Kingston Hospital Integration Perceptions of the General Public. Survey Results Final Report October 21, 2016 Prepared by HILL+KNOWLTON STRATEGIES

Kingston Hospital Integration Perceptions of the General Public Survey Results Final Report October 21, 2016 Prepared by HILL+KNOWLTON STRATEGIES

HIGHLIGHTS 2

Highlights 57% of residents in the GKA are aware of the integration, while only 25% of people in the rest of the LHIN are aware. 69% think that cost reduction is one of the reasons behind the decision to integrate, but only 38% assume that reducing the number of doctors and nurses is part of the decision. 71% say they are excited about how the integration could improve the care available in [the] community. 67% expect that the creation of a new academic health sciences centre will have a positive impact on quality of care. 64% support the integration of KGH and HDH to create a new academic health sciences centre. 7% oppose the integration of KGH and HDH to create a new academic health sciences centre. 53% say that it is important to me that each hospital keeps their identity and mission after integration. 71% saying that they need to know more about how integration will impact the care in our community. 3

Conclusions SUPPORT Support for integration and the creation of a new academic health sciences centre is very high, with about two-thirds of the population saying they mostly or definitely support the move. Support is also remarkable broad and consistent across the LHIN. Not only are people supportive, most are even excited about prospects of integration and the creation of the centre. This level of support and excitement, coupled with people s thirst for more information, presents an opportunity to generate strong momentum in the region, through sustained engagement. PERCEPTIONS AND UNDERSTANDING Cost reduction is seen as one the main driver of integration, but the public does not necessarily equate the fulfillment of this objective with staff reduction, particularly when it comes to doctors and nurses. Thus, from a communications standpoint, the message that integration will lead to budget efficiencies, but will not result in a reduction of public-facing staff, is quite believable. Indeed, most people (72%) think that integration and creation of the new academic health centre will have a positive impact on hospital funding. And, similarly, people are much more likely to expect positive impacts on hospital staff and employment at the hospitals, than they are to think that the impacts will be negative. 4

Conclusions OUTREACH AND COMMUNICATIONS Awareness of integration and creation of the centre in the GKA is 57%, and only about 25% in the rest of the LHIN. There is an appetite for more information, even among those who describe themselves as definitely aware. In terms of what people want to know about, the survey tells us that when it comes to the future of hospital care in the region, people prioritize quality of care, access to care, and wait times for procedures, as well as at emergency. In addition, residents of the LHIN also told us what their concerns and questions are, with the most salient for guiding communications being: Impacts of hospital staff and employment; Impacts of quality and access to care; Information on anticipated benefits of integration and the creation of the new academic health sciences centre; and Information about costs/financing (e.g., who is paying for what?). 5

OBJECTIVES & METHODOLOGY 6

Research Objectives & Issues Objectives 1. To obtain a reliable assessment of public opinion within the South East Local Health Integration Network (LHIN) around the integration of Kingston General Hospital (KGH) and Hotel Dieu Hospital (HDH) to create a new academic health sciences centre. 2. To generate research-based guidance to help further refine the communications and engagement framework that supports the integration process; and 3. To provide initial food for thought as the hospitals look towards the development of a brand and engagement strategy for a new integrated academic health sciences centre. Issues Awareness Perceived motivations for integration Perceived anticipated impacts of integration Support/opposition to integration Priorities for the future of health care in the region Concerns and key questions. 7

Methodology 10-minute bilingual telephone survey Random sample of n=1,000 adults residents of South East LHIN (n=700 in Greater Kingston Area (GKA) and n=300 in rest of the LHIN) Data collected from September 28 to October 11, 2016 Data weighted to Census population figures for age and gender using Kingston CMA to ensure representativeness of findings Margin of error is 3.1% 19 times out of 20 Data was analysed according to socio-demographic questions (e.g., age, gender, education, region within the LHIN), by other profiling questions (e.g., works in health care, visited the hospitals), and awareness of the integration. 8

WHO RESPONDED 9

ANNUAL HOUSEHOLD INCOME EDUCATION GENDER 49% 51% Elementary to High School $50-$75k College 34% CHILDREN AT HOME UNDER 18 REGION $100k+ 66% Yes 26% 25-34 35-44 Rest of LHIN 'Other 45-54 34% No 73% 14% 23% AGE 18-24 Greater Kingston area 15% 33% $75-$100k University 30% <$50k 34% 55-64 65+ 13% 16% 15% 19% 17% 20% 10

