A time of tremendous challenge and change

A message from Niagara Health System Board of Trustees Chair Betty-Lou Souter, President and Chief Executive Officer Debbie Sevenpifer, and Interim Chief of Staff Dr. Joanna Hope

Looking back at this past fiscal year, the Niagara Health System has emerged through a time of tremendous challenge and change – the most significant transformation since the hospital first amalgamated nearly a decade ago.

Throughout this difficult time, our dedicated leaders, staff, physicians, fundraisers and volunteers continued to serve the healthcare needs of the people of Niagara. All of this was made possible by our 4,300 staff members, 500 medical staff members and 1,100 volunteers who do their best to serve patients and families across our system of seven sites every day of the year.

A new path for the future

Niagara Health charted a new path for the future through fiscal year 2008-09 (April 2008 to March 2009) with the development of the Hospital Improvement Plan (HIP). Aimed at reorganizing hospital services across our system to ensure the sustainability of quality health services, the HIP was also balanced against resources available to us now and into the future. These resources include doctors, nurses and other health professionals, finances, facilities and equipment.

The HIP vision recommended significant change to the way many hospital services are provided in Niagara. While change is never easy, change in healthcare is amongst the most complex and multi-faceted. The development and evolution of the HIP marked a very difficult and divisive period, from which we have much to rebuild and renew.

The HIP touches every one of our sites and services and through its development incorporated the recommendations and work of nearly 100 of our healthcare leaders.

The implementation of the HIP will take place over the next four years with some initiatives like the first steps to create a Centre of Excellence in eye care completed in May 2009 and the conversion of Emergency Rooms at our Port Colborne Site and Douglas Memorial Site in Fort Erie to 24 hour/seven day a week Urgent Care Centres underway for the summer and fall of 2009 respectively.

Through the changes in the HIP, a number of our employees’ jobs will be affected directly and indirectly. Some positions will change, others will be eliminated. The commitment of the hospital continues to be to minimize the impact on our staff and support them through this difficult time.

Members of our medical staff are also adjusting to change, which in some cases involves relocating surgical services and clinics across our sites and in other cases involves changing the model of care such as the Urgent Care conversions.

Our patients and local communities are also adapting to service changes that are ultimately aimed at improving quality.

Addressing the Alternate Level of Care (ALC) Challenge

One of the most significant challenges faced by hospitals across Ontario, including Niagara Health, comes from the number of patients residing in acute care beds who no longer need acute care treatment. These patients – known as alternate level of care (ALC) patients — have to stay in hospital beds as they wait for appropriate services and/or placement in the community.

One third of all NHS acute care beds are occupied by ALC patients. Having to wait in hospital is a difficult situation for all of these patients and their families. Hospitals do not provide the kind of home or residential setting that these patients deserve and require. The impact of the high percentage of ALC patients across NHS is also felt by thousands of patients coming through our Emergency Rooms. Wait times are often lengthened when acute care beds cannot be readily found for those ER patients who must be admitted. This backlog, in turn, creates additional wait times
for other patients coming to the ERs.

Working with healthcare partners in the community, including our Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN), Community Care Access Centre and Hotel Dieu Shaver Health and Rehabilitation Centre, a great deal of effort has been, and will continue to be, made to make the appropriate investments outside of hospital to serve Niagara’s aging population.

Patient Safety and Quality

NHS implemented a number of new patient safety and quality accountability performance measures in 2008-09 as part of the Ministry of Health and Long-Term Care (MOHLTC) initiatives and through the hospital’s participation in the national Safer Healthcare Now initiative. These include regular reporting on staff hand hygiene and infection control rates. The NHS website includes enhanced reporting and transparency on a wide range of quality performance measures.

A key achievement in 2008-09 was the development of a strategic plan for patient
safety which we continue to implement.

Rebuilding Infrastructure

Rebuilding infrastructure was a key focus in 2008-09 and will continue as such in the years to come. Construction of the 375-bed healthcare complex in St. Catharines began in May 2009. Plenary Health Niagara was the group selected to design, build, finance and maintain this facility, which will be ready to open its doors to patients
in 2013.

This achievement marks the beginning of a new and promising era for healthcare in Niagara. For the residents of St. Catharines, Thorold and Niagara-on–the-Lake, the new facility will provide a new local acute care facility to replace the aging St. Catharines General and Ontario Street sites. The new facility will also offer – for the first time in Niagara — comprehensive cancer treatment, longer-term mental health inpatient services and regional cardiac catheterization services for all residents of Niagara.

This state-of-the-art complex will undoubtedly attract a new generation of doctors, nurses and healthcare professionals. It’s also important to acknowledge the sizable injection the project will have on the regional economy through the creation of approximately 5,400 jobs. At the peak of construction activity, an average of 1,000 skilled tradespeople and construction workers are expected to work on the building site daily.

Important planning and design work for the Port Colborne Urgent Care Centre also began this fiscal year. A comprehensive design and development process resulted in two unique design and location concepts for the Urgent Care Centre. We look forward to a final decision on the design proposal and building renovations to start as soon as possible. Planning for the next 15 years for Greater Niagara General Site (GNG) is underway.

Once developed, the GNG Master Plan will allow us to anticipate the future space requirements and enable us to develop plans for services and physical redevelopment at the site, including operating room renovations and a new satellite dialysis unit. In June 2008, we opened the new Welland Site Dialysis Centre to serve chronic kidney disease patients residing in Welland, Port Colborne and surrounding area.

The Welland Hospital Auxiliary Dialysis Centre, named for the Auxilians who made a $1-million pledge to the new unit, is 12,500 square feet and features 21 dialysis stations capable of treating 63 patients each day. Looking to the future, additional hook-ups are in place for up to 26 dialysis stations.

Douglas Memorial Site RN Beverly Ashton with patient Dorothy Michaud.

Nursing

NHS benefited from the province’s New Graduate Guarantee, employing over 50 Registered Nurses and 13 Registered Practical Nurses. We are most pleased to welcome all of our new graduates and appreciate the support and involvement of our nurse mentors.

Our Late Career Nursing Initiative had 15 nurses actively take part in special projects within their programs. Nurses demonstrated leadership through these special projects that included prevention of falls and computerized medication
administration records.

Niagara Satellite Medical School Campus

The physician teaching landscape in Niagara received a boost in September 2008 when the satellite campus for McMaster University’s Michael G. DeGroote School of Medicine welcomed its first class of medical students in the region. Then, in May of this year, Niagara received more great news with the announcement of an additional 13 spaces for medical students attending the Niagara campus. By 2011, the Niagara campus will have 84 medical student spaces. Our hope is that many of the medical students who are educated and trained in Niagara will stay in Niagara.

Changes on the Board of Trustees

Many important and difficult decisions were made around the Board table over the last fiscal year, and we would like to thank all of the members of the Board for their leadership and wisdom. At this time, we say goodbye to four of our Board members, whose terms on the hospital board came to a close at the Annual General Meeting on June 23. A big thank you to Past Chair Paul Leon, Pat Balasiuk, Doug Frazer and Tony Pylypuk for their volunteer contributions over the years. Their guidance and knowledge will be missed.

Renewing Relationships

Coming out of the HIP, Niagara Health is refocusing and working to renew and rebuild relationships, including relations with the members of the hospital’s medical staff. As a critical first step, the Board of Trustees engaged Dr. Chris Carruthers, retired Chief of Staff of the Ottawa Hospital, to identify the key issues and help create an action plan aimed at improving relationships and collaboration.

Improving relationships with local communities is another priority. New stakeholder relations programs like the HIP Community Advisory Forum and community information sessions are underway and ongoing. «