CHEDOKE • CHILDREN’S • GENERAL • JURAVINSKI • McMASTER • ST. PETER’S • WEST LINCOLN Reaching beyond our walls: Creating new possibilities

We’ve all heard it. The prediction that our healthcare system is in trouble.

What many are overlooking is the remarkable resilience of healthcare providers across our community, our province and beyond.

With an unwavering commitment to the patients and families we serve, organizations like are working together to fi nd new solutions to old problems.

Conversations are happening. Collaboration is taking place. And solutions are emerging.

With optimism and energy, we’re reaching beyond our walls to build new relationships and create possibilities that will advance care and improve outcomes.

Integration is a key word going forward – connecting the dots for our patients to ensure they receive the care they need, where they need it, when they need it.

Here at Hamilton Health Sciences, we are focused on the future, and we’ve set some very specifi c goals that we intend to achieve.

We believe that innovation is vital in order to reach these very ambitious goals.

We also see promise ahead, and many opportunities for change. Through this report, learn more about how we are preparing for the future with initiatives undertaken during this past year.

Paul Chapin Rob MacIsaac Chair, Board of Directors, President & CEO, Hamilton Health Sciences Hamilton Health Sciences

Visit this link: vimeo.com/hamiltonhealthsciences/beyondourwalls CONTENTS

5 Our vision is to provide the Best Care for All. Our Vision

6 We will bring this vision to life through Seamless System our fi ve strategic goals, which are:

10 • to provide an excellent patient experience for all Community Partnerships • to be world leaders in moving evidence into practice to deliver the best patient care • to be leaders in driving change to achieve a seamless healthcare system 14 • to be a leader in attracting and stewarding resources to advance our mission Patient & Family-Centred Care • to be the organization of choice for talented people 18 Patient Safety We embark on this journey with our core values at the forefront 22 Quality & Performance of everything we do.

26 They are: Research

30 Respect | Caring | Innovation | Accountability Milestones

32 Hamilton Health Sciences Care in numbers

34 Financial Overview

36 Hamilton Health Sciences Foundation

38 Hamilton Health Sciences Volunteer Association

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Health Links Over time, the Health Links are expected Cathy (pictured, centre) works with staff and therapists in the LiveWell program at the YMCA. to improve the healthcare system by: In late 2012, the provincial government They helped her to stay active through her recovery from breast cancer. reducing unnecessary admissions launched an initiative called Health Links. and emergency department visits; reducing A Health Link is a voluntary collaboration time between initial referrals to specialist between local health providers, community appointments and fi rst home care visits; service agencies and organizations, and reducing the time patients spend waiting municipalities. Its purpose is to enhance for discharge from hospital to other the lives of seniors and individuals with kinds of care settings like long-term care complex conditions by doing a better job of homes; and enhancing the experience of coordinating and personalizing their care. the system for patients with the greatest healthcare needs. Hamilton Health Sciences is privileged to lead the Hamilton West and the Niagara LiveWell Partnership North West Health Links. The Health Links include local healthcare providers such LiveWell is a unique partnership between as family physicians, specialists, , the YMCA of Hamilton/Burlington/ long-term care, home care, and other Brantford, McMaster University and community supports like educational Hamilton Health Sciences aimed at providers, food banks, emergency improving the health outcomes of people medical and police services. Together, with cancer, a spinal cord injury, mobility we are helping patients get the care they impairment, heart disease, or who are need when they need it and in the most recovering from stroke or heart attack. appropriate setting. We are doing this by sharing patient information and developing The partnership links hospital care with solutions that address each patient’s community health and wellness programs. specifi c needs. It is coordinated by staff from the YMCA and Hamilton Health Sciences, and Health Links will ensure that patients: is continually evaluated by McMaster University. • No longer need to answer the same questions asked by diff erent providers Following treatment for breast cancer • Have support to ensure they are taking at the , Cathy the right medications appropriately Webster (pictured in centre on p. 6) was encouraged to join the LiveWell program. • Have a care provider they can call, “I was able to connect with other women eliminating unnecessary visits to doctors’ who are going through what I am,” says offi ces and emergency departments Cathy. “They gave me the support I needed • Have an individualized, comprehensive to get through this. At the same time, I Hamilton Health Sciences is pleased to lead and be plan for every patient, developed with the was able to stay connected to staff from patient and their care providers, with Hamilton Health Sciences who monitored part of a number of exciting initiatives which are all involved in ensuring that the plan is my progress and encouraged me to take aimed at improving the coordination of care for being followed. care of myself.” More than 500 people benefi t from this individuals in our region and beyond. partnership each year.

