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Operational Review Report Submitted To: Lake of the Woods District Hospital

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Operational Review Report Submitted To: Lake of the Woods District Hospital www.BIGhealthcare.ca Operational Review Report Submitted to: Lake of the Woods District Hospital BIG Healthcare 60 Atlantic Avenue Suite 200 Toronto, Ontario M6K 1X9 www.BIGhealthcare.ca June 6, 2018 Benchmark Intelligence Group Inc. 60 Atlantic Avenue, Suite 200, Toronto, ON, M6K1X9 www.BIGhealthcare.ca Contents EXECUTIVE SUMMARY ............................................................................................................. 1 LISTING OF RECOMMENDATIONS ........................................................................................ 8 1.0 BACKGROUND AND OBJECTIVES .............................................................................. 17 1.1 LAKE OF THE WOODS DISTRICT HOSPITAL ................................................................... 17 1.2 PROJECT BACKGROUND ................................................................................................ 18 1.3 PROJECT OBJECTIVES .................................................................................................... 18 1.4 STEERING COMMITTEE .................................................................................................. 19 1.5 PEER FACILITIES ........................................................................................................... 19 2.0 UNDERSTANDING THE HOSPITAL ............................................................................. 21 2.1 CLINICAL ACTIVITY DATA SOURCES ............................................................................ 21 2.2 LWDH CAPACITY AND CLINICAL PROFILE .................................................................. 21 2.3 NORTH WEST LHIN GEOGRAPHY ................................................................................. 29 2.4 WHO ARE LWDH PATIENTS? ....................................................................................... 31 2.5 RELIANCE ON LWDH FOR HOSPITAL CARE .................................................................. 32 2.6 PROJECTED GROWTH IN DEMAND FOR INPATIENT ACUTE CARE AT LWDH ................ 37 2.7 FINANCIAL PROFILE ...................................................................................................... 38 2.8 WORKING CAPITAL ....................................................................................................... 42 3.0 GOVERNANCE & MANAGEMENT ............................................................................... 44 3.1 GOVERNANCE ............................................................................................................... 44 3.2 MEDICAL AND ADMINISTRATIVE MANAGEMENT ......................................................... 52 3.3 RELATIONSHIP WITH EXTERNAL PARTNERS ................................................................. 58 4.0 UTILIZATION OF HOSPITAL SERVICES ................................................................... 64 4.1 ANALYSIS APPROACH ................................................................................................... 64 4.2 UTILIZATION OF HOSPITAL INPATIENT SERVICES IN NORTHERN ONTARIO .................. 65 4.3 POPULATION-BASED ANALYSIS OF KENORA DISTRICT RESIDENTS .............................. 66 4.4 PSYCHIATRIC UTILIZATION AND ACTIVITY ................................................................... 74 4.5 EMERGENCY DEPARTMENT UTILIZATION AND ACTIVITY ............................................. 79 4.6 LWDH DAY SURGERY UTILIZATION AND ACTIVITY .................................................... 86 4.7 USE OF MANITOBA HOSPITALS BY KENORA DISTRICT RESIDENTS ............................... 88 5.0 CLINICAL EFFICIENCY .................................................................................................. 90 5.1 CLINICAL EFFICIENCY APPROACH ................................................................................ 90 5.2 CLINICAL EFFICIENCY FINDINGS .................................................................................. 92 5.3 DISCHARGE DISPOSITIONS AND ALTERNATE LEVEL OF CARE ...................................... 96 5.4 NON-ACUTE HOSPITAL BEDS ..................................................................................... 102 6.0 OPERATING EFFICIENCY ........................................................................................... 108 6.1 LINES OF ENQUIRY: OPPORTUNITIES FOR IMPROVEMENT IN OPERATING EFFICIENCY 113 6.2 ADMINISTRATIVE AND SUPPORT SERVICES ................................................................. 114 6.3 INPATIENT AND OUTPATIENT SERVICES ...................................................................... 132 6.4 DIAGNOSTIC AND THERAPEUTIC SERVICES ................................................................ 