2017 CORPORATE ENVIRONMENTAL SCAN Our Patients, Our Community, Our Hospital 2017 CORPORATE ENVIRONMENTAL SCAN

Our Patients, Our Community, Our Hospital EXECUTIVE SUMMARY EXECUTIVE SUMMARY OUR PROGRAMS AND SERVICES FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 % CHANGE FY 2016/17 vs. TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE FY 2012/13 On December 1, 2016, the Scarborough and Rouge As a result of this merger, SRH is the third largest SRH Inpatients 44,539 59% 43,725 59% 44,238 58% 42,725 58% 42,461 58% -4.7% Hospital (SRH) was formed from the amalgamation community hospital in Ontario located within the Age < 19 10,417 49% 9,904 49% 10,056 49% 9,719 49% 9,410 48% -9.7% of the Birchmount and General sites of The diverse community of Scarborough. The hospital 20 - 49 Scarborough Hospital (TSH) and the Centenary site offers a range of clinical programs including: 12,703 82% 11,778 82% 11,712 82% 11,119 82% 11,055 83% -13.0% 50 - 79 of Rouge Valley Health System (RVHS). Much has 13,977 47% 14,209 47% 14,417 47% 14,386 47% 14,547 47% 4.1% changed since our legacy organizations developed • 24/7 Emergency departments 80+ 7,442 57% 7,834 56% 8,053 56% 7,501 57% 7,449 56% 0.1% their strategic plans a few years ago. Now, in 2017- • Critical care Source: Discharge Abstract Database (DAD) MOHLTC Intellihealth 18, we will launch our strategic planning process • Obstetrical and paediatric services to develop a vision, mission, values, and strategic • General medicine and surgical services The top five highest volume clinical categories for ANNUAL ALC RATE directions for the new organization. A first input our acute inpatients are: Pregnancy and Childbirth, Province / LHIN / FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 into the strategic planning process is to gather and • Cardiac services Facility / Site Newborns and Neonates with Perinatal Conditions; Provincial analyze information about the current state of both • Cancer care services 14.1% 13.8% 13.7% 13.9% 15.1% Circulatory System; Digestive System and Central East 17.5% 17.5% 18.0% 17.7% 23.3% internal and external environments. When combined • Nephrology services Respiratory System. These five clinical categories Birchmount 9.2% 12.1% 15.1% 16.5% 23.5% with stakeholder input, this environmental scan • Post-acute care account for 58% of acute inpatient volumes. General 10.5% 12.1% 15.7% 17.8% 25.9% will help to guide SRH in creating an appropriate Centenary 14.7% 12.5% 9.3% 11.9% 16.7% direction and priorities for the next three years. • Palliative care Patient acuity has increased steadily over the past • Mental health services Source: Access to Care (ATC) – Cancer Care Ontario five years. The aging of the population is having HISTORY • Diagnostic services an impact on the type of patients we see. The Patients in acute beds awaiting placement in • Ambulatory care clinics greatest increase in the number of patients in the On April 28, 2016, the Minister of Health and another setting pose a challenge for patient flow last five years was in the 50-79 and 80 and above Long-Term Care announced his support for the as the hospital aims to reduce unnecessary days of SRH is also home to four regional programs age groups, with an increase of 4.1% and 0.1%, implementation of the recommendations of the stay. Increasing alternate level of care volumes has including nephrology, cardiac care, vascular surgery, respectively from 2012-13 to 2016-17. Although Scarborough-West Durham Expert Panel. This increased wait times for admitted patients waiting and eye care. We are also recognized as a centre of most patients are discharged home, many elderly subsequently led to the creation of SRH and the in the emergency department (ED) with a carryover excellence in areas such as mental health. patients are unable to return home and require Ajax-Pickering site of legacy RVHS becoming a part impact to non-admit patients relying on the same placement in a long-term care home or another of Lakeridge Health. It is unprecedented in Ontario ED resources and space for care. OUR PATIENT PROFILE AND SERVICE level of care. The wait time for a bed to become for a hospital to undergo a merger and the transfer UTILIZATION available in another setting can be extensive. While of a facility simultaneously. Over the past several In fiscal year 2016-17, there were 187,975 visits the average acute length of stay has decreased months, a significant amount of progress has been in our three Emergency departments, with an In fiscal year 2016-17, SRH cared for 42,461 acute 4.3% compared to five years ago, the alternate level made in terms of establishing leadership structures, overall admission rate of 10.5%. SRH has seen a inpatients. Fifty-eight percent of these patients are of care (ALC) influence on total length of stay has transition plans, and a focus on standardization steady increase in emergency visits over the past female; the higher proportion of female patients grown. The ALC rate in the province, Central East of quality care, and support for the Ajax-Pickering five years, with an increase in acuity of patients is aligned with volumes in obstetric services (e.g. LHIN, and at all SRH sites increased in 2016-17, site transition. Principles that provided direction to presenting in the Emergency department. females account for 83% of acute inpatient volumes creating challenges for patient flow. SRH throughout the pre-merger and post-merger in the 20-49 age group). process were the following (our CASE for change): Collaboration and engagement; Accessibility; Sustainability; Excellence.

4 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Executive Summary • 5 FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 % CHANGE Over 1,500 volunteers provided a combined total of Diversity and inclusion are essential ingredients health research and collaborates in health research

FY 2016/17 vs. over 115,000 hours last year; the largest number of for serving and supporting our workforce and initiatives with other organizations. SRH research TOTALTOTAL TOTALTOTAL TOTAL FY 2012/13

SRH ED Visits 173,280 182,433 184,688 186,150 187,975 8.5% hours is seen in patient care areas. community. At SRH, we recognize similarities and has approximately 90 ongoing clinical research Age < 19 35,234 36,286 37,923 37,163 36,258 2.9% differences, both visible and invisible, among people studies on the go, approximately 35% are clinical 20 - 49 64,965 67,511 66,770 67,557 67,461 3.8% There are over 1,000 professional staff (physicians, and groups. Being inclusive means we accept, trials. There is a well-established Research Ethics 50 - 79 54,740 57,934 59,867 61,904 63,553 16.1% dentists and midwives) at SRH, with the majority respect, and embrace our global community of board that reviews all studies. Medical education, 80+ 18,341 20,702 20,128 19,526 20,703 12.9% being active. There are almost 225 physicians staff, volunteers, professional staff, patient and teaching and research are areas of potential growth Source: National Ambulatory Care Reporting System (NACRS) - with a University of Toronto Faculty of Medicine families. As part of our standardization, SRH will and opportunity requiring careful consideration in MOHLTC Intellihealth Appointment and over 80 active research studies continue internally to support diversity, equity, and the strategic planning process. Sixty-nine percent of SRH acute inpatients reside approved by the Research Ethics Board. Key inclusion so our team can continue to support the within the primary catchment of Scarborough – priorities for this group as we move further together community it serves. Many quality initiatives are in place at the 12% live in Durham and 6% in Markham. There is as a SRH team are to address privileging and governance, hospital-wide and departmental a similar trend for day surgery patients. However, credentialing, the medical leadership model, the The SRH human resources framework includes four levels. Both legacy organizations had a successful a higher percentage (80.6%) of ED patients comes medical staff integration plan, and professional strategies to shape workplace culture and enhance accreditation visit in 2016, meeting over 97% of the from our local community. staff by-laws. engagement: customer service model, capabilities accreditation standards. SRH anticipates the next framework, performance feedback structure and survey visit to take place in 2020 and will continue The Report of the Scarborough/West Durham In June 2017, SRH conducted the first organization- recognition program. These elements are evidence to learn more about the anticipated changes to Panel provided hospital utilization projections for wide culture and engagement survey of employees, based proven strategies and build on previous the Accreditation Canada process with potential Scarborough residents. In Scarborough, acute professional staff, and volunteers. This was an success in both legacy organizations. standards at the system level and a greater inpatient services (patient days) are projected opportunity for everyone to share their opinions emphasis on involving patients as surveyors in to increase by 24% from 2013-14 to 2028-29; and thoughts on their workplace. One key metric is SRH is a Community Affiliated Hospital with the the survey visit process. SRH submitted its first emergency visits are projected to increase by 12%. the engagement score, which measures the level University of Toronto, Faculty of Medicine. In Quality Improvement Plan (QIP) to Health Quality of engagement based on factors related to the job, 2016-17, SRH was the largest provider of Medical Ontario (HQO) in March 2017. The QIP was informed OUR TEAM work environment, and organization as-a-whole. The Trainee Days (MTD) in the Central East LHIN. by input from a range of stakeholders including engagement scores for SRH from the recent survey Over 225 physicians with University of Toronto current and former patients/families, community The hard work and dedication of the people that (67.1% employees, 61.7% professional staff, 81.6% faculty appointments in all different specialties members, health system partners, staff, clinicians, work at SRH have led to many successes as we volunteers) provide a baseline on which to make provide education to clinical clerks, residents, and leadership. The 2017-18 QIP focuses on move along as a newly merged organization. SRH action plans based on reflections of respondents. fellows and international medical graduates. One sixteen indicators that are being tracked through is the workplace of choice for 5,133 employees. of the main stays of the SRH medical education the organization’s Quality and Safety Scorecard. Approximately 57% are regular full-time employees ENABLERS OF HIGH PERFORMANCE program is the Family Medicine Teaching Unit The Scorecard is anchored to the HQO quality and the average age is 45 years. Almost half of our (FMTU) which accounts for approximately 30% of elements: Safe, Timely and Effective, Patient employees have more than ten years of service; the SRH has adopted both Patient and Family Centred all teaching at SRH. It provides medical education Centred, Efficient, and Our People. SRH continues average tenure corporately is 12 years. Eighty-six Care (PFCC) and Lean Thinking as key philosophies. through the University of Toronto Department to participate in external reporting of several percent of our staff members belong to a particular Legacy organizations have been on a journey to Of Community and Family Medicine Residency patient safety indicators to the MOHLTC which are union (ONA is the largest, followed by CUPE and further involve patients and families in their care, Program and partners with community based SRH publicly available on the HQO site, and the Canadian OPSEU). Workforce integration requires investment and in quality improvement, planning, evaluation, primary care physicians. SRH also has a number of Institute for Health Information’s Your Health including workforce restructuring, workforce and committees such as our Patient and Family established rotations with the University of Toronto System Performance biannual reports. harmonization of compensation and benefits, Advisory Council. Both PFCC and Lean hold the undergraduate academies. Beyond medication and pay equity, as well as a major focus on union patient and family as the primary focus in service education, teaching and education of other health alignment. delivery. care professionals occurs in various service areas and involves several universities and colleges. In addition to teaching and education, SRH conducts

6 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Executive Summary • 7 The socioeconomic and health status profile of Scarborough highlights issues that must be taken into account Aging infrastructure is a significant issue at all COMMUNITY DEMOGRAPHICS in the planning and delivery of health services. Diversity in Scarborough is evident in comparisons with the three sites. The Facility Condition Index for all three Central East LHIN population, as reported in Central East LHIN Community Profiles. These diversity dimensions sites is high, with the Birchmount site ranked in the The environmental scan includes an overview of show our population as vulnerable so it is important for SRH to have an equity lens embedded into every aspect lowest 10% of hospital facilities in Ontario and both our community including geography and population of our work, from planning to implementation. the General and Centenary sites in the bottom half. distribution. SRH’s primary catchment area is Several capital projects are in progress to address the municipality of Scarborough. Scarborough the state of existing building infrastructure and accounts for approximately 40% of the population Scarborough North Health Scarborough South Health Indicator Central East LHIN the hospital is responding to recommendations in the Central East LHIN, but only 1.1% of the LHIN’s Link Community Link Community from the Expert Panel report regarding both interim geography. Scarborough’s population is expected Land Area (square kilometer) 16,667.8 42.4 138.3 and long-term capital investment needs in the to increase by 10% in the next 15 years. Population Population Density (persons per 4,165.5 3,015.6 Scarborough region. Significant investment in projections into 2041 show relative growth among square kilometer) 89.8 Information Management/Information Technology those 65+ years of age is predicted to account for Population (Years of Age) Population % Population %Population % (IM/IT) is required to support standardization and the largest proportion of demographic growth. 0-18 34,225 19.38 97,950 23.49 integration while keeping pace with advances 338,875 22.60 in the sector. A detailed three year plan has The Central East LHIN has seven sub-regions 19-64 934,845 62.44 112,000 63.41 262,105 62.85 been developed to support five IM/IT integration (previously called “Health Links”) and two of 65-74 118,525 7.92 15,070 8.53 29,835 7.15 priorities for SRH: 1) Consolidate enterprise hospital them are in Scarborough: Scarborough North and 75+ 104,970 7.01 15,380 8.71 27,145 6.51 information systems, 2) Consolidate department Scarborough South. There are 24 neighbourhoods Education: No High School, 15.29 11.54 clinical systems, 3) Consolidate back office within these sub-regions, defined by the City Aged 25-64 (%) 10.56 systems, 4) Merge networks and email systems, of Toronto. The City of Toronto identified 31 Unemployment Rate (%) 9.66 10.76 11.55 and 5) Merge telecommunication systems. neighbourhoods as ‘Neighbourhood Improvement Areas’ with priority needs requiring special attention Low Income Population (%) 14.37 20.21 19.94 SRH has a 2017-18 operating budget of $635.5 based on social risk factors; several fall within Knowledge of Official Languages: Neither English 3.18 16.16 3.60 million. Sustaining surpluses while meeting growing Scarborough, with the majority in Scarborough nor French (%) patient needs is a challenge for the hospital sector. South. Knowledge of Official 0.07 0.10 SRH must focus on attracting new funding and Languages: French Only (%) 0.07 community partnerships, and developing and Access to transportation is a high profile public Visible Minority Population (%) 37.20 83.65 66.25 executing strategies that will improve outcomes issue in Scarborough. The City of Toronto has two Immigrant Population (%) 33.21 69.07 53.18 and lower costs. Over the long-term, there are main priorities for transit planning – connecting Recent Immigrant Population potential savings for the integrated organization but Scarborough Centre to higher order rapid transit (period of immigration: 3.83 10.19 7.57 significant upfront investments such as building and to better serve existing transit riders. Some of 2006-2011, %) renovations may be required. SRH has a newly the options being explored would enhance access Indigenous Population (%) 2.05 0.06 0.96 integrated Foundation that plays an important role to one or more of SRH’s sites. Population of Lone Parent 19.81 23.65 in raising funds to support the purchase of critical Families (%) 18.71 medical equipment and building projects. Population Living Alone (%) 6.17 5.10 7.40

Source: Central East LHIN Health Link Community Profiles

8 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Executive Summary • 9 Compared to the Central East LHIN, the two year 2016-17 and 53% for our secondary catchment. In Central East LHIN there are nine hospitals Several provincial and LHIN priorities are captured Scarborough sub-regions have a higher percentage As expected, the capture rate for ED patients is operating out of 15 sites, including SRH. These below: of residents with no high school education, higher at 68%. For day surgery visits, our percentage hospitals face many of the same challenges. lower income, visible minorities, immigrant market share is 60% for residents within our primary Strategic plans from other hospitals provide an • Legislative changes to the Excellent Care populations, and lone parent families than the catchment. important lens into priorities of our regional hospital for All Act, 2010 (ECFAA) and the Quality Central East LHIN. Scarborough North has a high partners. Common themes that are top of mind Care Information and Protection Act (QCIPA) percentage of residents that do not know how to The top five other hospitals that residents of for our regional partners include PFCC, partnering strengthen the patient relations process, speak either English or French. Significant visible Scarborough utilize are: with other health care providers for seamless and ensure that patients and families are engaged minority groups in Scarborough include South integrated care, and trying to achieve financial in the development of the organization’s Asian, Black, Chinese, and Filipino residents. • Michael Garron Hospital stability. QIP, promote transparency, and elevate the The top five countries that new immigrants to (Toronto East Health Network) importance of the patient/family voice. Scarborough originate from are: China, Sri Lanka, • North York General Hospital PARTNERSHIPS • The province expanded the role of the LHINs Philippines, India, and Hong Kong. According to • Sunnybrook Health Sciences Centre beyond planning and funding to play a role in the 2016 Census, the top five languages (outside SRH values the opportunity to engage with local delivering home and community services. • St Michael’s Hospital English and French) spoken most often at home health system partners on a variety of issues. SRH • The funding model continues to evolve. In for Scarborough residents include: Cantonese, • University Health Network has a number of successful partnerships with other addition to global funding, organization- Mandarin, Tamil, Tagalog (Filipino) and Bengali. health service providers within the Central East level funding is allocated using the Residents of Scarborough also have a high LHIN including Central East Home and Community Health Based Allocation Model (HBAM) According to an updated Canadian Community percentage of emergency department visits to Care, Carefirst Seniors and Community Services and Quality Based Procedures. Health Survey (CCHS) from 2014, the health the Hospital for Sick Children in Toronto; for Association, Ontario Telemedicine Network, • There is a focus on value for money. indicator of life satisfaction – satisfied or very day surgeries, residents also visit Humber River Toronto Public Health. SRH is also a partner in the Significant findings, observations, and satisfied has decreased in the Central East LHIN Regional. Scarborough Diabetes Network alongside Taibu recommendations from a recent audit of from 92.8% in 2012 to 87.9% in 2014. Additionally, Community Health Centre, Scarborough Center large community hospitals were published the indicator, perceived health – very good or HEALTH SERVICE PROVIDERS IN for Healthy Communities, and Carefirst. SRH also in the Auditor General’s Annual Report. excellent has also dropped from 61% in 2012 to CENTRAL EAST LHIN partners with Taibu Community Health Centre on 59% in 2014. SRH needs to continue with strategies the delivery of services to individuals with sickle • The 2017 Ontario budget includes several to address socio-economic challenges, ethnic The market share analysis above shows that cell anemia. SRH partners with twelve community items of importance to the health care diversity, language barriers and accessibility of residents of Scarborough are served by several agencies as part of a patient navigation centre, system, including an additional $7 billion services to those living alone within our community. hospitals in the Greater Toronto Area. Residents Global Community Resource Centre. SRH has in health care over the next three years. of Scarborough also receive health services and several other partnerships, including many other • There is a strong and growing focus WHERE SCARBOROUGH RESIDENTS supports from many community-based service community agencies, which we work with to provide on PFCC at many levels. SEEK HOSPITAL CARE high quality care to the Scarborough community providers within the Central East LHIN. There • There are more requirements for and beyond. are 131 health service providers funded by the hospitals to keep privacy top of mind, Given SRH’s location within the Greater Toronto Central East LHIN. There are 1,264 family and higher penalties for failing to Area, most patients have several hospital options PROVINCIAL AND LHIN PRIORITIES physicians practicing in Central East LHIN, seven comply with the updated legislation. within driving distance. The capture rate, or Family Health Teams, and six Community Health • There is a clear focus on timely access percentage of Scarborough residents that visited Centres dispersed throughout the LHIN. There are The hospital’s external environment is influenced and patient flow fro`m hospital to home, SRH, for acute inpatient services in our primary 68 long-term care homes with 9,957 beds in the largely by the provincial government and the and keeping patients from returning catchment of Scarborough is around 59% in fiscal Central East LHIN, however, there is a LTC capacity Central East LHIN. Next year’s provincial election to hospital once discharged. challenge which has increased our number of ALC adds an element of potential uncertainty regarding • There is an ever increasing need for patients. future government priorities. The MOHLTC continues to build on its action plan, Patient’s First.

10 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Executive Summary • 11 hospitals to have strong partnerships with TRENDS • Upcoming provincial and municipal elections community partners as part of the trend •Municipal government commitment to invest in transit infrastructure towards an integrated health system. This section uses the “PESTEL” framework to •Strong focus on patients and families being at the table •Creation of a provincial Patient’s Ombudsman Office describe the broader trends that are impacting SRH. Political Trends • Health Quality Ontario (HQO) identified three • Expanded role of LHINs in home and community care and emphasis on smooth patient flow across providers/hospitals; patients receiving care at home PESTEL analysis is a useful tool for understanding key areas requiring attention: smoothing •Funding model evolution and the introduction of voluntary bundled care QBPs the “big picture” of the environment in which the out transitions between care providers, • Public wanting value-for-money from the public sector organization operates, and the opportunities and improving timely access to primary care, and •MOHLTC and Ontario Medical Association working toward new Physician Services Agreement threats that lie within it. A condensed PESTEL • Canada expected to lead the G7 group in Gross Domestic Product (GDP) growth reducing inequities. HQO is providing advice analysis for SRH is provided below, which is • Health care expenditure growth as percentage of GDP, 47%, 2010 to 2030 to the Minister regarding the addition of a expanded upon within the full report. •Population growth, drop in the unemployment rate, increase in job creation mandatory indicator related to workplace • Swelling household debt and housing market cooling after a high earlier this year

violence prevention in hospital QIPs. Economic • Anticipate that the Bank of Canada will raise interest rates There has been a great deal of research done on the Trends • The Ontario Hospital Association (OHA) • Hospital sector receiving a 3% funding increase this year, more than recent years factors that are shaping health care. Around the • Lifting of the public sector wage freeze for non-union employees released a new strategic plan with the world health care systems are facing many of the • Scrutiny on how hospitals are delivering value for money, achieving high quality following purpose, Serving Ontario’s hospitals same trends and challenges. •Growing private sector interest in contributing to a transformation agenda to build a better health system, and values • Visits to Toronto food banks increased in the last year, specifically, Scarborough saw the largest increase in visits, up 30% compared to last year

of humility, discovery, and passion. •Population aging; living longer with chronic conditions, multiple comorbidities Below is a list of key health care trends identified by •Growing diversity and health equity challenges • The number of hospital integrations researchers in both Canada and the U.S.: •Growing interest in alternative medicine/remedies has increased in the past few years • Increased emphasis on flexible work hours and work life balance

with several within the GTA. • Chronic disease management and prevention Social Trends • Increased consumerism (growing access and service expectations) • Increased patient and public engagement at all levels of the health care system • The Central East LHIN’s Integrated Health • Care of the frail elderly ‘the greying • Increased use of social media/social networking Service Plan 2016-19 (IHSP) supports patient’ and the aging population •Patients/families involvement in care, improvement initiatives, co-design an overarching goal, Living Healthier at • Health human resources planning, •Population engaged in monitoring their health/lifestyle Home – Advancing integrated systems of ‘the greying provider’ •Advances in information management technologies care to help Central East LHIN residents •Advances in clinical/medical technologies • Access to care and wait times live healthier at home. Four main areas of •Technology makes information more accessible to health care users focus to achieve this goal are in the areas • Health information technology and • Innovation driving new models of care of seniors, vascular health, mental health the information revolution Technological • Office of Chief Health Innovation Strategist to help accelerate adoption and diffusion of new innovative health technologies and processes Trends • First-of-its kind best practice guideline released by the Registered Nurses Association of Ontario (RNAO) and Canada Health Infoway re: eHealth adoption and addictions, and palliative care. • The new health care consumer • Auditor General evaluates Electronic Health Record implementation status • The Central East LHIN notes several upcoming • Population and public health • Increased access to remote patient monitoring, virtual interactions •Availability of business intelligence, Enterprise Data Warehouse, analytics priorities: building on success with bundled • Patient engagement for improvement care; Home Care Roadmap priorities; support • Increased threat of cyber-security breaches •Green facility design and environmentally sustainable practices for access to specialists; Open Minds, • Recognition of performance in energy, water, waste, pollution prevention Health Minds commitment; establishment Environmental Trends • Public expectations of hospitals operating in an environmentally friendly manner

of Patient Family Advisory Councils; and • Shift towards paperless operations

sub-region planning and priorities. • Accessibility for Ontarians with Disabilities Act (AODA) – requirements for an accessible Ontario by 2025 Legal Trends •Several new legislations and regulations impacting hospitals

12 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Executive Summary • 13 TRANSITIONAL STRATEGIES AND Streamlining legacy strategic initiatives from 54 Value Realization Framework to outline the anticipated value, or benefits, of the SRH amalgamation for the READINESS FOR STRATEGIC PLANNING original initiatives, down to 15 to continue, six to community we serve. The bringing together of all of the hospital facilities in Scarborough was a significant event be put on hold, and 33 to be discontinued, as many for the Scarborough community and a substantial short-term investment. This framework helps to answer Five transitional strategies have shaped the current were operational. There is an opportunity to assess the questions: Now that we have merged, so what? Was it worth it? What have we gained? The framework is state of SRH and provide a launching point for the status and outcomes of all initiatives and based on three themes (Foundation for Successful Transition, Quality Patient Experience, and Innovation for a creative, forward-looking strategic planning consider them in the strategic planning process. Long-Term Sustainability) and six goals. Each goal is mapped to key strategies to get us there, and indicators process. They include: Legacy strategic plans provided common ground that signal our delivery of value to the SRH community. The framework acknowledges that integration is a for the start of a shared journey as there are several journey and identifies value in the short-term, medium-term and long-term. The framework has been developed Pre-merger planning including the work of the similarities in vision, mission, values, and strategic into a progress report, which is a tool for the Board of Directors and Senior Leadership Team to support Expert Panel and development of Integration directions. communication with internal and external stakeholders. Proposals to submit to Central East LHIN.

Bridging Integration Plans • 100-Day Integration Plan based on evidence- based practices for merger success VALUE REALIZATION FRAMEWORK THEMES AND GOALS and an assessment of potential risk • Six Month Integration Plan to pick up where Foundation for Quality Patient Innovation for the 100-day plan left off and provide a Successful Transition Experience Long-term Sustainability bridge to the arrival of a new CEO. This plan continued with progress made with the 100 Preserve a sense of stability Enhance standardized, Foster a culture of learning day plan, advanced standardization work and for our community evidence-based service delivery and innovation

informed the development of leadership’s Ensure our employees, clinicians Improve timely, local access Leverage the benefits of a 2017-18 annual goals and initiatives. and volunteers are optimally to services single capital planning process supported through the transition and make effective use of process capital investments

Transition Communications and Engagement Plan, Establish singular governance, Sustain and enhance hospital leadership and strategy to set services and infrastructure to to inform SRH’s internal and external audiences the stage for organizational meet the community’s growing about the six month period following our 100-day transformation needs plan and the ongoing changes taking place at Support transfer of the Ajax site to Lakeridge Health to ensure SRH. This plan would also solicit a broad spectrum access to safe, stable care for of views regarding how SRH can best meet the the community needs of the Scarborough community as we move forward with standardization work. SRH introduced the Growing Together campaign, which is built * Short-Term Medium-Term Long-Term upon four themes: establishing strong systems, * Anticipated timeframe for achieving improvement target and realizing measurable value: building teams and culture, enhancing the patient Short-Term: Within Year 1; Medium-Term: 1 to 3 Years; Long-Term: > 3 Years experience, and collaborating with our community.

14 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Executive Summary • 15 CONCLUSION AND Access NEXT STEPS • Improving access to care across the continuum and in the appropriate setting This environmental scan takes an in-depth look • Addressing capacity shortfalls in the at the current state of SRH and changes that long-term care and community sectors have occurred over the last few years since the • Reducing inequities to remove variation last legacy strategic plans were completed. The by geography and population groups scan includes quantitative and some qualitative CONTENTS information on both our internal and external Efficiency environment. Several key themes arise from the • Continue to find efficiencies while driving EXECUTIVE SUMMARY 3 analysis of trends within this report. These themes Our Patient Profile and Service Utilization 4 high-quality care in a time of fiscal restraint will require careful consideration in the strategic • Public demand for value-for- planning process: INTRODUCTION 19 money from the public sector Background 20 • Appropriate investments in Methodology 20 Patient and Community infrastructure (facilities, equipment, • Growth in the communities we serve IT) to enable high performance INTERNAL ENVIRONMENT 23 • Aging, and people living longer History 24 with chronic diseases Care Providers SRH Programs and Services 25 • Growing diversity and • Aging workforce Our Patient Profile and Clinical Service Utilization 26 opportunities for inclusion • Expanding scope in certain professions Our Team (Staff, Volunteers, and Professional Staff) 40 Enablers of High Performance 44 • Relatively low utilization of hospital services (e.g. nurse practitioners)

EXTERNAL ENVIRONMENT 57 Patient/Family Engagement Technological Advancements Community Demographics 58 • Involvement of patients and families in • Innovation for information management Where Scarborough Residents Seek Hospital Care 76 their care, planning, design of services and clinical service delivery Health Service Providers in Central East LHIN 87 • Creation of Patient and Family Partnerships 91 Advisory Councils at the provincial, Future stakeholder engagement will add another Provincial and LHIN Properties 92 LHIN, and hospital levels rich layer of qualitative analysis around these Trends 100 key themes to further inform the development of vision/mission/values, the identification of Partnerships TRANSITIONAL STRATEGIES AND strategic choices, and development of the strategic READINESS FOR STRATEGIC PLANNING 103 • Hospitals continuing to build strong directions that will guide the hospital for the next networks and partnerships as part of a three years. CONCLUSION AND NEXT STEPS 115 trend toward an integrated health system • REFERENCES 117

APPENDICES 123

16 • Executive Summary SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN INTRODUCTION INTRODUCTION METHODOLOGY In addition, global healthcare trends were included and implications to SRH. It is important that our based on leading Canadian and U.S. research. corporate strategies are driven by current, relevant BACKGROUND A detailed analysis of the environmental scans of A final section on transitional strategies and information and evidence-based projections of our two legacy organizations was completed in readiness for strategic planning expands on the what we are likely to face in future years. The On December 1, 2016, the Birchmount and General May 2017 and similarities and differences were transitional strategies that have helped to shape the Strategy and Planning Office received feedback sites of The Scarborough Hospital (TSH) and the noted. The SRH Strategy and Planning Office began current state of the organization and provide a solid from the leadership team before finalization of the Centenary site of Rouge Valley Health System preparations for the new SRH environmental scan starting point for our strategic planning process. environmental scan. • (RVHS) merged to become one hospital corporation, in June 2017. All inputs were assessed in terms of relevance with the temporary name, Scarborough and Rouge Hospital (SRH). As a result of this merger, SRH is The SRH environmental scan has three areas the third largest community hospital in Ontario. of focus: the internal environment, external SRH is located within the diverse community of environment, and a final section on SRH transitional Scarborough that is home to over 600,000 people. strategies and readiness for strategic planning. The internal environment section informs us about our

Much has changed since TSH and RVHS (our Y “legacy organizations”) developed their strategic programs and services, our patient profile, clinical plans a few years ago. It is important in 2017-18 to service utilization, our team, and our enablers of start a fresh and exciting strategic planning process high performance. Data provided by our Decision to develop a vision, mission, values, and strategic Support department was used to identify service directions for the new organization. volumes and patient characteristics and track changes over time. The time period examined LEGA L SOCIAL

A first input into the strategic planning process includes fiscal years 2012-13 to 2016-17, as POLITIC S ECONOMY for the new organization is to gather and analyze available and appropriate for the specific analysis. TECHNOLOG information about the current state of both internal In many cases, we note the percentage change over ENVIRONMENT and external environments. This scan focuses on the past five years. SRH’s community (Scarborough), the Central East Local Health Integration Network (Central East Next, the scan outlines our external environment LHIN), and the province. We also considered the in terms of community demographics, market organization’s transitional strategies and readiness share, and government priorities. Details of health for strategic planning post-merger. When combined service providers within our LHIN were collated with stakeholder input, this environmental scan from Central East LHIN publications. Hospitals will help to guide SRH in creating an appropriate within the Central East LHIN are listed and their direction and priorities for the next three years. strategic plans were reviewed to identify key Topics within the scan are constantly changing and strategic priorities of our regional partner hospitals. evolving. The SRH environmental scan will serve as Additionally, we outline some key partnerships and a key source of information and education for the emerging trends. Through a literature review of in-depth engagement we will do as part of strategic reports, documents, and presentations, the Strategy planning. Going forward, the scan will be reviewed and Planning Office was able to synthesize key and refreshed on a regular basis. trends and themes. Trends were categorized using the PESTEL model: Political, Economic, Social, Technological, Environmental, and Legal.

20 • Introduction SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Introduction • 21 INTERNAL ENVIRONMENT INTERNAL ENVIRONMENT Sustainability; Excellence. With this integration, SRH PROGRAMS AND SERVICES based sites in Scarborough, Pickering, SRH is now the 3rd largest community hospital in Ajax, Whitby, Oshawa (2), Bowmanville, This part of the environmental scan will look Ontario (by budget), behind Trillium Health Partners At SRH we are committed to putting our patients Cobourg, Port Perry, Lindsay, Peterborough, internally at SRH. The internal environment section and William Osler Health System. and their families first – where planning, delivery Campbellford, Seaton, and Bobcaygeon. includes a brief history of the organization, our and the evaluation of one’s health is a mutually beneficial partnership among patients, families programs and services, our patient profile and In some respects the new organization is still in Regional Nephrology Program and health care providers, while at the same time clinical service utilization, our team, and our its infancy – a vision, mission, permanent name • The largest regional program in North providing the best patient experience possible. SRH enablers of high performance including our key and brand have yet to be identified – however, a America with more than 6,000 patients is a large community hospital which offers a range philosophies of Patient and Family Centred Care significant amount of progress has been made with kidney disease receiving care from the of clinical programs and non-clinical services which (PFCC) and Lean Thinking, diversity and inclusion, in the nine months since amalgamation. The program and its affiliated 11 Nephrologists teaching, research and education, quality and organization established a new Board of Directors, support these programs. An organizational chart is • The largest home dialysis program and safety, infrastructure, and our financial position. a transition Senior Leadership Team, a 100 day included in Appendix A. chronic kidney disease program in Ontario plan, and a focus on standardization of quality care, • Highest number of patients listed for kidney HISTORY and support for the Ajax-Pickering site transition. Clinical programs include: transplant in Ontario are SRH patients A special committee of the Board, the Integration • 24/7 Emergency departments On April 28, 2016, the Minister of Health and Committee, was formed to provide direction and • Critical care • A tailored palliative care program for patients with kidney disease who choose Long-Term Care announced his support for the oversight for the effective integration of clinical and • Obstetrical and paediatric services implementation of the recommendations of the non-clinical programs and services. Internal tools not to be treated with dialysis • General medicine and surgical services Scarborough-West Durham Expert Panel, which were developed to support consistent, evidence- • The program services are offered at the • Cardiac services was tasked with providing recommendations to based approaches to standardization, including General site, satellite sites (Yee Hong address infrastructure needs, improvements to the harmonization of policies and committees. • Cancer care services Centre for Geriatric Care, 78 Corporate access, and the integration of acute health care In April 2017, a corporate leadership structure • Nephrology services Drive, and Bridgepoint Health) services in Scarborough and the West Durham was established and a six month integration plan • Post-acute care • A number of initiatives to expand dialysis region. Legacy RVHS was divided, as the Ajax- was developed to build on the 100 day plan and • Palliative care capacity to meet growing needs are underway Pickering site became a part of Lakeridge Health (a incorporate the critical standardization work as well large community hospital in Durham Region) and as tasks that could be done to prepare for strategic • Mental health services Regional Vascular Centre for the the Centenary site merged with The Scarborough planning and master planning. Our new CEO • Diagnostic services West Central East LHIN Hospital’s General and Birchmount sites to create started in July 2017. • Ambulatory care clinics • The General Site is a Level 2 Regional a new hospital corporation in Scarborough, with Vascular Centre providing minimally the temporary name Scarborough and Rouge SRH continues to support the safe and effective A few highlights: invasive aortic aneurysm repair. Hospital. It is unprecedented in Ontario for a transfer of services from legacy RVHS’ Ajax site hospital to undergo a merger and the transfer of to Lakeridge Health. This support is guided by Central East Regional Cardiac Centre a facility simultaneously. Although this was very a Transfer of Services Agreement (TSA) and a Mental Health Services • One of 19 Cardiac Centres in the province. challenging, it also provided incredible learning and governance structure is in place to monitor the • The mental health program offers a complete cultivation of expertise in change management and agreement. Most services are now operated • The Centenary-based regional cardiac range of services for adults and child/ transformation that will serve the new organization independently by Lakeridge Health however, support program delivers a wide range of cardiac adolescents to meet the unique needs of well in this rapidly changing environment. continues to be provided in a few areas (e.g. patient services, including life-saving cardiac individuals experiencing mental health relations, privacy, nursing education, food services) catheterization and intervention procedures; issues. These include crisis supports Principles that provided direction to SRH and it will take some time to disentangle the arrhythmia management and treatment; in the ED, inpatient and outpatient throughout the pre-merger and post-merger information technology systems. and cardiovascular rehabilitation. services; supportive housing; specialized process were the following (our CASE for change): • The regional cardiac rehabilitation service outreach programs; as well as social Collaboration and engagement; Accessibility; is offered at 14 community and hospital- recreational programming for individuals recovering from serious mental illness.

