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CEO Discussion Board
| Headlines... On Monday, I made a presentation to the Rotary Club of Peterborough, a club I intend to join (actually a transfer from Chatham-Kent). I had asked to address the Club well before my arrival – it does take a bit of lead time to get onto the agenda. Perhaps it was President’s month because last week, Steven Franklin, the new President at Trent University spoke about his role and accomplishments in the field of wildlife and environmental research.
Since my work doesn’t seem as interesting as installing radio collars on bears and using satellite-based technologies to monitor environmental degradation, I thought I might have trouble finding a comparable topic to captivate a very discerning audience. Since nothing catches public attention like healthcare, funding and change, I took a chance on a topic close to my comfort zone.
The bulk of my presentation spoke to the tectonic shift that is occurring in healthcare. Contrasting “old world” and “new world” thinking in healthcare as they collide with the emerging trends of the 21st century is an easy speech. However, as the geological metaphor would predict, as land masses collide, the landscape is dramatically altered with spectacular results. The case is the same for healthcare.
What garnered the headline though is that PRHC is predicting a year-end deficit in excess of $12,000,000 or, stated another way, a deficit that grows by about $35,000 per day of operation. Although our operating budget approaches a quarter-billion dollars per year, that is a lot of money. Unchecked that gap between revenues and expenses will grow in 2010-2011 as inflation affects revenues and expenses differently.
Notwithstanding a LHIN-directed peer review process, the need for an intervention is both necessary and urgent. “Setting the table” for the challenges and changes ahead is a fundamental step for any successful change management. Some call it the “case for change”, “painting the picture” or “establishing the burning platform”. In any jargon, the message is the same: the current state cannot be maintained without grave risk to the enterprise and its future. In contrast, the potential benefits of moving to a new steady state far outweigh the risk of the status quo. In short, we need to act and we need to act now.
And, it is like that age old question: how do you eat an elephant? …one piece at a time! Our deficit is much the same. Stated in its totality, a large deficit is sometimes overwhelming. Breaking it into smaller bits gives it the granularity and scale to make it real for people charged with its resolution. Thus, the headline that PRHC’s deficit is growing by $35,000 per day is very real. If that makes this looming challenge uncomfortable, yet meaningful, so be it.
However, readers need to know that we must deal with this reality in order to build a stronger PRHC, a PRHC better positioned for future growth, growth enabled by our new facility and the capabilities and capacities it contains. While the road ahead may be a bit bumpy, there is an opportunity here and we must ensure that we deliver. The people who rely on PRHC expect and deserve no less.  | |
| Wow! Go see wonderful photo exibit for Emerg.
In many ways, Peterborough Regional Health Centre is the metaphorical heart of our community; the patients and families are its pulse; and the caring professionals are its rhythm. Our goal, in addition to life saving and compassionate care, is to ease the anxiety and concern that accompany any visit to the hospital.
Dr. John R. Lingertat, Untitled, 2007
On Wednesday afternoon I had the opportunity to preview a unique photo installation called the Emerge project. As part of our larger commitment to art and healing, this collection was conceived by local volunteers and photographers who sought to contribute their talent in a meaningful way to the patient and family experience at PRHC.
Dr. Hardy Friesen, Loon with Baby, 2007
As an avid photographer myself, I know how powerful and inspiring this art form can be. I hope this permanent collection of photography will comfort visitors and caregivers alike. I believe that these unique images of life in our community will bring solace and peace amidst the anxiety of life fractured by time in the emergency department.
Dr. Jennifer Darling, Cedar Waxwing in Juniper, 2008
The installation is open for public viewing at Artspace, 378 Aylmer St N, on Feb 25-26 from 10-6 and Feb 27-28 from 12-4. I encourage you to go and take a look.
Dr. Temba M’Cwabeni, MNR, 2009
On behalf of PRHC and the community we serve, I want to extend our thanks to the volunteer Art Steering Committee for their time and inspiration in building this collection, to the donors who have supported the installation (including our own ER physicians) and to the photographers who have shared their images with us all. I know you will enjoy this collection and, more importantly, I know you will appreciate how such images will make a difference to the thousands of patients and families who come to PRHC when they need us most.
Lise Brown, Winter Magic, 2009
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| Hey, the new CEO was in our staff orientation session!
On-boarding...
One of the interesting dynamics of joining a new organization is to attend new staff orientation, or at PRHC calls it, “on-boarding”. In the audience with me were folks from clinical areas, clerical areas, information technology and a student. Nothing says “healthcare” more than the briefings on WHIMIS, occupational health and health surveillance, handbooks, directories, tours, IT orientation, way finding, codes of conduct, dress codes, confidentiality and privacy and, of course, a presentation by the CEO about the vision, values, mission and strategic directions of Peterborough Regional Health Centre. Yep, I was both participant and presenter today!
I confess, my presentation was not as much fun as the overview about health surveillance and other occupational health issues which are mandatory for Ontario hospitals. Nor was it as interesting as the overview about PRHC Foundation. But, it was about why this CEO feels it is so important to have new staff understand the why quality, safety, performance, innovation, goal alignment, respect and accountability are pivotal to our collective contribution to the healthcare of our community.
As healthcare morphs in response to the information age, we are shifting from a service industry to a knowledge industry. Increasingly, our most important asset is the human and intellectual capital behind highly trained and mobile professionals who, in this economy and country, can work anywhere. New graduates are looking for the tools and technologies that support their vocation, high performance teams and programs, opportunities for lifelong learning, great workplaces and facilities and communities supporting their lifestyles and work / life balance.
This places great expectations at the feet of leaders who must create the organizational cultures that support this shift in the workplace and organization. So, in addition to the usual challenges of Canada’s evolving healthcare system, we have the activities associated with making our workplace and health centre the place to be.
Psssst – wash your hands
We all know that higher hand washing rates are linked to lower rates of hospital-acquired infections such as C. difficile, MRSA and VRE. Given that hospitals house hundreds of patients, employ thousands of employees, have clinics with tens of thousands of out-patients and many more visitors, the hospital environment is a crossroads for pretty much every bug and infection out there (not to mention the H1N1 outbreak of 2009).
Thus, it comes as no surprise that the results of hand hygiene audits, mandatory in Ontario, will posted by hospitals on April 30th. The actual audits for the four moments of hand hygiene will occur in March. Last year, PRHC posted 89% and 94% compliance with the first and fourth moments, rates that we targeted for improvement for 2010.
Audit results will be posted on our website for the entire year and we look forward to both our absolute results and those relative to other hospital providers. Hand hygiene, along with many other initiatives dealing with safety, quality, wait times and mortality rates, are part of a larger scheme to drive performance improvements across hospitals and across the system. Avoiding infections, reducing length of stay, keeping the workplace healthier and driving both performance and accountability are the currencies of these important initiatives and I hope we build on our 2009 results. | |
| Amidst the chaos in the daily life of a hospital...
Some of the things we do in hospitals have no metric, no benchmark, no ratio. I recently attended a remembrance service in our Multi-faith Centre to recognize staff, physicians and volunteers from the hospital family who passed away in 2009. PRHC is a family of thousands that help others each and every day – how do we help staff when one of our own succumbs to the very passages that we deal with every day in the ED, wards, clinics and in the community?
This got me to thinking. There are, of course, many measures of organizational performance and excellence in the domain of human resources management. Most in management can recite the traditional metrics of such things as employee turnover rate, or time to fill vacancies, or indices such as overtime, absenteeism and productivity, or even levels between CEO and staff and “span of control”—all things that differentiate between average and superior workplaces. As healthcare morphs from a “service” to a “knowledge” workplace, these traditional Human Resource measures are being supplemented by new workplace “engagement” rates. We now look at IT adoption, hours of lifelong learning, scope of practice and performance-based recognition strategies. Important shifts are taking place in what and how we measure and improve our workplaces. And, any scan of evaluative criteria used to identify top employers provides evidence of these new indicators. But can any set of indicators ever completely explain it all? I don’t think so.
