Strategic Plan
2010-2014
October 7, 2010
Table of Contents
Foreword ........................................................................................................................................ 1
Context ........................................................................................................................................... 2
The System............................................................................................................................... 2
The Environment ..................................................................................................................... 4
The Organization ..................................................................................................................... 6
Mission, Vision, Values and Mandate ......................................................................................... 12
Our Mission............................................................................................................................ 12
Our Shared Vision .................................................................................................................. 12
Our Core Values ..................................................................................................................... 13
Our Service Values ................................................................................................................. 13
Our Service Mandate ............................................................................................................. 14
Strategic Directions, Goals and Objectives ................................................................................. 15
Strategic Direction #1: Patients First ........................................................................................... 17
Strategic Direction #2: Our Team, Our Strength ......................................................................... 21
Strategic Direction #3: Operational Excellence ........................................................................... 23
Strategic Direction #4: Collaborative Networks.......................................................................... 25
Strategic Direction #5: Building a Sustainable Future ................................................................ 27
Dependencies and Enablers ......................................................................................................... 29
Partners ................................................................................................................................. 29
Continuing Engagement ........................................................................................................ 29
Alignment with the MOHLTC and CE LHIN .................................................................................. 32
How We Are Aligned.............................................................................................................. 32
Alternate Level of Care Patients, Wait Times and Vascular Disease ..................................... 33
Appendix A: Definitions of Our Service Values ........................................................................... 34
Appendix B: Key Reference Documents ...................................................................................... 35
Northumberland Hills Hospital Strategic Plan 2010-2014
Foreword
Since opening its doors in 2003, Northumberland Hills Hospital has become an organization recognized
for its exceptional patient care, strong community linkages, and dedicated individuals who take pride in
what they do. We have achieved this success by making our patients the focal point in everything we do;
by visionary thinking; by attracting a highly skilled and motivated team of clinicians, support staff,
managers and volunteers; and, by investing in state-of-the art medical and information technologies.
Serving the health care needs of our community is a privilege we take very seriously. Health care is
constantly changing. To achieve the best possible health outcomes, our Hospital must continually seek
innovative ways of delivering services, ensure value for money with our limited resources, invest in our
people, engage our community, and collaborate with our health care partners.
Now is the time to set a new direction for our Hospital that will enable us to achieve continued success.
NHH’s Strategic Plan 2010-2014 is guided by a new Mission, a Shared Vision and a strong set of Core
Values. It is a comprehensive, long-range road map that takes a multi-pronged approach in transforming
NHH to meet today’s challenges and take advantage of tomorrow’s opportunities. It is anchored on our
commitments for quality, safety, transparency, and leadership. This Plan will allow us to continue to
flourish as a community hospital and fulfill our mission of providing Exceptional Patient Care. Every time.
John Hudson
Chair of the Board of Directors
Robert F. Biron
President and CEO
Northumberland Hills Hospital Strategic Plan 2010-2014
Dr. David Broderick
Chief of Staff
Page 1
Context
Northumberland Hills Hospital (NHH) opened in 2003 and is located approximately 100km east of
Toronto where it serves a population of 60,000 residents living in west Northumberland County.
The System
Like most hospitals, NHH plays an important role in improving and maintaining the health of its
surrounding citizens. But it does not do so in isolation. NHH provides services in the context of both a
larger system and an environment that support and place pressures on the Hospital every day. The
system consists of the Ministry of Health and Long-Term Care (MOHLTC), Local Health Integration
Networks (LHINs) across the province, and numerous health care providers and partners that provide
citizens with a range of services to meet their care needs.
Quality and Safety
Accreditation Canada defines quality as “the degree of excellence; the extent to which an organization
meets clients needs and exceeds their expectations.” The Ontario Hospital Association adopted the
Agency for Healthcare Research and Quality (AHRQ) definition of quality as meaning “Doing the right
thing, at the right time, in the right way, for the right person – and having the best possible results.” At
NHH, quality health care means providing service excellence to our patients and the community.
While the health system and NHH have always focused on providing such care, there has nevertheless
been a renewed focus on quality and safety in recent years. The findings of the Canadian Adverse Event
Study, often referred to as the Baker Report, as well as more recent reports from the Canadian Institute
of Health Information (CIHI) and other health agencies have highlighted opportunities for improvement
in the quality of health care services.
The Baker Report 1 estimated that approximately 7.5% of all acute care hospital admissions in Canada
result in Adverse Events (AEs), which are “…unintended injuries or complications resulting in death,
disability, or prolonged hospital stay.” 2 The report also found that approximately 37% of these events
were preventable or the result of medical error. In practice, at the time the report was issued, this
meant that approximately 185,000 AEs happened every year in Canada, and that as many as 70,000 of
them could have been prevented.
More recently, the Ontario Health Quality Council published key findings in the Quality Monitor, 2010
Report on Ontario’s Health System. These findings indicated that although some improvements have
been made in the province during the past few years, there is room for improvement in various areas,
including:
1
G. Ross Baker, Peter G. Norton, Virginia Flintoft, Régis Blais, Adalsteinn Brown, Jafna Cox, Ed Etchells, William A. Ghali, Philip
Hébert, Sumit R. Majumdar, Maeve O'Beirne, Luz Palacios-Derflingher, Robert J. Reid, Sam Sheps and Robyn Tamblyn (2004).
The Canadian Adverse Events Study: The Incidence of Adverse Events Among Hospital Patients in Canada. Canadian Medical
Association Journal, 170(11), pp. 1678-1686.
2
Baker et al. (2004), p. 1688.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 2
•
•
•
•
patient flow through the system from emergency department to hospital to long-term care
facilities;
chronic disease management;
electronic medical records; and,
reducing hospital-acquired infections.
Enhancing the quality of care that patients receive is a top priority in Ontario’s health care system.
Numerous initiatives and improvements have been implemented by hospitals in the past decade,
including mandatory public reporting of patient safety indicators. The MOHLTC now requires hospitals
to report hospital-acquired infection rates and other quality indicators, such as hand hygiene, wait times
and surgical safety checklist compliance.
As well, many hospitals, including NHH, have adopted quality improvement methods to reduce waste
and unnecessary steps in their processes. Accreditation Canada has introduced its Qmentum
accreditation program in 2008 to provide organizations with a “roadmap for quality,” which emphasizes
best practices in patient safety. New legislation, such as the The Excellent Care for All Act (Ontario,
2010), further extends the commitment to quality and establishes explicit accountabilities for quality
improvement by health care providers.
Coupled with this emphasis on the quality and safety of acute care services, the MOHLTC and LHINs are
also focusing on the efficiency of the system by reducing emergency department (ED) wait times and
reducing the number of alternate level of care (ALC) patients in hospitals. ALC patients are those who
cannot be discharged from an acute care hospital because the appropriate community-based care is not
yet available.
NHH is a strong supporter of all these initiatives and priorities. Clearly, with health outcomes so closely
related to quality and safety, the Hospital cannot compromise on either of these elements in the
services provided.
