annual report Workplace Excellence Patient Centred Care Workplace Excellence Workplace Excellence Financial Sustainability Financial Sustainability

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1 annual report Brantford General The Willett, Paris Patient Centre Care 2012/13

2 Brant Community Healthcare System A Focus On Quality Improvement Board of Directors 2012/13 Leading the way~exemplary Care The past year has seen the Brant Community Healthcare Mr. Paul Moore Chair Mr. Jon Lynne-Davies Vice Chair Ms. Jean Kincade Director Dr. Carolynne Locke Director, (President, Medical Staff) Mr. Tom Lockyer Director Ms. Dorothy Mays Director Dr. Bernadette McNeil Director (Vice President, Medical Staff) Ms. Janice Mills Director Mr. George Mychailenko Director Mr. Douglas Parker Director Ms. Lina Rinaldi Chief Nurse Executive Dr. Charmaine Roye Chief of Staff Mr. Ken Stead Director Ms. June Szeman Director Mr. Paul Stillman Director Mr. Gordon Stratford Director Mr. James Hornell Secretary, President & CEO Mr. Barton Brennan President, Volunteer Association Mr. Reg Madison President, Foundation 2012/13 Mission Brant Community Healthcare System (BCHS) is one of Canada s pre-eminent community healthcare organizations. Brantford General Hospital, a regional acute care centre, and the Willett, an ambulatory centre providing urgent care, in nearby Paris, Ontario, have 2,300 staff, physicians and volunteers. BCHS embraces performance excellence, has leading-edge medical technology and is a nationally recognized, award winning organization, Accredited with Exemplary Standing by Accreditation Canada. System continuing on a journey of performance excellence and improved patient satisfaction. Aligning our strategic and Quality Improvement Plans, QIP, has inspired a new way of doing business. 92% of leaders completed Performance Excellence training. Supportive activities were apparent as staff held regular huddle sessions and participated in rapid improvement events designed to improve the patient experience, staff satisfaction and efficiency. There was also a renewed emphasis on our staff receiving timely feedback on performance. We did well on most QIP metrics. However, like many hospitals, we realize that the time for patients to get a bed on a unit once they are admitted through the Emergency Room takes too long. This is a patient flow issue. Restructuring to value streams will challenge the processes and culture that contribute to unacceptable wait times. We changed the way in which we engage our community and several novel techniques were utilized to seek input and validation for our strategic plan. A large cross-section of patients/clients, family members, community partners, staff, physicians, volunteers and board Quality Indicator for We had an 83% response rate for our in-house survey about addressing patient s anxieties and fears. members were asked to share with us what is working and what opportunities they see in the future. BCHS achievements did not go unnoticed across the nation. CHCH News reported on our designation as a Trillium Gift of Life hospital for organ and tissue donation, City TV featured our hand-washing video and the new mammography machines were featured in Canadian Healthcare Technology. BCHS is also represented well on various committees of the Hamilton Niagara Haldimand Brant Local Health Integration Network, LHIN, collaborating and providing a valuable link with healthcare partners throughout the region. Among changes taking place in healthcare is a shift in the way the province funds hospitals. Traditionally, hospitals in Ontario have received one lump sum to provide services. This global funding has begun to move to an activity and quality based model which will reduce our flexibility. In essence the dollars will follow the patients in the new model. Thanks to the talents, professionalism and caring of staff, physicians and volunteers we have listened, identified challenges and begun to make improvements and adapt to a changing world where we place patients first, create a great place to work and use our resources wisely.