Take last week when I attended the memorial service led by our pastoral care department. I was impressed by the compassion, respect and dignity we offered to our own who lost their battles with the very conditions we treat each and every day as healthcare professionals. From Dr. Beaubien who played the piano, to staff who offered their heartfelt reflections, I witnessed the elements that traditional human resources indicators rarely define, let alone “measure”.
Thank you Father Joe and your team for your recognition of passages experienced on this side of the bedside. I know your gesture of remembrance was appreciated by all who participated and attended.
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| On Great DI Media, letters we get, and meeting PRHC's Foundation
Congratulations Dr. Wilson and PRHC’s Imaging Team
Imaging technologies are revolutionizing clinical care with newfound diagnostic precision. A case in point is PRHC’s new CT SPECT scanner as profiled in the February 2010 issue of Canadian Healthcare Technology. Increasingly, advances in diagnostics result from the convergence of existing technologies. In this example, the image resolution of CT is combined with the anatomical precision of nuclear medicine to create a new way to localize tissue and diseases susceptible to isotope uptake. In the wake of international shortages of some radioisotopes, this hybrid technology allows candidate patients to receive needed diagnostics, particularly bone and cardiac studies without delay.
Well done and thank you for sponsoring this innovative technology at PRHC.
And, we get letters
Thank you to the many people who have written letters to me upon my arrival. In addition to their well wishes and sincere welcome to the community, many go on to offer comments and observations about PRHC and the financial pressures we face as reported in the media and this blog. Some wish me good luck as we “tame” the seemingly resistant and persistent gap between the revenues we receive and our ability to manage within that funding envelop. Some opine about the need for a peer review, that we should be able to orchestrate needed solutions internally. Some are rather critical of previous fiscal recovery attempts and offer their hope that this regime achieves better and more sustained results. Some relate a fear that gains in productivity, aka reduction of paid hours through aggressive benchmarking techniques, might cause job losses or reductions in capacity that limit or reduce access to needed care. In all cases, there seems to be a sense that the new PRHC needs both sustained performance and capacity to meet the needs of the community.
I couldn’t agree more. Balancing budgets is about performance (i.e., the metrics that differentiate between mediocre and superior providers and optimal use of their resources), improving quality, assuring safety and entrenching this new steady state as we grow needed programs and expand our role as a regional provider. In the weeks ahead, I will share some of the trends and issues shaping this mandate and how we intend to build a platform for performance and the capacities and capabilities enabled by our newly built facilities.
Fiscal recoveries – the processes of returning organizations from the brink of irreversible or permanent financial losses – are neither easy nor short-lived. The agenda ahead is about change, not loss: be it performance, capacity or outcomes. The road ahead is marked by those who have gone before us; there are literally dozens of hospitals that have been “encouraged” to see a future through the lens of performance within negotiated levels of funding. As unique as PRHC is, the challenges, issues and solutions ahead are not.
So, thank you for your letters and encouragement. It is amazing what people of vision, courage and skill can achieve when the goal ahead is both essential and urgent.
Meeting the leadership and friends of PRHC Foundation
Sometimes, work is fun! Wednesday night, I was able to meet the many people of PRHC Foundation. Board members, supporters and staff hosted a small reception to meet the “new guy”. Following a brief introduction by Foundation President Julie Davis and comments from me, the bulk of the evening was to meet a wide variety of community leaders who have committed their time and directed their philanthropy towards patient care at PRHC.
There is no indicator more telling of community confidence in and support of a hospital than that of voluntary donations by business and private citizens. The corresponding duty for the hospital is uncompromising performance. That these two dynamics are synergistic is the sweet spot for both hospital and foundation. Thank you all for coming out and I look forward to our successes together.
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| End of Week Two: On being the "Hippy Dippy Weatherman" among other things...
Coming soon to a cafeteria near you: President’s Forum
Starting March 5th, I will host monthly President’s Forums to keep staff (employees, physicians and volunteers) apprised of, well, stuff. Issues like progress on important initiatives (safety, quality, performance, programs and regional initiatives), kudos for staff, departments and programs that have achieved some milestone or other goal, updates on issues that shape the landscape of healthcare delivery and how they affect PRHC, highlights from Board meetings and other policy changes underway at PRHC. Best of all though: time with the CEO to ask questions important to you.
There are two ways to have questions raised: the obvious, attend and raise your hand; the other, via e-mail. E-mail questions will be answered either directly or saved for the Forum. In either case, I hope that the exchange will be constructive. See you on the 5th.
If you're a member of the general public reading this blog, I will be presenting to community groups in the months ahead, and doing media--all with the intent of keeping you informed too.
End of Week Two
As the first week blur of meeting hundreds of people wanes, I can share some of the activities I have incorporated into the balance of my arrival. I continue to expand the number of departments and programs toured. Of particular note: occupational health and safety. I have personal experience that our health surveillance program works, particularly TB screening (I hate needles) and my immunology profile (aka blood test). There were more walk-bys (unlike drive-bys or drive throughs) for ambulatory care, cancer clinic, specimen collection centre (see above), the ED and cardiac catheterization laboratory. I chatted with many staff, volunteers and even some people in waiting rooms. And, I handed out some vouchers to staff who shared some time with me in the coffee line. I popped into a new staff orientation session knowing that soon I will be attending such a session officially as both participant and presenter.
Hospitals are filled with committees. This week I attended my first Medical Advisory Committee. This is the Board Committee populated by Chiefs, Medical Directors and elected physicians to govern and manage those duties prescribed by the Public Hospitals Act and assigned by the medical staff by-laws of PRHC. Heady issues but I enjoyed a warm welcome by our clinical leaders. I was impressed by their commitment to the quality of care and related performance of its standing committees, departments and programs at PRHC. For hospital administrators, the MAC can be a lion’s den and one must remember three things about lions: they are ambush predators, they hunt in groups and they are carnivorous! (Serengeti unplugged was the name of my photo exhibit from a safari in Tanzania.)
I met the leaders and representatives of PRHC’s various unions and non-union staff. The Fiscal Advisory Committee is a venue to exchange information, issues and perspectives between senior managers and organized labour. We spent some time reviewing the challenges ahead for PRHC in the wake of growing red ink and the Peer Review process currently underway at PRHC. Particularly noteworthy was a recap of the issues leading up to the LHIN’s decision to use a Peer Review process to assist with the financial recovery plan (balanced budget) so essential for PRHC’s sustained fiscal health.
Speaking of which, I had a one-hour interview with members of the Peer Review Team. We compared notes and observations; the CEO is but one of a long cast of interviewees surveyed about the issues and possible solutions needed to end PRHC’s pattern operating outside the expected margins and available resources. The Peer Review will confirm that "business as usual" is both high risk and not sustainable. But we will speak more about that later.
I heard with some pride that the Team at PRHC helped the United Way of Peterborough achieve its target of some $2.5 million for member agencies. PRHC’s tally was up some 18%! Well done Alicia and team for unleashing the generosity of the good people at One Hospital Drive.
Psssst – Tremblay was the weather guy Wednesday on the KRUZ-FM. While my meteorological acumen is highly suspect, I had flashes of George Carlin’s signature character: the Hippy Dippy Weatherman. I tried my best to banter with Mike but, like the pro he is, I think he got more points, lines, jabs, guffaws (or whatever the output currency is for morning show hosts). Click here for a you tube video clip.
What week would be complete without the requisite external meetings. One was with MPP Jeff Leal (congratulations on the new role!) and PRHC Board Chair, Barb Cameron. To say that healthcare in Canada contains a universe of issues observed through the lenses of social policy and political interest is stating the obvious. Clearly a gentleman with a long history and interest in the affairs of healthcare, Jeff was both articulate and forthcoming with his take on issues and the perspectives advanced by the electorate and the government. While I didn’t take actual notes, his expectations for a person in my role have been echoed by many leaders in many communities.