Financial Outlook
Excellent health care costs money. However, the Province of Ontario, like so many other governments
around the globe, made clear in its 2009-10 Budget that it has entered a new period of fiscal restraint. 3
The MOHLTC has consequently entered a period of fiscal restraint as well, not least because the
provincial government spending for the health sector comprises $43 billion or 39% of the province’s
total expenses and 43% of its program spending. 4 As recent studies have made clear, the share of
government spending devoted to the health care sector is expected to grow at an alarming rate, such
that there is intense pressure to “bend the cost curve”. 5
In Ontario, the MOHLTC gives funding envelopes and authority over health spending to 14 regional
LHINs, which in turn distribute those funds to hospitals, community care access centres, community
3
Ontario Ministry of Finance (2009). 2009 Ontario Budget: Budget Papers. Toronto: Queen’s Printer for Ontario, p. 85.
Ontario Ministry of Finance (2009), p. 102.
5
Ontario Association of Community Care Access Centres, Ontario Federation of Community Mental Health and Addiction
Programs, and Ontario Hospital Association (2010). Ideas and Opportunities for Bending the Health Care Cost Curve: Advice for
the Government of Ontario.
4
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 3
health centres, long-term care homes and numerous other health care providers. In return for the funds,
the LHINs enter into Service Accountability Agreements with health care providers that specify the
services they will provide. The MOHLTC and the LHINs take an integrated, system-wide view of how
health is funded and delivered. Care happens at many different times and places, and a variety of
organizations have important roles to play in providing that care. Through planning, funding, and
performance monitoring, the LHINs oversee the system in each region.
The system as a whole is under pressure. In addition to new budget constraints and strong cost
pressures, Ontario’s population is ageing rapidly, placing demands on the health system and reducing
the number of workers who support it with taxes from employment. These pressures create
tremendous challenges for the system as a whole and the organizations that operate within it, and
hospitals are no exception to that rule. The system must operate on a financially sound basis if it is to
survive.
At the same time, NHH will not compromise on quality and safety. This means that all organizations
must make choices about which services they will provide in this uncompromising fashion. No health
care provider can be everything to everyone. It is, therefore, imperative that NHH work collaboratively
with other health service providers in the community to ensure quality of care and health system
affordability.
The Environment
NHH encounters these system-wide pressures and choices in the specific environment of the Central
East LHIN (CE LHIN), which stretches from Victoria Park Avenue in Scarborough up to Algonquin Park.
More precisely, the CE LHIN encompasses parts of Scarborough, Durham region, the Kawarthas,
Haliburton Highlands, Peterborough and of course, west Northumberland County. The LHIN is the 6th
largest by geographic area and 2nd largest by population in Ontario, covering over 11% of the Ontario
population. 6 Within the CE LHIN, NHH serves the catchment area known as west Northumberland
County highlighted in Figure 1.
6
Central East Local Health Integration Network (2009). Integrated Health Service Plan 2010-2013.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 4
Figure 1: NHH Catchment Area
West Northumberland County encompasses approximately 60,000 residents in the Town of Cobourg,
Municipality of Port Hope, and the townships of Hamilton, Alnwick/Haldimand and Cramahe. The
populations of Cobourg and Port Hope represent 60% of the people served by NHH.
NHH’s catchment population is relatively advantaged with respect to the demographic factors that are
associated with positive health outcomes. 7 Relative to the CE LHIN and the province, people in the
Hospital’s catchment are also less likely to be lone parents, have low incomes, or be unemployed. NHH
also serves an aboriginal population which tends to be disadvantaged in its health outcomes relative to
the rest of the population.
The core health challenge faced by many in NHH’s catchment is age and its associated health
complications. The population is relatively old when compared to the CE LHIN and the province as a
7
Data discussed in this section comes from HCM (2009). Northumberland Hills Hospital Environmental Scan.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 5
whole: 18% of the people in NHH’s catchment are 65 or older, compared to just 14% in the CE LHIN and
Ontario. The proportion is even higher (24%) in the Town of Cobourg, which represents roughly one
third of NHH’s catchment population. These percentages are all expected to grow dramatically over the
next 25 years.
Age is consequently a key driver of the primary health challenges that NHH’s population faces – injuries,
immobility and disability, high blood pressure, heart disease, strokes, and cancer. This reality has
informed NHH in updating its service mandate, which is described below in more detail.
The Organization
Background and Strengths
The local community relies upon NHH heavily for its health needs. As Figures 2 through 5 below
demonstrate, NHH provides the significant majority of the acute care in the west Northumberland
catchment area in terms of inpatient cases (3,346 in 2008-2009), newborn cases (609), and emergency
department visits (31,764).
At the same time, NHH functions as part of a broader system. While NHH provides the most inpatient
surgeries for the catchment area (473 cases in 2008-2009 or 31.6% of the market share), it does not
provide a majority of them – regional centres play a significant role as well. Hence, there are
opportunities for NHH to provide expanded acute care services, particularly in the surgical program.
NHH can position itself as a viable and strong partner within the acute care network of hospitals in the
CE LHIN to help improve access and reduce wait times across the entire LHIN geography.
Today, the primary demand for NHH’s services is in acute care services, which include:
•
•
•
•
•
inpatient and outpatient surgical program;
emergency department;
surgical and medical inpatient program;
intensive care unit; and,
maternal child care.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Figure 2: Catchment Share of All Inpatient Cases Except Newborns
Catchment Share of All Inpatient Cases
(Except Newborns)
2008-2009
Northumberland Hills Hospital - 59%
Peterborough Regional Health Centre - 13%
13%
2% 3%
4%
Lakeridge Health - 5%
5%
Kingston General Hospital - 4%
59%
13%
Quinte Health Care - 2%
St. Michael's Hospital - 3%
All Other Hospitals - 13%
Figure 3: Catchment Share of Newborn Cases
Catchment Share of Newborn Cases
2008-2009
Northumberland Hills Hospital - 70%
3%
3%
1%
Peterborough Regional Health Centre - 13%
5%
5%
Lakeridge Health - 5%
13%
Kingston General Hospital - 1%
70%
Quinte Health Care - 3%
Mount Sinai Hospital - 3%
All Other Hospitals - 5%
Northumberland Hills Hospital Strategic Plan 2010-2014
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Figure 4: Catchment Share of Emergency Department Visits
Catchment Share of Emergency Department Visits
2008-2009
Northumberland Hills Hospital - 87%
4%
Peterborough Regional Health Centre - 2%
2%
1%
2% 2%
Lakeridge Health - 2%
Quinte Health Care - 2%
87%
Campbellford Memorial Hospital - 1%
All Other Hospitals - 4%
Figure 5: Catchment Share of Adult Inpatient Surgery Cases
Catchment Share of Adult Inpatient Surgery Cases
2008-2009
Northumberland Hills Hospital - 32%
Peterborough Regional Health Centre - 25%
20%
32%
6%
4%
5%
Lakeridge Health - 9%
Kingston General Hospital - 5%
9%
Quinte Health Care - 4%
25%
Sunnybrook Health Sciences Centre - 6%
All Other Hospitals - 20%
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 8
In addition, NHH provides outpatient services which include:
•
•
•
•
ambulatory care clinics;
community mental health and addictions;
a satellite chemotherapy clinic; and,
a satellite dialysis clinic.
