Tag Archives: Rouge Valley Health System

Scarborough: The first and last VP of Patient Experience

John Wright, The Scarborough Hospital’s (TSH) former CEO once proudly told staff that they were among the first in Canada to have a Vice-President of Patient Experience. While there is much rhetoric around patient-centered care, it appears the Scarborough Hospital was at least trying to walk the talk.

TSH may have been among the first in Ontario to establish such a position. It is also among the first to eliminate such a position.

One of the first projects that VP undertook was a revamping of the food served to patients at the hospital. As we reported last week, the TSH had engaged a consulting chef and invested in equipment to be able to serve patients fresh local foods. Now that project, like the former VP who spawned it, appears to be on the way out according to a discussion paper generated by a merger committee between the TSH and Rouge Valley Health System.

We get it that money is tight.

The two hospitals admit that together they need to find $28 million next year to weather an ongoing freeze in base funding to hospitals. This is not a one-time event, but a long road of deliberate fiscal restraint. The amount needed could be even higher should the two hospitals decide to make a recommendation to formally merge. Mergers generally do not save money. They cost more.

TSH has gone through recent community battles over potential changes to services. It is one of the reason merger discussions are leaving out any issues around location of service delivery, however, that “elephant in the room” is getting increasingly difficult to avoid as working committees try to determine what a merged or “integrated” hospital might look like.

The demographics around such a merger are particularly sensitive. It is one of the most diverse multicultural areas in the GTA. It is where many new immigrants first arrive – the 2006 Census indicated 57 per cent of the area’s residents were born in another country. Poverty in Toronto is also moving east. Eight of 13 priority Toronto neighborhoods identified by the United Way are in Scarborough.

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Chef says Scarborough-Rouge merger could be bad news for good food

Last week we wrote about a possible Scarborough-Rouge Valley hospital merger that threatens an innovative local food program.

We tweeted our story to Toronto chef Joshna Maharaj , a rising star in the culinary scene who served as a consultant on The Scarborough Hospital food service initiative.

Maharaj has posted her own comments, calling this potential situation “bad news for good food in hospitals.”

She writes on her blog “We cannot let business decisions stand in the way of what is truly best for patients in this case. We cannot continue to allow our health care system to serve its budgets before it serves the people.”

We couldn’t have said it better.

You can view Joshna’s complete post by clicking here.

You can also participate in one of two open telephone town halls the two hospitals are conducting. You do need to sign up in advance (click here). The first town hall is on September 24 at 7:10 pm, the other October 8 at 7:05 pm.

Going backwards — Fresh food preparation may be lost in Scarborough-Rouge merger

The Scarborough Hospital has been an innovator in food services at its main campus. Last year it garnered considerable media attention by bringing in a consulting chef to work with the hospital in developing a menu that would feature locally grown foods that are prepared from scratch in their kitchens.

Toronto Chef Joshna Maharaji told the Toronto Star last year “now their humanity is required when they work. Now they have to smell and taste and make judgments instead of just executing a very standardized plan. That’s real evidence of change.”

Now that change may be under threat as The Scarborough Hospital looks to standardize food services with its potential merger partner, the Rouge Valley Health System.

Instead of going to the innovative service Scarborough began, merger talks appear to be leaning towards the less-than-optimal rethermalized food service at Rouge.

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Scarborough-Rouge: Merger process open, if not entirely perfect

After a lengthy period where hospitals appeared to be more interested in regional cooperation than formal mergers, the trend appears to be shifting again.

The financially stressed Scarborough Hospital has been looking for a dance partner for some time, initially proposing merger with Toronto East General Hospital. When that initiative spectacularly fell apart, the Central East LHIN directed the hospital to look closer to home at the Rouge Valley Health System which maintains a hospital on the eastern part of Scarborough and another in Ajax.

Our initial thoughts were that a formal merger would be very unlikely. After crawling out of their own significant financial difficulties, Rouge has been running surpluses for several years. It has also had to contend with rapidly growing demand on the Ajax side – the eastern GTA among the fastest growing regions in the province. Would they really want to take on new financial challenges that a merger with Scarborough would bring?

Both Rouge and Scarborough have been bruised by past battles with their communities over changes to clinical services. OPSEU even took the Central East LHIN to judicial review in 2008 over the secretive nature of its decision-making process when Rouge failed to consult on changes to its mental health services.

During those earlier battles Rouge Valley admitted to the Durham Regional Council that community opposition to their plans had made a dent in the ability of their foundation to raise money. Durham Region at that point had been considering withholding contributions (it didn’t).

Things have certainly changed.

