The Emergency Department at Strathroy Middlesex General Hospital (SMGH) maintained 24/7 coverage throughout last summer, Mike Mazza, CEO of the Middlesex Hospital Alliance, says.

Hospital administration had warned that intermittent closures might become necessary during the summer season. There were several

doctors retiring and that, in addition to summer holidays, was creating gaps in scheduling.

“We weathered the summer very well, with no emergency department closures. We are thankful to all our physicians who stepped in to fill the gaps in coverage,” Mazza says.

“We are especially grateful to Dr. Julie Copeland, our new chief of Emergency Services at SMGH. Dr. Copeland worked tirelessly with her team, maintaining summer coverage and recruiting new physicians to the Emergency Department,” Dr. Paul Ferner, chief of staff at SMGH, says.

REPORT TO THE COMMUNITY 2009

HealthcarePhysicians at MHA pages 9 & 11

Patient Safetysee page 5

Dr. Copeland practices out of her office at the Southwest Middlesex Health Centre in Mt. Brydges and assumed the position of chief of Emergency Services at Strathroy on June 1, 2008. The SMGH Emergency Department is a busy place. In 2008, there were about 24,000 visits. (continued on next page)

Connecting with the Future of Care

Wait TimesThe Ontario Ministry of Health and

Long-Term Care (MOHLTC) now tracks Wait Times in Emergency Departments in hospitals throughout the province.

You can check these, along with surgical and diagnostic Wait Times, from the MHA website.

www.mhalliance.on.ca

Going Green!see page 4

What’s InsideEmergency Department (continued) . . . . . . . . . . . . 2

Telepsychiatry at FCHS . . . . . . . . . . . . . . . . . . . . 2

Messages from the CEO and the board chair . . . . . . 3

Busy Being Green . . . . . . . . . . . . . . . . . . . . . . . . 4

Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Wireless Communications at FCHS . . . . . . . . . . . . . 6

Diabetes Conference . . . . . . . . . . . . . . . . . . . . . . 7

FCHS Foundation News . . . . . . . . . . . . . . . . . . . . 8

SMGH Foundation News . . . . . . . . . . . . . . . . . . 10

Transformation Plan for SMGH . . . . . . . . . . . . . . . 11

Four Counties Mini Bus. . . . . . . . . . . . . . . . . . . . 12

Strathroy’s Emergency Department is Vital

Dr. Julie Copeland

To maintain full time emergency services at Strathroy, the MHA engaged in a number of strategies. “Our own family physicians jumped in and increased their hours,” Dr. Copeland says, “And we are thankful to the physicians from Four Counties who were invaluable in keeping Strathroy staffed. We also called upon colleagues in Sarnia, London and St. Thomas areas to help out in covering the ED shifts.”

Additionally, the MHA worked with Health- Force Ontario to assist in finding physicians. HealthForce Ontario is the province’s strategy to ensure that Ontarians have access to qualified healthcare providers. HealthForce Ontario involves the Ministry of Health and Long-Term Care (MOHLTC) and the Ministry of Training, Colleges and Universities (MTCU) through several initiatives that identify healthcare human resource needs, develop new provider roles, and

Strathroy’s Emergency Department is Vital (continued)

work with the education system. “Working with HealthForce Ontario has been beneficial,” Dr. Copeland says.

There is a provincial shortage of Emergency physicians and the MHA is not immune to it. In the past, the MHA, like many smaller hospitals, has relied on family practice physicians to cover all the shifts in ED - 24/7, 365 days a year. “This is changing at hospitals everywhere in Ontario,” Dr. Copeland says, “We are looking to recruit more physicians for the ED, especially ED-focused physicians.”

“Our recruitment strategy and the hard work of Dr. Copeland and her team are paying off,” Mazza says, “Strathroy has recruited one full time emergentologist and three physicians who will provide regular part-time commitment – in addition to our existing roster of physicians who do emergency coverage.”