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Some of the ways we’re ClinicalConnect™ For patients and their family members, building and enhancing ClinicalConnect™ eliminates the need relationships in order In health care, as elsewhere in society, for them to recount vital and accurate to help foster a healthier information sharing is more important information in stressful situations. In community for all. today than ever before. Patients are cared addition, care providers can instantaneously for by many healthcare professionals, share X-ray, lab and other digital test through a wide range of services, agencies results with patients, encouraging greater CONNECT and organizations. collaboration around a patient’s care plan. Individuals benefi t each year from the LiveWell program, a unique Each step along the way, comprehensive Integrated Decision Support (IDS) and complex information is generated partnership between the YMCA, about the patient’s condition and Business Intelligence Portal McMaster University and Hamilton Health Sciences that links hospital treatment. While this province’s eff orts Hamilton Health Sciences and the Hamilton care to community-based health to develop a common eHealth system Niagara Haldimand Brant Local Health & wellness programs has been challenging and, at times, Integration Network have developed a high controversial, HHS and its partners in south level information sharing system that, like central have quietly built a system ClinicalConnect™, has created a great deal that will soon encompass one third of the of interest and engagement across Ontario. population of the province. It is called IDS – Integrated Decision It is called ClinicalConnect™ and it’s a Support – and it provides health system secure, online web portal that gives planners and leaders with data about healthcare providers real-time access to how patients receive care in hospitals, their patient’s medical information. Already, rehabilitation centres, acute mental health COLLABORATE INTEGRATE the ClinicalConnect network includes 28 facilities, complex care centres, Community 55 healthcare providers across hospitals plus two Community Care Access ClinicalConnect™ integrates Care Access Centres and some Community our region are able to work Centres and Cancer Centres in two Local patient data from 36 hospitals, Health Centres. This allows doctors and more collaboratively through Health Integration Networks (Hamilton 4 community care access other healthcare professionals to better the Integrated Decision Niagara Haldimand Brant, and Waterloo centres, 4 oncology centres and understand patients’ needs and better Support (IDS) system, which Wellington.) Two more LHINs are coming 3 provincial data repositories, manage services. Ultimately, this sharing allows users to share and access on board next (Southwest, and Erie St. making it easier for care providers of information improves the way patients information that provides valuable Clair.) That will bring 71 hospitals and 1,800 to access important information experience care, and improves their insight into how patients access health organizations online, and include 3.6 about a patient’s care journey. outcomes. care in their community, and how million patients. to create better connections The Integrated Decision Support (IDS) between care providers. Through ClinicalConnect™, healthcare system is emerging as an important tool the providers can access a patient’s medical province’s new Health Links program (see information – lab results, diagnostic story page 7). In our region, the Hamilton tests, allergies, treatment plans, hospital West Health Link utilized IDS to identify discharge summaries, and much more – individuals whose lives could be enhanced anytime, anywhere on a desktop computer through improved coordination of care or portable device. In addition to improved among providers in their community. access to patient information, care providers can continually update the online IDS also has participants in Toronto Central health record throughout a patient’s health LHIN, South West LHIN, and parts of journey, further enhancing the fl ow and Waterloo Wellington LHIN. quality of information.

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All aboard for improving access On June 26, 2013 the Hamilton Niagara Haldimand Brant Regional Cancer Program Screen for Life Coach to cancer screening made its offi cial debut in the McQuesten neighbourhood in North Hamilton. The Hamilton Niagara Haldimand Brant Regional Cancer Program is making it possible for more people to get on board with breast, colorectal and cervical cancer screening with the launch of the Screen for Life Coach, which rolled into Hamilton on June 26, 2013.

The Screen for Life Coach is about the size of a large passenger bus and is fully equipped with state-of-the-art The Screen for Life Coach digital mammography technology, and is provides screening services for: supported by allied health professionals • cervical cancer trained to perform Pap tests and provide cancer screening consultations. Fecal • breast cancer Occult Blood Test kits, the at-home • colorectal cancer test for colorectal cancer screening, are also available to patients who meet the eligibility criteria. The Coach is equipped with:

The coach is modeled after the very • a full-fi eld digital mammography suite successful northern Ontario coach that has • an exam room been traveling to remote areas, off ering • two change rooms mammography in those communities since • wheelchair accessibility 1992. This is the fi rst time that cervical and colorectal screening has been made • calming neutral decor available in a mobile screening coach. • running water The Screen for Life Coach program is • two back-up generators focused on reaching under- or never- • Wi-Fi to support information systems screened women, 50 to 74 years old, who and communications may face cultural, social and other barriers that make it diffi cult for them to participate in screening. During the initial year of its launch, the coach is serving priority areas which include McQuesten, Keith/Jamesville Our diverse, collaborative partnerships with and Riverdale neighbourhoods in North organizations across our community and region Hamilton. Services off ered through the Screen for enable us to achieve a higher level of care and Life Coach are off ered in partnership with service to the people we serve, and a healthier Hamilton Public Health, the Creating Access to Screening and Training in the Living community for us all. Environment (CASTLE) project and other community planning teams. 10 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 11 COMMUNITY PARTNERSHIPS COMMUNITY PARTNERSHIPS

Growing in the community, together Academic Over the last year, Hamilton General institutions Hospital (HGH) has embarked on several community engagement projects to explore diff erent ways of providing support to Community Community those less fortunate living in the immediate health & wellness advisory neighbourhood surrounding the hospital. centres committees “As members of the healthcare community, we often serve those who are most vulnerable,” says Teresa Smith, president, Hamilton General Hospital. “The General is Put a lid on it! – situated in Hamilton’s northeast community, Hamilton Helmet Initiative which has with many strengths, but is also facing many challenges. As healthcare Head injuries are the leading cause of providers and as neighbours, we are well serious injury and death in children. A aware of those challenges and we want to properly fi tted helmet can reduce brain Businesses injury by 88 per cent, and can prevent Municipal help.” & bicycle-related deaths in children by services One such challenge is the community’s 75 per cent. entrepreneurs reliance on food banks and its lack of fresh produce. Hamilton General Hospital staff A new collaboration between Hamilton volunteer at the Hamilton Victory Gardens, Public Health Services, McMaster a non-profi t team that grows fresh produce Children’s Hospital, and Hamilton Police on raised garden beds on unused land Services, is aimed at reducing brain throughout the city for food banks and hot injuries by increasing helmet use and skill meals programs. development in the community.

