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Arnprior Regional Health is proud to provide quality health care services as close to home as possible.   Having services available within our own community increases the overall health of our growing and aging community.  In the past month we welcomed two new family physicians, a plastic surgeon, and commenced planning towards our Rural Health Hub. 

We know that we cannot provide all the health care services that our community needs, as some are very specialized and we would not have the skills and expertise needed. On the other hand, we have exceptional results for the services that we do offer as measured by our patients/residents and clients.  One of our most respected and sought after service is that of care provided at the Grove Nursing Home.  In March of this year a survey was carried out at the Grove which confirmed that 82% of residents and families would definitely recommend the Grove.   That is outstanding!

Despite these results, we are saddened to see the long wait list for residents of our community to receive care at the Grove.  Last year, more than 100 people in our community (Arnprior, McNab/Braeside, and West Carleton) were seeking care in a long-term care facility.  Only 11 of them were accommodated at the Grove.   Over 50% of residents remained on the wait list, and the other 40% had to leave our community to receive care elsewhere.   

I was recently told about the circumstances of a member of our community who is 86 years old and his wife is suffering from dementia. Since there was no space for his wife in the Grove and the respite services were limited, he had to move his wife out of their home into a long-term care facility in Ottawa. This 86 year old gentleman is driving every day from Arnprior to Ottawa, 65 kilometers each way, to spend time with and care for his loved one. He has explained to us that he is afraid for the harsh winter to come. He expects that there will be a number of days that he will not be able to visit her, or unable to travel back home from Ottawa.

 

Arnprior Regional Health is advocating for the expansion of additional long-term care beds as part of the Grove Redevelopment.  Over the summer, with the support of the Grove Redevelopment Task Force and the Greater Arnprior Seniors Council, we launched a campaign to raise awareness around the challenges The Grove is facing and advocate for the additional long-term care bed licenses our community deserves. Our messages as noted below have been shared with several area MPP’s and the Local Health Integration Network.  

+      We want to help The Grove grow, so seniors in our community have a place to grow old.

+      Our community currently sits at 42.5 long-term care beds per thousand residents over the age of 75, which is well below the provincial average of 88.2.

+      The Grove, which is the only facility in Arnprior that offers long-term care to seniors, is a 60-bed nursing home that is eligible for redevelopment under the Minister of Health and Long-Term Care’s Redevelopment Program.

+      The Arnprior Regional Health Board of Directors has completed a comprehensive review of The Grove, which supports the need for redevelopment of the site to increase to 96 long-term care beds, 20-30 affordable seniors’ accommodation, and seniors’ programming such as assisted living and an adult-day program.

+      This expansion would provide care to dozens of seniors who are currently on the waitlist, allowing our loved ones to age within our community.

+      This expansion would mean that fewer seniors in our community will have to leave their community and their families behind to receive long-term care.

+       We ask that a solution is found, so that 36 additional long-term care bed licenses can be allocated to The Grove, so that redevelopment can move forward and our seniors can age in the community they call home. Equitable access to long-term care is needed for our community.

The advocacy for additional long-term care beds is advanced and gaining traction, but we have yet to hear a positive commitment to address the gap, rather we hear – “we will support you...your case is strong”.  As a supporter of equitable access to long-term care beds in our community you can help by sharing your stories of what it means to not have equitable access to local health care services like many other rural communities do.

 

 

Please let me know your thoughts.

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As with many organizations, we celebrate the years of service one provides to an organization.   This year we recognized fifty staff members representing over 705 years of employment service to ARH.  I am proud to say that we have people working as part of the ARH team for under one week and a few that have been here more than 45 years!   The dedication and loyalty many of our staff have towards our organization is exceptional.  Thank you everyone!

Arnprior Regional Health is also very proud of the vibrant culture we are building!  This culture is based upon the values of the corporation – Honesty, Accountability, Respect and Teamwork (HART).  Having our own individual values aligned with the values of the organization helps all of us provide the best patient/resident/client experience along with the best opportunity for our patients/resident/clients to achieve their health care goals. 