DO YOU CURRENTLY WORK, OR HAVE YOU EVER WORKED, IN HEALTH CARE? DO YOU CURRENTLY WORK AT QUEEN S UNIVERSITY OR ST. LAWRENCE COLLEGE? 95% 75% 12% 12% 4% Yes, currently Yes, used to No Yes, Queen's 1% Yes, St. Lawrence No 11

HAVE YOU EVER RECEIVED CARE AT THE KINGSTON GENERAL HOSPITAL OR HOTEL DIEU HOSPITAL? HAVE YOU EVER HAD A HEALTH ISSUE THAT REQUIRED YOU TO RECEIVE CARE AT BOTH HOSPITALS? 65% 61% 34% 19% 11% Yes, KGH 8% Yes, HDH Yes, both No Yes No 12

DETAILED FINDINGS 13

Awareness Overall, 1 in 2 respondents have heard at least something about the integration or merger of KGH and HDH to create a new academic health sciences centre. Awareness levels are significantly higher in the GKA than in the other parts of the LHIN. Indeed, the majority of those outside of GKA (75%) are not even vaguely aware of the planned hospital integration. There is also a cleavage in awareness levels by age, with those under 45 years of age being significantly less aware. The vast majority of those with some degree of awareness heard about the integration either through traditional media (i.e., TV/radio and/or newspapers) and/or word of mouth (e.g., friends or family). Seniors were much more likely to have heard about the integration in the newspaper (40%) than were others, particularly those under 35 years of age (10%). 14

HAVE YOU HEARD ANYTHING ABOUT THE INTEGRATION OR MERGER OF THE KINGSTON GENERAL HOSPITAL AND THE HOTEL DIEU HOSPITAL TO CREATE A NEW ACADEMIC HEALTH SCIENCES CENTRE? South East LHIN HOW DID YOU HEAR ABOUT THIS? Yes, definitely 27% TV or radio Word of mouth / friends or family 36% 39% Newspaper 24% Yes, vaguely 21% Social media Phone call from hospital / foundation 1% 6% Email from hospital 1% No 52% Other Don't know / can't remember 3% 11% South East LHIN; n=1,000 16

Perceived Motives for Integration The public sees a wide range of motives and objectives behind integration: eight different objectives are seen by 60% or more of the public as contributing to the decision to integrate (i.e., rated 5 to 7 on a 7- point contribution scale). At top of the list of 12 potential objectives/motives for integration are: To reduce costs (i.e., rated 7 on a 7-point contribution scale by 37%); To improve coordination between the hospitals (35%); To get more funding from government (35%); and To allow the two hospitals to work more closely with Queen s University (33%). Despite the salience of cost reduction as a contributor to the decision to integrate, the public places the reduction of technical and support staff (i.e., rated 7 on a 7-point contribution scale by 19%), and the reduction of doctors and nurses (14%), at the bottom of the list of motives and objectives for integration. We also find that results are very consistent across all of our profiling questions. The only noteworthy difference is that people who live outside of the GKA (i.e., 5 to 7 on a 7-point contribution scale by 67%) are significantly more likely to see the decision to integration as motivated by a desire to attract more world class doctors and researchers to Kingston than are those living in the GKA (53%). 17

HOW MUCH DO YOU THINK EACH OF THE FOLLOWING CONTRIBUTED TO THE DECISION OF KGH AND HOTEL DIEU HOSPITAL TO INTEGRATE INTO A NEW ACADEMIC HEALTH SCIENCES CENTRE? To reduce costs 37% 16% 16% To improve coordination 35% 22% 18% To get more funding from government 35% 17% 15% To allow the two hospitals to work more closely with Queen's 33% 21% 21% To pool staff and resources 31% 24% 19% To make it easier for patients to receive treatment 31% 18% 17% To improve patient care 30% 16% 18% To do more leading-edge health research 28% 17% 21% To reduce the number of executives and managers 25% 13% 19% To attract more world class doctors and researchers 23% 15% 20% 7 6 5 To reduce technical and support staff To reduce the number of doctors and nurses 14% 19% 10% 15% 14% 18% On a 7-point scale, where 1 means not at all and 7 means very much South East LHIN; n=1,000 18