NHH also provides a full range of diagnostic imaging services using digital imaging technology that
support both inpatient and outpatient care, including:
•
•
•
•
•
•
•
magnetic resonance imaging (MRI);
computed tomography (CT);
radiology (X-ray);
ultrasound;
nuclear medicine;
mammography; and,
bone mineral densitometry;
Finally, NHH also provides post acute care services, which currently include:
•
•
•
•
interim long-term care;
complex continuing care (occupied by alternative level of care and long-term care patients);
inpatient rehabilitation; and,
palliative care.
NHH has traditionally been exceptionally strong in its ability to engage the community (for more detail,
please see the Relationship with the Community subsection below and the Continuing Engagement
section later in the document) and to attract highly qualified and engaged volunteers. Accreditation
Canada noted in their recent Report that NHH’s volunteers’ “…presence and engagement with the
hospital is remarkable.” 8 NHH’s ability to attract volunteers allows it to broaden and extend the reach of
its services. In recent years, teamwork has also been an area of strength, contributing to the sustained
improvement in a number of patient safety indicators.
Financial Challenges
For three fiscal years ending March 31, 2010, NHH experienced significant budgetary pressures, many of
which stem from the system-wide pressures discussed above. NHH incurred operating deficits of
approximately $560K in 2007-2008, $1.1M in 2008-2009, and $423K in 2009-2010. Restructuring costs
associated with improvement efforts have then added to costs, resulting in overall deficits of over
$2.0M in 2008-2009 and $2.6M in 2009-2010.
These operating deficits have contributed to the short- and long-term debt load of $5.0M at the end of
2008-2009, and $7.1M at the end of 2009-2010. 9 These debt loads threaten the long-term viability of
8
9
Accreditation Canada (2010). Northumberland Hills Hospital Accreditation Report, p. 2.
Short- and long-term debt load calculated as working capital deficit plus long-term debt, excluding other long-term liabilities.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 9
the Hospital. Going forward, NHH must balance its budget and put itself in a position to pay back its
debts in a sustainable manner. This Strategic Plan identifies real opportunities in meeting these financial
challenges, while enhancing quality of care and patient safety.
In December 2008, NHH began a collaborative budget initiative – Shared Challenge, Shared Solution – to
identify opportunities for cost savings through operating efficiencies. This process has highlighted the
fact that NHH operates as part of a larger system. Coordination among health care providers is essential
to ensure quality of care and health system affordability, and many services can be provided most
efficiently and effectively within the community. NHH has therefore made difficult decisions to realign
certain services into the community, including the Hospital’s Diabetes Education Clinic and its
Outpatient Rehabilitation program in April 2010.
NHH has also begun and will continue to build formal relationships with other health care providers –
particularly regional hospitals – to provide other types of services. The development of these and other
relationships are opportunities to build local expertise, enhance service quality and improve access to
services that could not otherwise be delivered in our community. This Strategic Plan positions NHH not
only as a viable community hospital, but also as one that it is an integral part of the CE LHIN acute care
system.
Relationship with the Community
NHH has had strong and deep links to the local community since its earliest days. The NHH Foundation
led a very successful fund raising campaign to build the Hospital, which opened in 2003. Local financial
support has since continued to be generous to help ensure that the Hospital is equipped with the latest,
state-of-the-art medical technologies.
In addition, the NHH Auxiliary – our volunteer organization – has been successful in recruiting and
retaining a very significant base of active volunteers. Involved in most facets of the Hospital, the
volunteers provide needed support to patients and staff. The Auxiliary has also raised significant funds
for capital equipment through various revenue generating operations and special events.
No doubt, NHH is blessed with a generous and supportive community.
And it is for this reason that the Hospital Board undertook a comprehensive and innovative community
engagement exercise in 2009-2010. The approach included the Hospital’s first Citizens’ Advisory Panel;
members were selected through a civic lottery. Its mandate was to provide the NHH Board advice on
service prioritization. This initiative is discussed in detail in the Continuing Engagement section below
and reflects NHH’s intent to sustain and further enhance its relationship with the community.
NHH is proud of its exceptional record of community engagement, particularly because this record has
continued in the face of the difficult service choices made in early 2010. Indeed, it is at such times that
community engagement is the most important. As the CE LHIN has said, the challenge “…is not ‘whether
to involve’ but how to involve well.” 10 NHH has found many ways to “involve well”.
10
Central East Local Health Integration Network (2006). A Framework for Community Engagement and Local Health Planning,
p.1.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Strategic Planning Process
The results of NHH’s community engagement activities have informed, both informally and formally, the
development of this Strategic Plan. Developing this plan has been an intensive process, involving a
variety of internal and external consultations, including the Citizens’ Advisory Panel, LHIN
representatives, service providers, physicians, front-line staff, management, and the Board over the past
year. NHH first used these consultations to understand the needs of the system and its environment, in
addition to commissioning research on the demographic factors affecting west Northumberland County.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Mission, Vision, Values and Mandate
Our Mission
Everything NHH does is anchored in its Mission, Vision, and Values. Our Mission is what we exist to do
for the people of west Northumberland County:
Exceptional patient care. Every time.
As a publicly funded organization, NHH’s community and patients expect to receive value for money
from NHH. In other words, the Hospital is expected to provide quality services – local access, short wait
times, pleasant encounters, health improvement, safe care – through the effective and efficient use of
its limited resources. Patients expect this kind of service and performance for every encounter they have
with NHH.
As demonstrated by its 2010 Accreditation results, NHH excels as a community hospital. The Hospital
met 97% of 1,411 standards, including all Required Organizational Practices which focus on patient
safety practices. The NHH team is committed to setting and achieving an even higher performance
standard: to achieve excellence in patient-centred care for every patient at every encounter.
Our Shared Vision
To deliver on this Mission, the NHH team has agreed upon a Shared Vision.
Leaders and partners creating health care excellence.
This Shared Vision statement situates NHH in its broader context within the health system, and it also
speaks to what the Hospital aspires of its team members. It also describes how NHH wishes to continue
to engage, as partners, its internal and external stakeholders and other health care providers.
Health care in Ontario is changing in many ways, and today’s hospitals are embedded in this large,
changing system as never before. Coordination between health service providers is essential to ensuring
quality of care and health system affordability. In west Northumberland County, NHH is not the single
source of health services, and nor should it be. Our Shared Vision therefore emphasizes that providing
quality health services to our community means being a leader and a partner within the broader health
care system.
The words “leader” and “partner” are deliberately plural. The entire NHH team – the Foundation, the
Auxiliary, the physicians, the front-line staff, the management team, and the Board – must all
demonstrate leadership in their respective circles of influence and responsibility. As leaders, NHH
representatives must also work collaboratively with other health services providers, patients,
community, and funding agencies to partner and strengthen the health care system so that it is better
integrated, more seamless and affordable, and improved in terms of patient safety and quality
outcomes.
Northumberland Hills Hospital Strategic Plan 2010-2014
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The community expects NHH to be a leader, and in doing so, NHH will not shy away from innovative and
creative solutions that improve patient care and overall health system performance. It takes courage
and strong leadership to implement new solutions, and NHH is up for the challenge.