Telepsychiatry Now at Four Counties Health Services

In early November Four Counties Health Services (FCHS) introduced Shared Care Telepsychiatry, welcoming Dr. R. Chandrasena, Chief of Psychiatry at Chatham Kent Health Alliance, and Dr. R. Fairbairn, to the MHA physician team.

Drs. Chandrasena and Fairbairn will link with FCHS Primary Health Care Nurse Practitioner Lisa Plank RN(EC) via the Ontario Telemedicine Network (OTN) to provide psychiatric services to patients in the FCHS catchment area.

Initially, patients seeking mental health services meet first with Nurse Practitioner Plank, then the psychiatric consultations take place via the two-way videoconferencing system. This consultation takes place in a private room with an “I-doc” – basically a 2-way video-conferencing system monitor. At this time, crisis services are not available through Telepsychiatry.

The addition of Shared Care Telepsychiatry at FCHS is a great benefit to the community – reducing wait time for a psychiatric consultation

and eliminating the need to travel to Chatham or London for consultation. Telemedicine minimizes the time lost in travel for both patients and clinicians.

“Telemental health services improves patient access to care; it improves the opportunity for follow-up care and provides continuity of care close to the patient’s home,” Plank says.

Healthcare focus page 2

Lisa Plank RN(EC)

Green has become so much more than a colour. Everywhere one looks these days, people are “going green” – and that includes the Middlesex Hospital Alliance.

In this Report to the Community, you can read about the very many “green” initiatives that the staff

and physicians have already initiated. I am proud to say that our energetic Housekeeping department has led the charge in our “green-ing” (see page 4).

This newsletter itself is a green story. Last year we printed more than 40,000

copies and delivered one, as best we could, to every mailbox in the catchment area. This year we are inviting residents of our catchment area and other interested individuals and organizations to visit the MHA website and view and/or download this Report to the Community. This method saves money, and it saves trees. (We appreciate that not everyone has a computer with Internet access, so we are printing a small number of copies for distribution through our community partners; municipal offices and libraries, health clinics and medical offices.)

This Report to the Community is an annual publication, reporting on the past year’s challenges and successes. But as we are all aware, communication everywhere is happening more and more quickly. Events become news almost instantly as someone with a camera phone snaps a photo, emails it to an Internet site and it propagates through that network again and again. In minutes a local event can have a global reach.

The MHA is also increasingly using technology as a way to communicate more effectively and more efficiently. Staff, physicians and board now use an internal network – much like a restricted website, and recently named the MHA Insider, – as our primary method of internal communication. On the external MHA website (www.mhalliance.on.ca ) we post information about the MHA and increasingly, information from our healthcare neighbours and beyond. It gives our website visitors a wider range of information and assists in appreciating MHA news in the larger context.

Healthcare delivery in Ontario is being challenged in many ways and the MHA is not exempt from these challenges. Last year, our corporation faced concerns about the Emergency Department (ED) coverage at SMGH especially during the summer season. Our physicians rallied

and as you can read on the front page, they really came through. We are grateful to all those physicians from FCHS and SMGH who helped to cover ED shifts and especially to Dr. Julie Copeland, our new Chief of Emergency Services at SMGH for her tireless work with the team.

While an External Review was initiated by the Southwest (SW) Local Health Integration Network (LHIN) to eliminate the deficit at SMGH, an internal Transformation Team was

already hard at work (see page 11).The SMGH Transformation Plan is an ongoing

initiative with the goal of eliminating the operating deficit. The Transformation Team – which includes physicians, nurses, senior administration along with physical plant and financial staff, has been meeting regularly. The Team is exploring a variety of cost-savings initiatives and every department at the hospital is looking for ways to reduce costs or increase, or generate, new revenue. Many changes have already been made and every department of SMGH will see some type of impact on the way they do business.

The Transformation Plan continues this year and will include the consolidation of floors. The Transformation Team is managing all the details of these changes and the ways that this consolidation will impact on the hospital staff, services and patients. Work to implement the consolidation of the floors is already underway and is expected to be completed by beginning of July.

The hospital will continue to transform itself to meet the changing needs of the population it serves.