I attended a meeting of provider CEOs from across the Central East LHIN. From Haliburton to Scarborough, nine of us met in Bowmanville to catch up on some shared initiatives and LHIN-sponsored projects. Meeting new colleagues is always a pleasure and, most were well known to me though previous relationships or contacts. As the opportunities for regional collaboration increase, finding methods to deliver on them is essential. For example, all of the providers share common information technology platforms and technologies: how should this feature be leveraged to improve healthcare delivery and health system performance for patients and providers?
When I left Chatham-Kent, the CEO of the Erie St. Clair LHIN presented me with a tie, a special tie designed to increase the probability of my success with the transformation underway in healthcare. I took that tie to the Central East LHIN offices in Ajax on Wednesday. The obligatory photo was taken for an e-mail to my former LHIN colleagues. Given that my meeting was with six senior LHIN staff and that the topic was our requirement to wrestle our one-quarter billion dollar budget to a sustainable steady state, I though the tie would be a humorous ice-breaker to what might be a difficult meeting and topic. Three hours later, I emerged somewhat less anxious and with a better sense of the approaches needed for an ambitious recovery plan for PRHC. Having been in this seat before as well as a peer reviewer myself, the recipe for success is a challenge…. the implementation more so. Oh, what did the tie say? Using a heart icon made famous by New York: I love LHINS!
The week also included a Board meeting of COHPA – the Central Ontario Healthcare Procurement Alliance. COHPA was established as a shared services organization (SSO) to combine scale and economies associated with group purchasing and integrated supply chain management activities among participating organizations. Like many other similar models, COHPA is designed to reduce the constituent costs of delivering essential supplies and services to end users. Embedded are many practices and methods to ensure that expenses are minimized and opportunities are leveraged among participants. At the end of the day, Ontario’s hospitals spend millions of dollars on their supplies and supply chain activities (procurement, distribution, inventory management, accounts payable, information systems, etc); efforts to reduce these costs ensure more resources for patient care and, ultimately, savings for the healthcare system.
Team at PRHC cited by Safer Healthcare Now!
Safer healthcare now is a national organization designed to facilitate and lead improvements in key performance indicators associated with clinical safety. Two metrics being reported nationally are ventilator-associated pneumonia (VAP) in intensive care units and central line- associated / bloodstream infections (CLA- BSI). Both complications can be reduced through vigilance and adherence to best practice protocols. In this month’s newsletter from the folks at SHN, our team at Peterborough Regional was cited for some of the best compliance and associated improvements in Canada. Demonstrating achievable results is important messaging for Canada’s institutional healthcare providers and the public. Well done PRHC!
In a related story, Ontario’s former Associate Deputy Minister of Health and Long Term Care Hugh MacLeod is SHN’s new CEO. Hugh has been a longstanding proponent of driving performance into the corporate and clinical landscape of Ontario’s healthcare system. With this appointment, he can advance that important agenda and message across Canada. Congratulations, Hugh.
Moving to Peterborough
And, this week I visited our new house for some measurements and picked up more boxes for the upcoming move. Living in a hotel, commuting to the "old place" for weekends, packing and the long list of things that any move brings will conclude in two weeks. At some, I will give you a note about Charlie’s take on the new digs.
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| Whew! The end of Week One My first week was a bit of a whirlwind…
It started on Monday February 1 at 7:30 as I drove up to the front doors to unload boxes and briefcases destined for my new office – the usual array of degrees, photos, files, briefings, coffee mugs, mementos and memorabilia.
The first person I met was a volunteer covering the front desk. “Hi. I’m Ken… the new guy”, I said as I squirted hand sanitizer all over the place, some making it to my hands, the rest landing on my shoes. While her face said “Show me your badge”, she quickly realized that wasn’t possible if I really was just arriving. By the time I parked the car (I’m sure I’ll blog about parking at some point!), word had spread (hospitals are like that) and, when I returned, my stuff was on a cart was surrounded by a small group of curious onlookers. Names and greetings were exchanged, more hand sanitizer flowed, hands were shook, heads nodded and off we went to my new office. Hmmmm, nice folks!
By 0800, strangers started to trickle in, most importantly my Administrative Assistant whose name and voice I knew; her welcoming broke the ice. My heart rate came down a notch – Kathy was exactly who I expected. More new guy quips, more hand shakes, quick run for coffee and first meeting of the senior team and their support staff. Life story, few jokes and then the reality of my first official meeting: Meet the Peer Review Team and, over the day, attended their four presentations to senior leaders, managers, medical leaders and the Board. Having the Peer Reviewers at PRHC on Day One felt like having your in-laws on your honeymoon….
At 1000, we hosted a Meet ‘n Greet in the cafeteria, a few hundred staff attended that. Board Chair Barb Cameron offered some introductory comments about “ the successful candidate” and I mused about my decision to join PRHC. I told my favourite story about eating a patient’s dried peanuts that had actually been chocolate-covered until her dentures went awry (usual laughs) - and a cavalcade of employees, union leaders, physicians, volunteers, managers lined up to offer their sincere best wishes and welcome – more nice folks genuinely glad to meet the new CEO.
That session was followed by a brief lunch with the senior team followed by a cavalcade of stuff: photo ID, parking pass, paperwork with human resources, phone and Blackberry, computer passwords, other forms, bank signatures, more sessions with the Peer Review team, brief session with managers and wrap up with an informal meeting with members of the Board of Directors.
As the week unfolded, there was a “quick” building tour, walkabouts in the ED, Materials Management, Engineering, Nursery, Mental Health, Nutrition Services, Operating Rooms, Maintenance, Finance, Health Records and Diagnostic Imaging. I popped into both medical staff lounges – always time well spent!
Day Four was “media day” with introductory meetings with two radio, two print and one television outlet. Pleasant enough but some poignant questions focused on the Peer Review, fiscal recovery, ambulance service, funding, initial perceptions and future activities. (Note to self: Examiner photos seem to indicate sudden weight gain….) Interspersed throughout the week were quick calls to the local MPP (returning his call), the Central East LHIN CEO, real estate agent, moving company and brief desk time to sift through congratulatory e-mails from colleagues across Ontario.
I started one-to-one interviews with senior leaders and had dinner one night with the Chief of Staff, perhaps the most important colleague a hospital CEO has. Meanwhile, more introductory meetings, more walkabouts, more hellos and hand shaking - with 2500 staff, that’s a lot of hand sanitizer!
It takes a village to operate a large hospital 24/7, 365 days per year. To a person, I have begun to appreciate a great organization poised for a bright future and I’m glad we picked each other.
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| Hello Peterborough and PRHC
Welcome to my blog as Peterborough Regional Health Centre’s new CEO. My intention is to make regular installments about the activities, issues and topics finding their way to my office, this organization, this region and Ontario’s healthcare landscape.
Sometimes, they will be short; sometimes not. Some blogs will contain a brief synopsis of my activities and musings; others, a discourse that be akin to Healthcare 101. I will strive to be engaging and fair, as balanced as possible and as timely, accurate and forthcoming as circumstances allow. The notion of a CEO blog is mine and its content and opinions are those of its author although some commentary may include published data, literature references or linkages to other organizations and publications.
I started a blog at my last organization and found it a great way to share information, perspectives and start conversations within the organization and broader community. The challenges we face in healthcare are numerous and complex. Their solutions are often elusive and usually difficult to implement. However, the constant is a need for dialogue as gaining an understanding of issues and their solutions enhance the chance that any success can be sustained. Health services management is always challenging, never easy, yet incredibly rewarding.
Canada’s healthcare system defines us as a society and country. That we raise and spend tax revenue and economic gain to support a system of care that is universal, accessible, comprehensive, portable and publicly administered places us among a very small cadre of countries that value the health of its people as one of its defining characteristics.
There is nothing more important to me than my role and commitment to strengthen and improve a system of care that will be there for thousands of people I will never know and never meet. That is my professional role and personal commitment to a community I am now calling home.
So, welcome and I hope we get to know each other better through these pages. Over the years, I know we will build a great hospital, a better healthcare system and a healthier community which will be a model for others.