Barb Klassen, trauma prevention “Although it’s the easiest way to prevent Non-profi t serious head injuries and even death, many Regional coordinator at HGH, was among the 15 staff organizations members and fi ve Regional Rehabilitation children and adults in our community do hospital & advocacy Centre patients who volunteered over three not wear their helmets when riding,” says partners days in Fall 2013. They prepared beds for Dr. Karen Bailey, pediatric trauma surgeon groups replanting and harvested vegetables. at McMaster Children’s Hospital. Provincial “What an experience,” said Barb. “It was a The Hamilton Helmet Initiative is committed beautiful day and a great opportunity to to providing education, tools and resources government discuss and learn about agriculture, food to individuals and families across Hamilton. resources, growing conditions and small To date, the Hamilton Helmet Initiative space utilization in urban settings, while has facilitated the purchase of more than helping in the community.” 12,000 high-quality bike and multi-sport helmets to Hamilton-area families and schools.

“Your brain is you,” says Dr. Bailey. “It only makes sense to put a lid on it!”

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Family-Centred Care End-of-life care: The most Maria Restivo, child life specialist at McMaster Children’s Hospital important conversation uses a medical play doll with Keaton to help him understand his treatment. One of the biggest challenges facing hospitals, and indeed society itself, is ensuring that people die in the setting they prefer, whether that be at home, in a hospice, or a hospital. How they would like to spend their last days is one of the most important conversations those patients and their families and caregivers will ever have. We know that there are several barriers Artful Moments: Supporting preventing eff ective communication around personhood through art therapy end-of-life goal setting. This can lead to a disconnect between a patient’s wishes By combining specialized strategies for and the treatment they actually receive. dementia care with art appreciation and These barriers can include: patient and art-making activities, “Artful Moments” family members’ lack of acceptance of explores how art can help to create a prognosis; language barriers; lack of an world of in-the-moment engagement and available substitute decision-maker; or, a enjoyment for patients with dementia. healthcare providers’ lack of experience, This new program is a unique partnership time, and training to address end-of-life between St. Peter’s Hospital (SPH) and care eff ectively. Foundation and the . Hamilton Health Sciences is committed Despite the cognitive and physical to ensuring all patients at HHS receive impairments that can be caused by end-of-life care that is compassionate dementia, it’s important to remember and respectful. that persons aff ected by the disease In 2009, HHS established the Quality have emotions, social relationships and a End of Life (QEoL) Taskforce. One of its personal history. They want and need to initiatives has been an end-of-life protocol express themselves. The “Artful Moments” that sets out a standardized approach to program uses art therapy to support resuscitation orders. creativity and feelings of self-worth, and to off er comfort and stimulation, even when More than ever, quality end-of-life care is individuals are unable to communicate at the forefront of what we do every day, verbally. as part of our vision to provide the best care possible for our patients throughout Providing the best experience means supporting “We’re committed to ensuring that our their care journey and in all chapters of patients are able to have the best life their lives. and relating to each of our patients in ways that possible,” says Rebecca Repa, president of SPH. “Artful Moments” is motivated by are unique as they are. a deep respect and understanding that personhood is an essential element to dementia care.”

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Expanding our capacity to care Empowerment through play “The fi rst step to alleviating compassion fatigue is awareness of one’s physical More than 200 HHS staff members At McMaster Children’s Hospital, child life and mental state. Awareness is cultivated and physicians have participated in specialists use specially-made medical through mindfulness, which means bringing Mindfulness-Based Stress Reduction, dolls to help teach young patients about full attention to the present moment, in a program designed to support frontline diff erent treatments and procedures, a non-judgemental way,” says Dr. Andrea care providers and leaders in reducing encouraging them to develop a sense of Frolic, director of the offi ce of clinical stress and enhancing resilience. control and ease around their hospital & organizational ethics at HHS. “These experience. courses are designed to support frontline sssssssssssssssssssssssssssssssssssssssss care providers and leaders in developing a ssssssssssssssssssssssssssssssssssssssssssssssssss repertoire of practices to reduce stress and sssssssssssssssssssssssssss ssssss enhance resilience. ssss200+ssssssssssssssssssss sss Mindfulness at Hamilton Health “Even when there isn’t time for a formal ssssssssssssssssssssssss Sciences: Increasing our break, being mindful allows me to take a break from the sometimes chaotic ward by ssssssssssssssssssssss capacity to care stopping my mind, even for half a minute,” sssssssssssssssssssss There is a quiet revolution going on at says Bonnie Buchko, physiotherapist at ssssssssssssssssssss Hamilton Health Sciences. The weapon of Hamilton General Hospital who completed choice? Stopping and breathing. the MBSR program. “This helps me recharge and be able to enter my next Healthcare workers are extraordinary—they patient encounter with greater focus embrace the care of others, sometimes and presence.” at the expense of their own well-being. Supporting patients and families in heart- wrenching situations every day and working to improve care in a complex and chaotic system, takes its toll. Studies confi rm that many helping professionals experience high levels of “compassion fatigue”, a profound emotional and physical exhaustion that occurs over the course of a career when workers are not adequately refueled or recharged to meet the needs of A voice in what matters Supporting the person behind “the patient” their roles, colleagues and patients. Patient & Family Advisory Councils Over the past three years, Hamilton provide a forum for information sharing New initiatives such as the “Artful Health Sciences (HHS) has partnered between hospital staff and patients and Moments” art therapy program at with the McMaster University Program their families, helping to contribute to St. Peter’s Hospital support and for Faculty Development (PFD) to off er the understanding and improvement of encourage each patient’s unique needs staff , physicians, students and faculty patient-centred care and the patient/family and sense of self-worth, helping to foster access to courses designed to alleviate experience. better outcomes and a more positive compassion fatigue and promote resilience. hospital experience. Since its inception in 2011, over 200 HHS staff and physicians have participated in the Mindfulness-Based Stress Reduction (MBSR) program.

