The Hospital Improvement Plan
Who was involved in the development of the Hospital Improvement Plan?
The clinical leadership of the NHS was involved in developing this plan. These are the physician and administrative leads of the programs, including clinical directors and departmental chiefs.
How realistic is this Plan? Is it achievable?
The plan is both realistic and achievable. Our leaders came together to create a plan that will achieve a balanced budget in four years while improving healthcare. It meets the tests of being both financially viable and improving hospital care for every resident of Niagara. It will be achievable with the necessary enablers in place as identified in the plan to ensure the successful implementation of the plan such as transportation and investments in non-acute care services such as primary care, home care, supportive housing and rehabilitation.
Doesn’t this plan raise more questions than provide answers?
In any plan of this scope, there will be some questions that require more discussion during the implementation phase, but our direction is clear. In this plan, we have a road map that will get us from where we are today to a position where we can improve the quality of hospital care for every resident of Niagara, attract new doctors and nurses to the region and ensure that we can provide sustainable hospital care for our children and grandchildren.
Is it realistic that all the conditions in the Plan will be met?
We have identified what we call ‘enablers’ that will help us implement the plan. These are part and parcel of our vision to improve the quality of healthcare for everyone in Niagara.
Some of these enablers require outside co-operation and approval, such as a regional transportation network, more non-acute care services such as primary care, supportive housing and home care and complimentary health care professionals. But with a clear plan and clearly-defined benefits, we believe the support and approvals will be forthcoming.
When will this Plan be implemented?
The Hamilton Niagara Haldimand Brant Local Health Integration Network (LHIN) has committed to providing final direction for the HIP by the end of 2008. We will immediately the task of planning an implementation strategy. It’s important to point out that these changes are going to take place over the next several years, and that no changes will occur until the right supports and resources are in place. There is a lot of work to do during the implementation phase. Some changes will be able to be made sooner than others. We will work with the community and keep them informed.
The cornerstones of our implementation strategy are as follows:
- The extent to which residents’ timely and equitable access to appropriate hospital-based programs and services is assured now and in the future,
- Evidence of best practice,
- The feasibility of implementation, including financial viability and available human resources,
- Our readiness to manage and implement the plan, and
- Alignment with the LHIN’s strategy for delivering healthcare.
What if the LHIN doesn’t approve your Plan – what happens then?
The LHIN, upon the advice of the Advisor, can accept the plan or make modifications to the plan. The NHS will wait for the LHIN’s decision before developing any implementation plans.
Why wasn’t this Plan developed sooner?
The NHS was created in 2000, just eight years ago. We have made major progress since then in restructuring and integrating our hospitals. There have been planning initiatives underway in our clinical programs, which are reflected in the Hospital Improvement Plan. As well, in 2005, the NHS went through yet another major change with the exchange of governance and programs operated by Hotel Dieu Hospital and the transfer of the Shaver/Rehab sites to Hotel Dieu. With this transfer, the NHS assumed the primary role for the delivery of all acute care hospital services in Niagara, with the exception of Grimsby. With this transfer came the opportunity to start looking at how acute care services could be delivered across our sites to make better use of scarce health resources. Further, in the last three years we have had a number of external reviews and recommendations arising from our Accreditation surveys that have pointed to the need to reorganize clinical services differently across our sites. When the LHIN directed us to put together a submission in six weeks, we were able to achieve this comprehensive Plan mainly because of the work and discussions that have taken place in the months and years leading up to today.
How is this Plan better for patients in NHS hospitals?
Evidence and best practices in other areas show that patient outcomes actually improve when services are combined and Centres of Excellence are created. By treating more patients, doctors and nurses can focus and hone their skills. More specialists can be attracted and the technology will be there to support the most up-to-date procedures.
How will this Plan change patient care services?
Patient care will be improved on a number of levels. There are several major visions to help Niagarans in a number of ways, such as:
- Manage chronic disease like diabetes or asthma while living at home,
- Offer more services for the elderly,
- Provide better services for people with addictions and mental health issues,
- Enhance our stroke program by having dedicated inpatient beds,
- Improve our surgical services by creating Centres of Excellence for various specialties such as Urology, Ophthalmology, Orthopaedics, etc.
The list goes on and is identified in detail in the Plan. The bottom line is that these visions will bring major improvements to patient care in Niagara. Our goal is to provide the right care at the right time in the right place. This plan will do that.
How can Centres of Excellence be implemented throughout Niagara without a transportation system when so many seniors don’t drive?
Transportation is a key issue and is one of the enablers required to implement the visions. We will need to work collaboratively with multiple partners, including the Region of Niagara and Municipal Councils to develop a strategy for residents who have transportation issues. There is a growing desire in Niagara to develop a transportation network, both for medical and non-medical needs.
Is the Hospital Improvement Plan only about saving money?
No. The Plan is about providing the health care Niagara needs and deserves in a way that is sustainable. There aren’t enough patients in some of our smaller sites to keep doctors and nurses busy, yet, we have to have these doctors and nurses at each of our sites to provide 24-hour emergency care. By consolidating services, we can eliminate this duplication and care for more people with fewer doctors and nurses.
With this plan we will work with other healthcare providers and the LHIN to deal with the shortage of primary care as well as supportive housing and long term care.
Why won’t you reconsider building the new health-care complex planned in St. Catharines on available land at the intersection of Highways 406 and 20 to be more accessible for all Niagarans?
A very detailed selection process was undertaken to select the parcel of land to build the new health-care complex. Over 20 parcels of land were assessed, including land at Highways 406 and 20. The location at First Street and Fourth Avenue in west St. Catharines met all of the criteria including: size of property, transit access, proximity to roads such as Highway 406, QEW, St. Paul St and 4th/Welland Ave, compliance with official plan, ease of site services, proximity to Hamilton and central location in Niagara. The major advantage to this 40-acre property is that it accommodates future growth and capability for a complete rejuvenation of the complex in 50 to70 years, as required.
The new health-care complex being built in St. Catharines is primarily a new community acute care hospital to replace the two aging hospital buildings in St. Catharines on Queenston Street and Ontario Street. The new acute care community hospital will primarily serve the residents of St. Catharines, Thorold and Niagara-on-the-Lake, in the same way our five other hospitals service their local and surrounding communities.
We cannot build the new regional services – the cancer centre, cardiac catheterization and specialty mental health beds – as stand-alone regional services in the middle of Niagara. All of these services need to be located with a acute care community hospital. We were directed by the province to co-locate these regional services with the planned St. Catharines community hospital, due mainly to St. Catharines’ closeness to Hamilton’s tertiary (specialty) care, as well as to other complimentary services already provided at that hospital.
What is all this talk about one ‘super hospital’ for Niagara – why isn’t this being done?
There are different views of what a super hospital means. A super hospital to some means building one new, mega hospital in the middle of Niagara and closing the rest of the hospitals in Niagara. To others, it means building a new, additional hospital in the middle of Niagara and leaving the remainder of hospitals in Niagara as is.
The Niagara Health System supports neither option. One hospital for Niagara does not balance the need for specialization and concentration of services versus the need for emergency, surgery, and dialysis care closer to home. One hospital in Niagara does not allow for back-up services in case of emergencies such as a fire in the hospital or an infectious outbreak such as SARS. There is not enough evidence or sufficient population growth to suggest that the construction of a new additional hospital in Niagara is feasible or practical.
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