And...a bit about me
Born in Sudbury, my early life included White River and Sault Ste. Marie. Public school years were in Mississauga with high school in Arthur (we moved to a dairy farm). Following an undergraduate degree in physiology and pharmacology at UWO, I did a summer research project at DND Suffield (my first published paper was in the European Journal of Pharmacology) and started graduate school at the U of T in Health Administration.
Following graduation in 1980, I started my career at St. Joe’s Toronto where I became Assistant Executive Director of its diagnostic and therapeutic services. By 1986, I became CEO of St. Joe’s in Brantford, then York Central in Richmond Hill, followed by St. Boniface General in Winnipeg. Returning to Ontario in 1999, I became an executive recruiter for physician leaders and healthcare executives. In 2003, I returned to the CEO ranks at Chatham-Kent Health Alliance and, in early 2010, Peterborough Regional Health Centre.
When not doing leadership, I am active with editorial boards and journals, professional organizations, service clubs and have been a preceptor for several masters students from the U of T and McMaster. There is a raft of other stuff that a career of some 30 years can assemble.
Personally, I am married to Siobhan and we have a white schnoodle named Charlie (he thinks he runs the household). Hobbies are rather numerous, from woodworking to wine collection, from photography to gardening, from skiing to golf. Ask me about my Caesar salad dressing…
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Started: 3/9/2010 8:54 AM | |
| First President’s Forum What a turnout! Thank you PRHC for attending my first President’s Forum last Friday and asking all the questions. While the message was a tough one to give as a new CEO, it was important for everyone to know where we stand financially. I regret that our first experience was about the dark cloud but I also know that getting everyone on the same page is a key step in any significant change process.
I have no doubts that we will be successful and weather this challenge as a stronger organization, better positioned for the way the healthcare system is evolving. From my perspective, how we got here is an analysis for another day – what we do from here on in will define us as an organization.
Stay tuned and thanks again for attending our first session together.
Hey, how’s your orientation going – having “fun” yet?
Learning about a new organization, becoming familiar with a new community (there are a lot of one-way streets here!) and its leaders, as well as meeting provider colleagues takes a little time…but we’re getting there.
First impressions are always important and I have really appreciated the welcome I have received – virtually everywhere. That means a lot, especially when you come to a community where you know very few people.
Add to that – stuff at the house: boxes, boxes and more boxes! Hey – got to the laundry room too! The frustrating part is that every little project requires access to stuff (tools, gizmos, brackets, etc.) that seems to be buried somewhere – the search takes longer than the actual activity!
But, yes, we are having fun. We’ve been to some great restaurants, found some friendly retailers and we’re learning where to go for stuff – something the locals seem to know implicitly. So…the adventure continues!
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Started: 3/16/2010 11:21 AM | |
| National Nutrition Month
March is Nutrition Month in Canada and March 17th is National Dieticians Day. The goal of Nutrition Month is to highlight nutrition as a key component of health, especially behaviours that deal with healthy and not so healthy food choices. Dieticians are the profession best equipped to assist the public and patients with reliable information about nutrition. When one considers the impact of diabetes, obesity, hypertension and a host of other chronic conditions, the value of good information is huge.
This year’s theme goes a bit further – from field to table – as the profession and public are becoming more aware and concerned about long supply chains, support of Canadian producers and quality standards within and across the food chain.
Best wishes to our dieticians as they sponsor public and consumer awareness and continue their efforts to improve the health of Canadians through better nutrition and healthy choices. I will reflect on their advice next time I have a craving for poutine! | |
Started: 3/16/2010 11:22 AM | |
| Weekends and meeting folks
Weekends and meeting folks
One of the consequences of moving is organizing stuff for the new house – drapes, carpet, paint, lights, etc. As such, you quickly meet community business leaders and they get to meet you. Given media attention of my arrival, it comes as no surprise that folks are quick to recognize the name, the role and the mandate.
A couple of trends have surfaced quickly. First, local merchants are friendly and helpful and I have been impressed with their willingness to help a new arrival. Second, they have an opinion about PRHC, and expectations for its performance. Third, most want to see the hospital as a high performance organization with deficit-free finances as indicators of good management and sustainability. Fourth, with varying degrees of candour, most note that my work is cut out for me and it will not be an easy task to wrestle the dragon. Lastly, there is this universal sense that they are glad it is me, and not them, at the helm. It is not the frequency of these statements; rather, it is their consistency that is remarkable.
Leading a high performance organization, in any industry, is never easy. And, as I have noted for some audiences, most organizations are designed perfectly for the results they deliver. So, once we have decided the results we need, there is clarity to the resultant design. I do believe that the organizational design should do a couple of things: define our service lines, articulate our priorities and establish lines of accountability for performance.
So, to these leaders, thank you for the feedback. Message heard. | |
Started: 3/18/2010 6:10 PM | |
| This isn’t Kansas, Toto!
Healthcare is changing. Technology (diagnostic, therapeutic and communication), clinical management of lifelong chronic conditions, the role of hospitals and other providers, public policy on wellness and disease prevention, the capacity and capabilities of community providers, the evolving scope of practice of health professions and the impact of their supply and distribution, the entire drug and insurance industry, the speed and knowledge of the information age, the power of the consumer, the intolerance of poor performance, mistakes or results and the rise of class action litigation are but a few of the trends shaping this thing called “healthcare”.
Each year, Canada and its 31 million-plus residents are spending just shy of $200 Billion on healthcare. While the bulk is publicly funded, a growing proportion is not, i.e., insurance companies, employers and self-pay. With that much money and that many people affected, the resultant debate is both loud and passionate. In Canada as most industrialized countries, this debate is also political – healthcare as a economy-fuelled social policy field defines us as both country and as a society on the world stage.
Thus, when the economy falters, when needs change, when cost structures morph over time, when any of the trends above exact their toll, a ripple (arguably a tidal wave) follows. Managing that change is the essence of leadership and the first stage is recognizing the early ripple amidst a backdrop of other changes afoot.
There is no doubt healthcare is changing. However, we can choose whether we select positive or negative change. We can choose if we are to be the driver or victim of change. We can choose to be early or late adopters of change. We can choose to think of change as the exception or the norm. Leadership is called leadership because others have not yet beaten a path for the rest to follow. So for us, in the wake of commissioning new facilities, in the midst of new structures and accountabilities, in the churn of a financial recovery, it’s time to lead because that is what great organizations do. This isn’t Kansas, Toto! | |
Edited: 3/22/2010 3:52 PM | |
| Wow, and a note about St. Patrick's Day
Wow!
As many readers know, our fiscal challenges are significant and as I have said, no one cause got us here and no one solution will get us out. Enter “Renew,” actually the “new” Renew which is actually “Renew – like you’ve never seen it before!”
Okay Ken, what are you talking about?
The Renew process and its multidisciplinary leadership team were unveiled late last fall to develop targets and strategies to improve the efficiency and performance of PRHC. While these initial targets were ambitious (seeking some $5 million in savings), it became apparent in January and February that the financial pressures at PRHC required more aggressive interventions (as the target needed to approach $20 million in new revenues or expense reductions). This is how “Renew – like you’ve never seen it before” was born.
The idea generation, or first phase of the process, is now underway. Groups of physicians, staff members and volunteers, as well as external stakeholders are being asked to consider new and novel approaches to reaching our financial targets. With the assistance of facilitators and provocative questions, to date some 225 ideas have been listed on the HUGE spreadsheet in the Fiscal Recovery Room off the library. As more groups add their ideas, this list will grow. And as one of our staff members, Bojay Hansen, wrote to me: “the more paddles in the water, the better.”
So, if you are a staff member and you would like to paddle, or in other words, submit an idea, you can do it a number of different ways. E-mail renew@prhc.on.ca, write it down and put it into the suggestion box in the library, or attend one of two sessions on March 22 from 1 – 3 pm in C1330 or March 25 from 4:30 – 6:30 pm in W4919 (but first rsvp to klarocqu@prhc.on.ca, please).