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Reducing transmission of In January 2013, McMaster Children’s Hospital led the largest-known hospital simulation exercise antibiotic resistant organisms to prepare for the opening of the second phase of its new pediatric emergency department. Antibiotic resistance is a concern for hospitals all over the world. Antibiotic resistance occurs when bacteria in the body change in a way that prevents antibiotics from eff ectively fi ghting them. This can happen when bacteria are repeatedly exposed to the same antibiotics, or when bacteria are left in the body after taking antibiotics (particularly, when someone does not fi nish a full round of Hamilton Early Warning Score: antibiotic medicine). These bacteria can multiply and become strong enough to Catching in-hospital cardiac events resist the antibiotic in the future, increasing before they happen the risk of infection and transmission. A new project at Hamilton Health Sciences In February 2014, Hamilton Health Sciences has taken the act of monitoring vital signs modernized its identifi cation and fl agging to a whole new level. process for patients with antibiotic resistant organisms (AROs) such as staph bacteria, The “Hamilton Early Warning Score” is an C-diffi cile and other potentially deadly innovative project modelled after systems infections. This revised process helps to introduced in the United Kingdom and reduce error and increase communication modifi ed to suit patients in Hamilton about ARO patients. hospitals. A patient’s vital signs are assigned a score refl ective of what is The ARO fl ag will automatically appear in considered “normal” and “not normal”. a patient’s chart, so that the information Using a strategy called “track and trigger”, is clearly visible to registration staff staff can respond promptly to vital sign once the patient arrives in hospital. This scores that are not normal and indicate that allows for better communication of the a risky situation is developing. patient’s history and increased monitoring throughout their care journey. The preliminary results following implementation at HHS have been Staff can more eff ectively monitor impressive and have resulted in a 50 per antibiotic treatment and carry out cent decrease of in-hospital cardiac arrests. appropriate preventative procedures when caring for an ARO patient, increasing safety “It’s a unique program that adds an extra of both the patient and the caregiver. layer of safety for patients,” says Dr. Alison Making our hospitals as safe as possible for our Fox-Robichaud, a critical care physician and patients means understanding how mistakes occur project lead. and fi nding innovative, effi cient solutions to prevent them from happening in the future.

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McMaster Children’s Hospital leads largest known hospital simulation exercise in North America 99.9% 50% It’s January, 2013, and a three-week-old accuracy rate patient arrives at the McMaster Children’s reduction in Code Blue off ered by new robotic pharmacy Hospital (MCH) emergency department (cardiac arrest) dispensing system at St. Peter’s Hospital crying, and begins to vomit as doctors, shown in preliminary analysis nurses and staff try to assess the cause. of Hamilton EaEarly Warning Only, the patient isn’t real. She’s a mirror SScorecore pipilotlot project image of the real child who came into the emergency department only a short time earlier, on the other side of the department. Pharmacy robotics: This simulation exercise tested the fi nal Minimizing medication errors phase of the new children’s emergency department before it opened to patients The mechanism itself is so big that it fi lls an in January 2013. But it’s not like anything entire room. But it can defi ne and count the ever tried before. In fact, this is the largest smallest of pills. Pharmacy robotics improve known hospital simulation exercise in North individual patient safety by reducing America, a unique mirroring of what’s really medication errors. happening in the emergency department Hamilton Health Sciences’ fi rst robotic duplicated with simulation dolls and actors pharmacy went live at St. Peter’s Hospital in near real time. in June 2013, and a second is scheduled H “The best way to create a typical day is to be operational at the Hamilton General to use a typical day,” explains Dr. Ehud in September of this year. The Juravinski Rosenbloom, pediatric emergency Cancer Centre is also planning for a robotic physician at MCH. The day earned the chemotherapy pharmacy. team fi rst place for a Program Innovation Each robot holds many diff erent Abstract from the 2014 International medication types and can dispense as Meeting of Simulation in Healthcare. It many as 1,000 doses per hour. But those also ensured the new space would be safe aren’t the impressive numbers. According when it opened the following month to to the patient safety literature, about 23 Largest known hospital In 2013, a hand hygiene awareness our young patients. per cent of hospital errors are related to simulation exercise poster campaign created by the medication errors, and 14 per cent of those led by McMaster Children’s Hospital pediatric intensive care unit team at occur at the dispensing time. Already, the emergency department in January 2013 McMaster Children’s Hospital St. Peter’s technology has created a 99.9 was the winning selection per cent accuracy rate at the dispensing in the Canadian Patient Safety Institute’s point. “Stop! Clean Your Hands Day” contest. All of this will provide more time for pharmacists to interact on a personal level with patients, creating not only a better patient experience, but another way to improve patient safety.