24 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 25 SRH currently has 802 inpatient beds and 87 Furthermore, we describe our alternate level of care ALC population, we are seeing a decline bassinets across our three acute care sites. Like • The percentage of patients between (ALC) population and trends related to patient flow, in acuity in the hospital CCC population. most hospitals, SRH has reduced bed capacity over 50 and 79 visiting SRH is increasing followed by trends for our emergency department the years in response to new treatment approaches due to conditions such as: digestive, • The ALC rate in the province, Central and day surgery patients. The final section includes that reduce length of stay, advances in outpatient circulatory and respiratory system, East LHIN, and at all SRH sites a description of our catchment area and data on modalities, and expansion in community-based musculoskeletal system and connective increased in 2016-17, creating patient residence. services. Important indicators of the scope of tissue and kidney, urinary tract challenges for patient flow. services we provide are listed below: and male reproductive system. • SRH has seen a steady rise in ACUTE INPATIENT POPULATION • The number of births at SRH has Emergency department (ED) visits, • 42,461 acute inpatient discharges been fluctuating year over year and with a five year increase of 8.5%. Volumes • 54,898 inpatient weighted cases (based on there has been a decrease compared On average, 10.5% of ED patients In fiscal year 2016-17, SRH served a total of 42,461 application of an acuity weighting to discharge to five years ago. Compared to all get admitted to hospital. There has acute inpatients. As an organization, SRH for volumes using the Health-Based Allocation Ontario hospitals, SRH is ranked fourth been an increase in the acuity of the most part has seen a steady decrease in its Model (HBAM) Inpatient Grouper (HIG)) in the total number of deliveries. patients presenting to the ED. inpatient population, with a five year (2012-13 vs. 2016-17) change of -4.7%. The trend differed across • 187,975 Emergency department visits • While the average acute length of • The majority of surgeries at stay has decreased 4.3% compared SRH are done on an outpatient the three sites. Both Birchmount and General • 602,776 ambulatory clinic visits to five years ago, the alternate basis. SRH sees over 50,000 day sites experienced a decrease in acute inpatients, • 6,424 births level of care (ALC) influence on surgery patients annually. particularly the Birchmount site (-16.8%). However, the Centenary site has experienced stable increases total length of stay has grown. • The majority of SRH patients live within OUR PATIENT PROFILE AND CLINICAL (five year change of 6.1%). • The majority (83.8%) of SRH the primary catchment of Scarborough, SERVICE UTILIZATION patients are discharged home followed by Durham and Markham. Gender and Age with or without home support. • Acute inpatient services are projected Key Points and Strategic Considerations The majority of inpatients are females. In fiscal year • Patient acuity has increased to increase by 24% from fiscal • In fiscal year 2016-17, SRH saw 42,461 2016-17, females represented 58% of all inpatients. steadily over the past five years. 2013-14 to 2028-29. The number of acute inpatients. This is a 5% overall The proportion of female patients has remained unscheduled ED visits is projected decrease in volume compared to five • For mental health inpatient services, stable over the last five years. The proportion of to increase by 12% in the same time years ago (decrease at Birchmount both patient days and acuity have males receiving acute inpatient services is greater period. Scarborough will see an and General; increase at Centenary). decreased over the past five years. A than that of females only among those under 19 decrease in days is driven by increasing increase in ambulatory visits of 22%. years of age and in the 50-79 year old age group. • The high proportion of females at outpatient treatment to proactively For all other age categories, acute inpatient 58% in fiscal year 2016-17 is aligned address client needs in the community services are used more by females than males. with volumes in obstetric services. thereby avoiding admissions. The obstetrical services offered at SRH have a Females represent 83% of the This section will describe the SRH acute and non- significant impact on the gender mix of our patient inpatients in the 20-49 age group. • A post-acute program is provided at the Centenary site. Rehab discharges acute inpatient populations, which include acute group. For example, females represent 83% of the • The top five highest volume clinical are down, but the acuity is up. Complex inpatients, mental health, and post-acute. Trends inpatients in the 20-49 age group. The table below categories for our acute inpatients are: continuing care (CCC) patient numbers will be analyzed by site, as well as, age group and depicts the age and gender mix of the patients that Pregnancy and Childbirth, Newborns are up, with a decline in acuity. gender. Additional information includes the number use our hospital for acute inpatient services. and Neonates with Perinatal Conditions; of births, average length of stay, where our patients • Assessments have higher weightings Circulatory System; Digestive System are going after discharge from hospital, acuity, for patients who receive more intense and Respiratory System. These and the top five clinical conditions of patients. five clinical categories account for care such as therapies. Due to the high 58% of acute inpatient volumes.

26 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 27 Table 1: Acute Inpatient Volumes by Gender and Age Group, SRH and by Site, 2012-13 to 2016-17 Table 2: Acute Inpatient, by Age Group, 2012-13 to 2016-17 SRH provides inter-professional care and a

FY 2012/13 FY 2016/17 % CHANGE collaborative model that involves obstetricians,

FY 2016/17 vs. FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 % CHANGE TOTAL %FEMALE TOTAL %FEMALE midwives and family physicians. The program FY 2012/13 FY 2016/17 vs. TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE offers a complete range of services for our diverse FY 2012/13 SRH Inpatients 44,539 59% 42,461 58% -4.7% Age < 19 community in a welcoming and caring environment. SRH Inpatients 44,539 59% 43,725 59% 44,238 58% 42,725 58% 42,461 58% -4.7% 10,417 49% 9,410 48% -9.7% 20 - 49 12,703 82% 11,055 83% -13.0% These services include early pregnancy assessment Age < 19 10,417 49% 9,904 49% 10,056 49% 9,719 49% 9,410 48% -9.7% 50 - 79 13,977 47% 14,547 47% 4.1% clinics (EPAC) and prenatal classes, which are 20 - 49 12,703 82% 11,778 82% 11,712 82% 11,119 82% 11,055 83% -13.0% 80+ 7,442 57% 7,449 56% 0.1% delivered in different languages to meet the 50 - 79 13,977 47% 14,209 47% 14,417 47% 14,386 47% 14,547 47% 4.1% needs of our patients, antenatal breastfeeding 80+ Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth 7,442 57% 7,834 56% 8,053 56% 7,501 57% 7,449 56% 0.1% classes and perinatal inpatient services, midwifery, Births non-stress test clinic and genetic counseling. Birchmount 11,861 60% 11,487 60% 10,757 59% 9,902 60% 9,871 60% -16.8% Inpatiens The total number of births at SRH has been Other well established Women’s Health Services include: sexual assault clinic, minimally invasive Age < 19 2,931 47% 2,650 49% 2,431 48% 2,377 49% 2,380 47% -18.8% fluctuating year over year. There has been a decrease in the number of births from fiscal year gynecologic surgery, urogynecology, maternal fetal 20 - 49 3,404 84% 3,074 84% 2,801 84% 2,718 85% 2,718 85% -20.2% 2012-13 to 2016-17 and a five year change of-10.8%. medicine and a community of practice in cervical 50 - 79 3,138 47% 3,253 49% 3,034 48% 2,524 46% 2,592 48% -17.4% A similar pattern was observed across all sites, screening and colposcopy. Of the 6000+ deliveries 80+ 2,388 58% 2,510 58% 2,491 57% 2,283 57% 2,181 57% -8.7% in particular, the Birchmount site experienced the in Table 3, 400 are midwifery deliveries; in the past largest five year change (-17.9%). 10 years, our midwifery deliveries have tripled. Our General Inpatients 17,985 59% 17,824 58% 17,517 59% 17,217 59% 17,005 59% -5.4% midwives provide care to women throughout their Age < 19 3,710 48% 3,492 47% 3,635 49% 3,406 49% 3,290 48% -11.3% Table 3: Total Number of Newborns, SRH and by Site, 2012-13 to 2016-17 pregnancy, labour and birth, as well as, care of the 20 - 49 5,267 80% 4,737 81% 4,744 83% 4,452 83% 4,436 84% -15.8% mother and her newborn for six weeks thereafter. %CHANGE 50 - 79 5,920 48% 5,747 47% 5,842 47% 6,237 48% 6,242 49% 5.4% FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 (FY 2016/17 vs. FY 2012/13) There are presently over 25 midwives at SRH.

80+ 3,088 56% 3,308 55% 3,296 55% 3,122 56% 3,037 56% -1.7% Total # of Newborns 7,205 6,643 6,663 6,402 6,424 -10.8%

Birchmount 2,120 1,861 1,722 1,761 1,740 -17.9% Length of Stay in Hospital General 2,848 2,620 2,764 2,549 2,614 -8.2% Centenary 14,693 59% 14,954 58% 15,964 57% 15,606 57% 15,585 57% 6.1% Centenary 2,237 2,162 2,177 2,O92 2,070 -7.5% The length of time that patients spend in hospital Inpatients receiving acute care can be an indication of patient Age < 19 3,776 50% 3,762 51% 3,990 48% 3,936 48% 3,740 49% -1.0% Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth acuity and the seriousness of the interventions 20 - 49 4,032 82% 3,967 81% 4,167 79% 3,949 81% 3,901 82% -3.2% Even though the number of newborns at SRH has needed. It can also be influenced by internal 50 - 79 4,919 45% 5,209 46% 5,541 46% 5,625 45% 5,713 45% 16.1% decreased over the years, compared to all Ontario processes and availability of the community 80+ 1,966 59% 2,016 56% 2,266 57% 2,096 58% 2,231 55% 13.5% hospitals, SRH is ranked fourth in the total number supports the patient requires after leaving the Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth of deliveries. The table below shows the number hospital. The table below shows that the average of newborn deliveries for Ontario hospitals by acute length of stay for acute inpatients has • Birchmount Site: digestive, circulatory The highest proportion of users of SRH acute gestational age. decreased by 4.3%. and respiratory system inpatient services are those in the 50-79 age group, Table 4: Ontario Hospital Newborns by Gestational Age Range, Table 5: Length of Stay for Acute Inpatients, followed by those in the 20-49 age group. The • General Site: musculoskeletal system 2016-17 2012-13 to 2016-17 greatest increase in the number of patients in the and connective tissue, circulatory Full-Term Pre-Term Post-Term Total # of ( 37 to 40 %CHANGE (<37 weeks) (>40 weeks) Newborns FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 (FY 2016/17 vs. weeks) last five years was in the 50-79 and 80 and above system and kidney, urinary tract FY 2012/13) Trillium Health Partners 594 6,984 980 8,558 Average Inpatient age groups. For those SRH patients in the 50-79 age and male reproductive system Length of Stay 4.7 4.5 4.5 4.4 4.5 -4.3% William Osler Health Centre 584 6,459 745 7,788 (days) - Acute Only group, the top major clinical conditions accounting • Centenary Site: circulatory system, Sinai Health System 1,089 5,353 393 6,835 Scarborough and Rouge Hospital 474 5,353 597 6,424 for the visit, noted upon discharge, were as follows: other reasons for hospitalization, Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth The Ottawa Hospital 877 4,481 787 6,145 and digestive system Note: Unknown is excluded from analysis Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth

28 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 29 MENTAL HEALTH AND POST-ACUTE After patients have received care at SRH they measures of patient acuity that are used by •Pregnancy and TOP 5 ACCOUNT FOR: are either discharged home or to other health hospitals to understand the acuity of the hospital Childbirth INPATIENT POPULATION care facilities. Most (83.8%) of SRH patients are patient population. One is Resource Intensity •Newborns and Neonates with discharged home (with or without support) and Weight (RIW). A higher average RIW (>1.0) suggests Birchmount Perinatal Conditions Mental health and post-acute patient data is 64% Inpatient collected by clinical staff, during a patient’s visit, 8.3% are transferred to continuing care. higher patient acuity. However, the measure is •Digestive System Volumes relative to other hospital patient populations. An •Respiratory System via assessments. The data is used by the hospital average RIW of 1.0 is the peer group average. The •Circulatory System to detect quality trends, plan for care, and compare with peers and by the MOHLTC to determine table below suggests that the overall patient acuity •Pregnancy and 715 levels for all Major Clinical Categories has steadily Childbirth funding levels. A patient day is simply a count of Discharged Home without Home Support increased over the last five years with the largest •Newborns and each day that a patient is reported as staying in Neonates with increase in fiscal year 2016-17. The other acuity Perinatal Conditions hospital. Upon discharge, a patient’s episode is General weighting is the, Health-Based Allocation Model •Musculoskeletal 59% Inpatient weighted based on their length of stay and clinical Volumes System and (HBAM) Inpatient Group (HIG weight) Using the HIG, condition. Lastly, a Case Mix Index (CMI) value is 123 83 79 Connective Tissue calculated which reflects the daily relative weight of Discharged Home Transfer to Other there has been a similar steady increase over the •Circulatory System with Support Continuing Care resources used by an individual compared to a base last five years with the largest increase observed in •Digestive System fiscal year 2016-17. resource level (average resource use of the broader •Circulatory System population). Even though clinically patients are ready to leave •Pregnancy and Table 7: Average Acuity Measure, SRH, 2012-13 to 2016-17 Childbirth the hospital, they may have to wait for space to be %CHANGE •Newborns and MENTAL HEALTH FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 (FY 2016/17 vs. 59% Inpatient available in another care setting (e.g. a long-term FY 2012/13) Centenary Neonates with Volumes Perinatal Conditions care home or rehab centre). When this happens, Average RIW 1.10 1.14 1.14 1.18 1.25 13.6% Inpatient mental health services are provided at Average HIG 1.15 1.18 1.17 1.21 1.29 12.2% •Digestive System patients are designated “ALC” to signify that they •Other Reasons for the Birchmount and Centenary sites – with a focus are waiting for an “Alternate Level of Care”. For Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth Hospitalization on child/adolescent mental health provided at these patients, the length of stay can be divided Centenary. Mental Health assessments are only into an acute portion and an ALC portion. The Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth SRH provides services to patients presenting with completed for adults. The number of adult mental table below shows that when the ALC portion various conditions or injuries. The top five highest health patient days at both the Birchmount and is considered, the length of stay in hospital has volume clinical categories for our acute inpatients Acute Inpatient Program Level Volumes Centenary sites has decreased in the last five years. increased by almost 6% in the last five years. in fiscal 2016-17 are: Pregnancy and Childbirth, Due to the fact that SRH is in a transition phase Also, the System for Classification of In-Patient Newborns and Neonates with Perinatal Conditions; post-merger, all hospital level processes are Psychiatry (SCIPP) Weighted Patient Days (SWPD) Table 6: Length of Stay for Acute Inpatients (Acute and ALC combined), 2012-13 to 2016-17 Circulatory System; Digestive System; and being revisited and standardized to reflect new and CMI have decreased, meaning that we are SRH guidelines. At this time, the program level seeing less acutely ill inpatients, according to the %CHANGE Respiratory System. These five clinical categories FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 (FY 2016/17 vs. FY 2012/13) account for 58% of acute inpatient volumes. Below assignment methodology has not been finalized. patient assessment data. Average Inpatient Length of Stay As a result, acute inpatient volumes and occupancy 5.2 5.1 5.1 5.1 5.5 5.8% (days) - Acute and are the top five highest volume Major Clinical ALC Combined Categories by site that were associated with acute rate by acute program will not be presented in this Table 8: Mental Health Inpatient Key Stats, SRH, 2012-13 & 2016-17 Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth inpatients. environmental scan. Information on mental health and post-acute programs is provided below. BIRCHMOUNT CENTENARY %CHANGE %CHANGE FY 2012/13 FY 2016/17 (FY 2016/17 vs. FY 2012/13 FY 2016/17 (FY 2016/17 vs. FY 2012/13) FY 2012/13) Patient Acuity Patient Days (PD) 15,210 12,332 -18.9% 15,025 13,707 -8.8% SCIPP Weighted Patient Days 19,121.42 14,416.55 -24.6% 17,953.21 15,989.33 -10.9% In simple terms, patient acuity is an indicator of (SWPD) Case Mix Index (CMI) 1.26 1.17 -7.0% 1.19 1.17 -2.4% how sick patients are. Acuity can be measured Source: Ontario Mental Health Reporting System (OMHRS) - for individual patients and also for the hospital Canadian Institute for Health Information (CIHI) population as a whole. There are two crude

30 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 31 It is important that our mental health program Complex Continuing Care (CCC) • The lack of capacity in post hospital care determining potential contingency measures and offers a range of services as an alternative to According to assessment data in the following (i.e. Long-Term Care (LTC) homes) has advocating for further investments. inpatient admission including crisis supports in table, the number of CCC patient days has increased led to the increase in ALC patients. the Emergency department to prevent admission, by 8.9% since fiscal year 2012-13. However, the • ALC patients occupying acute and post- EMERGENCY DEPARTMENT outpatient services, community services, and Resource Utilization Group (RUG) Weighted Patient acute care beds impact patient flow supportive housing. Mental health and addictions is Days (RWPD) and CMI have both decreased throughout the continuum - from ED Emergency department (ED) care is one of the a priority for the Central East LHIN and specifically meaning that we are seeing less acutely ill patients. to acute inpatient to post-acute. largest volume patient activities in the country, continuing to support people to achieve an A reason why we are seeing the increase in patient making it a key component of the continuum of optimal level of mental health and live healthier at days and decrease in CMI is because the CCC unit health services in Canada. Table 11: Annual ALC Rate, Province, Central East LHIN, SRH Sites, home by spending 15,000 fewer days in hospital has several alternate level of care (ALC) patients 2012-13 to 2016-17 and reducing repeat unscheduled emergency with long lengths of stay but less need for intensive Volume ANNUAL ALC RATE-5 department visits for reasons of mental health or resources such as allied health (i.e. physiotherapy Province / LHIN / In fiscal year 2016-17, there were 187,975 visits in FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 addictions by 13% by 2019. and occupation therapy). Facility / Site our three EDs. The vast majority of patients that Provincial 14.1% 13.8% 13.7% 13.9% 15.1% visit our EDs are discharged home. The overall Central East 17.5% 17.5% 18.0% 17.7% 23.3% Table 10: Complex Continuing Care Key Stats, SRH, POST-ACUTE SERVICES 2012-13 & 2016-17 Birchmount 9.2% 12.1% 15.1% 16.5% 23.5% admission rate is 10.5% (Birchmount=11.2%; General 10.5% 12.1% 15.7% 17.8% 25.9% General=10.1% and Centenary=10.4%). SRH has Post-acute care, which encompasses both CENTENARY Centenary 14.7% 12.5% 9.3% 11.9% 16.7% seen a steady increase in emergency visits, with %CHANGE rehabilitation and complex continuing care, is FY 2012/13 FY 2016/17 (FY 2016/17 vs. a five year (2012-13 vs. 2016-17) change of 8.5%. FY 2012/13) Source: Access to Care (ATC) – Cancer Care Ontario provided at the Centenary site. Patient Days (PD) 14,996 16,325 8.9% Similar patterns were observed across all SRH sites,

RUG Weighted Patient Days (RWPD) 15,581.23 15,438.28 -0.9% with the highest five year change at the General site Rehabilitation Case Mix Index (CMI) 1.04 0.95 -9.0% There are a few challenges to patient flow including (11.9%). As shown in the following table, the number of aging infrastructure and sub optimal space in Source: Continuing Care Reporting System (CCRS) - Canadian rehabilitation discharges decreased in fiscal year Institute for Health Information (CIHI) some clinical areas (e.g. low percentage of private Gender and Age 2016-17 to 258 compared to 406 in fiscal year 2012- room accommodations, insufficient isolation and The majority of patients seen were females - 13. The weighted cases also decreased by 18.4%. Alternate Level of Care (ALC) negative pressure rooms), insufficient capacity in representing 54% of all ED visits. The proportion However, the CMI increased by 28.4%. The number The following table shows that the ALC Rate (for all post hospital care (i.e. Long-Term Care), a continual of female patients has remained stable over the of patient discharges have significantly decreased inpatient services) was at its highest in fiscal year increase in community service demand, and an last five years; the proportion of males was greater which directly affects the weighted cases (patient 2016-17, for the Central East LHIN as a whole, and aging population with increasingly complex needs. than that of females only among those 19 years of discharges × CMI = weighted cases). for all SRH sites. The Centenary ALC rate (16.7%) SRH has an opportunity to review and standardize age and under. For all other age categories, the ED was slightly above the provincial average (15.1%) best practices related to patient flow across its was used more by females than males specifically, Table 9: Rehabilitation Key Stats, SRH, 2012-13 & 2016-17 but below the Central East LHIN average (23.3%). large, three site community hospital. females age 80 and above represented 58% of all ED visits. The highest proportion of users of SRH CENTENARY In May 2017, the Central East LHIN had the highest The Ontario Hospital Association (OHA) released a emergency services are those in the 20-49 age %CHANGE FY 2012/13 FY 2016/17 (FY 2016/17 vs. percentage of patients’ designated ALC occupying memo in September 2017 reporting on a concerning group, followed by those in the 50-79 age group. FY 2012/13) acute care beds (36.8%) compared to the other 13 trend of extremely high ALC patient volumes over The greatest increase in the number of patients Patient Discharges 406 258 -36.5% LHINs in the province. Also, for post-acute care, the the summer months in Ontario hospitals. This in the last five years was in the 50-79 and 80 and Weighted Class 377.86 308.41 -18.4% Central East LHIN had the second highest percent led to an increase in wait times for patients being Case Mix Index 0.93 1.20 28.4% above age groups. The table below depicts the age of beds being occupied by patients designated ALC admitted to hospital through the ED. Last winter, and gender mix of the patients that use our hospital Source: National Rehabilitation Reporting System (NRS) - Canadian (27.8%) compared to the remainder of the LHINs. a surge of acute care and ALC patients created Institute for Health Information (CIHI) for ED care (Note: excludes patients with unknown Some implications include: a situation where unbudgeted beds were opened age and stillbirths). and many remain open and in use, which affects the financial position of hospitals. The OHA will be

32 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 33 Length of Stay in ED with a carryover impact to non-admitted patients According to a recent report from the Canadian relying on the same ED resources and space for

Table 12: Emergency Department Visits, SRH and by Site, 2012-13 to 2016-17 Institute for Health Information (CIHI) on care. Inadequate physical space also contributes emergency wait times, compared to other to wait times in the ED. According to Figure 1, for industrialized countries, Canada has the highest the most part, across all sites the ED length of stay FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 % CHANGE proportion of patients reporting excessively long for complex patients has been above target (target FY 2016/17 vs. TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE TOTAL %FEMALE FY 2012/13 waits in the ED. For example, one out of three of 7.7 hours at Birchmount and 8 hours at General SRH ED Visits 173,280 54% 182,433 53% 184,688 53% 186,150 54% 187,975 54% 8.5% Canadians reported waiting four or more hours the and Centenary), with the exception of Birchmount Age < 19 35,234 46% 36,286 46% 37,923 45% 37,163 47% 36,258 46% 2.9% last time they went to the ED. Increasing ED visit meeting their target in fiscal year 2014-15 (Q1 and

20 - 49 64,965 57% 67,511 57% 66,770 57% 67,557 57% 67,461 57% 3.8% volumes has a significant impact on wait times. Q2) and fiscal year 2015-16 (Q1 and Q2). As a result,

50 - 79 54,740 53% 57,934 53% 59,867 53% 61,904 53% 63,553 54% 16.1% Barriers to inpatient flow is also a factor with not meeting the target could have implications on

80+ 18,341 60% 20,702 55% 20,128 59% 19,526 60% 20,703 58% 12.9% increasing ALC volumes contributing to increased funding. wait times for admitted patients waiting in the ED

Birchmount ED Visits 47,251 53% 48,276 53% 49,085 53% 49,238 53% 50,549 54% 7.0%

Age < 19 9,067 44% 9,041 45% 9,362 45% 9,400 45% 9,682 46% 6.8% Figure 1: 90th Percentile ED Length of Stay for Complex Patients by Site, SRH, 2014-15 to 2017-18 (Q1) 20 - 49 17,675 55% 17,683 56% 17,443 55% 17,662 56% 17,810 56% 0.8%

50 - 79 14,872 53% 15,718 53% 16,102 53% 16,320 53% 16,838 55% 13.2% 16 80+ 5,637 61% 5,834 59% 6,178 59% 5,856 59% 6,219 59% 10.3%

14 General ED Visits 63,,569 53% 67,874 52% 68,191 53% 69,779 53% 71,154 53% 11.9% 13.9

Age < 19 12,157 46% 12,743 47% 12,998 47% 13,470 47% 13,067 45% 7.5% 12 12.7

20 - 49 11.9 24,009 55% 24,925 56% 25,068 57% 25,567 57% 26,054 57% 8.5% 11.7 11.6 11.6 11.6 11.2 11.1 11.4 11.5 10 10.7 10.7 10.7 10.5 10.5 10.4 50 - 79 19.967 52% 20,934 52% 22,002 52% 22,635 52% 23,645 52% 18.4% 10.3 10.1 10.0 9.9 9.8 9.7 9.6 9.6 9.5 9.1 80+ 7,436 60% 9,272 50% 8,123 58% 8,107 59% 8,388 57% 12.8% 9.0 8.7 8.6 8.6 8.3

8 8.2 8.1 7.8 7.7 7.2 Centenary 7.1 6 6.7 ED Visits 62,460 55% 66,283 55% 67,412 53% 67,133 55% 66,272 55% 6.1%

Age < 19 14,010 46% 14,502 47% 15,563 44% 14,293 48% 13,509 47% -3.6% 4 20 - 49 23,281 59% 24,903 59% 24,259 58% 24,328 58% 23,597 58% 1.4%

50 - 79 19,901 55% 21,282 54% 21,763 53% 22,949 54% 23,070 55% 15.9% 2 80+ 5,268 61% 5,596 60% 5,827 60% 5,563 61% 6,096 59% 15.7%

0

Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 2014/15 Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 2016/17 Q1 2017/18

Birchmount General Centenary Birchmount Target General Target Centenary Target

Source: National Ambulatory Care Reporting System (NACRS) – Health Information Management (HIM)

34 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 35 Table 16: Total SRH Emergency Department Patients by Place of Patient Acuity acuity level of urgent/potentially serious or even Acute Inpatient Utilization Residence, 2015-16 to 2016-17 In Emergency departments, acuity is measured more severe acuity at time of triage (CTAS I, II or The majority of acute inpatients cared for at SRH FY 2015/16 FY 2016/17 using the Canadian Triage and Acuity Scale (CTAS). III). In addition, over the last five years there has reside within the hospital’s primary catchment area #% of Total #% of Total The goal of CTAS is to support and appropriately been an increase in acuity, specifically an increase of Scarborough – approximately 69% in both fiscal Living in Scarborough 150,489 80.8% 151,459 80.6% assign acuity scores in order to effectively triage in the number of CTAS III patients and a five year year 2015-16 and 2016-17, as displayed in the table Living in Durham 10,689 5.7% 11,208 6.0% Living in Markham 7,816 4.2% 7,691 4.1% and treat our ED patients. The CTAS is a five point change of 20.2%. In addition, SRH EDs saw a drop in below. The percentage of acute inpatients coming Other 17,168 9.2% 17,632 9.4% scale with CTAS I representing the highest acuity non-urgent (CTAS V) patients in fiscal year 2014-15 from Scarborough dropped slightly over the past and CTAS V representing the lowest acuity. Breaking which has remained consistent over the past three year. There was a small increase in the percentage Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth down the number of ED visits by CTAS shows that, years. of acute inpatients from Durham. Those living in fiscal year 2016-17, 4 out of 5 patients had an outside of Scarborough, Durham and Markham Day Surgery Utilization Table 13: Emergency Department Visits by CTAS, SRH, 2012-13 to 2016-17 (Other) accounted for 12.6% of our acute inpatients. In 2016-17, over half of day surgery patients (55.9%) Of those 5,355 discharged patients, 32.7% were FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 % CHANGE came from within our primary catchment area, living directly west of Victoria Park Avenue in North FY 2016/17 vs. TOTAL%TOTALTOTAL %TOTAL TOTAL%TOTALTOTAL %TOTAL TOTAL%TOTAL followed by Durham and Markham. Those living FY 2012/13 York – in proximity to the Birchmount site. Overall, outside of Scarborough, Durham and Markham SRH ED Visits by CTAs 173,291 100% 181,016 100% 183,698 100% 186,156 100% 187,977 100% 8.5% these patients from North York accounted for 4.1% (Other) accounted for 21.8% of our day surgery (I) Resuscitation / 1,094 1% 1,057 1% 1,090 1% 999 1% 961 1% -12.2% of our total acute inpatient discharges in fiscal Life-threatening patients. Of those 10,997 day surgery patients (II) Emergent / 32,519 19% 35,189 19% 38,346 21% 37,514 20% 36,571 19% 12.5% 2016-17. Potentially Life-threatening outside of Scarborough, Durham and Markham, 24%

(III) Urgent / Potentially Serious 94,389 54% 103,061 57% 108,555 59% 111,807 60% 113,491 60% 20.2% Table 15: Total SRH Acute Inpatient Discharges by Place of were living in North York. Overall, these patients 1 (IV) Less-urgent / Semi-urgent 40,955 24% 38,429 21% 33,303 18% 33,362 18% 34,507 18% -15.7% Residence, 2015-16 to 2016-17 from North York accounted for 5.2% of our total day (V) Non-urgent 4,334 3% 3,280 2% 2,404 1% 2,474 1% 2,447 1% -43.5% FY 2015/16 FY 2016/17 surgery visits in fiscal 2016-17.

#% of Total #% of Total Source: National Ambulatory Care Reporting System (NACRS) – Health Information Management (HIM) Living in Scarborough 29,820 69.7% 29,417 69.2%

Living in Durham 4,904 11.5% 5,088 12.0% Table 17: Total Day Surgery Patients by Place of Residence, 2015- DAY SURGERY PATIENT RESIDENCE Living in Markham 2,810 6.6% 2,637 6.2% 16 to 2016-17 Other 5,234 12.2% 5,355 12.6%

FY 2015/16 FY 2016/17 The majority of surgeries at SRH are done on SRH’s primary catchment is the Scarborough Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth #% of Total #% of Total an outpatient basis. In fiscal year 2012-13, SRH municipality (Figure 2 below). SRH’s secondary Living in Scarborough 28,485 55.5% 28,212 55.9% saw the highest volume of day surgery patients catchment area is based on actual acute inpatient, Living in Durham 6,735 13.1% 6,529 12.9% Emergency Department Utilization Living in Markham 4,841 9.4% 4,741 9.4% at 53,937. However, the number of day surgery Emergency department and day surgery utilization In 2016-17, 80% of ED patients came from Other 11,285 22.0% 10,997 21.8% patients declined thereafter (percentage change to patterns by people who live in neighbouring Scarborough, followed by Durham and Markham. Source: National Ambulatory Care Reporting System (NACRS) - 2016-17= -6.4%). Day surgery visits have declined communities outside of Scarborough. Those living outside of Scarborough, Durham and MOHLTC Intellihealth at both General and Centenary sites, but have Figure 2: Scarborough Municipality Markham (Other) accounted for 9.4% of our ED increased at the Birchmount site. The table below patients. Of those 17,632 ED patients living outside shows the number of day surgery visits at SRH and of Scarborough, Durham and Markham, 38.7% were by site along with the five year percentage change. living in North York. Overall, these patients from

Table 14: Day Surgery Visits by Site, SRH, 2012-13 to 2016-17 North York accounted for 3.6% of our total ED visits in fiscal 2016-17. FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17 %CHANGE (FY 2016/17 vs. TOTALTOTAL TOTALTOTAL TOTAL FY 2012/13)

SRH Day Surgery Visits 53,937 51,019 51,204 51,346 50,479 -6.4%

Birchmount 16,267 15,679 15,593 16,377 16,989 4.4%

General 17,946 17,131 17,076 16,476 15,520 -13.5% 1 Centenary 19,724 18,209 18,535 18,493 17,970 -8.9% Note: Scarborough: defined using FSA M1*; Durham: defined using FSA L1S, L1T, L1Z, L1V, L1W, L1X, L1Y, L1M, L1N, L1P, L1R, L1G, L1H, L1J, L1K, L1L, L1E, L1B, L0B, L1C, L0C, L0K, L9P, L9L; Markham: defined using FSA L6C, L3R, L6G, L6E, L3P, L3S, L4A, L6B; Other: not in Scarborough, Durham and Markham. Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth Source: http://bsma.ca/pdfs/FSA-Toronto.pdf

36 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 37 HOSPITAL UTILIZATION PROJECTIONS Acute Inpatient Services Post-acute and Mental Health • In Scarborough, acute inpatient services • The number of active cases and discharges for complex continuing care, inpatient The following section describes the hospital (patient days) are projected to increase by rehabilitation, and inpatient mental health are projected to increase by fiscal utilization projections for Scarborough residents 24% from fiscal year 2013-14 to 2028-29. year 2028-29 by 36%, 28% and 8%, respectively, in Scarborough. (using fiscal year 2013-14 data as the baseline) • Even though admissions to all acute inpatient for acute inpatients, Emergency department visits, services are increasing within the next 15 Table 19: Complex Continuing Care, Inpatient Rehabilitation and Mental Health Projections, 2013-14 post-acute inpatients (rehabilitation and complex years, the medicine program is projected to continuing care), mental health, day surgery, COMPLEX CONTINUING CARE, INPATIENT REHABILITATION AND MENTAL HEALTH ACTUAL (2013/14) AND PROJECTED VOLUMES see the highest change (28%) followed by Scarborough Residents West Durham Residents oncology and dialysis visits. Projections were Baseline (2013/14) Projected Volume Projected Volumne surgery (25%) and mental health (25%). VOLUMES extracted from the Report of the Scarborough/West % Change % Change % Change % Change West 2023/24 + 2028/29 + 2023/24 + 2028/29 + Scarborough from from from from Sector Metric Durham 2023/24 efficiency 2028/29 efficiency 2023/24 efficiency 2028/29 efficiency Residents Baseline, Baseline, Baseline, Baseline, Residents measure measure measure measure Durham Panel. with eff. with eff. with eff. with eff.

Complex continuing care Active Cases 1,402 1,095 1,700 1,600 14% 2,000 1,900 36% 1,700 1,600 46% 2,200 1,900 74% Table 18: Acute Inpatient Projected Volumes by Program, 2013-14 Inpatient Rehabilitation Discharges 1,327 1,343 1,600 1,500 13% 1,800 1,700 28% 2,100 1,900 41% 2,500 2,200 64% Inpatient Mental Health Active Cases 2,317 1,968 2,400 2,400 4% 2,500 2,500 8% 2,200 2,200 12% 2,400 2,300 17% ACUTE INPATIENT BASELINE (2013/14) AND PROJECTED VOLUMES Source: Report of the Scarborough/West Durham Panel Baseline 2013/14 Volumes Projected Volume

2023/24 + % Change from 2028/29 + % Change from Rest of Sector Metric Scarborough West Durham efficiency Baseline (with efficiency Baseline (with Central East measure efficiency) measure efficiency) Day Surgery, Oncology and Dialysis Total by Program Total Days 256,200 202,800 247,300 294,317 15% 316,417 24% • Scarborough will see an increase of 23,500 ambulatory visits by 2023 (15%) Medical Total Days 137,800 99,300 139,000 161,374 17% 175,790 24% and an increase of 36,100 ambulatory visits by 2028 (22%). Surgical Total Days 73,800 61,500 67,700 85,445 16% 92,335 25%

Newborn / Neonate Total Days 21,500 16,000 12,200 23,008 7% 22,929 7% Table 20: Day Surgery, Oncology and Dialysis Projections, 2013-14 Obstetrics Total Days 15,100 12,200 8,600 15,340 2% 15,100

Mental Health Total Days 8,000 13,900 19,700 9,104 14% 10,024 25% DAY SURGERY AND CARDIAC CATHETERIZATION; AMBULATORY ONCOLOGY; AND RENAL DIALYSIS BASELINE (2013/14) AND PROJECTED VOLUMES Source: Report of the Scarborough/West Durham Panel Figure 3: Unscheduled ED Visit Projections, 2013-14 Baseline Scarborough West Durham 2023/24 + 2028/29 + 2023/24 + 2028/29 + Scarborough West Durham PROJECTED PERCENTAGE CHANGE IN UNSCHEDULED ED VISITS Sector Metric efficiency efficiency efficiency efficiency RELATIVE TO 2013/14 (DOES NOT INCLUDE EFFICIENCY MEASURE) Residents Residents measure measure measure measure 80% Day Surgery Visits Visits 45,100 47,900 50,900 54,000 59,300 65,400 including Cardiac CACS weighted 70% Catheterization visits 8,100 9,300 9,100 9,600 11,400 12,500 Emergency Department Visits 60% 43,600 36,200 50,100 54,500 47,800 53,400 • In Scarborough, the number of unscheduled Ambulatory Oncology CACS weighted visits 4,900 4,500 5,600 6,000 5,900 6,500 ED visits in fiscal year 2013-14 was 190,000. 50% Visits 72,500 40,800 83,700 89,800 55,000 63,300 • By 2023, the number of ED visits is 2023 2028 Renal Dialysis CACS weighted 40% visits 4,600 2,700 5,300 5,700 3,600 4,100 projected to increase by 14,600 ED

visits or 8% (from baseline). 30% Source: Report of the Scarborough/West Durham Panel

• By 2028, the number of ED visits is 20% projected to increase by 22,400 ED visits or 12% (from baseline). 10%

0%

2014 2019 2024 2029 2034 2039

West Durham Ontario Central East (Total)

Rest of Central East Scarborough

Source: Report of the Scarborough/West Durham Panel

38 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 39 OUR TEAM (STAFF, VOLUNTEERS, AND Figure 4: Employees by Years of Service, by Site, 2016-17 PROFESSIONAL STAFF) • The engagement scores for SRH from the June 2017 survey are 67.1% employees, 61.7% professional Key Points and Strategic Considerations staff, and 81.6% volunteers. • SRH is the workplace of choice for 484 0-2 YEARS 379 5,133 employees (3,160 Birchmount 254 and General sites; 1,973 Centenary site), This section provides an overview of the SRH with the majority being full-time (57.4%). workforce including employees, volunteers, and The average age of SRH employees is professional staff (physicians, dentists, and 45 years. Almost half of our employees midwives). 361 have more than ten years of service; the 3-5 YEARS 249 average tenure corporately is 12 years. 143 EMPLOYEES Eighty six percent of our staff members belong to a particular union (ONA is the SRH has 5,133 employees (3,160 Birchmount and largest, followed by CUPE and OPSEU). General sites; 1,973 Centenary site). Full time staff • Workforce integration requires investment 298 make up 57.4% of the organization; there are 35.5% 6-10 YEARS 385 including workforce restructuring, part-time and 7.1% casual. Over one-third of the 170 workforce harmonization of compensation employees at each site are nurses. The average age and benefits, and pay equity, as well as of SRH employees is 45. Currently at SRH, 86% of a major focus on union alignment. our staff members belong to a particular union, as

• Over 1,500 volunteers provide service shown in the following table, by site. The largest 830 11+ YEARS across 81 departments. Volunteers have union groups are: ONA at 42% (1,838 employees), 1060 520 a significant role to play in community CUPE at 37% (1,617 employees), and OPSEU at 21% engagement as the average tenure (922 employees). is greater than 15 years. Volunteers provided over 115,000 hours last Table 21: Union and Non-Union Headcount, by Site, and Status, Centenary Site General Site Birchmount Site 2016-17 year; the largest number of hours is seen in patient care areas. Group Birchmount General Centenary Total Full Time Part-time Casual Union 934 1,657 1,806 4,397 2,361 1,700 336 Source: SRH Human Resources Report – March 31, 2017 • There are over 1,000 professional staff Non-Union 128 324 103 555 419 110 26 Management 25 92 64 181 168 12 1 (physicians, dentists, midwives) at Total 1,087 2,073 1,973 5,133 2,948 1,822 363 Key priorities for Human Resources to advance • Harmonizing the non-union job, compensation SRH, with the majority being active. Source: SRH Human Resources Report – March 31, 2017 workforce integration include the following: and benefits structures and programs. There are almost 225 physicians with a • Rolling out change management • Implementing a standardized service University of Toronto Faculty of Medicine Length of service reflects the organization’s ability education across the organization. excellence and service expectations Appointment and over 80 active research to engage and retain staff, and foster a positive • Conducting a baseline workforce engagement model for all employees that engrains studies approved by the Research Ethics corporate culture (healthy work environment). It and culture assessment survey. a quality service culture. Board. Key priorities for professional also encompasses the collective corporate history staff leadership address privileging and • Aligning union representation • Standardizing key human resources and memory. Almost half of our employees across credentialing, the medical leadership across all sites to ensure greater strategies and processes by adopting all sites have more than ten years of service model, the medical staff integration uniformity and higher consistency of best practice standards. (Centenary 42%, General 51%, Birchmount 48%); plan, and professional staff by-laws. employment terms and conditions. the average tenure corporately is 12 years.

