Sunnybrook shines a spotlight on 2016–17

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TABLE OF CONTENTS1. Introduction 2

2. Financial Performance 5

3. Occupancy & Strategic Plan 7

4. Human Resources 9

5. Education 11

6. Sunnybrook Research Institute (SRI) 13

7. Nursing 15

8. Health Professions 16

9. Greening Sunnybrook 17

10. Community and Patient Engagement 18

11. Web Communications 20

12. Improving Service for Patients & Families 22

13. Safety 24

14. Digital Technology 25

15. Partnerships & System Improvement 27

16. Fundraising 28

17. Financial Outlook 30

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1. INTRODUCTIONAchieving excellence and defining new standards in patient care, research and education were once again hallmarks of 2016/17 for Sunnybrook. Amid the many successes, the Hospital continued to be challenged by high inpatient occupancy and demand for outpatient care.

Sustained demand resulted in the Hospital often being above 100 per cent inpatient occupancy. During this pressure, the commitment of the Sunnybrook’s frontline staff and leadership teams shone, with team members putting in a significant amount of effort to ensure patients and their families received the care they needed.

Despite occupancy pressures, Sunnybrook worked with the Ministry of Health and Long-Term Care and other system partners to become the second program in the Greater Toronto Area for stem cell transplantation. The Hospital will house a new facility for the care of patients who have blood cancers such as leukemia and other haematological illnesses.

Sunnybrook continued to push boundaries in clinical research, becoming the first centre in Canada to be named a Centre of Excellence by the Focused Ultrasound Foundation. Researchers at SRI continued to make groundbreaking advances in focused ultrasound, leading in technology development and preclinical research. Clinician-researchers safely improved the symptoms of a common neurological disorder that causes involuntary shaking using non-invasive ultrasound therapy.

The Hospital remained committed to continuallyimproving the quality and safety of all programs and services, and continued work to prepare for Accreditation Canada

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surveyors visiting in the fall of 2017. By participating in accreditation every four years, the organization learns both what it is doing well and identifies possible areas for improvement.

The Choosing Wisely initiative aimed to reduce the number of unnecessary tests and procedures in the Hospital, prompting staff to make appropriate and cost-conscious decisions for care to meet the needs of patients while ensuring that appropriate healthcare is available for everyone.

There were challenging times during the past year, including the fire in the Emergency Department, with teams from all three sites rallying to ensure patients were moved in and out of the Hospital in a timely manner.

The past year also featured touching moments captured on video, such as staff gathering to sing the Tragically Hip song “Courage” to thank those who donated to the Gord Downie Fund for Brain Cancer Research. Nurses from the Neonatal Intensive Care Unit sang a holiday carol to a premature infant. Both videos resulted in hundreds of thousands of views, across Canada and internationally.

The year also marked the end of Dr. Barry McLellan’s leadership as the President and CEO of Sunnybrook. During his 10 years with the Hospital, Dr. McLellan attracted an unprecedented amount of support from partners in the health system and the community. His leadership helped Sunnybrook become one of Canada’s most respected teaching and research hospitals, with a strong reputation as a system leader.

And of course, ultimately, the many successes of 2016/17 would not have been possible without staff going above and beyond to achieve the best possible results each and every day for patients and families.

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2. FINANCIAL PERFORMANCE Sunnybrook’s reported Revenue over Expenses for the fiscal year 2016/17 is $23.8 million. It represents approximately 2.2% of Total Revenue and these generated funds will be used to reinvest in capital equipment and facilities. Generating between 2 - 3% of Total revenue for reinvestment purposes is supported by the OHA and seen as necessary in view of the capital intensity of hospitals. These results are multifactorial but significantly reflect strong fiscal discipline, achievement of Ministry priorities and funded volumes, final and favourable settlement of several prior year Ministry of Health reconciliations, in-year success in implementing additional savings initiatives, combined with several one-time recoveries. The two most significant recoveries were the receipt of $2.1M from our insurer (Healthcare Insurance Reciprocal of Canada), primarily a return of prior year premiums due to positive claims performance; and $2.3M proceeds on the sale of Sunnybrook’s membership interest in Booth Centennial Healthcare Linen Services (“Booth”). The sale of Booth monetized value that had accrued to Sunnybrook and other members since Booth’s incorporation and included both stable and reduced linen pricing for five years, both of which are important in today’s resource constrained healthcare environment.

Sunnybrook continues to incur significant operational and capital costs in connection with renewing its aged infrastructure. According to Sunnybrook’s 2015-16 VFA report, despite regular and substantial infrastructure investments, our Facilities Conditions Index (FCI) has increased to 33% from the last report in 2001 - a poor (and worsening) rating by industry standards. The VFA identified top Priority 1-3 items increased from a cost of $198 million in 2001 to $248 million in 2016. The most pertinent risks include our electrical power distribution system, mechanical steam plant boiler system, heating ventilation and air conditioning system (HVAC), medical gas supply system, and fire protection system. Sunnybrook has taken ownership of this issue to the extent possible by creating an infrastructure renewal project budget, investing nearly $5 million annually at a time when we are challenged to maintain a balanced budget and protect patient care services. These funds are in addition to the Ministry’s Health Infrastructure Renewal Fund (HIRF) allocation of approximately $10M. Despite these efforts, the combination of self-funded and HIRF allocations, while substantial, have been insufficient in addressing the necessary investments required towards our core infrastructure. Sunnybrook continues to advocate for additional Ministry funding to address these risks.