Healthcare focus page 3

From the Chair, MHA Board of

Directors

Chief Executive Officer, MHA

Message from Ineke Haan

Message from Mike Mazza

Just some of the 2008 Extra Housekeeping Efforts• Contributed to Way-Finding initiative

• Trained with Evacusleds

• Now perform testing for waste anesthetic gas leaks in the ORs and Birthing Rooms

• Participated in the Canberra and CBRN first receivers training for incidents and natural disasters

• Stripped and waxed the second and fourth floor hallways for accreditation

• Stripped and waxed the entire ER and Ambulatory Care Areas

• Increased the cleaning in a C.difficle room from once to four times (two cleanings and two disinfections) every day

Some of Housekeeping’s Green Suggestions• Point-of-use water heaters

• Motion sensor lighting for hallways, janitor closets; washrooms; clean and soiled utility rooms

• Planting of shade trees at the south end of the building

• Closing outside doors, windows and slanting blinds properly to cut down on the sun’s heat coming into the building, Turning off unnecessary lighting (and making overhead announcement reminders about these)

• Wearing cool cotton or hemp uniforms

• Dual-Flush Flushometer toilets for saving water

Healthcare focus page 4

The self-named Green Team had a busy year implementing its own green initiatives and working with others at the MHA to enhance the safety of patients and staff. On the green front, “we all contributed an excellent slate of suggestions for going green and many of them help cut costs, too,” says Sharon Sicoli, housekeeping supervisor.

For instance, if you visited the hospital last summer, you may recall some overhead announcements about closing blinds to keep out unwanted solar heat – “It’s cool to be cool!” – or those about turning off unnecessary electric lights. Or you may have encountered one of eight dual-flush toilets which have replaced models that use more water. Each team member makes a unique contribution: “Winnie is our green conscience and she walks the walk – she walks to work,” says Sicoli. “Zelia is our one-

woman recycling police force and Carrie got the overhead announcements

started. Ana pointed out how even electric lights create heat in the summer, and Sher alerted us to options for cooler uniforms.” Sicoli herself? She bikes to work – and that’s not on a Harley!

Clockwise from right front: Sher Brown,

Sharon Sicoli, Zelia Picanco, Winnie Gare,

Ana Dos Santos and Carrie Morgan.

It’s a wonder that Housekeeping even had a chance to catch its collective breath this past year.Green!

The Green Team

Sicoli bikes to work (and that’s not on a Harley!)

Busy being

At MHA Patient Safety is a Priority

Infection Reporting Required for All Hospitals

Over the past year, the Ontario Ministry of Health and Long-Term Care (MOHLTC) has required an increasing number of infection rates to be publicly posted on its site and on individual hospital’s websites.

During 2008, Ontario hospitals faced a new requirement to publicly report on their rates of the hospital-acquired infections C.difficile (Clostridium difficile), Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE).

“We support the Ministry’s new public reporting requirements. Our staff, nurses, and doctors are dedicated to providing the best possible care to our patients,”

Nancy Maltby-Webster, Chief Operating Officer for MHA, says.

A hospital-acquired infection, as the name suggests, is one that the patient contracts while staying in the hospital – not the reason the patient entered the hospital. Hospital patients can be more vulnerable to infection as their immune systems may be compromised by illness.

According to Yvonne Richardson, Infection Control Professional at MHA, C.difficile is a bacteria that can be part of the normal bacteria in the intestine of 3-5% of adults and is one of the many bacteria that can be found in stool (a bowel movement). A C.difficile infection occurs when other good bacteria in the bowel are eliminated or decreased, allowing the C.difficile bacteria to grow and produce toxin. The toxin produced can damage the bowel and cause diarrhea. C.difficile is one example of a hospital-acquired infection and has been a known cause of healthcare associated diarrhea for about 30 years.

“Patient safety is a priority at Middlesex Hospital Alliance,” Maltby-Webster says, “We have ongoing patient safety initiatives and support a

“transparent” approach to patient safety. This means that the MHA requires accurate reporting of all incidents by staff and supports sharing of patient safety information, such as infection rates, on the website.”

