Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

When Health Care Aide Jocelyn Laderoute uses the new blanket warmer or other new equipment on the Trillium Unit at Greater Niagara General Site, she automatically thinks about the patient who became like family after living on the unit for 38 years following a plane crash. “Peter was part of our family on Trillium,” Jocelyn says. “Every time I use the new equipment, whether it be the new patient lifts or shower chairs, I think about Peter and his family. We are so grateful.”

Jocelyn is referring to Peter Griffiths, who was confined to his bed, dependent for all of his care, unable to speak after the plane he was flying crashed almost four decades ago. The staff on Trillium cared for Peter for 38 years, becoming like his family.

“Today, patients and staff of the Complex Continuing Care Unit are benefiting from the generosity of Peter and his father Judge Franklyn Griffiths,” says Mike Somerville, Executive Director of the Greater Niagara General Hospital Foundation. “Through their family donation, the Foundation was able to upgrade existing equipment with a full inventory of modern state-of-the-art equipment. Some of the new equipment was not previously available to patients.”

When Judge Griffiths died in 1991, the bulk of his estate was directed to provide care for Peter as long as he needed it. When Peter died in September 2008, the remainder of the estate was left to the Trillium Unit at Greater Niagara General Site, as stipulated by his father, to provide care for chronically ill patients. So far, approximately $600,000 of the $750,000 estate gift has been used to buy new equipment for Trillium.

“This amount was substantial and was used to purchase much-needed new equipment that promotes patients’ independence and allows the hospital staff to provide care in a more comfortable environment for patients,” says Frank Demizio, Vice President Patient Services at the Greater Niagara General Site. The new equipment includes 41 electric beds and mattresses, 11 patient lifts, a blanket warmer, two shower chairs, 10 commodes and 10 Hollister boots for wound healing.

Benefits from the new equipment are plentiful and significant in terms of improving patient care, independence and safety. The mattresses improve Family’s generosity improves patient care, promotes independence the patients’ comfort, help to prevent pressure ulcers and promote wound healing. The beds can be lowered close to the floor, minimizing the risk of patient falls. The beds also have an alarm, weight scale and floor lighting, all options that promote patient safety. There are now ceiling lifts in every room on the Trillium Unit. Patients are much more comfortable using the ceiling lift, and the ceiling lifts make it easier for transferring patients with heavier care needs. In the past, staff would have to make room changes to accommodate patients who need the lift. Now, with lifts in all the rooms, patients do not need to be moved for this reason.

“Peter and his family have significantly enhanced the quality of care we are providing for our patients,” says Heather Paterson, Clinical Manager of the 56-bed unit. The unit cares for patients with a broad spectrum of needs and includes patients recovering from strokes and congestive heart failure, joint replacements and other surgeries, and patients receiving chemotherapy and endof- life care.

“The ability to provide patient-centred care was the focus of the Foundation and the NHS when deciding how to spend this extraordinary donation,” says Heather. “When we chose the equipment, all of our staff on the unit was involved in the process. This ensured that we were able to receive equipment that would have maximum benefits for the patients.” Among the many grateful patients are Muriel Biggar, whose new electric bed has given her new independence.

“These beds are great,” says Muriel. “The bed goes so low to the ground that I can now do all my care myself, including my socks and shoes. I can also do all the controls myself. I don’t have to ask for help.” Niagara Health and the Foundation organized a celebration on the Trillium Unit for June 25 to recognize Peter and the Griffiths family, and the impact they have had on enhancing patient care in Niagara Falls.

“The Griffiths family has significantly enhanced the quality of care our health-care professionals provide to patients,” says Mike. “We organized this celebration so our hospital community and the community at large would know how important Peter and the Griffiths family are to Trillium.”

“I’m getting questions at work, when I get groceries, when I go to church – in fact, just about everywhere,” says Marcia, Port Colborne native and current resident. “I know the public is concerned about the changes happening.”

Marcia is the lead on the conversion of the Port Colborne ER to a 24/7 Urgent Care Centre, slated for this July. The exact date will be confirmed when all the details are worked out.

Marcia and her staff are on a mission to create the best Urgent Care Centre possible. Since late April, she has been speaking to local service agencies and business groups to allay fears and uncertainty.