The two primary funding mechanisms for Sunnybrook are Health Based Allocation Methodology (HBAM) and Quality Based Procedures (QBPs). Using the HBAM

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methodology, released in February 2017, Sunnybrook has been confirmed as an efficient organization and has again demonstrated improvement compared to prior years. With respect to QBPs, Sunnybrook is committed to achieving quality outcomes. For example, Sunnybrook has successfully lowered the length of hospitalization for stroke patients and for total joint replacement patients both increasing patient satisfaction and lowering their risk. In order to achieve the Ministry’s mandate, Sunnybrook has also focused efforts to achieve funded volumes. There is financial risk in under-achievement of funded volumes and this is particularly so in unscheduled (emergent) activity. For the second consecutive year Sunnybrook has not achieved its emergent QBP volumes despite the number of visits in the Emergency Department (ED) increasing by another one percent while our admission rate remained stable. Since 2012-13, which represents the initiation of many QBPs, ED volume has increased by more than 5,700 visits, a 10% increase. The loss of revenue that is unearned due to underachievement of emergent QBP volumes is exacerbated by ever increasing ED visits and admissions.

In this challenging time of increased demand but limited financial and physical resources the hospital continues to focus on reducing its current level of occupancy in both ward and critical care beds, which are often in excess of 100%. Sunnybrook’s strategic plan reflects an ongoing commitment to working towards 95% occupancy since high occupancy can result in less than optimal patient flow including long wait times in the ED, surgical cancellations, and treatment of patients in hallways, all of which results in reduced patient satisfaction, inefficiencies and an increased financial burden. Sunnybrook has achieved many successes in various initiatives intended to reduce occupancy but continued patient volume growth has offset much of the benefit of improved patient flow. However, two notable achievements in F2016/17 were no closures to trauma and significantly reduced number of OR cancellations due to a lack of available beds compared to F2015/16.

In 2016-17, the Ontario Ministry of Health and Long Term Care issued a parking directive for all hospitals in the province, with a stated objective of making hospital parking more affordable for frequent users. Fortunately, the directive has many similarities to the discount parking packages that Sunnybrook has had for many years, but requires further discounts for a broader patient population. Sunnybrook has fully implemented the directive. In 2016-17 revenue from patient and visitor parking was $18.8 million. These funds have been used to support hospital operations and core research facilities that are not otherwise funded by government or research grants. These projects are essential to Sunnybrook’s success in inventing the future of healthcare through the innovations we are developing in patient care.

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The chart below reflects how Sunnybrook has used the resources entrusted to it to provide patient care and, in particular, indicates that the vast majority of funds are used for direct patient care. Sunnybrook’s overall efficiency is further evidenced by less than 10% of total expenses being incurred in Corporate Support.

FISCAL 16 /17: WHAT DO THESE EXPENSES BUY?

Clinical ServicesLab, Diagnostic Imaging & PharmacyFood & Physical SupportCorporate SupportMedical Staff & Clinical EducationOther (insurance & Interest)

Direct Care Expenses:Clinical Services 61.7%Lab, Diagnostic and Pharmacy 13.7%

Total 75.4%

Clinical Services61.7%

Lab, Diagnostic Imaging & Pharmacy13.7%

Other (Insurane & Interest)1.6%

Medical Staff & Clinical Education3.1%Corporate Support

9.3%

Food & Physical Support10.6%

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3. OCCUPANCY & STRATEGIC PLANSunnybrook’s inpatient occupancy was regularly in excess of 100 per cent, sometimes operating at more than 110 per cent, during 2016/17. Early in 2017, patient admissions across the Greater Toronto Area and throughout Ontario resulted in pressures across the entire system. In addition to high levels of inpatient occupancy, Emergency Departments across the province were very busy, and hospitals faced additional pressure with patients waiting to be placed in community care settings.

Sunnybrook responded by opening surge beds, and team members met daily to ensure patients moved in, out and around the hospital in as timely a manner as possible. The Hospital also continued to strive to increase the percentage of patients with planned discharges, who leave the hospital by 11 a.m., to 40 per cent. A “discharge by 11 a.m.” dashboard was created to facilitate conversation about discharge and continuous quality improvement. The dashboard data provides insight into corporate trends and current status, and allows staff to identify areas to celebrate success and areas to improve.

REPATRIATION IN ACTIONAs a major academic health sciences centre, Sunnybrook once again provided 24/7 access to specialized services so the sickest patients received the right level of care. Repatriation involves ensuring everything possible is done to ensure patients with life threatening conditions are accepted for care by transferring patients back to their referring hospital, or the hospital “closest to home”, as soon as Sunnybrook has addressed their critical needs. Repatriation became a primary focus in helping to manage occupancy and provide the most appropriate care for all patients. Repatriation, like discharge planning at Sunnybrook, starts upon admission. Patients and families are engaged in these discussions as early as possible with all members of the health care team.