3 A Year of Accomplishments Clearing the Air On September 10th, 2012 The Brant Community Healthcare System declared itself a smoke-free facility. A staff smoking cessation support program was implemented and staff were trained in how to assist patients to quit smoking and/or manage their withdrawal while in hospital. Preparing for Future Technology Information and Communication Technology undertook major upgrades to our infrastructure during 2012/13. Upgraded server core technology allows them to operate with no downtime if hardware fails. In addition the phone systems received an upgrade. Recognized by Our Partners The St. Leonard s society presented the BCHS with a community award for the Early Intervention in Psychosis Program, the establishment of the Brant Crisis Response Network and for working on a collaborative proposal to determine whether a detox and rehab program is required in Brantford. The Hamilton Niagara Haldimand Brant Community Care Access Centre, CCAC, also presented us with a Systems Partnership award. These are examples of the close working relationship the BCHS has with community partners. An Award Winning Workplace For the 3rd year in a row the BCHS was awarded a Quality Healthcare Workplace award (Gold) from the Ontario Hospital Association, OHA. As well, we were recognized as a Top 10 Employer in Hamilton/Niagara. Inter-Professional Collaboration After much preparation, the BCHS implemented an inter-professional collaborative care model. In 2012 three departments of the BCHS implemented the model, calling it Improving Patient Care, IPC. After an initial three month assessment there was a reduction in falls, medication errors and an increase in patient satisfaction. There will be further implementation in While the use of call bells by patients increased, the response time by staff decreased significantly. The new model is representative of healthcare organizations of the future and helps ensure the skills of all are best utilized to improve care and patient satisfaction. BCHS Teams Ensuring Safety in Our Community The BCHS was able to overcome two major challenges through teamwork. When Sandoz Canada was forced to reduce production at its Quebec plant it caused a cascading series of drug shortages. A BCHS Incident Management Team, IMT, was struck to mitigate this crisis and guide staff through this emergency. At the same time Brantford/Brant County were struck early and hard with Influenza. A second IMT swung into action to make plans and coordinate a response. With more patients admitted during the holiday season, many staff volunteered to work extra hours. Additional staff helped with infection control auditing and the hospital managed to minimize the effects of an extreme influenza season. Quality Indicator for Our hand hygiene rate increased to 84%. While the improved rate is good, we must continue to improve for the health and safety of our patients. The BCHS performed 139,124 procedures in 2012/13.

4 Bringing Our Strategic Directions to Life Patient Advocates The voice of the patient increased as a concerted effort was made to bring patients and their families into many projects at the BCHS. From Rapid Improvement Events to a new Patient and Family Advisor program, the inclusion of community members have proven very insightful and helpful. To encourage more real time data, the BCHS has been surveying patients regarding their anxieties and fears in the hospital with an eye to improving the patient experience while they are in our care. Bed Mapping In June of 2012, staff initiated an extensive, bed mapping exercise. They examined the current location of beds to ensure they are located in the most appropriate units to address patient care needs. After gathering expert input and advice from staff, physicians and volunteers, a bed mapping scenario was developed which will be implemented in 2013/14. Better Quality Information in the ER EDtracker is a computerized system that utilizes innovative technology to improve patient s care, including tests ordered, consults requested, etc. This tool was installed to improve patient flow in the Emergency Department. Its display gives providers key patient information such as clinical reason for visit, patient urgency, length of time waiting in various locations and status. Listening to Surveys Staff completed random respectful workplace surveys monthly and answered questions around disrespectful behaviour in the workplace. 80% said they worked in a respectful workplace. Leaders Working to a Standard Clinical leaders participated in a rapid improvement event to establish a standard of work which helped to focus their schedule, eliminate unnecessary meetings and committees and established metrics to trend and act upon opportunities for improvement. Low Turnover and Sick Time The BCHS continues to be a popular place to work. Vacancy rates and sick days were well below industry standards. Dr. Andrea Unger was honoured by graduating medical students at McMaster University with an award for best Emergency Medicine preceptor. Working To Address ALC Our Alternate Level of Care, ALC, rates remained high in 2012/13. These are patients who received acute care treatment in the hospital and no longer require it, yet their level of care needed is unavailable in our community. The rate of ALC patients remained around 15%. We are working with our community partners to reduce this rate and ensure patients receive the right care at the right time and place. This will provide more beds for acute patients who truly need them. Community Partnerships The BCHS actively participated in the Brant County Community Collaborative Continuum. All local organizations funded by the Ministry of Health and Long-Term Care as well as their partner agencies meet on a monthly basis to discuss issues of common concern. The BCHS also has been providing back office services to West Haldimand General Hospital, Grand River Community Health Centre and Participation House. A large cross section of the community shared their opinions with us in the Join the Conversation open house. Quality Indicator for As part of our Performance Excellence big dot targets for Total Margin, our target was zero (balanced position), however, we exceeded this target by 1.34% reflecting this year s surplus.

