoughtfully formulated• Established solid foundation for PRHC Strategic Planning based on evidence-based health planning principles:

ê Continued evolution in next Plan imperative• Good internal stakeholder involvement:

ê External involvement of partners necessary to ensure ongoing successê Added internal leadership on future state design, input, and buy-in will strengthen execution & accountability

Plans for the Future • Propel PRHC forward based on realistic future environmental conditions (political, economic, structural) & service/care delivery models (e.g. Minimally Invasive Surgery, Cancer Care, Outpatient trends, hospital/ community service mix).• Be aspirational - use “…est” words (e.g. best, greatest, safest, strongest, …).• Become a defining statement designed to act as guideposts (destination beacon) for difficult decisions between competing priorities. • Be engaging, motivating and galvanizing for our partners and community – providing them a reason to come along on this journey:

ê Be laser-like in focus on priorities and directions regarding the services that the hospital has to offer.ê Advance to the next level of sophistication in defining future state, execution plan, market share etc.

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Appendix

For full details of strategic initiatives, please visit www.prhc.on.ca

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