Once the ideas are compiled, they will be assessed for their ability to contribute to the PRHC goal, fine-tuned for their actual target and then sequenced with the many strategies that will be rolled out across PRHC. We will be asking a couple of directors to assist us with results tracking; as each strategy is implemented, it will be monitored for its timely contribution to the cumulative target for PRHC. In short, we are off to a great start – thanks everyone for your suggestions. And, again, I concur with Bojay: I, too, am looking forward to the PRHC of the future, a PRHC we will build and strengthen through this recovery plan.
St. Patrick’s Day
Thanks to staff members Mike Landry (Printing), Glen Groh (Building Services), Christa Fallis (Children’s Mental Health), John Whitehead (Mental Health Services), Glynis Devitt (Outpatient Mental Health), and Leanne Lamothe (Outpatient Mental Health), who shared their love of things Irish with their musical tribute in the cafeteria. What a great way to take the edge off a day with a tune or two and ice cream too! Thanks to dedicated PRHC volunteers Joan Arnold, Josie McCutcheon and Dennis Cooling for arranging to have the ice-cream and for serving it up.
Seems that we all have a wee bit o’the Irish in us at PRHC! | |
Started: 3/25/2010 11:52 AM | |
| On leadership
Leaders can define their times or their times can define their leadership. In either case, what happens next sets the stage for the next chapter in an organization’s history. To state that the financial picture at PRHC is challenging in an understatement in the extreme; however, it sets the stage for what happens next. Our deficit will either set in motion the precursors for a defining moment in leadership or it will initiate a cascade of actions summarized by those who follow as “too little, too late”. Only with the passage of time will the legacy be revealed.
However, at last night’s meeting of the Board of Directors, amidst the plethora of reports and information items, two things were remarkable. Both hold the potential to demonstrate that leaders can define their times.
The first was a series of recommendations prepared by the Medical Advisory Committee in response to the financial crisis at PRHC. In short, they explicitly focused medical staff attention on the accountabilities necessary to drive clinical performance at the program level (versus the individual level). By defining expectations for clinical performance within the organization, the MAC recommendations set the stage for significant performance gains linked to our financial recovery, notably length of stay, accountabilities for patients admitted by attending physicians (called Most Responsible Physicians) and the responsibilities for Department Chiefs, Service Heads and Medical Directors when it comes to in-patient care and resource utilization. Resource utilization is the link to a fiscal recovery for PRHC.
The second defining moment found root in a Stewardship Committee motion. It set the stage for the CEO and Chief of Staff to design and implement a series of interventions to balance the budget of PRHC both now and well into future. In the wake of many years of deficits, erosion of working capital and the clarion call of our Peer Review, the Board of Directors passed the Committee’s motion. For the record, I have included it below.
More importantly, the combined effect of these two decisions entrenched the precursors for a high performance organization, both now and the long term. Even with the knowledge that the implications are large and activities both complex and numerous, the Board of Directors defined their moment. And so, a new chapter in our history begins its first paragraph….
MOTION BY THE PRHC BOARD
March 8, 2010
Whereas the Board of Directors wishes to ensure the PRHC has the financial resources to provide a full range of medical services in line with the strategic plan.
And whereas the Board of Directors recognizes that financial stability is an important ingredient to maintaining the highest quality of care for patients,
And whereas the Board of Directors desires to implement a sustainable operating model which will facilitate the full use of the physical infrastructure made available through the construction of the new hospital,
And whereas the Board of Directors desires that the hospital operate at the top quartile for
Ontario Hospitals,
And whereas the Board of Directors recognizes it has the primary responsibility to address the current operating deficit and accumulated debt,
Be it resolved that:
1. The Board directs the CEO and Chief of Staff:
· to improve the institution’s productivity so that the average weighted cost per patient is reduced to the expected level on a monthly run rate basis for the month of March 2011;
· to operate at the top quartile for Ontario Hospitals; and
· to attain a surplus position by fiscal year end 2012;
The Board further directs the CEO and Chief of Staff to present a preliminary plan which details the specific actions they intend to undertake to achieve these objectives. This preliminary plan will detail the specific impact (expressed as average cost per patient) for each action and all associated patient care, staffing, organizational and other significant impacts. This preliminary plan will be presented to the Stewardship Committee at the April meeting.
2. The board directs the CEO and the Chief of Staff to present a final plan which incorporates additional observations made by the current Peer Review, the LHIN and the public through consultation to the Board at the earliest possible opportunity.
3. The Board directs the CEO to present a revenue assessment that identifies whether PRHC is collecting the appropriate revenue (including but not limited to determining the accuracy of ministry billings, appropriate charting, adjusting ancillary fees and other measures as he may determine) as well as assessing opportunities for revenue growth to the Board at the earliest possible opportunity.
4. The Board directs the CEO to prepare and present a debt retirement strategy at the earliest possible opportunity.
5. The Board directs the CEO and Chief of Staff to provide monthly reports to the Stewardship Committee on progress in meeting the goals and objectives outlined.
6. The fiscal recovery plan will be discussed with the public on a regular basis.
7. the Board, the CEO and Chief of Staff will adhere to the principles and values enunciated in the Health Centre's Strategic Plan in its fiscal recovery efforts.
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Started: 3/31/2010 3:25 PM | |
| Peterborough 2017
Last weekend I was invited to speak at a session linked to a national program geared to the challenges of Canada in 2017. My topic dealt with how Canada’s healthcare system might fare given the realities of epidemiology, traditional versus emerging trends in healthcare delivery and how we might assure sustainability of the future steady state.
I opened with seven questions, not so much to answer them but to frame the dialogue. They mused if expenditures in healthcare were an investment or an expense? Who and how should we decide “value for money” in healthcare? How does Canada demonstrate global leadership in healthcare if its delivery is a provincial mandate? What is the appropriate ratio of the GDP we should allocate to healthcare? What is “medically necessary” as our system morphs into the information age and knowledge economy? How do we sustain the ideology of Canada’s system when it is under siege by so many variables and perspectives? In short, can healthcare be managed when saying “no” is, as others have noted, politically incorrect?
These are lofty topics and not for the faint hearted. For Canadians, these are defining moments for system, a system that is a approaching its 60th anniversary. The healthcare system and the economic engine needed to sustain it are much different today. In the 1950s, an appendectomy was major surgery; now we perform transplants. X-rays have been supplemented with MRIs. The list of innovations and advances is both huge and expensive. Canada’s diverse geography, demographics, modest economy and high incidence of chronic diseases exacerbate the need to change delivery models, their impact on clinical outcomes and the implications for portfolios other than healthcare.
How can we embrace the benefits of the information age or chronic diseases if literacy rates are low? How can we assist people navigate the system over the course of their lives if providers or professions operate in distinct silos? How do we make investments in technology if bricks and mortar remain the currency of service delivery?
What I enjoyed about the session at Trent University was the ability to think at a system and population health level. A hospital CEO’s office can easily become mired in details of hospital operations and sessions like these are a bit of a refresh about why we lead and champion change in healthcare. | |
Started: 3/31/2010 3:26 PM | |
| Tough questions...answered
I get lots of hard questions from physicians, staff and community members. The following questions and answers – part of an exchange with a staff member – pertain to our financial situation; how we got here and why? You too, may be asking some of the same questions, so I thought I’d share my responses…
Q - Why did the two previous CEOs and Board of Directors allow the situation to get this point?
A - Perhaps for a couple of reasons – the long standing practice in healthcare to leverage deficits into new funding; the hope that advocacy would bring new dollars to the health centre; the notion that the new building would generate clinical growth to qualify for funding calculations made before construction commenced; that the best laid plans did not materialize with the new site; that the LHIN changed some of the funding rules at the behest of the Ministry of Health and Long Term Care; there was no incentive to lay off staff or cut programs and face the wrath of affected stakeholders.
Q - Does the person in the CFO position not report directly to the CEO?
A - The CFO reports to the CEO and is also a support role to the Board committee that deals with the budgets and finances.