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Quality-Based Procedures enhance Sue Swayze, nurse clinician at and case manager with the quality and effi ciency of care Seniors Mobile Assess Restore (SMART) pilot project meets with one of her patients. In Ontario, there is a shift toward providing funds to hospitals that can demonstrate they are providing care that is of high quality, effi cient and based on the latest, scientifi c evidence. The provincial government has instituted a new review and improvement process that examines specifi c procedures and treatments. They are called Quality-Based Procedures or “QBPs”. PAWS: A unique approach to Properly designed and implemented improving hand hygiene QBPs will result in process improvements, enhanced patient experience and Hand hygiene is an important step in the outcomes, as well as cost savings. patient care process to reduce the spread of infections. As healthcare providers, This work is foundational to providing washing our hands is one of the easiest the best care and to balancing our ways we can help to protect our patients, organization’s budget in the future. colleagues, hospital visitors and ourselves Hamilton Health Sciences is pursuing the from infections and communicable disease. implementation of four QBPs: congestive heart failure, chronic obstructive pulmonary In 2013, the McMaster University Medical disease, non-cardiac vascular procedures, Centre Hand Hygiene Committee launched and stroke. Preliminary investigation “PAWS”, a code word that staff members has also begun on two additional QBPs: and physicians can use to remind each chemotherapy treatment and endoscopy. other to wash their hands. The code word is another tool that will help us improve our “Our work in designing and implementing hand hygiene rates. Quality-Based Procedures exemplifi es HHS’ commitment to managing our PAWS is an acronym for “Please Attend organization’s resources in a way that is Wash Station”, but also implies to take a fi scally responsible and off ers the best pause, or to wash your “paws” (i.e. hands). possible outcome for our patients,” says Staff and physicians can use this word Dr. Dick McLean, executive vice president to remind their colleagues to wash their of inter-professional practice and chief hands, if they have forgotten to do so, in medical executive. “Each of our facilities a way that is positive and non-punitive. “ Each of our facilities will be providing the will be providing the highest quality care for every patient. It aligns with our vision highest quality care for every patient. of best care for all.” It aligns with our vision of best care for all.”

Dr. Richard McLean – executive vice president of inter-professional practice & chief medical executive.

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Medical Directives for nursing care

A ‘SMART’ approach “Time is brain” – Evidence- The Main Street West Urgent Care Centre to seniors’ care informed practice in stroke care SMART (UCC) recently became one of the fi rst regional centres to implement medical For an elderly patient, a lengthy hospital In stroke care, there’s a saying that “Time Outcomes for Senior Patients directives for nurses, the fi rst two of which stay can heighten the risk of conditions is brain” after a stroke occurs. In fact, one allow UCC nursing staff to order X-rays such as delirium and physical de- to two million brain cells die for every In winter 2014, HHS received one-time and perform extremity splinting under the conditioning due to reduced independence minute blood fl ow is cut off to the brain. funding to pilot the Senior’s Mobile direction of a physician. This is helping to and physical mobility. At Hamilton Health To optimize outcomes following a stroke, Assess Restore (SMART) program, a case improve the fl ow of Sciences, we have several strategies in patients receive tissue plasminogen management-based approachroach to ffosteringostering patients through place that help us create a stimulating, activator, or tPA, a blood clot-busting successful transitions andd reducing the centre. supportive environment for our senior pharmaceutical administered by injection. the length of hospital stayay foforr patients to ensure the best possible To maximize the eff ectiveness of tPA, senior patients. outcomes. provincial and national benchmarks suggest that the drug be administered to patients In January 2014, Hamilton Health Sciences within 60 minutes of the stroke. (HHS) received one-time funding to pilot the Senior’s Mobile Assess Restore At HHS, the Emergency Stroke Care (SMART) program, aimed at creating Quality Improvement Committee has led a seamless transitions through hospital and thorough quality improvement project to reducing the length of hospital stay for bring HHS below the provincial 60-minute senior patients. The program involved “door-to-needle” (DTN) benchmark. a dedicated, inter-professional team The committee identifi ed barriers and that monitored the progress of patients bottlenecks in effi ciency in tPA treatment throughout their hospital stay and, and found areas for improvement. ultimately, their discharge back into Since the implementation of the project, the community. HHS has seen a 28-minute reduction in its Case managers followed each patient median DTN time, from 67 to 39 (as of Oct. closely, screening for complications that 30, 2013). This means more patients receive relate to their physical and psychological tPA within the 60-minute benchmark, 28 min. REDUCTIONRE IN WAIT TIME well-being, including: mobility, medication, enhancing patient recovery. nutrition, hydration, pain, cognition “This remarkable reduction in our stroke Quality-Based Proceduresedures Stroke Care and psycho-social. When necessary, thrombolysis door-to needle times patients received further assessment and could not have been achieved without In 2013-14, HHS pursued the Through Lean Six Sigma methodology, intervention from a SMART team member, the outstanding commitment of all staff implementation of four “quality-based HHS’ Emergency Stroke Care Quality including physiotherapy, occupational involved in the process,” says Louise procedures”, involving multidisciplinary Improvement Committee generated a therapy, social work, nursing, and/or MacRae, director for the Central South teams in an evaluation procedure or 28-minute reduction in the time between pharmacy. Results from the fi rst SMART Regional Stroke Program. process to better understand the patient’s when a stroke patient arrives in the pilot, which was completed in March 2014, experience and identify opportunities emergency department to when they showed promise. The mobile assess restore “I’m proud that our team is a top performer for quality improvements and increased receive the clot-busting drug, tPA. This approach may actually help to reduce in the country, but more proud that effi ciency. In the coming years, we will do improves outcomes for patients who have hospital readmissions and length of stay. patients have a better chance of recovering more, gradually building a comprehensive had strokes. from their stroke,” says Dr. Wes Oczkowski, set of best practice standards for numerous neurologist at Hamilton General Hospital treatments and procedures. and medical director for the Central South Regional Stroke Program.