“I am conveying the message that the same nurses and doctors in the ER have emergency training, and that same staff will continue to provide care after the name of the departmentchanges. Even though the Urgent Care Centre will be mainly for cases that aren’t an emergency, our staff will be able to handle any case that comes in the door.”

“Our focus now is on educating the public about when to call 911, when to go to a full-service ER, when to go to the Urgent Care Centre, and when a trip to the family doctor is the right choice,” Marcia says. “We held a Public Info Session June 16 in Wainfleet. We’re holding another session June 25 at the Port Colborne Guild Hall and a third one July 15 at Douglas Memorial Site in Fort Erie, to educate that community about its transition to Urgent Care in September.”

Also part of the multi-pronged communications plan by the NHS are ads in Niagara’s daily newspapers this month, thanks to generous sponsorship by Sun Media.

“Our website at www.niagarahealth.on.ca has a new section providing lots of information on the difference between ER and Urgent Care and we’re also finalizing a brochure which will be distributed to all Port Colborne and Wainfleet households, doctors’ offices, pharmacies, etc., in early July. We want people to post our brochure on their fridge and keep the clip-out info card in their wallet or purse.”

Annual reports are published to shine a light on the hospital’s performance over the past year and to broadly share with readers the hospital’s future direction and strategic priorities. Annual reports provide a wealth of information and increasingly are published to demonstrate accountability in the hospital sector. I want to take this opportunity to thank the small but mighty Niagara Health Corporate Communications team for ramping up to bring our readers this informative annual report special edition and extend a huge thank you to our Chief Financial Officer Angela Zangari and the Finance Department for pulling together the bulk of the information contained in our 2008-2009 Annual Report.

We’re all consumers of healthcare. Having the right information about where to go for services when we need them is crucial. Public education provides everyone the opportunity to be a more informed consumer. And public education is one of the key elements of the Emergency Department conversions to 24 hour/7 day a week Urgent Care Centres at our Douglas Memorial and Port Colborne sites as part of the Hospital Improvement Plan. Marcia Ladouceur, Project Lead and Emergency Services Manager for Welland and Port Colborne sites, is the face and voice of this year’s Urgent Care conversions. A Registered Nurse, Marcia has spent most of her 24-year career working in Emergency Services and in 2005 led the conversion of the Ontario Street Site Emergency Department in St. Catharines to a 14 hour / 7 day a week Prompt Care or Urgent Care service. Marcia is keen to get the word out to local residents on when to go to an Urgent Care Centre, when to go to an Emergency Department, and when to call 911.

I welcome you to join in our public education efforts and pass on this important healthcare information to friends, neighbours and relatives. «

Christine Clark, Chief Communications Officer

Debbie Sevenpifer,
President and Chief Executive Officer

It’s that time of year again – time for our hospital’s Annual General Meeting (AGM) and the publication of the Niagara Health System’s Annual Report. Our Annual Report provides an overview of activities, achievements and challenges of the past fiscal year. You will find our 2008-2009 Annual Report on pages nine though 16 in this issue, and I encourage all to read and learn more about our performance over the past year and what’s ahead for Niagara Health.

An important order of business at the AGM each year is the confirmation by the Board of Trustees of the members who will serve for the upcoming year on the Board.

As key decision makers for our hospital, the people who serve on our Board are skilled individuals with backgrounds in healthcare, business, finance, law, engineering and a number of other professions. Our Board members reside across the region and are first and foremost committed to making decisions that are in the best interests of patient care, the hospital and the community of Niagara as a whole.

Hospital Boards play a vital role by providing the leadership necessary to ensure hospitals offer the best patient care possible while functioning efficiently, effectively and economically. Board members are unpaid volunteers who can serve on the board for a maximum of three three-year terms. All of our Board members are listed on our website, with their credentials and backgrounds. Our meetings are open to the public, and minutes are posted on the NHS website. The Board Q & A is a new initiative in Niagara Health Now to give you more insight into the people who serve on our Board.

The NHS Board uses a broad-based recruitment process to find potential new members to fill vacancies on the Board as well as on our three Community Standing Committees for Fort Erie, Niagara-on-the-Lake and Port Colborne. Community members are invited to send a letter of application along with a detailed resume which goes to the Recruitment Committee of the Board. This year we received more than 40 applications from Niagara residents interested in filling four openings on the Board as well as a number of applications for openings on the Standing Committees.