ACCURACY OF ESTIMATED DATE OF DISCHARGE Staff can now view estimated date of discharge in SunnyCare, Sunnybrook’s user-centered integrated clinical information system, with a highlighted flag noting if a patient is planned for discharge on the same or the next day. This feature assists staff to plan and prioritize care. When a discharge date has passed, SunnyCare flags this, enabling the team to set a new date. Sunnybrook over the past year established a goal of 80 per cent accuracy of estimated date of discharge figures. When the estimated date of discharge is accurate, it enables all teams to support quality discharge planning, communicate effectively with patients and families and support decision making for the patient flow team.

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EMERGENCY DEPARTMENT CHECK-IN KIOSKS Sunnybrook’s Emergency Department unveiled a custom kiosk, which has allowed patients to check-in by swiping their health card and identify their symptoms from a list of common complaints. When their number is called, patients see a triage nurse. Early results show the mean time to first contact with patients was reduced from 15.2 minutes to 1.7 minutes with the kiosk system. A total of 233 patients were surveyed, with overwhelmingly positive responses, reporting the kiosks are easy to use and the process is straightforward.

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4. HUMAN RESOURCESEach year, Sunnybrook’s 10,000-member team invents the future of health care and impacts the lives of the thousands of patients and their families who rely on the Hospital to be there for them ‘when it matters most’. Sunnybrook once again attracted new talent and retained top employees this past year. The organization’s belief that its staff members are its future was exemplified by the numerous honours Sunnybrook received through the past year. Once again, Sunnybrook was named as one of Canada’s Top 100 Employers, Greater Toronto’s Top Employers and also one of Canada’s Top Employers for Young People.

SUNNYBROOK EARNS NATIONAL FAMILY-FRIENDLY HONOURSunnybrook was once again named as one of Canada’s Top Family-Friendly Employers for 2017. The annual competition recognizes employers offering the most progressive and forward-thinking programs for employees with young children. The Hospital was selected as one of 20 winners based on benefits and initiatives such as maternity leave top-up, employee wellness programs, and the “Life Stages Program” that supports staff through all stages of life, from student life to parenthood to retirement.

SUPPORTING STAFF THROUGH THEIR LEADERSHIP JOURNEYSunnybrook remained committed to building the organization’s leadership capacity by providing teaching and learning opportunities for all staff, leaders and physicians. The Sunnybrook Leadership Institute was committed in 2016/17 to supporting all staff throughout their career and leadership journey. The institute provides classroom and online learning opportunities for professional and personal development.

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RECOGNIZING EXCEPTIONAL STAFFSunnybrook’s annual Bertin Awards for Excellence in Customer Service celebrated staff who continually go above and beyond their usual role to exemplify the values of the Hospital. Those honoured came from a variety of roles, including patient administrative associates and administrative assistants, who demonstrated excellent customer service in their daily work with patients, families and colleagues. In a similar vein, the Schulich Awards recognized nursing and clinical excellence and honored the work of staff demonstrating the values of Sunnybrook in their daily work.

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5. EDUCATION Sunnybrook welcomes more than 4,000 students each year, representing more than 25 professions. Learners come from all over the world to study with the organization’s renowned faculty and become important members of Sunnybrook’s interprofessional, person-centered teams. A highlight of the past year was the development of a new strategic plan for education, aiming to improve patient care, as well as the student experience and boost Sunnybrook’s international reputation. New priorities included in the plan are the patient as educator; team-based learning; learner experience and culture and education scholarship.

HIGH PRAISE FROM STUDENTSA highlight of the past year was the overwhelmingly positive response from students about their experience at the Hospital. Students are asked to complete a survey at the end of their placement, regardless of whether it is a short two-week visit or a year-long rotation. This past year, 91 per cent of students said their experience at Sunnybrook met their educational and professional expectations. Qualitative feedback included comments like: “Good team spirit. Team members were really helpful in our growth”. Of those surveyed, 89 per cent would recommend their placement to a classmate or friend. Students were positive about their teachers, preceptors and supervisors, with 93 per cent of students agreeing their supervisor modelled professional values in their behaviour and interactions with staff, patients and students.

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THE SKILL OF SPEAKING TO A LAY AUDIENCESummer students were invited this past year to submit a simple summary of their work in a way the lay public, even children, would understand. More than 30 projects were submitted, with six undergraduate summer student researchers presenting their projects to a small group of 5th grade students. The initiative was part of an ongoing effort to involve patients and the community in all aspects of the health care setting. Elias Hazan, a third-year undergraduate biology major at Queen’s University, took home first-place for his presentation about using a clock drawing to see if patients have a concussion. “The work we do is supposed to help everyday people so it is important for researchers to remain in touch and understood by their larger audience - the general population,” commented Elias.

REACCREDITATION AND A FOCUS ON TECHNOLOGYDuring the last year, the Sunnybrook Canadian Simulation Centre received accreditation from the Royal College of Physicians and Surgeons of Canada for the next five years. The Hospital is the first centre in Ontario and the third in Canada to be re-accredited by the Royal College. Sunnybrook also remained committed to enhancing teaching and learning by increasing accessibility to technology. A SimBaby™ was purchased to allow emergency and trauma teams to maintain and improve their skills, and as training equipment for support of the Women & Babies Program.