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Research & Teaching The truth about Aspirin Dr. P.J. Devereaux, HHS cardiologist and researcher at and clonidine use prior to Hamilton Health Sciences is more than a Population Health Research Institute, takes a patient’s pulse. family of local healthcare facilities. Patients non-cardiac surgery from across Ontario are referred to our Worldwide, 200 million adults undergo hospitals to receive treatment they can’t major noncardiac surgery annually and 10 get at home. To continue this tradition of million of these patients will suff er a major excellence into the future, we are helping heart-related complication. to develop the next generation of highly advanced and specialized care providers. Dr. P.J. Devereaux, HHS cardiologist and Population Health Research Institute • We are a referral centre for highly researcher (pictured, p. 26) spearheaded advanced and specialized care. Patients two international studies to evaluate come to our hospitals from across south whether two commonly used drugs – central Ontario, and beyond, to receive Aspirin and clonidine – used around the treatment they can’t get at home. time of surgery are eff ective in reducing • We are also a living classroom for major heart related complications after the next generation of healthcare noncardiac surgery. professionals. Students from McMaster These very large studies enrolled more University, and other than 10,000 patients at 135 institutions educational institutions gain valuable in 23 countries. The fi ndings concluded experience by learning how to care for that neither Aspirin nor clonidine was patients under the careful guidance of eff ective in preventing heart attacks after our talented and committed staff . surgery, but that there are side eff ects • The third, vital component of our mission associated with the administration of both is research. Hamilton Health Sciences is interventions. one of the most prolifi c and respected “These results can benefi t patients health research institutions in the immediately in that physicians can now world. We have earned that reputation have patients stop their aspirin prior through many years of success in leading to surgery and this will decrease their ambitious, innovative studies that have risk of a major bleeding event. Likewise, changed health care everywhere and anesthesiologists can stop using clonidine saved countless lives. To learn more, visit in the surgical setting,” said Dr. Devereaux. http://www.hhsresearchadmin.ca/ “Moreover, these studies provide important Patient care, teaching and research – insights that inform new ideas for together they make Hamilton Health decreasing the risk of complications after Sciences stronger. Together they make Our exceptional track record of lab-to-bedside surgery.” the care we provide the best it can be. innovation has earned us recognition as one of the Findings of these studies were featured in the New England Journal of Medicine. world’s leading health science research organizations.

26 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 27 RESEARCH RESEARCH AT HHS: IN OUR COMMUNITY AND AROUND THE GLOBE

Dr. Salim Yusuf: Transforming the treatment and prevention of cardiovascular disease around the world