I’d like to take this opportunity to acknowledge four long-service Board members who each completed their service with the Board at the NHS AGM on June 23. They are Past Board Chair Paul Leon, Pat Balasiuk, Doug Frazer and Tony Pylypuk. Paul, Pat, Doug and Tony have each served on the NHS Board since the formation of the hospital system in 2000 and prior to that served for many years on boards of the NHS founding hospitals. We sincerely appreciate their guidance and service over the years.

As we wish our outgoing Board members well in their future endeavours, we are also welcoming four new members to the Board. Look for the story about these new Board and Standing Committee members in the next issue of Niagara Health Now.

I’d like to take a moment to acknowledge the efforts that have been underway and are continuing to confirm the Hospital Improvement Plan (HIP) implementation details for our Douglas Memorial and Port Colborne sites.

A number of important discussions have taken place and are continuing with local physicians and community leaders in both Fort Erie and Port Colborne as well as with our healthcare partners including Niagara Emergency Medical Services (NEMS), our Local Health Integration Network (LHIN) and the Ministry of Health and Long-Term Care. Through dialogue at a number of tables and through creative solutions, we have been able to address a number of concerns that we have heard from our Southern lakeshore communities.

I look forward to sharing more information with you on the small site visions in the next issue of Niagara Health Now.

Because the hospital entrance was being expanded to accommodate the new Ambulatory Care Unit, the time capsule was re-situated this year in a new location. Twenty-five years of history was again sealed for the future, this time commemorating 50 years at the hospital’s Portage Road location. A photo book of Niagara Falls, manuals for new equipment, staff photos and much more were inserted in the capsule. « Maintenance Technician Gerry Novosel bolts the cover on and ensures the metre-long capsule is firmly supported in a wall cavity in the foyer. Gerry placed the drywall cover over the unit and a plaque now marks the spot where it will again be opened in 2033.

We’re Still Here to Care for You...
Port Colborne Urgent Care staff from left –
Dr. Jeannie Walton, RN Jack Benes,
RN Patti Tufnell

• Port Colborne Site’s Emergency Room Department will convert to an Urgent Care Centre
  (targeting July/09).
• Douglas Memorial Site’s Emergency Room Department will convert to an Urgent Care Centre
  (targeting September/09).
• Both Centres will be open 7 days/week , 24 hours/day.
• Main differences are ambulances will no longer bring emergency cases to these sites and patients will no longer be admitted directly to these sites. Discussions are underway with Niagara Emergency Medical Services (EMS) to have non-emergent ambulance calls continue to go to the 24/7 Urgent Care Centres.
• As has been the case for the past few years, patients will be transferred to a larger Niagara Health site for consultations with specialists and when they need sophisticated diagnostic tests.

Frequently-Asked Questions

Q: For residents of Port Colborne, what are the care options when there
is no longer an ER?
A: Think about what it is you need – do you have a minor ailment? Would you go to a doctor’s office if you could? If you can’t, then go to the Urgent Care Centre. Do you think you need admission to hospital? Do you need a specialist? Then go to an Emergency Department. Are you having difficulty breathing, chest pain, symptoms of stroke? Call 911.

Q: What is going to happen to the ‘H’ sign at Port Colborne Site?
A: The ‘H’ will stay on the building, signaling that hospital-based services are available.

Q: How will Welland handle all the extra patients in that ER when they have such long waits now?
A: The Welland ER was built to handle 43,000 visits/year so there is enough space. Currently, there are two physicians on duty during peak hours five days a week. We’ve just introduced 22 Medical Directives – these reduce patient wait times as now nurses can start some tests before the patient is seen by the ER doctor. As well, a new Clinical Systems Investigation Unit will fast track non-urgent patients through the Welland ER.

Know Your Options

The Ontario government has launched a new website to let communities know about the primary healthcare services available to them. Learn more about your options – go to www.ontario.ca/healthcareoptions and click on the grey Find Your Health Care Options box or call 1-866-330-6206.