40 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 41 VOLUNTEERS Figure 5: Volunteer Hours by Site and Service PROFESSIONAL STAFF Figure 7: Professional Staff by Department, SRH, as of August 24, 2017

35,000.00 Volunteers offer their time, talent and dedication The term “professional staff” refers to physicians, TOTAL SRH throughout the hospital in patient care and dentists and midwives. The Medical Administration Anesthesia 69 support service settings, staffing the gift shops, 30,000.00 Office is responsible for all matters related to the Cardiology 25 31,807 and providing donations to the hospital through 30,131 professional staff. Critical Care 13 fundraisers that help buy necessary equipment. 25,000.00 Diagnostic Imaging 31 The merger brought changes in processes and Physicians represent the largest component of new opportunities to Volunteer Services. One of professional staff. As displayed in the following Emergency 87 the key priorities was to focus on streamlining 20,000.00 figures, there are over 1,000 physicians, dentists Family Medicine 282 and standardizing processes, such as volunteer and midwives at SRH, with the majority being Medicine 190 recruitment. active. The distribution across departments is 15,000.00 Obstetrics/Gynaecology 86 also highlighted. The largest groups are Family 16,759.29 Paediatrics 65 Over 1,500 volunteers currently provide services Medicine and Medicine. There are almost 225 Pathology 12 10,000.00 across 81 department locations and offer 25 14,800.02 physicians with a University of Toronto Faculty of discrete programs across SRH. 13,670.91 Medicine Appointment and over 80 active research Psychiatry 38 studies approved by the Research Ethics Board. Surgery 165 5,000.00 Youth/high-school students represent 28% of 8,496.60 Total 1,063 Figure 6: Professional Staff by Status, SRH, 2016-17 our active volunteer pool. Five service dogs also Source: SRH Fast Facts – August 24, 2017 support the program. The average tenure for our 0.00 TOTAL SRH adult volunteers is over 15 years, which allows OCT 2016 - APR 2016 - MAR 2017 SEPT 2016 A SRH Medical Advisory Committee is in place. them to build strong relationships with employees, Active 582 Key priorities post-merger address privileging General 16,759.29 13,670.91 professional staff, and members of the community. and credentialing, the medical leadership model Birchmount 14,800.02 8,496.60 Associate 33 Many of our volunteers have been recognized for (which is currently different across legacy sites), Centenary 31,807 30,131 Courtesy 393 their profound impact on patient and family centred the medical staff integration plan, and professional care in the three focus areas of patients’ and family Locum Tenens 28 staff by-laws. centered services, support services and fundraising. 35,000.00 Fellow 1

Eighteen volunteers across all three SRH sites were 34912.94 30,000.00 34,399.32 SRH ENGAGEMENT AND CULTURE Term 26 selected to receive 2017 Ontario Volunteer Service SURVEY RESULTS

Awards presented by the Ministry of Citizenship 25,000.00 Total 1,063 and Immigration at a ceremony in March. Volunteer In June 2017, SRH conducted the first 0% hours are displayed below, by site and by service; 20,000.00 3% 2% 3% organization-wide culture and engagement survey the number of hours across all three sites exceeds of employees, professional staff, and volunteers. 15,000.00 115,000 hours. The majority of volunteer hours are This was an opportunity for everyone to share their 16,396.25 Active provided in patient care areas. 10,000.00 Courtesy opinions and thoughts on their workplace.

11,158.12 Associate Feedback from past surveys at our three hospital 10,090.31 5,000.00 37% 55%

8,607.88 Locum Tenens sites has been instrumental in contributing to

Term positive change and in promoting a quality healthy 0.00

PATIENT SUPPORT FUNDRAISING Fellow work environment. The survey results will be used FOCUS SERVICE by leaders to create action plans, in consultation Oct 2016 - Mar 2017 34,912.94 16,396.25 11,158.12

Apr 2016 - Sep 2016 34,499.32 10,090.31 8,607.88 with employees, on how to address any workplace

Source: SRH Fast Facts – August 24, 2017 issues that have been flagged, and to sustain and Source: Volunteer Services Report – March 31, 2017

42 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 43 expand on what is currently working well. Results close connection is shown with language. The top and integration while keeping pace will also be used to understand key corporate-wide languages, other than English or French, spoken that is synergistic with the teaching with advances in the sector. concerns. Below is a snapshot of the engagement most often at home in Scarborough align with the that it does. Medical education, • SRH has a 2017/18 operating budget scores for SRH from the recent survey (67.1% ones spoken by SRH employees and professional teaching and research are areas of of $635.5 million. Sustaining surpluses employees, 61.7% professional staff, 81.6% staff. Note that responding to these questions was potential growth and opportunity while meeting growing patient needs volunteers) and from prior surveys from legacy optional within the SRH engagement survey and not requiring careful consideration in is a challenge for the hospital sector. organizations. The detailed survey results will all respondents answered all questions. the strategic planning process. Since the Health-Based Allocation provide a baseline on which to make action plans • A harmonized Quality and Safety Methodology (HBAM) funding formula based on reflections of respondents. ENABLERS OF HIGH PERFORMANCE Scorecard is in place that aligns to works on a two-year lag, SRH needs the SRH Quality Improvement Plan to be able to manage and absorb Figure 8: SRH Engagement and Culture Survey Results and is anchored to the Health Quality additional HBAM funded volumes Key Points and Strategic Considerations Ontario (HQO) quality elements: within its current cost structure. SRH • SRH has adopted both PFCC and Safe, Timely and Effective, Patient 67.1% EMPLOYEES 68.3% must focus on attracting new funding 67.0% Lean Thinking as key philosophies. Centred, Efficient, and Our People. and community partnerships, and 61.7% • SRH has a strong commitment • SRH continues to report mandatory PROFESSIONAL 62.7% STAFF developing and executing strategies that 68.8% to diversity, equity, and inclusion. indicators to the MOHLTC which

81.6% will improve outcomes and lower costs. VOLUNTEERS N/A Both legacy organizations had a are published on the HQO site. In 91.3% • Over the long-term, there are potential successful accreditation visit in addition, the Canadian Institute for 2016 and SRH anticipates the next savings for the integrated organization 2017 SRH 2016 TSH 2015 RVHS (excl. Ajax) Health Information’s Your Health but significant upfront investments such survey visit to take place in 2020. System Performance biannual as building renovations may be required. Hospital Sector Database Average : Employees – 65.4%; • The SRH human resources framework reports are evolving to include Professional Staff – 66.5% includes four strategies to shape infection control indicators and a Source: SRH Human Resources workplace culture and enhance new measure of alcohol harm. engagement: customer service • Aging infrastructure is a significant PATIENT AND FAMILY CENTRED CARE model, capabilities framework, According to the 2017 SRH culture and engagement issue at all three sites. The Facility (PFCC) survey respondents, one third of SRH employees performance feedback structure Condition Index for all three sites is and recognition program. are White (European, North American) followed high, with the Birchmount site ranked PFCC is a philosophy that embraces health-care by South East Asian (Filipino, Malaysian – 12%). • SRH is a Community Affiliated in the lowest 10% of hospital facilities professionals working together with patients Of professional staff respondents, 42% are White Hospital with the University of Toronto, in Ontario and both the General and and their families to plan, deliver, evaluate, and (European, North American) followed by East Faculty of Medicine and has a robust Centenary sites in the bottom half. improve health care. PFCC defines what a quality Asian (Chinese, Japanese – 23%). Half of SRH education program. Beyond medical • Several capital projects are in progress care experience should feel like at our hospital. employee respondents were foreign born and 40% education, teaching and education of to address the state of existing building There are four pillars of PFCC: Respect and were born in Canada. On the other hand, half of other health care professionals occurs infrastructure and the hospital is Dignity, Information Sharing, Participation, and SRH professional staff who responded to these in various service areas and involves responding to recommendations from Collaboration. questions were born in Canada and 42% were several universities and colleges. In the Expert Panel report regarding both foreign born. The top languages spoken at home by addition to teaching and education, interim and long-term capital investment SRH employees and professional staff are: English, SRH conducts health research and needs in the Scarborough region. Tagalog, Cantonese, Mandarin, and Tamil. Staff collaborates in health research • Significant Information Management/ diversity does reflect community diversity in some initiatives with other organizations. SRH Information Technology (IM/IT) is areas, as several employees have similar ethnic also has a robust research program required to support standardization backgrounds and were born outside of Canada. A

44 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 45 Both legacy organizations have been on a journey sexual orientation, language, ability, socioeconomic • Recognition Program – HEART @ Work except for Trillium Health Partners. At SRH, over to further involve patients and families in their status and religion. SRH is inclusive, as we accept, Program consisting of annual appreciation 225 physicians with University of Toronto faculty care, and beyond in terms of involvement in respect, and embrace our global community of staff, events and service spotlights appointments in all different specialties provide quality improvement, planning, evaluation and volunteers, professional staff, patient and families. education to clinical clerks, residents, fellows and various hospital committees. The organization An inclusive environment is one which every person These elements are evidence based proven international medical graduates. SRH physician has a dedicated manager for PFCC with a focus feels welcomed and valued. When we feel included, strategies and build on previous success in both teachers are also well known for their excellence in on building a sustainable program structure and we feel a sense of belonging. The commitment legacy organizations. teaching with a number of teaching awards granted standardized processes to support implementation. to diversity and inclusion will be preserved as every year. SRH has over 50 Patient Family Advisors assigned we harmonize policies and practices in our new TEACHING, EDUCATION AND RESEARCH to various programs and committees. A Patient organization. For example: One of the mainstays of the SRH medical education and Family Advisory Council has been created. SRH is committed to delivering high quality patient program is the Family Medicine Teaching Unit A critical feature to embedding PFCC at SRH has • In the 2017 SRH Engagement Survey, care, advocating for the community’s health and (FMTU) which accounts for approximately 30% of been engaging patients and families in quality ‘support for diversity’ was within the top wellness issues and maintaining leadership in all teaching at SRH. It provides medical education improvement processes and opportunities. 10 identified areas of strength by staff; research, teaching, and learning. Through education through the University of Toronto Department diversity demographics are collected (on and research, we can leverage the collective wisdom of Community and Family Medicine Residency LEAN THINKING a voluntary basis) as part of this survey in and creativity of our teams, our community, and Program and partners with community-based SRH order to better understand our workforce. others to develop innovative solutions that meet primary care physicians. This Program is a learner- As a newly integrated organization, SRH has • Interpretation Services, which includes or exceed our patients’ expectations. SRH has a centered program which hosts 24-26 residents adopted Lean Thinking, an approach entrenched staff providing non-clinical language high volume of patients from diverse populations, per year, providing them with community-based at both legacy organizations, as a fundamental support at the bedside and certified regional health programs serving populations with experiences with an emphasis on real-world, hands- philosophy underpinning our standardization medical interpretation is available. disease burden complexity and innovative health on clinical training, along with core academic and transformation efforts. SRH can take teaching with specialists at SRH. Training is • The collection of patient demographic professionals addressing their needs. These factors advantage of the different experiences of each available in various settings such as obstetrics, data, through voluntary surveys, is being provide both an engaging site for research and legacy organization to learn from each other. pediatrics, internal medicine, surgery, psychiatry, spread across our three sites in order to provide learners with an opportunity to experience a Lean is a management philosophy of continuous and emergency medicine, among others. In addition better understand access barriers and range of programs and services at SRH. improvement with an emphasis on respect for to the Family Medicine residency program, the health disparities amongst the diverse people and elimination of waste. An Improvement Family Medicine teaching unit also provides and vulnerable population we serve. SRH is a Community Affiliated Hospital with the Office, consisting of staff skilled in Lean University of Toronto, Faculty of Medicine. The teaching to over 21 clinical clerks per year. FMTU methodology, exists to support the use of Lean for affiliation with the University of Toronto, established has been accredited by the Royal College of WORKPLACE CULTURE AND quality improvement throughout the organization. in the 1970s by SRH predecessor organizations, has Physicians and Surgeons as well as the Canadian ENGAGEMENT Lean aligns and supports PFCC. Both hold the grown over several decades into a robust education College of Family Medicine. patient and family as the primary focus in service program providing excellent clinical experience with The SRH human resources framework includes four delivery. a diverse population. One of the unique features of SRH also has a number of established rotations strategies to shape workplace culture and enhance the SRH medical teaching model is that teaching is with the University of Toronto undergraduate engagement: DIVERSITY AND INCLUSION done on a 1:1 ratio of student to teacher. The main academies including Anesthesia, Family Medicine, measure of medical education in Ontario hospitals Emergency Medicine, Obstetrics, Pediatrics, • Customer Service Model – Communicate Diversity and inclusion are essential ingredients is the number of Medical Trainee Days (MTD). Psychiatry, Ear Nose and Throat (ENT), Cardiology with H.E.A.R.T. (Cleveland Clinic Program) for serving and supporting our workforce and our SRH has consistently grown its number of MTD and Surgery. These placements are organized • Capabilities Framework – MIT Sloan community. At SRH we recognize similarities and year after year. In 2016-17, SRH was the largest through the different academies and are not elective Management four capabilities framework differences, both visible and invisible, among people provider of MTD for the Central East LHIN and placements. They are secured core rotations by and groups. We go beyond culture and ethnicity to • Performance Feedback Structure – Valuing provides more teaching than all other Community SRH for each academic year. include differences such as age, gender, Individual Performance (VIP) through VIP Chats affiliated University of Toronto hospitals in Ontario

46 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 47 Table 23: SRH Scorecard Indicators Aligned to Health Quality SRH also hosts the Clinical Elective placements Committee of the Board provides stewardship (HSO). Areas of interest include exploring setting Ontario Quality Elements for all levels from clinical clerks to post-graduate and oversight on quality and risk issues. This standards at the system level versus institutional Quality Element Scorecard Indicator specialty fellowship trainees in almost all areas of legislated committee meets monthly and includes standards, and involving patients as surveyors in • Clostridium difficile infection rate per the hospital. The Emergency Departments at two representation from board members, senior leaders the survey visit process. Accreditation Canada’s 1,000 patient days SRH sites have developed their own point of care and clinicians. Key areas of oversight include: current standards reflect the latest research in •% Hand hygiene compliance before patient contact ultrasound fellowship that takes two Emergency person-centred care. The new approach is due to •% Hospital acquired inpatient pressure Safe trained physicians per year who stay at SRH for the • Encouraging a Patient Safety Culture be released for standards in January 2018, with ulcers ( Stage 2) year learning this important skill set; it has been • Excellent Care for All Act requirements, assessments taking place in 2019. SRH is well • Inpatient falls rate per 1,000 patient days (moderate/severe harm) running for the last three years. positioned to respond to the new Accreditation including development of a •* Medication reconciliation at admission Quality Improvement Plan Canada requirements based on the trajectory for •% Medication reconciliation at discharge Beyond medical education, teaching and education PFCC work as mentioned earlier in this report. • 90th percentile emergency department • Risk Management of other health care professionals occurs in various length of stay for complex patients • Program and Corporate Performance Indicators • Alternate level of care rate service areas and involves several universities and Quality Improvement Planning and Reporting • 30-day readmission rate to own facility - colleges. • Patient Incidents and Patient Complaints The first Quality Improvement Plan (QIP) was Congestive Heart Failure (CHF) developed for SRH and submitted to Health Quality • 30-day readmission rate to own facility - Chronic Obstructive Pulmonary Disease Timely and Effective In addition to teaching and education, SRH Accreditation Ontario (HQO) in March 2017. The QIP was informed (COPD) conducts health research and collaborates in health Accreditation is an external peer-review process by input from a range of stakeholders including •% Patient satisfaction: Did you receive enough information when you left the research initiatives with other organizations. SRH current and former patients/families, community led by Accreditation Canada. Hospitals participate hospital? (medial and surgical research has approximately 90 ongoing clinical in accreditation as part of the continuous quality members, health system partners, staff, clinicians, inpatients) research studies on the go, approximately 35% are improvement process. During accreditation, and leadership. The 2017-18 QIP focuses on •% Inpatients identified as palliative who are discharged home with support clinical trials. There is a well-established Research surveyors come on-site to assess how hospital sixteen indicators that are being tracked through •% Patient satisfaction in the ED: Would Ethics Board that reviews all studies. Our research programs, services, and policies/procedures the organization’s Quality and Safety Scorecard (see you recommend emergency program aligns with our teaching program. For below Table). The Scorecard is anchored to the HQO department? are meeting national standards of excellence. Patient Centered •% Patient satisfaction: Would you example, the SRH research program reviews and Accreditation is a key component of the SRH quality quality elements: Safe, Timely and Effective, Patient recommend inpatient care? (medical and assists with the mandatory research projects and patient safety agenda. Both legacy RVHS and Centred, Our People, and Efficient. The Scorecard is surgical inpatients) required in the Family Medicine residency program. legacy TSH were surveyed in fall 2016 with strong produced quarterly and shared with leadership and •# of ideas implemented per full time Our People Each family medicine resident must complete a results. SRH anticipates the first Accreditation the board. equivalent (FTE) Efficient • Net Margin research project by the end of their residency. survey visit for the new organization will take place in 2020. As a newly integrated organization, opportunities SRH is preparing for changes to the Accreditation exist to build on our relationships with the academic Canada process. Accreditation Canada is revamping community in both primary and specialty care. its approach to standard setting and inspections in Medical and interprofessional education, teaching collaboration with Health Standards Organization and research are areas of potential growth and opportunity requiring careful consideration in the Table 22: Legacy Organization Accreditation Results strategic planning process. Accreditation Legacy RVHS Legacy TSH

2,547 criteria met out of 2,626 criteria 2,418 criteria met out of 2,434 criteria Criteria met evaluated (97%) evaluated (99%)

Reuired 1 unmet ROP: Falls Prevention in Organizational Ambulatory Care Services and 1 unmet ROP: Safe Surgery Checklist QUALITY & SAFETY Practices Diagnostic Imaging Services

There are many quality initiatives in place at the hospital-wide and departmental levels. The Quality

48 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 49 In fiscal year 2016-17, positive performance conducted to understand the root cause of patient Figure 9: Age of Asset and Facility Condition Index (FCI) Rating against target was seen in several areas (refer incidents, learn lessons and identify ways to prevent AGE OF ASSET AND FCI RATING to Appendix B). Opportunities existed for a few a similar incident from occurring in the future. The metrics that did not achieve target at all sites. patient/family perspective is an integral part of the 2010 0.90 Performance is consistently below target in 90th review. 2000 0.80 percentile emergency department length of stay 1990 0.70 for complex patients. Challenges related to wait Opportunities to improve patient care and service 1980 0.60 time in the ED were discussed in the earlier section are also identified through patient/family feedback. 1970 0.50 on ED utilization. In addition, patient satisfaction The integrated Patient Relations department is 1960 0.40 on inpatient medical and surgical units in terms in place to respond to patient complaints at all of response to the survey question, ‘Would you sites and to provide support to staff and clinicians 1950 0.30 recommend this hospital to family and friends?’ on patient/family interactions and strategies 1940 0.20 remains below target. to increase patient satisfaction. Patients and 1930 0.10

families can access Patient Relations using a 1920 0.00

Ontario hospitals publicly report several patient range of channels such as email, telephone, letter S AL

safety indicators, which are published on the HQO or in-person. SRH aims to acknowledge patient YS & 25 HOSPIT WER WING EAST WING WEST WING TO TH WA TION BUILDING CENTRAL WING

website. Results are available by LHIN, location, complaints within 48 hours. PA TA LLEY CENTENARY LLEY CENTENARY LLEY CENTENARY LLEY CENTENARY CROCKFORD WING SITE COMPONENTS SITE COMPONENTS VA VA VA VA

hospital type or hospital. SRH also participates in SUBS ENGINEERING BUILDING ROUGE ROUGE ROUGE ROUGE TSH - BIRCHMOUNT CAMPUS TSH - BIRCHMOUNT CAMPUS TSH - BIRCHMOUNT CAMPUS the CIHI Your Health System Performance biannual INFRASTRUCTURE TH CENTRE — MAIN BUILDING TH CENTRE — TH CENTRE — SITE COMPONENT HEAL HEAL TSH - SCARBOROUGH GENERAL SITE TSH - SCARBOROUGH GENERAL SITE TSH - SCARBOROUGH GENERAL SITE TSH - SCARBOROUGH GENERAL SITE TSH - SCARBOROUGH GENERAL SITE TSH - SCARBOROUGH GENERAL SITE TSH - SCARBOROUGH GENERAL SITE indicator reporting, which is publicly reported on the & NEWBORN TH CENTRE — BIRTHING HEAL

CIHI website. Along with the typical set of indicators Facilities HEAL

(e.g. Hospital Standardized Mortality Ratio (HSMR), The table below outlines the current footprint and ASSET Year Constructed ASSET FCI total time spent in ED, in-hospital sepsis, etc.), the details of each SRH site. Source: Nadine Database latest release includes infection control indicators Table 24: Facility Details by Site, 2017 (in-hospital Clostridium difficile infections, in- The Birchmount site is in the bottom 10% of In addition, the Minister’s direction is that there hospital Methicillin-resistant Staphylococcus aureus Site Square Feet Acres Parking Spaces Cleanable Square Feet hospital facilities in Ontario and both the General is a compelling need for detailed capital planning (MRSA) infections) and a new indicator with a Birchmount 429,645 22 628 365,200 and Centenary sites rank in the bottom half despite for facility enhancement and expansion for the focus on alcohol harm, though this indicator is not General 584,682 26 1,221 516,000 Centenary 807,479 24 1,357 686,400 infrastructure investments over the past several Scarborough community. A major focus for SRH will released at the facility level. years at each of the sites. be responding to recommendations from the Expert Source: Nadine Database Panel report, and planning for a new hospital in Management of Patient Incidents and Complaints The creation of SRH streamlines capital planning Scarborough. These recommendations include: The Facility Condition Index (FCI) is used to Electronic incident reporting is available for use processes and better positions the hospital to categorize the condition of hospital buildings – by staff to ensure timely documentation of patient receive funding for capital investments in facility • With the support of the MOHLTC and Central this is a rating system that assigns a value to incidents and near misses. Leadership receives redevelopment. There are currently several capital East LHIN, planning must begin for the siting each building as a function of the value of deferred automatic alerts of incidents where patients are projects in progress across SRH. These projects will and construction of a new comprehensive (backlog) maintenance over the cost of replacing harmed. The number of reported incidents has help to maintain the existing facility infrastructure. acute care hospital, taking into account the the asset. A low FCI indicates that an asset is remained fairly constant over the last three years. As stated in the integration proposal to the Central full spectrum of health care required to meet in good condition; a high FCI indicates the need Over ninety percent of reported incidents and near East LHIN, integration opens up new opportunities for the needs of the Scarborough community well for significant capital investment or otherwise misses did not result in an injury or resulted in a infrastructure renewal and allows for more efficient use into the future. Prepare and submit plans replacement. The chart below illustrates, by site slight injury that did not require treatment. Falls and of scarce capital resources and the development of a for an expanded ED at the Birchmount site component, the age of the asset and the FCI. medication incidents are the most common types new plant. taking into consideration the anticipated of incidents reported. Quality of care reviews are needs for patient care for the next 15 years.

50 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 51 • Undertake an early works capital project SRH. The Transition Services Agreement for IM/ IT service delivery model for a single HIS solution), • High volume of acute care beds in the 1) surgical suites and 2) diagnostic IT Services is supported by an external report from as a way to generate benefits while minimizing occupied by ALC patients. imaging suite at the General site subject HealthTech Consultants that defines the roadmap overall HIS costs and the number of distinct HIS • Higher than budget volumes of ED to a final functional plan being approved. for divestment of the Ajax-Pickering site systems to vendor solutions. Moving forward, hospitals that visits which result in higher than budget • Undertake an early works capital project Lakeridge Health. have procured services from the same HIS vendor inpatient acute care admissions. will form a HIS Collaborative; initial Collaboratives in the ED at the Centenary site subject to • Fluctuating non-elective Quality Based Several requirements must be met to ensure patient supported by the Ministry will be Cerner, Epic, and a final functional plan being approved. Procedure (QBP) volumes, such as Chronic safety and minimize risk by enabling sharing of Meditech. Each HIS Collaborative will be chaired • Undertake an early works capital project for a Obstructive Pulmonary Disease (COPD) patient information across sites. Fortunately, legacy by a lead hospital and will be represented at a satellite Chronic Kidney Disease and Dialysis and Congestive Heart Failure (CHF). sites use many (approximately 50%) of the same provincial leads table that will set core principles Centre, as part of plans for a new Bridletowne systems and applications, however, with different and requirements to provide a framework for all Community Centre in Scarborough, subject Delivering surpluses to fund capital investments configurations and functionality. In some cases, master service agreements. The latest Ministry to a final functional plan being approved. (e.g. equipment, building renovations and repairs, harmonizing to a single system or full replacement memo from May 2017 explained the provincial and information technology and systems) while may be required. Five IM/IT integration priorities for approach to engage HIS vendors in this direction A facility master plan is underway that will address meeting growing patient needs, is a challenge for SRH are: and receive their innovative ideas for achieving HIS both current facilities and the new facility. The the hospital sector. Over the long-term, there are hubs. master plan guides future capital development that potential savings for the integrated organization 1. Consolidate enterprise hospital is based on the current and evolving needs of the but significant upfront investments such as information systems SRH is participating in the Central East LHIN HIS local community; it sets a vision for how the health building renovations are often required to fund the 2. Consolidate department clinical systems Collaborative process. A consultant is working with care services will be delivered to the community integration. the participating Central East LHIN hospitals to through the facilities/sites. Implementation 3. Consolidate back office systems develop a Request for Proposal for a HIS. SCARBOROUGH AND ROUGE HOSPITAL timelines are uncertain but once SRH has a master 4. Merge networks and email systems STATEMENTOF OPERATIONS FOR 2017/18 (IN THOUSANDSOF DOLLARS) plan, including a capacity and future growth 5. Merge telecommunication systems FINANCIAL POSITION Annual Budget analysis, there are elements that can potentially Revenue move forward under the Ministry’s capital planning Ministry of Health and Long Term Care and Cancer Care Ontario 554,333 A detailed 3-Year Plan has been developed to SRH has a 2017/18 operating budget of $635.5 process. A master plan will be a deliverable over the Patient Revenues 42,257 million. The majority of SRH revenue comes from support these integration priorities. Recoveries and Other Income 25,150 next two years and include assessment, options, the MOHLTC. The majority of expenses relate to Ancillary Operations 5,281 and preferred direction. Like many hospitals, the SRH legacy organizations compensation for our over 5,000 employees. Amortization of Capital Grants 8,525 635,547 have been challenged to upgrade and renew IM/IT Information Management and Information Expenses systems to keep up with technological advances Key financial indicators for 2017/18 include: Technology (IM/IT) Compensation 421,502 and support PFCC. Financial constraints and Medical and Surgical Supplies 47,957 The most significant financial investments required Current Trend Drugs 35,453 provincial directives have had an impact on Desired March Projected Final Indicators (March 2017 to for the foundational work that will be critical in the Trend 2017 March 2018 Supplies and Other Expenses 92,294 the pace of investment. In 2015, the MOHLTC March 2018) post-merger implementation phase relate to IM/IT. Current ratio ↑ 0.37 0.41 ↑ Ancillary Operations 2,548 put a pause on all Health Information System Amortization of Capital Grants 27,759 The Health Information Technology Services (HITS) Operating Margin as a % Revenue ↑ 1.14% 0.00% ↓ (HIS) investments. The HIS Renewal Advisory Bad Debt Expense 3,080 department must continue to provide operational Panel was struck and in August 2016, the panel Interest on Long Term Debt 1,159 support services to the Lakeridge Health Ajax- 631,752 released recommendations within the following SRH ended fiscal year 2016-17 with a $7.3M Pickering site, work with Lakeridge Health to Excess of Revenue Over Expenses Before Non-Recovering Items 3,795 surplus. The 2017/18 projected excess of revenue four categories: partnering, clinical adoption and Integration Expenses 3,795 separate and divest systems that were shared outcomes, procurement, and financing. Hospitals over expenses is $0, which the Hospital is on track Excess of Revenue Over Expenses After Non-Recurring Items 0 between Ajax-Pickering and the Centenary site and were directed to form HIS clusters (group of to meet as of July 31, 2017. Examples of key move forward with system integration between hospitals that serve a specialty or geographic financial challenges that will need to be managed the Birchmount, General and Centenary sites of referral base), or the more advanced HIS hubs (an include:

52 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 53 Like all hospitals, SRH is impacted by Health Since the HBAM methodology works on a two-

Figure 10: SRH Statement of Operations for 2017/18 System Funding Reform that was introduced year lag, SRH needs to be able to manage and in 2012. New funding approaches aim to move absorb additional volumes within their current Ontario’s healthcare system away from global cost structure as much as possible. SRH must funding to a model in which funds primarily follow focus on attracting new funding and community 1.4% the care that patients need and are provided. Under partnerships, and developing and executing 0.8% the new model, Ontario’s hospitals are compensated strategies that will improve outcomes and lower 4.5% REVENUE based on how many patients they look after, the costs. services they deliver, the evidence-based quality of 6.5% Ministry of Health & Long-Term those services or procedures, and the specific needs Foundation Support Care and Cancer Care Ontario of the broader population they serve. Patient-based Patient Revenues funding is comprised of two components:

Recoveries and Other Income • QBPs are specific sets of clinically related services, diagnoses, or treatments for which 86.8% Ancillary Operations funding is the product of a specified volume Amortization of Capital Grants level and a stated price. This approach SRH has a newly integrated Foundation that plays reimburses healthcare providers for the an important role in raising funds to support the types and quantities of patients they treat, purchase of critical medical equipment and building using evidence-informed rates that are projects. Current campaigns are aligned with the associated with the quality of care delivered. hospital’s capital/redevelopment needs. Foundation Detailed handbooks have been published goals include having significant participation by for QBPs that provide hospitals with hospital leadership, staff, and professional staff 1.3% EXPENSES information on best practices for effective in raising funds, and then achieving success in 0.2% and efficient management of QBP conditions marketing to the community. Salaries, Wages, and Benefits • 4.3% /procedures. Global funding will be reduced 0.5% Medical and Surgical Supplies in proportion as funding for QBPs increases. 14.1% • HBAM is a population based allocation Drugs methodology that quantifies the appropriate 5.6% Other Supplies and Expenses share of funding for each hospital, for non- QBP services and is influenced significantly Ancillary Operations by an organization’s relative market share. 7.9% Amortization of Capital Assets

Interest on Long-Term Debt

66.1% Integration Expenses

Source: Finance

54 • Internal Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Internal Environment • 55 EXTERNAL ENVIRONMENT EXTERNAL ENVIRONMENT Scarborough North covers an area of approximately based on social risk factors and health – very good or excellent has 42 km2 with the following boundaries: This section of the environmental scan examines several fall within Scarborough, with also dropped from 61% in 2012 to 59% key characteristics and trends of the broader the majority in Scarborough South. in 2014 for the Central East LHIN. Border Description environment in which SRH operates. It explores • Access to transportation is a high profile • There are opportunities for enhanced • The northern border follows Steeles Ave what is happening within the communities that SRH public issue in Scarborough. Population responses to the health disparities from Victoria Park Ave to Markham Road. North serves, oversight bodies that SRH is accountable projections into 2041 show relative and access barriers amongst the This border is adjacent to the Central to, and across the broader healthcare system. growth among those 65+ years of age diverse population it serves. LHIN. The external environment and how it is predicted is predicted to account for the largest • The western border follows Victoria Park to change within the next several years provides proportion of demographic growth. Ave from Steeles Ave to Highway 401. West cues for the issues that SRH will need to be able to This border is adjacent to the Toronto • Diversity in Scarborough is evident GEOGRAPHY address, and the opportunities that are emerging. Central LHIN. in comparisons with the Central East Relationships and connections will be drawn and • The southern border follows Highway 401 LHIN population. Compared to the SRH’s primary catchment area is the municipality identified between SRH’s current state and issues from Victoria Park Ave to Markham Road. Central East LHIN, the two Scarborough of Scarborough. Scarborough is part of the City and trends seen in the external environment. These South This border is adjacent to the sub-regions have a higher percentage of Toronto. It covers approximately 181 km2 and connections will provide further insight into the Scarborough South Health Link of residents with no high school is a densely populated urban area. Scarborough opportunities and risks facing SRH. Community. education, lower income, visible accounts for approximately 40% of the population • The eastern border follows Markham minorities, immigrant populations, in the Central East LHIN, but only 1.1% of the LHIN’s COMMUNITY DEMOGRAPHICS Road from Steeles Ave to Highway 401. and lone parent families. Scarborough geography. The Central East LHIN is one of the East This border is adjacent to the fastest growing geographic regions in the province North has a high percentage of Scarborough South Health Link Keypoints and Strategic Considerations and encompasses more than 11.7% of Ontario’s residents that do not know how to Community. • SRH’s primary catchment area is speak either English or French. population. The Central East LHIN is a mix of urban the municipality of Scarborough. and rural geography and is the sixth-largest LHIN in Source: Central East LHIN Health Link Community Profiles • The largest visible minority groups in Scarborough accounts for land area in Ontario (16,667.8 km2). Scarborough include South Asian, Black, approximately 40% of the population in The neighbourhoods that make up the Scarborough Chinese, and Filipino residents. The the Central East LHIN, but only 1.1% of The Scarborough community is often divided into North sub-region are listed below: top five countries that new immigrants the LHIN’s geography. Scarborough’s smaller geographical areas, or neighbourhoods, to Scarborough originate from are: population is expected to increase by for the purpose of planning and local service China, Sri Lanka, Philippines, India, and Neighbourhoods 10% in the next 15 years. Population delivery. The Central East LHIN has seven sub- Hong Kong. The top five languages Agincourt South-Malvern West projections into 2041 show relative regions and two of them are in Scarborough (outside English and French) spoken growth among those 65+ years of age -- Scarborough North and Scarborough South. Agincourt North most often at home for Scarborough is predicted to account for the largest There are 24 neighbourhoods defined in the two residents include: Cantonese, Mandarin, L’Amoreaux proportion of demographic growth. Scarborough sub-regions. Scarborough North has Tamil, Tagalog (Filipino) and Bengali. Milliken • The Central East LHIN has seven six neighbourhoods and Scarborough South has • According to an updated Canadian Steeles sub-regions and two of them are in 18 neighbourhoods. These neighbourhoods were Community Health Survey (CCHS) Scarborough: Scarborough North defined by the City of Toronto. Tam O’Shanter-Sullivan from 2014, the health indicator of life and Scarborough South. There are satisfaction – satisfied or very satisfied 24 neighbourhoods within these sub- Source: Central East LHIN Health Link Community Profiles has decreased in the Central East LHIN regions, defined by the City of Toronto. from 92.8% in 2012 to 87.9% in 2014. The City of Toronto identified 31 Additionally, the indicator, perceived neighbourhoods with priority needs

58 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 59 Scarborough South covers an area of approximately The neighbourhoods that make up the Scarborough • Malvern (Scarborough South) improve quality of life across Scarborough. Several 2 140 km with the following boundaries: South sub-region are listed below: • Kingston-Galloway (Scarborough South) options to improve public transit in Scarborough are being explored. Some of these options would • Steeles-L’Amoreaux (Scarborough North) Border Description Neighbourhoods (Census Sub Divisions) enhance access to one or more of SRH’s three sites. • Eglinton East-Kennedy Park • The northern border follows Highway 401 Bendale (Scarborough South) to Markham Road. It then continues north POPULATION DISTRIBUTION Birchcliffe-Cliffside along Markham Road until reaching • Dorset Park (Scarborough South) Centennial Scarborough Steeles Ave, which follows east until The following table, from the Central East LHIN North • Scarborough Village (Scarborough South) truncating at the service boundary for the Clairlea-Birchmount Health Link Community Profile, highlights some city of Pickering. This border is adjacent of the key characteristics of the two Scarborough Cliffrest In March 2014, the City of Toronto, through the to the Scarborough North Health Link sub-regions, as compared to the Central East LHIN. Community and the Central LHIN. Dorset Park Toronto Strong Neighbourhoods Strategy 2020, These diversity dimensions show our population Eglinton East identified 31 neighbourhoods as falling below the • The western border follows Victoria Park as vulnerable and highlight the importance of Ave south from Highway 401 until it Neighbourhood Equity Score and requiring special Guildwood embedding cultural safety and health equity reaches Eglinton Ave, which to follow east attention. The 13 Priority Areas have been replaced Highland Creek into all aspects of service delivery and planning. until reaching Warden Ave. It then follows by 31 Neighbourhood Improvement Areas (NIAs). Compared to the Central East LHIN, Scarborough Warden Ave south until reaching Milne Ionview has a higher percentage of persons with no high Ave. It follows Milne Ave until intersecting Kennedy Park Eight out of 31 NIAs (26%) are in Scarborough and West school education, lower income, visible minority, with the railroad tracks. It continues most are in Scarborough South: Malvern south-west along the railroad tracks until immigrant population and lone parent families. reaching Mack Ave which it follows south Notably, Scarborough has a very high percentage of Morningside • Oakridge (Scarborough North) until truncating at the shoreline of Lake visible minorities at 83.65% in the North and 66.25% Rouge • Ionview (Scarborough South) Ontario. This border is adjacent to the in South, as compared to the Central East LHIN Scarborough Village Toronto Central LHIN. • Morningside (Scarborough South) (37.20%). In addition, Scarborough North has a high • The southern border follows the shoreline West Hill • West Hill (Scarborough South) percentage of residents that do not know how to of Lake Ontario until intersecting with the Wexford/Maryvale speak either official language (16.16%), compared South • Eglinton East (Scarborough South) Toronto Hunt Golf Club. This border is Woburn to 5.19% for the Central East LHIN. adjacent to Lake Ontario. • Kennedy Park (Scarborough South) • Woburn (Scarborough South) • The eastern border is defined by the Source: Central East LHIN Health Link Community Profiles western service boundary of the city of • Scarborough Village (Scarborough South) East Pickering and ends at Steeles Ave. This Neighbourhoods with Priority Needs border is adjacent to the Durham West Between 2005 and 2013 the City of Toronto Health Link community. Transportation identified 13 Priority Areas (also called Priority Access to transportation is a high profile public Source: Central East LHIN Health Link Community Profiles Neighbourhoods and Priority Improvement issue in Scarborough. According to a briefing note Neighbourhoods) based on over 20 social risk put forth by the Toronto City Planning Division, there factors. Six of the 13 priority areas in the City of are “two overarching priorities for transit planning Toronto were in Scarborough: in Scarborough: Priority 1 (Regional): Connecting Scarborough Centre to higher order rapid transit to encourage residential and employment growth and intensification; and Priority 2 (Local): Better serve existing transit riders, improve access to transit and