“We have been publicly reporting the MHA rates for hospital-acquired infections – C.difficile, VRE and MRSA – on our website (www.mhalliance.on.ca) since the beginning of 2008,” Maltby-Webster, says, “The Ministry mandate will simply ensure that all Ontario hospitals are reporting at the same time and using the same criteria.”

For example, the Ministry requires that the C.difficile infection rate be publicly reported as a rate and as a number of new cases. The rate is calculated as a rate per 1,000 patient days. The “total patient days” represents the sum of the number of days during which services were provided to all inpatients during the given time period.

For the actual number reporting, the Ministry requires that any number of cases under 5 be reported as “less than 5” – whether that is one or four cases.

Additionally, all Ontario hospitals will have their C.difficile infection rates posted on the Ministry website, grouped by “comparable” hospitals, not necessarily by geography. That site is at www.ontario.ca/patientsafety .

“In terms of reporting rates, the smaller the hospital, such as SMGH and FCHS, the greater the rates will vary, from month to month, because a change in even one case in a small facility will cause the rate to go up or down considerably,” Dr. Pravin Shah, chief of pathology at MHA, says.

Increased reporting is continuing through 2009. You can see the most up-to-date infection rate information on the MHA website under the heading Patient Safety. (www.mhalliance.on.ca). “Sharing this information on our website allows patients, staff, our partners and stakeholders to be informed about our patient safety initiatives – and results,” Maltby-Webster says.

Healthcare focus page 5

Wireless Communication at Four Counties

Nurses Sheila

Cartier and Candice

Verhelle in the

Active Care depart-

ment show their

Vocera badges.

Wireless Vocera Communications badges were implemented in May at Four Counties Health Services (FCHS). Fifty-seven staff members from the FCHS site, including physicians, attended training sessions to learn how to use the new technology.

The basic Vocera badges are lightweight, wearable IP devices that resemble the ‘comm badges’ popularized by the show, Star Trek: The Next Generation. Each small black plastic oblong ‘badge’ has an LCD display, volume buttons, a Call button and a Hold/Do-Not-Disturb button. The Call button and the Hold/Do-Not-Disturb button are used for “Yes” and “No” responses, respectively.

“The Vocera Communications System assists with easy, instant staff communication,” says Lynda Robinson, director of patient services at FCHS. “The technology enhances staff efficiencies and safety, as well as patient safety.”

The Vocera Communications System is particularly popular in hospitals and other health- care settings. It was developed as a way to contact people when they were away from their desks.

The Vocera technology is “voice driven” and controlled with simple, naturally spoken commands.

To initiate a conversation with Jim Smith and Mary Jones, for example,

the user simply says, “Conference Jim Smith and Mary Jones.” In addition, when a live conversation is not necessary, a text message or alert can be sent.

When receiving a call, the badge announces the caller’s name, and can ask if the recipient wishes to take the call. Merely saying “Yes” or

Healthcare focus page 6

“No,” or pressing either Call or Do-Not-Disturb, causes the badge to accept or deny the call. The system can also be set to answer automatically, with the option of holding or rejecting the call with the Do-Not-Disturb button.

Robinson says staff have incorporated this new technology into their on-site communications and are using it regularly.

There were more than 300 registrants last June for the Aboriginal Diabetes Conference organized by the Diabetes Education Centre (DEC) of the

Middlesex Hospital Alliance (MHA) in partnership with the First Nations of Southwestern Ontario.

“The rate of diabetes is three to five times greater for Aboriginal Peoples than for the general population,” says Marilyn Tobias, community health representative, Moravian of the Thames First Nation.

“The goal of this conference is to empower adult First Nations people to take positive self-care action that will result in better health outcomes for diabetes.”

“Diabetes can be managed to reduce the risk

Diabetes Education Centre’s First Conference a Huge Success

of serious complications,” says Alison Lenny, program co-ordinator of the DEC, “Teaching how to manage the disease is one of the major roles played by the DEC.”

The conference also demonstrated the unique partnership between diabetes educators and Aboriginal communities, and their shared commitment to education and support.