EMERGENCY

Call 911
for a life-threatening emergency

You should use 911 only in an emergency. Dialing 911 provides you with emergency response and transport to emergency services and should be reserved for those who really need assistance. Sometimes it is difficult to know whether your problem is serious or not. Call 911 or go to an Emergency Department for:

• pains or tightness in the chest
• severe pain
• shortness of breath
• choking or having difficulty breathing
• fractured or broken bone
• sudden, severe headaches, vision problems, sudden weakness, numbness and/or tingling in the face, arm or leg, trouble speaking, or dizziness (stroke symptoms)
• child has diarrhea and vomiting and won’t eat or drink
• baby under six months has a fever over 38.5°C (101°F)

If you have any doubts about whether you are experiencing a medical emergency, call 911. The ambulance will take you to the appropriate ER. To learn more about Niagara EMS services, go to www.niagararegion.ca and click on living/ emergency services.

Go to
A Hospital Emergency Room

ERs accept ambulances and are staffed by physicians and nurses trained in emergency medicine treating patients with severe illnesses or injuries. ERs experience high volumes of patients, especially during the winter and holiday season. Patients are seen in order of urgency, not by arrival time, so please be patient. The ER is designed to handle the above emergency medical situations.

Niagara Health Emergency ROOMs

Fort Erie: Douglas Memorial Site, 230 Bertie Street, Open 24 hours a day, 7 days a week (Converts to 24-hour Urgent Care Centre September/09)

Niagara Falls: Greater Niagara General Site, 5546 Portage Road, Open 24 hours a day, 7 days a week

Port Colborne: Port Colborne Site, 260 Sugarloaf Street, Open 24 hours a day, 7 days a week (Converts to 24-hour Urgent Care Centre July/09)

St. Catharines: St. Catharines General Site, 142 Queenston St., Open 24 hours a day, 7 days a week Welland: Welland Site, 65 Third Street, Open 24 hours a day, 7 days a week

URGENT

Go to
An Urgent Care Centre

Urgent (Prompt) Care Centres are similar to Emergency Rooms in that they are staffed by physicians and nurses trained in emergency medicine. These professionals treat illnesses or injuries that cannot wait for a scheduled appointment with a primary care physician. Urgent Care Centres are equipped to do diagnostic tests such as X-rays and ultrasounds as well as blood tests.

They treat adults and children who have non lifethreatening illnesses or injuries such as:

• cuts or wounds that may require stitches
• sprains, strains or deep bruises • mild to moderate asthma attacks
• ear infections
• urinary tract infections
• coughs, congestion, sore throats
• diarrhea
• insect bites and rashes, abrasions, fever, simple fractures

Niagara Health Urgent Care Centres

St. Catharines: Prompt Care Centre, Ontario Street Site, 155 Ontario St., Open 7 days a week, 8 a.m. to 10 p.m. (note – name is changing to Urgent Care Centre July 09)

Port Colborne: OPENING JULY/09 – Urgent Care Centre, Port Colborne Site, 260 Sugarloaf St., Open 7 days a week, 24 hours a day (currently ER Department is located at this site)

Fort Erie: OPENING SEPTEMBER/09 – Urgent Care Centre, Douglas Memorial Site, 230 Bertie St., Open 7 days a week, 24 hours a day (currently ER Department is located at this site)

SICK

Go to
Your family physician

Ask your doctor’s office what back-up coverage they offer or recommend when they are closed (i.e. after-hours clinics or on-call service).

Call
Telehealth Ontario at 1-866-797-0000 or go to www.health.gov.on.ca

Telehealth Ontario provides free access to a registered nurse, 24 hours a day, 7 days a week for general health questions. You will receive confidential advice on what to do or where to go about any health-related concerns.

Go to
A Walk-in Clinic

A walk-in clinic is available to anyone requiring non life-threatening medical care. It is a primary care clinic, but not an urgent care facility or Emergency Department, providing same-day care by a physician without an appointment. Walk-in clinics provide care for non life-threatening illness such as:

• fever
• sore throat
• cough
• earaches
• muscle/joint pain
• skin lesions

Niagara Health Location

Niagara-on-the-Lake: Walk-in Clinic, Niagara-on-the- Lake Site, 176 Wellington St., Open Monday to Friday, 9:30 a.m. to Noon and 2 to 4:30 p.m., Thursdays 12:30 to 8 p.m.

A message from Chief Nursing Executive Sue Matthews

Each and every day, I witness or hear of situations where nurses have truly made a difference in someone’s life. This is one of the many reasons why I believe that nursing is who you are, not what you are.