60 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 61 Table 25: Indicator Comparison, Central East LHIN and Scarborough Health Link Communities Figure 11: Federal Electoral Districts in Scarborough POPULATION GROWTH PROJECTIONS

Scarborough North Health Scarborough South Health Indicator Central East LHIN Link Community Link Community The Central East LHIN is the second largest LHIN in population and is projected to remain so over Land Area (square kilometer) 16,667.8 42.4 138.3 the next 10 years. Between 2016 and 2041, the Population Density (persons per 4,165.5 3,015.6 Central East LHIN is expected to grow by 26.5% and square kilometer) 89.8 Toronto (includes Scarborough) is expected to grow Population (Years of Age) Population % Population %Population % by 30.4%. Specifically, Scarborough’s population 0-18 338,875 22.60 34,225 19.38 97,950 23.49 is expected to increase by 62,648 or 10% in the 19-64 934,845 62.44 112,000 63.41 262,105 62.85 next 15 years (as presented in the Report of the Scarborough/West Durham Panel). 65-74 118,525 7.92 15,070 8.53 29,835 7.15

75+ 104,970 7.01 15,380 8.71 27,145 6.51

Education: No High School, Figure 13: Population Projections, Central East LHIN and Toronto 15.29 11.54 Aged 25-64 (%) 10.56

Unemployment Rate (%) 9.66 10.76 11.55 4,000,000

Source: Census Profile – Statistics Canada Low Income Population (%) 14.37 20.21 19.94 3,500,000 3,742,826

Knowledge of Official 3,592,423 HISTORICAL POPULATION GROWTH RATE 3,000,000 Languages: Neither English 16.16 3.60 3,429,961

3.18 3,255,351 nor French (%) 3,070,803 2,500,000 2,870,396 Between 2011 and 2016, in Ontario, the TION Knowledge of Official POPULA 0.07 0.10 2,000,000 Languages: French Only (%) 0.07 population increased by 4.6%; the Scarborough 2,046,004

population increased by one percent, to 631,884 1,500,000 1,960,602 1,874,007 Visible Minority Population (%) 37.20 83.65 66.25 1,785,995 1,699,712 in 2016. Scarborough – Centre (3.5%) followed 1,617,165 Immigrant Population (%) 33.21 69.07 53.18 1,000,000 by Scarborough – Southwest (3.3%) noted the Recent Immigrant Population 500,000 highest increase in population growth whereas, (period of immigration: 3.83 10.19 7.57 2006-2011, %) Scarborough – North (-2.3%) and Scarborough – 0 2016 2021 2026 2031 2036 2041 Indigenous Population (%) 2.05 0.06 0.96 Rouge (-0.4%) decreased in population. CELHIN 1,617,165 1,699,712 1,785,995 1,874,007 1,960,602 2,046,004 Toronto 2,870,396 3,070,803 3,255,351 3,429,961 3,592,423 3,742,826 Population of Lone Parent 19.81 23.65 Families (%) 18.71 Figure 12: 2011 and 2016 Population by FED, Scarborough

Population Living Alone (%) 6.17 5.10 7.40 Source: Ministry of Finance 115,000

Source: Central East LHIN Health Link Community Profiles 110,000 Table 26: Population Projections, Scarborough 112,603 110,278 108,826 105,000 106,733 Federal Electoral Districts whereas; the boundaries used for the 2016 Census Population Population Increase Percent Increase 105,542 104,499 100,000 Next 10 Next 15 Next 10 Next 15 For planning purposes, Scarborough can also be are based on the 2013 representation order. 2014 2023 2028 102,386 POPULATION 102,646 years years years years 101,914 102,275 101,080 broken down into Federal Electoral District (FED) 98,800 Total Population 95,000 628,506 668,664 691,154 40,158 62,648 6% 10% Scarborough Areas. FED is an area represented by a member To provide a more in-depth understanding of the

90,000 of the House of Commons. The Scarborough diversity within the Scarborough community, the SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- Source: Report of the Scarborough/West Durham Panel AGINCOURT CENTER GUILDWOOD NORTH ROUGE PARK SOUTHWEST community FEDs are displayed in the following following pages of this environmental scan will 2011 Census 104,499 108,826 101,914 101,080 102,646 106,733 Figure. The boundaries used for the 2011 Census summarize the socio-demographic and census data 2016 Census 105,542 112,603 102,386 98,800 102,275 110,278 are based on the 2003 representation order according to the six FED areas shown in the map. Source: Census 2011 and 2016 - Statistics Canada

62 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 63 The following figures further breakdown the data • Between 2016 and 2041, the Central East LHIN Figure 15: Population Projections, by Age Group, Toronto by age group for the Central East LHIN, Toronto age group 45-64 is projected to increase by 1,400,000 and Scarborough. While there is growth across all 10.9% whereas, those individuals 45-64, living age groups, including our younger demographics, in Toronto, are projected to increase by 24.5%. relative growth among those 65 years and older 1,200,000 606,965

• Both the Central East LHIN and Toronto 596,384 590,579 581,973 is predicted to account for the largest proportion (includes Scarborough) are seeing an 571,155 of demographic growth from 2016-2041, in both increase in their elderly patient (65-84) 1,000,000 552,622 the Central East LHIN and Toronto (includes population, with the highest increase

Scarborough). Some key points to consider are: 800,000 507,218 observed in the 85+ age group (Central 473,995 451,532

East LHIN =182.7%; Toronto=136.1%). 453,648

• Consistent with all other areas in the province, 460,839 • Children (age group 0-14), in the Central 600,000 457,482 more significant growth is expected for 294,383 East LHIN and Toronto will see an 292,247 older age cohorts (65+) (Ontario by 97.9%; 286,988 400,000

increase in population year-over-year. 273,487 259,128

in 2016 = 2,295,329 to 4,542,827 in 2041). POPULATION • In Scarborough, seniors over the 245,342 227,476 232,667

• Toronto (includes Scarborough) high 213,619 200,000 208,004

age of 65 are expected to increase 205,366 179,685 growth areas are coupled with an 180,772 152,906 by 46% in the next 15 years. 149,126 124,719 185,749 95,882 177,382

aging population (age 65+) that is 167,786 163,575 81,301 103,819 134,149 155,117 149,858 0 145,485 projected to double from 2016-2041. 0-14 15-19 20-44 45-64 65-74 75-84 85+

Figure 14: Population Projections, by Age Group, Central East LHIN 2016 409,131 149,858 1,119,990 753,318 229,017 138,020 71,059

700,000 2021 444,861 145,485 1,186,930 782,048 278,989 151,496 80,994

2026 475,454 155,117 1,219,260 803,918 321,732 190,062 89,800

2031 498,981 163,575 1,238,470 834,446 357,557 233,104 103,819 600,000 2036 508,392 177,382 1,257,600 882,735 360,032 272,124 134,149 606,965

596,384 2041

590,579 511,958 185,749 1,281,550 938,081 352,018 305,683 167,786 581,973

500,000 571,155 552,622

507,218 Source: Ministry of Finance 473,995

400,000 460,839 457,482 453,648 451,532

300,000

Table 27: Population Projections for Age 65+, Scarborough 294,383 292,247 286,988

200,000 273,487 259,128 245,342 232,667 POPULATION 227,476 213,619 208,004 205,366 Population Population Increase Percent Increase 180,772

100,000 179,685 152,906

149,126 2014 2023 2028 Next 10 years Next 15 years Next 10 years Next 15 years 124,719 110,064 108,389 104,389 95,645 95,882 92,955 85,339 92,811 88,356

81,301 Population Age 63,690 51,353 38,337 44,667 92,848 118,216 136,002 25,369 43,154 27% 46% 0 65+ Scarborough 0-14 15-19 20-44 45-64 65-74 75-84 85+

Source: Ministry of Finance 2016 245,342 92,955 552,622 457,482 149,126 81,301 38,337

2021 259,128 88,356 571,155 460,839 179,685 95,882 44,667

2026 273,487 92,811 581,973 453,648 208,004 124,719 51,353

2031 286,988 95,645 590,579 451,532 232,667 152,906 63,690

2036 292,247 104,389 596,384 473,995 227,476 180,772 85,339

2041 294,383 110,064 606,965 507,218 213,619 205,366 108,389

Source: Ministry of Finance

64 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 65 AGE DEMOGRAPHICS Seniors Health As a result, a highly coordinated system response, As the size of the senior population continues to that strives to understand and then deal with root Figure 16 displays the 2016 Census population distribution by FED areas. Consistent with the Ontario rise, improving health care for seniors continues cause(s) of seniors’ health care needs, is required population, approximately 30% of the Scarborough population are between the ages of 20 and 44 years to be a top priority of the Central East LHIN. The to better service this population, particularly the whereas, individuals 65 years and older account for 15-21% of the total population. Central East LHIN has the largest number of relatively high percentage of seniors living in seniors (65+) in the province. Specifically, Scarborough-Agincourt within the Scarborough Scarborough-Agincourt has the highest percentage community.

Figure 16: Population Projections, by Age Group, Ontario, Central East LHIN and Scarborough FEDs of seniors (21.4%) whereas; Scarborough- Southwest has the lowest percentage (15.0%). Child Health The age distribution of the Central East LHIN In addition, to the growing number of seniors, our POPULATION ESTIMATES BY AGE COHORT FOR ONTARIO AND SCARBOROUGH 40.0% population and Scarborough FED areas is shown child or paediatric population (0 days to 18 years

35.0% above (Figure 16). According to The Central of age) is also projected to increase in the Central East LHIN 2016-19 Integrated Health Services East LHIN and Toronto (includes Scarborough) 30.0% Plan (IHSP) Goal & Strategic Aims, this priority by 20.0% and 25.3%, respectively. Almost one 25.0% population is growing and impacting the demand in three of Ontario’s paediatric population is 20.0% for health care services: residing in the Central East LHIN. With this in % POPULATION 15.0% mind, the Central East LHIN has Child and Family

10.0% • Over 16% of Central East LHIN’s population as one of their direct care priorities. Advancing

5.0% are seniors aged 65+ (up from 14% in 2011). integrated systems of care across the LHIN will enable health care providers to offer consistent, 0.0% • By 2021, seniors will account for 18% of 0-14 15-19 20-44 45-64 65-74 75-84 85+ the Central East LHIN’s population. standardized care across the region, for complex Ontario 16.4% 6.0% 32.3% 28.5% 9.4% 5.1% 2.2% neonatal and paediatric patients and their families CELHIN 15.2% 5.7% 34.2% 28.3% 9.2% 5.0% 2.4% • Central East LHIN has the highest waitlist with appropriate, timely access to quality clinical Scarborough 15.9% 6.3% 32.5% 28.4% 8.9% 5.4% 2.5% and 2nd highest Long-Term Care (LTC) Scarborough-Agincourt 13.5% 5.5% 31.1% 28.4% 10.2% 7.5% 3.7% services, at the right place and at the right level, demand rate in the province - 118 of every Scarborough-Center 16.2% 6.2% 33.6% 27.8% 8.0% 5.3% 2.8% along the continuum of care and aligned with Scarborough-Guildwood 17.7% 6.5% 33.6% 26.6% 7.9% 5.3% 2.3% 1,000 seniors aged 75+ are living in, or provincial strategies – such as childhood obesity Scarborough-North 15.1% 6.3% 32.7% 28.8% 9.6% 5.3% 2.3% waiting for LTC. However, the LTC bed

Scarborough-Rouge Park which is described below. 16.0% 7.0% 31.6% 29.2% 10.1% 4.4% 1.7% supply per capita has decreased for the 75+ Scarborough-Southwest 16.9% 6.1% 32.2% 29.8% 8.0% 4.4% 2.4% population from 90.1 LTC beds per 1000 Childhood Obesity population age 75+ to 82.9 LTC beds per Source: Census 2016 – Statistics Canada According to a background paper put forth by the 1000 population age 75+ since 2010. Paediatric Obesity Network and the Provincial • Over 40% of the 85+ population live alone Council for Maternal and Child Health, it is well in the community. known that child and youth obesity tracks into • By 2020, an estimated 32,700 Central adulthood. According to 2007 Statistics Canada East LHIN residents will be living with data, in Ontario, 529,000 children/youth under 19 dementia, the second highest in Ontario years of age were overweight and 280,000 were (Alzheimer Society of Canada). obese.

66 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 67 In 2012, the Canadian Health Measures Survey Marital Status and Family Characteristics According to Figure 18, Scarborough – Southwest • Lack of affordable housing showed that nearly 33% of 5-17 year olds were Almost half of Scarborough residents are married has the highest percentage of persons living alone • Discrimination and unfair rental practices overweight or obese. Child and youth obesity and 32% are single. In particular, Scarborough (61%) followed by Scarborough – Centre and • Inadequate building conditions carries with it a number of immediate and long- – North has the highest percentage of married Guildwood (54% and 53%, respectively). • Overcrowding term physical, mental and social effects including families (53.0%) followed by Scarborough – Figure 18: Percentage not in Census Families, • Insufficient availability of services but not limited to type 2 diabetes, high cholesterol Agincourt (52%) and Rouge Park (50%) (Ontario Scarborough and Scarborough FEDs and hypertension and a significant economic is 49%). Lone parent families are highest in • Negative client experience with services burden associated with increased hospitalization Scarborough – Guildwood, reporting 25.7% of lone 100% • Inadequate coordination and length of stay. Table 28 below shows that parent families. The majority of lone parent families 80% among service providers an estimated 39,000 children, aged 2-18 years of are female (80.9-86.0%) (Ontario is 84.2%). Figure • Lack of awareness of services 60% age, living in Scarborough are overweight and/or 17 below illustrates family characteristics for MILIES FA obese and about 30% of this population will have Scarborough and Scarborough FEDs. • Issues with the social assistance system 40% complex needs that require additional support. • Barriers created by social housing policies

Particular challenges faced in some Scarborough Figure 17: Marital Status, Scarborough and Scarborough FEDs 20% % OF PERSONS NOT IN CENSUS % OF PERSONS NOT neighbourhoods include low income as a barrier LANGUAGE 100% 0% to healthy eating and the perception of unsafe H RK PA NO RT neighbourhoods due to crime limiting options with 80% CENTER In Scarborough, 92% of people have knowledge AGINCOURT GUILDWOOD SOUTHWEST ROUGE SCARBOROUGH respect to outdoor exercise (e.g. walking, jogging). SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- of English, 5% have knowledge of French and 60% SRH wants to be a part of helping children in our Living with Relatives Living with Non-Relatives Only Living Alone 7% do not have knowledge of either English or community to build the healthiest bodies they 40% French. The areas with the highest percentage of can. Working together with community partners, Source: Census 2011 – Statistics Canada residents without knowledge of English or French %POPULATION 15+ YEARS 20% we are pleased to offer the Healthy Outcomes are Scarborough – North (17%) and Scarborough Paediatric Program for Scarborough (HOPPS). This The proportion of families in Scarborough who are 0% – Agincourt (15%). Figure 19 below depicts H clinic supports young patients and their families in RK led by lone-parent families is slightly higher than in PA the percent knowledge of official languages in NO RT CENTER AGINCOURT GUILDWOOD SOUTHWEST making important lifestyle changes that will lead ROUGE Toronto as a whole (23% vs. 21%, respectively). Scarborough and Scarborough FED areas. Not SCARBOROUGH SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- to improved health, stronger bodies and a better being able to speak English can have implications Married Common Law quality of life. Data from the Central East LHIN indicates that in Single Other (Separated, Divorced or Widowed) on how health care is accessed and delivered. For Scarborough, 18% of the senior population lives example, a study by Karliner et al. 2010 showed Source: Census 2016 – Statistics Canada alone (excluding seniors residing in LTC homes). Table 28: Overweight and/or Obesity Prevalence that outpatients who don’t speak English well, tend Estimates for Scarborough This figure is higher for Scarborough South at 19.4% to have less access to a usual source of care and Household and Dwelling Characteristics compared to Scarborough North at 15.3%. lower rates of physician visits and preventative Prevalence Estimates for Scarborough Age Range In Scarborough, the majority of persons (85.6%) services. Even if outpatients who do not speak an Total Male Female live in a census family (i.e. a couple family or lone- Homelessness is also a concern in Scarborough. official language do have access to care, they may 2 to 4 years 6,229 3,200 3,026 A recent report on housing and homelessness in 5 to 11 years 15,772 9,611 6,120 parent family). Persons living alone tend to have have poorer adherence, decreased comprehension Scarborough, Laying a Foundation: A Housing and 12 to 17 years 14,415 7,339 7,042 poorer perceived health status, decreased quality of of their diagnosis, decreased satisfaction with care, Homelessness Research Report for Scarborough, 18 years 2,480 1,263 1,217 life and a lower life expectancy compared to those and increased medication complications. Similarly, suggests that the key issues related to Total 38,895 21,413 17,405 living with a partner and that difference in mortality compared to English speakers, inpatients who don’t is more pronounced for men than for women. As homelessness and housing instability are as speak English well may experience longer length Source: Census – Statistics Canada a result, it is crucial to consider accessibility of follows: of stays and have more adverse events while in services to those living alone within our community. hospital.

68 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 69 Figure 20: SRH Telephone and Face-to-Face Interpretation ETHNIC DIVERSITY Based on single responses, in Scarborough, 62.4% Requests, 2016-17 SRH is also working on standardizing the process of the population speak an official language of asking patients to voluntarily share demographic (English and French) at home whereas, 37.6% most information at registration to help us deliver more The Central East LHIN is an ethnically diverse 1% often speak a non-official language at home. The 1% personalized and equitable care for patients in our region, specifically Scarborough. In Scarborough, 1% 70% of the population is considered visible minority, top five languages, other than English or French, 1% community. This will also assist us in having more spoken most often at home in Scarborough include: 1% 10% recent snapshots of our patient population than the with the top three being: South Asian, Chinese and data we receive from national surveys. Launched at Black (approximately 50% of the visible minority • Cantonese 7% 36% Birchmount and General sites in 2016, we currently population). In 2011, 37.2% of Central East LHIN residents were visible minorities (Ontario is 25.9%). • Mandarin ask SRH patients who are inpatients or same day surgery patients to voluntarily share their ethnicity, Figure 21 below illustrates the different ethnic • Tamil 11% ability status, length of time in Canada, and family groups and their proportions in Scarborough FED • Tagalog (Filipino) income. Starting in August 2017, we will expand to areas compared to Ontario. 27% • Bengali patients in pre-admitting, EDs, and mental health satellite sites. Part of the harmonization and Figure 19: Percentage Knowledge of Official Languages, standardization work discussed throughout this Scarborough and Scarborough FEDs TELEPHONE INTERPRETATION REQUESTS document will be the expansion of this initiative to Mandarin Spanish 100% the Centenary site. Cantonese Korean

80% Arabic Nepali Figure 21: Ethnic Diversity, Ontario and Scarborough FEDs Tamil Hindi GES

UA 60% Hungarian Other Languages ONTARIO Farsi 40% SCARBOROUGH- SCARBOROUGH- AGINCOURT CENTRE TOTAL NUMBER OF REQUESTS = 953 20% % KNOWLEDGE OF OFFICIAL LANG

0% 3% H RK PA NO RT CENTER AGINCOURT GUILDWOOD SOUTHWEST ROUGE SCARBOROUGH SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH-

English Only French Only English and French Neither English nor French

SCARBOROUGH- SCARBOROUGH- Source: Census 2016 – Statistics Canada GUILDWOOD NORTH 47% 50%

As outlined in a recent SRH Diversity Services report, between October 2016 and March 2017, the organization received 4,842 telephone and face- to-face interpretation requests. The top languages South Asian Chinese being requested for interpretation are Cantonese SCARBOROUGH- SCARBOROUGH- Black Filipino FACE-TO-FACE INTERPRETATION ROUGE PARK SOUTHWEST and Mandarin. It is important to have interpretation REQUESTS Latin American Arab services available, and also to consider the diversity TOTALCantonese NUMBER OF MandarinREQUESTS =3,889Tamil Southeast Asian West Asian of our population when creating any written Korean Japanese materials, such as patient information pamphlets. TOTAL NUMBER OF TELEPHONE AND Visible Minority, n.i.e. Multiple Visible Minorities FACE-TO-FACE INTERPRETATION REQUESTS = 4,842 Not a Visible Minority

Source: SRH Diversity Service Report Source: National Household Survey (NHS) 2011

70 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 71 Ethnicity is a key determinant of health and impacts sexual health services and nutrition and recreation EDUCATION INCOME AND EMPLOYMENT health care access and utilization. For example, a programs. Barriers to access faced by newcomers study by Quan et al. 2006 found that after adjusting might include lack of familiarity with the Ontario In 2011, Ontario reported 18.6% of residents aged Poverty is a well-established predictor of poor for socio- demographic and health characteristics, health system, language barriers, lack of trust of 15+ had no post-secondary certificate, diploma health. A recent Canadian Institute for Health minority members were more likely than whites to government services and prioritization of other or degree. For Scarborough that figure is slightly Information (CIHI) analysis suggests that have had contact with a general practitioner, but not critical issues over preventative health care (e.g. higher at 20%. Figure 23 displays the Scarborough individuals with a lower socio-economic status specialist physicians. Members of visible minorities employment, housing, family reunification). population aged 15 years and over by highest (SES) have higher morbidity and mortality related were less likely to have been admitted to hospital, certificate, diploma or degree. injury than individuals from higher SES groups, tested for prostate-specific antigen, administered Therefore, understanding immigration patterns may specifically, males in lower SES gradients have a mammogram or given a Pap test. In addition, help identify what service is needed and how to higher hospitalization rates for unintentional Figure 23: Education Levels, Scarborough and Scarborough FEDs injuries. In 2011, Ontario’s unemployment rate different cultural practices have implications for tailor access and service delivery accordingly. 100% service delivery, particularly end-of-life and palliative 90% was 7.8% and the Central East LHIN had one of 80% care. SRH needs to consider the ethnic make-up of Immigration period is the date in which an 70% the highest unemployment rates in the province 60% at 9.7%. Unemployment rates within Scarborough our local community as our population may be at immigrant first obtained his/her landed immigrant 50% higher risk for particular diseases/conditions such or permanent resident status. In 2011, 59% of 40% were even higher ---Scarborough – North at 10.8%; 30% % LEVEL OF EDUCATION as sickle cell in our Black community and kidney Scarborough residents were immigrants and one 20% Scarborough – South at 11.6%. Approximately 20% 10% of Scarborough residents have low incomes and disease risk in the South Asian community. in six arrived in Canada between 2006 and 2011. 0%

H more of its residents rely on government transfer While the economic trajectories of immigrants vary, RK PA NO RT CENTER payments than in other parts of the Central East

IMMIGRATION STATUS immigrants are much more likely to be at risk of AGINCOURT GUILDWOOD SOUTHWEST ROUGE SCARBOROUGH homelessness than individuals who are Canadian SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- LHIN. Postsecondary Certificate, Diploma, or Degree No Certificate, Diploma, or Degree In relation to ethnicity, immigration status is born. Examining recent immigration data (2006- Highschool Diploma or Equivalent an important characteristic to examine in order 2011), in most Scarborough areas, 10% of the Source: National Household Survey (NHS) 2011 to inform service delivery. According to ‘The population immigrated after 2006 (Ontario is 4%). Global City: Newcomer Health in Toronto’ report, This data is displayed in Figure 22. The top five Table 29: Low Income* Population by Geographic Area, Central East LHIN newcomers are healthier, overall, than Canadian- countries that new immigrants have come from born residents. Newcomers have lower rates of who are now living in Scarborough are as follows: Geographical Area Total Population (N) Low Income Population (n) Low Income Population (%) heart disease mortality, cancers and mental health China, Sri Lanka, Philippines, India, and Hong Kong. Durham North East Health Link Community 284,155 29,840 10.50 problems. This health advantage is often referred Durham West Health Link Community 317,870 27,255 8.57 to as the “healthy immigrant effect”. However, Haliburton County and City of Kawartha Lakes Health Figure 22: Percentage of Recent Immigrants, 2006-2011, 88,280 11,615 13.16 research has shown that after settling in Canada, Scarborough and Scarborough FEDs Link Community immigrants lose this advantage over time. The 12% Northumberland County Health Link Community 68,890 8,165 11.85 rates of some health issues among immigrants 10% Peterborough City and County Health Link Community 130,560 17,765 13.61 increase until they equal or exceed rates seen in 8% Scarborough North Health Link Community 174,745 35,320 20.21 the Canadian-born population. Accessibility for 6% Scarborough South Health Link Community 411,955 82,150 19.94 newcomers is also an important issue. Access 4% Central East LHIN 1,476,455 212,110 14.37 % OF RECENT IMMIGRANTS 2% to quality primary and preventative care is crucial Source: Central East LHIN Health Link Community Profiles 0% for maintaining good health. Findings show that *Population defined by the low-income measure after tax (LIM-AT). LIM-AT is a fixed percentage (50%) median adjusted after-tax income of H households observed at the person level, where ‘adjusted’ indicates that a household’s needs are taken into account. RK PA NO RT newcomers are less likely to use primary and CENTER AGINCOURT GUILDWOOD SOUTHWEST ROUGE SCARBOROUGH preventative care and that some services are SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- SCARBOROUGH- difficult to access such as mental health care, Source: National Household Survey (NHS) 2011 perinatal care, dental care, services and care not covered by the Ontario Health Insurance Plan,

72 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 73 The average individual income for Toronto (includes Scarborough) is $44,517, while the median individual PERCEIVED HEALTH STATUS (Figure 26). For the most part, Ontario, Central East income is $27,371. The average total household income for Toronto (includes Scarborough) is $87,038, while LHIN and Toronto Public Health Unit residents have the median income is $58,381. Figure 24 shows the distribution of individual income and Figure 25, shows the Perceived health status reflects ones view of their rated or perceived their health status to be lower distribution of household income. health in general (either rated by themselves or in when compared to the CCHS 2012, with the largest some cases a proxy response). According to the decrease observed in the Central East LHIN for Figure 24: Total Individual Income, Population Age 15+, Scarborough World Health Organization, health is defined as life satisfaction – satisfied or very satisfied (2012 = a state of complete physical, mental and social 92.8% vs. 2014 = 87.9%). In addition, the indicator 80000 well-being and not merely the absence of disease perceived health – very good or excellent has also 70000 or infirmity. According to the updated Canadian dropped from 61% in 2012 to 59% in 2014. This data Community Health Survey (CCHS 2014), the Central 60000 is not available specifically for Scarborough. East LHIN rates are on par with the rest of Ontario 50000

40000 TION Figure 26: Health Indicator Profiles, Ontario, Central East LHIN, Toronto Public Health Unit, 2014

30000 POPULA

20000 91% LIFE SATISFACTION: 88% SATISFIED OR VERY SATISFIED (%) 89% 10000

0

to to to to to to to to to 68% SENSE OF COMMUNITY BELONGING: 68% Under SOMEWHAT OR VERY STRONG (%) $9,999 $5,000 69% $14,999 $19,999 $29,999 $39,999 $49,999 $59,999 $79,999 $99,999 and over $5,000 $100,000 $10,000 $15,000 $20,000 $30,000 $40,000 $50,000 $60,000 $80,000

Source: National Household Survey (NHS) 2011

RS 22% PERCEIVED LIFE STRESS: TO QUITE A LOT (%) 20% Figure 25: Total Household Income in 2010 of Private Households, Scarborough 23% INDICA

35000

70% PERCEIVED MENTAL HEALTH: 70% 30000 VERY GOOD OR EXCELLENT (%) 71%

25000

20000 59% PERCEIVED HEALTH: 59%

TION VERY GOOD OR EXCELLENT (%) 58% 15000 POPULA

10000 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

5000 Ontario Central East LHIN Torento Public Health Unit

0

r Source: National Household Survey (NHS) 2011 to to to to to to to to to to to Unde $9,999 $5,000 $14,999 $19,999 $29,999 $39,999 $49,999 $59,999 $79,999 $99,999 and over $5,000 $124,999 $149,999 $150,000 $10,000 $15,000 $20,000 $30,000 $40,000 $50,000 $60,000 $80,000 $100,000 $125,000

Source: National Household Survey (NHS) 2011

74 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 75 # of Cases for Hospital and Clinical Condition % of Cases Scarborough Residents

SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 12,365 24.9% PREGNANCY AND CHILDBIRTH 1,930 3.9% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,897 3.8% CIRCULATORY SYSTEM 1,230 2.5% OTHER 7,308 14.7% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 10,234 20.6% PREGNANCY AND CHILDBIRTH 1,523 3.1% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,489 3.0% CIRCULATORY SYSTEM 1,336 2.7% OTHER 5,886 11.8% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 6,831 13.8% WHERE SCARBOROUGH RESIDENTS SEEK The tables that follow will also outline the top ten PREGNANCY AND CHILDBIRTH 1,197 2.4% HOSPITAL CARE hospitals that Scarborough residents use for that NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 187 0.4% service, and the specific clinical conditions of the RESPIRATORY SYSTEM 714 1.4% This section will identify where local residents are patients. This assists us in understanding why OTHER 4,733 9.5% obtaining their hospital services and what services residents in our catchments might be travelling to TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 4,168 8.4% they are receiving. This data is also known as hospitals other than SRH. PREGNANCY AND CHILDBIRTH 748 1.5% ‘market share’. Proximity to home is a key factor in NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 725 1.5% determining which hospital a patient uses however, ACUTE INPATIENT RESPIRATORY SYSTEM 349 0.7% there are additional factors including physician OTHER 2,346 4.7% referral, patient perceptions, travel time, public In 2016-17, 59.2% of Scarborough residents NORTH YORK GENERAL HOSPITAL 3,557 7.2% transportation flow, proximity to patient’s place of requiring acute inpatient services came to SRH. PREGNANCY AND CHILDBIRTH 815 1.6% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 811 1.6% work, religious affiliations, historical allegiances These residents visited SRH for the following DIGESTIVE SYSTEM 352 0.7% and so forth. Market share refers to the percentage acute inpatient services: Pregnancy and childbirth, OTHER 1,579 3.2% of residents from a defined geography that visit newborns and neonates with perinatal conditions, SUNNYBROOK HEALTH SCIENCES CENTRE 3,388 6.8% a particular hospital. It can be a measure of circulatory system, and respiratory system CIRCULATORY SYSTEM 543 1.1% “commitment”. As defined earlier in this report, SRH conditions. Other hospitals that served the PREGNANCY AND CHILDBIRTH 373 0.8% has both a primary and secondary catchment. The highest volume of Scarborough residents as acute NERVOUS SYSTEM 342 0.7% tables that follow identify percentage market share inpatients were: Michael Garron Hospital, North OTHER 2,130 4.3% based on primary catchment area (Scarborough) York General Hospital, and Sunnybrook Health ST MICHAEL'S HOSPITAL 1,970 4.0% and secondary catchment area (Scarborough Sciences Centre. The following tables provide CIRCULATORY SYSTEM 506 1.0% plus postal codes L3R, L3S (Markham) and L1V details of the hospitals capturing market share PREGNANCY AND CHILDBIRTH 189 0.4% (Pickering)). For each type of service, and for from SRH’s primary and secondary catchment NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 179 0.4% the primary and secondary catchments, the populations, and the specific clinical conditions of OTHER 1,096 2.2% next sections of this report will describe SRH’s acute inpatients. UNIVERSITY HEALTH NETWORK 1,875 3.8% percentage market share in fiscal year 2016-17. CIRCULATORY SYSTEM 380 0.8% BLOOD AND LYMPHATIC SYSTEM 210 0.4% NERVOUS SYSTEM 148 0.3% Table 30: Acute Inpatient Percentage Market Share by Hospital and Major Clinical Category for SRH Primary Catchment, 2016-17 OTHER 1,137 2.3% SINAI HEALTH SYSTEM-MOUNT SINAI SITE 1,378 2.8% # of Cases for Hospital and Clinical Condition % of Cases PREGNANCY AND CHILDBIRTH 470 0.9% Scarborough Residents NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 361 0.7% SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 12,365 24.9% DIGESTIVE SYSTEM 97 0.2% PREGNANCY AND CHILDBIRTH 1,930 3.9% OTHER 450 0.9% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,897 3.8% HOSPITAL FOR SICK CHILDREN (THE) 1,350 2.7% CIRCULATORY SYSTEM 1,230 2.5% DIGESTIVE SYSTEM 187 0.4% OTHER 7,308 14.7% EAR, NOSE, MOUTH AND THROAT 134 0.3% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 10,234 20.6% RESPIRATORY SYSTEM 120 0.2% PREGNANCY AND CHILDBIRTH 1,523 3.1% OTHER 909 1.8% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,489 3.0% ALL OTHER HOSPITALS IN ONTARIO 2,557 5.1% CIRCULATORY SYSTEM 1,336 2.7% OTHER 5,886 11.8% TOTAL 49,673 100.0% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 6,831 13.8% PREGNANCY AND CHILDBIRTH 1,197 2.4% Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 187 0.4% RESPIRATORY SYSTEM 714 1.4% 76OTHER • External Environment SCARBOROUGH AND ROUGE HOSPITAL:4,733 2017 CORPORATE ENVIRONMENTAL9.5% SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 77 TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 4,168 8.4% PREGNANCY AND CHILDBIRTH 748 1.5% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 725 1.5% RESPIRATORY SYSTEM 349 0.7% OTHER 2,346 4.7% NORTH YORK GENERAL HOSPITAL 3,557 7.2% PREGNANCY AND CHILDBIRTH 815 1.6% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 811 1.6% DIGESTIVE SYSTEM 352 0.7% OTHER 1,579 3.2% SUNNYBROOK HEALTH SCIENCES CENTRE 3,388 6.8% CIRCULATORY SYSTEM 543 1.1% PREGNANCY AND CHILDBIRTH 373 0.8% NERVOUS SYSTEM 342 0.7% OTHER 2,130 4.3% ST MICHAEL'S HOSPITAL 1,970 4.0% CIRCULATORY SYSTEM 506 1.0% PREGNANCY AND CHILDBIRTH 189 0.4% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 179 0.4% OTHER 1,096 2.2%

UNIVERSITY HEALTH NETWORK 1,875 3.8% CIRCULATORY SYSTEM 380 0.8% BLOOD AND LYMPHATIC SYSTEM 210 0.4% NERVOUS SYSTEM 148 0.3% OTHER 1,137 2.3%

SINAI HEALTH SYSTEM-MOUNT SINAI SITE 1,378 2.8% PREGNANCY AND CHILDBIRTH 470 0.9% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 361 0.7% DIGESTIVE SYSTEM 97 0.2% OTHER 450 0.9%

HOSPITAL FOR SICK CHILDREN (THE) 1,350 2.7% DIGESTIVE SYSTEM 187 0.4% EAR, NOSE, MOUTH AND THROAT 134 0.3% RESPIRATORY SYSTEM 120 0.2% OTHER 909 1.8%

ALL OTHER HOSPITALS IN ONTARIO 2,557 5.1%

TOTAL 49,673 100.0% # of Cases for Hospital and Clinical Condition % of Cases Scarborough Residents

SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 13,333 21.9%

PREGNANCY AND CHILDBIRTH 2,252 3.7%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 2,213 3.6%

CIRCULATORY SYSTEM 1,266 2.1%

OTHER 7,602 12.5%

SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 11,368 18.7%

PREGNANCY AND CHILDBIRTH 1,694 2.8%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,659 2.7%

CIRCULATORY SYSTEM 1,481 2.4%

OTHER 6,534 10.8%

SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 7,618 12.5%

PREGNANCY AND CHILDBIRTH 1,353 2.2%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,346 2.2%

RESPIRATORY SYSTEM 770 1.3%

OTHER 4,149 6.8%

NORTH YORK GENERAL HOSPITAL 4,349 7.2%

PREGNANCY AND CHILDBIRTH 1,085 1.8%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,083 1.8%

DIGESTIVE SYSTEM 394 0.6%

OTHER 1,787 2.9%

TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 4,317 7.1%

PREGNANCY AND CHILDBIRTH 776 1.3%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 749 1.2%

RESPIRATORY SYSTEM 363 0.6%

OTHER 2,429 4.0%

MARKHAM STOUFFVILLE HOSPITAL 4,206 6.9%

PREGNANCY AND CHILDBIRTH 621 1.0%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 617 1.0%

DIGESTIVE SYSTEM 436 0.7%

OTHER 2,532 4.2%

When SRH’s secondary catchment area, including neighbouring communities outside of Scarborough, is SUNNYBROOK HEALTH SCIENCES CENTRE 3,988 6.6% included in the market share analysis, SRH provides acute inpatient services to 53.2% of the population residing CIRCULATORY SYSTEM 610 1.0% in its primary and secondary catchment areas. PREGNANCY AND CHILDBIRTH 452 0.7%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 410 0.7% Table 31: Acute Inpatient Percentage Market Share by Hospital & Major Clinical Category for SRH Primary and Secondary Catchment, 2016-17 OTHER 2,516 4.1%