Q - Why was the CEO and the Board of Directors not making sure that the budget was being better maintained?
A - Perhaps answered in Question 1 above. As well, the irony is that the managers have come in exactly on budget – that the budget was a $13 m deficit is the issue.
Q - Is it not the Hospital Board that approves and makes the final decision regarding budgets and spending?
A - Yes and it is “negotiated” with the LHIN.
Q - What responsibility is the Board of Directors taking regarding the decisions they have made over the years which has put the Hospital in this large deficit?
A - By passing their motion last month, the Board accepted responsibility for the financial health of the organization and set a new direction for the performance targets needed over the next few years. Also at issue is the 7 year window that hospitals have when they complete major capital expansions as in the case at PRHC. This “Post Construction Operating Plan” (PCOP) process is a dynamic review process that is supposed to match incremental costs with incremental volume increases…this growth does not seem to have materialized and the hospital does not seem to have curtailed expenses when the clinical volumes did not arrive, post construction.
Q - Will the Board of Directors be held accountable for their decisions, as they do have a fiduciary responsibility to the hospital and the community of Peterborough?
A - The Peer Review will likely comment on this issue. Yes, the Board has that duty. Having said that, recent case studies around Ontario demonstrate what can happen when the community feels that the Board is too aggressive with their fiscal duties (see Niagara Health System, Stevenson Memorial, Bluewater, etc).
Q - What plan does the Board of Directors have in place to improve themselves in their decision making?
A - We will be addressing Board reporting and the metrics necessary for a fiscal recovery and no doubt, the Peer Review Committee will make some observations / recommendations.
Q - Has the hospital ever had a freeze on pay increases?
A - Over the past 13 years, PRHC would have been required to sponsor / implement the prevailing policies in place in Ontario hospitals, e.g., the current directions on the recent Ontario budget. Unionized staff are one issue; non-union quite another. When St. Joe’s and the Civic came onto a single site, some $6+ million was taken out of the budget / saved.
Q - Why did the Board approve a pay increase for management then announce the hospital’s deficit?
A - All non-union salary increases in the Broader Public Service (BPS) have been the focus of the recent budget – we are waiting for more details, e.g., if we combine two departments and downsize management ranks – can the remaining manager get an increase (via job evaluation, for example). Non-union salary grids / increases have been frozen for the next two years; however, the details are still unclear given the complex nature of compensation, organizational design, regionalization and movement of personnel within facilities and the broader system.
Q - Has the CE LHIN been receiving copies of the Hospital Financial Statements?
A – Yes.
Q - What is their response to the deficit?
A - The Peer Review process and a mandatory recovery plan to be tabled in its wake. In the interim, we await news of our final transfer payments and several special accounts associated with specific programming, e.g., dialysis, cancer clinic, etc.
Q - I am not questioning your decision to restructure. I understand these types of decisions have to be made in this type of situation. I question why has this been going on all these years.
A - Let’s put this into perspective – there are about 15 – 20 jobs per million dollars (with benefits, etc) of our funding. Thus, correcting a $10 million deficit is cutting around 200 people…$20 million is 400 positions. There are about 50-60 managers here for 2500 full and part-time employees and we operate 24/7/365. Of course, the answer is complex and the solutions needed cannot be fully explained in an e-mail – but I did want to give you a sense of scale.
Healthcare cannot be turned on and off as quickly as a production line – people still have babies, accidents, heart attacks and cancer. As well, it takes time to ramp up recruitment of specialists. If the Government can only afford a portion of this obligation (free, accessible, timely, universal, comprehensive, etc), does it follow that transfer payments be reduced to providers? This is the consequence of a publicly funded system – how do you fund a portfolio as bedrock as healthcare when the economic model supporting it is a rollercoaster ride of boom and bust? If Ontario loses billions in its revenues from a recession, and healthcare is 45% of the social fund transfer payment, should healthcare be cut pro rata or should the Province mitigate the downsizing with its own deficit…? Stated another way, should healthcare be downsized by 45% of Ontario’s $25 billion deficit or 169,000 jobs only to rehire them all when the economy allows…if that were the case, I imagine we would be having a totally different e-mail exchange.
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Started: 4/6/2010 10:56 AM | |
| Hospital turnarounds - when things need to be set straight
As most know, PRHC’s fiscal challenge has destabilized the status quo – it is not business as usual as we plan for and roll out our financial recovery plan. This includes both the recommendations that will be contained in the Peer Review process and those that will take shape through the lens of a new CEO charged with the mandate to balance the books, establish a new steady state and determine the configuration needed for our regional role and mandate.
As well, most have heard about the “recovery room” located within the library as the site for information, data, ideas and meetings associated with our efforts to achieve our financial targets.
What I wanted to add is that we did some research about hospital turnarounds and why some of these approaches failed while others succeeded. Courtesy of Julie Davis, who took the lead on this, here are some of the lessons learned as reported in the literature:
- Be honest with the organization and be absolutely clear with everyone that the survival of the enterprise depends on the success of a concerted recovery plan;
- Listen to what employees are saying and ask them for suggestions;
- Redefine roles and perspectives through goal oriented action teams;
- Offer constant feedback and ensure the organization stays on track;
- Celebrate success and milestones;
- Use humour appropriately;
- Focus on key goals and avoid trying to do everything at once;
- Turn data into information and help people with interpretation; and,
- Let staff address their own targets and performance rather than some artificial or abstract target.
On reflection, I think we have addressed these points in our approach. These are rather tried and true concepts and that we have embraced them along the way is good to know.
Also important were articles that chronicled mistakes and barriers to success. Highlights from this cohort of articles included:
- Inadequate participation. Failure to engage unions, managers, physicians and other stakeholders in fundamental change was cited as a prerequisite for successful change and a sustained steady state. While downsizing management gave quick wins, developing key skills and making new managers responsible for complex functions amidst large scale organizational change was noted as a potential challenge for success.
- Lack of direction. Maintaining focus and clear direction to avoid scope creep, constant communication of goal alignment and attention to the roll out of plans were noted as essential change management dynamics.
- Not challenging organizational culture. Changing culture is a difficult and often bumpy process, in some cases a war of wills. It takes a couple of iterations and years to achieve but the old culture needs to see that the new culture is fundamental to the new steady state.
- Excessive speed of change. Pick your battles and know that everything cannot occur at once. Restructuring organizations, driving financial recoveries and culture shaping are complex processes that have to be complimented with related activities such as budgeting, leadership development, excellence in clinical care, improving quality and recruiting new talent. While early gains are always great, excellence does not occur overnight.
- Organizations that fail to plan, plan to fail. The value of strategic planning to backstop change is pivotal. On a parallel track, strategic plans unimplemented are neither plans nor strategic.
- Inadequate training, skills and tools. Few people and organizations can address new challenges and environments without some investment in the competencies required of the new steady state. Skills are both technical / managerial and related to change management the process. These are not intuitive and are honed through application, practice and reflection / evaluation.
- Inadequate communication. What’s important: content, frequency, timeliness, accuracy, consistency, authenticity, venues, proactive, forthright and honest.
- Failure to deliver. Achieving progress or early wins are essential for the new culture. As well, culture is not changed through pilot projects; culture is a jump into the deep end of the pool, a feature that is not for the feint hearted.
Now that we know the above, the real question is what will we do with this feedback as we plan our organizational transformation? Hopefully, plan for success because the alternative is not very appealing.
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Started: 4/9/2010 2:22 PM | |
| Okay already – here’s the Caeser Salad recipe!
Seems that a lot of readers want the recipe for my Caesar Salad. So, here we go:
To a blender, add:
2 whole eggs
6 oz extra virgin olive oil
6 oz vegetable oil
1 oz red wine vinegar
Juice of 2 freshly squeezed lemons
2-3 garlic cloves
1 tablespoon Worchestershire sauce
2-4 dashes of Tabasco sauce
2 anchovy filets
1 teaspoon dry mustard
1 teaspoon black pepper
Blend at high speed for about 10-15 seconds until creamy. Add dressing to dry romaine lettuce in a large bowl. Mix well and add seasoned bacon bits (try a few drop of hot sauce and garlic powder when frying up finely chopped bacon strips), your favourite brand of seasoned croutons and both shredded or sliced fresh parmesan cheese. Garnish with lemon wedges and chopped parsley.