I am deeply proud of Judy Dean, a Registered Nurse in the Dialysis Unit at the Welland Site, for being nominated for the provincial Toronto Star Nightingale Award for 2009. This recognition from the wife of a patient confirms what I already know — that Judy Dean is a wonderfully professional and caring nurse who puts patients and their families first.

With her consent, I am reproducing the nomination letter written by Welland resident Bonnie Vadacchino in appreciation of her acknowledgement of Judy and in honour and memory of her beloved husband Vince, who passed away in May 2008. This letter reflects the life and death realities facing our patients and their families as well as our dedicated nurses who the patients and families rely on when it matters most.

A widow’s reflection on her husband’s care

Our family life changed dramatically and forever in May 2003 when my husband Vince came to the point of requiring kidney dialysis treatment. And so he began four-hour treatments, three times weekly, with not even holidays off, for the rest of his life. I promised him that he would never be alone, and so I was always at his side.

Judy Dean, RN, was the nurse assigned to give Vince his first treatment. She gave us the tour, and started the procedure, all the while explaining, demonstrating, and counselling. Vince was quiet and courageous, and I cried for most of that treatment. We were terrified. Judy was calm and compassionate. She offered us hope that indeed, we would be able to manage this new lifestyle.

Over the next five years, and although the entire dialysis staff was great, Judy continued to be our favourite nurse. We felt safe with her. She was more than competent, quietly observing changes in Vince’s medical condition, and in both of our emotions, and taking charge professionally to effect positive changes for us. We got to know all about her husband and children; their hockey, skating and baseball games; their schoolwork, report cards, and teachers; their camping trips and Disney holidays; their faith commitment.

And Judy came to know our family … our children, ten little grandchildren, and all of our family celebrations and adventures. She really cared about us, as a family, not just as a patient. She treated us always with dignity. Judy supported Vince and me through open-heart surgery, the loss of one eye and both of Vince’s legs, and more heart attacks. She rejoiced with us at the births of three more treasured grandchildren. Judy was with us in both the worst, and the best of times. During the fourth year of dialysis we gave Judy a gift … a small Guardian Angel pin, for she was truly our “ministering angel,” as Florence Nightingale was to her patients.

Fittingly, Judy was also Vince’s nurse for his last full dialysis treatment; Vince died two days later, on May 2, 2008. She was with us from the beginning to the end, over hundreds of treatments. We treasure her compassion and commitment both to our family, and to her profession.

Judy Dean is a wonderful tribute to her vocation, and in all ways deserving of the honour of “The Toronto Star Nightingale Award.”

And by the way, almost one year after the death of her patient, Judy still manages to keep in touch with me (just the wife of her patient) on a regular basis. Judy continues to show that compassion we saw on the very first day we met her. With grateful thanks to you, Judy! «

Where do you live?
I was born in Welland and have lived in Niagara all my life, except for the eight years I spent at University of Toronto and Osgoode Hall Law School at York University, as well as a short stint in the family furniture business. After our children Adam and Jennifer left home, we began to spend May through to Christmas at our cottage property in Port Colborne, making it our permanent home several years later.

Occupation:
I was called to the Bar in 1973 and restrict my law practice to Estates, Business Law and Commercial and Residential Real Estate. What are the greatest rewards from your job? As well as the great satisfaction from exploring solutions and solving challenges facing my clients, just getting to know and be a small part of the lives of so many terrific and dynamic people has been very rewarding.

What influenced you to become a member of the NHS Board of Trustees?
Since my return to Welland from Toronto in 1973, I have volunteered with many community organizations including the Canadian Cancer Society, Lung Association, Community Living, and the Deaf and Hard of Hearing Association. I decided if I was going to have a balanced family and work life, I best concentrate my contribution to one area where I could continue to serve my community and still meet my family and law practice obligations. I chose to apply for a position on the Welland Hospital Board, and today I bring more than 30 years of Trustee experience to my work on the NHS.

What is your greatest achievement or reward as a member of the Board?
As a member of the NHS team, I can claim no great achievement as my own, since even as Chair, I only carried out the decisions and deliberations of the Board of Trustees with whom I had the privilege to serve. There was much accomplished in the early days of the NHS. The melding of the many diverse corporate cultures, the settlement of the longstanding issues in St. Catharines with the then Hotel Dieu Hospital, the negotiations for the new hospital and purchase of the new hospital site, and the Michael G. DeGroote School of Medicine satellite campus established in Niagara are a few of the outstanding accomplishments of the Board during my term.