Our Core Values
Our Mission and Shared Vision are grounded in our Core Values:
•
Integrity
•
Quality
•
Respect
•
Collaboration
•
Compassion
Our Service Values
In January 2010, the NHH Board held a strategic planning retreat where it initiated the first iteration of a
Decision Making Framework for Service Prioritization. Subsequently, additional iterations of the
Framework were developed with input from other stakeholders, including representatives from our
physicians, staff, Auxiliary, and Foundation. The final version of the Framework was completed by the
Citizens’ Advisory Panel, which provided the community and patient perspective.
In essence, the Framework is a set of Values that are used as lenses or filters when prioritizing or
evaluating services. These Service Values were used extensively in preparing the 2010/11 Operating and
Service Plan that included the realignment of services into the community. The Decision Making
Framework for Service Prioritization and the related Service Values will continue to be used as a
resource tool for future decision making.
Our Service Values are:
Accessibility
Collaboration
Community Needs and Responsiveness
Effectiveness, Safety and High Standards
Relationships and Public Trust
Sustainability
For detailed definitions on our Service Values, please refer to Appendix A.
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Our Service Mandate
Our Mission, Shared Vision and Values are important statements about what NHH does and will do over
the long term. Today more than ever, these statements must be translated into tangible decisions that
are supported by the community.
In the spring of 2010, NHH’s Board of Directors had to make a most important decision: what core
services should the Hospital continue to provide, given its budgetary pressures? Drawing from
consultations with the full range of stakeholders, the Board developed a new Service Mandate for the
Hospital, which takes into account the geographic, environmental, and service provision demands
discussed earlier. In March 2010, the Board approved the following Service Mandate:
NHH is a community hospital providing acute care services to the west Northumberland
community. In addition, when financially feasible and appropriate, in order to improve
local access, our Hospital partners with other health service providers to deliver advanced
or specialized health services.
NHH is committed to continuously explore and implement delivery models that will
integrate services across the health care system in order to enhance quality of care,
improve access to services and ensure effective use of resources.
This Mandate reflects the strong consensus that NHH’s core services must focus on acute care. It reflects
what the health system and community needs, what the environment demands, and what NHH can best
provide. NHH cannot be all things to all people. Hence, the Hospital must work collaboratively with
community providers to ensure local access to services. And NHH must also partner with regional
centres to ensure coordination for advanced specialty services, to bring in and access expertise not
available locally, to ensure that quality and safety are never compromised, and to ensure that all of the
services are provided in a sustainable manner.
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Strategic Directions, Goals and Objectives
NHH’s Vision is to be leaders and partners creating health care excellence. To deliver on this vision, NHH
has developed a set of Strategic Directions which will drive its Goals and Objectives over the next four
years. Those Strategic Directions are:
1. Patients First: Through our culture of service excellence, we will: deliver safe patient care every
time; design quality into all elements of our care and service; engage patients and families in
their care; and, actively seek innovative ways to improve our care and services.
2. Our Team, Our Strength: Though our commitment to health, teamwork and learning, we will:
retain and attract exceptional people; engage each other in creating a dynamic, healthy and safe
environment; create and promote opportunities for growth, development and mentorship; and,
enable the full potential and scope of practice of all team members.
3. Operational Excellence: Through our commitment to continuous improvement and high
standards of performance, we will: achieve solid financial performance and a culture of
accountability; pursue leading practices and evidence based decision-making; align ourselves,
our processes and financial resources to achieve our goals; and, leverage information
technology to improve decision-making and patient safety.
4. Collaborative Networks: Through our work to create a seamless health care system for our
community, we will: engage our community and partners for their valued input; anticipate and
respond to the population’s changing health care needs; build networks and relationships with
other providers; and, enhance patient care through interprofessional practice, collaboration and
care.
5. Building a Sustainable Future: Through our responsibility to ensure the long-term viability of
our hospital, we will: foster a culture of learning and knowledge sharing; adapt to our changing
environment in a timely fashion; create new and sustainable revenue streams; and, pursue and
choose environmentally responsible solutions.
For each of the Strategic Directions, NHH has set out an Outcome for 2014 along with Goals designed to
bring it about. In essence, the Goals outline what NHH must do to realize its Vision. For each Strategic
Goal, NHH has also specified short-term Objectives it must achieve. These Objectives are the specific
actions that NHH, its departments and people must undertake to move toward realizing the Hospital’s
Vision. Some of these Objectives will be achieved in a year or less, while others will require longer
timeframes to complete. Regardless of how long they take to achieve, they are important because they
represent discrete actions on which progress can be made day in and day out.
Figure 6 below maps out these ideas and acts as an overall guide for the rest of this section. The figure
also highlights the role that Dependencies and Enablers play. As discussed in the next section, NHH’s
success will depend upon the support of its Partners and be enabled by its own Continuing Engagement
with the community.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 15
Figure 6: Strategic Directions and Goals Toward the Vision
Our Shared
Vision
Leaders and partners
creating health care excellence.
Strategic
Directions
Patients
First
Our Team,
Our Strength
Operational
Excellence
Strategic
Goals
1. Culture of Service
2. Culture of Quality and
Safety
3. Patient-Centred
Model of Care
4. Responsive to Unique
Needs of Population
5. Best Prepared
Workforce
6. Progressive, Healthy
Work Environment
7. Team Leading the
Transformation
8. Partnership with the
Physician Community
9. Strong Financial
Performance, Stability
10. Integrated Decision
Support Model
11. Fully Leveraged
IT and EHRs
Collaborative
Networks
12. Engaged Community
13. Integrated Network
of Partners
14. Collaborative Interprofessional Culture
Building a
Sustainable Future
Dependencies
and Enablers
15. Culture of Inquiry
and Innovation
16. Clear Mandate
17. Reduced Reliance on
Government Funding
18. Environmental
Leader
Partners
Continuing
Engagement
The Goals and Objectives for each of NHH’s Strategic Directions are set out below.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Strategic Direction #1: Patients First
Improving the health of Ontarians in west Northumberland County means improving both the
status and quality of their health one patient at a time. By 2014, NHH expects to achieve the
following Outcome:
NHH is recognized for its culture of customer service and quality patient-centred care.
Discussion
A significant amount of foundational work was completed in 2009-2010 that will guide and foster a
culture of customer service, quality and patient-centred care.
Improving customer service in health care organizations has been linked to better patient care, satisfied
staff, and a reduction in preventable medical errors. 11 A customer service strategy will be introduced to
the organization that focuses on three key factors to improve customer satisfaction: understanding,
managing and exceeding our customers’ expectations; communicating effectively to both our internal
and external customers; and, obtaining feedback and using the feedback to improve our processes.
Supporting its strong commitment and focus on quality, the Hospital published its Quality and Safety
Framework: A Commitment to Quality in February 2010. This Framework provides an organizational
definition of quality and safety, describes the structures that the Hospital will use to monitor quality,
describes risk management processes, and outlines criteria for prioritizing quality initiatives.
The four cornerstones of the NHH’s Quality and Safety Framework are Quality Attributes, Safety, Risk
Management, and Performance Monitoring. With the implementation of this Framework, the
interprofessional and quality teams throughout the Hospital are equipped with the necessary expertise;
are supported by the necessary processes and structures; and have the tools necessary to support them
to integrate the quality principles into the care and service they provide on a daily basis.
