Women and Children's Program Clinical Service Review Report
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Women and Children’s Program Clinical Service Review Report December 2018 Prepared on behalf of the Women and Children’s Clinical Service Review Co-Leads: Dr. Zoutman and Linda Calhoun 1 Preface This report was prepared on behalf of the Co-Leads of the Women and Children’s clinical service review. This report is intended to be a composite of the many seminal reviews and reports that have been undertaken over the last many years, and the past and current perspectives, ideas and points of view shared by the numerous program team members, and our community members who have provided their input and expertise. The Co-Leads fully endorse the recommendations put forward in this report and look forward to advancing these ideas through further discussion with the Senior Leadership Team, the External Advisors, and ultimately the Board of Directors. 2 Table of Contents Preface ............................................................................................................................................ 2 Section 1.0: Executive Summary ..................................................................................................... 4 Section 1.1: Purpose of the Review ............................................................................................ 4 Section 1.2: Overview of Reports and Analysis .......................................................................... 4 Section 1.3: Summary of Recommendations.............................................................................. 5 Section 2.0: Introduction ................................................................................................................ 6 Section 2.1: Brief History of the Hospital.................................................................................... 6 Section 2.2: Program Background .............................................................................................. 6 Maternal Newborn Services ................................................................................................... 7 Children’s Services................................................................................................................... 7 Section 2.3: Structure of the Program ........................................................................................ 8 Section 2.4: Purpose of the Review ............................................................................................ 8 Section 2.5: Review of Decision Making Structure ..................................................................... 9 Section 2.6: Glossary of Terms .................................................................................................. 10 Section 3.0: Review of Findings .................................................................................................... 11 Section 3.1: Overview of the reports and analysis completed to date .................................... 11 Section 3.2: Key Findings and Recommendations .................................................................... 12 Theme: Program structure and delivery ............................................................................... 12 Theme: Strategic vision ......................................................................................................... 16 Theme: Governance and structure ....................................................................................... 17 Theme: Clinical care .............................................................................................................. 18 Theme: People and culture ................................................................................................... 19 Theme: Physical environment .............................................................................................. 21 Theme: Communications and marketing ............................................................................. 21 Theme: Service delivery processes ....................................................................................... 22 Section 4.0: Implementation and Transition Planning ................................................................. 23 Section 5.0: Consolidated Recommendations .............................................................................. 25 Section 6.0: Appendix...................................................................... ………………………………………………26 Appendix A: Summary of Key Findings and Recommendations from Reports and Analysis ……… 28 3 Section 1.0: Executive Summary Section 1.1: Purpose of the Review As part of the new strategic vision for the newly established Scarborough Health Network (SHN), the hospital is undertaking clinical service reviews across all of the hospitals clinical programs. The intention of these reviews is to assess the current state of the program and determine what the future state of the program should be, and what actions need to be taken to move towards the future vision. This is particularly important because SHN includes a wide variety of programs, services and sites within its network. The clinical service reviews will help the organization take an enterprise wide view of the network, focus on providing the highest quality of care across all clinical services, and develop the best course of action for each program and service. The Women and Children’s program was the first program to begin the clinical service review process, due to a sense of urgency and clear desire on behalf of the program team and external stakeholders to determine the path forward for the program. The Women and Children’s program has had a number of reviews over the last decade that have highlighted the need for change. This document is intended to be a composite report that captures the essence and recommendations from all of the past seminal reviews and the current perspectives of internal and external stakeholders including our communities. The recommendations in this report were developed in consultation with the program team, and are consistent with the recommendations that experts have provided in their reviews. The recommendations in this document will need to be reviewed in conjunction with the broader clinical service planning and Master Planning that is underway for SHN. Part of this work will be to determine the vision for each of the hospital sites within the network. The recommendations in this report are intended to support this work and provide a perspective for the Women and Children’s program. Section 1.2: Overview of Reports and Analysis This report is a composite of a number of seminal documents that have been developed over the last decade. The chart below provides a list of the key reports and events that have informed where the program is today. 1998 The Scarborough Centenary Hospital merged with the Ajax and Pickering General Hospital to form the Rouge Valley Health System (RVHS) 1999 The Scarborough Grace and Scarborough General hospitals merge to form The Scarborough Hospital (TSH) 2012 Corpus Sanchez International Consultancy (CSIC) completes a review of the maternal newborn and child care program at The Scarborough Hospital 2013 The Central East LHIN Board passed a motion (Motion 1b) directing RVHS and TSH to participate in a facilitated integration process; the process concluded that RVHS and TSH should merge but the merger did not take place as planned 2015 (Jan) The Motion 1b final report on the service delivery model for maternal-child youth is concluded; there is no final decision made on the future state service delivery model 2015 (Nov) The Minister of Health and Long-Term Care created the Scarborough / West Durham panel, which concluded that there should be a merger of The Scarborough Hospital (including TSH Birchmount and TSH General) with the Rouge Valley Hospital System (RVHS) Centenary Sites 4 2016 RVHS Centenary Site and TSH merge to form Scarborough and Rouge Hospital (SRH) 2017 Master Planning activities begin to chart a path forward for the next 10-20 years 2018 (June) An external expert in Obstetrics is asked to complete an analysis of safety related concerns at the Birchmount and an extensive review of the delivery of obstetrical 2018 (June) The new Strategic Plan for the hospital is completed and the Scarborough and Rouge Hospital changes its name and becomes Scarborough Health Network (SHN) 2018 (Dec) Deloitte co-design process to develop a preferred direction for the high-level future state model of the program Section 1.3: Summary of Recommendations Themes Recommendations Program structure 1. The Birthing and Core Paediatrics1 cluster of services be delivered at the and delivery General and Centenary sites. 2. The Women and Children’s program continue clinical services planning to determine how the other clinical programs be delivered. Strategic vision 3. The Women and Children’s program, in conjunction with the broader SHN, develop a clear vision that aligns to the SHN clinical service planning that is underway. Governance 4. The Women and Children’s program develop a unified governance model for the medical side of the program. The program establish a corporate chief and medical director for obstetrics and gynaecology, a corporate chief of midwifery and a corporate chief and medical director for paediatrics. Clinical care 5. The Women and Children’s program continue to identify leading clinical practices, and actively implement evidence based clinical practices in a consistent manner across the program. People and culture 6. SHN, and the Women and Children’s program