Perceived Impacts of Integration Overall, the public is very sanguine about the impacts that the creation of the new academic health sciences centre will have in a range of areas. The expectation of positive impacts significantly outweighs expectations of negative impacts across all eight of the dimensions examined in the survey. The most positive impacts are expected with respect to: Kingston s brand and reputation (i.e., rated 5 to 7 on a 7-point impact scale by 75%); Hospital funding for Kingston (72% overall and 82% of those under 35 years of age); and Quality of care (67%). Impacts in the areas of employment at the hospitals and on current hospital staff are expected by most people to be positive, though opinion here is somewhat polarized, with 25% expecting a negative impact on staff, and 29% expecting a negative impact on employment at the hospitals. Those with a high school education or less (18%), and those with a household income of under $50,000.00 (17%) are significantly less likely to think that integration will have a negative impact on hospital staff. 19

It was announced that Kingston General Hospital and Hotel Dieu Hospital will be coming together in April as one organization with one board, CEO and management team to create a new academic health sciences centre. This new Centre is expected to put Kingston on the same map as the largest health science centres in the province. As an integrated centre, each hospital site will continue to exist, and all of the same services will still be offered. WHAT IMPACT, IF ANY, DO YOU THINK THE CREATION OF THE NEW ACADEMIC HEALTH SCIENCE CENTRE WILL HAVE ON EACH OF THE FOLLOWING? Kingston's brand and reputation 75% 14% 9% Hospital funding for Kingston 72% 16% 8% Quality of care 67% 19% 13% Access to care 65% 20% 13% Kingston's economy 57% 25% 14% Hospital staff 53% 19% 25% You and your family 49% 31% 18% Employment at the hospitals 48% 20% 29% POSITIVE (5-7) NEUTRAL (4) NEGATIVE (1-3) South East LHIN; n=1,000 20

Other Perceptions and Opinions of Integration Overall, the public is excited about the creation of a new academic health sciences centre in Kingston. (65% agree), as well as excited about how the integration could improve the care available in [the] community. (71%). At the same time, the public is looking for information (and possibly some reassurance), with 71% saying that they need to know more about how integration will impact the care in our community. Here, it is important to note that the appetite for information is consistent across the entire population; there is no variation based on region of the LHIN, whether one has ever visited one or both hospitals, or even one s level of awareness, which means that those who already have some familiarity with the planned integration want to know more. About half (53%) say that it is important to me that each hospital keeps their identity and mission after integration. Analysis reveals that importance is inversely correlated with education and household income (but not with age). 21

PLEASE INDICATE WHETHER YOU AGREE OR DISAGREE WITH EACH OF THE FOLLOWING STATEMENTS Agree (5-7) Neither (4) Disagree (1-3) I m excited about how the integration could improve the care available in our community. 71% 17% 10% I need to know more about how the integration will impact the care available in our community. 71% 17% 71% 11% I m excited about the creation of a new academic health sciences centre in Kingston. 65% 22% 13% It s important to me that each hospital keeps their identity and mission after integration. 53% 21% 24% South East LHIN; n=1,000 22

Support for the Integration of KGH and HDH to Create a New Academic Health Sciences Centre The survey finds that support for hospital integration to create a new academic health sciences centre is very high, with about two-thirds of the population saying they mostly or definitely support the move. In contrast, only 4% are definitely opposed, and 3% are mostly opposed. About one in four residents indicate that they are unsure and need more information to help them form an opinion about integration. 23

FROM WHAT YOU HAVE READ OR HEARD, DO YOU SUPPORT OR OPPOSE THE INTEGRATION OF KINGSTON GENERAL HOSPITAL AND HOTEL DIEU HOSPITAL TO CREATE A NEW ACADEMIC HEALTH SCIENCES CENTRE? Definitely support Mostly support Not sure / Need more information Mostly oppose Definitely oppose South East LHIN 35% 29% 25% 3% 4% SUPPORT 64% vs. 7% OPPOSE South East LHIN; n=1,000 24

SPOTLIGHT: ANALYSIS OF COMMENTS PROVIDED BY THE 7% WHO EXPRESSED OPPOSITION TO INTEGRATION Concern for the impact on staffing levels 26% Express opposition without mentioning source of concern 22% Concern for the standard of patient care 17% Prefer hospitals to maintain their separate identities 11% Concern for maintaining the access to care 9% Concern for how much the intergration with cost 8% Other 6% South East LHIN; n=1,000 25