In our most recent employee engagement survey, 73% of employees reported that their values were similar to the organization.  This is an increase of 14% from five years ago where the results indicated only 59% of employees had similar values to the organization. 

There is a saying that some things are not rocket science.  However, I would add “but they are hard to do”.  Ensuring the alignment of one’s personal values with those of the organization is just that – “it’s not rocket science” to suggest it should be the case, “but it is hard” to ensure that it happens.

At ARH, we want to acknowledge when things are going well, but more importantly we want to celebrate when we sustain results.  Living our values is one of those celebrations.  In keeping with this ARH has created the annual HART awards. 

 

The HART Award – is awarded to employees at the Hospital & Grove and a physician who best champion ARH’s values of Honesty, Accountability, Respect and Teamwork.   Nominations from staff and physicians at ARH determine recipients.  Awards are presented at the same time as the long service awards.  However, the recipients are not aware they are a winner; rather only aware they have been nominated. 

 This year's winners of the HART award are Julie Byers, a health information professional at the hospital; Grove RPN Jill Giles; and Dr. Terence Woods of the Emergency Department. 

Years of service are certainly very important to one’s individual personal milestones. However, the recognition from one’s peers seems to be equally if not more gratifying to our recipients this year. 

"Receiving this award means a lot, and really validates that everything I do on a daily basis means something to my peers and residents at the Grove"  
Jill Giles

 “I started at the Arnprior and District Memorial Hospital 15 years ago and have seen a lot of positive change from that time until now…..even the name has changed to Arnprior Regional Health.  It is an environment that makes it easier for me to live the values of ARH; Honesty, Accountability, Respect and Teamwork.  I feel that people notice and appreciate when you work hard and you are recognized for that. I believe ARH consists of a great group of people and feel honored that some of these people appreciate me enough to nominate and award me the H.A.R.T. award this year.  I feel valued by the organization and the ARH team.”

Julie Byers

"It's fulfilling to be part of a hospital-wide team in which efforts to improve people's experiences are encouraged and recognized. I've seen positive changes in this regard over the last few years here, especially in terms of seeing each patient's case as a shared problem to be solved rather than a simple consumer-provider relationship. It makes for a fun place to work when people respect patients and their colleagues."

Dr Terence Woods

The culture at Arnprior Regional Health, as illustrated by living the values, is alive and well.  With a positive and collaborative culture we have seen staff turnover decline to less than 3%, patient/resident/client satisfaction ratings continue improving and overall staff engagement to be higher than the average of our peers! 

The annual HART awards are just one of the many ways we celebrate at Arnprior Regional Health.   

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The vision of Arnprior Regional Health is to be recognized for exemplary care.  Achieving our vision is accomplished by establishing goals which continuously improve how we operate and deliver our care to patients, residents and clients.  In establishing these goals we need to ensure that we create improvement across more than one theme in our organization.  If, for example, we only focus upon financial goals, we may do so at the peril of the quality of our services.  At Arnprior Regional Health the Board of Directors establishes annual goals under 5 themes or, what we have come to call, pillars.  These pillars represent 5 categories of performance: Experience, Quality, People, Finance and Community.

 

To reach our full potential, we need to establish and cascade goals which impact all of our services including acute care, long term care and community programs and services.  The illustration that follows outlines the Board approved goals for 2016/17.  

Arnprior Regional Health has made significant strides in performance as measured both internally and externally.  From previous successes and failures we have learned that we must:

1.      Ensure that our staff is aware of our annual goals.

2.      Be transparent and measure and communicate progress against the goals throughout the year.

3.      Create and communicate 90 day action plans for our goals.

4.      Practice our value of Accountability with respect to who owns the goal.

5.      Acknowledge progress or slippage in our plans.

6.      Celebrate success when the results have been sustained.

We also know that to be successful we need to engage the staff, physicians and volunteers in our plans.  We will do this through leader rounding on staff, open forums, and ensuring our meetings have an agenda item which allows for deliberation upon the organizations goals.