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6. SUNNYBROOK RESEARCH INSTITUTE (SRI)Whether discovering a new therapy or tailoring a treatment to curtail side effects, teams at Sunnybrook Research Institute (SRI) invented tomorrow’s health care. The strongest example in 2016/17, a world first, was breaching the blood-brain barrier to deliver chemotherapy to the brain of a patient with brain cancer. As a hospital-based research institute, making discoveries and getting them to patients is what drives SRI. Spanning the three Hospital campuses, with more than 300 scientists and clinician-scientists committed to achieving an “end-to-end” solution, a recent focus has involved precision medicine. Precision medicine seeks to treat and ultimately prevent disease by taking into account individual variability. Ultimately, SRI strives to ensure patients benefit from breakthroughs faster than ever.

NOT YOUR AVERAGE OPERATING ROOMSRI opened the Biophotonics Experimental Operating Room, a project spearheaded by Dr. Victor Yang, a senior scientist in Physical Sciences. The operating room is equipped with 3-D augmented reality visualization, optical imaging, automated medical laser ablation and tools for surgical navigation. The aim is to translate technological developments into minimally invasive imaging for improved diagnosis and therapy monitoring.

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SRI RECRUITS LEADING NEUROSCIENTISTDr. Carol Schuurmans was named the Dixon Family Chair in Ophthalmology Research and senior scientist in Biological Sciences at SRI. As a neuroscientist, Schuurmans studies how neurons are generated in the developing nervous system. She is particularly interested in how different types of neurons form at distinct times in the developmental process and acquire their specialized functions. Her research focuses on two specific areas: the neocortex region of the brain and the retina.

SUNNYBROOK RESEARCH PRIZESix undergraduate students from universities across Canada were selected to present their research projects to scientists and trainees at the sixth annual competition at SRI. A fourth- year chemical engineering student at the University of Waterloo, Nidhi Juthani, won the prestigious award, along with $10,000, for her research on cell sheet engineering. The finalists came from Alberta and Ontario and presented projects that included developing a real-time, image-guided surgical navigation system; understanding the role of ultrasound pulse parameters at clinical frequencies; and designing a computerized, head-mounted imaging device for the early detection and monitoring of age-related macular degeneration, an eye condition that causes vision loss.

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7. NURSINGSunnybrook’s 3,000 nurses are at the heart of patient care at the Hospital, providing compassionate and highly specialized care for the most vulnerable patients and their family members. The organization’s nursing team set new standards of excellence by developing and implementing best practices in pain management, least-restraint use and falls prevention, skin and wound care, critical care monitoring, infection prevention and control, and many other areas. This extraordinary team cares for the health care system’s most complex cases and works to improve the lives of hundreds of thousands of people each year.

ONCOLOGY NURSES ‘CHAMPION’ AWARDSunnybrook nurses were again recognized for providing exceptional and committed care to patients. Sonali Kirshenbaum, nurse in the Odette Cancer Centre, was honoured by the Toronto Chapter of Oncology Nurses as a champion for her passion for oncology nursing and for quality oncology patient care. Sonali is committed to person-centred care through her work to advance screening for distress in patients living with head and neck cancer. By triaging for distress or significant concerns, Sonali ensures patients are seen rapidly in clinic, or followed up proactively by telephone.

NEONATAL NURSES SING TO A PREEMIEA holiday song by two neonatal intensive care nurses was heard around the world in 2016/17, as Marieneth Montenegro and Lisa Sampson sang “Have Yourself a Merry Little Christmas” to a premature baby Anya. Anya was just two days old when the video was filmed and shared through the hospitals social media channels. The nurses have their hands gently placed on Anya’s body, a technique known as “hand hugging” that mimics uterine walls and comforts premature babies. The video was picked up by national and international media outlets, and viewed by millions.

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SUNNYBROOK NURSE NAMED A ‘NURSING HERO’ For the third consecutive year, a Sunnybrook nurse placed in the top three in the annual Nursing Hero Awards organized by Hospital News, one of Canada’s leading healthcare newspapers. Eleanor Miller, an oncology nurse and patient care manager with Sunnybrook’s Odette Cancer Centre, was honoured. Miller was described as “a fierce leader, the calm in the storm, but more importantly she is one of those unsung heroes whose ability to blaze the trail within the health-care system will leave a legacy of commitment, courage and strong leadership.” Miller has worked in oncology at Sunnybrook for 28 years and currently manages the inpatient Medical and Radiation Oncology unit.

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8. HEALTH PROFESSIONSInterprofessional education and care thrived at Sunnybrook throughout 2016/17. The Hospital’s teams have adopted a culture of collaboration and shared decision-making in order to deliver the best possible care to patients and their families. This means physicians, social workers, nurses, volunteers, physiotherapists and occupational therapists – and many more – working collaboratively to make care decisions together with patients and their families.