UNIVERSITY HEALTH NETWORK 2,315 3.8% # of Cases for Hospital and Clinical Condition % of Cases CIRCULATORY SYSTEM 471 0.8% Scarborough Residents BLOOD AND LYMPHATIC SYSTEM 275 0.5% SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 13,333 21.9% RESPIRATORY SYSTEM 183 0.3% PREGNANCY AND CHILDBIRTH 2,252 3.7% OTHER 1,386 2.3% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 2,213 3.6% ST MICHAEL'S HOSPITAL 2,251 3.7% CIRCULATORY SYSTEM 1,266 2.1% CIRCULATORY SYSTEM 579 1.0% OTHER 7,602 12.5% NERVOUS SYSTEM 220 0.4% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 11,368 18.7% PREGNANCY AND CHILDBIRTH 200 0.3% PREGNANCY AND CHILDBIRTH 1,694 2.8% OTHER 1,252 2.1% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,659 2.7% HOSPITAL FOR SICK CHILDREN (THE) 1,660 2.7% CIRCULATORY SYSTEM 1,481 2.4% DIGESTIVE SYSTEM 226 0.4% OTHER 6,534 10.8% EAR, NOSE, MOUTH AND THROAT 161 0.3% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 7,618 12.5% BLOOD AND LYMPHATIC SYSTEM 155 0.3% PREGNANCY AND CHILDBIRTH 1,353 2.2% OTHER 1,118 1.8% NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,346 2.2% ALL OTHER HOSPITALS IN ONTARIO 5,359 8.8% RESPIRATORY SYSTEM 770 1.3% TOTAL 60,764 100.0% OTHER 4,149 6.8%

NORTH YORK GENERAL HOSPITAL 4,349 7.2% Source: Discharge Abstract Database (DAD) - MOHLTC Intellihealth PREGNANCY AND CHILDBIRTH 1,085 1.8%

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 1,083 1.8%

DIGESTIVE SYSTEM 394 0.6% OTHER 1,787 2.9% EMERGENCY DEPARTMENT Other hospitals capturing the highest ED market TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 4,317 7.1% share for Scarborough residents were Michael PREGNANCY AND CHILDBIRTH 776 1.3% In 2016/17, 68.2% of Scarborough residents Garron Hospital, North York General Hospital,

NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 749 1.2% requiring emergency services came to SRH. The and the Hospital for Sick Children. The following top clinical condition (based on the Comprehensive RESPIRATORY SYSTEM 363 0.6% tables provide details of the hospitals capturing Ambulatory Condition System (CACS)) for each OTHER 2,429 4.0% market share within our primary catchment hospital’s ED visits for residents of Scarborough is area (Scarborough), within both our primary and MARKHAM STOUFFVILLE HOSPITAL 4,206 6.9% provided in the table below. Diseases or disorders secondary catchments, and the specific clinical PREGNANCY AND CHILDBIRTH 621 1.0% of the digestive system is the top reason for conditions for the emergency department visits. NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 617 1.0% Scarborough residents visiting our EDs at SRH. DIGESTIVE SYSTEM 436 0.7%

OTHER 2,532 4.2%

SUNNYBROOK HEALTH SCIENCES CENTRE 3,988 6.6%

CIRCULATORY SYSTEM 610 1.0%

PREGNANCY AND CHILDBIRTH 452 0.7% 78 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 79 NEWBORNS AND NEONATES WITH PERINATAL CONDITIONS 410 0.7%

OTHER 2,516 4.1%

UNIVERSITY HEALTH NETWORK 2,315 3.8%

CIRCULATORY SYSTEM 471 0.8%

BLOOD AND LYMPHATIC SYSTEM 275 0.5%

RESPIRATORY SYSTEM 183 0.3%

OTHER 1,386 2.3%

ST MICHAEL'S HOSPITAL 2,251 3.7%

CIRCULATORY SYSTEM 579 1.0%

NERVOUS SYSTEM 220 0.4%

PREGNANCY AND CHILDBIRTH 200 0.3%

OTHER 1,252 2.1%

HOSPITAL FOR SICK CHILDREN (THE) 1,660 2.7%

DIGESTIVE SYSTEM 226 0.4%

EAR, NOSE, MOUTH AND THROAT 161 0.3%

BLOOD AND LYMPHATIC SYSTEM 155 0.3%

OTHER 1,118 1.8%

ALL OTHER HOSPITALS IN ONTARIO 5,359 8.8%

TOTAL 60,764 100.0% # of Cases for Hospital and Clinical Condition Scarborough Residents % of Cases

SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 59,342 27.3%

DISEASE OR DISORDER DIGESTIVE SYSTEM 7,670 3.5%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,205 1.9%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 4,179 1.9%

OTHER 43,288 19.9%

SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 53,280 24.5%

DISEASE OR DISORDER DIGESTIVE SYSTEM 5,990 2.8%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,276 2.0%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 3,790 1.7%

OTHER 39,224 18.0%

SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 35,874 16.5%

DISEASE OR DISORDER DIGESTIVE SYSTEM 4,368 2.0%

DISEASE OR DISORDER SKIN & BREAST 2,538 1.2%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 2,439 1.1%

OTHER 26,529 12.2%

TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 16,264 7.5%

DISEASE OR DISORDER DIGESTIVE SYSTEM 1,729 0.8%

DISEASE OR DISORDER SKIN & BREAST 1,234 0.6%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 1,159 0.5%

OTHER 12,142 5.6%

NORTH YORK GENERAL HOSPITAL 12,083 5.6%

DISEASE OR DISORDER DIGESTIVE SYSTEM 1,539 0.7%

DISEASE OR DISORDER SKIN & BREAST 838 0.4%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 833 0.4%

OTHER 8,873 4.1%

HOSPITAL FOR SICK CHILDREN (THE) 7,402 3.4%

SYSTEMIC INFECTION 1,299 0.6%

DISEASE OR DISORDER DIGESTIVE SYSTEM 1,079 0.5%

DISEASE OR DISORDER EAR 978 0.4%

OTHER 4,046 1.9%

SUNNYBROOK HEALTH SCIENCES CENTRE 5,672 2.6%

OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 876 0.4%

DISEASE OR DISORDER DIGESTIVE SYSTEM 505 0.2%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 394 0.2%

OTHER 3,897 1.8%

MARKHAM STOUFFVILLE HOSPITAL 5,592 2.6%

DISEASE OR DISORDER DIGESTIVE SYSTEM 685 0.3% Table 32: Emergency Department Market Share by Hospital and Clinical Condition for SRH Primary Catchment, 2016-17 DISEASE OR DISORDER SKIN & BREAST 455 0.2% # of Cases for Hospital and Clinical Condition DISEASE OR DISORDER EAR 449 0.2% Scarborough Residents % of Cases OTHER 4,003 1.8% SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 59,342 27.3% ST MICHAEL'S HOSPITAL 4,226 1.9% DISEASE OR DISORDER DIGESTIVE SYSTEM 7,670 3.5% OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 382 0.2% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,205 1.9% DISEASE OR DISORDER DIGESTIVE SYSTEM 366 0.2% DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 4,179 1.9% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 356 0.2% OTHER 43,288 19.9% OTHER 3,122 1.4% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 53,280 24.5% UNIVERSITY HEALTH NETWORK-GENERAL SITE 2,535 1.2% DISEASE OR DISORDER DIGESTIVE SYSTEM 5,990 2.8% OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 260 0.1% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,276 2.0% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 253 0.1% DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 3,790 1.7% DISEASE OR DISORDER DIGESTIVE SYSTEM 252 0.1% OTHER 39,224 18.0% OTHER 1,770 0.8% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 35,874 16.5% ALL OTHER HOSPITALS IN ONTARIO 15,372 7.1% DISEASE OR DISORDER DIGESTIVE SYSTEM 4,368 2.0% TOTAL 217,642 100.0% DISEASE OR DISORDER SKIN & BREAST 2,538 1.2%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 2,439 1.1% Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth

OTHER 26,529 12.2%

TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 16,264 7.5% When SRH’s secondary catchment area, including neighbouring communities outside of Scarborough, is

DISEASE OR DISORDER DIGESTIVE SYSTEM 1,729 0.8% included in the market share analysis, SRH provides emergency services to 59.6% of the population residing in its primary and secondary catchment areas. DISEASE OR DISORDER SKIN & BREAST 1,234 0.6%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 1,159 0.5% Table 33: Emergency Department Market Share by Hospital and Clinical Condition for SRH Primary and Secondary Catchments, 2016-17 OTHER 12,142 5.6% # of Cases for NORTH YORK GENERAL HOSPITAL 12,083 5.6% Hospital and Clinical Condition Scarborough Residents % of Cases DISEASE OR DISORDER DIGESTIVE SYSTEM 1,539 0.7% SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 60,633 22.9% DISEASE OR DISORDER SKIN & BREAST 838 0.4% DISEASE OR DISORDER DIGESTIVE SYSTEM 7,832 3.0% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 833 0.4% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,294 1.6% OTHER 8,873 4.1% DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 4,259 1.6% HOSPITAL FOR SICK CHILDREN (THE) 7,402 3.4% OTHER 44,248 16.7% SYSTEMIC INFECTION 1,299 0.6% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 57,116 21.5% DISEASE OR DISORDER DIGESTIVE SYSTEM 1,079 0.5% DISEASE OR DISORDER DIGESTIVE SYSTEM 6,452 2.4% DISEASE OR DISORDER EAR 978 0.4% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,637 1.7% OTHER 4,046 1.9% DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 4,040 1.5% SUNNYBROOK HEALTH SCIENCES CENTRE 5,672 2.6% OTHER 41,987 15.8% OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 876 0.4% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 40,473 15.3% DISEASE OR DISORDER DIGESTIVE SYSTEM 505 0.2% DISEASE OR DISORDER DIGESTIVE SYSTEM 5,004 1.9% DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 394 0.2% DISEASE OR DISORDER SKIN & BREAST 2,889 1.1% OTHER 3,897 1.8% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 2,729 1.0% MARKHAM STOUFFVILLE HOSPITAL 5,592 2.6% OTHER 29,851 11.3% DISEASE OR DISORDER DIGESTIVE SYSTEM 685 0.3% (ContinuedMARKHAM on STOUFFVILLE the next page) HOSPITAL 26,186 9.9% DISEASE OR DISORDER SKIN & BREAST 455 0.2% 80 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OURDISEASE PATIENTS, OR OURDISORDER COMMUNITY, DIGESTIVE OUR HOSPITAL SYSTEM 3,113 External Environment1.2% • 81 DISEASE OR DISORDER EAR 449 0.2% DISEASE OR DISORDER EAR 1,987 0.7% OTHER 4,003 1.8% DISEASE OR DISORDER SKIN & BREAST 1,915 0.7% ST MICHAEL'S HOSPITAL 4,226 1.9% OTHER 19,171 7.2% OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 382 0.2% TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 16,513 6.2% DISEASE OR DISORDER DIGESTIVE SYSTEM 366 0.2% DISEASE OR DISORDER DIGESTIVE SYSTEM 1,749 0.7% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 356 0.2% DISEASE OR DISORDER SKIN & BREAST 1,258 0.5% OTHER 3,122 1.4% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 1,176 0.4% UNIVERSITY HEALTH NETWORK-GENERAL SITE 2,535 1.2% OTHER 12,330 4.6% OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 260 0.1% NORTH YORK GENERAL HOSPITAL 13,371 5.0% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 253 0.1% DISEASE OR DISORDER DIGESTIVE SYSTEM 1,680 0.6% DISEASE OR DISORDER DIGESTIVE SYSTEM 252 0.1% DISEASE OR DISORDER SKIN & BREAST 935 0.4% OTHER 1,770 0.8% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 922 0.3% ALL OTHER HOSPITALS IN ONTARIO 15,372 7.1% OTHER 9,834 3.7% TOTAL 217,642 100.0% LAKERIDGE HEALTH-AJAX SITE 10,370 3.9%

DISEASE OR DISORDER DIGESTIVE SYSTEM 1,151 0.4%

DISEASE OR DISORDER SKIN & BREAST 744 0.3%

CONTUSION 729 0.3%

OTHER 7,746 2.9%

HOSPITAL FOR SICK CHILDREN (THE) 8,717 3.3%

SYSTEMIC INFECTION 1,542 0.6%

DISEASE OR DISORDER DIGESTIVE SYSTEM 1,290 0.5%

DISEASE OR DISORDER EAR 1,148 0.4%

OTHER 4,737 1.8%

SUNNYBROOK HEALTH SCIENCES CENTRE 6,488 2.4%

OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 993 0.4%

DISEASE OR DISORDER DIGESTIVE SYSTEM 591 0.2%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 442 0.2%

OTHER 4,462 1.7%

ST MICHAEL'S HOSPITAL 4,706 1.8%

OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 431 0.2%

DISEASE OR DISORDER DIGESTIVE SYSTEM 411 0.2%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 396 0.1%

OTHER 3,468 1.3%

ALL OTHER HOSPITALS IN ONTARIO 20,728 7.8%

TOTAL 265,301 100.0% # of Cases for Hospital and Clinical Condition Scarborough Residents % of Cases

SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 60,633 22.9%

DISEASE OR DISORDER DIGESTIVE SYSTEM 7,832 3.0%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,294 1.6%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 4,259 1.6%

OTHER 44,248 16.7%

SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 57,116 21.5%

DISEASE OR DISORDER DIGESTIVE SYSTEM 6,452 2.4%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 4,637 1.7%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 4,040 1.5%

OTHER 41,987 15.8%

SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 40,473 15.3%

DISEASE OR DISORDER DIGESTIVE SYSTEM 5,004 1.9%

DISEASE OR DISORDER SKIN & BREAST 2,889 1.1%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 2,729 1.0% Table 33: Emergency Department Market Share by Hospital and Clinical Condition for SRH Primary and Secondary Catchments, 2016-17 DAY SURGERY The following tables provide details of the hospitals (Continued)OTHER 29,851 11.3% capturing market share for residents of our primary MARKHAM STOUFFVILLE HOSPITAL 26,186 9.9% In 2016-17, 60% of Scarborough residents requiring catchment area (Scarborough), our primary and DISEASE OR DISORDER DIGESTIVE SYSTEM 3,113 1.2% day surgery services came to SRH. The top clinical secondary catchment area populations, and the DISEASE OR DISORDER EAR 1,987 0.7% conditions related to day surgery visits for residents specific clinical conditions for the day surgery DISEASE OR DISORDER SKIN & BREAST 1,915 0.7% of Scarborough are provided in the following table. visits. The majority of procedures involve diseases OTHER 19,171 7.2% Other hospitals capturing the highest day surgery and disorders of the digestive system, diseases and TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 16,513 6.2% market share for Scarborough residents were disorders of the kidney, genitourinary tract, male DISEASE OR DISORDER DIGESTIVE SYSTEM 1,749 0.7% Michael Garron Hospital, North York General and female reproductive system, and diseases and DISEASE OR DISORDER SKIN & BREAST 1,258 0.5% Hospital, and Sunnybrook Health Sciences Centre. disorders of the eye. OTHER DISEASE OR DISORDER CARDIAC SYSTEM 1,176 0.4%

OTHER 12,330 4.6% Table 34: Day Surgery Market Share by Hospital and Clinical Condition for SRH Primary Catchment, 2016-17

NORTH YORK GENERAL HOSPITAL 13,371 5.0% # of Cases for Hospital and Clinical Condition DISEASE OR DISORDER DIGESTIVE SYSTEM 1,680 0.6% Scarborough Residents % of Cases

DISEASE OR DISORDER SKIN & BREAST 935 0.4% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 9,717 20.7%

OTHER DISEASE OR DISORDER CARDIAC SYSTEM 922 0.3% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 4,768 10.2%

OTHER 9,834 3.7% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 2,713 5.8% LAKERIDGE HEALTH-AJAX SITE 10,370 3.9% DISEASES AND DISORDERS OF THE EAR, NOSE, MOUTH AND THROAT 426 0.9% DISEASE OR DISORDER DIGESTIVE SYSTEM 1,151 0.4% OTHER 1,810 3.9% DISEASE OR DISORDER SKIN & BREAST 744 0.3% SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 9,608 20.5% CONTUSION 729 0.3% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE OTHER 7,746 2.9% AND FEMALE REPRODUCTIVE SYSTEM 3,515 7.5%

HOSPITAL FOR SICK CHILDREN (THE) 8,717 3.3% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 3,419 7.3%

SYSTEMIC INFECTION 1,542 0.6% DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND BREAST 769 1.6% DISEASE OR DISORDER DIGESTIVE SYSTEM 1,290 0.5% OTHER 1,905 4.1% DISEASE OR DISORDER EAR 1,148 0.4% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 8,802 18.8% OTHER 4,737 1.8% DISEASES AND DISORDERS OF THE EYE 3,152 6.7% SUNNYBROOK HEALTH SCIENCES CENTRE 6,488 2.4% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 2,984 6.4% OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 993 0.4% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASE OR DISORDER DIGESTIVE SYSTEM 591 0.2% AND FEMALE REPRODUCTIVE SYSTEM 1,175 2.5%

DISEASE OR DISORDER MUSCULOSKELETAL AND CONNECTIVE TISSUE 442 0.2% OTHER 1,491 3.2%

OTHER 4,462 1.7% TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 4,766 10.2%

ST MICHAEL'S HOSPITAL 4,706 1.8% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,525 3.3%

OTHER CONDITION WITH ACUTE ADMISSION/TRANSFER 431 0.2% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 1,307 2.8% DISEASE OR DISORDER DIGESTIVE SYSTEM 411 0.2% DISEASES AND DISORDERS OF THE EYE 1,047 2.2% OTHER DISEASE OR DISORDER CARDIAC SYSTEM 396 0.1% OTHER 887 1.9% OTHER 3,468 1.3% NORTH YORK GENERAL HOSPITAL 2,053 4.4% ALL OTHER HOSPITALS IN ONTARIO 20,728 7.8% (Continued on the next page) DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,143 2.4% TOTAL 265,301 100.0% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 348 0.7% Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL 82 • External Environment CONNECTIVE TISSUE 166 External Environment0.4% • 83

OTHER 396 0.8%

SUNNYBROOK HEALTH SCIENCES CENTRE 2,052 4.4%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 934 2.0%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 298 0.6%

DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND BREAST 146 0.3%

OTHER 674 1.4%

ST MICHAEL'S HOSPITAL 1,764 3.8%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 608 1.3%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 465 1.0%

DISEASES AND DISORDERS OF THE EYE 225 0.5%

OTHER 466 1.0%

NORTH YORK GENERAL HOSPITAL-BRANSON SITE 1,217 2.6%

DISEASES AND DISORDERS OF THE EYE 822 1.8%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 381 0.8%

EXAMINATION AND OTHER HEALTH FACTORS 12 0.0%

OTHER 2 0.0%

HUMBER RIVER HOSPITAL - WILSON SITE 841 1.8%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 327 0.7%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 232 0.5%

DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 62 0.1%

OTHER 220 0.5%

MARKHAM STOUFFVILLE HOSPITAL 794 1.7%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 310 0.7%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 189 0.4%

DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 98 0.2%

OTHER 197 0.4%

ALL OTHER HOSPITALS IN ONTARIO 5,300 11.3%

TOTAL 46,914 100.0% # of Cases for Hospital and Clinical Condition Scarborough Residents % of Cases

SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 9,717 20.7%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 4,768 10.2%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 2,713 5.8%

DISEASES AND DISORDERS OF THE EAR, NOSE, MOUTH AND THROAT 426 0.9%

OTHER 1,810 3.9%

SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 9,608 20.5%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 3,515 7.5%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 3,419 7.3%

DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND BREAST 769 1.6%

OTHER 1,905 4.1%

SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 8,802 18.8%

DISEASES AND DISORDERS OF THE EYE 3,152 6.7%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 2,984 6.4%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 1,175 2.5%

OTHER 1,491 3.2%

TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 4,766 10.2%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,525 3.3%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 1,307 2.8%

DISEASES AND DISORDERS OF THE EYE 1,047 2.2% TableOTHER 34: Day Surgery Market Share by Hospital and Clinical Condition for SRH Primary Catchment, 2016-17887 (Continued) 1.9% When SRH’s secondary catchment area, including neighbouring communities outside of Scarborough, is NORTH YORK GENERAL HOSPITAL 2,053 4.4% included in the market share analysis, SRH provides day surgery services to 55% of the population residing in its

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,143 2.4% primary and secondary catchment areas.

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 348 0.7% Table 35: Day Surgery Market Share by Hospital and Clinical Condition for SRH Primary and Secondary Catchments, 2016-17 DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 166 0.4% # of Cases for Hospital and Clinical Condition Scarborough Residents % of Cases OTHER 396 0.8%

SUNNYBROOK HEALTH SCIENCES CENTRE 2,052 4.4% SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 11,322 19.3%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 5,494 9.4% AND FEMALE REPRODUCTIVE SYSTEM 934 2.0% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 298 0.6% AND FEMALE REPRODUCTIVE SYSTEM 3,169 5.4%

DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND DISEASES AND DISORDERS OF THE EAR, NOSE, MOUTH AND THROAT 548 0.9% BREAST 146 0.3% OTHER 2,111 3.6%

OTHER 674 1.4% SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 10,583 18.1%

ST MICHAEL'S HOSPITAL 1,764 3.8% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 608 1.3% AND FEMALE REPRODUCTIVE SYSTEM 3,975 6.8%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 3,708 6.3% AND FEMALE REPRODUCTIVE SYSTEM 465 1.0% DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND DISEASES AND DISORDERS OF THE EYE 225 0.5% BREAST 847 1.4%

OTHER 466 1.0% OTHER 2,053 3.5%

NORTH YORK GENERAL HOSPITAL-BRANSON SITE 1,217 2.6% SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 10,327 17.6%

DISEASES AND DISORDERS OF THE EYE 822 1.8% DISEASES AND DISORDERS OF THE EYE 3,659 6.2%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 3,549 6.1% AND FEMALE REPRODUCTIVE SYSTEM 381 0.8% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE EXAMINATION AND OTHER HEALTH FACTORS 12 0.0% AND FEMALE REPRODUCTIVE SYSTEM 1,399 2.4%

OTHER 2 0.0% OTHER 1,720 2.9%

HUMBER RIVER HOSPITAL - WILSON SITE 841 1.8% TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 5,012 8.6%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 327 0.7% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,582 2.7%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 232 0.5% AND FEMALE REPRODUCTIVE SYSTEM 1,361 2.3%

DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND DISEASES AND DISORDERS OF THE EYE 1,130 1.9% CONNECTIVE TISSUE 62 0.1% OTHER 939 1.6%

OTHER 220 0.5% MARKHAM STOUFFVILLE HOSPITAL 3,216 5.5%

MARKHAM STOUFFVILLE HOSPITAL 794 1.7% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,461 2.5%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 310 0.7% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 770 1.3% AND FEMALE REPRODUCTIVE SYSTEM 189 0.4% DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 352 0.6% CONNECTIVE TISSUE 98 0.2% OTHER 633 1.1% OTHER 197 0.4% NORTH YORK GENERAL HOSPITAL 2,469 4.2% (Continued on the next page) ALL OTHER HOSPITALS IN ONTARIO 5,300 11.3% DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,364 2.3% TOTAL 46,914 100.0% DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 425 0.7% Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND 84 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OURCONNECTIVE PATIENTS, OUR TISSUE COMMUNITY, OUR HOSPITAL 183 External Environment0.3% • 85

OTHER 497 0.8%

SUNNYBROOK HEALTH SCIENCES CENTRE 2,453 4.2%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 1,107 1.9%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 348 0.6%

DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND BREAST 174 0.3%

OTHER 824 1.4%

ST MICHAEL'S HOSPITAL 2,077 3.5%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 740 1.3%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 540 0.9%

DISEASES AND DISORDERS OF THE EYE 256 0.4%

OTHER 541 0.9%

NORTH YORK GENERAL HOSPITAL-BRANSON SITE 1,717 2.9%

DISEASES AND DISORDERS OF THE EYE 1,264 2.2%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 436 0.7%

EXAMINATION AND OTHER HEALTH FACTORS 15 0.0%

OTHER 2 0.0%

LAKERIDGE HEALTH-AJAX SITE 1,489 2.5%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 796 1.4%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 250 0.4%

DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 156 0.3%

OTHER 287 0.5%

ALL OTHER HOSPITALS IN ONTARIO 7,902 13.5%

TOTAL 58,567 100.0% # of Cases for Hospital and Clinical Condition Scarborough Residents % of Cases

SCARBOROUGH AND ROUGE HOSPITAL-CENTENARY SITE 11,322 19.3%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 5,494 9.4%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 3,169 5.4%

DISEASES AND DISORDERS OF THE EAR, NOSE, MOUTH AND THROAT 548 0.9%

OTHER 2,111 3.6%

SCARBOROUGH AND ROUGE HOSPITAL-GENERAL SITE 10,583 18.1%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 3,975 6.8%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 3,708 6.3%

DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND BREAST 847 1.4%

OTHER 2,053 3.5%

SCARBOROUGH AND ROUGE HOSPITAL-BIRCHMOUNT SITE 10,327 17.6%

DISEASES AND DISORDERS OF THE EYE 3,659 6.2%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 3,549 6.1%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 1,399 2.4%

OTHER 1,720 2.9%

TOR. EAST HLTH NTWRK-MICHAEL GARRON HOSP 5,012 8.6%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,582 2.7%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 1,361 2.3%

DISEASES AND DISORDERS OF THE EYE 1,130 1.9%

OTHER 939 1.6%

MARKHAM STOUFFVILLE HOSPITAL 3,216 5.5%

DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,461 2.5%

DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE AND FEMALE REPRODUCTIVE SYSTEM 770 1.3%

DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 352 0.6% Table 35: Day Surgery Market Share by Hospital and Clinical Condition for SRH Primary and Secondary Catchments, 2016-17 (Continued) HEALTH SERVICE PROVIDERS IN Primary Care in Central East LHIN OTHER 633 1.1% CENTRAL EAST LHIN • As noted above, there are 1,264 family NORTH YORK GENERAL HOSPITAL 2,469 4.2% physicians practicing in Central East LHIN. DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 1,364 2.3% The market share analysis above shows that • There are seven Family Health Teams DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE residents of Scarborough are served by several AND FEMALE REPRODUCTIVE SYSTEM 425 0.7% and six Community Health Centres hospitals in the Greater Toronto Area. Residents DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND dispersed throughout the LHIN. CONNECTIVE TISSUE 183 0.3% of Scarborough also receive health services and • Scarborough has the most family health OTHER 497 0.8% supports from many community-based service team clinics compared to the rest of the SUNNYBROOK HEALTH SCIENCES CENTRE 2,453 4.2% providers within the Central East LHIN. There Central East LHIN (4 of 12 or 33.3%). DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE are 131 health service providers funded by the AND FEMALE REPRODUCTIVE SYSTEM 1,107 1.9% Central East LHIN. This creates opportunities DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 348 0.6% for partnership among providers and choice for Access to primary care can have an impact on DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND patients but may also make it challenging for hospital utilization (e.g. ‘after hours’ emergency BREAST 174 0.3% patients/families to navigate the wide array of department use). Appropriate access to primary OTHER 824 1.4% services. Information on key health sectors within care service providers within the local community ST MICHAEL'S HOSPITAL 2,077 3.5% our LHIN is provided below. For a complete list of is critical during one’s health journey. The tables DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 740 1.3% the Health Care Service Provider Organizations in below outline the number of locations in the DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE the Central East LHIN, please see Appendix C. Central East LHIN for the following service AND FEMALE REPRODUCTIVE SYSTEM 540 0.9% providers: family health teams, walk-in clinics DISEASES AND DISORDERS OF THE EYE 256 0.4% Physicians in Central East LHIN and, nurse practitioners. OTHER 541 0.9% According to the Ontario Physician Human NORTH YORK GENERAL HOSPITAL-BRANSON SITE 1,717 2.9% Resource Data Centre, there were 1,925 active Table 36: Family Health Teams Locations by Geographic Area and Central East LHIN DISEASES AND DISORDERS OF THE EYE 1,264 2.2% physicians in the Central East LHIN as of December DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE 31st, 2015; this includes 1,264 family physicians Geographical Area Clinic(s) AND FEMALE REPRODUCTIVE SYSTEM 436 0.7% and 1,108 specialists. Specialists are further broken Durham North East Health EXAMINATION AND OTHER HEALTH FACTORS 15 0.0% 1 down as follows: Link Community OTHER 2 0.0% Durham West Health Link LAKERIDGE HEALTH-AJAX SITE 1,489 2.5% 1 • Internal Medicine – 330 Community DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM 796 1.4% • Paediatrics – 93 Haliburton County and City of DISEASES AND DISORDERS OF THE KIDNEY, GENITOURINARY TRACT, MALE Kawartha Lakes Health Link 3 AND FEMALE REPRODUCTIVE SYSTEM 250 0.4% • Surgery – 296 Community

DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND • Laboratory Medicine – 32 Northumberland County CONNECTIVE TISSUE 156 0.3% 2 Health Link Community • Other Specialties – 357 (includes OTHER 287 0.5% diagnostic radiology, anaesthesiology, Peterborough City and ALL OTHER HOSPITALS IN ONTARIO 7,902 13.5% County Health Link 1 psychiatry and others) TOTAL 58,567 100.0% Community Scarborough North Health 2 Link Community Source: National Ambulatory Care Reporting System (NACRS) - MOHLTC Intellihealth Scarborough South Health 2 Link Community

Central East LHIN 12

Source: Central East LHIN Health Link Community Profiles

86 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 87 Scarborough has 36 walk-in clinics which Within the Central East LHIN, Scarborough, Durham Long-Term Care (LTC) in Central East LHIN Strategy. The Central East LHIN has the longest represents 46.8% of the walk-in clinics in Central and Peterborough are the only sub-regions with a • There are 68 long-term care homes with recorded LTC wait list for all LHINs and the largest East LHIN. 72% of Scarborough’s walk-in clinics nurse-practitioner led clinic. 9,957 beds in the Central East LHIN. 75+ population in the province, which is expected are in Scarborough South. to grow, suggesting the LTC and ALC pressures will Scarborough has the highest number of LTC increase over time. According to the final report, Table 37: Walk-In Clinics by Geographic Area Table 38: Nurse Practitioner-Led Clinic Locations by Geographic the vast majority of people on the LTC wait list are and Central East LHIN Area and Central East LHIN locations (22) followed by Durham (19) in the Central East LHIN. Thirty-two percent (22 out of 68) waiting in the community and virtually all out-of- Geographical Area Clinic(s) Geographical Area Clinic(s) of the LTC locations in Central East LHIN are region people on Central East LHIN’s LTC wait list are waiting for a Scarborough LTC home. A small Durham North East Health Durham North East Health in Scarborough. 15 1 Link Community Link Community group of homes is driving a large proportion of the Table 39: Long Term Care Locations by Geographic Area Durham West Health Link Durham West Health Link out-of-region wait list as these homes are ethnic, 21 0 and Central East LHIN Community Community cultural, religious, or linguistic specific.

Haliburton County and City of Haliburton County and City of Geographical Area Clinic(s) Kawartha Lakes Health Link 1 Kawartha Lakes Health Link 0 Durham North East Health Home Care in Central East LHIN Community Community 12 Link Community The tables below outline the number and rate per Northumberland County Northumberland County 1 0 Durham West Health Link 1,000 individuals that receive home care services Health Link Community Health Link Community 7 Community within the Central East LHIN. In Scarborough, 20 Peterborough City and Peterborough City and Haliburton County and City of individuals per 1,000 population are receiving home County Health Link 3 County Health Link 1 Kawartha Lakes Health Link 11 Community Community care services compared to the rest of the Central Community Scarborough North Health Scarborough North Health East LHIN; home care utilization in Scarborough 10 1 Northumberland County Link Community Link Community 8 is amongst the lowest in the Central East LHIN Health Link Community Scarborough South Health Scarborough South Health and is fairly consistent in Scarborough South and 26 0 Peterborough City and Link Community Link Community County Health Link 8 Scarborough North. Central East LHIN 77 Central East LHIN 3 Community Table 40: Individuals Receiving Home Care (formerly CCAC) Scarborough North Health Service by Geographic Area 5 Source: Central East LHIN Health Link Community Profiles Source: Central East LHIN Health Link Community Profiles Link Community Individuals Scarborough South Health Individuals Receiving 17 Total Receiving CCAC Link Community Geographical Area Population CCAC Services (N) Central East LHIN 68 Services (n) (Rate per 1,000)

Durham North East Health Source: Central East LHIN Health Link Community Profiles 287,800 6,295 21.87 Link Community

Durham West Health Link 320,400 4,805 15.00 Within the Central East LHIN, there is a LTC capacity Community challenge which has increased our number of Haliburton County and City of Kawartha Lakes 90,260 2,546 28.21 ALC patients. In 2016, the Central East Executive Health Link Community

Northumberland County Committee (CEEC) commissioned a LHIN-wide 71,200 1,981 27.82 Health Link Community initiative examining strategies to improve ALC rates Peterborough City and in the Central East LHIN. Our high inpatient ALC rate County Health Link 134,920 3,800 28.16 Community is primarily attributable to ALC patients waiting for Scarborough North Health 176,675 3,610 20.44 LTC. The Central East LHIN has fewer LTC beds per Link Community Scarborough South Health population than the Ontario average. Some of these 417,060 8,368 20.06 Link Community homes and beds are undergoing redevelopment as part of the provincial Enhanced LTC Home Renewal Source: Central East LHIN Health Link Community Profiles

88 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 89 Table 42: Strategic Priorities of Hospitals within the Central East PARTNERSHIPS The table below shows that 2.5 children per LHIN to serve 4,000 patients annually at 14 1,000 population aged 18 years or younger in community sites across the region. Organization Strategic Directions/Goals/Areas of Focus SRH values the opportunity to engage with local Scarborough, are receiving home care services. • Central East LHIN Home and Community •Provide the best experience for you health system partners on a variety of issues. SRH and your family Care staff attend daily discharge bullet Lakeridge Health (815 beds) Table 41: Children Receiving Home Care Services (formerly CCAC) • Relentlessly focus on quality and has a number of successful partnerships with other by Geographic Area (Oshawa, Bowmanville, Port rounds at all three of our sites. performance health service providers within the Central East Perry, Ajax/Pickering, Whitby) •Attract and inspire the best people • SRH has taken the initiative to form a working 2016-2021 Population Aged Population Aged 18 LHIN. Examples include: Population •Working with partners to improve 18 Years or Years or Younger group consisting of representatives of the local Geographical Area Aged 18 Years Younger Receiving Receiving Home Care or Younger your care Home Care (n) (Rate per 1,000) long-term care sector, Central East LHIN Home • Deliver Culturally Safe, Outstanding • SRH has one of the largest regional nephrology Durham North East 66,580 66 0.99 and Community Care and Ontario Telemedicine Health Link Community Care programs in North America and has one of Durham West Health Peterborough Regional Health • Deliver Seamless Care Transitions 84,070 89 1.06 Network to collaborate on strategies to ensure Link Community Centre (181 beds) • Deliver Regional Programs in the largest home dialysis programs in the Haliburton County and a smooth transition of residents/patients City of Kawartha Lakes 16,400 25 1.52 (Peterborough) Collaboration with Our Care province. We have a program at Carefirst Health Link Community between long-term care homes and hospitals. 2017-2020 Partners where they have the ability to provide Northumberland County 13,830 14 1.01 • Build Strong Foundations to Health Link Community This has included looking more closely at Achieve our Mission Peritoneal Dialysis (PD) while PD patients Peterborough City and ways to prevent the need for residents to be County Health Link 26,050 21 0.81 •Patient and Family-Inspired Care access their various wellness programs at Community Ross Memorial Hospital • Consistent, Reliable Quality transferred to the hospital for emergency care Scarborough North Carefirst. Our patients do not have to worry 34,225 58 1.69 Health Link Community (179 beds) • Enhancing Teamwork and Care and better sharing of discharge information. about getting home to do their PD because Scarborough South (Lindsay) Models 97,950 273 2.79 Health Link Community 2015-2021 • Championship Partnerships Carefirst care providers have the ability to • Our hospital works closely with Toronto •Safeguarding Financial Health administer PD and they were trained by our Public Health on infection prevention Source: Central East LHIN Health Link Community Profiles • Health System Integration Haliburton Highlands home dialysis team. Now, we are looking to and control and other programs. • Community Engagement Health Services (107 beds) •Effective People and Teams redesign home-based dialysis and ensure that • Our hospital has a patient navigation centre, (Haliburton) • Quality and Service Excellence Hospitals in Central East LHIN 2014-2017 it is delivered to many more patients. This called the Global Community Resource • Sustainability In Central East LHIN there are nine hospitals includes expanding our network of partners. Centre (GCRC). The collaborative model for • Quality and Safety Northumberland Hills operating out of 15 sites, including SRH. These •Great Place to Work and Volunteer • Also, in order to address the needs of high- the GCRC includes partnerships with twelve Hospital (104 beds) • Collaborative Community health and community agencies that provide hospitals face many of the same challenges. (Cobourg) risk geriatric patients, we enhanced our Partnerships Strategic plans from other hospitals provide 2017/18-2020/21 ongoing partnership with Carefirst Seniors information and referrals to patients and • Operational Excellence visitors seeking to access services in the an important lens into priorities of our regional • Ensure CMH is sustainable as a and Community Services Association hospital partners. All plans except Campbellford hospital through a partnership with Carefirst’s new Scarborough community. These agencies Hospital and Haliburton Highlands are relatively • Ensure safe quality care and Transitional Care Centre. The Transitional include newcomer organizations, health service excellence for our patients - centres, public health, etc. Patient education new and reach out to 2020 or beyond. There are Campbellford Memorial both now and in the future Care Centre began to receive patients from several common themes as hospitals are focused Hospital (34 beds) • Recruit and retain the best people two of our sites in May 2016 and provides sessions and workshops are also conducted (Campbellford) • Share the CMH story with our on patient and family centred care, partnering community-based Transitional Beds for in the GCRC to provide patients with holistic 2014-2017 community and the broader health with other health care providers for seamless and care community patients who require a bit more care before support in navigating the health care system. integrated care, and trying to achieve financial • Enhance our physical plant, clinical they transition home or elsewhere. • SRH is a partner in the Scarborough Diabetes stability. For further details, refer to Appendix D. equipment, and technological infrastructure • Our Central East Regional Cardiovascular Network alongside Taibu Community •Excellence Rehabilitation Service offers individually- Health Centre, Scarborough Center for Bellwood Health Services, Inc. • Compassion customized education and exercise training Healthy Communities and Carefirst. (Scarborough) • Courage •Advocacy across the Central East LHIN. The service • SRH partners with Taibu Community