As defined by the Institute for Healthcare Improvement (IHI), patient-centred care “considers patients’
cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It
makes the patient and their loved ones an integral part of the care team who collaborate with health
care professionals in making clinical decisions. Patient-centred care puts responsibility for important
aspects of self-care and monitoring in patients’ hands — along with the tools and support they need to
carry out that responsibility. Patient-centred care ensures that transitions between providers,
departments, and health care settings are respectful, coordinated, and efficient 12.”
To successfully achieve IHI’s principles of patient-centred care, it will require the active participation and
commitment of NHH’s team of regulated health professionals. NHH will introduce an Interprofessional
Patient-Centred Practice Framework that will complement the goal of patient-centred care. Through a
culture of interprofessional practice, the care team responds to patient and family goals; opens
mechanisms for continuous communication; fosters mutual respect; and, collaborates among health
11
O’Hagan, Joshua and Persaud, David, Healthcare Management Forum, Making Customer – service a priority in health care
organizations , p 27, Winter 2008
12
www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCeneredCareGeneral/. June 2010.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 17
care professionals. The outcomes of this practice include improved workload management, reduced
wait times for patients, and reduced adverse outcomes to care.
A significant component of Interprofessional Patient-Centred Practice is the team’s uncompromised
focus on streamlining and enhancing care processes with the view of making them more patientcentred. Recent initiatives include:
•
•
•
•
•
a focus on reducing the number of ALC patients that will positively impact ED wait times, critical
to the viability of NHH’s acute care services;
the implementation of the LHIN-funded Hospital to Home Program that supports timely
discharge home;
as a component of NHH’s commitment to creating a centre of excellence in geriatrics, the
Hospital Elder Life Program (HELP), which will be introduced with the goal of maintaining the
mental and physical function of at-risk adults while they are at NHH;
a commitment to the introduction of Restorative Care beds focused on returning individuals to
their highest level of independence before they return to the community; and,
the emergency department’s recent LEAN process improvement initiatives, which have resulted
in ED wait times being reduced by 30% on a sustained basis.
NHH has set four Goals to ensure a culture of service and patient-centred care.
Goal #1: A Culture of Service that creates and delivers the ideal patient and
customer experience.
Patients not only receive but also experience care when they come to NHH. Putting them first,
therefore, means providing an experience as close as possible to their individual ideal. To deliver
this experience, NHH needs to create a culture of service.
To achieve a culture of service, NHH must accomplish the following objectives:
•
Objective #1: Identify a customer service model that aligns with our Vision, Mission,
Values and Mandate.
•
Objective #2: Develop a plan to adopt this service model across the Hospital.
•
Objective #3: Commence implementing the service model to high priority service
areas.
•
Objective #4: Update and implement an Accessibility Plan for persons with disabilities
to improve accessibility to our facility and services.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 18
Goal #2: A Culture of Quality and Safety that guides the delivery of patient
care and services.
Excellent patient experiences and care do not happen through processes alone. They require a
hospital to have a culture of quality and safety that guides how people make decisions when
they are facing multiple pressures.
To achieve a culture of quality and safety, NHH must accomplish the following objectives:
•
Objective #1: Develop and implement the Hospital’s Quality and Safety Framework.
•
Objective #2: Develop and implement an Annual Quality and Safety Plan based on the
Quality and Safety Framework.
Goal #3: A Patient-Centred Model of Care.
With a commitment to foster a culture of Interprofessional Patient-Centred Care, as described
above, it is essential that the Hospital align its services to reflect the unique needs of the
community it serves. This alignment will enhance the Hospital’s capacity to provide quality, safe,
patient-centred care and achieve our Mission of Exceptional Patient Care. Every time.
To ensure that it is meeting the unique needs of west Northumberland County, NHH must
accomplish the following objectives:
•
Objective #1: Identify and establish a model of care that supports patient-centred care
and aligns with the interprofessional practice model.
•
Objective #2: Develop a plan to inform, educate and receive feedback from patients
and families about their role as it relates to their care.
Goal #4: A Hospital that is Responsive to and meets the Unique Needs of our
Population.
Hospitals monitor the needs of their patients and communities because they must be prepared
to respond to them in a timely and effective manner. By forecasting needs, hospitals can also
ensure that changes in population needs can be responded to in a timely and proactive manner.
To ensure that it is responding to its population, NHH must accomplish the following objectives:
•
Objective #1: Identify the unique needs of our community as articulated in the
environmental scan/population demographics analyses.
•
Objective #2: Establish innovative patient-centred clinical/service practices, systems
and processes that meet the needs of our population.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 19
•
Objective #3: Complete program plans (short- and long-term) that project future
population needs and align resources through service, operating and
capital plans, as necessary.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Strategic Direction #2: Our Team, Our Strength
If NHH is to have transformational leadership that produces health quality and safety for patients, it will
need to be able to describe itself in terms of the following Outcome in 2014:
NHH is a community of individuals and teams who are fully engaged and inspired to
achieve excellence in everything we do.
Discussion
NHH will need to be vigilant in strengthening its team over the next several years, particularly as the
number of employees eligible for retirement grows. An updated Human Resources Plan is expected to
be completed in the fall 2010, which will provide the necessary road-map and detailed actions necessary
to achieve the Goals outlined below.
For the future, NHH has set itself three Goals to ensure that it has strong teams and strong leadership.
Goal #5: The Best Prepared Workforce that delivers quality patient care in a
culture of continuous learning and high performance.
Excellent care is not delivered by the Hospital so much as the people that comprise it. To ensure
that patients receive the best care, NHH must ensure that its staff are continually learning and
performing at the highest level possible.
To have the best prepared workforce, NHH must accomplish the following objective:
•
Objective #1: Develop and implement a comprehensive Human Resource Plan.
Goal #6: A Progressive, Healthy Work Environment that complements the
unique culture of our hospital.
Even when individuals across the organization are performing their best, they have lives outside
of it. They also want to feel they are a part of the organization. A progressive and healthy work
environment is critical for ensuring that people continue to be at their best at work and at
home.
To have a progressive and healthy work environment, NHH must accomplish the following
objectives:
•
Objective #1: Develop and implement a plan to enhance and support a positive quality
of worklife.
•
Objective #2: Develop and implement strategies to improve staff communication and
engagement in decision-making.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Goal #7: A Team Leading the Transformation with the necessary
competencies.
The health care system today requires transformational leadership. Leaders cannot transform
an organization on passion and drive alone, however. NHH needs to ensure they have the
necessary competencies, skills and time to develop into the best leaders they can be.
To have a leadership team that has the necessary competencies to lead transformation, NHH
must accomplish the following objective:
•
Objective #1: Develop and implement a talent management plan that includes
education, skills development and succession planning for our leadership
team.
Goal #8: A strong Partnership with the Physician Community to support and
enhance patient care in hospital-based services.
NHH is fortunate to have a dedicated complement of medical professionals that support patient
care services at the Hospital. A full complement of family physicians and specialists is essential in
ensuring the long-term sustainability of NHH. Given the ageing physician workforce, it will be
necessary for NHH to enhance its retention and recruitment strategies.
To ensure a continued strong partnership with the physician community, NHH must achieve the
following objectives:
•
Objective #1: Develop and implement a comprehensive Physician Human Resource
Plan. The Plan will address opportunities for recruitment and retention
for family physicians and specialists.