The Board of Directors of Arnprior Regional Health also play a pivotal role in ensuring that we succeed in achieving our goals.  Our skills based board will provide the necessary oversight, insight and foresight into the strategies and tactics we implement to achieve our goals. 

In summary, at ARH we always start with the WHY – our Vision to be recognized for exemplary care.  Next, we describe the WHAT- what is it that we want to accomplish to achieve our vision – the WHAT are our annual goals.  Finally we describe the HOW – these are the tactics that will be developed to elevate our current practices and performance.  In most cases the tactics are NOT new, but rather existing practices that we need to refine or more often than not ensure the practice ALWAYS occurs.

 

The journey to exemplary care is just that…a journey.  While we need a structure such as strategic themes and aspirational annual goals, we need to remind ourselves of the quote from Maya Angelou, “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

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In my last blog I discussed the current environment of the health care system in Ontario, one where change is now constant, a transition from where change was once considered to be episodic.   With so much change would we not be expecting resistance, burnout, and perhaps errors in execution?   Yes to all, however I have come to realize that leading change can be successful if we always start with the WHY. 

John Kotter, wrote an article entitled Leading Change[1]  why transformation efforts fail.  In the article he noted that a key first step is to get people out of their comfort zone, an understanding WHY the status quo is no longer appropriate.  Understanding where our performance is in relation to our vision and more importantly the expectations of our patients/residents/clients.

The WHY supporting the need for change can emanate from a number of sources, including ARH corporate documents, legislation, funding imperatives, and feedback from the patient/resident/client but regardless of the source, the WHY needs to be explicit. If it isn’t…. we need to make it so.

The vision of Arnprior Regional Health is “to be recognized for exemplary care, making your health our priority.”To achieve this vision we will follow our values of Honesty, Accountability, Respect, and Teamwork.   Our mission, vision and values form a foundation for the WHY. 

When we are proposing any new change, connecting back to the vision statement will help to confirm that even though it may be hard to make the changes we are proposing they are related to our aspirations. 

Accreditation Canada provides more than 2000 standards to guide health care organizations in pursuit of the highest quality of care.   A number of the standards propose the use of best practices; in particular those contained under priorities processes for decision support. For example, “The team uses current research, evidence-based guidelines, and leading practice information to improve the quality of its services.”  This standard confirms that the WHY for the introduction of the quality improvement is sourced from the research, is evidenced based and leading practices. 

In a recent report by the Ontario Hospital Association[2]-the authors concluded the need to say WHY -  “a shared purpose (mission, vision and values) with the active participation by all stakeholders promotes ownership of the common agenda and helps to ensure that work is driven by a shared platform of consensus and commitment to common objectives.”

 



[1] Leading Change – Why Transformation Efforts Fail – John P Kotter 2006 Harvard Business Review

[2] Fostering Effective Working Relationships Between Hospitals and Physicians, Ontario Hospital Association, October 2015

 

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The Right Care and the Right Time in the Right Place

When we need care, we would like to be confident that we can receive the right care, at the right time, in the right place.   If we as a health care system do not “get it right the first time” it only creates inefficiency, but more importantly a poor experience.

At Arnprior Regional Health (ARH) we are undertaking a number of strategies to “get it right the first time”; below I am highlighting a few of them.

1.      Post Discharge Phone Calls – Every month we make close to 100 calls to patients who have been discharged from our medical inpatient unit.   We want to make sure they transitioned home ok.   When we ask them about taking their medications, and having a follow up visit with their doctor, we do this knowing it will reduce the likelihood of their having to be readmitted to the hospital.

2.      Home First – For some of us we will need to go to a long-term care facility when we are not able to remain independent at home.  In the past we were too fast in making this transition directly from a hospital to a nursing home.  Now, working with the Community Care Access Centre, patients are able to receive additional enhanced home services to allow them to go home directly from the hospital. 