Each year, more than 17.5 million people die from cardiovascular disease globally. Dr. Salim Yusuf, Executive Director of Population Health Research Institute 86COUNTRIES (PHRI), is an internationally renowned cardiologist and epidemiologist whose work over 35 years has changed the way GERAS: The newest addition cardiovascular disease is prevented and to HHS’ research centres treated all over the world. More than one million patients in 85 A dedicated team of experts at St. Peter’s countries have been involved in the massive 1,000,000+ Hospital and McMaster University have clinical studies that are the hallmark of PHRI. ENROLLED PARTICIPANTS come together in a research venture that will focus on aging. The St. Peter’s Geriatric The work led by Dr. Yusuf and his Population Thrombosis and Escarpment Off ord Centre Geriatric Education and Research in Aging Sciences colleagues improved our understanding of (GERAS) Centre will aim to improve the risk factors for heart disease and strokes Health Atherosclerosis Cancer for Child Education and quality of living for seniors with chronic and tested drugs to reduce mortality Research Research Research Studies Research in diseases through innovative research. They from these conditions. His current work Institute (PHRI) Institute (TaARI) Institute (ECRI) (located at the Aging Sciences explores the role of the environment, health will also educate health professionals who (located in the David Braley (located in the David Braley (located at the Juravinski ) (GERAS) care for seniors, and develop and evaluate policies and health systems in infl uencing Cardiac, Vascular & Stroke Cardiac, Vascular & Stroke Hospital & Cancer Centre) DIRECTOR: (located at St. Peters Hospital) educational health promotion strategies cardiovascular disease mortality globally. Research Institute) Research Institute) Dr. Michael Boyle that enhance quality of life, function and SCIENTIFIC DIRECTOR: SCIENTIFIC DIRECTOR: Dr. Yusuf’s infl uence on international EXECUTIVE DIRECTOR: EXECUTIVE DIRECTOR: independence for seniors and their families. Dr. Mark Levine RESEARCH FOCI: Dr. Alexandra researchers is perhaps one of his most Dr. Salim Yusuf Dr. Jeff rey Weitz enduring gifts. By involving researchers in RESEARCH FOCI: • Determinants Papaioannou “The GERAS Centre demonstrates the collaborative networks, and by providing RESEARCH FOCI: RESEARCH FOCI: of child mental respect our team of experts has for older • Translational RESEARCH FOCI: practical training in the conduct of • Cardiovascular • Basic to Bedside health and adults and the commitment we have to Research • Frailty, Falls and productive research projects, he has helped Research Research functioning providing exemplary care in geriatrics,” says Fractures an astounding number of research fellows • Clinical Trials Dr. Alexandra Papaioannou, geriatrician, • Stroke, Diabetes, • Blood Disorders, • Programs and advance their own work. • Quality Health • Dementia and St. Peter’s Hospital; professor of medicine, Genomics Cardiac, Stroke, policies to Care and Delirium McMaster University and scientifi c director Prestigious honors for Dr. Yusuf in 2013/14 Research DVT, Pulmonary improve child Knowledge of GERAS. “This work acknowledges Embolism mental health • End of Life Care • Population the link between research, practice and • 2014 The Canadian Gairdner Translation Sciences and education and the importance of quickly Wightman Award Clinical Trials implementing evidence-based strategies • 2014 Canadian Medical Hall of Fame that will make a diff erence to patients.” • 2013 J. Allyn Taylor International Prize in Medicine • 2013 The Order of Canada • 2013 President Elect World Heart Federation (Dr. Yusuf was elected president taking eff ect January 2015.) 28 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 29 Milestones

June 26, 2013 September 16, 2013 September, 19 2013 October 16, 2013 On June 26, 2013, the Screen for Life On September 16, 2013, McMaster Children’s St. Peter’s Hospital and Foundation, St. Peter’s Hospital and the HHS research Coach made its public debut in the Hospital celebrated it’s 25th anniversary with along with McMaster University launch the community celebrate the launch of the new McQuesten neighbourhood in North a “Day in the Life” photo celebration, which Artful Moments art therapy program Geriatric Education and Research in Aging Hamilton. The state-of-the-art coach had a group of photographers capturing Sciences (GERAS) Centre provides screening services for breast, moments of care throughout the hospital. cervical and colorectal cancers. Community members followed along on social media, where the photographers’ photos were shared near reareal time.

December 4, 2013 February 1, 2014 February 6, 2014 June 23, 2014 Mark Farrow, vice president and Rob MacIsaac is welcomed West Lincoln Memorial Hospital The Boris Clinic is an innovative adult chief information offi cer (CIO) at HHS, as the new president and CEO offi cially joins the Hamilton outpatient unit for general internal CIO at St. Joseph’s Healthcare Hamilton, of Hamilton Health Sciences Health Sciences family medicine that combines both patient care and CIO & eHealth lead at Hamilton and teaching. The fi rst phase opened Niagara Haldimand Brant LHIN, on June 23, 2014 for diabetes patients is named one of Computerworld and those requiring assessment after Magazine’s Premier 100 IT Leaders emergency visits. The second phase will bring adult specialists in general internal medicine under one roof in 2015.

30 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 31 Care in numbers

11,780 1,899 1,535 5,315 employeesoyeesoyees physiciansphysi volunteersvolunteers studenttudent plplacementsacements 7 hospitals 45,030 inpatient stays H H H H

! ! ! ! ! ! ! H H H 1,228! ! ! ! ! ! ! inpatients/day! (avg.) ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! 152,131 683,630 24,576 !3,800! ! ! ! ! ! emergency room visits ambulatory visits surgeries ! ! ! !births! ! ! ! 30,035 1,873 51,036 ! ! ! ! ! ! ! ! ! ! Urgent Care Centre visits ambulatory visits/day (avg.) surgical hours ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

32 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 33 Responding to budget pressures

Life in our LHIN: Caring for our aging population Doing more with less

This fi scal year, we know that infl ation will increase our annual costs, and that we will receive minimal additional funding. Hamilton Niagara Haldimand Brant LHIN: Hamilton Health Sciences is already doing its part to address this challenge. We Aging have been very successful at accomplishing signifi cant savings while serving more will add about patients and continuing to work toward our vision of providing the best care for all. 1% per year In the last 8 years: 200,000+ to the cost of HALTON seniors runnrunningin hospitals and the largest number cocommunitym care. of seniors of all HAMILTON Ontario LHINs based on BRANT