151 7.0 PERI-OPERATIVE SERVICES ...................................................................................... 158 7.1 OR GOVERNANCE AND LEADERSHIP .......................................................................... 158 7.2 SURGERY MANAGEMENT AND STAFFING .................................................................... 161 7.3 CLINICAL PRACTICES .................................................................................................. 167 7.4 SCHEDULING AND PRE-SURGICAL SCREENING ............................................................ 168 7.5 SURGICAL SUPPLY CHAIN AND MDRD ...................................................................... 170 8.0 SUMMARY OF SAVINGS OPPORTUNITIES ............................................................. 172 Benchmark Intelligence Group Inc. ii 60 Atlantic Avenue, Suite 200, Toronto, ON, M6K1X9 www.BIGhealthcare.ca 9.0 HOSPITAL IMPROVEMENT PLAN ............................................................................. 173 9.1 REQUIREMENT FOR COST REDUCTIONS ...................................................................... 173 9.2 IMPLEMENTING THE HOSPITAL IMPROVEMENT PLAN ................................................. 174 9.3 COMMUNICATING THE HOSPITAL IMPROVEMENT PLAN ............................................. 175 9.4 TIMING OF OPERATIONAL IMPROVEMENT SAVINGS INITIATIVES ................................ 175 9.5 SAVINGS FROM CLINICAL AND OPERATIONAL IMPROVEMENT INITIATIVES AND REQUIRED FUNDING .............................................................................................................. 178 9.6 MONITORING IMPLEMENTATION OF HIP ..................................................................... 180 9.7 IMPLICATIONS OF NO ADDITIONAL FUNDING ............................................................. 180 Benchmark Intelligence Group Inc. iii 60 Atlantic Avenue, Suite 200, Toronto, ON, M6K1X9 www.BIGhealthcare.ca Executive Summary The Lake of the Woods District Hospital (LWDH) in Kenora is Northwestern Ontario’s largest hospital west of Thunder Bay. Services are provided to approximately 35,000 residents of the City of Kenora and a large surrounding area, including several First Nations Communities. The population served by the hospital expands to over 70,000 in the summer months due to the influx of summer residents and tourists to the area. The hospital was originally founded in 1897 as the Rat Portage Jubilee Hospital and became the Kenora General Hospital in 1905. The St. Joseph’s Hospital and the Kenora General Hospital amalgamated in 1968 to form the Lake of the Woods District Hospital. A comprehensive Operational Review was undertaken to examine financial and clinical processes and identify strategies to allow the hospital to manage it operations within its fiscal constraints, achieve long-term sustainability and provide accessible, high quality and safe care that aligns with population health care needs. The objectives of Operational Review included the development of a: § Hospital Improvement Plan (HIP); § governance improvement plan; and § review of the effectiveness of hospital leadership. The HIP is to provide recommended mitigation strategies and other remedial actions that, in the short term, will return the hospital to a balanced operating position and protect its rapidly deteriorating working capital position, and, in the long term, will provide a sustainable operating plan to ensure high quality, safe, accessible, and sustainable hospital services. A review of the current governance model will provide comparisons to best practices and produce recommendations for a governance improvement plan. The effectiveness of hospital leadership (management and medical staff) will be examined to provide recommendations on strategies to strengthen and improve relationships. The first step in the review was to develop an understanding of the clinical, operating and fiscal characteristics of the hospital; details are presented in Chapter 2 of this report. LWDH financial results for the fiscal years (FY) 2011/12 through 2016/17 are summarised in the following exhibit1. As can be seen, LWDH has run an ‘operating deficit’ in two of the last six years. The hospital results have ranged from a deficit of 2.0% of revenues (2014/15) to a surplus 0.4% of revenues (2011/12). Importantly, when building depreciation and deferred contributions are considered, LWDH has had an ‘accounting deficit’ in 5 of the previous 6 years. An accounting surplus is necessary to support the hospitals’ capital needs. 1 The historical information presented here was taken largely from the Board approved financial statements of the hospital, and supplemented with information from management along with some modifications made for restated building and equipment amortization and expenses to match the HSAA definition of Operating Surplus / Deficit. Benchmark
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