Unity Health Toronto - Annual Report 2018-19 by St. Michael's Hospital

Unity Health Toronto Annual Report 2018-19

Becoming Unity Health Toronto

It has been a year of firsts – a first full year as an integrated organization, a first CEO, our new network name, a first integrated quality plan and the development of our first Unity Health Toronto strategic plan. These are truly important milestones in 2018-19 to celebrate, while being ever mindful of what has sustained our tradition of compassionate care across three centuries – a shared commitment to our mission and values. It’s rooted in the legacy of our more than 10,000 people improving outcomes, safety, access and coordination across the spectrum of care for our patients, clients, residents and families. It’s in the call to provide care with a deep respect for the intrinsic value and dignity of every human being. It’s in how we treat those experiencing marginalization or disadvantage that is embedded in our day-to-day practices. Our new name – Unity Health Toronto – describes this shared purpose. We are united in our dedication to compassionate care for the whole person. It also signals our enduring commitment to inclusivity. Unity speaks to our connections with each other, to our patients and to our communities.

Through this plan, we continued to build on the strong safety culture across our network, worked to improve our patient and family engagement, aimed to create smoother transitions home from the hospital and improved the resident and caregiver experience in our long-term care home. We also embarked on the exciting process of creating Unity Health Toronto’s inaugural strategic plan. This has been a remarkably inspiring process as a result of the deep engagement of our skilled and passionate staff and physicians; our patients, clients, residents and families; our system partners; and our communities in helping us to shape the future of Unity Health Toronto. This plan, completed in May 2019, represents the shared vision of the hearts and minds of countless folks committed to creating the best care experiences together. Thank you to everyone who has supported us over the past year – our patients, clients, residents and families, health care providers, staff members, researchers, learners, educators, volunteers, donors and community partners. We could not have accomplished all that we have in our first full year as a network without you.

We launched our very first networkwide Quality Improvement Plan.

Tom Woods Chair, Board of Directors Unity Health Toronto

Dr. Tim Rutledge President and CEO Unity Health Toronto

Creating our future together Over the past year we embarked on a thorough strategic planning engagement process to capture what was most important to our people, patients, clients, residents, families and partners. Through surveys, focus groups, workshops, pop-up events and existing forums (pictured right) we received more than 4,000 individual suggestions that helped to create Unity Health Torontoâ&#x20AC;&#x2122;s new mission, values, vision and strategic plan, which launched in May 2019. Our consultation process allowed us to build ideas over time, testing and refining concepts to make sure it truly reflected our legacy, our identity and our goals for the future.

Our Vision

The best care experiences. Created together. Our Mission

Our Values

Unity Health TorontoÂ is a Catholic health care organization providing compassionate physical, emotional and spiritual care to all in need. We advance excellence in health care through world-class education, research and innovation.

READ MORE AT

www.bestcareexperiences.com

Our network by the numbers (2018-19 fiscal year) A C R O S S U N I T Y H E A LT H T O R O N T O

455

St. Michael’s Hospital

231

Providence Healthcare

780,558 52,435 16,783 Ambulatory care visits

Family Health Team enrolments

Staff, learners and physicians

288

317

St. Joseph’s Health Centre

Neonatal ICU bassinets

25,773 St. Michael’s Hospital

3,132

Providence Healthcare

20,681

5,833 Births

Adult critical care beds (ICU)

Long-term care beds

176,813 $86 million Emergency visits

Research funding

St. Joseph’s Health Centre

IMPROVING CARE

“The primary objective is to help patients. The goal is to get patients better sooner.”

Move to improve Early rehabilitation for patients in critical and intensive care is helping them to recover faster and maintain their strength For patients admitted to an intensive care unit (ICU), early

go to an inpatient rehabilitation program afterwards. The shift

mobility can be a key factor to a successful recovery. A pilot

from rest and recovery to early mobility has been embraced

project taking place at St. Joseph’s and St. Michael’s will study

at both sites and guidelines were already in place before

how to best implement early mobility in an ICU and provide a

the PERCC pilot project. This pilot will create the next set of

standardized toolkit to critical care units across the province

guidelines and help formalize practices in critical care units

as part of the Provincial Early Rehabilitation in Critical Care

across Ontario.