5 A Legacy of Caring The last year has been a time of unrelenting change and activity. It has been a long time coming but the final plans for the Family Birthing Centre are well underway. These plans are approved with a target for completion in The ongoing relationship we have with the Juravinski Cancer Centre has been a wonderful addition to our stream of care. Extending the hours of service for medical oncology was well received by patients. During 2012/13 the Palliative Care Consult Team reached a full complement. Thanks go out to the doctors who joined and our team lead, Dr. McNeil for her excellent leadership. We received some help from technology this year with the installation of the electronic Tracker Board in our emergency department. Prior to this, various metrics requested by the LHIN and the Ministry of Health and Long-Term Care were hand collated. This meant that the results were not as timely and therefore not as useful for trying to come up with solutions for our access issues. This electronic data will help improve patient care and wait times in our emergency department. A partnership with the McMaster University Faculty of Medicine is starting to take shape. As part of the Grand Erie, Six Nations Clinical Education Campus Brantford Centre, the Family Medicine Residency program will begin this year with Dr. Scott Elliott as the physician lead. Six residents per year will be accepted into the program. This will be very good for the community and for the BCHS. Studies have shown that physicians who do most of their training in a community setting are more likely to return when they set up practice. Hopefully this will prove true for these graduates. As I get ready to take on my new role as Director, Professional Relations and Strategic Health Alliances at the Canadian Medical Association, I look back on my time here with fondness. Brantford has been a great place to practice, learn and grow. I will miss the patients, my colleagues, the Board of Directors, the administration, staff and volunteers at the BCHS and wish everyone all the best as they enter their next phase of activity. Dr. Charmaine Roye Chief of Staff Thank You Dr. Charmaine Roye for your leadership and commitment as the Chief of Staff for the Brant Community Healthcare System. Statistics Inpatient Days 86,593 Newborns 1,439 Surgical Cases Operating Room Inpatient 2,495 Operating Room Outpatient 6,843 Ambulatory Care 8,368 Emergency Visits 43,877 Urgent Care Visits 18,788 Outpatient Visits 90,432 Clinical Laboratory Tests 1,839,745 Diagnostic Imaging Procedures 139,124 Pharmacy Workload Units 3,229,302 Patient Meal Days 101,407 "We are the only centre in Canada with a formal training program for practicing physicians who want to become proficient in both basic and advanced emergency ultrasound." Dr. Greg Hall annual report 2012/13

