Hamilton Health Sciences Stage 1A Submission Table Of Contents Executive Summary 3 1.1.2 Current and Projected Activity 79 1. Service Delivery Model Report 7 Approach to Projected Workload 81 1.1. Master Program 9 Data Sources 81 Introduction 9 1.1.3 Service Delivery Model Options 103 Background 9 Approach to Service Delivery Options 105 Strategic Direction 15 Scope and Siting Options 108 HHS Facilities: Current State Challenges 17 1.2. Human Resources Plan 113 Submission ontext & Challenges Staffing Plan C 22 115 1A Alignment with MOHLTC and Project Impact – Meeting the Need HNHB LHIN Priorities 24 for Additional Resources 115 1.1.1 Present and Future Service 1.3. Preliminary Operating Cost ery 7 timates for New Services Deliv 2 Es 117 Our Approach 29 Changes in Model of Care 119 Stage Program Parameters 37 Operating Cost Estimates 119 Scope and Model of Clinical Services 41 Appendices 121 A. Adult Regional Patient Care 45 A. Leading Practice Summary 123 B. Cancer Patient Care 59 B. Stakeholder Engagement Summary 147 C. Children’s and Women’s C. Organizational Chart 171 Reproductive Health 64 D. Inventory of Services by Site 175 D. Community Patient Care 66 E. Full Time Equivalents (FTE) By Site 205 E. Community Surgical Care 71 Collaboration and Partnerships 75 July 2016 Hamilton Health Sciences Health Sciences Hamilton Stage 1A Submission Stage 2 Hamilton Health Sciences Health Sciences Hamilton Executive Summary In April 2015, Hamilton Health Sciences (HHS) about the system to advocate for the embarked on a process to create a new patient’s interests. clinical services model – a long term vision detailing what services the hospital will deliv- 4. Navigating the System: Ensure the er and how it will deliver them. This visioning HHS system is easy to understand and navigate especially in times of crisis and process is essential for planning both services transition. and facilities over the next 10-20 years. HHS has entitled this process Our Healthy Future 5. Respect: Create a service model where (OHF). no person feels invisible, inadequate, Our Healthy Future was powered by five Pa- unheard or undeserving of our care and tient-Centred Working Groups (PCWG), each respect. focused on a dis tinct patient population. The Based on the invaluable input of the 200 PCWGs were assigned the task of creating a participants in the PCWGs and more than viable, long-term service delivery model for 600 community members, as well as data the following categories of care: analytics presented by Preyra Solutions 1. Adult Regional Patient Care Group (PSG), this robust Clinical Visioning 2. Child, Newborn & Maternal Care process generated: 25 bold opportunities, 3. Community Surgical Patient Care and 7 ‘building blocks’, which together 4. Cancer Patient Care support the Triple Aim Framework, and 5. Community Patient Care ultimately form the basis of the Our Healthy Future clinical vision that has been developed 1A Submission Stage Input from patients, families, and community by Hamilton Health Sciences and is presented members was integral to the visioning pro- in this summary report. cess. Event-based, community listening ses- sions explored the community’s perspectives Fundamental to the achievement of the on what they value most from their health- vision is the adoption of a Population care. Further input was obtained through Health approach by HHS. Clinicians, staff engagement ventse and online platforms physicians, and leaders within each PCWG coupled with social media. As a result of HHS’ recognized that the urban population community engagement efforts, five themes served by HHS is unique in the Province emerged early in the process and were pre- sented to the PCWGs to inform and refine the of Ontario, due to above average use of vision being developed. These themes were: hospital resources, a high rate of poverty, and resulting inequalities related to the 1. High Quality Patient Experience: Create social determinants of health among the a high quality experience for our patients communities served by the organization. throughout their entire journey - from Consistently throughout the clinical visioning preventive care, to hospitals, to follow process, stakeholders and staff identified the up in the community, and at every importance of defining and targeting patient transition point. populations with customized strategies that 2. Empowered Families and Caregivers: address barriers to accessing care and other Include patients and their family, inequities. In addition, a range of predictive caregiver and others in the circle of care models that combine healthcare and social as members of the healthcare team. services were identified as crucial to meeting the region’s patient needs over the next 3. Patient Advocates: Ensure