Verbatim Quotes From Some of Those Who are Opposed I think they should stay separate. I don't agree with anything that the government does, all they care is about saving a dollar Less time worrying about money, and a little more time worrying about patient care. Quality of patient care. Don t do it. We have gone through too much. Don't compromise personal health care. Will u be more devoted to patient care? Hope money will go to improve patient care Don't do the merger How will it affect jobs? I m concerned about using less resources for staff members. I prefer the choice of selecting either one of these hospitals. Don't let it ruin the whole health system and actually research stuff. They need their separate identities, one needs to be known as kids hospital and the other a adult hospital. My concern is that because Hotel Dieu and Kingston are Catholic and Secular I am afraid that the women s clinic could lose and that is what concerns me. 26

Support for the Integration of KGH and HDH to Create a New Academic Health Sciences Centre We also find that support is also very broad across the South East LHIN, as well as among all population subgroups (i.e., gender, age, education, income, whether one has children under 18 years at home). In fact, it is remarkably so: Support for integration within the GKA is 66%, while in the rest of the LHIN it is at 63%. Support among those who have been to one or both hospitals is 65%, while support among those who have never been is 66%. 27

FROM WHAT YOU HAVE READ OR HEARD, DO YOU SUPPORT OR OPPOSE THE INTEGRATION OF KINGSTON GENERAL HOSPITAL AND HOTEL DIEU HOSPITAL TO CREATE A NEW ACADEMIC HEALTH SCIENCES CENTRE? By region Definitely support Mostly support Not sure / Need more information Mostly oppose Definitely oppose GKA 36% 30% 27% 3% 4% Rest of LHIN 34% 29% 30% 5% 4% South East LHIN; n=1,000 28

Support for the Integration of KGH and HDH to Create a New Academic Health Sciences Centre The only place in our analysis where we find variation, is with respect to level of awareness of the planned integration, with awareness being positively correlated with support: Support among those who are definitely aware stand at 77%; It is at 67% among people who are vaguely aware; and Support falls to 58% among those who are not aware. It is very important to note that the opposition to integration does not vary based on awareness. Rather, those who are either vaguely or not aware are more likely to say that they need more information to come to judgment (27% and 35% respectively, compared to only 14% among those who describe themselves as definitely aware). 29

FROM WHAT YOU HAVE READ OR HEARD, DO YOU SUPPORT OR OPPOSE THE INTEGRATION OF KINGSTON GENERAL HOSPITAL AND HOTEL DIEU HOSPITAL TO CREATE A NEW ACADEMIC HEALTH SCIENCES CENTRE? By awareness Definitely support Mostly support Not sure / Need more information Mostly oppose Definitely oppose Definitely aware 47% 30% 14% 4% 5% Vaguely aware 32% 35% 27% 3% 2% Not aware 31% 27% 35% 3% 3% South East LHIN; n=1,000 30

Priorities for the Future of Health Care in the Kingston Area Survey respondents were asked to rate the importance of 11 aspects when it comes to the future of hospital care in the Kingston area. Four of the aspects form a first tier of importance, revolving around quality, access and wait times: Quality of care (i.e., rated 7 on a 7 point importance scale by 63% overall, and 70% of women compared to 56% of men); Access to care (59% overall, and 65% of women compared to 53% of men); Wait times for surgery, procedures and tests (56%); and Emergency room wait times (54%). Four aspects occupy a middle tier of importance, and the following two aspects make up the bottom tier of the list: Access to research and clinical trials (37%); and Hospital expansion (28% overall, and 17% among the university education compared to 36% of those with no more than a high school education). With respect to this last aspect (i.e., hospital expansion), it is interesting to note that expanding the range of available services and procedures, is viewed as very important by 48% of the public, thus suggesting that hospital expansion is not automatically equated with the expansion of services in the mind of many. We also find that expanding the range of available services and procedures is significantly more important to women (i.e., rated 7 on a 7 point importance scale by 55%) than men (42%). It is also more important to residents living outside of the GKA (57% compared to 45% within the GKA). 31

HOW IMPORTANT ARE THE FOLLOWING TO YOU PERSONALLY WHEN IT COMES TO THE FUTURE OF HOSPITAL CARE IN THE KINGSTON AREA? Quality of care 63% 17% 8% Access to care 59% 19% 11% Wait times for survey, procedures and tests 56% 18% 11% Emergency room wait times 54% 16% 9% Efficient use of resources 49% 20% 16% Expanding the range of available services and procedures 48% 24% 14% Communication with your care providers 48% 19% 14% Attracting health-care talent 45% 24% 16% Providing more seamless care between the hospitals Access to research and clinical trials 37% 44% 20% 22% 15% 18% 7 6 5 Hospital expansion 28% 15% 23% On a 7-point scale, where 1 means not at all and 7 means very important South East LHIN; n=1,000 32