The process at this stage appears to be an open one and perhaps even a partial model for other hospitals considering merger. A web site has been set up including an on-line survey. 16 community town halls are taking place. Staff town hall meetings are even being shared on YouTube by Rouge Valley. Staff who cannot attend the town halls are being invited to communicate during “huddles” in patient areas. Three tele-town hall meetings are being planned for September and October. Fifteen working groups have been set up between the two hospitals – 11 for front line clinical services and four looking at back office functions. The discussions from these groups are being shared in on-line workbooks that the public and staff can further contribute to.

The problem at this point is that everything is very vague – as one would expect early in the process. There are few concrete proposals to react to, and the hospital has suggested that many decisions may not even happen until a merger has already taken place and a new board appointed — including which services get offloaded to community-based providers. That may not satisfy those worried about loss of jobs, services and relocation of clinical care. Before a final recommendation is made, staff and the community should have an opportunity to look and respond to the proposed detailed plan. The hospitals have promised that the community will have an opportunity to respond should a recommendation come forward for merger.

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Will by-elections become referendum on hospital cuts in Scarborough, Ottawa?

Five provincial by-elections could be a referendum on changes to the health care system that are starving local hospitals. Two of these contests are in ridings where hospital cuts have been especially prominent on the public agenda.

Called for August 1st, the very short by-election campaigns are being held mid-summer, a time when voter turnout is expected to be low – generally an advantage to the government.

The most interesting contest to watch will be Scarborough-Guildwood, where the two urban hospitals are starting to talk about merging to deal with a collective $28.4 million impending shortfall next year.

The hospitals contend that their costs are rising by 5 per cent per year while their funding has remained stagnant.

Cuts have already begun – this year The Scarborough Hospital is eliminating close to 200 positions, has closed two surgeries and 20 surgical beds, and last week shuttered an outpatient clinic for those suffering from rheumatoid arthritis.

Most of these are not services likely to find their way to community-based provider agencies despite Health Minister Deb Matthews’ assertion that the funding freeze is an intentional part of her restructuring plan. Users of the arthritis clinic have already told the media they don’t know where they will go this month.

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Scarborough/Rouge: Surprising merger talk despite evidence pointing to higher costs

When the Central East Local Health Integration Network (LHIN) asked the Scarborough and Rouge Valley hospitals to work together to plan hospital services in the eastern most part of Toronto, few would have thought the CEOs would come back talking merger instead.

Given the impetus for the talks was The Scarborough Hospital’s difficult financial situation, a merger could be a costly and risky response. Robert Biron, new CEO of The Scarborough Hospital, said no final decision will be made until residents, staff and doctors are first consulted.

“Almost all studies suggest that hospital consolidations raise costs of care by at least two per cent and, in the U.S., sometimes significantly more,” states retired consultant Thomas Weil in a 2010 edition of the Journal of Health Services Research and Policy.

A 2012 UK report on hospital mergers in that country also concluded the “financial performance declines, labour productivity does not change, waiting times for patients rise and there is no indication of an increase in clinical quality.”

It may be one of the reasons why we have seen so few of them in the second decade of the century after witnessing so many in the first. With funding already extremely tight, who would want to risk making the situation worse?

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Freedom of Information: $1637.76 to access info from 20 hospitals

Now that hospitals are subject to Freedom of Information requests, how accessible will this information really be? It all depends on the hospital and how much money you have.

It cost us $1,637.76 to find out what the ratio of staff to management was at 20 hospital corporations. That includes the $5 processing fee it takes to initiate the request.

Hospitals came under the Freedom of Information and Protection of Privacy Act on January 1st of this year, although the Ontario Hospital Association sought and received additional exemption from divulging quality information under specific circumstances.

For years we have heard front line staff complain that their numbers have dwindled while the ranks of management have increased. We decided to test that question with requests to 20 randomly selected hospitals where OPSEU represents members. This includes four mental health centres – Penetanguishene’s Waypoint Centre, Whitby’s Ontario Shores, London’s St. Joseph’s Health Centre (Regional Mental Health), and the Royal Ottawa Health Care Group.

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LHIN warns merger of two Toronto hospitals could undermine access and quality

As The Scarborough Hospital (TSH) openly advocates for a merger with the Toronto East General, CEO Dr. John Wright may have difficulty persuading the Central East Local Health Integration Network of the merits of bringing the two hospitals together.

In a preliminary report recently posted online, the Central East LHIN raises a number of concerns, including the fact that such a merger does not align with their clinical services plan.

The CE LHIN states there is no evidence that “this will improve quality or access,” suggesting that it may possibly undermine it.

The LHIN states that the current activity is not client-focused, lacks a clear engagement strategy, and has not garnered physician support.

They further state there is no evidence to suggest a merger would assist in addressing population health challenges within Scarborough.

The LHIN suggests that if TSH is interested in an alliance, that it would make more sense to look towards “integration” with the Scarborough Centenary Hospital, which is part of the Rouge Valley Health System.