Enjoy!
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Started: 4/14/2010 9:54 AM | |
| Once a Rotarian, and Why blog?
Once a Rotarian, always a Rotarian
When we were living in Chatham-Kent, I joined one of the Rotary Clubs in town. It was the first time I participated in a service club in any community; partly because of my busy schedule, partly because as public figure and healthcare executive, my professional volunteer activities were quite numerous and a possible hindrance to attendance.
But joining Rotary is more than a service club. In addition to a time tested value system shaping behaviours and relationships, membership in Rotary is about giving back to community at an entirely different level. Whether it is cleaning garbage from roadways, funding local, regional and international activities, supporting exchange students, socializing with wonderful people or sharing goodwill amongst community, the Rotary movement is about service above self and making a difference.
Thus, it was an easy decision to seek out and “transfer” to the Peterborough Rotary Club. I hope to continue my commitment to give back to the community and forge new friendships in our new surroundings. From what I can tell so far, it is a great group of community leaders and people who truly care about the community and take pride in making it better for all.
Why blog?
Because healthcare is too complex and important for a sound bite. The case in point is the recent op ed piece about our recent hiring freeze. Its author opined about his take on the implications for the morale of healthcare professionals, barriers to recruitment and retention and, in the absence of additional funding, a shift in our employee demographics to the detriment of the care we provide to an aging community.
Well?
The temporary hiring freeze was meant to stem the haemorrhage of red ink stemming from, not our level of funding, but our performance. As we develop more durable cost recovery strategies, they will overtake the current hiring freeze with far more robust and sustained savings. With millions spent on overtime and absenteeism, huge opportunities for gains in productivity, reduction of employee injuries (and WSIB premiums), excessive length of stay for patients in some clinical areas as well as major performance gains from benchmarking against peer hospitals and new models of care, gaining a few turnovers to mitigate job losses is both prudent and indicated. As well, the use of attrition mitigates future layoffs as a method to drive down paid hours and other productivity gains. The counterpoint: operating a hospital with some $41.065 million in cumulative deficits and no working capital for equipment and information technology is not exactly an attractive workplace for new graduates or physicians.
PRHC’s costs are out of control and current revenues are generous for the work we do. Declining performance and clinical metrics are at the heart of our financial woes. While that is a tough message, it is also a challenge. In the new world of healthcare, performance is the currency of growth and market share, not the pitch or volume of advocacy and its messenger. | |
Started: 4/14/2010 9:56 AM | |
| Supporting the Peterborough Medical Brigade
Last weekend, my wife and I attended “Brigade Aid” – a fund raiser supporting Dr. Hardy Friesen’s team and efforts to bring healthcare to remote areas of the world. Their next trip is to Indonesia in June 2010. During the evening, the audience saw photographs of their last trip to Flores, Indonesia, and gained an appreciation of the difference their team made to the lives who lined up for care. We were pleased to add our contribution to the Brigade’s efforts.
But there was a sidebar to the event. We were able to see and hear some great musical talent from the community. The arts have always been a part of our household, so hearing wonderful performances by Father Paul Massel, Sarah Iles, Danny Bronson, John Friesen and the Peterborough Pop Ensemble was a perfect capstone to a busy week.
Arriving in a new community and being able to enjoy its riches is a big part of leadership. Thanks, Hardy, for the invitation to the evening and the opportunity to meet some great people from the community we serve. | |
Started: 4/21/2010 11:11 AM | |
| I pledge...and putting our best foot forward
PRHC is pleased to introduce its Partnership Pledge. It’s posted all over the Health Centre, it’s inside every patient handbook, and now, it’s time to make it sing…
As care providers, patients and family members at PRHC, we’re all in this together. And the Partnership Pledge is as simple, and as complicated, as that. It’s a promise, of sorts, to recognize our respective responsibilities in creating the best care possible. It speaks to communication, courtesy, hand hygiene, proper patient identification and much more. Research tells us that educating patients about their role and engaging them in their care improves their experience and their outcomes. In fact, this practice is now considered a standard of care and is an Accreditation Canada required practice. (Of note, as we prepare to welcome Accreditation Canada surveyors next week…)
The idea behind PRHC’s Partnership Pledge comes from Johns’ Hopkins Hospital in the US, an international leader in patient safety. However, it’s very much our own…Hundreds of PRHC physicians and staff members and some of our patients and family members contributed to its development. Thanks to all involved, most notably our quality experts Lisa Ruston and Christina Porcellato.
And so, the things that were previously part of our routine as health care providers, are now part of a very public promise to our patients and family members. Similarly, the Partnership Pledge sets out our expectations of patients and visitors. Together, we’ve articulated these standards; put this commitment in place and now, we all know to expect nothing less.
Please take a moment to review the Partnership Pledge, and reflect on its sentiment – to partner in providing the best patient care possible. Visit www.prhc.on.ca
Putting our best foot forward
This morning I had the pleasure of officially opening PRHC’s first-ever Leading Practices Expo. It’s a showcase of the hospital’s best work, and demonstrates our strategic directions – in action. At PRHC those directions, I’m learning, are far more than well-chosen words with attractive icons to match. Our physicians, staff, volunteers and Board of Directors strive for High Quality Patient Care, A Strong Regional Centre and A Great Place To Work – it’s evident in the exceptional work they do, be it hand hygiene compliance, blood conservation, stroke protocol, or onboarding for new staff members. Congratulations to all involved – of your innovation and leading practices, you should be proud.
The Best Practices Expo displays will line the main hallway of the 4th floor of the hospital for the next couple of weeks for all to see. | |
Started: 4/21/2010 11:11 AM | |
| A big week It’s a very important, very busy week at PRHC. And so, I’ll keep it short here – there’s lots to do…
Today we welcomed surveyors from Accreditation Canada for our on-site survey. The surveyors are hospital leaders from across the country who are trained to evaluate the quality of care we provide. This week they will evaluate our hospital and its practices against national performance standards.
Tomorrow, the Peer Review Team will present its report and recommendations to the Central East LHIN Board of Directors. I look forward to hearing from Dan Carriere and his team and recognize that the recommendations will be numerous and diverse in nature. Going forward, there will be an opportunity to incorporate these findings into Renew – the fiscal recovery process already underway at PRHC.
Also this week, we recognize our medical laboratory professionals as part of National Medical Laboratory Week. In disciplines such as clinical chemistry, microbiology, histology and blood bank, medical laboratory technologists have highly-specialized skills. Each year, they perform hundreds of thousands of sophisticated laboratory tests to quickly diagnose and treat disease. In fact, up to 85% of decisions about diagnosis and treatment are based on laboratory test results. These professionals, and their attention to accuracy and great detail, are an integral part of the PRHC clinical team.
This is also National Volunteer Week, developed to thank the 12.5 million volunteers in Canada who generously donate their time, talent and energy to the organizations that matter to them. Recognizable by their green vests and patient-focused approach, PRHC’s volunteers work in all areas of the hospital; often, they are the first faces our patients and visitors see at the main and emergency department entrances. Very proudly, we benefit from the contributions of more than 600 volunteers of all ages. Thank you for the thousands of hours you contribute every year.
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Started: 4/23/2010 4:11 PM | |
| An Open Letter to the Community Following the Peer Review
Dear Community:
When I joined PRHC on February 1st, 2010, I was charged with delivering on the hospital’s regional mandate, further enhancing our high quality care, and successfully implementing a financial recovery plan.
As you know, healthcare is changing rapidly. Canada invests just shy of $200 billion in healthcare each year. Recently, provincial governments have made clear that funding to hospitals will be reduced in order to divert funds to community-based, primary care in order to focus on disease prevention and wellness. In turn, hospital deficits have become unacceptable. I support these policy changes.