(PERCC) initiative with Critical Care Services Ontario. “Maintaining strength is very important,” said Dr. Andrew Baker, chief of Critical Care at St. Michael’s. “It allows one to maintain activities of daily living, everything from getting out of a chair, taking care of one’s own personal needs, eating meals independently and of course, being able to enjoy activities with one’s family, like walking and shopping.” Early rehabilitation has the potential to reduce the length of stay in a hospital and reduce – or even eliminate – the need to

As part of the pilot, St. Joseph’s and St. Michael’s both have additional physiotherapy coverage. “We’re able to see more patients, see patients twice a day,” said Danny Slack, a physiotherapist in the ICU at St. Joseph’s. “This speeds up recovery times, especially for more complex patients.” “The primary objective is to help patients,” said Dr. Baker. “The goal is to get patients better sooner.”

Ken Slak (centre) walks around the ICU at St. Joseph’s with assistance from physiotherapist Danny Slack (left) and physiotherapy assistant Kelly Hyduk (right).

ADDRESSING NEEDS

“The benefits of managing responsive behaviours are felt by the patient, staff and our health care system.”

Better communication, safer care De-escalation strategies for responsive behaviours help Unity Health Toronto care providers safely and compassionately address individual needs Teams across Unity Health Toronto are seeing immediate and

A working group co-led by Cecilia Santiago, a nursing practice

positive benefits as a result of training programs on managing

manager at St. Michael’s, designed the MRB training specifically

responsive behaviours. Individuals with complex mental

for its acute-care context.

health, dementia and other neurological conditions may exhibit responsive behaviours – which can include cursing and resistance to essential care – when trying to communicate what they want or feel.

“Prior to MRB, we were using a lot of constant monitoring – keeping observers with patients at all times,” said Santiago. “However, there’s very little data to demonstrate that observation actually prevents harm, and it’s expensive.

The Gentle Persuasion Approach (GPA) is used at Providence

The benefits of MRB are felt by the patient, staff and our

and St. Joseph’s and the Managing Responsive Behaviours

health care system.”

(MRB) training is in place at St. Michael’s. The two training programs have the same goal: to provide a variety of strategies that can help staff successfully prevent and de-escalate responsive behaviours.

At Providence, 67 staff members have completed the GPA training in the Cardinal Ambrozic Houses of Providence and 50 have completed the GPA training in the hospital since 2018. Eight GPA-certified coaches at St. Joseph’s had trained 350

GPA reinforces the idea of personhood; that there is a person

people as of January 2019. At St. Michael’s, 479 practitioners

behind the condition who is still capable of interacting

have participated in the MRB training and the team has even

with others and that their behaviour is closely linked to the

made alterations to the curriculum with course materials for

progression of their dementia.

specific patient populations.

As Deborah Francis, a nursing practice consultant who

Feedback on the training programs show that participants

conducts GPA training at Providence explained, “GPA really

are eager to practice their new skills. They also feel safer

forces you to stop and reflect on some of your attitudes and

and more confident in their ability to provide respectful and

misconceptions. As a result, you see people with dementia

compassionate care for patients and residents after the

Nursing practice consultants Viani Tropiano (left) and Deborah Francis (right) run the Gentle Persuasion Approach training at Providence.

differently. Instead of saying, ‘This person is aggressive’, you

training.

Nus ea con non conem. Cab id eosanis est laborum non reste dolum faces volupic tem et alique veriatum fugit qui cust ressi in

are they trying to communicate through it?’”

ask, ‘Why are they displaying this type of behaviour and what

D R I V I N G I N N OVAT I O N

“If today is Monday, we can tell you that on Wednesday from noon to 6 p.m., we’ll have 82 patients showing up to our Emergency Department.”

Forecasting with AI St. Michael’s Li Ka Shing Centre for Healthcare Analytics Research and Training has developed an AI-powered early warning system that helps emergency departments prepare for patient surges In 2018-19, St. Michael’s saw approximately 200 patients come

“If today is Monday, we can tell you that on Wednesday

through its Emergency Department (ED) on a daily basis. If that

from noon to 6 p.m., we’ll have 82 patients showing up to

number of patients goes up or if a large number of patients

our Emergency Department,” said Dr. Muhammad Mamdani,

arrive to the ED at the same time, the ED may experience

director of LKS-CHART. “We’ll be able to tell you that about 10

a “surge” where wait times increase as care providers work

of them will have mental-health issues, 12 will be fairly high-

together to support a greater number of patients.

intensity cases – such as heart attack or trauma – and the rest

To help the ED prepare for surges, the Li Ka Shing Centre for

of them will be probably low- to moderate-intensity.”