•
Objective #2: Enhance opportunities for family physicians to continue to practice
hospital-based patient care.
•
Objective #3: Renew the medical leadership structure to be further aligned with Board
governance, legislative requirements and best practices in quality and
safety.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Strategic Direction #3: Operational Excellence
Operational excellence for NHH is essential for achieving long-term sustainability and an integrated
health care system. In 2014, NHH expects to achieve the following Outcome:
NHH is financially healthy and provides “value for money” – quality services through the
effective use of our limited resources.
Discussion
As described above, NHH has already made some key decisions to ensure that it returns to strong
financial performance and stability. The collaborative budget strategy, Service Mandate, and
realignment of certain programs reflect NHH’s resolve to balance the budget and preserve the Hospital’s
core services. NHH must continue with this focus and work to develop an integrated decision support
model and leverage technology to improve patient care.
For the future, NHH has set itself three Goals to ensure that it is achieving operational
excellence.
Goal #9: A hospital that has Strong Financial Performance and Stability
through comprehensive service, operating and capital plans.
Strong and stable financial performance for services, operations, and capital investments can
only be achieved through sound financial planning, taking into consideration the resources
available to the Hospital.
To have comprehensive plans creating strong financial performance and stability, NHH must
accomplish the following objectives:
•
Objective #1: Develop and implement strategies to expand traditional revenue sources.
•
Objective #2: Leveraging the Hospital’s capital life cycle plan and anticipated needs,
develop a strategy to ensure timely renewal of the Hospital’s
infrastructure and equipment.
•
Objective #3: Develop and commence implementing a debt repayment plan.
•
Objective #4: Pursue opportunities to maximize operating efficiency.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Goal #10: A Decision Support model that is Integrated into our practices to
improve evidence-based decision making, operating efficiency,
quality and safety.
Strong organizational cultures can help hospitals make the right decisions. But people’s
determination to make the right decisions need to be supplemented by an integrated decision
support function that supplies the data and information necessary to maximize efficiency,
quality, and safety.
To have an integrated decision support model, NHH must accomplish the following objective:
•
Objective #1: Establish a decision support framework (or plan) and identify preferred
processes, tools and skills that integrate with other programs, including
quality and safety.
Goal #11: A hospital that has Fully Leveraged information technologies (IT)
and electronic health records (EHRs) as essential tools and
enablers in achieving our strategic goals.
IT and EHRs can save time and enhance patient safety by reducing errors and ensuring that
critical information is always available and visible. Leveraging these tools is important for any
hospital to achieve its strategic goals.
To have a hospital that has fully leveraged IT and EHRs, NHH must accomplish the following
objective:
•
Objective #1: Develop and implement IT and e-Health plans that support the
achievement of our patient goals.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Strategic Direction #4: Collaborative Networks
Improving access to care for Ontarians requires service and system integration. NHH expects to achieve
the following Outcome by 2014:
NHH has teams and partnerships that enable seamless health care within our Hospital
and in our community.
Discussion
In the 2009-2010 fiscal year, one of NHH’s most significant achievements has been the voluntary
integration of its Mental Health program with that of Ontario Shores Mental Health Centre. The joint
administration of these functions by the two organizations has been widely regarded as a success from
an access, care, and community partner perspective.
NHH continues to collaborate in other areas as well. The Ontario Breast Screening Program is offered at
NHH. It offers to eligible women aged 50-74 without charge and without a doctor’s referral a high
quality mammogram along with their results, educational materials and access to follow up care. NHH
also provides chemotherapy services as a satellite from the regional centres in Kingston and Oshawa
with the assistance of Cancer Care Ontario. NHH is also strengthening the role it plays in the Regional
Renal Program affiliated with the Peterborough Regional Health Centre.
Because seamless care involves community engagement, NHH also needs to build formally on its recent
successes. One of these successes is the Volunteer Chaplaincy program initiative in 2010 to serve
patients and families from many faiths.
For the future, NHH has set itself three Goals to ensure that it creates a seamless health care
system for the community.
Goal #12: An Engaged Community and hospital team in planning for our
community’s health care system.
NHH has an exceptional track record of success in engaging the surrounding community (for
more detail, see the Continuing Engagement section). NHH needs to build on this success to
ensure that the population’s needs are met by the system as a whole.
To have an engaged community, NHH must accomplish the following objective:
•
Objective #1: Develop and commence implementing an Engagement Framework and
strategy.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Goal #13: An Integrated Network of Partners that provide seamless health
care services in our community.
System and organization pressures have forced NHH to make hard choices about what services
it provides. This does not mean, however, that NHH’s population cannot receive the services it
needs. By building an integrated network of partners, NHH can ensure its population receives
the care it requires, regardless of which organizations actually provide it.
To have an integrated network of partners, NHH must accomplish the following objectives:
•
Objective #1: Implement alternative models of service delivery in collaboration with
other service providers and government agencies by leveraging the
Hospital’s redefined services and the LHIN Making Choices Framework.
•
Objective #2: Continue to respond to the recommendations of the CE LHIN Clinical
Service Plan, and continue to participate in other regional service
planning activities.
Goal #14: A Culture of Interprofessional practice, Collaboration, and care
that enables quality patient care and a healthy workplace.
Health care is becoming ever more complex, and a great variety of professionals are needed to
ensure that patients receive the right type of care at any given time. This reality demands that
NHH develop a culture of interprofessional practice, collaboration and care. The goal will, in
turn, support the Hospital’s staff retention and recruitment efforts.
To create a culture of interprofessional collaboration, NHH must accomplish the following
objectives:
•
Objective #1: Design and implement an interprofessional and ethical practice model.
•
Objective #2: Identify and build upon organizational structures and processes that
enable interprofessional practice, collaboration and care.
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Page 26
Strategic Direction #5: Building a Sustainable Future
Building a Sustainable Future means creating a future that is financially, operationally, and
environmentally sustainable. By 2014, NHH expects to be able to say that:
NHH has realized new opportunities to ensure long-term sustainability.
Discussion
NHH has adopted a Decision Making Framework for Service Prioritization using a values-based model
and it has developed a new Service Mandate outlined previously in this document. In the coming
months, NHH will take concrete actions to produce a genuinely sustainable future.
For the future, NHH has set itself four Goals to ensure the long-term sustainability of the organization.
Goal #15: A Culture of Inquiry and Innovation that enables the timely
adoption of leading practices, concepts and ideas.
Hospitals need to constantly expand the stock of knowledge they use, even while they face
challenges in integrating what they already know into their practice. NHH therefore needs to
foster a culture of inquiry and innovation to ensure that it is always aware of the best ideas
available.
To create a culture of inquiry and innovation, NHH must accomplish the following objectives:
•
Objective #1: Investigate and identify key success factors of innovative organizations.
Establish a plan to foster a culture of innovation that is appropriate for
our Hospital.
•
Objective #2: Establish a multi-year plan that will support and reward staff for
innovation.
•
Objective #3: Pursue opportunities for student training (medical, clinical and nonclinical professionals), particularly in high-need areas.
Achieving the objectives identified under Strategic Goal #4 (Responsive Hospital) will also help
to achieve a culture of inquiry and innovation.
Goal #16: A Clear Mandate that defines the scope of services the hospital is
able to provide to its community.