SCHWARTZ CENTRE ROUNDSThe past year featured the launch of the Schwartz Center Rounds, an interprofessional forum where caregivers are given an opportunity to discuss difficult emotional and social issues that arise in caring for patients and families. Open to staff across the Hospital, these rounds provide a forum for caregivers to share their experiences, thoughts and feelings on topics drawn from actual patient cases, such as “A Husband’s Choice – Wife or Child?”. After listening to a panel’s brief presentation on an identified case or topic, caregivers in the audience are invited to share their own perspectives on the case and broader related issues.

HEALTH PROFESSIONS IMPROVING QUALITYThe Health Professions Innovation Fellowship Program provided a unique opportunity for health professionals to lead an innovative practice-based quality improvement project. Sponsored by the Toronto Academic Health Sciences Network practice sub-committee, the fellowship included protected time for participants to lead a quality improvement project, as well as a weekly educational program and support and mentorship. Just one example included the St. John’s Rehab Health Professions Innovation Fellowship by Wendy Lopez, Registered Dietitian, titled “Matters of the Plate” – A Meal Assistance Program to Improve the Dietary Intake of Stroke Patients in a Rehabilitation Unit”.

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PRACTICE-BASED RESEARCH IN ACTIONSunnybrook once again provided health professionals with funding and education support for practice-based research studies. In addition to annual funding over a two-year period for projects with an expected impact on clinical practice and patient care, the program featured educational support and mentorship. Natalie Coyle, a physician assistant and Andrew Kennedy, a registered nurse, received funding for a project focused on reducing the time to first electrocardiogram (ECG) for chest pain patients in the Emergency Department.

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9. GREENING SUNNYBROOKEnergy and sustainability were once again top of mind for the organization, with continued efforts to promote sustainable practices and behaviours throughout the facility. The Hospital encouraged staff to become ‘green champions’, responsible for sharing green initiatives and projects with their team members. Sunnybrook was selected as one of Canada’s Greenest Employers, a special designation recognizing those who lead the nation in creating a culture of environmental awareness.

SUNNYBROOK WINS FOR SMART COMMUTING Sunnybrook surveyed staff to understand their travel choices and attitudes toward transportation and commuting. The survey revealed the highest modes of transportation (48 per cent for driving alone and 30 per cent for public transit) and also asked staff about their willingness to try new models. The survey was flagged by Smart Commute, a program of Metrolinx, when the organization awarded Sunnybrook a Smart Commute Gold Workplace. The award is granted to outstanding workplaces with demonstrated success in convincing their employees to choose other ways to get to work than driving alone. In addition to secure bicycle parking cages, there is support at Sunnybrook for a dedicated Bikers User Group, a car pooling program and four shuttle buses providing free rides for staff.

WASTE MANAGEMENTSunnybrook continued to manage a number of enhanced waste management programs, from aggressive recycling and reuse programs to a unique anesthetic gas absorption technology that reduces the amount of waste gas released into the environment, a seemingly small initiative but equivalent to removing over 200 cars from the road.

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10. COMMUNITY AND PATIENT ENGAGEMENTThe Hospital continued its leadership in the area of engagement, reaching out to patients, visitors and family members through the traditional channels such as the Sunnybrook Speaker Series, while also adding new opportunities to seek input from patients in the areas of research, education and patient care. The Personal Health Navigator blog answered questions from patients and family members, providing a reliable source of information about emerging trends in the health sector, including opioids and electronic medical records. The Sunnybrook Magazine was also distributed to nearly 100,000 people, twice through the year, through the Globe and Mail, direct mail out and in-hospital distribution. The publication has won best medical publication at the Pearl Awards for five years in a row.

HELPING FAMILY MEMBERS NAVIGATE INTENSIVE CAREA project to assist family members with a loved one in the intensive care unit was so successful it was recognized with an Innovation Award. The project involved the creation of a new section of Sunnybrook’s website to provide interactive tools to help family members navigate the intensive care unit. The Innovation Fund, which provides seed money to improve health care delivery, is a joint venture between the Ontario Ministry of Health and Long-Term Care, the Ontario Medical Association and the Academic Physicians of Ontario. The award noted, “this project was deemed to be the most innovative, transformative and adoptable program” in Emergency and Critical Care in 2016.

REACHING PATIENTS AND FAMILIES ONLINESunnybrook is the only Canadian hospital providing direct uploads of in-house videos highlighting innovations, research and patient stories. Many videos are rebroadcast by outlets like CTV, reaching over 200,000 viewers. The Hospital’s YouTube page reached five million views during 2016/17.

PATIENTS PROVIDING ADVICE AND GUIDANCEThe Patient Experience Advisory Committee continued its work of facilitating objective advice and guidance from community volunteers on developing new initiatives and policies, and consulting on case reviews. Over the last year, the committee reviewed parking issues, co-gender occupancy and provided advice to the Office of the Patient Experience on resolving patient concerns.

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PATIENT ASSESSMENT OF LEARNERS Sunnybrook began to involve the Hospital’s patients in education activities. By using invaluable patient insight, the goal was to improve the experience for all Sunnybrook patients. Patient assessment of learners began to take place in 2016/17 in Family Practice, as well as Radiation Oncology. Early feedback showed consensus among medical students that the initiative contributed positively to their professional development, by providing an opportunity to better understand the patient perspective. Students reported this experience motivated them to change their practice, particularly with respect to body language, active listening, sensitivity, empathy and mindful communication.