Healthcare Analytics Research and Training (LKS-CHART) at

The ED early warning system boasts an accuracy of well

St. Michael’s has developed an early warning system that

over 90 per cent and is now in place at St. Michael’s Hospital,

predicts when they will happen.

Michael Garron Hospital and Mount Sinai Hospital. The system

Equipped with three years of historical data on patient volumes and environmental data, such as inclement weather and events in the area, the LKS-CHART team developed an algorithm using machine learning – a form of artificial intelligence (AI). With this algorithm, the forecasting system can predict patient volumes up to four weeks into the future and in six-hour intervals over

is automated to take in relevant data each night and – within moments – send a patient volume forecast to department managers. Managers can then make staffing resource decisions to prepare for patient volumes, having a positive impact on patient care in the ED.

(From left to right) Chloé Pou Prom, Joshua Murray, Michaelia Young and Dr. Muhammad Mamdani are part of the core LKS-CHART team at St. Michael’s.

the next three days.

St. Joseph’s Health Centre St. Michael’s Hospital Providence Healthcare

Cheryl Peever

Hematology/Oncology team

Team leader, Operating Room

Patient care manager, Adult Inpatient Mental Health

Mika Muira, Carl Leushuis, Charmaine Mothersill, Althea Stewart, Dr. Dory Abosh, Dagmara Kolodziejczyk, Dr. Martina Trinkaus and baby and Merlyn Samuray

EXCELLENCE AWARD

Dr. Jennifer Hopfner

Shelagh Scanga

Substance Use in Pregnancy team

Ann Guillen

Physician, Pallative Care

Nurse, Mobile Crisis Intervention Team

Heather Campbell, Lisa Blanco-Ruibal, Dr. Maya Nader, Dr. Erin Lurie and Dr. Suzanne Turner

Registered nurse, Nephrology/Urology

Registered practical nurse, Stroke and Neuro Rehabilitation

HUMAN DIGNITY AWARD

COMMUNITY OF SERVICE AWARD

SOCIAL RESPONSIBILITY AWARD

PRIDE OF ACHIEVEMENT AWARD

COMPASSIONATE SERVICE AWARD

Teresita Magtibay

Dr. Kay Shen

Daniel Cormier

Rosemary Suchy Sandy Trpcic

Sandy Trpcic

Karen Steele

Charge nurse, Haemodialysis

Physician, Addictions Medicine

Clerical assistant, Emergency Department

Clinical planner, Planning and Redevelopment

Research manager, Trauma and Neurosurgery

Rehabilitation assistant, Orthopaedic and Amputee Rehabilitation

SOCIAL RESPONSIBILITY AWARD

COMPASSION AWARD

HUMAN DIGNITY AWARD

COMPASSION AWARD

COMMUNITY OF SERVICE

SANCTITY OF LIFE AWARD

Giselle Magtoto

Values Awards

Dr. Richard Brodie Physician, Palliative Care

COMPASSIONATE SERVICE AWARD

Here are a few of the people who bring our values to life through their daily work with with patients, clients, residents and families across Unity Health Toronto. Next year we will showcase the winners of Unity Health Toronto’s new values awards program, Our Shared Values.

Erika Solomon

Objectives

C O R P O R AT E O B J E C T I V E S 1.0

Over the past year, we set out and accomplished a number of objectives to further our shared vision of creating the best care experiences. We put focus in the following key areas:

1.1 2.0 2.1 3.0

Achieve Quality Improvement Plan targets Protect patients and residents from harm by implementing necessary changes arising from safety incidents within the committed timeframe

Improve the experience of patients admitted through our emergency departments (EDs) Improve the time from triage and registration to the time the patient is admitted

Establish a shared vision for the newly integrated organization

2018-19

3.1

Develop a new strategic plan for the organization

Corporate Objectives

4.0

Build research impact across the network

4.1

Integrate research processes across the network

Patients, Families, Community and Heath System

5.0

Internal Process

5.1 6.0 6.1

Financial

Learning and Growth

7.0

Explore professional practice collaboration opportunities and advance care and professional practice priorities at each of our sites