What is the greatest opportunity for the NHS?
One of the greatest strengths of the NHS is its ability to assess and respond in a timely manner to the healthcare needs of the 435,000 residents within its catchment area. The Dialysis Unit in Welland and the proposal for the same in Niagara Falls, as well as the new Emergency and Ambulatory Care Unit in Niagara Falls are examples of resource allocation based on demographic evidence of healthcare needs. The Hospital Improvement Plan (HIP) is a similarly evidence-based response to the healthcare needs in Niagara and incorporates assurances of the continuation of quality outcomes in the provision of hospital care. With provincial dollars spent on healthcare approaching more than 45 per cent and with the capital deficit for hospitals being in the billions of dollars, it is clear there is a desperate need for change on how we deliver these vital services.

What is the NHS’s greatest challenge?
Hospitals have been described by numerous governance and business leaders as the most complex organizations in the world. It is difficult to get people to appreciate and understand the challenges to the ongoing delivery of quality healthcare and patient safety.

What community causes are closest to your heart?
I was a founding member of the Niagara Community Foundation, the Niagara College Foundation and the Niagara Health System Foundation. I am an honorary member of the Welland Hospital Foundation. My heart is closest to the NHS. I have not completed certain causes which I am personally championing (continued enhancement to quality and patient safety). I do hope to be invited back in the future.

How would you describe yourself to someone who doesn’t know you?
I would be unable to describe myself to anyone who did not know me as I really do try not to promote myself.

What is your greatest personal achievement?
I am still working on my greatest personal achievement which involves where I will spend eternity. I will let you know how I make out. «

Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

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. «

Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

Our Financial Performance

The Niagara Health System publishes its audited financial statements every year as part of our financial accountability and responsibility to the community. The complete set of financial statements for fiscal 2008-09 is posted on the NHS website at www.niagarahealth.on.ca.

The NHS ended the year with an operating deficit of $18.4 million, or a negative operating margin of 4.77 per cent, on an annual budget of $370 million.

The auditors expressed no major issues or concerns during the course of the audit.

CONDENSED STATEMENT OF FINANCIAL POSITION as at March 31

CONDENSED STATEMENT OF OPERATIONS year ended March 31

Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

How do we measure financial performance?

Revenue Breakdown The following chart illustrates the breakdown of revenue sources for 2008-09. Approximately 85 per cent in base and one-time funding was received from the Ministry of Health and Long-Term Care and the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) during the fiscal year. 

Expense Breakdown
The following chart illustrates the breakdown of expenses for 2008-09. The majority of funds are directed towards direct patient care, 77.9 per cent in 2008-09 compared to 76.9 per cent in 2007-08, representing a one per cent decrease in the administrative support category.

Average Inpatient Cost Per Day $946
The average cost per day of an inpatient stay is $946. Approximately 77 per cent of expenses are related to direct patient care like nursing, pharmacy, diagnostic imaging, laboratory and therapies. An additional 14 per cent is related to support services like housekeeping, food and maintenance. The remaining 9 per cent is for administrative costs like administration, human resources, finance, material management, information and communication services.

Average Emergency Visit $221
The average cost of an emergency visit is $221. Eighty per cent of expenses are related to direct patient care like nursing, pharmacy, diagnostic imaging, laboratory and therapies. An additional 10 per cent is related to support services like housekeeping, food and maintenance. The remaining 10 per cent is for administrative costs like administration, human resources, finance, material management, information and communication services.

Equipment
In 2008-09, the hospital invested $11.6 million in equipment and building infrastructure upgrades. The majority of capital spending is financed through the provincial government and local Foundations and Auxiliaries.

In the absence of positive working capital and cash, the NHS must rely solely on donations from Foundations and Auxiliaries to fund necessary new and replacement medical equipment. Annually, the NHS’s equipment needs exceed $14 million. Last year, $4 million was raised through local fundraising activities and $1 million was drawn from operations to deal solely with unfunded emergency purchases.

The outstanding equipment list for new and replacement equipment at the end of March 2009 was $30 million. Estimated equipment requirements over the next five years will exceed potential sources of funding by an additional $8 million (approximate) each year.