Questions and Advice Pertaining to Future of Health Care in the Kingston Area A total of 679 respondents either provided advice or raised a question about the integration of KGH and HDH to create a new academic health sciences centre. The lion s share of the input (i.e., 86%) is in the form of advice or concerns, with most of it pertaining to impacts on staff, quality of care, access to care, or an expressed desire to obtain more information about integration. Similarly, most of the questions ask either about the impacts of integration on staff, or about impacts on quality of care or access to care. There are also a number of questions about the financial aspect of integration (e.g., impacts on taxpayers), and on the expected benefits that integration and the creation of a new academic health sciences centre are expected to bring. 33

IF YOU COULD ASK ONE QUESTION OR PROVIDE ONE PIECE OF ADVICE ABOUT THE INTEGRATION OF THE KINGSTON GENERAL HOSPITAL AND THE HOTEL DIEU HOSPITAL TO CREATE A NEW ACADEMIC HEALTH SCIENCES CENTRE, WHAT WOULD IT BE? [BASED ON 679 RESPONSES] Advice Questions 14% 86% South East LHIN; n=1,000 34

ADVICE/CONCERNS [BASED ON 584 RESPONSES] The impact of integration on staffing levels 17% Improving/maintaining the standard of patient care/services 16% Improving/maintaining the access to care (e.g. wait times) 13% The need for quality internal communication 11% The need for access to information/consultations 11% No advice, content with current the plan 8% Personal experience 7% Funding/costs 6% There should be no integration 3% Other 8% South East LHIN; n=1,000 35

Advice I want to make sure that there is no jobs losses, and more healthcare I just want to know that not too many jobs will be lost I would say they need to do something about the wait times in emergency rooms. Shorter wait times for appointments Better quality health and for them to both keep their own identities. I just hope that patient care improves through the integration. I think it would help if they would send pamphlets to people in the mail to give them more information on this. because not everyone always watches the news or reads every newspaper. 'I need more information in general. This is the first I've heard about it & my wife hasn't heard about it. There needs to be better communication between the doctors and nurses and they should have access to all records between both hospitals. I think it s great. Not to cut back on funding and keep the level of service and research Cooperation between the facilities and the staff there. There needs better communication between both camps and the doctors and nurses should have access to all records between both hospitals. 36

Advice Make sure you actually hire more staff & improve patient care. Especially nurses because it's mostly LPNs now & they can't do as much as nurses. Make it more seamless between the two hospitals To decrease the wait time for people to see a specialists Training of workers regarding the merge as to individual procedures required for each hospital To have less waiting time, in the emergency rooms and for follow-up appointments. Work together for better service Take good care of the staff at both hospitals. 'They should really focus on cutting down waiting times. Try to minimize the reduction in staff- minimizing is not always the optimal way to go. I think the integration will help our community. Reduce the management the positions and the duplicate of services and patient care first Government needs to listen to the patients who use the services at those hospitals. Improve the quality of the food. Improve waits times. get more patient input. 37

QUESTIONS [BASED ON 95 RESPONSES] How will the integration effect current staff? 32% Will the standard of patient care be effected? 13% How much the integration will cost/effect taxpayers? 13% Will access to care be maintained/improved? (e.g. wait times) 11% How can we learn about the specific benefits/information about the plan? 6% How programs/unions be effected by the integration? 6% Other 19% South East LHIN; n=1,000 38

Questions How will it affect jobs? How is the level of care going to be impacted? How many staffs are going to be effected by this? Will this improve clinical service for patients and enable physicians to do their jobs properly? What s the total cost will it be? What would be the costs to the taxpayers of Kingston? Just how it`s going to patient care, at the hospital? Are we going to get better patient care in terms of the waiting times for appointments, procedures, surgeries and treatments? To what extend will this merger positively impact post secondary institutions in the Kingston area? Who is going to oversee the combine hospitals? How is it going to affect jobs, are people going to lose jobs during the integration? Will the cost of this integration be evident in improved services? What will be the impact on continuity on care and how it will be implemented? Is the focus going to be on patient care or money? 39

CONCLUSIONS 40

For more information PAT BEAUCHAMP Account Director Research + Analytics pat.beauchamp@hkstrategies.ca HILL+KNOWLTON STRATEGIES CANADA 55 METCALFE STREET, SUITE 1100 OTTAWA, ONTARIO, K1P 6L5 HKSTRATEGIES.CA 43