3.      Outreach Programs – We offer a number of programs at the hospital site of ARH that enable our local residents to receive care at home versus the drive to Ottawa.   For example, telehealth services include access to specialists such as neurology and clinical oncology.  In addition, there are more than 20 specialists visiting our hospital including paediatric, dermatology, hematology, and psychiatry. 

4.      Community Programs – ARH has two key community programs – the adult day program and assisted living services.  Both of these programs provide support and care to enable these seniors to stay at home with as much independence as possible.   Both programs have increased in capacity over the past few years through additional funding from the Local Health Integration Network  (LHIN)

Looking forward we see additional opportunities to ensure the right care, at the right place, at the right time.  For example, the following potential changes are being investigated:

1.      There are a significant number of day surgery cases performed in Ottawa on our residents.  Some of these surgeries are within our scope of practice and could be safely performed here at ARH.  We are in discussions with other health care providers about providing more services here (services such as Urology). 

2.      We know that a large number of seniors in our community are often only able to receive nursing home services in other communities such as Almonte and Renfrew.  Both of these communities have more nursing home beds than Arnprior, yet their communities are the same size.  In fact both Renfrew and Almonte have more than double the number of nursing home beds than we have at the Grove.  Our Board of Directors and the LHIN are aware of this significant discrepancy and are investigating opportunities to expand the Grove during the pending redevelopment.

3.      We have recently undertaken the role of project sponsor for health links for our community along with residents in Kanata and Stittsville.  This project uses limited new funding to help coordinate the care of our most complex patients.   We know that the top 5% of our most complex patients consume more than 60% of our health care resources.  Health links will help to ensure these complex patients receive the appropriate care in a more coordinated way.

The Board of Arnprior Regional Health is responding to the challenge of ensuring the right care, at the right time, in the right place.  Our Directors are asking ….

·        Do we have too many people using the emergency department that should be using other services?

·        Do we have the right partnerships with other health care providers to ensure our community has access to care?

·        Are we deploying the ARH resources where our community needs them most?

Change was once episodic, now change is constant.  ARH will continue to make changes to ensure that our community receives the right care, at the right time, in the right place.

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Arnprior Regional Health continues to identify opportunities to increase the engagement of patients, residents, clients and families in their care.  In a study[1]  completed in 2013, the authors concluded that hospitals have opportunities to improve communication with patients.  In particular, the authors noted: 

“Patient whiteboards help physicians and ancillary staff with communication, improve patients' awareness of their care team, admission plans and duration of admission, and significantly improve patient overall satisfaction.”

In April of 2015 ARH the hospital introduced patient communication boards on the Inpatient Unit (44 patients).  This patient communication board is updated on a regular basis with information that informs not only the patient, but families and visitors, of key elements of the patients care.  As the graphic below illustrates the communication board includes: nurse’s name, doctor’s name, the name the patient prefers to be called and key aspects of their care plan such as discharge day, goals for the day and scheduled tests.   

 

Comments obtained from our patients during post discharge phone calls confirm that these patient communications boards are having a positive impact.  Some of their comments are noted below. 

 

·        “I appreciated the way the nurses interacted with me with the communication boards”

 

·        “I liked the communication boards and I found it was helpful to my family when they wanted to know who my nurse was”

 

 

 

Patient communication boards are used to keep patients informed of a variety of aspects of ones care. In addition to the benefits attributed to the patients we noted that implementing patient communication boards has put our interdisciplinary team closer to the bedside and improves information shared between our patients and their care team.

 

Our vision is to be recognized for exemplary care, and we are pleased to confirm that the use of this new communication tool will create a better experience for the patient and their families. 

 



[1]Patient whiteboards to improve patient-centred care in the hospital.

Tan M, Hooper Evans K, Braddock CH 3rd, Shieh L.