6 Finances in healthcare in 2012/13 were uncertain and challenging. Even with that uncertainty we were able to reinvest resources into forward thinking programs such as lean strategies, Pharmacy, Hospitalists and patient flow initiatives and achieved an operating surplus of $2,116,896. The Health System Funding Reform, HSFR, was introduced in 2012/13 and represents a significant culture shift in Ontario s healthcare system. This shift is designed to ensure funding models are fairer, more evidence-based, and more responsive to the emerging healthcare needs of the province s changing population. HSFR is based on the key principles of quality, sustainability, access and integration and the action plan has three priorities: keeping Ontario healthy; faster access to stronger family health care; and right care, right time, right place. We continue to work with our funding partners to understand the impact of these changes on patient services and our operations. Where your healthcare dollars were spent in 2012/13 Total Expenses: $155,913,809 Direct Inpatient 33.4% ($52,129,374) Direct Outpatient 18.5% ($28,760,458) Lab/Diagnostic Imaging 13.8% ($21,589,767) Housekeeping, Plant Maintenance, Patient Food Services, etc. 13.1% ($20,399,806) Finance, Human Resources, IT & other services 10.2% ($15,956,948) Pharmacy, Speech Pathology, Social Work, etc. 2.9% ($4,595,987) Amortization 2.6% ($4,009,488) Therapeutic Services 2.0% ($3,096,837) Community Mental Health, Organizational Health & Development etc 1.8% ($2,861,132) Marketed Services & Other Expenses 1.7% ($2,514,012) Wellness Focus Healthcare organizations and funders recognize the need to provide care and support to Ontarians in taking charge of their own health. As a commitment to our community, we plan to continue developing key partnerships within our community and industry, including group purchasing, sharing programs and services where applicable, investing in lean strategies and controlling costs. Clearly our agenda in the coming year must be one of transformation and ensuring we create true value for those we serve. Where your healthcare dollars came from in 2012/13 Total Revenue: $158,030,705 LHIN 4/MOHLTC 80.8% ($127,629,593) OHIP Revenue 11.1% ($17,559,459) Paid Parking, Rebates, Diabetes Education Grant, etc. 4.1% ($6,424,728) Preferred Accommodation 1.2% ($1,923,606) Amortization1.1% ($1,823,671) Marketed Services 0.8% ($1,208,457) Outpatient Revenue 0.6% ($951,940) WSIB, Uninsured, Non Resident Inpatient Revenue 0.3% ($509,251) Please visit our website to see our Auditor s Report and full financial statements for the fiscal annual year ended March 31, report 2012/13

7 Annual Report- Foundation The Brant Community Healthcare System, BCHS, Foundation would like to express our sincere thanks to the many generous donors that have supported us this year. Did you know? The BCHS Foundation has invested approximately $1.2 Million in essential patient equipment since April 1, Equipment such as portable ultrasound units to fetal heart monitors, from wheelchairs to ultrasound beds are all supported thanks to the generosity of our amazing donors. This equipment helps our caregivers provide exemplary care to our community. Did you know? Over the past 6 years, the BCHS Foundation has granted more than $15.5 Million to the Brant Community Healthcare System for capital and patient equipment. Your support of the BCHS Foundation helps us purchase medical equipment that is not paid for by the Ministry of Health and Long- Term Care, provide essential resources to maintain the exceptional level of compassionate patient care, and invest in new and innovative technology. Thank you for your support, advocacy and investment; we are truly grateful! Together, we are transforming healthcare in our community. The BCHS Foundation Board of Directors is comprised of a committed group of community leaders from Brantford/Brant County. We are pleased to continue to be able to serve both the Brantford General and the Willett, Paris with their significant funding priorities. BCHS Foundation Statistics from April 1, March 31, 2013 Total Raised: $1,945,000 Total Donors: 2,804 Total Gifts Received: 5,490 We are thankful for the 604 donors who increased their donation from last year, for our 145 monthly donors that provide ongoing support and our 579 new donors that gave this past fiscal year to the BCHS Foundation. Please contact the Brant Community Healthcare System Foundation at or visit our website at to learn more about how you can invest in healthcare in our community. Find us on Facebook and Mr. Reg Madison - Chair Mr. Peter Jackman - First Vice- Chair Mr. Chris McCurdy - Second Vice- Chair Ms. Marilyn Sewell - Treasurer Mr. James Hornell - President/ CEO, BCHS, Secretary (Ex-officio) Mr. Wayne Branchaud - Director Mr. Dan Chagnon - Director Mr. Mario Colombo - Director Ms. Sherry Kerr - Director Ms. Shalaka Kulkarni - Director Mr. George Mychailenko - Director, BCHS Board Representative (Ex-officio) Mr. Steven Portelli - Director Mr. Ken Stead - Director Volunteers Contributing to the Patient Experience Volunteers eagerly received their own personalized training in customer service to enhance the patient experience at the hospital and improve workplace excellence. The message the volunteers received through the training was clear everybody can make a difference. Volunteers also received training around the patient declaration of values that the BCHS lives by. These two initiatives are now a standard part of any volunteer s orientation to the hospital. A new patient-centred program was launched where volunteers visited newly admitted patients to hand out patient handbooks and ask them if there is anything they can help them with. This was such a success on medical unit B7 that it will be expanded to other units. Brant Community Healthcare System Volunteer Association Statistics 2012/13 Total funds donated = $112,141 # of volunteers =453 Total volunteer hours = 68,807 Cost = priceless Thanks! This new patient and family handbook was published at the BCHS in 2012/13 and it features everything a patient might need to know regarding their experience and care at BCHS. As a patient experience volunteer, Mike Conway was assigned to give the handbook to new patients. They were happy to see him and most wanted to engage him in conversation. Mike recalls a man who had lost his watch. Mike quickly called down to the ER and the watch was located. Meeting new patients is a great experience and helps improve communication, Mike Conway - Volunteer