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11. WEB COMMUNICATIONS Sunnybrook continued to nurture its proven track record as a digital conversation-starter in 2016/17. The organization continued to lead Canadian hospitals in digital engagement, according to a respected third party metric known as Klout. Sunnybrook discovered ways to leverage traditional mediums such as the Sunnybrook Magazine by effectively navigating new mediums like Instagram. By turning content from a print source into an effective web and social media strategy, the Hospital has received significant interest from mainstream media.

VIDEOS GO VIRALTwo videos created in 2016/17 reached a tremendous number of Canadians, even extending beyond the nation’s borders. A staff sing-along of the Tragically Hip song “Courage”, in tribute to Gord Downie and those who generously donated to the Gord Downie Fund for Brain Cancer Research, reached an estimated 3,800,000 people through Twitter, Facebook and Instagram, and local media coverage. During the holiday season, two neonatal intensive care unit nurses sang a Christmas carol to one of Sunnybrook’s premature babies. The video received an estimated 17.5 million impressions worldwide, and was picked up by large media outlets such as TIME Magazine, Disney publication Babble, as well as national news outlets and those in Australia and New Zealand.

FROM PRINT TO INTERACTIVEThe web team created a web application for the Antimicrobial Stewardship team. The application provides caregivers, both internal and external to Sunnybrook, with easy access to antibiotic usage information to ensure the appropriateness of use. The senior friendly toolkit, in the same vein, provides resources directed at health care providers with the goal of fostering a comprehensive approach to senior care. The web-based application can be accessed on a desktop, as well as on iPhones, androids and tablets, and looks at mobility, confusion assessment, preventing and managing delirium and antipsychotic geriatric dosing. The toolkit is a best practice for health care professionals across Ontario.

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STORYTELLING THROUGH ANIMATIONMoving in the direction of many video production agencies, Sunnybrook’s web communications team has produced and developed animated ‘explainer’ videos as a communications tool for various areas of the Hospital. These videos are captivating tools used to explain services or processes around Sunnybrook, using visuals and language that help keep viewers interested.

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12. IMPROVING SERVICE FOR PATIENTS & FAMILIES Underlying everything that Sunnybrook does is the goal of improving the patient experience, and being there for patients and families when it matters most. This past year was no exception, with clinical, support and administrative areas of the Hospital working every day to achieve excellence. The infectious diseases team launched a new rapid referral clinic for patients requiring outpatient IV antibiotics. Staffed by an interdisciplinary team, the clinic performs an initial assessment and also follow-up care if necessary. This new rapid referral clinic has allowed Sunnybrook to offer continuity of care, while at the same time facilitating operational issues associated with outpatient antibiotic management.

REDEVELOPMENT OF SUNNYBROOK’S KIDNEY PROGRAMFor patients, dialysis means a lot of time spent indoors, with each treatment lasting as long as four hours, several times a week. Sunnybrook’s opened its new Kidney Care Centre at the Canadian National Institute of the Blind at 1929 Bayview Avenue, bringing a little of the outdoors into patients’ lives. The new hemodialysis unit is open and airy, and the CNIB space also houses home dialysis training and care, as well as kidney care and specialty clinics. The second phase of redevelopment will involve renovation of the space at the Bayview campus to provide additional hemodialysis space and an assessment space for home dialysis patients.

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RAPID DIAGNOSIS OF PROSTATE CANCERThe Hospital created the Prostate Centre for rapidly diagnosing prostate cancer and treating it with extreme precision. The centre will be a catalyst for prostate cancer discoveries, focusing on advanced diagnostic techniques and rapid treatment. The centre is committed to returning patients to the best quality of life possible through precise, minimally invasive treatments that keep side effects to a minimum.

SCALPEL-FREE SURGERYFocused ultrasound, or ‘scalpel-free surgery’, pairs magnetic resonance imaging with high-powered ultrasound energy to focus precisely on a target within the body, like a tumour or malfunctioning cells. Sunnybrook was named as Canada’s only Centre of Excellence by the Focused Ultrasound Foundation, a direct result of the Hospital’s groundbreaking progress in this area. Following the use of focused ultrasound to non-invasively breach the blood-brain barrier in a patient with a brain tumour, Sunnybrook is researching its use for other conditions, including Alzheimer’s disease and obsessive compulsive disorder.

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13. SAFETYEnsuring safety and improving quality of care is top of mind for Sunnybrook’s staff, students, physicians and volunteers who, through their outstanding leadership, inspire improvements in the quality of services each day. The Quality Improvement Plan helped the organization to set priorities for improvement and monitor progress through the identification of key measures. For the first time, Sunnybrook began to engage patients and families to help guide the Hospital as quality improvements are made. There were many unit-based safety projects, including General Medicine Inpatient Units at the Bayview campus who created a sticker to be placed on patients’ Kardex (a summary of individual patient needs that is updated at every shift change) at the onset of delirium. The Kardex is brought to rounds for the interprofessional team to discuss delirium management or investigation. The result has been increased team awareness about patients with delirium, leading to timely clinical management.