Achieve integration transition milestones and objectives Complete portfolio transitions in support services areas: education, facilities and engineering, finance, human resources, information technology, mission, performance, quality, and strategy and public affairs

Modernize our spaces to support exceptional patient care and experience

7.1

Complete facilities planning studies for submission to the Ministry of Health in order to support major redevelopment at St. Josephâ&#x20AC;&#x2122;s

7.2

Complete successful transition to the Peter Gilgan Patient Care Tower and begin demolition of St. Michaelâ&#x20AC;&#x2122;s Shuter Wing

8.0 8.1 9.0

Partially complete

Improve care through the shared expertise across our network

9.1 10.0

Pursue operational excellence to achieve financial sustainability Harmonize and balance the budget

Advance excellence in teaching and learning Establish education needs through an organizational learning scan and set priorities to inform education and enable support service strategic plans

Develop strategies for employee and physician engagement

Complete 10.1

Use the results from the employee and physician pulse survey to develop a plan for employee and physician engagement

Status

Our network in the news Number of references to our work in top-tier media outlets

S T. J O S E P H ’ S H E A LT H C E N T R E Pediatrician Dr. Anne Wormsbecker (pictured below, left) was called on by the CBC to explain why measles has re-emerged globally in an extended in-depth interview that also covered the misinformation trend online.

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ST. MICHAEL’S ST.HOSPITAL MICHAEL’S HOSPITAL

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PROVIDENCEPROVIDENCE HEALTHCAREHEALTHCARE

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activities which helpedactivities them build which helped them build

new Knowledge Centre new to create Knowledge Centre to create a better environment to a better support environment to support professional development professional and development and home-grown innovation. home-grown innovation.

Unity Health Unity Toronto Health Toronto total number totalof number followers: of followers: 20

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2018-19: 3,903 2018-19: 3,903 21

GOVERNANCE

Board of Directors

Executive Committee

ELECTED MEMBERS

Dr. Glen Bandiera

Mary MacLeod

Medical Advisory Committee chair

Vice-president of Clinical Services and chief nursing executive, St. Joseph’s Health Centre (to Oct. 5, 2018)

Jennifer Bowman

Vice-president of People and Transformation (as of Jan. 7, 2019) Vice-president of Clinical Programs, Providence

Vice-president of Human Resources and Legal Services (to Oct. 5, 2018)

Beverly Bulmer

Dean Martin

Maggie Bruneau Nora Aufreiter

Wayne Barwise

Domenic Belmonte

Joe Calderone

Hazel Claxton

Yves Denommé

Executive vice-president of Corporate Services and chief financial officer (as of Oct. 9, 2018)

Vice-president of Education

Sonya Canzian Vice-president of Clinical Programs, St. Joseph’s Health Centre (as of Oct. 9, 2018); vice-president of Clinical Programs, St. Michael’s Hospital; and chief nursing and health professions officer as of Sept. 26, 2018

Tony Graham

Kamala Jean Gopie

Peter Gordon

Doug Guzman

Maria Dyck

vice-chair

to June. 30, 2018

Colleen Johnston

Ellen Malcomson

President of St. Joseph’s Health Centre Foundation

Michael McTeague

Rosemary Moodie

Denise O’Neil Green

Virginia West

Darryl White

Tom Woods

E X- O F F I C I O

Dr. Tim Rutledge

Sonya Canzian

Andrew Branion

CEO and president

Chair of the Providence Healthcare Foundation Board of Directors (as of July 1, 2018)

Representative of the Archdiocese of Toronto

Vice-president of Clinical Programs, St. Joseph’s Health Centre (as of Oct. 9, 2018); vice-president of Clinical Programs, St. Michael’s Hospital; and chief nursing and health professions officer

Dr. Trevor Young

Dr. Glen Bandiera and Dr. José Silveira

Representative of the University of Toronto

Representatives of the Medical Advisory Committee

Mary MacLeod

Dr. Peter Ballyk and Dr. David Lipson

Vice-president of Clinical Services and chief nursing executive, St. Joseph’s Health Centre (to Oct. 5, 2018)

Representatives of the Medical Staff Association

David Mulroney

Kevin Dougherty Chair of the Providence Healthcare Foundation Board of Directors (to June 30, 2018)

President and CEO

Vice-president of Redevelopment and Support Services (interim, Aug. 1, 2018, to Feb. 28, 2019) and vice-president of Facilities and Planning and chief planning officer (as of March 1, 2019)