Postgrad Med J. 2013

 

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Arnprior Regional Health continues to aggressively pursue its vision “to be recognized for exemplary care”.  Our activities to achieve this vision are prioritized by the Board of Directors on an annual basis.  Specifically, the Board establishes goals under five pillars.  The pillars provide the foundation for setting organizational goals and direction as well as providing consistency and focus.  The pillar model also helps our organization understand its performance on a system-wide basis.Our five pillars are Experience, Quality, People, Finance, Community, and are defined below:

1.      Experience -  How our patients, residents and clients perceive their experience;

2.      Quality -  How we plan, deliver and evaluate the quality of services provided in the hospital, nursing home and Assisted Living Services;

3.      People - How staff and physicians perceive their engagement at ARH;

4.      Finance - How we effectively deploy and achieve value from our financial resources across the various services of the corporation;

5.      Community - How we engage our community, partners, and government in the planning, delivery and evaluation of our services.

 

 

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At Arnprior Regional Health, we are all focused upon achieving the best experience for our patients, residents and clients. As articulated in our vision statement “We want to be recognized for exemplary care”. The tremendous success of 2014 is due to the hard work and effort put forth by our staff, physicians and volunteers. 

In February 2014 we were awarded Accreditation with Exemplary Standing, this is the highest level of accreditation and demonstrates excellence in quality improvement. In October we received the Quality Healthcare Workplace Bronze Award from Health Force Ontario and the Ontario Hospital Association. 

The goals we set for the past year are on track. We see Emergency Department patient satisfaction scores consistently higher than 50%, where patients are stating their care to be excellent. Residents of the Grove rated their overall care at 96.5%.  Compliments from patients are consistently coming in for the Day Surgery Program.  The Inpatient Unit has successfully implemented tactics which have decreased the number of patients who contract c. diff, and there have been no new cases over the last four months!  Our finances are on track and facility improvements are taking place at the Grove and ADMH.

The Employee Satisfaction Surveys resulted in departmental tours where everyone gained an appreciation of the daily job functions of our colleagues.  Staff input also led to the launch of the Respectful Workplace Initiative and over 170 people attended the Employee & Physician Service and Recognition Awards.

The community showed us their support of our hospital, nursing home and services through the Tree Lighting Ceremony having donated $31,175 which exceeded the financial goal set by Partners in Caring. The employee led Social Committee threw a fantastic Christmas Party with over 120 tickets sold. We finished off 2014 by giving back to the community with donations to the Arnprior Food Bank.  The staff at the Grove collected 8 boxes of food and personal care items and hospital staff raised $1,521 with the dietary department led gift basket auction.

As we move forward to 2015 we will continue to focus on the patient/resident/client experience.  The patient, resident and client voice is increasingly becoming a critical component of effective health care.  Once again, we will be asking staff for their feedback when we administer the Employee Experience Survey in January.

 

On behalf of the Board of Directors and the Senior Management Team, I wish each and every one of you a healthy and Happy New Year.

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As the President and CEO of Arnprior Regional Health, I am pleased to launch my first blog.  I have been contemplating this move into social media for some time.  The health care environment is now in a constant state of change, creating an unprecedented number of people asking “Why?  Why are we embarking on this direction? Why do we need to change? Why, why?”

I hope to utilize this blog as a place to provide some insight into “Why Arnprior Regional Health is changing.”

The second objective of the blog is to provide an opportunity to recognize the achievements our team has made with respect to our vision of being recognized for exemplary care.  At Arnprior Regional Health we have over 300 staff, 200 physicians and 200 volunteers who make our organization a great place to work, volunteer and receive care. 

The last objective of the blog is to provide an opportunity to inform you of issues and to provide opportunities where we will seek your input.  At ARH we live by four values – Honesty, Accountability, Respect and Teamwork.  This form of communication is one vehicle I believe will strengthen the practice of our values. 

I invite you to join me on this journey of cyberspace communication.  I hope you will let me know what you think about the topics we post and offer your input into the questions we ask you to consider.

Until next time,

Eric

 

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