Ontario Shores Centre for • Be bold is led by SRH in collaboration with hospital Health Centre on the delivery of services Mentel Health Sciences • Be Inspiring and community partners. The regional to individuals with sickle cell anemia. (628 beds) • Be Caring service was launched in 2012, and with the (Whitby) • Be Extraordinary 2017-2022 Central East LHIN’s support, has expanded

90 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 91 PROVINCIAL AND LHIN PROPERTIES PROVINCIAL LEVEL Ombudsman is a champion for fairness in Ontario’s health sector organizations. Her There are several key issues and trends at the office facilitates resolutions and investigates Key Points and Strategic Considerations • The Ontario Budget provides an provincial level that are important considerations patient and caregiver complaints – without • Next year’s provincial election adds additional $7 billion in health for strategic planning. taking sides – about patient care and health an element of potential uncertainty care over the next three years. care experiences in public hospitals, long-term Upcoming Provincial Election care homes and home and community care. regarding future government priorities. • HQO identified three key areas requiring The next provincial election takes place in June • Under Bill 41, the province attention: smoothing out transitions • Legislative changes to the Excellent Care 2018. Election cycles are relevant to hospital expanded the role of the LHINs between care providers, improving for All Act, 2010 (ECFAA) and the Quality planning as they can lead to potential shifts in and there are opportunities for timely access to primary care, and Care Information and Protection Act (QCIPA) policy, priorities and initiatives, and timelines of hospitals to have a seat at the new reducing inequities. HQO is providing strengthen the patient relations process, government approvals, regardless of whether there sub-region planning tables. advice to the Minister regarding the ensure that patients and families are engaged is a change in leadership. • There is a strong and growing addition of a mandatory indicator in the development of the organization’s focus on PFCC at many levels related to workplace violence prevention QIP, promote transparency and elevate the Putting Patients First in the health care system in hospital Quality Improvement Plans. importance of the patient/family voice. • In February 2015, the MOHLTC released • The Ontario Hospital Association • There are more requirements for Patient’s First: Action Plan for Health Care, ‘to put (OHA)’s new strategic plan outlines the Health System Restructuring hospitals to keep privacy top of mind, people and patients first by improving their health purpose, Serving Ontario’s hospitals to • The MOHLTC has restructured the province’s and higher penalties for failing to care experience and their health outcomes.’ build a better health system, and values 14 LHINs by integrating Community Care comply with the updated legislation. The Plan focuses on four key objectives: of humility, discovery, and passion. Access Centres (CCACs) into LHINs. Former • There is a clear focus on timely access • Access: Improve access – providing CCAC employees are now LHIN employees and and patient flow from hospital to home, • Provincially, the number of hospital faster access to the right care. the role of LHINs has been expanded beyond and keeping patients from returning integrations has increased • Connect: Connect services – delivering planning and funding to now play a role in to hospital once discharged. There is in the past few years. better coordinated and integrated care delivering home and community services. an ever increasing need for hospitals • The Central East LHIN’s Integrated in the community, closer to home. • Each LHIN has established sub-regions to have strong partnerships with Health Service Plan 2016-19 • Inform: Support people and patients – and sub-region planning tables to guide community partners as part of the trend (IHSP) supports an overarching providing the education, information service delivery at the local level. This is towards an integrated health system. goal, Living Healthier at Home – and transparency they need to make described further in the next section. • The number of QBPs being funded Advancing integrated systems the right decisions about their health. has increased year over year and of care to help Central East LHIN the MOHLTC has increased the residents live healthier at home. • Protect: Protect our universal public These health system changes were directed by health care system – making decisions “The Patients First Act”, which passed in 2016. roles of the LHINs and Cancer • The Central East LHIN notes based on value and quality, to sustain Below is a summary of the Act components and Care Ontario in the planning and several upcoming priorities post- the system for generations to come. linkages to Ontario’s transformation strategy, taken management of QBP volumes. transition: building on success with from the MOHLTC Keynote presentation, presented • There is an emphasis on value for bundled care; Home Care Roadmap • In December 2015, the MOHLTC at the Utilization Manager’s Network of Ontario money and 17 recommendations priorities; support for access to released a discussion paper, Patients (UMNO) Education Day earlier this year. from the Auditor General of Ontario specialists; Open Minds, Health First: A Proposal to Strengthen Patient- The expanded role of the LHINs is further for large community hospitals. Minds commitment; establishment Centred Health Care in Ontario. described in the next section of this of Patient Family Advisory Councils; • Christine Elliott was appointed Ontario’s first environmental scan. and sub-region planning. Patient Ombudsman in July 2016. The Patient

92 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 93 SUMMARY OF THE PATIENTS FIRST ACT, 2016 Funding Reform • More recently, bundled care has become a Part 1 — LHIN Governance and Mandate • In addition to global funding, organization-level voluntary option for some organizations,

• Amends LHIN objects to reflect LHIN role in home and community care, health promotion, equity funding is allocated to hospitals using the which is applicable to episodic QBPs. Bundled • Requires LHINs to establish sub-regions Health Based Allocation Model (HBAM) and for care provides a single payment to cover • Allows for establishment of entity to support LHINs with shared services, e.g. payroll specific procedures (Quality Based Procedures, care needs of a patient across multiple care • Requires each LHIN to have one or more Patient and Family Advisory Committees or QBPs) based on a price X volume approach. settings. Each year, it is important for SRH to be aware of the latest clinical handbooks and Part 2 — Primary Care • In 2017-18, the funding model continues to evolve and SRH utilizes tools created by those QBPs under consideration for potential • Adds primary care models (not physicians) as health service providers funded by LHINs funding as QBPs. For example, QBPs under • Allows LHINs to collect information about practice and service capacity from primary care the Ontario Hospital Association (OHA) and MOHLTC to better forecast our future funding. consideration, but not currently being funded Part 3 — Home and Community Care include: Integrated Corneal Transplant, Low- • The number of QBPs being funded has Risk Delivery, Aortic Valve Disease, Coronary • Provides for transfer of CCAC staff and functions to LHINs increased year over year and the MOHLTC Artery Disease, Non-Emergent Integrated Spine has increased the roles of the LHINs and Part 4 — Public Health Care, Shoulder Surgery, and Hysterectomy Cancer Care Ontario in the planning and • Establishes a formal relationship between LHINs and local boards of health for both benign and cancer cases. management of QBP volumes. A detailed Part 5 — Accountability review took place in 2016 of the QBPs Focus on Value-for-Money • Gives LHINs accountability mechanisms for health service providers and long-term care homes being funded, which led to a few changes. • Gives Minister accountability mechanisms for LHINs and ability to set standards Refer to the list of current MOHLTC and • In fiscal year 2016-17, the Auditor General non-MOHLTC managed QBPs below. of Ontario conducted a value-for-money Part 6 — Complementary Legislative Changes audit of large community hospitals; its • Allows for integrated clinical care council to be established to advise on clinical standards significant findings, observations and • Gives Patient Ombudsman oversight of complaints for health services provided/arranged by LHINs • Congestive Heart Failure (CHF) recommendations were published in •Chronic Obstructive Pulmonary Disease (COPD) • Allows for provincial Patient and Family Advisory Council the Auditor General’s Annual Report. •Stroke (Hemorrhage, Ischemic or Unspecified, TIA) • Value-for-money audits assess whether • Hip Fracture HOW THE ACT SUPPORTS TRANSFORMATION AND INTEGRATION • Pneumonia money was spent efficiently and whether • Neonatal Jaundice procedures were in place to evaluate the Timely Access to Stronger Links • Non-Cardiac Vascular - Lower Extremity More Effective More Consistent Primary Care, and Between Population Obstructive effectiveness of government programs. S Service Integration, Seamless Links and Accessible Home MOHLTC Managed QBPs & Public Health and • Disease, Aortic Aneurism Repair Greater Equity Between Primary Care and Community Care and Other Services Other Health Services • Cataract GOAL • Legacy RVHS was one of three large • Inpatient Rehabilitation - Primary Unilateral Hip community hospitals audited as part of this Establishment of Designation of Transfer of • Inpatient Rehabilitation - Primary Unilateral Knee sub-regions new health CCACs to LHINs Formal linkages • Hip Replacement Surgery service providers value-for-money audit. Recommendations between LHINs and • Knee Replacement Surgery Boards of Health •Tonsillectomy are targeted to the MOHLTC, the hospitals, • Knee Arthroscopy Shared services or both. Recommendations for hospitals Establishment of • Cataract Complex/Bilateral LHIN Objects entity to support sub-regions IVE ENABLERS back-office functions •Chronic Kidney Disease are in response to findings associated with AT • Systematic Treatment timely transfer of patients and patient flow, • Gastrointestinal Endoscopy

LEGISL Establishment of Establishment of • Cancer Surgery appropriate scheduling of nursing resources, Physician Expanded LHIN sub-regions Ontario Quality Planning Governance • Colorectal Standards Council Non-MOHLTC Managed QBPs safeguarding personal health information •Prostate •Breast (with immediate reconstruction, without (PHI), and preventive maintenance for immediate reconstruction, delayed reconstruction) hospital equipment. Both the MOHLTC Services That Address Needs of Indigenous People Across Ontario • Thyroid and hospitals had the opportunity to Ontario is engaging Indigenous partners through a parallel process that will collaboratively identify respond to the 17 recommendations, the requirements necessary to achieve responsive and transformative change as appropriate. See Appendix E for the full list of recommendations.

94 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 95 Provincial Budget Health Quality Ontario (HQO) was released in May 2017. Once confirmed • Our Organization: To deliver on our The 2017 Ontario Budget includes several items • Stemming from the Excellent Care for All Act by the Minister, HQO will provide further mandates, the OHA will cultivate its of importance to SRH and the healthcare system. (ECFAA, 2010), HQO has a mandate to advise details to hospitals including guidance for culture, relationships and practices. The budget provides an additional $7 billion in the government and health care providers supporting quality improvement and technical health care over the next three years. In addition, on evidence to support quality care, support specifications regarding the specific indicator. SRH looks forward to working with the OHA as it the province is introducing OHIP+, Children and quality improvements, and monitor and report • A new HQO quality initiative that SRH moves forward in enacting the plan. Youth Pharmacare, which covers the cost of all on provincial health care performance metrics. participates in is the Emergency Department medicines funded through the Ontario Drug Benefit • Over the last several years, HQO has Return Visit Quality Program. We review Hospital Integrations Program for children and youth aged 23 and under, studied and reported on the state of data on return visits to the ED and conduct Provincially, the number of hospital integrations has regardless of family income. Other new investments quality in the health care sector, including audits on a quarterly basis to identify the increased: can be stratified under three main priorities: hospitals, home care, primary care, and underlying causes of these return visits

Table 43: 2017 Ontario Budget Priorities long-term care. Annually, HQO produces and then implement strategies to address • Trillium Health Centre and The Credit Valley Measuring Up, a comprehensive report on the issues. Learnings are shared externally Hospital form Trillium Health Partners (2011) • Additional $9 billion over 10 years health system performance and health of with HQO and internally with the program to support construction of new • Sunnybrook Health Sciences Centre major hospital projects the local population The report identifies and hospital leadership through a report and St. John’s Rehab (2012) • Increasing operating funding for three key areas requiring attention: to the Quality Committee of the Board. Increasing Access all public hospitals • Windsor Regional Hospital took responsibility • Enhancing inter-professional • Smoothing out the transitions for hospital services at the Metropolitan primary care teams between care providers Ontario Hospital Association (OHA) campus and the Ouellette campus - formerly • Modernizing and enhancing • The OHA recently released a new Strategic cancer screening • Improving timely access to primary care Hôtel-Dieu Grace Hospital (2013) Plan 2018-2021 with the following purpose, • Reducing the time to see a • Reducing inequities, to remove variation • Mount Sinai and Bridgepoint Health specialized care provider through Serving Ontario’s hospitals to build a better by geography and population groups. Partners (and Circle of Care affiliate) investments in enhanced referral health system, and values of humility, pathways, including eReferrals • HQO has also had a significant form Sinai Health System (2015) discovery, and passion. After extensive and expansion of a central intake focus on patient and family centered • University Health Network and Toronto Rehab system for each LHIN internal and external engagement, the care and patient relations. Institute (2011) and Michener Institute (2016) • Reducing wait times for key plan reveals three strategic pillars: services through funding more Reducing Wait Times • Another noteworthy trend is increased • St. Joseph’s Health Centre, St. Michael’s priority procedures • Our Members: At the OHA, our members direction on the specific quality metrics Hospital and Providence Healthcare (2017) • Expanding home and community are at the heart of everything we care through program that health service providers are required do. Through advocacy, learning and • Hôtel Dieu Hospital and Kingston investments to track and report to HQO. In July 2017, •Faster access to mental health engagement, labour relations and General Hospital formed Kingston Regulation 187/15 under ECFAA came into services through investments in improved access to data and analytics, Health Sciences Centre (2017) new supportive housing units and force and states: “A health care organization the OHA is enhancing the direct structured psychotherapy shall include in its annual quality improvement services it provides to members. • Launching Ontario’s Dementia plan indicators that the Minister, after having Strategy • Our System: Hospitals are changing. • Expanding the Northern Health considered the advice of the Council [HQO], The OHA will take a long-term view Travel Grant Program directs in writing.” Health Quality Ontario of their evolution and the path to •Investing in new funding for will be providing advice to the Minister Enhancing the Patient community programs to enable create a high-performing system by Experience people to remain at home regarding a proposed mandatory indicator conducting evidence-based research, • Improving maternal care through related to workplace violence prevention proposing ideas, convening members funding breast pumps for mothers for the 2018-2019 Quality Improvement of premature babies, enhanced and partners and encouraging newborn screening and more Plans, as proposed by the Joint Ministry responsible dialogue about change. midwifery services Project on Workplace Violence Prevention in

Source: Ontario Ministry of Finance, 2017 Healthcare Year One Progress Report that

96 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 97 CENTRAL EAST LOCAL HEALTH INTEGRATION NETWORK There are four specific aims to achieve the goal of health services resources available to achieve the (CENTRAL EAST LHIN) PRIORITIES Living Healthier at Home: commitments outlined in the IHSP.

The Central East LHIN’s Integrated Health Service Plan 2016-19 (IHSP) supports an overarching goal, Living • Seniors – Continue to support frail older This has been a year of LHIN renewal and Healthier at Home – Advancing integrated systems of care to help Central East LHIN residents live healthier at home. adults to live healthier at home by spending transformation across the province. Strategies The Central East LHIN Strategy Map outlines the strategic goals, priorities, and enablers. 20,000 fewer days in hospital and reducing included the expansion of LHIN boards, leadership ALC days for people age 75+ by 20% by 2019. transitioning and restructuring to incorporate Figure 27: Central East LHIN Strategy Map, IHSP 2016-19 • Vascular Health – Continue to improve the CCACs, the creation of Health Shared Services vascular health of people to live healthier Ontario (HSSO), and the development of sub- at home by spending 6,000 fewer days in regions within each LHIN to aid in planning Vision & Directions/ Strategic hospital and reducing hospital readmissions health care services. The goals of LHIN sub- 1 Mission 2 Outcomes 3 Aims for vascular conditions by 11% by 2019. regions, according to the Central East LHIN, are to bring local health and community partners and • Mental Health and Addictions – Continue to leaders together for health system planning and Central East LHIN Vision Strategic Directions Living Healthier at Home support people to achieve an optimal level improvement, assess population health need and Engaged Communities Transfomational Leadership of mental health and live healthier at home Healthy Communities Quality and Safety service capacity, and provide health system data Service and System Integration by spending 15,000 fewer days in hospital Fiscal Responsibility and information for the sub-region population. Central East LHIN Mission and reducing repeat unscheduled emergency Population Health There is a new Vice President, Clinical to oversee To lead the advancement of an department visits for reasons of mental integrated sustainable healthcare Focus on Population Health clinical roles and provide leadership on the LHIN system that ensures better health, Equitable Seniors Vascular Health health or addictions by 13% by 2019. better care, and better value. senior team. Every LHIN sub-region will have a Patient Experience • Palliative Care – Continue to support designated Clinical Lead (family physician) who Integrated palliative patients to die at home by choice Values Accessible will be the local champion of quality, safety and Accountability Person Centered and spend 15,000 fewer days in hospital by Responsiveness Effective clinical engagement, and be involved in health care increasing the number of people discharged Respect Safe planning and the design and implementation of the Integrity home with support by 17% by 2019. Innovation Cost Control Mental Health Pallative Care LHIN primary care strategy. The LHINs have a new Equity and Addictions Efficient role to partner with the Clinical Lead and connect Appropriately Resourced All of these areas are addressed in SRH’s 2017-18 patients with primary care services. Primary care Quality Improvement Plan. models, such as Family Health Teams, can now be funded by LHINs. LHINs will also conduct health • Health Links • Supported Living Environments The 2016-17 Central East LHIN Annual Business workforce planning, supported by Health Force Direct Care • Primary Health Care • Health Equity — Diversity Priorities • Patient and Family Caregivers • Child and Family Plan includes an assessment of issues or Ontario. Health Shared Services Ontario (HSSO) is 4 • Home and Community Care considerations facing the Central East LHIN as it a new organization, created in March 2017 through works toward realization of the goals outlined in the merger of three legacy organizations. HSSO • Pursuing Quality and Safety • Enabling Technologies and Integration the IHSP. The Central East LHIN acknowledges the aims to generate efficiencies through shared and Health System through Effective Access and (Electronic Health Information Management) need to a) consider demographic factors of the Enablers Transitions • Health System Funding Reform consistent back office support services such 5 • System Design and Integration local population in the planning and development as Information Technology, Finance, Human of integrated systems of care, b) for effective Resources, Communications, etc. to all 14 LHINs. succession planning to meet patient needs, due to Source: Central East LHIN Integrated Health Services Plan 2016-19 physician demographics, c) promote a culture that Over the summer/fall 2017, the LHIN is supports change and innovation to increase the seeking membership on sub-region tables, with integration of services due to the current political representation from each sector. Each sub-region focus and agenda, and d) consider the fiscal and table drives local change by identifying needs,

98 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 99 • Upcoming provincial and municipal elections • Municipal government has committed to make significant investments in transit infrastructure, including new subway and light transit •Strong focus on patients and families being at the table (e.g. province and all LHINs will have patient and family advisory councils) •Creation of a provincial Patient’s Ombudsman Office • Bill 41 leads to expanded role of LHINs in home and community care and opportunity for organizations to participate on LHIN sub- region tables Political Trends •Focus on smooth patient flow across providers and hospitals having strong connections with community partners through home/ community service delivery models. Central East LHIN focus on patients receiving care at home •Funding model evolution and the introduction of voluntary bundled care QBPs to provide a single payment across multiple care providers •Focus on the public wanting value-for-money from the public sector (e.g. value for money audit, new ask for physician salaries to be made public) • MOHLTC and Ontario Medical Association working toward new Physician Services Agreement

• International Monetary Fund (IMF) states that Canada is expected to lead the G7 group in GDP growth this year • Health care expenditure growth as percentage of GDP, 47%, 2010 to 2030 •Strong population growth. Statistics Canada reports a drop in the unemployment rate in Ontario and an increase in job creation • Swelling household debt and housing market cooling after a high earlier this year • Anticipate that the Bank of Canada will raise interest rates • Hospital sector receiving a 3% funding increase this year, more than recent years • Lifting of the public sector wage freeze for non-union employees • Increased scrutiny on how hospitals are delivering value for money and achieving high quality care (e.g. value for money audit, Economic Trends Choosing Wisely campaign) •Growing private sector interest in contributing to a health care transformation agenda (e.g. the Ontario Chamber of Commerce began the Health Transformation Initiative in January 2016. “Two central principles have guided their work on health care reform: that the health sector should be considered an economic driver in the province, and that there are tremendous benefits to be obtained from bringing the private sector on-side as a partner in the public health care system” (Source: Health Transformation: An Action Plan for Ontario. Ontario Chamber of Commerce) • According to a report by the Daily Bread Food Bank, visits to Toronto food banks increased 9% in the last year. The part of the city that saw the largest increase in visits was Scarborough, up 30% compared to last year. planning, and making recommending key priorities. TRENDS •Population aging; living longer with chronic conditions, multiple comorbidities The overall aim is to improve health and wellness, •Growing diversity and health equity challenges •Growing interest in alternative medicine/remedies This section uses the “PESTEL” framework to patient experience and outcomes, and value for • Increased emphasis on flexible work hours and work life balance money. In June 2017, the CEO of the Central East describe the broader trends that are impacting SRH. Social Trends • Increased consumerism (growing access and service expectations) LHIN presented to the SRH Board of Directors and PESTEL analysis is a useful tool for understanding • Increased patient and public engagement at all levels of the health care system • Increased use of social media/social networking the “big picture” of the environment in which outlined the following upcoming priorities for the •Patients/families involvement in care, contributing to quality improvement initiatives, and co-designing services LHIN: the organization operates, and the opportunities •Population engaged in monitoring their health/lifestyle , wearable/trackable devices (e.g. sleep, physical activity) and threats that lie within it. The acronym •Advances in information management technologies. MOHLTC has committed to funding 15 innovative technologies via grants from the new Health Technologies Fund (HTF). Grants support development of software and mobile devices that aim to deliver better • Building on success with bundled care PESTEL stands for: Political, Economic, Social, home and community care. Technological, Environmental, and Legal. These • Home Care Roadmap priorities •Advances in clinical/medical technologies are often factors which are beyond the control or •Technology makes information more accessible to health care users through patient portals, launch of information sites (e.g. • Support for access to specialists influence of a single organization, however are ontario.ca/health) to provide information about health services and navigation assistance for patients • Innovation driving new models of care. Canada Health Infoway with two key priorities since 2016; e-prescribing service and growing • Open Minds, Healthy Minds commitment important to be aware of when doing strategic telehomecare • Establishment of Patient Family Advisory planning. A PESTEL analysis for SRH is provided. Technological Trends • Office of Chief Health Innovation Strategist to help accelerate adoption and diffusion of new innovative health technologies and processes - innovative brokers announced in 2017 to connect to innovators and health care providers Councils, provincially and in LHINs • First-of-its kind best practice guideline, Adopting eHealth solutions: Implementation Strategies, released in 2017 by the RNAO and • Sub-region planning and priorities Canada Health Infoway with 26 recommendations to improve patient outcomes, clinician satisfaction, and efficiency by adopting an evidence-based eHealth implementation strategy • Auditor General evaluates Electronic Health Record implementation status, 12 recommendations Table 44: PESTEL Analysis • Increased access to remote patient monitoring, virtual interactions •Greater availability of business intelligence, Enterprise Data Warehouse, analytics • Increased threat of cyber-security breaches (e.g. ransomware, phishing) • Upcoming provincial and municipal elections •Green facility design and environmentally sustainable practices • Municipal government has committed to make significant investments in transit infrastructure, including new subway and light • Recognition of performance in energy, water, waste, pollution prevention, and corporate leadership through the annual Ontario Green transit Environmental Trends Health Care Awards based on results of the Green Hospital Scorecard (HGS), a comprehensive health care benchmarking tool •Strong focus on patients and families being at the table (e.g. province and all LHINs will have patient and family advisory councils) •Growing public expectations of organizations operating in an environmentally friendly manner •Creation of a provincial Patient’s Ombudsman Office • Shift towards paperless operations • Bill 41 leads to expanded role of LHINs in home and community care and opportunity for organizations to participate on LHIN sub- • Accessibility for Ontarians with Disabilities Act (AODA) – requirements for an accessible Ontario by 2025 region tables Political Trends New legislation and regulations: •Focus on smooth patient flow across providers and hospitals having strong connections with community partners through home/ • Bill 168, an Act to amend the Occupational Health and Safety Actwith respect to violence and harassment in the workplace and other community service delivery models. Central East LHIN focus on patients receiving care at home matters •Funding model evolution and the introduction of voluntary bundled care QBPs to provide a single payment across multiple care • Bill 41, Patients First Act, 2016, expanded roles for LHINs providers • Bill 119, Health Information Protection Act, 2016 amends the Personal Health Information Protection Act (PHIPA) and strengthens •Focus on the public wanting value-for-money from the public sector (e.g. value for money audit, new ask for physician salaries to be privacy requirements made public) • Bill 84, Medical Assistance in Dying Status Law Amendment Act, 2017; hospitals creating policies to address • MOHLTC and Ontario Medical Association working toward new Physician Services Agreement • Bill 87, Protecting Patients Act, 2017 that strengthens measures to prevent and respond to the sexual abuse of patients by any • International Monetary Fund (IMF) states that Canada is expected to lead the G7 group in GDP growth this year Legal Trends regulated health professional • Health care expenditure growth as percentage of GDP, 47%, 2010 to 2030 • Bill 114, Anti-Racism Act, 2017 embeds Ontario’s Anti-Racism Directorate in law, creating a framework for continued work to promote •Strong population growth. Statistics Canada reports a drop in the unemployment rate in Ontario and an increase in job creation equity for racialized groups across Ontario • Swelling household debt and housing market cooling after a high earlier this year • Bill 127, Stronger, Healthier Ontario Act (Budget Measures), 2017 • Anticipate that the Bank of Canada will raise interest rates • Cannabis Act introduced in April 2017, if passed, this Act will create a strict legal framework for controlling the production, • Hospital sector receiving a 3% funding increase this year, more than recent years distribution, sale and possession of cannabis • Lifting of the public sector wage freeze for non-union employees • Increased scope of practice for Nurse Practitioners including prescribing controlled substances • Increased scrutiny on how hospitals are delivering value for money and achieving high quality care (e.g. value for money audit, Economic Trends • Increased litigation related to privacy breaches in health care organizations Choosing Wisely campaign) •Growing private sector interest in contributing to a health care transformation agenda (e.g. the Ontario Chamber of Commerce began the Health Transformation Initiative in January 2016. “Two central principles have guided their work on health care reform: that the health sector should be considered an economic driver in the province, and that there are tremendous benefits to be obtained from bringing the private sector on-side as a partner in the public health care system” (Source: Health Transformation: An Action Plan for Ontario. Ontario Chamber of Commerce) • According to a report by the Daily Bread Food Bank, visits to Toronto food banks increased 9% in the last year. The part of the city that saw the largest increase in visits was Scarborough, up 30% compared to last year.

•Population aging; living longer with chronic conditions, multiple comorbidities

100 • External Environment•Growing diversity and health equity challenges SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL External Environment • 101 •Growing interest in alternative medicine/remedies • Increased emphasis on flexible work hours and work life balance Social Trends • Increased consumerism (growing access and service expectations) • Increased patient and public engagement at all levels of the health care system • Increased use of social media/social networking •Patients/families involvement in care, contributing to quality improvement initiatives, and co-designing services •Population engaged in monitoring their health/lifestyle , wearable/trackable devices (e.g. sleep, physical activity)

•Advances in information management technologies. MOHLTC has committed to funding 15 innovative technologies via grants from the new Health Technologies Fund (HTF). Grants support development of software and mobile devices that aim to deliver better home and community care. •Advances in clinical/medical technologies •Technology makes information more accessible to health care users through patient portals, launch of information sites (e.g. ontario.ca/health) to provide information about health services and navigation assistance for patients • Innovation driving new models of care. Canada Health Infoway with two key priorities since 2016; e-prescribing service and growing telehomecare Technological Trends • Office of Chief Health Innovation Strategist to help accelerate adoption and diffusion of new innovative health technologies and processes - innovative brokers announced in 2017 to connect to innovators and health care providers • First-of-its kind best practice guideline, Adopting eHealth solutions: Implementation Strategies, released in 2017 by the RNAO and Canada Health Infoway with 26 recommendations to improve patient outcomes, clinician satisfaction, and efficiency by adopting an evidence-based eHealth implementation strategy • Auditor General evaluates Electronic Health Record implementation status, 12 recommendations • Increased access to remote patient monitoring, virtual interactions •Greater availability of business intelligence, Enterprise Data Warehouse, analytics • Increased threat of cyber-security breaches (e.g. ransomware, phishing)

•Green facility design and environmentally sustainable practices • Recognition of performance in energy, water, waste, pollution prevention, and corporate leadership through the annual Ontario Green Environmental Trends Health Care Awards based on results of the Green Hospital Scorecard (HGS), a comprehensive health care benchmarking tool •Growing public expectations of organizations operating in an environmentally friendly manner • Shift towards paperless operations

• Accessibility for Ontarians with Disabilities Act (AODA) – requirements for an accessible Ontario by 2025 New legislation and regulations: • Bill 168, an Act to amend the Occupational Health and Safety Actwith respect to violence and harassment in the workplace and other matters • Bill 41, Patients First Act, 2016, expanded roles for LHINs • Bill 119, Health Information Protection Act, 2016 amends the Personal Health Information Protection Act (PHIPA) and strengthens privacy requirements • Bill 84, Medical Assistance in Dying Status Law Amendment Act, 2017; hospitals creating policies to address • Bill 87, Protecting Patients Act, 2017 that strengthens measures to prevent and respond to the sexual abuse of patients by any Legal Trends regulated health professional • Bill 114, Anti-Racism Act, 2017 embeds Ontario’s Anti-Racism Directorate in law, creating a framework for continued work to promote equity for racialized groups across Ontario • Bill 127, Stronger, Healthier Ontario Act (Budget Measures), 2017 • Cannabis Act introduced in April 2017, if passed, this Act will create a strict legal framework for controlling the production, distribution, sale and possession of cannabis • Increased scope of practice for Nurse Practitioners including prescribing controlled substances • Increased litigation related to privacy breaches in health care organizations GLOBAL HEALTH CARE TRENDS The American College of Healthcare Executives: FUTURESCAN™ 2015 Healthcare Trends and Rising demand and associated spending Implications 2015-2020 (2015) looks at the are being fueled by an aging population; the impact of global health care trends by comparing growing prevalence of chronic diseases and the current state to the anticipated future state. comorbidities; development of costly clinical The table below is taken from University Health innovations; increasing patient awareness, Network’s adaptation of the FUTURESCAN report knowledge, and expectations; and continued as reported in UHN’s own environmental scan. • economic uncertainty despite regional pockets of recovery are just a few of the key issues and Figure 28: FUTURESCAN™ 2015 Healthcare Trends as adopted by University Health Network trends impacting the global health care sector. (Deloitte 2017 Global Health Care Sector Outlook) TODAY FUTURE

Focus Individual Patient Community health / There has been a great deal of research done on the Population health factors that are shaping health care. Around the Care Fragmented, Coordinated, Episodic longitudinal care world health care systems are facing many of the Treatment same trends and challenges. Below is a synopsis Goal Treating Sickness Achieving Wellness of key health care trends identified by a Canadian Rewards Volume-driven Value-based, source and an American source. (fee-for-service) Outcomes-driven Settings Institution-based; Community-based; Table 45: Key Healthcare Trends Hospital Oriented wide range of settings

•Chronic Disease Management and Technology Health care Data organization that Prevention organization that works in healthcare. Healthcare Priorities in •Care of the Frail Elderly works in data Transformative techniques Canada: A Backgrounder • Health Human Resource Planning to treat and cure patients (2014) By the Canadian • Access to Care and Wait Times Demographics People aged 65+ People aged 65+ will make Foundation for • Health Information Technology make up 15% of up 25% of the population Healthcare Improvement •Population and Public Health the population with increased chronic •Patient Engagement for Improvement conditions

• The Rise of Chronic Disease - multi- Empowered Limited hours and Increased virtual care and morbidity Patients standardized personalization of • The Greying Patient (and Provider) - treatment plans treatments, protocols and the aging population and workforce medicines retirements TRANSITIONAL Quality Co-mingling quality Decoupling quality and • The Information Revolution - and safety and safety with widespread drive to adopt clinical IT using incremental transformational, Critical Disruptions: The systems, the promise of better data approaches to intersectoral approaches Five Forces Shaping and analysis (Management support, change STRATEGIES Health Care’s Future. Patient empowerment, Personalized (2015) By the Advisory care, Quality and safety, Population Board Company, Global management, Clinical decision Source: Environmental Scan for Strategic Planning, 2017. University Health Network Forum for Health Care support) AND READINESS Innovators • The Blessing and Curse of Technology - positive patient outcomes but costly • The New Health Care Consumer - FOR STRATEGIC negative publicity around quality, media relentlessly covers high profile incidents, hospitals losing public trust PLANNING 102 • External Environment SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN TRANSITIONAL STRATEGIES In 2015, the Minister of Health and Long-Term Care, BRIDGING INTEGRATION PLANS annual quality improvement plan. In addition, to AND READINESS FOR created the Scarborough/West Durham Expert these requirements, and unlike other hospitals in STRATEGIC PLANNING Panel (Panel) to “develop a plan to address how 100-Day Integration Plan the province, SRH was also still very much involved hospitals in the region can work together to deliver To provide a roadmap in the initial post-merger in bringing the new organization together. With The opportunity to create a new organization is rare, acute health care programs and services in a way period, the SRH senior leadership team developed the arrival of the hospital’s new CEO expected in challenging and very exciting. As SRH prepares that meets the needs of local residents.” The Panel and implemented a plan for the first 100 days to the summer, a Six-Month Integration Plan was to begin its first strategic planning process it was also to provide recommendations on program achieve the following goals: developed to cover the period April 1 to September is important to acknowledge the transitional and service integration, as well as infrastructure 30, 2017. This plan would pick up where the strategies that have provided stability and direction needs. The Panel’s work included capacity plan • Set the stage to create a hospital system that 100-day plan left off and provide a bridge to the in the initial post-merger period. These transitional analysis that examined current and projected future will succeed in improving quality and safety, arrival of a new CEO. A one-day session in early strategies have shaped the current state of the hospital utilization, community engagement and enhancing access to services, and delivering April brought administrative and medical leaders organization and provide a launching point for a stakeholder consultation. patient-centered care to the community. together to discuss the priorities for the six-month creative, forward-looking strategic planning process • Build cohesiveness including culturally- plan. The goals of the six-month integration plan that will position SRH for future success. In the months leading up to amalgamation, RVHS, aligned teams that are aware of organizational were: They include: TSH and Lakeridge Health planned collaboratively directions, integrated operational to ensure the stability of patient care and continuity structures and building our reputation. • Continue the progress made • Pre-merger planning of services. Formal integration committees, • Fulfil transition service agreements with with the 100 day plan facilitated by the Ministry-appointed Facilitator • Bridging Integration Plans Lakeridge Health to facilitate the smooth • Advance standardization across our three sites (Mark Rochon) were struck to guide the transition • Transition Communications transition of the Ajax-Pickering site. • Inform the development of leadership’s process, establish the new board and recruit a CEO. and Engagement Plan 2017/18 annual goals and initiatives Operational work groups gathered due diligence The 100-day plan was based on evidence-based • Position the organization to realize the short, • Streamlining legacy strategic initiatives information and prepared for ‘Day 1’ as a new practices for merger success and an assessment medium and long-term value set out in the • Value Realization Framework organization. An important output of the transition of potential risks. The plan included 144 activities Value Realization Framework planning phase was the RVHS/TSH Integration related to supporting, creating, planning, integrating (see below) Proposal submitted to the Central East LHIN in July PRE-MERGER PLANNING and harmonizing to establish a foundation for the 2016. The Integration Proposal set out the goals new organization. A central coordination function of integration, an implementation strategy, risk The clear priority for the six-month integration For many years, RVHS and TSH had worked was created and leadership monitored progress assessment, timelines and resource requirements. plan was standardization, particularly clinical together to identify opportunities for further on the plan on a regular basis. The Integration Stakeholder engagement was an ongoing focus standardization to reduce variation in clinical collaboration and explore models for greater Committee of the board provided governance throughout the transition planning phase. practice. Non-clinical, or back-office, services integration. Since 2013, deliberate integration oversight for the plan. The 100-day plan was made were also to be standardized. There was a desire efforts within the region have focused on the need available to the hospital’s internal stakeholders and The following four guiding principles provided to provide a consistent level of service to users of for bold change - to rethink and reorganize how to the general public. Much was achieved in the first direction throughout the pre-merger process: our hospital regardless of which site they visited. health care is governed and delivered for better 100 days. Activities that were outside the scope of the patient outcomes. In 2013-14, the two hospitals • Collaboration and Engagement six-month integration plan were: embarked on the Leading for Patients facilitated Six-Month Integration Plan integration process. Although this process did • Accessibility The end of the 100-day period occurred in March • Integration in the form of corporate-driven not culminate in amalgamation, through extensive • Sustainability 2017 as the new hospital prepared to begin its siting and sizing of clinical programs planning, analysis and stakeholder consultation first full fiscal year. SRH was engaged in the same • Excellence (departmentally-driven integrations may be several integration opportunities were identified and required year-end activities as other hospitals considered within the 6 month period) the momentum for change and will for local system including development of the annual operating plan • Strategic Planning transformation remained strong. (budget), financial auditing and development of the • Branding

104 • Transitional Strategies and Readiness for Strategic Planning SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Transitional Strategies and Readiness for Strategic Planning • 105 SRH Portfolio Challenges Opportunities

• Surge in ED Volumes •Stroke care in Scarborough • Alternate Level of Care (ALC) •Providence Healthcare as potential partner • Physical Infrastructure • Mental Health community supports - forming linkages to • High demand for dialysis and cardiac procedures decrease ED use; increase HealthLinks - Coordinated Care Plans • Financial Pressures •Strengthen relations with primary care Patient Services and •Leverage Lean Management System (LMS) and Business Professional Practice Process Improvement (BPS) methodologies • Build culture and lead the way in PFCC •Leverage Regional Centers of Excellence (Cardiac, Nephrology, Vascular etc.) • HQO Quality Standards