8 Looking Ahead To enhance the quality of our care for patients and community, we had extensive input into our strategic plan through surveys and the Join the Conversation, initiative. A New Direction Based on feedback, a new mission was adopted Providing Excellent Care To Our Community. We also clarified our direction, or True North, BCHS Your Partner in Lifetime Health; Patient First; A Great Place to Work; Using Resources Wisely. To move us in the direction of our True North, we are transforming the traditional structure of the organization to one based on value streams. Value streams are about understanding all the activities and actions required for the patient through their journey of care while ensuring that everything we do adds value from the patient s perspective. As part of the value stream process, our leadership structure has been simplified and more resources have been allocated to support front-line care. Improving Patient Care Among other projects coming to fruition will be the bed mapping initiative developed in June of 2012/13. The current historical location of our beds will be improved to ensure that our complement of beds are located in the most appropriate units to better address patient s needs. This will improve patient flow and safety, as well as reduce wait times. We will also be continuing on our journey of improving patient care, IPC, and will continue the roll out across the BCHS. Improving the BCHS s patient satisfaction scores will be a major initiative for this year and coming years. For success we must see the care at BCHS through the patient s eyes. To do so, Patient and Family Advisors are being sought and given prominent representation on hospital committees and projects. One of the Patient Advisors on an incident management team said, It really opened my eyes as to what a large and complex organization this hospital is. You people really know what you are doing. Family Medicine Residents We will be completing our renovations this year for the opening of the Grand Erie, Six Nations Clinical Education Campus Brantford Centre. This educational program brings together the City of Brantford, McMaster University s Michael G. DeGroote School of Medicine and the BCHS to accommodate, initially, six full-time, first year Family Medicine Residents for a two-year program in our area. This will be a boost to our community since research has shown that students tend to set up practice in the area they study in. Strengthening Partnerships and Integration As part of integration with other healthcare organizations and a commitment to best practice, the BCHS will be the location of an Integrated Stroke Unit that will improve care for stroke victims throughout Haldimand Norfolk, Six Nations, Brantford and the County of Brant. This year the BCHS will be the lead agency for a patient first initiative, Health Links, that will improve the care experience of those who most frequently require hospital healthcare services in our area. Studies show that a small percentage of patients use the majority of hospital resources. A key role for Health Links will be to bring together primary care, specialists, CCAC, hospitals and community services to develop care plans that will enable these patients to receive coordinated care in the most appropriate settings. Working closely with other healthcare organizations will become increasingly important as we look ahead. A steering committee has been struck with the CEOs and Chairs of BCHS, Dunville Memorial Hospital, West Haldimand Memorial Hospital and Norfolk General Hospital to discuss opportunities for further integration. I like the care here and would do anything for these nurses Dialysis patient Serena Davis. annual report 2012/13

9 We are committed to improving the environment and using less natural resources. This publication is printed in limited numbers and on paper created with mixed resources, meaning the paper is recycled or harvested from renewable resources. 200 Terrace Hill St Brantford General The Willett, Paris