that every 20 years. patient has someone knowledgeable 3 Health Sciences Hamilton The robust data analysis provided to the Designing services that help patients manage visioning process by PSG showed that an their own health more efficiently, such as above average number of HHS patients community programs (through a shared present with multiple co-morbidities governance model), condition-specific and would benefit from an approach to technology (online, or tele-monitoring), intervention and follow-up that involves proactive outreach visits (in the urban tailored care designed to meet the unique core, in particular) and better care planning needs of individual patients. The PCWGs (such as enhanced palliative care pathways recognized that in order to achieve coordinated with primary care), will support transformational change over the next a population health approach that optimizes 10-20 years, it will be critical to develop and health and function within the home and analyze health information and other forms community. Critical enablers to improving of ‘Big Data,’ and to be proactive identifying care, such as technology and education, were people within the region most at risk of highlighted through the PCWG discussions disease or preventable hospitalization. HHS and community engagement activities. must enable this proactive approach through Through this process, HHS has set an partnership with other community agencies, ambition to become a leader in population as well as health and social service providers, health in partnership with other providers and also contribute to the development and in concert with their tripartite mission: and implementation of a strong shared clinical care, education, and research, with governance model among these partners patients and families at the centre of their within the region served by HHS. Through planning. HHS is committed to improving this work and the development of community the health of its population by becoming a Stage 1A Submission Stage hubs and clinics, HHS’s clinical service population health enterprise. vision is to demonstrate a commitment to integrated and seamless, coordinated care that is offered in more places in the community in order to produce better Siting Opportunities patient outcomes. Throughout the Our Healthy Future process, This vision of the future for clinical services it was clear that, in order to achieve this at HHS was subsequently discussed and vision, HHS would have to undergo key refined with community service organizations physical changes. Specifically, HHS needs who provided their input and observations to redevelop the Hamilton General Hospital at a series of focus group sessions and (HGH) and Juravinski Hospital and Cancer at a Community Summit event held in Center (JHCC) sites, to replace aging the spring of 2016. Numerous additional infrastructure and to allow the realignment staff engagement sessions were also held of post acute services from the St. Peter’s throughout the winter and spring of 2016 to Hospital (SPH); develop a new purpose-built discuss aspects of the vision outlined above. Children’s and Women’s Hospital on the campus of the Hamilton General Hospital Patients and families were at the forefront (HGH); and transition some ambulatory of each discussion. The groups involved surgery activity to a redeveloped West recognized the importance of patient Lincoln Memorial Hospital. activation through health coaching and self-management. The transformational As part of the master programming process, changes being sought by HHS must continue HHS identified opportunities to reduce the to involve input from, and meaningful number of large acute care hospital sites it dialogue with, patients and families. operates in Hamilton by relocating services Hamilton Health Sciences Health Sciences Hamilton 4 currently provided at McMaster University Health Centre (RJCHC). HHS also Medical Centre (MUMC) and SPH to the HGH anticipates significant efficiencies in and JHCC. clinical support services (i.e., Pharmacy, Diagnostic Services, and Lab) as some of The proposed strengthening of the HGH and these services are currently duplicated JHCC campuses is driven by a combination across four hospital sites and could be of site-specific infrastructure issues and offered more efficiently in a two-site opportunities for a more efficient service scenario. delivery model in the future. These include: • Opportunities for non-clinical • Lack of infrastructure flexibility to efficiencies. HHS anticipates that accommodate future needs, particularly reducing the number of operating sites at the MUMC site. The MUMC site is would offer significant opportunities owned by McMaster University, and HHS for efficiencies in non-clinical functions has a space