• Standardization of care and patient experience across all • Clinical/department integration sites • Increased Professional staff collaboration •Potential physician anxiety and dissatisfaction with • Expansion of call groups clinical integration changes •Teaching: expansion of teaching culture • Physician change management: clinical services planning, • Enhanced clinical services for sites and key recruitment change in clinical practice locations, rationalization of opportunities Medical Administration, services • Research: marketing potential research and related funding Medical Education and opportunities Research Ethics • Retention of physicians • Robust physician recognition • Medical leadership development •Development of centres of excellence (orthopaedics, cardiac, nephrology) •Excellence in peer review

•Workflow engagement • Integration and standardization of back office functions and • Labour relations and settlement of PSLRTA-related issues teams, policies and procedures •Workforce stability - retention, recruitment challenges • Engagement of volunteers in integration and standardization • Harmonization of back office functions programs/services Human Resources/Volunteer • Differences in organizational culture • Integration of diversity initiatives Services •Wage and job harmonization • Expansion of diversity initiatives •Functionality gaps in legacy systems • Identification of opportunities for systems integration and • Integration of multiple existing systems across all areas efficiencies • Sharing of programs and services - ‘best of both worlds’ for workforce and patients The six-month integration plan was specifically period, SRH leadership identified top challenges • Balance the Ajax-Pickering Transition Services Agreement •Work with Lakeridge partners to effectively dives Ajax-Pickering (TSA) and separation plans with the Scarborough site focused on merger-related activities (e.g. and opportunities for the purpose of Board integration and day-to-day operational needs • Use technology to improve efficiencies (e.g. Electronic Data standardization). Concurrent with the orientation. These are outlined in the following •Create staff roles for three sites, provide training and Interchange (EDI)) implementation of the six-month integration plan, table. Challenges facing SRH include capacity, knowledge sharing opportunities and find staffing • Implement Lean Business Performance System (BPS) across all Corporate Services efficiencies in a short period of time sites the organization also developed a comprehensive resources, and physical infrastructure and new • Consolidate IT infrastructure, clinical and business •Leverage best systems and processes from all sites set of Annual Goals and Initiatives for 2017-18 that workload demands stemming from the merger in systems and licensing contracts/agreements • Maintain dynamic Finance, IM/IT and Supply Chain teams included ‘regular’ operational activities in addition terms of standardizing or harmonizing roles and that can deliver on the integration to those linked to the recent merger. processes. Opportunities involve standardization • Manage matrix reporting structure for some departments and leveraging best practices, centres of excellence, • Infrastructure continues to deteriorate at a rate greater • Integrate capital planning and facilities operations across sites; than capital investment e.g. standardize dispatching of calls related to support services EARLY CHALLENGES AND community partnerships and building on our PFCC Capital Planning and • Unplanned surge volumes continue to place a burden on through Call Centre Facilities Operations OPPORTUNITIES IDENTIFIED and Lean foundation. These perspectives provide labour needs helpful insights to inform the strategic planning •People fatigue •Safeguarding patient privacy in an increasingly connected • Integrated teams Although a formal organizational assessment has process. and technology-driven world; building awareness of •Training hormonization (e.g. Lean, Privacy) not been conducted, during the initial pre-merger privacy requirements • Integrated and enhanced patient relations process • Emergency preparedness and keeping abreast of new/ • Corporate Integrated Risk Management framework Quality, Strategic Planning emerging threats; maintaining specialized resources to • Integrated reports Table 46: SRH Portfolio Challenges and Opportunities as Identified in January 2017 and Performance respond to significant Chemical Biological Radiological • Enhanced PFCC model Nuclear (CBRN) events •Policy Harmonization SRH Portfolio Challenges Opportunities • Supporting policy harmonization hospital-wide

• Surge in ED Volumes •Stroke care in Scarborough • Managing reputational risks

• Alternate Level of Care (ALC) •Providence Healthcare as potential partner • Differing organizational cultures • Stakeholder engagement • Physical Infrastructure • Mental Health community supports - forming linkages to Communications, • Branding, including separate intranets and websites • New Community Advisory Council • High demand for dialysis and cardiac procedures decrease ED use; increase HealthLinks - Coordinated Care Plans Engagement and • Reputational risk •Patient and Family Advisors, PFCC • Financial Pressures •Strengthen relations with primary care Government Relations • De-integration of Ajax-Pickering from Centenary •Diversity - language, culture, etc. Patient Services and •Leverage Lean Management System (LMS) and Business communications tools and distribution database • New website and intranet Professional Practice Process Improvement (BPS) methodologies • Build culture and lead the way in PFCC Source: SRH Executive •Leverage Regional Centers of Excellence (Cardiac, Nephrology, Vascular etc.) • HQO Quality Standards • Standardization of care and patient experience across all • Clinical/department integration TRANSITION COMMUNICATIONS AND 1. Continue to inform SRH’s internal sites • Increased Professional staff collaboration ENGAGEMENT PLAN •Potential physician anxiety and dissatisfaction with • Expansion of call groups and external communities and clinical integration changes •Teaching: expansion of teaching culture stakeholders about the new SRH. • Physician change management: clinical services planning, • Enhanced clinical services for sites and key recruitment The transition communications and engagement change in clinical practice locations, rationalization of opportunities 2. Articulate SRH’s goals and strategic direction Medical Administration, services • Research: marketing potential research and related funding plan was created to inform SRH’s internal and Medical Education and as it moves forward with standardization. opportunities external audiences about the six month period Research Ethics 3. Provide awareness around the specific • Retention of physicians following our 100-day plan and the ongoing • Robust physician recognition activities, initiatives, and events that • Medical leadership development changes taking place at SRH. It would also solicit the hospital will be carrying out. •Development of centres of excellence (orthopaedics, cardiac, a broad spectrum of views regarding how the nephrology) 4. Foster increased buy-in among •Excellence in peer review organization can best meet the needs of the

•Workflow engagement • Integration and standardization of back office functions and Scarborough community as we move forward with staff, physicians, volunteers, and the • Labour relations and settlement of PSLRTA-related issues teams, policies and procedures standardizing policies and procedures. The goals community for our continuing journey •Workforce stability - retention, recruitment challenges • Engagement of volunteers in integration and standardization to grow as one hospital organization. • Harmonization of back office functions programs/services of the transition communications and engagement Human Resources/Volunteer • Differences in organizational culture • Integration of diversity initiatives plan are to: Services •Wage and job harmonization • Expansion of diversity initiatives •Functionality gaps in legacy systems • Identification of opportunities for systems integration and • Integration of multiple existing systems across all areas efficiencies • Sharing of programs and services - ‘best of both worlds’ for workforce and patients

106 • Transitional Strategies and• Balance Readiness the Ajax-Pickering for Strategic TransitionPlanning Services AgreementSCARBOROUGH •W ANDork with ROUGE Lakeridge HOSPITAL: partners 2017 to effectively CORPORATE dives ENVIRONMENTALAjax-Pickering SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Transitional Strategies and Readiness for Strategic Planning • 107 (TSA) and separation plans with the Scarborough site integration and day-to-day operational needs • Use technology to improve efficiencies (e.g. Electronic Data •Create staff roles for three sites, provide training and Interchange (EDI)) knowledge sharing opportunities and find staffing • Implement Lean Business Performance System (BPS) across all Corporate Services efficiencies in a short period of time sites • Consolidate IT infrastructure, clinical and business •Leverage best systems and processes from all sites systems and licensing contracts/agreements • Maintain dynamic Finance, IM/IT and Supply Chain teams that can deliver on the integration • Manage matrix reporting structure for some departments

• Infrastructure continues to deteriorate at a rate greater • Integrate capital planning and facilities operations across sites; than capital investment e.g. standardize dispatching of calls related to support services Capital Planning and • Unplanned surge volumes continue to place a burden on through Call Centre Facilities Operations labour needs •People fatigue

•Safeguarding patient privacy in an increasingly connected • Integrated teams and technology-driven world; building awareness of •Training hormonization (e.g. Lean, Privacy) privacy requirements • Integrated and enhanced patient relations process • Emergency preparedness and keeping abreast of new/ • Corporate Integrated Risk Management framework Quality, Strategic Planning emerging threats; maintaining specialized resources to • Integrated reports and Performance respond to significant Chemical Biological Radiological • Enhanced PFCC model Nuclear (CBRN) events •Policy Harmonization • Supporting policy harmonization hospital-wide • Managing reputational risks

• Differing organizational cultures • Stakeholder engagement Communications, • Branding, including separate intranets and websites • New Community Advisory Council Engagement and • Reputational risk •Patient and Family Advisors, PFCC Government Relations • De-integration of Ajax-Pickering from Centenary •Diversity - language, culture, etc. communications tools and distribution database • New website and intranet 5. Solicit a broad spectrum of views on how the and engagement with the community. hospital can best meet the needs of current • The hospital is focused on quality care and and future communities in Scarborough. the growth and innovation of services, and 6. Form medium and long term is looking for a broad spectrum of views on strategies for engaging government how we can best meet the needs of current and our community partners. and future communities in Scarborough. 7. Standardize the use of new media as an outreach tool to our community. SRH has a broad range of stakeholders. It is 8. Address any questions related important to communicate to and engage these to changes at the hospital. stakeholders as SRH continues to transition and grow. The communications and engagement plan is an evolving document that will adapt to new Key messages to be shared through the transition approaches and information as SRH continues to communications and engagement plan include: navigate its ongoing transitional journey. • SRH is dedicated to providing the highest quality of care to our There were two phases planned to support patients and their families. communications, the first for the 100-day plan • After a successful 100-day plan, the hospital and the latter for the six-month integration and is moving forward with implementing medium transition plan. and long term objectives while standardizing policies and procedures across all three sites. Phase 1: 100-day plan • Since the merger, the hospital has integrated These activities included a range of methods and the senior leadership team, integrated tools to best allow SRH to achieve its engagement The framework is built on four themes shown in the diagram and summarized in the following table. committees and stakeholder forums, goals over a short timeframe. harmonized human resource policies and Table 47: SRH Growing Together Themes and Descriptions payroll models, standardized order sets Phase 2: Growing Together – ongoing transition Enhancing the patient Collaborating with our Theme Establishing strong systems Building teams and culture to guide patient care, integrated financial As SRH continues moving forward, there is experience community

planning, harmonized information systems, an opportunity to communicate more detail • Harmonizing current •Promoting •Working together • Reaching out to and standardized communications tools. to stakeholders about what is happening now systems and teamwork and to put the the community • SRH is embarking upon a robust that SRH has merged as one, single hospital processes shared purpose experiences of our for input on their •Developing systems across our patients and needs and what communications and community engagement corporation, and to paint a picture of the journey and processes workforce and families first they want to see the hospital and the community are taking through exercise to ensure our patients and their • Setting the workplace • Aligning our goals in their hospital this transitional, interim period. An overarching families, staff, physicians, volunteers, and foundation and • Bringing our staff in the delivery of •Fostering a What is this community partners are aware of the activities campaign has been developed called “Growing adopting best and our cultures care philanthropic theme about? being undertaken in this post-transition period. Together”, which will serve as a framework practices for together as part of • Harmonizing and interest and for communications and engagement on sustainable growth one organization integrating connection with • As part of SRH’s ongoing journey of growing harmonization and standardization activities and •Fostering a sense of services the hospital together as one hospital organization, we will confidence and • Actively involving initiatives. continue to work towards harmonizing and positive anticipation the community in standardizing our systems and processes; for what we can helping to shape teams and culture; services, care and the achieve together our journey patient/family experience; and our partnership Source: SRH Communications

108 • Transitional Strategies and Readiness for Strategic Planning SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Transitional Strategies and Readiness for Strategic Planning • 109 The campaign uses visual graphics for each of the themes that will be reflected in the communications STREAMLINING LEGACY STRATEGIC INITIATIVES materials (see sample below). In this way, SRH will create standardized templates for communications around the various transition activities, helping to demonstrate that they are all connected. Prior to amalgamation in 2016, both legacy organizations had recent strategic plans that articulated clear vision, mission, values and strategic directions. The legacy strategic plans are contained in the appendices (Appendices Figure 29: SRH Growing Together Visual Graphics by Theme F and G) and a comparison of them is in the table below.

Legacy RVHS Legacy TSH

Strategic Plan Time Horizon 2015-2018 (extended to 2019) 2015-2019

Together - the best at what we do To be recognized as Canada’s leader in Vision providing the best health care for a global community

To provide the best health care experience To provide an outstanding care Mission for our patients and their families experience that meets the unique needs of each and every patient

PATIENT Complete your Passport during EXPERIENCE WEEK • Responsive, respectful and caring for our • Integrity KICK-off EvENT Canadian Patient Safety Week! PATIENT Monday, April 24 Scarborough and Rouge Hospital is celebrating Canadian Patient Safety Week, 12 noon patients, colleagues and community • Compassion October 30 to November 3, with our Passport to Safety education event. EXPERIENCE Opening remarks by SRH senior APRIL 24-28 leader with a patient story from Staff and physicians are invited WEEK a patient family advisor, followed • Value the diversity of our organization • Accountability Join us for this interactive event focusing on patient safety “through our patients’ eyes”, by cake cutting with learning stations on medication safety, hand hygiene, two client identifiers, Locations: transfer of accountability, Sepsis, workplace violence prevention, falls, and risk Birchmount site, Cafeteria (Level 2) and community • Respect management and patient safety. The concepts of patient and family centred care and General site, Cafeteria (Ground floor) patient privacy will be woven throughout. Centenary site, Cafeteria (Third floor)

Monday, October 30 Thursday, November 2 Friday, November 3 Values • Honest, trustworthy and accountable for • Excellence HoNouRINg Centenary site General site Birchmount site Dr. Bruce Johnston ouR PATIENTs Auditorium Irene Stickland Centre Conference Room Tuesday, April 25 our resources, our services and our Passport to Safety will be held between 9 a.m. and 4 p.m. with rooms left open in 9 to 11 a.m./2 to 4 p.m. evenings for staff and physicians to visit. Greeting patients and family members at main entrances at behaviours all hospital sites GROWING Building TOGETHER teams PATIENT ANd • Strive for innovation, high performance fAmILy CENTREd CARE (PfCC) dIsCussIoN AT and commitment to continuous learning sTAff HuddLEs Wednesday, April 26 (and/or other dates throughout Patient Experience Week) 1. Innovators of a Quality Patient 1. Patients as Partners Experience 2. Innovation and Learning GROWING Enhancing the TOGETHER patient experience Strategic Directions 2. Champions of a Connected Health 3. Integrated Care Networks

System for Patients 4. Quality and Sustainability 3. Workplace of Choice

Join Scarborough and Rouge Hospital’s Community Advisory Council

Scarborough and Rouge Hospital is growing together in many In coming together, the similarities in the vision, mission, values, and strategic directions provided common ways, including launching a new Community Advisory Council. We are looking for dedicated community members representing ground for the start of a shared journey. the variety of diverse backgrounds, cultures and age groups that make up Scarborough to join this voluntary body. Help us shape the local health-care experience and advance our commitment to patient and family centred care. Privacy Training

Scarborough and Rough Hospital (SRH) is committed to upholding our patient’s privacy. After the merger, the combined number of strategic initiatives was 54. In April 2017, the Senior Leadership Team Learn more and apply online today at We are rolling out our new organization-wide privacy policy, statement of responsibility, and Privacy eLearning module, which is mandatory for all SRH employees, privileged srhhospital.ca/CAC staff, volunteers, researchers, contractors, and all other partners-in-care to complete. was reorganized to provide corporate (3-site) leadership for all programs and services. The team conducted a Applications should be submitted by November 2, 2017 What you need to know review of all legacy strategic initiatives to decide on one of three options: • All hospital personal must review the new privacy policy, sign our GROWING SRH Staff and hospital’s new statement of confidentiality, and review the TOGETHER Volunteers privacy eLearning module and complete the attestation • Training must be completed by September 22, 2017

SRH Physicians • Physicians are only required to complete privacy training through the reappointment process 1. Continue with the strategic initiative in the short-term.

If you have questions about your privacy responsibilities, please contact the Privacy Office at [email protected] or Michelle Ferreira at 416-284-8131 ext. 4302. 2. Put the initiative on hold (e.g. until the Strategic planning or Master planning process).

GROWING 3. Discontinue managing the initiative as a ‘strategic‘ initiative, which meant in several cases that TOGETHER the initiative was either complete or the requirements had shifted to operational activity.

Source: SRH Communications

110 • Transitional Strategies and Readiness for Strategic Planning SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Transitional Strategies and Readiness for Strategic Planning • 111 Of the 54 legacy strategic initiatives, 15 would 14. Implement Medicine and Surgery standardized VALUE REALIZATION FRAMEWORK The value realization framework has been continue, six were put on hold and 33 were block schedules for ambulatory care. developed into a progress report, which is a tool discontinued as strategic initiatives. A list of those 15. Complete retail food services strategy. There will come a time when SRH will reach a for the Board of Directors and Senior Leadership initiatives that are continuing and those currently ‘steady state’ and will not be defined by the merger Team to support communication with internal and on hold is provided below. of 2016. However, the bringing together of all external stakeholders. LEGACY STRATEGIC INITIATIVES – of the hospital facilities in Scarborough was a ON HOLD FOR SRH LEGACY STRATEGIC INITIATIVES – significant event for the Scarborough community The initiatives described in this chapter TO CONTINUE IN THE SHORT-TERM and a substantial short-term investment. A value (pre-merger planning, bridging integration plans, 1. Implement the RNAO – Best Practice Spotlight realization framework was developed to outline communications and engagement, streamlining Organization (BPSO) Guidelines at the 1. Enhance the patient experience through the anticipated value, or benefits, of the SRH legacy strategic initiatives and the Value Realization Centenary site (Note: Completed for General a partnership approach to co-design amalgamation for the community we serve. The Framework) position the organization well for its and Birchmount sites. On hold until 2018 planning and service delivery. framework helps to answer the questions: Now first strategic planning exercise. The process has when formal participation of the Centenary that we have merged, so what? Was it worth it? cultivated expertise in change management and 2. Continue efforts to become a site in the BPSO program can occur.). senior friendly hospital. What have we gained? The SRH Value Realization transformation that will serve the new organization 2. Conduct planning to identify complex Framework (displayed in the following figure) is well. Stakeholders have been engaged all along the 3. Create an integrated and functional continuing care/rehab models that based on three themes and six goals. Each goal way and are anxious to contribute to the next steps cancer care service. enhance acute care capacity. is mapped to key strategies to get us there, and in our journey. • 4. Develop and implement standardized 3. Implement advanced clinical indicators that signal our delivery of value to the care pathways for all patients information systems. SRH community. The framework acknowledges that admitted with stroke at SRH. 4. Select a virtual support (mobile integration is a journey and identifies value in the 5. Improve timely access to palliative care health) technology and vendor. short-term, medium-term and long-term. for inpatients across all three sites. 5. Research, educate, design and integrate Figure 30: SRH Value Realization Framework 6. Support development of a regional complementary medicine and therapies palliative care program. into our service delivery models. VALUE REALIZATION FRAMEWORK THEMES AND GOALS 7. Develop a regional maternal/ 6. Expand teaching affiliation agreements child care program. with current and new academic Foundation for Quality Patient Innovation for Successful Transition Experience Long-term Sustainability 8. Develop a regional orthopaedic program and research institutes. including sports injuries, shoulder Preserve a sense of stability Enhance standardized, Foster a culture of learning and joint replacement centres. There is an opportunity to assess the status and for our community evidence-based service delivery and innovation 9. Increase regionalization of cardiac services. outcomes of these initiatives and consider them in Ensure our employees, clinicians Improve timely, local access Leverage the benefits of a and volunteers are optimally to services single capital planning process the strategic planning process. supported through the transition and make effective use of 10. Promote the appointment of physicians process capital investments

to university lecturer status. Establish singular governance, Sustain and enhance hospital leadership and strategy to set services and infrastructure to 11. Promote the appointment of nurses the stage for organizational meet the community’s growing transformation needs and allied health professional to Support transfer of the Ajax site university adjunct professor status. to Lakeridge Health to ensure access to safe, stable care for 12. Enhance the complement of nursing, the community and allied health student placements to support our interprofessional model. * Short-Term Medium-Term Long-Term

13. Enhance our healthy workplace strategy * Anticipated timeframe for achieving improvement target and realizing measurable value: and implement a culture of staff safety. Short-Term: Within Year 1; Medium-Term: 1 to 3 Years; Long-Term: > 3 Years

112 • Transitional Strategies and Readiness for Strategic Planning SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Transitional Strategies and Readiness for Strategic Planning • 113 CONCLUSION AND NEXT STEPS CONCLUSION AND Access NEXT STEPS • Improving access to care across the continuum and in the appropriate setting This environmental scan takes an in-depth look • Addressing capacity shortfalls in the at the current state of SRH and changes that long-term care and community sectors have occurred over the last few years since the • Reducing inequities to remove variation last legacy strategic plans were completed. The by geography and population groups scan includes quantitative and some qualitative information on both our internal and external Efficiency environment. Several key themes arise from the • Continue to find efficiencies while driving analysis of trends within this report. These themes high-quality care in a time of fiscal restraint will require careful consideration in the strategic planning process: • Public demand for value-for- money from the public sector • Appropriate investments in Patient and Community infrastructure (facilities, equipment, • Growth in the communities we serve IT) to enable high performance • Aging, and people living longer with chronic diseases Care Providers • Growing diversity and • Aging workforce opportunities for inclusion • Expanding scope in certain professions • Relatively low utilization of hospital services (e.g. nurse practitioners)

Patient/Family Engagement Technological Advancements • Involvement of patients and families in • Innovation for information management their care, planning, design of services and clinical service delivery • Creation of Patient and Family Advisory Councils at the provincial, The environmental scan doesn’t include detailed LHIN, and hospital levels profiles of our many clinical programs. This will be a key next step and input to strategic planning. Future stakeholder engagement will add another Partnerships layer of qualitative analysis to further inform • Hospitals continuing to build strong the development of vision/mission/values, the networks and partnerships as part of a identification of strategic choices and development trend toward an integrated health system of the strategic directions that will guide the hospital for the next three years. • REFERENCES

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120 • References SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL References • 121 APPENDICES APPENDIX A: SRH ORGANIZATIONAL CHART, JULY 2017 APPENDIX B: SRH QUALITY & SAFETY SCORECARD 2016-17 SCARBOROUGH AND ROUGE HOSPITAL QUALITY AND SAFETY SCORECARD Q4 2017/18

Indicator Site Target 2015/16 Actual YTD Actual Period Current Status Current Period Year End

Birchmount 7.7 8.1 9.4 10.0 R

Scarborough and INTERIM CHIEF 90th Percentile ED LOS for complex patients (hrs) General 8.0 9.6 10.3 10.5 R Q4 2016/17 Rouge Hospital MEDICAL OFFICER BOARD OF DIRECTORS Dr. Michael Chapman Centenary 8.0 11.1 11.9 13.9 R DIRECTOR, MANAGER MEDICAL & ACADEMIC Birchmount 4.2 4.4 4.6 4.6 Y OFFICE OF THE PRESIDENT & CEO INTERIM CHIEF MEDICAL AFFAIRS, RESEARCH PRESIDENT & CEO & Elizabeth Buller OFFICER & CHAIR OF MAC ADMINISTRATION Q4 2016/17 BOARD OF DIRECTORS Dr. Naresh Mohan Margaret Kahng Acute Care Average Inpatient Length of Stay (days) General 4.3 4.6 4.7 4.9 R Trish Matthews (Jan-Feb) Centenary 4.2 4.1 4.1 4.2 G

Birchmount 100 85 76 G VICE PRESIDENT VICE PRESIDENT VICE PRESIDENT VICE PRESIDENT VICE PRESIDENT VICE PRESIDENT VICE PRESIDENT CORPORATE SERVICES CAPITAL PLANNING & HUMAN RESOURCES PERFORMANCE, STRATEGY PATIENT SERVICES PATIENT SERVICES PATIENT SERVICES & CFO FACILITIES OPERATIONS & VOLUNTEER SERVICES & INNOVATION & CNE Mark Vimr Nurallah Rahim Hospital Standardized Mortality Ratio (HSMR) General 100 96 101 Y Q4 2016/17 Cara Flemming Rick Gowrie Rhonda Lewis Michele James Linda Calhoun (Interim) Centenary 86 84 87 Y

CHIEF INFORMATION DIRECTOR DIRECTOR DIRECTOR DIRECTOR, PRO. PRACTICE DIRECTOR DIRECTOR Birchmount 0.32 0.17 0.17 0.17 G OFFICER SUPPORT SERVICES & HUMAN RESOURCES INNOVATION & ALLIED HEALTH & CHRONIC DISEASE MGMT. EMERGENCY CARE EXECUTIVE DIRECTOR Thodoros Topaloglou BUSINESS DEVELOPMENT Karen Dobbie IMPROVEMENT NURSING RESOURCE TEAM & NEPHROLOGY & MEDICINE GOV’T RELATIONS & Rate of Hospital Acquired C. difficile Associated Diarrhea Penny Lalopoulos Alfred Ng Minette MacNeil Ethel Doyle Nancy Veloso COMMUNICATIONS General 0.31 0.52 0.40 0.46 R Q4 2016/17 David Belous (CDI) (Interim) Centenary 0.26 0.31 0.25 0.04 G DIRECTOR DIRECTOR DIRECTOR DIRECTOR DIRECTOR DIRECTOR, MENTAL HEALTH, DIRECTOR INFORMATION SERVICES BIOMEDICAL ORGANIZATIONAL DEV’T PATIENT SAFETY, WOMEN’S & CHILDREN’S SENIORS HEALTH & FAMILY CRITICAL CARE & Birchmount 90.0% 88.0% 81.4% 89.3% Y & TELECOMMUNICATIONS ENGINEERING & DIVERSITY PRIVACY & RISK MGMT. HEALTH MEDICINE TEACHING UNIT RESPIRATORY THERAPY Rate of hand hygiene compliance before initial patient/ Joseph Hagos Siamak Sadr Waheeda Rahman Pamela Marshall Glyn Boatswain Sari Greenwood Barbara Scott Q4 2016/17 patient environment contact (peer audits only) General 90.0% 83.9% 87.3% 83.2% Y

Rate of hand hygiene compliance before initial patient/ Q4 2016/17 DEPUTY CHIEF DIRECTOR DIRECTOR MANAGER DIRECTOR DIRECTOR DIRECTOR FINANCIAL OFFICER ENVIRONMENTAL WORKPLACE HEALTH PATIENT RELATIONS QUALITY, STANDARDIZATION ONCOLOGY & SURGERY & patient environment contact (blend of peer and Centenary 90.0% 79.6% 89.8% 93.4% G Cory Bryan SERVICES & FACILITIES & SAFETY Jeanette Dindial & INFECTION CONTROL CARDIOVASCULAR AMBULATORY CARE Tyler Crocker Mary Anne Adam Kim Brophy Trixie Williams Jacquie Ho (Interim) independent audits) Birchmount 2.1% 1.2% 1.2% 1.7% Pressure Ulcers - Prevalence of facility acquired pressure G Mar 2017 DIRECTOR DIRECTOR MANAGER MANAGER DIRECTOR DIRECTOR DIRECTOR ulcers Stage 2 and above (audit data) FINANCIAL SERVICES* CAPITAL PLANNING & VOLUNTEER SERVICES PATIENT- AND-FAMILY DIAGNOSTIC IMAGING LABORATORY SERVICES PHARMACY SERVICES General 2.1% 2.0% 1.6% 1.6% G Janine Ball PROJECT MGMT. OFFICE Florence Edebiri CENTRED CARE SERVICES* Petra Sheldrake Shelley Dorazio Faaiza Ali Kristy Macdonell Tom Jackson Pressure Ulcers - Facility acquired pressure ulcers Stage G Q4 2016/17 2 and above (Coded data for acute and post-acute) Centenary 0.8% 0.7% 0.3% 0.2%

DIRECTOR MANAGER Birchmount 0.20 0.20 0.20 0.17 INFORMATION SPIRITUAL CARE Falls - Falls resulting in Moderate/Severe Injuries per G MANAGEMENT Ajith Varghese Q4 2016/17 Richard Scheel 1,000 patient days General 0.20 0.20 0.22 0.34 R

Falls - Number of hospital falls with Minor, Moderate or Q4 2016/17 G DIRECTOR Severe Harm for Medicine and Post-Acute Patients Centenary 60 62 37 10 SPECIAL PROJECTS Jill Kouri Birchmount 12.1% 16.5% 23.6% 25.3% R Q4 2016/17 Alternate Level of Care (ALC) Rate General 12.7% 17.8% 25.2% 25.9% R DIRECTOR (Jan-Feb) SUPPLY CHAIN (PLEXXUS) Centenary 17.9% 11.9% 16.8% 15.1% G Nick Dimovski *Directors on Leave of Absence not included on chart Birchmount 16.8% 17.7% 19.3% 18.4% Y 30 day readmission rate to own facility - Congestive Heart Q4 2016/17 General 16.8% 18.4% 17.5% 14.9% G Failure (CHF) (Feb) Centenary 16.8% 15.9% 14.9% 14.3% G

Birchmount 17.7% 12.4% 17.5% 17.4% G 30 day readmission rate to own facility - Chronic Q4 2016/17 General 17.7% 17.6% 17.3% 19.4% Y Obstructive Pulmonary Disease (COPD) (Jan) Centenary 16.7% 15.9% 14.7% 15.6% G

Birchmount 13.8% 9.2% 9.3% 7.0% G Repeat unplanned ED visits within 30 days for mental Q4 2016/17 General 13.1% 3.0% 5.1% 7.3% G health conditions (to own facility) (Jan) Centenary 11.9% 13.1% 15.2% 11.4% G

Birchmount 83.1% 95.5% 87.5% 63.6% R Proportion of patients identified as palliative in hospital General 88.5% 92.6% 89.1% 82.8% Y Q4 2016/17 who are discharged home from hospital with support (%) Centenary 75.0% 86.4% 97.0% 100.0% G

Birchmount 60.3% 45.7% 54.5% Y

Patient Satisfaction in the ED (Would you recommend) General 60.3% 46.8% 50.0% R Q4 2016/17

Centenary 65.0% 46.8% 57.1% R

Birchmount 70.6% 49.6% 46.5% R Patient Satisfaction on Inpatient Medial and Surgical Q4 2016/17 units (Would you recommend) General 70.6% 46.6% 41.5% R (Jan-Feb) (Centenary started surveying in June 2016) Centenary 75.0% 55.2% 62.5% R

124 • Appendices SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Appendices • 125 APPENDIX C: HEALTH • Alzheimer Society Peterborough, Kawartha Projects- Peterborough* • Yee Hong Centre for Geriatric Care - Toronto* SERVICE PROVIDERS IN THE Lakes, Northumberland and Haliburton • Les Centres D’Accueil Heritage - Toronto* CENTRAL EAST LHIN - Peterborough* and Lindsay* • Lovesick Lake Native Women’s Family Health Teams • Brain Injury Association of Association- Buckhorn* • Durham West Family Health Team This list was developed by the Central East LHIN Durham Region- Oshawa* • March of Dimes Canada - Scarborough* • Kawartha North Family Health Team and is available on their website. It is intended • Branch 133, Legion Village - Cobourg* • Haliburton Highlands Family Health Team as an overview and may not be complete. Certain • Momiji Health Care Society - Scarborough* • Campbellford Memorial Multicare providers, services, programs and name changes • Osteoporosis Canada - - NEW • Peterborough Networked Family Health Teams Lodge- Campbellford* may not be listed. • Oshawa Senior Citizens Centre - Oshawa* • Northumberland Family Health Team • Canadian Hearing Society • Participation House Toronto - Toronto* • Scarborough Academic Family Health Team *Central East LHIN Funded agency (Peterborough)- Peterborough* • Personal Attendant Care - Whitby* • Trent Hills Family Health Team • Canadian Red Cross Society - Addictions Durham Region, Scarborough* • Regional Geriatric Program of Toronto - Toronto* Hospitals • Chinese Family Services of • Carefirst Seniors Community Services • Bellwood Health Services, Inc. Ontario - Scarborough* Association- Scarborough* • Regional Muncipality of Durham, Scarborough - Toronto* Senior Services - Oshawa* • Four Counties Addiction Services • Centre for Immigration and Community • Campbellford Memorial Team Inc - Peterborough* Services of Ontario- Scarborough* • Rehabilitation Foundation for the Hospital - Campbellford* Disabled - Durham Region* • Pinewood Centre- Oshawa* • CNIB Durham- Oshawa* • Haliburton Highlands Health Services • Saint Elizabeth Health Care • CNIB HKPR District- Peterborough* Corporation - Haliburton, Minden* After Hour Clinics • Scarborough Centre for Healthy • Community Care Durham- Ajax/ • Lakeridge Health - Clarington, • CAHC - Centenary After Hours Clinic Communities - Scarborough* Pickering, Brock (Cannington), Scugog Oshawa, Port Perry, Whitby* (Port Perry), Clarington (Bowmanville & • TransCare Community Support • Northumberland Hills Hospital - Cobourg* Community Health Centres Newcastle), Whitby, Uxbridge, Oshawa.* Services - Scarborough* • Carea Community Health • Peterborough Regional Health • Community Care Haliburton • St. John’s Retirement Home - Peterborough* Centre - Oshawa*, Ajax* Centre - Peterborough* County- Haliburton* • St. Paul L’Amoreaux - Toronto* • Scarborough Centre for Healthy • Ross Memorial Hospital - Lindsay* • Community Care, City of • Sunrise Seniors Place - Oshawa* Communities - Scarborough* • Scarborough and Rouge Kawartha Lakes- Lindsay* • Supportive Initiatives for Residents in • Taibu Community Health Hospital – Scarborough* • Community Care Northumberland- the County of Haliburton - Haliburton* Centre - Scarborough* • Ontario Shores Centre for Mental Campbellford* • Victorian Order of Nurses For Canada - Ontario • Port Hope Community Health Health Sciences - Whitby* • Community Care Peterborough- Peterborough* Branch (through Durham Site) - Durham* Centre - Port Hope* • Community Counselling and • VON Durham Hospice - Whitby* • Brock Community Health Centre - Cannington* Independent Health Facilities Resource Centre- Peterborough* • Victorian Order of Nurses For Canada - Ontario, • City of Kawartha Lakes Community • Dialysis Management Clinics Inc. - • Curve Lake First Nations - Peterborough* Branch (through Peterborough, Victoria Health Centre - Lindsay* Markham, Ajax/Pickering, Peterborough • Faith Place - Oshawa* and Haliburton Site) - Peterborough* • Victorian Order of Nurses For Canada - Ontario Community Support Services • Four Counties Brain Injury Long-Term Care Facilities Branch (through Toronto York Site) - Markham* • Alderville First Nation (Alderville Association- Peterborough* • Ballycliffe Lodge Nursing Home - Ajax* Community Care)- Roseneath* • Hospice Peterborough- Peterborough* • VON Hospice Scarborough • Bendale Acres - Scarborough* • Alzheimer Society of Durham Region- Oshawa* • Kawartha Participation • Whitby Seniors’ Activity Centre - Whitby • Bon-Air Nursing Home - Cannington*

126 • Appendices SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Appendices • 127 • Burnbrae Gardens Long-Term Care • Leisureworld Altamont Nursing Care - Scarborough* • Interact, Community Mental Residence - Campbellford* Home - Scarborough* • Trilogy Long-Term Care Centre - Scarborough* Health Program - Oshawa • Caressant Care Lindsay Nursing • Leisureworld Caregiving Centre, • Victoria Manor Home for the Aged - Lindsay* • Mental Health Services - Peterborough* Home - Lindsay* Ellesmere - Scarborough* • Village of Taunton Mills (The) - Durham • Northumberland Community Mental • Caressant Care McLaughlin • Leisureworld Caregiving Centre, Health Centre - Cobourg* • WynField (The) - Durham* Road - Kawartha Lakes* Scarborough - Scarborough* • Psychiatric Assessment Services for • Yee Hong Centre, Scarborough • Centennial Place Long-Term Care • Leisureworld Rockcliffe Nursing the Elderly (PASE) - Peterborough* Finch - Scarborough* Centre - Peterborough* Home - Scarborough* • Psychiatric Assessment & Schizophrenia • Yee Hong Centre for Geriatric • Community Nursing Home - Port Perry* • Marnwood Lifecare Centre - Bowmanville* Clinic - Peterborough* Care - Scarborough* • Community Nursing Home - Port Hope* • Marycrest Home for the Aged - Peterborough* • Salvation Army Community Support & Employment Program - Toronto* • Community Nursing Home - Pickering* • Mon Sheong Scarborough Long Term Mental Health • Community Nursing Home - Warkworth* Care Centre - Scarborough* • C.O.P.E. Mental Health Program • Scarborough Hospital Child and Adolescent Program - Scarborough* • Craiglee Nursing Home - Scarborough* • Pinecrest Nursing Home - Bobcaygeon* (Community Care Durham) - Oshawa* • Scarborough Hospital Community Mental • Ehatare Nursing Home - Scarborough* • Pleasant Meadow Manor - Norwood* • Campbellford & District Community Mental Health Centre - Campbellford* Health Program - Scarborough* • Extendicare Cobourg - Cobourg* • Regency Manor Nursing Home - Port Hope* • Canadian Mental Health Association • Sexual Assault/Eating Disorder Outreach • Extendicare Kawartha Lakes - Lindsay* • Revera LTC Inc - ReachView Village - Uxbridge* - Kawartha Lakes* Counselling Program - Peterborough* • Extendicare Lakefield - Lakefield* • Revera LTC Inc - Bay Ridges - Durham* • Canadian Mental Health • Shoniker Clinic - Scarborough* • Extendicare Port Hope - Port Hope* • Revera LTC Inc - Fenelon Court - Fenelon Falls* Association - Peterborough* • Survivors’ Psychiatric Advocacy • Extendicare Rouge Valley - Scarborough* • Revera LTC Inc - Fosterbrooke - Newcastle* • Canadian Mental Health Association - Toronto* Network (S.P.A.N.) - Lindsay* • Extendicare Guildwood - Scarborough* • Revera LTC Inc - Kennedy • Children’s Mental Health Program - Oshawa • United Survivors Support Centre - Oshawa* Lodge - Scarborough* • Extendicare Haliburton - Haliburton* • Children’s Mental Health • Victorian Order of Nurses For Cananda-Ontario • Revera LTC Inc - ThorntonView - Oshawa* • Extendicare Oshawa - Oshawa* Program - Peterborough Branch (through Durham Site) - Oshawa* • Revera LTC Inc - Winbourne Park - Ajax* • Extendicare Peterborough - Peterborough* • City of Kawartha Lakes Community Support • Ontario Shores Centre for Mental • Riverview Manor Nursing Health Sciences - Whitby* • Extendicare Scarborough - Scarborough* Program - City of Kawartha Lakes* Home - Peterborough* • Fairhaven Home for the Aged - Peterborough* • Canadian Mental Health Association, • Seven Oaks - Scarborough* Durham Branch - Oshawa* Seniors’ Services • Fairview Lodge - Whitby* • Shepherd Lodge - Agincourt* • DHS HealthCare Service • Durham Mental Health Services - Whitby* • Frost Manor - Lindsay* • Specialty Care Case Manor - Bobcaygeon* • Home Instead Senior Care • Community Counselling Services • Golden Plough Lodge - Cobourg* • Springdale County Manor - Peterborough* - City of Kawartha Lakes* • Next Steps Solutions • Hellenic Home for the Aged - Scarborough* • St. Joseph’s at Fleming - Peterborough* • Community Progress, Rouge • Highland Wood - Haliburton* Miscellaneous • Strathaven Lifecare Centre - Bowmanville* Valley - Scarborough • Hillsdale Estates- Oshawa* • Central East Infection Control Network • Streamway Villa - Cobourg* • Alzheimer Society of Durham • Hillsdale Terraces - Oshawa* Region - Oshawa* • Sunnycrest Nursing Home - Whitby* • Hyland Crest Senior Citizens’ Home - Minden* • Haliburton Highlands Mental • Tendercare Living Centre - Scarborough* • Ina Grafton Gage Home - Scarborough* Health Services - Minden* • The Wexford - Scarborough* • Lakeview Manor - Beaverton* • Hong Fook Mental Health Services - Toronto* • Tony Stacey Centre for Veterans

128 • Appendices SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Appendices • 129 OrganizationStrategic Directions/Goals/Areas of Focus Provide the best experience for you and your family: Goal 1: Put patients and their families at the centre of decision making about their own care and respecting their diversity Goal 2: Be recognized nationally as a leade rin delivering the best patient and family experience

Relentlessly focus on quality and performance: Goal 1: Constantly improve quality and performance Lakeridge Health (815 beds) Goal 2: Embrace technology to transform our care

(Oshawa, Bowmanville, Port Perry, Ajax/Pickering, Whitby) Attract and inspire the best people: 2016-2021 Goal 1: Personal commitment to excellence Goal 2: An engaged team Goal 3: Teaching and research excellence

Working with partners to improve your: care Goal 1: Partner with other health care providers to ensure integrated care Goal 2: Innovate to create new models of care Deliver Culturally Safe, Outstanding: Care 1. Focus on providing a safe and positive experience for patients, families and caregivers. 2. Support health equity through the provision of culturally competent patient care. 3. Collaborate with Indigenous communities to deliver appropriate care.