“The conference featured inspirational and entertaining speakers, the popular Southern Ontario Aboriginal Diabetes Initiative (SOADI) foot-care clinic, a Tai Chi break, exhibits and door prizes,” says Barbara Whiteye, a member of the planning committee and diabetes prevention co-ordinator for SOADI, Western Region.

Healthcare focus page 7

To enhance the comfort of patients and their families, the Four Counties Health Services Foundation has refurbished the main hospital lobby and waiting room at FCHS with the help of staff and financial security advisors of Freedom 55 Financial, the financial security planning division of London Life.

“We’re helping create a more comfortable environment that will improve patient care and the well-being of visitors at the hospital,” Janice Furlotte, regional operations manager, Freedom 55 Financial, says.

Through The Key to Giving™, the national corporate citizenship program of Great-West Life, London Life and Canada Life, a $10,000 contribution is funding the renovations, including the purchase of new furniture and flooring. The Key to Giving contributes to non-profit, charitable and community organizations to address health and wellness,

education, social services, arts and culture and civic initiatives.

“The people at Freedom 55 Financial have been generous in lending their personal and professional abilities to community programs and health facilities, making a difference for people in Middlesex, Elgin, Lambton and Chatham-Kent counties. We certainly appreciate their support with

this project,” Marigay Wilkins, Chair of the FCHS Foundation, says, “Ensuring the comfort of not only our patients, but also their families, is all part of exceptional patient care.”

Freedom 55 Financial Supports FCHS Refurbishment Project

Healthcare focus page 8

The Four Counties Health Services (FCHS) Foundation has purchased six new cardiac

monitors for improved patient care. Almost half of the $225,000 price tag was provided by the $100,000 donated last year by physician Dr. Earl Russell.

“Dr. Russell served this community as

an anesthetist and pain clinic director for many

years and his generosity was invaluable in purchasing this excellent new equipment,” says Dorothy Gilles, coordinator of the FCHS Foundation, “He is greatly appreciated.”

“The FCHS Foundation has done a splendid job of fundraising,” says Lynda Robinson, director of patient services at FCHS. “These new monitors are a huge benefit to patient care.”

The new monitors are being used in the Acute Care Nursing unit and in the Emergency Department.

FCHS Foundation buys New Cardiac Monitors

“Our previous monitors were hardwired to the walls in four of the rooms,” Robinson explains, “We can use these new wireless monitors on portable stands so we don’t need to have a ‘monitor room’ available for patients. We simply wheel the cart to where the patient is.”

Additionally, the new cardiac monitors have more leads – 12 instead of five – which provide expanded modality. “This technology is more accurate and more sensitive than our previous monitors,” Robinson says, “It allows us to monitor a patient over time

to determine how he or she is responding to treatment, then we can highlight benchmarks and print out a report. The clarity of picture is much better – like HDTV over regular television – so it’s easier to read and to see trends in movement.”

Healthcare focus page 9

New Dermatology Clinic at FCHSDr. Jon Dreyer, chief of staff at Four Counties Health Services (FCHS), welcomes Dr. Wei Loo to the team of physicians at the Middlesex Hospital Alliance.

“The new dermatology service at FCHS will be a great benefit to our community,” says Dr. Dreyer. “Until now the wait time for a dermatology consultation has been longer than 18 months, and patients needed to travel to London. Now patients will be able to access care close to home and likely faster.”

Dr. Loo received her internal medicine training at the University of New South Wales in Sydney, Australia. In 2006 she went on to complete a dermatology fellowship at Women’s College Hospital in Toronto, after which she was a dermatology consultant at University Hospital of North Durham in Durham, England, before returning to Canada with her family last spring.

The dermatology clinic at FCHS is available once a month.

On behalf of Strathroy Middlesex General Hospital Foundation, we would like to thank everyone who supported the Foundation in 2008-09. Together, we have taken significant strides to help Strathroy Hospital improve patient care.