Hospital Improvement Plan
The NHS’s operating revenue is not sufficient to cover the expenses associated with the delivery of services currently being provided. This is one of the key reasons the NHS developed a Hospital Improvement Plan (HIP) in July 2008. The HIP is a framework for the NHS to enhance quality of hospital care across Niagara over the long term while at the same time balance financial pressures, the needs of Niagara’s aging population and the challenges of the ongoing shortage of doctors, nurses and other health professionals. The plan was endorsed by the HNHB LHIN in December 2008.

The HIP includes more than $28 million of savings over the five-year period through the creation of Centres of Excellence, improved quality and efficiency initiatives and by working collaboratively with the HNHB LHIN and other community agencies to ensure patients are cared for in the most appropriate setting.

Approximately $7 million in savings were achieved during the 2008-09 fiscal year.

However, until 2012-13, Niagara Health will continue to operate annual deficits requiring further cash advances from the LHIN and bank financing in the absence of additional funding. The increased reliance on cash advances, the lack of positive cash flow and the ability to obtain additional bank financing to finance cash flow deficit from operations is in jeopardy without additional funding.

Hospital Accountability Agreement
The NHS has signed the Hospital Service Accountability Agreement with the HNHB LHIN for the 2008-09 and 2009-10 fiscal years. This agreement, posted on the NHS website, sets out the roles and responsibilities of both parties with respect to funding, performance and service.

In addition, Niagara Health has undergone the following significant reviews to ensure due diligence in the spending of taxpayer dollars:

• Independent Efficiency Review
  In November 2007, the Niagara Health System engaged Health Care Management Group in an independent comprehensive benchmarking process to identify efficiency and productivity improvements by, for example, standardizing supplies and ordering in bulk with other hospitals. The review identified $12.3 million in savings over a two-year period and indicated that Niagara Health was one of the most efficient hospitals in its peer group.
• Dr. Jack Kitts Review
  Dr. Jack Kitts and his team from Ottawa were selected by the HNHB LHIN as expert advisors to review in detail the elements of the HIP, including our financial outlook, as well as to elicit feedback from the community. The review supported that Niagara Health is an efficient organization compared to our peer hospitals and that additional funding is required.
• Deloitte Special Review Engagement
  The Niagara Health System engaged Deloitte Canada in February 2009 to provide an objective assessment of our current processes, policies and procedures around expenditures, cash management and the budget and reporting process. The overall Deloitte report supports that the Niagara Health System has effective
  policies, procedures and management oversight.

Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

Quality and Patient Safety Initiatives

Quality and patient safety for our patients is our priority. Niagara Health has a Quality Reporting Framework which serves to coordinate quality monitoring and reporting of information between the various programs and the Board of Trustees. The goal of the framework is to continuously monitor, improve and enhance patient care and to meet best practice and Accreditation Canada standards.

This framework serves as the foundation for quality improvement throughout the NHS, providing focus and strategic alliances for all departments and services supporting quality care.There are a number of initiatives implemented over the last year focused on improving quality and patient safety, such as:

• The development and implementation of a corporate Patient Safety Plan outlining key priorities and action plans designed to improve patient safety;
• The completion of a Patient Safety Culture Survey by front-line staff and healthcare providers;
• Refinement of morbidity and mortality reviews;
• Preparation and testing for emergency response situations (e.g. Fire safety, Pandemic Planning, H1N1, etc.);
• Focus on medication safety by improving our drug dispensing system;
• Focus on key patient safety projects, for example Safer Healthcare Now initiatives, including preventing infections after surgery;
• Public reporting of patient safety and quality indicators, such as wait times and patient satisfaction.

Quality continues to improve and is evidenced by:

• ER average wait times for high acuity patients are improving at all our sites;
• Nine out of 10 NHS patients wait less than LHIN and provincial averages in the areas of General Surgery, Cancer Surgery for Breast, Genitourinary, Gastrointestinal, and MRI;
• Marked reduction in wait times since 2005-06 for CT scans (49 per cent reduction) and Cataract surgeries (36 per cent reduction); and,
• The NHS has been identified as one of only two hospitals in the 2008 Hospital Report as a High Performer in Utilization & Outcomes Acute Care. Clinical indicators help to explain the amount of care hospitals provide (utilization) and the quality of that care (outcome). Indicators focus on readmission rates, adverse events and access to angiography.

Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

Human Resources Update

There have been many changes in the Human Resources Department since the arrival in summer 2008 of Terry McMahon, the NHS’s new Vice President Human Resources. Many new initiatives have already been introduced under Terry’s leadership or are planned in all aspects of Human Resources.

Labour Relations

This past year has witnessed major changes in labour relations priorities. A team of labour relations staff are now in place with a clear focus on improving the labour relations climate. Notable achievements include:

• Comprehensive training for all managers;
• Written agreement with all unions on a set of guiding principles to guide the improvement in our relationships;
• Significant reductions in grievance activity with a 33 per cent reduction in the overall number of grievances;
• Successful negotiations of collective agreements with both Ontario Nurses Association (ONA) and Ontario Public Service Employees Union (OPSEU).

Recruitment

Recruitment activity in the past year has been enhanced. The overall NHS vacancy rate of 5.5 per cent compares favourably with the province-wide average vacancy rate of 6.1 per cent. With regard to Nursing, the vacancy rate of 6.3 per cent also compared favourably to a province-wide vacancy rate of 7.9 per cent. There has been a particular emphasis on filling full-time Nursing vacancies – there are now 41 fewer full-time vacancies than last year for Nursing.

Student Resources

Student Resources provides learning opportunities for individuals working towards a career in healthcare. Over the past year, Student Resources coordinated placements for approximately 1,100 students throughout the NHS. Of all new hires last year, 20 per cent completed student placements.

Occupational Health and Safety

Occupational Health and Safety implemented a range of efficiency improvements throughout the year. A revised Attendance Management Program was implemented along with a renewed focus on disability management. Benchmark indicators for both lost-time frequency and injury severity are similar to hospitals across the province.

Organizational Development

Organizational Development activities included the revision of a Workplace Relations and Violence Prevention Policy. Special one-time funding was awarded by the Ministry of Health and Long-Term Care to support the training of staff in crisis prevention and alternate dispute resolution skills. Another major initiative involved implementation of a revised and simplified performance appraisal process for all staff.

Volunteer Resources

Volunteer Resources continues to develop programs and opportunities that meet the needs of the NHS and Volunteers and Auxiliaries to contribute in meaningful ways. Emergency Room Volunteers, Meal Time Friends and Art Therapy Volunteers are examples of just a few. With the implementation of initiatives such as the Take Care of Your Future program (introduces adolescents to various healthcare career opportunities), youth are introduced to, and witness first hand, the importance of volunteerism.

Niagara Health System Annual Report 2008-2009

Browse the report through the links below, or download the PDF version.

• A time of tremendous challenge and change
• Our Financial Performance
• How do we measure financial performance?
• Quality and Patient Safety Initiatives
• Human Resources Update
• About the Niagara Health System

About the Niagara Health System

Niagara Health System Board of Trustees

The Niagara Health System Board of Trustees is comprised of volunteers who live and work in communities across the region. Their leadership and efforts ensure that Niagara’s healthcare system meets the needs of its residents. Our Board of Trustees for 2008-09 is listed below.

Jean Armitage
Patricia Balasiuk
Stephen Butz, Vice Chair
Bruce Caughill
Carman Dix
Helen Eggleton
Doug Frazer
Dr. Joanna Hope, Interim Chief of Staff
Steve Hudson
Paul Leon
Dragan Matovic
Joe McCollum
Flo Paladino
Steven Pillar
Anthony Pylypuk
Dr. Ken Reddy, President, Medical Staff Association
Mark Sherk
Debbie Sevenpifer, President and CEO, Secretary to the Board
Alan Simpson
Betty-Lou Souter, Board Chair
Mary Turner, Vice Chair
Dr. Joseph Vedova, Vice President, Medical Staff Association

Our Vision
Together in Excellence – Leaders in Healthcare

Our Mission
Working within an integrated system for a healthier Niagara. Building on the contributions of our founding hospitals:

• We provide equitable and timely access for people throughout Niagara to a
  wide range of patient-focused care and services;
• We provide a full continuum of care through partnerships with other health and social service providers within and beyond Niagara;
• We enhance community well-being and healthcare delivery through promotion, education and research;
• We commit to innovation and continu us quality improvement in health services to meet our changing healthcare needs.

Success Factors

Focus on those we server

Bring out the best in each other

Build strong and successful relationships

Create a better way

Use our resources wisely

Our Values
Compassion, Professionalism, Respect