Rather than use deficits to advance “fair share” funding arguments, policy makers and system managers (such as Regional Health Authorities and, in Ontario, Local Health Integration Networks) now expect providers like PRHC to deliver performance and capacity for the funding received. What does this mean? Hospitals must deliver safe, quality care with the clinical and financial performance parameters contained in their accountability agreements.
The Central East LHIN commissioned a Peer Review for PRHC following years of deficits and a failure to deliver on its most recent accountability agreement. The Peer Review Report was tabled on April 20th. It made 60 recommendations on how our hospital might achieve its contractual obligation to balance its budget all the while delivering the clinical volumes and outcomes historically provided by PRHC. And, in the wake of PRHC’s recent redevelopment, it did this with the future in mind—one that includes service growth. Finally, in addition to financial targets, it made observations on governance and management practices and provided clear direction for change that the organization is already embracing.
Many will view this report as a setback. I, however, am emboldened. I am committed to embracing the challenges ahead and ensuring that we remain able to serve our community with care, skill and compassion.
The savings that must be achieved though are significant: $25 million on a $240 million annual budget. The hospital is now developing a Hospital Improvement Plan (HIP) for the CE LHIN for a June 30th submission. That plan, our made in Peterborough plan, may or may not include the specific recommendations included in the Peer Review. It will, however, incorporate the full value and breadth of the changes needed to achieve a modest surplus in order to fund debt retirement obligations.
The report has raised many questions and concerns. I want you to know that the Hospital will move forward on this agenda with board members, staff, managers, physicians, donors, patients and the community to maintain high quality care as we develop a recovery plan and set forth toward a new steady state for PRHC. We remain committed to our strategic plan which drives us to become a high performance regional provider. You deserve no less.
I should add that while the Peer Review was underway, hospital managers, staff and physicians developed additional recommendations to achieve a balanced budget. More than 2,400 ideas—big and small—were generated and are now going through a validation process to determine which will produce the savings we require and be right for our hospital and community. For example, our hiring freeze—to drive productivity gains and mitigate future job losses has, to date, generated over 160 vacancies. These will buffer the human resource changes we need to make at all levels of the organization. Vacancies gained through attrition and retirements will further reduce the negative impact of job loss in our recovery plan.
As part of developing our HIP, we will hold open information and consultation sessions and will make the final plan public, along with ongoing reports on progress in achieving the plan. Those dates and venues will be announced shortly. Please join us.
Our commitment to you, our community, is to make the changes necessary to address the deficit and stabilize the financial health of PRHC. Together we must ensure we can continue to provide the care you have always expected of us. And when we have accomplished this, and our financial house is in order, we will add new regional services to bring more care closer to home. Throughout this process, our patients remain our number one focus.
Sincerely
Ken Tremblay President & CEO, PRHC | |
Started: 4/27/2010 2:20 PM | |
| Culture of Quality and Safety
Last week, four surveyors from Accreditation Canada completed a four day visit to PRHC to assess our compliance with national standards governing hospital performance. Accreditation Canada surveys monitor compliance with some 1, 936 national standards and best practices in areas that cut across the entire organization, from the bedside to the boardroom and, literally, everything in between. In addition, surveyors also assessed our commitment to quality and safety through a “tracer” methodology. This approach followed patient processes across departments and services for evidence of compliance, outcomes and interventions when opportunities for quality and safety improvements surface. Scheduled every three years, Accreditation Canada status is one of the most rigourous methods to assure patients and their families, teaching programs, communities, regulators and the entire hospital family that we provide high quality care and a safe environment for patients and staff. Hundreds of staff, through teams, departments and programs, participated in the survey as did dozens of patients and their families as well as other community providers. Maintenance of standards through Accreditation Canada is the most important credential a hospital can have.
During the wrap up, Huron-Perth Health Alliance CEO Andrew Williams, who led a team that included nurses and a physician, was effusive with compliments about our tremendous commitment to quality and safety, evidence of teamwork, collaborative practice and a commitment to patient and family-centred care. These observations were more notable given the significant changes since our last visit, consolidating sites and commissioning our new facilities. In short, they noted that we had met 1,882, or 97%, of Accreditation Canada’s standards, with good progress on the balance. It was a real boost to hear the preliminary report given the other news of the week. Despite financial challenges, there was no doubt that a culture of quality and safety was always present.
Congratulations PRHC and the leadership team for three years of incredibly hard work. You made this new CEO very proud of your last three year’s accomplishments and longstanding commitment to excellence. | |
| Safety is a priority at PRHC
Safety is a priority for all hospitals. As a system of providers, we’re continually working to improve and PRHC is no exception. In fact, our commitment to employee and patient safety was highlighted by the Accreditation Canada surveyors as they completed their visit to our hospital two weeks ago.
Safety initiatives vary in shape, size and scope and there are hundreds of them underway at PRHC each and every day. However, a couple stand out as best practices in Ontario and place PRHC at the forefront of innovation. Though I have the pleasure of highlighting them, they are the result of the commitment, dedication and innovation of PRHC physicians, staff and volunteers.
PRHC publicly reported its hand hygiene compliance rates for the fiscal year ending March 31, 2010. With close to 94% and 97% compliance before and after patient contact, PRHC’s 2009/10 compliance rates are even higher than in 2008/09 (89% and 94%) and well above the provincial average of 66% and 79% respectively. In fact, PRHC posted the fourth highest ranking among its cohort of large community hospitals.
This level of performance did not materialize overnight. Over the last two years, PRHC has witnessed a significant behavioural shift and in effect, a culture change about hand hygiene. The approach has been multifaceted; and monthly audits, clearly defined targets and rapid-cycle feedback are among the keys to success here. As far as I’m concerned, this best practice provides us with an interesting model which can be adapted and applied to other management strategies – perhaps it’s one for the textbooks. Congratulations to the Infection Control team and to each and every one of you who, as part of routine practice, clean your hands.
Another high point for PRHC is our wound care program. In 2006, 21% of PRHC’s inpatients had some level of pressure ulcer that was hospital-acquired. PRHC’s leaders knew that the status quo was unacceptable and that pressure ulcer prevention and treatment needed to be standardized and evidence-based as it led to measurable, sustained improvement in our pressure ulcer rates. Four years later, the results of the program have exceeded our goals thanks to a commitment by all staff members, including unit champions, and Debbie Hanna-Bull, Advanced Practice Nurse. Now, the incidence of hospital-acquired pressure ulcers has decreased to 9%.
This best practice recognizes that facility-acquired pressure ulcer rates are a barometer of quality of care and provides us with an example of how improving that quality of care has earned some efficiencies. The reduction in incidence of pressure ulcers by more than 50% translates into a more than $4.5 million cost-saving. Great work.
All this talk of quality and safety is especially relevant, as we mark Employee Safety Week, also known as North America Occupational Health and Safety (NAOSH) Week, celebrated in Canada, along with North American partners in the United States and Mexico. Here at PRHC, we’ll recognize the week with daily events in an effort to strengthen the organization’s commitment to worker safety and improve everyone’s attitude toward working, and being safe. (Staff members can check the intranet for the calendar of events.) Each of us has a significant role to play in creating a safe environment and this week provides us with an opportunity to learn about how.
Meanwhile, back at the ranch
Meanwhile, back at the ranch, the home renovations are taking shape. Work by day and paint, wallpaper and build by night. It’s always fun transforming a new house into a “home” and we’re plugging away at all the projects on the list (yes, I have been given a “list” of things that need to be done).
Part of the adventure is also getting to know the community – lighting, shrubs, appliances, wallpaper, carpet, dog groomer (for Charlie), butcher, baker, internet, etc. Included are other events – we attended the Art Space fund raiser on the weekend. One measure of a community is its arts community – they were there in force Saturday night. And, so were several PRHC staff members who seemed equally enamored with the various works by local artists. As many recall, Art Space showcased our Emerge photo exhibit.
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