The Foundation’s purpose is to support the hospital by raising money to pay for capital expenses; a large annual cost to the hospital that is not funded by the province. These costs include new patient care equipment and technology, building and renovation projects, physician recruitment and staff education. The province is responsible for operating costs such as salaries, supplies, drugs, utilities and other day to day expenses. If you have received care at SMGH, I am sure you understand that the needs of the hospital do not decrease during an economic downturn.

Meeting the Challenges, Now More Than Ever

Lorna CampbellChair, SMGH FoundationManager of Customer Service of Scotia Bank, StrathroyandSusan McLean CFRECEO, SMGH Foundation

Like you, the primary challenge for the Foundation this year is the economic recession and the impact it has had on our donors and the community. We know that the dollars given to support the Hospital are very valuable to both you and to us, and in these times, it’s more important now than ever to share how grateful we are for your contributions. They will have a significant impact on patient care. For a summary of what you made possible with your donations at SMGH in 2008-09, please visit www.smghfoundation.on.ca, and review the Foundation’s 2008-09 Report to the Community.

Once again, thank you for your contributions.

We each hope that you will continue your support of the Foundation’s mission; to sustain Strathroy Middlesex General as a vibrant community hospital.

Healthcare focus page 10

The Strathroy Middlesex General Hospital (SMGH) is transforming. This transformation will enable SMGH to meet the changing healthcare needs of the community within the funding dollars provided by the South West Local Health Integration Network (SW LHIN).

In late 2008, the SW LHIN initiated an External Review of SMGH to address the legal requirement to balance the hospital’s deficit budget.

The External Review Team recognized the excellent quality of the healthcare services provided at SMGH,although its main objective was to align SMGH costs to that of similar-sized hospitals through a benchmarking comparison.

Prior to the External Review, the SMGH staff, physicians and board had already launched a Transformation Plan, to critically evaluate options for cost savings without loss of services. Many of the Transformation Team’s cost saving initiatives

were initiated and implemented in 2008. However key cost pressures remain.

These key cost pressures at SMGH are:

• Regional Shared IT Support Program

• Major increase in both elective and emergency Ortho Procedures

• Increase in Liability Insurance Premiums

• Increased cost of Physician Recruitment

• Borrowing cost for loan to deal with unforeseen asbestos during rebuild project

SMGH’s actions were able to reduce expenditures by about $900,000 by the end of 2008. This initial action was called Transformation Phase 1. These changes have resulted in significant savings. Phase 2 of the Transformation Plan is underway this year, including the amalgamations on the 4th floor. The Plan continues to find success.

SMGH Launches Transformation Plan

New Chief of AnesthesiaDr. Richard H. Tilsworth, MD, FRCPC, is the new chief of anesthesia at SMGH.

The former acting director of the Pain Clinic at Victoria Hospital in London, Ont., Dr. Tilsworth also heads the

Middlesex Hospital Alliance Pain Clinic at SMGH.

Healthcare focus page 11

It’s not a Magic Bus, but it’s very handy when you need to get to an appointment.

The new wheelchair accessible Four Counties Transit bus was purchased in

March 2008 with funds from the South West Local Health Integration Network.

The bus is available for residents of West Elgin, SW

Middlesex, Dutton/Dunwich, Dawn-Euphemia, Newbury and Eastern Chatham Kent.

Residents can book the bus for transportation to dental and healthcare appointments at Four Counties Health Services (FCHS) or one of the clinics, for example, with the Diabetes Education Centre. It is also available to take people banking, shopping or to the Adult Day and the Alzheimer programs at Four Counties.

Published by the Middlesex Hospital Alliance to provide information to the community it serves.

For more information, please visit our website:

www.mhalliance.on.ca

Four Counties Health Services

1824 Concession Drive RR3, Newbury, ON N0L 1Z0

Tel: 519-693-4441

Strathroy Middlesex General Hospital

395 Carrie Street Strathroy, ON N7G 3J4

Tel: 519-245-1550

Healthcare focus

Contact us at:

Little Bus meets Big Need

Healthcare focus page 12

In 2008, more than 1200 rides were provided to residents of our community who use wheelchairs or other assistive devices, to more easily enable them to get to errands and appointments.