APPROPRIATE ANTIBIOTIC USE IN THE SMALLEST PATIENTSThe neonatal intensive care unit developed a family-centred approach to an antibiotic stewardship program. Staff and families were informed about the importance of appropriate antibiotic use. When a standardized antibiotic reporting on daily bedside rounds was implemented, families participated in the conversation. During daily rounds, pharmacists report on the antibiotic each baby is receiving, the indication for the antibiotic and the intended plan for the antibiotic. As a result, 55 per cent fewer babies in the unit have been exposed to antibiotics, reducing antibiotic-associated adverse events.

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EXPANDED ELECTRONIC PATIENT IDENTIFICATIONSunnybrook continued to decrease patient safety incidents due to misidentification errors through the use of barcode technology. Two electronic ‘Positive Patient Identification’ solutions were initiated to minimize misidentification through barcode verification of the patient identification band during specimen collection and the administration of blood components. These steps have reduced the number of specimens rejected by the lab because they were unlabeled, improperly labeled or drawn from the wrong patient. The initiative has also resulted in a reduction of unnecessary recollection of specimens, and has optimized efficiency by reducing the number of staff required to verify information, prior to administration, from two to one.

I-START-END WINS AWARDDr. Irene McGhee, an anesthesiologist at Sunnybrook, was awarded the Innovations in Patient Safety Education Award for the development and use of a communication tool called I-START-END. The tool is an engagement process for a transitory group of people who come together during a medical event. Dr. McGhee drew on her own experience being called to assist with resuscitations outside of the operating room, from the cafeteria to the trauma room. As soon as a team member arrives on the scene, ‘who is in charge?’ is asked. The leader is informed of each team member’s specialty and level of experience. The END component of the tool addresses the importance of transitions of care, with each staff member alerting the leader when they are leaving, what they have done and what they think will happen next.

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14. DIGITAL HEALTH TECHNOLOGYFrom MyChart, a personal health record system, to SunnyCare, the electronic clinical care system, digital health is an integral part of Sunnybrook’s commitment to providing care when it matters most. Digital health technology provides staff with timely information on patients and also supports accurate communication between staff members, as well as with patients and families.

MYCHART TURNS 10Sunnybrook’s personal online health management record solution turned 10 in 2016. With over 140,000 active users, MyChart can be used 24/7 by computer or personal mobile device. Accetssed by users in over 157 countries, the solution allows users to access medical imaging, lab results, progress notes and more.

System partners who have launched MyChart include Baycrest, Central Community Care Access Centre, Mackenzie Health, Mount Sinai Hospital, the Ottawa Hospital, the Ottawa Heart Institute, Michael Garron Hospital, William Osler Health Systems, Medic Alert and St. Michael’s Hospital.

ELECTRONIC ORDER SETSSunnybrook took a step toward electronic order sets in 2016/17 in select areas of the Hospital, including general internal medicine and stroke services. Order sets are medical checklists that work to standardize diagnosis and treatment following pre-established clinical guidelines. Frequently used by nursing staff, as well as pharmacists and medical imaging technicians, moving away from paper-based order sets has several benefits. In addition to increased legibility, leading to reduced miscommunication, SunnyCare electronic order sets will reduce variation in clinical practice and improve cost effectiveness. An additional benefit of electronic order sets is seamless ordering of home medications as an important feature is admission medication reconciliation.

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CHARM GARNERS ACCOLADESThe Chemotherapy Appointment Reservation Manager (CHARM) at the Odette Cancer Centre received the 2016 Innovation Award from the Cancer Quality Council of Ontario for its positive impact for health care providers and the patient experience. The software eliminates the need for patients to access multiple systems within different locations in the Hospital as it operates as a one-stop data kiosk for patients to complete registration, surveys and print identification armbands. The software is the first-of-its-kind in Ontario and improves appointment scheduling and also enables patients to self-check-in. The software records and communicates a patient’s status in real-time at each step of treatment not only with the patient, but also between healthcare providers.

METAVISION ROLLS OUT IN ALL INTENSIVE CARE UNITS A clinical information system for intensive care units, developed by iMDSoft, rolled out across all intensive care units over 2016/17. The system improves staff productivity, fosters collaboration, reduces transcription errors and delivers better patient outcomes by minimizing the footprint of the current paper chart.

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15. PARTNERSHIPS & SYSTEM IMPROVEMENT The Hospital continued to collaborate with partners to ensure the health care system was responsive to the needs of the public. One example included Ontario’s Ministry of Health and Long-Term Care directing the Sunnybrook-led Ontario Emergency Medical Assistance Team to deploy to Attawapiskat First Nation and Weeneebayko General Hospital in Moose Factory. The team provided clinical and psychosocial support to the community and hospital following a significant number of suicide attempts, which caused a surge in the hospital.

SUPPORTING MICHAEL GARRON HOSPITALTo help ensure patients at Michael Garron Hospital continued to have access to the vital care they need, Sunnybrook allowed the partner hospital to utilize Cardiac Cath Lab 4 and the five-bed recovery area on M-3 at the Bayview campus. Physicians and nursing staff from Michael Garron used the space during weekdays to perform vital diagnostic angiograms while their site was undergoing the renovation.