This is not the first time that suggestion has been made. Community groups in Ajax, who have never been happy having their hospital linked to Scarborough Centenary, have long advocated that Centenary should join TSH, leaving the Ajax-Pickering Hospital to link to Durham’s Lakeridge Health.

No application has yet been made by the two hospitals to proceed with a formal merger.

High cost of parking a barrier to hospital services?

Does the high cost of hospital parking deter the public from accessing health services?

In 2006 we sought the answer to this question through a Vector Poll.

Over half of those surveyed in Ontario – 55 per cent – said the high cost of parking would deter low-income people from getting the health services they need. Another four per cent said it would depend on circumstances.

When the survey was broken out by income, that response climbed to 74 per cent among those earning less than $30,000 per year.

For those accessing regular services at their local hospital, this can add up to a significant amount, particularly for those on fixed incomes. We recently calculated that a rise in parking charges at Rouge Valley Health System would cost weekly users a total of $800 per year. For cancer patients attending three times per week, that would mean $2,400 per year.

One local community approached their local hospital and the Local Health Integration Network to complain about this access barrier in the wake of increased charges. Both the LHIN and the hospital pointed fingers at each other, the LHIN saying such charges were up to the hospital, the hospital charging the LHIN forced the hospital to increase its “own-source” revenues. Doing their own research, they told OPSEU that only four hospitals are left in the province that offer free parking.

Pushing hospitals to raise the rate of parking and other own-source revenues is not new. The province’s annual hospital planning submission guide always suggested raising revenues in the event of a funding shortfall. Parking was always on the list.

With hospitals continuing to see less funding for their core budgets, it is no surprise to see them picking away at more user-pay options allowed them under the Canada Health Act.

The question is, where do you draw the line? It appears hospitals are indifferent to market rates in their communities. In many small towns the only pay parking is at the hospital.

It is clear that these charges are no longer restricted to the costs of maintaining the parking facilities.

One municipality thinking aloud suggested making parking charges tax deductible, a cumbersome method that would only benefit those who pay taxes. If it is going to be tax supported, why not filter out all the steps in between?

Ironically, hospitals have used their own high-parking charges to justify cuts to services. At one hospital they suggested the closure of their outpatient lab would be welcomed by users who would no longer have to pay the hefty hospital parking fees by attending private lab collection facilities in the community.

So what is the solution? If Toronto’s University Avenue hospitals made parking free, everybody would park there, from Blue Jays fans to those ducking out of the cost of parking underneath City Hall.

In some local communities citizens have learned how to game the parking lot, taking a new tag before they return to the vehicle, often in lots where the first half hour is free.

Some hospitals have offered discount rates for patients or those who have family in their care. This appears to make some sense in high traffic areas, although there is some concern hospitals desperate for revenue may be moving away from this.

Perhaps it’s time the LHINs, the Ministry and the hospitals stop pointing fingers at each other and start to address this question in a constructive manner.

Five years ago Ontarians said this was a legitimate barrier to health care we all pay for. When Rouge Valley raises the parking fees from $8 to $16 for patients in their cardiac and cancer programs, it is clearly only getting worse.

Rouge Valley doubles parking costs for cardiac rehab patients

Where do you draw the line when it comes to user fees at hospitals?

At Rouge Valley Health Centre participants in the cardiac rehab program are upset that the hospital is changing the rules on parking. Whereas it used to cost $8 per day for cardiac rehab patients, it will now double to $16 per day.

This is on top of $500 per year they pay to continue in the program past six months. That $500 does cover access to the hospitals indoor track and exercise machines, but it also covers access to a dietician, stress tests, and other health-related activities. The hospital will likely argue that the $500 covers the exercise portion, but given it charges for the entire program, this would appear to be a direct violation of the Canada Health Act.

Recently Rouge Valley’s cardiac rehab program merged with Lakeridge Health’s program. At Rouge they charge beyond the six month period. At Lakeridge it is covered. The question is, are they also going to merge policies, forcing patients in Durham to now pay for what was once covered?

Under the Canada Health Act, hospitals are not allowed to charge for health services.

The cardiac rehab program is a successful model that dramatically reduces the mortality rate for patients who are coping with heart disease. By placing a fee for these services and doubling parking fees, this discourages patients of limited means from continuing on with the program. With parking, continuing past six months means a cost of $1300 per year. Given many of these individuals are elderly and on a fixed income, this is a hefty price to pay.

For those who come three times a week for cancer treatments, this change in parking fees also means a jump to $52 per week.

The government talks a good line when it comes to preventative care. But if hospitals are going to place considerable obstacles to participating in preventative programs like this, then it will cost us all much more in the long term.

Rouge Valley should not be trying to balance its budget on individuals battling heart disease and cancer.