Deliver Seamless Care Transitions: 1. Work with patients, families and healthcare partners to develop processes to drive and implement seamless transitions of care. 2. Strengthen our relationships with primary care providers, partner hospitals and other community partners to facilitate timely and appropriate access to care. 3. Explore and implement innovative care and service delivery models. Peterborough Regional Health Centre (181 beds)

Deliver Regional Programs in Collaboration with Our Care: Partners (Peterborough) 1. Be a reliable partner to meet specialized acute care needs of patients and their families. 2017-2020 2. Continue to enhance Centres of Excellence for Cardiac, Vascular and Cancer Care, and develop a Centre of Excellence for Seniors Care. 3. Develop an integrated model for Mental Health and Addictions services. 4. Explore and plan mutually beneficial clinical and support service opportunities with the NE Cluster and CELHIN partners.

Build Strong Foundations to Achieve our Mission 1. Develop a master program/master facility plan that will serve a s the blueprint for the delivery of care for the next generation. 2. Enable and sustain a long-term financial plan that ensures a positive operating position and secures the capital resources to achieve our mission. 3. In collaboration with our hospital partners, plan and implement an electronic patient record. 4. Be known for a People Strategy that fosters a culture in which our people can excel in the delivery of quality service.

Patient and Family-Inspired Care: Achieving Patient Goals Patient and family inspired care is inclusive and delivered with respect and compassion. We aspire to create the ideal patient experience. We are inspired by the health goals of our patients and their families, and will help develop an inclusive, achievable care plan that is: clear, effective, respectful, evidence-based, and draws upon the full breadth of health resources in our community. We are highly motivated to do our part to transition our patients back home, into the care of our community partners to restore their health. Consistent, Reliable Quality Every Patient – Every Day Enhancing Teamwork and Care Models Improving Outcomes Championing Partnerships Working Together Safeguarding Financial Health Strengthening Resilience

Consistent, Reliable Quality: Every Patient - Every Day Compassionate, accessible, safe, evidence-based quality care ...delivered to every patient, every day, in every encounter. We will treat patients like family, remembering that their health is precious and that they put profound trust in us. We are committed to provide: • Safe, evidence-based practices, standardization, and consistency; • The right care, by the right physician, at the right time; • A community of providers sharing information, resources, and patient care; • Resources to facilitate, coordinate and modernize communications; • Education opportunities to enhance skills.

Enhancing Teamwork and Care Models: Ross Memorial Hospital (179 beds) Improving Outcomes Our medical care team includes clinicians, support staff, community providers, and you, the patient. Together, we have the responsibility to work collaboratively and (Lindsay) creatively to help achieve your health goals and coordinate care connections. Every member of the team, from the bedside to the boardroom and beyond, offers individual expertise and deserves respect. Team members are knowledgeable, 2015-2021 reliable, accountable for their actions, and play important roles in our patients’ experiences. Together, we will seek to: • Improve outcomes by providing a wider array of services and comprehensive care extended to weekends and evenings; • Standardize interventions and care pathways with greater access to specialists for consultations and services; • Improve patient satisfaction through engagement, increasing access to information for greater capacity for patient self-management; coordinating transitions to home and community support; and, • Optimize resources with more integrated coordination, maximizing the scope of practice for healthcare providers and the use of community services.

Championing Partnerships: Working Together We will be the integration leader for innovative partnerships and facilitate seamless care, centered around patient needs. Always focusing on what’s best for the patient, we will champion progressive, coordinated care from illness to wellness. We will champion the needs and goals of patients with complex, continuing or chronic health conditions who are most at risk of returning to the hospital, by facilitating a smooth progression of care between healthcare partners. RMH believes that patient care is best served by healthcare providers working collaboratively to: • Coordinate patient care, ensuring that it is as smooth as possible; • Harmonize information and education for the patient; and • Proactively identify and resolve patient needs and issues.

Safeguarding Financial Health: Strengthening Resilience We must maintain financial health while facing increasing expenses, major project investments, and declining revenues. RMH continues to face significant challenges to reduce costs, increase efficiency, reduce debt, sustain infrastructure, and deliver more complex and robust care. This must be done without compromising services, quality of care, safety or patient satisfaction.

Health System Integration APPENDIX D: STRATEGIC PRIORITIES OF • Continue with, and identify new, integration opportunities with internal and external partners. • Work with our Primary Care, Community Care Access Centre, and Seniors Care Network partners to identify innovative improvements to the coordination of CENTRAL EAST LHIN HOSPITALS care in Haliburton County. Community Engagement • Develop a Community Engagement and Communication Plan to identify new and impactful ways to engage with community members, local councils, media, OrganizationStrategic Directions/Goals/Areas of Focus and other stakeholders so that HHHS is seen as the open and transparent organization it is. Provide the best experience for you and your family: • Create a Community Advisory Committee (CAC) to provide the community with a direct link to HHHS. Work with the new CAC to identify opportunities and Goal 1: Put patients and their families at the centre of decision making about their own care and respecting their diversity take action when necessary to address community needs and requests. Goal 2: Be recognized nationally as a leade rin delivering the best patient and family experience Effective People and Teams Haliburton Highlands Health Services (107 beds) • Implement a Recruitment and Retention Strategy to provide staff with the support they require, as well as ongoing education and training throughout the Relentlessly focus on quality and performance: organization. Goal 1: Constantly improve quality and performance • Enhance existing communication and engagement with staff and volunteers across the organization to build a culture of teamwork, accountability and (Haliburton) Lakeridge Health (815 beds) Goal 2: Embrace technology to transform our care recognition within the organization 2014-2017 Quality and Service Excellence (Oshawa, Bowmanville, Port Perry, Ajax/Pickering, Whitby) Attract and inspire the best people: • Identify and expand locally delivered services that the residents of Haliburton County will require. 2016-2021 Goal 1: Personal commitment to excellence • Improve the access to specialists through the use of technology and referral pathways Goal 2: An engaged team Goal 3: Teaching and research excellence Sustainability • Recognizing that the seasonal residents of Haliburton County have a strong willingness to contribute to the success of HHHS, work with our Foundation and Auxiliaries to identify how to best engage seasonal residents and encourage their participation and contributions to HHHS Working with partners to improve your: care • Plan for the long-term sustainability and success of HHHS. Develop a long-term master plan that meets the needs of Haliburton County and gains support Goal 1: Partner with other health care providers to ensure integrated care from the Ministry of Health and Long-Term Care and Central East LHIN. Goal 2: Innovate to create new models of care

Deliver Culturally Safe, Outstanding: Care Quality and Safety: 1. Focus on providing a safe and positive experience for patients, families and caregivers. • Improve outcomes and the patient and family experience 2. Support health equity through the provision of culturally competent patient care. • Build upon our leadership in seniors’ care in preparation for rising community needs 3. Collaborate with Indigenous communities to deliver appropriate care. • Expand palliative and end-of-life care capacity in our community • Advance mental health supports in our community Deliver Seamless Care Transitions:

1. Work with patients, families and healthcare partners to develop processes to drive and implement seamless transitions of care. Great Place to Work and Volunteer: 2. Strengthen our relationships with primary care providers, partner hospitals and other community partners to facilitate timely and appropriate access to care. • Enhance our culture 3. Explore and implement innovative care and service delivery models. Peterborough Regional Health Centre (181 beds) • Support ongoing staff training and development Northumberland Hills Hospital (104 beds) • Enrich the impact and experience of our volunteers and students Deliver Regional Programs in Collaboration with Our Care: Partners • (Peterborough) Sustain physician engagement on hospital and system priorities 1. Be a reliable partner to meet specialized acute care needs of patients and their families. 2017-2020 (Cobourg) 2. Continue to enhance Centres of Excellence for Cardiac, Vascular and Cancer Care, and develop a Centre of Excellence for Seniors Care. 2017/18-2020/21 Collaborative Community Partnerships: 3. Develop an integrated model for Mental Health and Addictions services. • Support the development of a more integrated health care experience for patients in our community 4. Explore and plan mutually beneficial clinical and support service opportunities with the NE Cluster and CELHIN partners. • Develop innovative local partnership opportunities

Build Strong Foundations to Achieve our Mission Operational Excellence: 1. Develop a master program/master facility plan that will serve a s the blueprint for the delivery of care for the next generation. • Enhance decision-support resources 2. Enable and sustain a long-term financial plan that ensures a positive operating position and secures the capital resources to achieve our mission. • Seek new and alternate sources of funding 3. In collaboration with our hospital partners, plan and implement an electronic patient record. • Prepare for and adapt to future service needs related to changing demographics 4. Be known for a People Strategy that fosters a culture in which our people can excel in the delivery of quality service. • Apply innovative approaches to managing our operations Patient and Family-Inspired Care: • Advocate for sustainable funding in the context of provincial funding reform Achieving Patient Goals Patient and family inspired care is inclusive and delivered with respect and compassion. 1. Ensure CMH is sustainable as a hospital. Campbellford Memorial Hospital (34 beds) We aspire to create the ideal patient experience. We are inspired by the health goals of our patients and their families, and will help develop an inclusive, achievable 2. Ensure safe quality care and service excellence for our patients – both now and in the future. care plan that is: clear, effective, respectful, evidence-based, and draws upon the full breadth of health resources in our community. We are highly motivated to do 3. Recruit and retain the best people. our part to transition our patients back home, into the care of our community partners to restore their health. Consistent, Reliable Quality Every Patient – Every Day (Campbellford) 4. Share the CMH story with our community and the broader health care community. Enhancing Teamwork and Care Models Improving Outcomes Championing Partnerships Working Together Safeguarding Financial Health Strengthening Resilience 2014-2017 5. Enhance our physical plant, clinical equipment, and technological infrastructure. Consistent, Reliable Quality: Excellence Every Patient - Every Day We are dedicated to clinical and organizational excellence, founded on our more than 30-year history of success in the fields of addiction disorders and mental Compassionate, accessible, safe, evidence-based quality care ...delivered to every patient, every day, in every encounter. We will treat patients like family, remembering that their health is precious and that they put profound trust in us. We are committed to provide: health. We are an organization that embraces change and drives innovation through evidence-informed, rigorous measurement practices. • Safe, evidence-based practices, standardization, and consistency; • The right care, by the right physician, at the right time; Compassion • A community of providers sharing information, resources, and patient care; We understand the suffering associated with addiction and mental illness, and the strength and determination it takes to confront it. We treat our patients, Bellwood Health Services, Inc. • Resources to facilitate, coordinate and modernize communications; clients, families and ourselves with compassion, care and empathy. • Education opportunities to enhance skills. (Scarborough) Courage Enhancing Teamwork and Care Models: We know nothing of consequence happens without courage. It takes courage to make meaningful connections and engage in challenging conversations with Ross Memorial Hospital (179 beds) Improving Outcomes respect, integrity and honesty. Our medical care team includes clinicians, support staff, community providers, and you, the patient. Together, we have the responsibility to work collaboratively and (Lindsay) creatively to help achieve your health goals and coordinate care connections. Every member of the team, from the bedside to the boardroom and beyond, offers individual expertise and deserves respect. Team members are knowledgeable, Advocacy 2015-2021 reliable, accountable for their actions, and play important roles in our patients’ experiences. We will work tirelessly to de-stigmatize mental illness and addiction disorders through education. and advocacy Together, we will seek to: • Be Bold, Be Inspiring, Be Caring, Be Extraordinary • Improve outcomes by providing a wider array of services and comprehensive care extended to weekends and evenings; • Standardize interventions and care pathways with greater access to specialists for consultations and services; • Enhance partnerships to deliver and advocate for a coordinated health and social care system • Improve patient satisfaction through engagement, increasing access to information for greater capacity for patient self-management; coordinating transitions to • Enable new ways to engage with patients, families and partners home and community support; and, • Explore and implement leading models of care that leverage innovative technology solutions to advance and address the unique needs of our patients • Optimize resources with more integrated coordination, maximizing the scope of practice for healthcare providers and the use of community services. • Maximize our Research and Academic enterprise to support system transformation • Demonstrate to our people that everyone has the ability to innovate and inspire, and regularly celebrate stories from all corners of our organization Championing Partnerships: Ontario Shores Centre for Mentel Health Sciences Working Together (628 beds) • Develop a multi-channel platform with our people to exchange knowledge and stimulate inventive thinking We will be the integration leader for innovative partnerships and facilitate seamless care, centered around patient needs. • Deepen our relationships with partners and work together to achieve breakthroughs in quality of care, research and education Always focusing on what’s best for the patient, we will champion progressive, coordinated care from illness to wellness. We will champion the needs and goals of (Whitby) • Enable our teams to engage and work closely with our patients and their families to improve their recovery-oriented care experiences patients with complex, continuing or chronic health conditions who are 2017-2022 • Advance the science and practice of recovery in mental health most at risk of returning to the hospital, by facilitating a smooth progression of care between healthcare partners. RMH believes that patient care is best served by healthcare providers working collaboratively to: • Equip our people with the necessary experience and tools to deliver the best care possible • Coordinate patient care, ensuring that it is as smooth as possible; • Encourage the growth, development, safety and wellness of our people • Harmonize information and education for the patient; and • Advance our analytics capabilities to drive continuous quality improvement and growth of our research and academic mandate • Proactively identify and resolve patient needs and issues. • Enhance patient outcomes through the development and evaluation of performance measures • Utilize real time data to provide the highest standard of clinical practice Safeguarding Financial Health: Strengthening Resilience We must maintain financial health while facing increasing expenses, major project investments, and declining revenues. RMH continues to face significant challenges to reduce costs, increase efficiency, reduce debt, sustain infrastructure, and deliver more complex and robust care. This must be done without compromising services, quality of care, safety or patient satisfaction.

Health System Integration • Continue with, and identify new, integration opportunities with internal and external partners. • Work with our Primary Care, Community Care Access Centre, and Seniors Care Network partners to identify innovative improvements to the coordination of care in Haliburton County. 130 • Appendices SCARBOROUGH AND ROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Appendices • 131 Community Engagement • Develop a Community Engagement and Communication Plan to identify new and impactful ways to engage with community members, local councils, media, and other stakeholders so that HHHS is seen as the open and transparent organization it is. • Create a Community Advisory Committee (CAC) to provide the community with a direct link to HHHS. Work with the new CAC to identify opportunities and take action when necessary to address community needs and requests.

Effective People and Teams Haliburton Highlands Health Services (107 beds) • Implement a Recruitment and Retention Strategy to provide staff with the support they require, as well as ongoing education and training throughout the organization. • Enhance existing communication and engagement with staff and volunteers across the organization to build a culture of teamwork, accountability and (Haliburton) recognition within the organization 2014-2017 Quality and Service Excellence • Identify and expand locally delivered services that the residents of Haliburton County will require. • Improve the access to specialists through the use of technology and referral pathways

Sustainability • Recognizing that the seasonal residents of Haliburton County have a strong willingness to contribute to the success of HHHS, work with our Foundation and Auxiliaries to identify how to best engage seasonal residents and encourage their participation and contributions to HHHS • Plan for the long-term sustainability and success of HHHS. Develop a long-term master plan that meets the needs of Haliburton County and gains support from the Ministry of Health and Long-Term Care and Central East LHIN.

Quality and Safety: • Improve outcomes and the patient and family experience • Build upon our leadership in seniors’ care in preparation for rising community needs • Expand palliative and end-of-life care capacity in our community • Advance mental health supports in our community

Great Place to Work and Volunteer: • Enhance our culture • Support ongoing staff training and development Northumberland Hills Hospital (104 beds) • Enrich the impact and experience of our volunteers and students • Sustain physician engagement on hospital and system priorities (Cobourg) 2017/18-2020/21 Collaborative Community Partnerships: • Support the development of a more integrated health care experience for patients in our community • Develop innovative local partnership opportunities

Operational Excellence: • Enhance decision-support resources • Seek new and alternate sources of funding • Prepare for and adapt to future service needs related to changing demographics • Apply innovative approaches to managing our operations • Advocate for sustainable funding in the context of provincial funding reform

1. Ensure CMH is sustainable as a hospital. Campbellford Memorial Hospital (34 beds) 2. Ensure safe quality care and service excellence for our patients – both now and in the future. 3. Recruit and retain the best people. (Campbellford) 4. Share the CMH story with our community and the broader health care community. 2014-2017 5. Enhance our physical plant, clinical equipment, and technological infrastructure. Excellence We are dedicated to clinical and organizational excellence, founded on our more than 30-year history of success in the fields of addiction disorders and mental health. We are an organization that embraces change and drives innovation through evidence-informed, rigorous measurement practices.

Compassion We understand the suffering associated with addiction and mental illness, and the strength and determination it takes to confront it. We treat our patients, Bellwood Health Services, Inc. clients, families and ourselves with compassion, care and empathy.

(Scarborough) Courage We know nothing of consequence happens without courage. It takes courage to make meaningful connections and engage in challenging conversations with respect, integrity and honesty.

Advocacy We will work tirelessly to de-stigmatize mental illness and addiction disorders through education. and advocacy • Be Bold, Be Inspiring, Be Caring, Be Extraordinary • Enhance partnerships to deliver and advocate for a coordinated health and social care system • Enable new ways to engage with patients, families and partners • Explore and implement leading models of care that leverage innovative technology solutions to advance and address the unique needs of our patients • Maximize our Research and Academic enterprise to support system transformation Ontario Shores Centre for Mentel Health Sciences • Demonstrate to our people that everyone has the ability to innovate and inspire, and regularly celebrate stories from all corners of our organization (628 beds) • Develop a multi-channel platform with our people to exchange knowledge and stimulate inventive thinking • Deepen our relationships with partners and work together to achieve breakthroughs in quality of care, research and education (Whitby) • Enable our teams to engage and work closely with our patients and their families to improve their recovery-oriented care experiences 2017-2022 • Advance the science and practice of recovery in mental health • Equip our people with the necessary experience and tools to deliver the best care possible • Encourage the growth, development, safety and wellness of our people • Advance our analytics capabilities to drive continuous quality improvement and growth of our research and academic mandate • Enhance patient outcomes through the development and evaluation of performance measures • Utilize real time data to provide the highest standard of clinical practice Auditor General Report Recommendation Primary Response

1. To ensure that funding to hospitals accurately reflects patient needs, the MOHLTC should plan MOHLTC appropriately so that surgeries are delivered when needed.

2. To better ensure timely transfer of patients from the emergency room to an acute bed when needed, Hospitals hospitals should: a. Monitor the bed-wait time by acute-care wards on a regular basis; b. Investigate significant delays; c. Develop a crisis response system to better handle difficult cases and high case volumes; and d. Take corrective actions as necessary.

3. To better ensure the equitable and timely treatment of patients requiring emergency surgery, hospitals Hospitals should: a. On a regular basis, track and assess the timeliness of emergency surgery performed; b. Document and analyze the reasons for delays in performing emergency surgery; and c. Evaluate dedicating emergency-surgery operating-room time and/or take other measures, such as ensuring surgeons perform only emergency surgeries while they are on call, as part of their regular planned activity, in order to reduce the risk that emergency-surgery delays result in negative impacts on patient health.

4. To ensure patients receive urgent elective surgery on a timely basis, the MOHLTC should: MOHLTC a. Review the relationship between the level of funding provided for urgent elective surgeries , the wait-time targets for those surgeries, and the difficulties hospitals are facing achieving those targets within the level of funding provided; and b. Using the information from this review, determine future urgent-elective surgery funding needs, such that the risk to patients is addressed and hospitals are enabled to achieve the Ministry’s urgent-elective survey wait-time targets.

5. To continue to make the most effective use of hospital resources within funding constraints, and to MOHLTC & hospitals better ensure that patients get urgent elective surgeries within the wait-time targets established by the MOHLTC, hospitals should consult with the MOHLTC and LHINs when necessary, and work with surgeons to identify ways to alleviate the backlogs, such as scheduling some elective surgeries for times other than typical daytimes business weekdays.

6. To help ensure that both patients and healthcare providers make informed decision, and that patients MOHLTC & Hospitals undergo elective surgery within an appropriate time, the MOHLTC should work with hospitals to: a. Implement a centralized patient referral and assessment system for all type of elective surgeries within each region; b. Break down the wait-time performance data by urgency level for each type of elective surgery on the Ministry’s public website; and c. Publicly report the complete wait time for each type of surgery, including the time from the date of referral by family physician to the date of a patient’s appointment with a specialist.

7. To ensure patients receive timely elective surgery consultation from a specialist, the MOHLTC should MOHLTC identify the reasons why there is a long wait for some specialists and work with the LHINs, hospitals and specialists to improve wait time and access to specialists and specialist services.

8. To ensure the safety of surgical patients, the MOHLTC should work with hospitals to ensure hospitals MOHLTC & Hospitals regularly monitor patient incident occurrences and take corrective actions as necessary. APPENDIX E: AUDITOR GENERAL OF 9.9. ToTo ensureensure optimal use of health-chealth-careare rresourcesesources for patients rrequiringequiring hospitalhospital ccareare and for those MOHMOHLTLTC ONTARIO RECOMMENDATIONS requiringrequiring long-term cacare,re, the MOMOHHLTLTC should: a. EnsureEnsure tthathat alternatealternate levellevel of carecare patients waiting in hospitalhospital areare safefe andand receivereceive tthehe rrestorativeestorative andand transitional carecare theythey need while theythey wait; Recommendations in the Table below are from the AGO Value-for-Money-Audit of Large Community Hospitals, b. EvEvaluatealuate policies in other jurisdictions aimed at placing rreasonableeasonable limits on the time patients which appears in the 2016 Auditor General Annual Report (Vol. 1; Chapter 3.08). Recommendations were can spend waiting in hospital for beds in long term ccareare hhomes,omes, sucsuchh as bbyy ddischargingischarging patients to the first appropriateappropriate avavailableailable home within rreasonableeasonable pproximity;roximity; and directed toward the MOHLTC, hospitals, or both; they are colour-coded below. c.c. ConductConduct capacity-planningcapacity-planning for senior carecare and adaddressdress bed shshortages,ortages, if aanny,y, in long term carecare homes.homes.

10.To help reduce the time that hospital patients must wait for beds after admission, hospitals should Hospitals Auditor General Report Recommendation Primary Response conduct cost-benefit analysis in adopting more efficient bed-management systems that provide real- 1. To ensure that funding to hospitals accurately reflects patient needs, the MOHLTC should plan MOHLTC time information about the status of hospital beds, including those occupied, awaiting cleaning or appropriately so that surgeries are delivered when needed. available for a new patient, as well ass the number of patients waiting for each type of bed in each 2. To better ensure timely transfer of patients from the emergency room to an acute bed when needed, Hospitals acute-care ward. hospitals should: 11.To help reduce the time patients have to wait for beds after admission, hospitals should review the Hospitals a. Monitor the bed-wait time by acute-care wards on a regular basis; times and days of the week where patients are waiting excessively at admission and discharge, and b. Investigate significant delays; make necessary adjustments to allow sufficient time for beds to be prepared for new admissions, c. Develop a crisis response system to better handle difficult cases and high case volumes; and especially those arriving at peak times. d. Take corrective actions as necessary. 12.To help reduce the time that patients have to wait for bed, hospitals should ensure that a sufficient Hospitals 3. To better ensure the equitable and timely treatment of patients requiring emergency surgery, hospitals Hospitals number of housekeeping staff are on duty to clean recently vacated rooms and beds on a timely basis, should: and that the order of cleaning is prioritized based on the types of beds most in demand. a. On a regular basis, track and assess the timeliness of emergency surgery performed; b. Document and analyze the reasons for delays in performing emergency surgery; and 13.To ensure that hospitals, in conjunction with physicians, focus on making the best decisions for the MOHLTC evolving needs of patients, the MOHLTC should review the physician appointment and appeal c. Evaluate dedicating emergency-surgery operating-room time and/or take other measures, such as ensuring surgeons perform only emergency surgeries while they are on call, as part of their processes for hospitals and physicians under the Public Hospitals Act. regular planned activity, in order to reduce the risk that emergency-surgery delays result in 14.To ensure that hospitals are able to make the best decision in response to the changing needs of MOHLTC negative impacts on patient health. patients, the MOHLTC should assess the long-term value of hospitals employing, in some cases,

4. To ensure patients receive urgent elective surgery on a timely basis, the MOHLTC should: MOHLTC physicians as hospital staff. a. Review the relationship between the level of funding provided for urgent elective surgeries , the 15.To ensure better use of hospital resources for nursing care in each ward, hospitals should: Hospitals wait-time targets for those surgeries, and the difficulties hospitals are facing achieving those a. Assess the need for implementing a more efficient scheduling system, such as a hospital-wide targets within the level of funding provided; and information system that centralizes the scheduling of all nurses based on patient needs; and b. Using the information from this review, determine future urgent-elective surgery funding needs, b. More robustly track and analyze nurse overtime and sick leave, and conduct thorough cost/ such that the risk to patients is addressed and hospitals are enabled to achieve the Ministry’s benefit studies to inform decision-making on the use of different types of nursing staff without urgent-elective survey wait-time targets. overreliance on agency nurses to fill in shortages.

5. To continue to make the most effective use of hospital resources within funding constraints, and to MOHLTC & hospitals 16.To ensure the safety of patients and that their personal health information is safeguarded, hospitals Hospitals better ensure that patients get urgent elective surgeries within the wait-time targets established by should have effective processes in place to: the MOHLTC, hospitals should consult with the MOHLTC and LHINs when necessary, and work with a. Perform criminal record checks before hiring new employees, and periodically update checks for surgeons to identify ways to alleviate the backlogs, such as scheduling some elective surgeries for existing staff, especially those who work with children and vulnerable patients; times other than typical daytimes business weekdays. b. Deactivate access to all hospital information systems for anyone no longer employed by the

6. To help ensure that both patients and healthcare providers make informed decision, and that patients MOHLTC & Hospitals hospital; c. Where appropriate, implement adequate automatic logout functions for computers and any undergo elective surgery within an appropriate time, the MOHLTC should work with hospitals to: a. Implement a centralized patient referral and assessment system for all type of elective surgeries information systems containing patient information; and d. Encrypt all portable devices, such as laptops and USB keys, used by hospital staff to access within each region; b. Break down the wait-time performance data by urgency level for each type of elective surgery on patient information the Ministry’s public website; and 17.To ensure medical equipment functions properly when needed, and that both patients and health care Hospitals c. Publicly report the complete wait time for each type of surgery, including the time from the date workers are safe when equipment is in use, hospitals should: of referral by family physician to the date of a patient’s appointment with a specialist. a. Maintain a complete inventory of medical equipment, with accurate and up-to-date information on all equipment that requires ongoing preventive maintenance; 7. To ensure patients receive timely elective surgery consultation from a specialist, the MOHLTC should MOHLTC identify the reasons why there is a long wait for some specialists and work with the LHINs, hospitals b. Perform preventive and functional maintenance according to manufacturers’ or other established specifications, and monitor maintenance work to ensure that it is being completed properly and and specialists to improve wait time and access to specialists and specialist services. on a timely basis; and 8. To ensure the safety of surgical patients, the MOHLTC should work with hospitals to ensure hospitals MOHLTC & Hospitals c. Monitor the performance of preventive maintenance staff to ensure equipment is being regularly monitor patient incident occurrences and take corrective actions as necessary. maintained in accordance with appropriate scheduling. 9.9. ToTo ensureensure optimal use of health-chealth-careare rresourcesesources for patients rrequiringequiring hospitalhospital ccareare and for those MOHMOHLTLTC requiringrequiring long-term cacare,re, the MOMOHHLTLTC should:

132 • Appendicesa. EnsureEnsure tthathat alternatealternate levellevel of carecare patients waiting in hospitalhospital areare safefe andandSCARBOROUGH receivereceive tthehe restorativerestorat ANDiv eROUGE HOSPITAL: 2017 CORPORATE ENVIRONMENTAL SCAN OUR PATIENTS, OUR COMMUNITY, OUR HOSPITAL Appendices • 133 andand transitional carecare theythey need while theythey wait; b. EvEvaluatealuate policies in other jurisdictions aimed at placing rreasonableeasonable limits on the time patients can spend waiting in hospital for beds in long term ccareare hhomes,omes, sucsuchh as bbyy ddischargingischarging patients to the first appropriateappropriate avavailableailable home within rreasonableeasonable pproximity;roximity; and cc.. ConductConduct capacity-planningcapacity-planning for senior carecare and adaddressdress bed shshortages,ortages, if aanny,y, in long term carecare homes.homes.

10.To help reduce the time that hospital patients must wait for beds after admission, hospitals should Hospitals conduct cost-benefit analysis in adopting more efficient bed-management systems that provide real- time information about the status of hospital beds, including those occupied, awaiting cleaning or available for a new patient, as well ass the number of patients waiting for each type of bed in each acute-care ward.

11.To help reduce the time patients have to wait for beds after admission, hospitals should review the Hospitals times and days of the week where patients are waiting excessively at admission and discharge, and make necessary adjustments to allow sufficient time for beds to be prepared for new admissions, especially those arriving at peak times.

12.To help reduce the time that patients have to wait for bed, hospitals should ensure that a sufficient Hospitals number of housekeeping staff are on duty to clean recently vacated rooms and beds on a timely basis, and that the order of cleaning is prioritized based on the types of beds most in demand.

13.To ensure that hospitals, in conjunction with physicians, focus on making the best decisions for the MOHLTC evolving needs of patients, the MOHLTC should review the physician appointment and appeal processes for hospitals and physicians under the Public Hospitals Act.

14.To ensure that hospitals are able to make the best decision in response to the changing needs of MOHLTC patients, the MOHLTC should assess the long-term value of hospitals employing, in some cases, physicians as hospital staff.

15.To ensure better use of hospital resources for nursing care in each ward, hospitals should: Hospitals a. Assess the need for implementing a more efficient scheduling system, such as a hospital-wide information system that centralizes the scheduling of all nurses based on patient needs; and b. More robustly track and analyze nurse overtime and sick leave, and conduct thorough cost/ benefit studies to inform decision-making on the use of different types of nursing staff without overreliance on agency nurses to fill in shortages.

16.To ensure the safety of patients and that their personal health information is safeguarded, hospitals Hospitals should have effective processes in place to: a. Perform criminal record checks before hiring new employees, and periodically update checks for existing staff, especially those who work with children and vulnerable patients; b. Deactivate access to all hospital information systems for anyone no longer employed by the hospital; c. Where appropriate, implement adequate automatic logout functions for computers and any information systems containing patient information; and d. Encrypt all portable devices, such as laptops and USB keys, used by hospital staff to access patient information

17.To ensure medical equipment functions properly when needed, and that both patients and health care Hospitals workers are safe when equipment is in use, hospitals should: a. Maintain a complete inventory of medical equipment, with accurate and up-to-date information on all equipment that requires ongoing preventive maintenance; b. Perform preventive and functional maintenance according to manufacturers’ or other established specifications, and monitor maintenance work to ensure that it is being completed properly and on a timely basis; and c. Monitor the performance of preventive maintenance staff to ensure equipment is being maintained in accordance with appropriate scheduling. APPENDIX F: LEGACY RVHS STRATEGIC PLAN APPENDIX G: LEGACY TSH STRATEGIC PLAN

The legacy TSH Strategic Plan is a 21 page document; the following are summary pages.

Birchmount campus General campus 3030 Birchmount Road 3050 Lawrence Avenue East Scarborough, ON M1W 3W3 Scarborough, ON M1P 2V5 416-495-2400 416-438-2911 2015 – 2019 StRAtEgic PLAN

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Transforming care

What emerged from a comprehensive planning process are four new strategic directions – our priorities that will help usus focusfocus onon whatwhat reallyreally mattersmatters andand transformtransform whatwhat wewe do.do. OnOn thethe followingfollowing pages,pages, considerconsider somesome majormajor successessuccesses alreadyalready –– andand learnlearn moremore aboutabout what’swhat’s comingcoming next.next.

Why it matters: What you can expect: getting valuable ideas and input from the A more active role for patients in planning and What it means: peoplepeople wewe serve,serve, andand sharingsharing informationinformation andand managing their treatment; a health care team Patients as We will engage patients and families in a meaningful knowledge,knowledge, willwill ultimatelyultimately helphelp usus toto provideprovide organizedorganized aroundaround thethe needsneeds ofof thethe patientpatient Partners way to enhance their experience, promote shared care, more timely, effective, and efficient solutions –– notnot thethe otherother wayway around;around; moremore satisfyingsatisfying andand improveimprove qualityquality ofof care.care. forfor patientspatients andand theirtheir families.families. encountersencounters withwith ourour hospital;hospital; andand fewerfewer barriersbarriers forfor patientspatients inin accessingaccessing care.care.

Why it matters: What you can expect: Our team and community have incredible Adopting leading practices, quicker than What it means: iinnovation and talents,talents, wisdom,wisdom, andand ingenuity.ingenuity. OnlyOnly byby tappingtapping before;before; improvedimproved abilityability toto attractattract andand engageengage We will enhance our team’s capacity for advanced learning intointo thisthis collectivecollective resourceresource cancan wewe innovate,innovate, thethe bestbest doctorsdoctors andand staff;staff; andand moremore educationeducation learning,learning, innovation,innovation, andand creativity.creativity. improve,improve, andand developdevelop newnew solutionssolutions –– onesones thatthat andand researchresearch activities.activities. meet or exceed our patients’ expectations.

Why it matters: What you can expect: As part of a broader health care system, we Better access and coordination of services, What it means: needneed toto betterbetter coordinatecoordinate patientpatient carecare andand easeease referrals,referrals, andand transitionstransitions ofof care;care; betterbetter We will collaborate with other service providers, iintegrated care thethe processprocess whenwhen patientspatients movemove fromfrom oneone carecare management of chronic diseases, resulting networks patientspatients andand theirtheir familiesfamilies toto co-designco-design accessibleaccessible providerprovider toto another.another. And,And, wewe needneed toto respondrespond inin fewerfewer hospitalhospital visits;visits; andand evidence-basedevidence-based andand coordinatedcoordinated services.services. toto ourour community’scommunity’s desiredesire forfor moremore holisticholistic practicespractices relatingrelating toto complementarycomplementary medicinemedicine treatmenttreatment options.options. andand therapies.therapies.

Why it matters: What you can expect: Our primary responsibility is to deliver better More standardized clinical practices; less waste What it means: Quality and valuevalue andand carecare outcomesoutcomes forfor ourour patients.patients. inin whatwhat wewe do;do; effortsefforts toto makemake thethe mostmost ofof newnew We will deliver quality and sustainable services by Sustainability thisthis includesincludes carecare thatthat isis consistentlyconsistently highhigh inin fundingfunding andand revenues;revenues; betterbetter resultsresults inin howhow designingdesigning andand adoptingadopting evidence-basedevidence-based practices.practices. quality,quality, costcost effective,effective, appropriate,appropriate, andand timely.timely. we measure quality; and a healthier financial positionposition forfor thethe ScarboroughScarborough Hospital.Hospital.

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