ORIENTING POLICE OFFICERSSunnybrook took a lead in the creation of an orientation program for all new police officers entering the trauma bay, seeing an opportunity to build awareness and familiarity with the environment. A special award was presented to Sunnybrook’s Canadian Simulation Centre and the Tory Regional Trauma Centre by Toronto Police Services to recognize the valuable collaboration. The program has incorporated filmed simulation to show new officers the roles and responsibilities of the trauma team members, as well as process and proper procedure in the trauma bay.

P.A.R.T.Y. PROGRAM TURNS 30 AND GOES WORLDWIDESunnybrook’s Senior Friendly Team created a glossary of responsive behaviour terminology for all Toronto Academic Health Science Network hospitals to facilitate a shared understanding, guide communication at transitions in care and influence policy development. Seniors are the fastest growing population and the greatest consumers of health care services in Ontario. Sunnybrook has a distinguished history of caring for the elderly and that commitment continues in every primary care program.

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Sunnybrook’s Senior Friendly Team created a glossary of responsive behaviour terminology for all Toronto Academic Health Science Network hospitals to facilitate a shared understanding, guide communication at transitions in care and influence policy development. Seniors are the fastest growing population and the greatest consumers of health care services in Ontario. Sunnybrook has a distinguished history of caring for the elderly and that commitment continues in every primary care program.

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16. FUNDRAISINGSunnybrook Foundation once again continued to raise funds to help purchase the most advanced equipment, attract the best minds, and support leading-edge research and innovation. Eighty per cent of money raised was invested into the priorities of the Hospital.

BOOSTING BRAIN CANCER RESEARCHWith donations that came in from across the country and around the world, Sunnybrook Foundation and the Canadian Cancer Society raised more than $1 million for brain cancer research through The Tragically Hip’s tour. With the announcement that Gord Downie was diagnosed with glioblastoma, a form of brain cancer that currently has no cure, thousands of fans joined together to raise funds through events and donations for the Gord Downie Fund for Brain Cancer Research at Sunnybrook and for the Canadian Cancer Society. From bake sales to raffles to concert viewing parties and ticket sales, thousands of fans donated to make a difference to those diagnosed with this life-threatening disease.

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FUNDRAISING RECORD FOR YOUTH MENTAL HEALTHYouth mental health received a strong message of support as the 2016 Race for the Kids raised $2.2 million to benefit Sunnybrook’s Family Navigation Project. t supports the Family Navigation Project, a program partnering families with professionals who guide them to the mental health and addiction services they need. The project was started in 2014 by parents frustrated by the challenges of finding their way through the complex mental health-care system. As a result of the RBC Race for the Kids, the project has helped over 1,300 families to date.

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17. FINANCIAL OUTLOOK FISCAL 2017/18 Sunnybrook has submitted a balanced budget for fiscal 2017/18 and has entered into a new Hospital Service Accountability Agreement (H-SAA) with the Toronto Central Local Health Integration Network (TC-LHIN). This has been achieved in significant part by the Government providing growth funding in F2016/17 beyond the reinstatement of inflation increases at 1% after four years of zero inflation, and a further commitment to approximately 2% in inflation funding for F2017/18. In addition to these funding increases the Hospital has established a Sustainability Program Office (SPO) whose role in the organization is focused on maintaining financial stability for the future, while ensuring quality of care remains excellent and focused on patient needs. This team leverages ideas directly from operations, as well as various analytics, including efficiency benchmarking and performance against budget. Savings have been achieved by reviewing staff skill mix, identifying less expensive but as efficacious supplies and similarly examining labour costs so as to minimize overtime.

Also in F2017/18 Sunnybrook is committed to working to achieve excellence in the following:

• Repatriation: As one of the busiest tertiary and quaternary hospitals in Canada, Sunnybrook sees a large volume of patients from outside its catchment area. Repatriation is defined as the process of moving patients received from another acute care hospital back to their referring hospital. Timely repatriation allows Sunnybrook to create capacity by reducing bed utilization hence positioning it for success in playing its role in the provision of specialized care for the Province e.g. Code STEMI, Stroke, Trauma, Burns etc..

• Patient Flow: The hospital has invested in additional Post Anaesthetic Recovery Room (PACU) resources to facilitate improved patient flow and reduced OR cancellations due to unavailable recovery beds.

• Choosing Wisely: Sunnybrook is considered an “early adopter” of the Choosing Wisely Canada campaign which aims to consolidate ongoing efforts focused on decreasing unnecessary tests or treatments, and creates a structured approach to engage healthcare providers in utilization improvements.

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Sunnybrook remains committed to quality outcomes and being a fiscally responsible organization. The challenges of an aging population demographic and a challenging economic environment are significant for both the Government and the healthcare system of Ontario. Recognizing the challenge ahead, Sunnybrook continues to collaborate with its community partners to ensure our patients receive accessible and coordinated care. This aligns with the Toronto Central LHIN’s “Innovation and System Sustainability” goal which recognizes that “key to sustainability of our health care system is the importance of ensuring that care is happening in the right place at the right time”. This means Sunnybrook is committed to meeting the needs of the population in our neighbourhood, while supporting and maintaining the critical role we play in providing specialized services to the province.

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Sunnybrook Shines a Spotlight on 2016–17

2017