Roman Dubczak

Dr. José Silveira

Medical Advisory Committee vice-chair

Dr. Eddy Lau

Dr. Art Slutsky

Lili Litwin

Jennifer Stewart

Mary Lowe

Anne Trafford

Chief medical officer (interim), St. Joseph’s Health Centre

Dr. Tim Rutledge

Vice-president and chief medical officer, Providence Healthcare (to Aug. 31, 2018)

Executive vice-president of Medical Affairs and Clinical Programs

Michael Keen chair

Dr. Peter Nord

Dr. Thomas Parker

Executive director of Mission Integration

vice-chair

Vice-president of Facilities and Support Services (to July 31, 2018)

Vice-president of Research (interim, as of Sept. 4, 2018)

Beth Johnson

as of Sept. 26, 2018

Mike Mendonca

Dr. Patricia O’Campo

David Graham

Vice-president of Finance (to May 25, 2018)

to June. 30, 2018

Mary Madigan-Lee

Vice-president of Research (to Aug. 31, 2018) President of Providence Healthcare Foundation

President of St. Michael’s Foundation

Vice-president of Quality and chief information officer

Vice-president of Strategy and Public Affairs

Chair of the St. Joseph’s Health Centre Foundation Board of Directors

Medical Advisory Committee

John Barford

Dr. Jennifer Anderson

Dr. Timothy Dowdell

Dr. Ori Rotstein

Dr. Peter Ballyk

Dr. Ralph George

Dr. José Silveira, vice-chair

Dr. Glen Bandiera, chair

Dr. Eddy Lau

Dr. Ashley Verduyn (as of Sept. 1, 2018)

Dr. Graham Berlyne

Dr. David Lipson

Dr. Tara Williams

Sonya Canzian (as of Oct. 9, 2018)

Dr. Peter Nord (to Aug. 31, 2018)

Dr. Jeff Zaltzman

Dr. Robert Cirone

Dr. Thomas Parker

Dr. Tim Rutledge (ex-officio)

Chair of the St. Michael’s Hospital Foundation Board of Directors

AUDITED FINANCIALS

As of March 31, 2019, in thousands of dollars

Financial position

Statement of operations

Current assets

Current liabilities

Cash and cash equivalents

113,189

Accounts payable and accrued liabilities

Accounts receivable

35,843

Long-term debt

Inventories Prepaid expenses and other assets Pension benefits - registered plan Residual pension assets to be transferred Restricted cash and investments

6,444 7,697 104,748 63,850

Due to Ministry of Health and Long-Term Care/Toronto Central LHIN

152,356 1,200

3.0 redevelopment project long-term funding receivable

4,902

Pension benefits - registered plan Property, plant and equipment

Medical and surgical supplies

79,592

Drugs and medical gases

61,255

842,461

Other votes and programs

51,768

Patient revenue from other payers

Residual pension transfer payable

63,850

Other income

80,560

530,221

3.0 redevelopment project

173,274

106,373

1,679,886

621,117

23,435

108,029

959,638

Salaries, wages and employee benefits

Deferred revenue

Pension contribution payable to Healthcare of Ontario Pension Plan (HOOPP) on integration

Ministry of Health and Long-term Care/Toronto Central LHIN:

52,493

198,450

83,654

Expenses

Grants

527,046

Restricted cash and investments

Revenue

Long-term debt

87,076

Pension benefits - supplementary plan

26,366

Deferred capital contributions Deferred research and trust contributions Other long-term liabilities

Grants and donations for research and other purposes

81,758

Amortization of deferred capital contributions

20,082 1,132,378

Total liabilities and net assets

Bad debts

4,928

Interest accretion

Other votes and programs

53,804

Amortization of capital assets

51,066

Research expenses

82,457

Expenses associated with pension transfer to HOOPP*

156,933 1,246,396

*HOOPP merger benefits expense: 48,904 Measurement date deficit: 103,000 Interest on measurement date deficit: 5,029

(Deficit)/surplus for the period

(114,018)

156,933

689,484 99,228

Net assets Invested in property, plant and equipment

5,432

Net assets, beginning of period Net assets assumed from predecessor organizations (Deficit)/surplus for the period

Net assets

135,153

31,174

1,468,114

Contingencies and commitments

3,256

2,308

3.0 redevelopment project