NIAGARAIAG ARA projectionsproj for 2019, seniorssenio will represent HALDIMAND

NORFOLK 18.7% of the HNHB LHIN population 4.8% 40.4% 26.3% increase in increase in increaseii in acute inpatient emergency/ ambulatory care services urgent care clinic visits visits 2019

Hamilton Health Sciences: 72% of rehabilitation & 80% seniors health of St. Peter’s patients are complex care 65+ patients araree $135 million 65+ 65++ expense reduction 33.5%35% 38.4%% of ER patients of acutete are inpatients are 65+ 65+

34 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 35 HEALTH CARE, TRANSFORMED

Each year Hamilton Health Sciences Pictured, from left: Amanda Coschi, student nurse; Christine Stevens, palliative care case manager; Foundation has the privilege of working and Dr. Bev Hattersley, palliative care physician at St. Peter’s Hospital. with donors and patients as we raise funds to support various projects and campaigns. In 2013, we completed fi ve major fundraising campaigns and behind each was the story of a life transformed.

The experience of Drew Nathan at St. Peter’s Hospital had a profound impact on his sister-in-law, Jennifer. Our ability to complete the campaign to support the purchase of 10 computerized ambulatory “Most importantly, the staff treated Drew drug delivery (CADD) pain pumps was with dignity, supported his choices and enabled by Jennifer’s touching story: gave him hope. They allowed him to explore the fi nal moments of his life so he was “Drew was a funny, honest, and trusting calm, allowing all of us to fi nd peace. A young man who wanted to make a CADD pain pump, which allows patients diff erence in the lives of others. He also to self administer pain medication, gave possessed a strong will. In 2011, at the age Drew a sense of autonomy and control. of 30, Drew was diagnosed with malignant While deeply saddened by his death, I take melanoma, and in January of 2013 his fi nal comfort knowing that his fi nal days were destination was into the loving arms of the peaceful.“ staff at St. Peter’s Hospital. This is a group of women and men beyond compare to any I’ve ever known and will likely ever know 2013 Funding to HHS: again. From the minute I walked in I could feel we were home. Every staff member in the building has an air of kindness around 44.4% equipment them and it provides families with a sense 22.1% research & fellowships of security so desperately sought during such sad times. 30% redevelopment 4.5% education & bursaries

DID YOU KNOW?

CAMPAIGNS COMPLETED IN 2013: Recognized as one of 14 We fund: • CADD Pain Pumps patient care amenities, • CIBC Breast Assessment Centre “best in class” $51.15 3,400+ healthcare foundations $10.7 MILLION equipment, research & fellowships, • Hogarth Family and Pioneer MONTHLYMONTHLY DONODONORSRS MILLIONMILLION in North America in 2013 for in contributions education & bursaries Energy Ophthalmology Centre TOTAL DISBURSEMENTS the 4th consecutive year over the last 5 years and facility redevelopment • Angiography Suite (2009-2013) • MRI at The General

36 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 37 MAKE A PURCHASE, MAKE A DIFFERENCE

The Hamilton Health Sciences Volunteer In 2013, the Hamilton Health Sciences Volunteer Association opened its new Give Shop Association (HHSVA) is a non-profi t in the front lobby of McMaster University Medical Centre. organization which operates retail and parking services across the HHS family of hospitals. All profi ts are donated to enhance patient care through the purchase of much needed capital and patient services equipment, and funding of many patient care programs. HHSVA serves thousands of customers a day including, patients, families, visitors and staff , through it 31 shops and services, including cafes, cafeterias and gift shops, 21 parking lots 2013/14 Funding to HHS: and garages, and many other services. HHSVA’s motto “Make a Purchase, Make a Diff erence” well defi nes the very important $12,192,493 role that customers play in supporting hospital operations patient care at HHS through the purchases 74% they make, from buying a cup of coff ee to 17.1% HHS capital parking their car. Every purchase translates into a positive impact on the patient 4.9% patient services experience and helps to support excellence in patient care at HHS. 2.2% Volunteer support

1.1% HHS staff education and events

DID YOU KNOW? P P P P P P P $12.2 31 21 4.5 1 300 MILLION MILLION SHOPS AND SERVICES PARKING LOTS AND GARAGES MILLION STAFFTAFF AND VOLUNTEEVOLUNTEERSRS contributed in 2013/14 including cafes, cafeterias customers served in coff ees served in working at HHSVA-operated and gift shops P P P P P P P 2013/14 2013/14 retail and parking services across HHS P P P P P P P

38 | 2013 - 2014 COMMUNITY REPORT | HAMILTON HEALTH SCIENCES HAMILTON HEALTH SCIENCES | 2013 - 2014 COMMUNITY REPORT | 39 For more information, contact Public Relations & Communications at (905) 521-2100 ext. 75387 [email protected] or visit www.hhsc.ca

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CHEDOKE • CHILDREN’S • GENERAL • JURAVINSKI • McMASTER • ST. PETER’S • WEST LINCOLN