Recent financial pressures have created a demand for clarity about what NHH can provide and
what it cannot. A clear mandate is essential if the Hospital is to deliver on its Mission and Vision.
Northumberland Hills Hospital Strategic Plan 2010-2014
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To have a clear mandate, NHH must accomplish the following objectives:
•
Objective #1: Finalize and adopt NHH Decision Making Framework for Service
Prioritization.
•
Objective #2: Redefine the core services for NHH in a transparent, inclusive and
proactive manner.
This goal and these objectives are essentially complete by June 2010. Please refer to the above
sections entitled, “Our Service Values” and “Our Service Mandate.” However, NHH will need to
reference these tools from time-to-time in its decision making and consider refinements as
deemed necessary by the Board.
Goal #17: A hospital that has Reduced Reliance on Government agency
Funding by pursuing non-traditional hospital revenues.
As the MOHLTC and CE LHIN experience their own pressures, the logical next step for NHH is to
pursue non-traditional revenue sources.
To have a hospital less reliant on government agency funding, NHH must accomplish the
following objectives:
•
Objective #1: Identify, pursue and secure new non-traditional funding sources.
•
Objective #2: Leverage the Hospital’s property assets to develop new revenue streams.
Goal #18: An Environmental Leader in our community and in the hospital
sector in choosing responsible solutions.
Hospitals place heavy demands on the environment, but those demands can lighten when
people are environmentally conscious and creative in how they do things. NHH wants to be a
leader on this front.
To be a leader in choosing environmentally responsible solutions, NHH must accomplish the
following objectives:
•
Objective #1: Develop an Energy Conservation Plan to reduce the Hospital’s carbon
footprint and reduce operating costs.
•
Objective #2: Update the Hospital’s procurement policies and procedures to reflect
environmental considerations.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 28
Dependencies and Enablers
While NHH is largely responsible for whether or not it achieves its strategic directions, success is also
dependent upon and enabled by other parties.
Partners
The MOHLTC and CE LHIN are key partners in supporting NHH in achieving its success, not least because
they provide the majority of the Hospital’s funding. As provincial, system and hospital budget pressures
increase, the MOHLTC, CE LHIN and NHH will need to work collaboratively with one another to ensure
alignment of goals and strategies.
In addition, NHH has established good working relationships with its labour unions, specifically the
Canadian Union of Public Employees (CUPE), the Ontario Nursing Association (ONA), and the Ontario
Public Sector Employee Union (OPSEU). It is imperative that a spirit of collaboration continue as the
Hospital responds to new expectations in health policy and legislation, and as the MOHLTC and CE LHIN
guide system-wide transformational changes that are expected in the coming years.
By working closely with its partners, NHH will succeed in achieving its strategic directions.
Continuing Engagement
Renewed community engagement is a Strategic Direction for the MOHLTC, and it has been an important
priority for the CE LHIN, as evidenced by its 2006 Framework for Community Engagement and Local
Health Planning. NHH has also had success in engaging the community, and must continue to do so
going forward.
Building from the Citizens’ Advisory Panel
The Citizens’ Advisory Panel (CAP) has been referenced throughout this document because it represents
a model upon which NHH will build in future. NHH will strive to incorporate its core elements – inclusive,
transparent and proactive – in all of its engagement activities going forward. The CAP process is
summarized below to better understand how NHH intends to build on its success.
In August 2009, the Board of Directors passed a resolution authorizing the CAP process. To oversee and
support this community engagement initiative, a Collaborative of expertise was established:
•
•
•
•
NHH Board of Directors;
External consultants, MASS LBP;
Researchers from Queen’s University’s School of Business; and
The Northumberland Community Futures Development Corporation.
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 29
The CAP’s terms of reference were to develop a Decision Making Framework for Service Prioritization
and apply it to develop recommendations about which services should be regarded as “core” and “noncore” for purposes of providing strategic direction to the Hospital.
To select the panel members a civic lottery was used. NHH retained a firm to mail invitations to 5,000
households, chosen at random, in west Northumberland County. Of the nearly hundred people that
volunteered, 28 were chosen to ensure that the sample was balanced by gender, age and geography.
This ensured a reasonably representative sample of the community and, given the methodology, as
legitimate a sample as anyone could expect.
The selected citizens (the CAP) were required to attend five Saturday sessions (between October and
December 2009) during which they were supported in learning about the health system and the hospital
sector. The sessions included many guest presentations, including: local physicians, the CE LHIN, the
Ontario Hospital Association, the Central East Community Care Access Centre (CCAC), the Port Hope
Community Health Centre, and a health planner who provided demographic analyses of the west
Northumberland community.
The CAP finalized the Service Values for making decisions about prioritizing services (see Appendix A for
definitions):
•
•
•
•
•
•
Accessibility
Collaboration
Community Needs and Responsiveness
Effectiveness, Safety and High Standards
Relationships and Public Trust
Sustainability
Subsequently, the CAP held a series of deliberative sessions to develop their recommendations,
including a Public Round Table that was held in Port Hope. The Round Table was attended by
approximately forty citizens.
The CAP then developed a list of potential services that could be considered core and non-core
services. 13 Finally, the CAP voted on which services they deemed “core” and “non-core”. The “non-core”
services the panel arrived at included the two services NHH recently realigned into the community.
To evaluate the process, NHH also retained researchers from Queen’s Monieson Centre to evaluate the
process as a whole. As the researchers’ final report noted, “The final decisions on service cuts made by
the NHH Board closely mirrored the advice from the CAP.” 14 The report also concluded that “…the
community engagement process followed by NHH achieved its major goals, and must be considered a
success.” 15
13
For additional detail, see Northumberland Hills Hospital Citizens Advisory Panel on Health Service Prioritization (2010). Final
Report.
14
The Monieson Centre (2010). Report on the Community Engagement Process, p. 32
15
The Monieson Centre (2010), p. 33.
Northumberland Hills Hospital Strategic Plan 2010-2014
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In April 2010, NHH’s CAP process was recognized by the Hon. Deborah Matthews, Minister of Health and
Long-Term Care: “I also want to take a moment to talk about the citizens' advisory panel. I think this is a
very innovative approach that Northumberland Hills Hospital took in this case. They actually brought
together citizens and gave them very intense education into what some of the choices were in the
hospital. There is no question that these are tough decisions, but the citizens' advisory panel was
something that I think other hospitals may wish to explore, because it does actually ask the people in
the community what they need to protect and what could be done better outside…” 16
Overall, this kind of innovative, open and transparent process is something that NHH continue to build
on for the future, particularly as it makes decisions about how to deliver patient services in a
coordinated fashion with other health service providers in an integrated health care system.
16
House Hansard. Ontario Legislative Assembly. Issue L022, Oral Questions, Health Care Funding. April 27, 2010.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Alignment with the MOHLTC and CE LHIN
Health services in Ontario are delivered through a system designed to ensure that health organizations
are accountable to the government and the citizens that elect it. To ensure that NHH provides services
that are both needed by citizens and well integrated into the broader spectrum of care provided by the
system, its vision and strategic directions should be well aligned with those of those of the MOHLTC and
CE LHIN.
How We Are Aligned
Like NHH, the MOHLTC and CE LHIN have both articulated Visions for the system and how it will operate
in throughout the region. As Figure 7 shows, NHH’s Vision is well aligned with their Visions.
Figure 7: Aligning Visions
MOHLTC
Vision
A health care system that helps people stay healthy, delivers good care to them
when they need it, and will be there for their children and grandchildren.
CE LHIN
Vision
Engaged Communities. Healthy Communities.
NHH
Vision
Leaders and partners creating health care excellence.
The Visions above are powerful statements about what these organizations will produce in the coming
years. The consistency among them is also clear – what is it to create health care excellence but to
deliver good care, engage people, help them stay healthy, and do so in a sustainable manner?
This consistency also holds when one looks more closely at the handful of Strategic Directions that each
organization has set out to keep its Vision front and centre as it moves forward. Figure 7 places NHH’s
Strategic Directions in the context of those charted by the MOHLTC and CE LHIN. 17
17
The Strategic Directions for the Ministry and CE LHIN come from the CE LHIN’s 2010-2013 Integrated Health Service Plan. For
presentational purposes, the two organizations’ Strategic Directions have been abbreviated and the order in which they are
presented changed to demonstrate their consistency with NHH’s Strategic Directions.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Figure 8: Aligning Directions
MOHLTC
Strategic Directions
CE LHIN
Strategic Directions
NHH
Strategic Directions
Improved Health Status
for Ontarians
Quality and
Safety
Patients
First
Improved Quality of
Health Outcomes
Our Team,
Our Strength
Equitable Access to Care
and Services
Transformational
Leadership
Renewed Community
Engagement
Service and System
Integration
Establish Framework for
Sustainability
Fiscal
Responsibility
Operational
Excellence
Collaborative
Networks
Building a Sustainable
Future
Figure 8 demonstrates the progression and consistency of Strategic Directions across the organizations.
The clusters of Strategic Directions overlap extensively with one another while permitting each
organization to speak directly to the concerns of its particular stakeholders.
This consistency of Vision and alignment of Directions provides the basis for ensuring that the chain of
accountability is preserved to ensure that the authorities, responsibilities, services and funding that
cascade down the system are properly exercised.
Alternate Level of Care Patients, Wait Times and Vascular Disease
The MOHLTC and CE LHIN have placed strategic emphasis on three initiatives or aims: reducing the
number of ALC patients; reducing ED wait times; and, reducing the impact of vascular disease. 18As
discussed in the Patients First section, NHH has a number of initiatives underway to reduce the number
of ALC patients, including the Hospital to Home Initiative and the Hospital Elder Life Program (HELP). In
addition, NHH and the CE LHIN are working with the Aging At Home Program to maintain existing
interim Long-Term Care (iLTC) and Restorative Care beds as part of NHH’s ALC strategy. Reducing ALC
patients in the Hospital will ensure that acute care services are not compromised by ensuring that beds
are available for acute surgical and medical patients when needed. Finally, NHH is recognized by the CE
LHIN as a partner in its Strategic Aim of reducing the impact of vascular disease. NHH works through its
inpatient and primary care programs to provide the prevention, screening, and early detection that will
help bring this reduction about.
18
Central East Local Health Integration Network (2009). Integrated Health Service Plan 2010-2013.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Appendix A: Definitions of Our Service Values
As described in the final report of the Citizens’ Advisory Panel, NHH’s Service Values are:
•
Accessibility. Services and patient care are considered accessible if they are delivered in a timely
manner, are easy for patients to navigate and do not impose costs on the patient. “Userfriendly” patient care stems from having a streamlined process throughout the continuum of
care. This process must ensure timely diagnosis, treatment, and follow-up care.
•
Collaboration. Services are considered collaborative if they work with other services and health
providers, both within the Hospital and within the wider community, to enhance patient
outcomes and increase service efficiencies. Collaborative services share knowledge, costs,
promote teamwork and ultimately work towards providing patients with fast, effective, and lowcost care.
•
Community Needs and Responsiveness. Services are considered responsive to community
needs if they use mechanisms to gather and use information about the community to proactively respond to current and future community health needs.
•
Effectiveness, Safety and High Standards. Services are considered effective if they lead to the
best possible patient outcome, safe if they are adequately resourced to respond to patients’
needs in a timely manner and safe environment, and of a high standard if they use leading
practices, information and technology.
•
Relationships and Public Trust. Services that inspire public trust, and that nurture a positive
relationship between the Hospital and the community, provide care that is approachable,
respectful, and strives to keep up to the highest standards. Highly trained staff and state-of-theart equipment help to ensure that patients trust the Hospital to give them the best care
possible.
•
Sustainability. Services are considered sustainable if they respond to the community’s needs as
these needs change, using partnerships with other health providers whenever it is appropriate
and possible. Sustainability requires maintaining the fiscal, human and technical resources
required to provide high-quality services. In particular, relationships with local health care
providers are important for sustaining services.
Northumberland Hills Hospital Strategic Plan 2010-2014
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Appendix B: Key Reference Documents
Throughout this Strategic Plan, NHH has referred to a variety of internal and external documents. For
interested readers, Table 1 below lists and provides links to the publicly accessible reference documents.
In the electronic version of this plan, a direct link to each document is provided in the title.
Table 1: Key Reference Documents
Author(s)
Year
Document Title
Website
Baker et al.
2004
Baker Report (Canadian
Adverse Events Study)
www.cmaj.ca/cgi/content/full/
170/11/1678
CE LHIN
2009
Integrated Health Service
Plan, 2010-2013
www.centraleastlhin.on.ca
CE LHIN
2006
A Framework for Community
Engagement and Local
Health Planning
www.centraleastlhin.on.ca
NHH
2009
Citizens’ Advisory Panel
Terms of Reference
www.nhh.ca
NHH (CAP)
2010
Citizens’ Advisory Panel on
Health Service Prioritization
Final Report
www.nhh.ca
NHH (HCM)
2009
Environmental Scan
www.nhh.ca
Ontario Ministry
of Finance
2009
2009 Ontario Budget: Budget
Papers
www.fin.gov.on.ca
OACCAC,
OFCMHAP, and
OHA
2010
Ideas and Opportunities for
Bending the Health Care Cost
Curve
www.oha.ca
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 35
In addition, the following chart summarizes the various reference documents (plans, frameworks,
models, etc.) that support the Strategic Plan. These reference documents are primarily tactical or
operational in nature and specifically address the Strategic Objectives outlined in this Strategic Plan.
NHH 2010-2014 Strategic Plan
Strategic
Directions
Patients
First
Strategic Goals and Objectives
(Reference Documents)
Quality and Safety
Framework
Interprofessional
Practice Model
Customer Service Model
Our Team,
Our Strength
Human Resource Plan
Physician
Human Resource Plan
Talent Management Plan
Operational
Excellence
Capital Life Cycle Plan
Information and
Communications
Technology Plan
Financial Plans for
Revenues and Debt
Repayment
Collaborative
Networks
Community Engagement
Framework
Central East LHIN
Clinical Service Plan
Building a
Sustainable Future
Decision Making
Framework for Service
Prioritization
Regional Program Plans
for Mental Health,
Dialysis and Cancer
Services
Campus
Development Plan
Energy
Conservation Plan
Northumberland Hills Hospital Strategic Plan 2010-2014
Page 36