Dr' Hugh Scott, President

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Community-based Initiatives For Community-based
Solutions
Roundtable Discussion

• Dr. Hugh Scott, President CEO
• The Scarborough Hospital
• April 6, 2006

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The Scarborough HospitalWho We Are

• Canadas largest urban community health system
• 4,000 health care professionals and 800
  volunteers
• We are employee, patient and community-service
  driven
• Our priority is outstanding health care for our
  community
• We are Scarboroughs largest employer

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Who We Are

• Two acute care campuses
• -General Campus Lawrence Ave East and McCowan
• -Grace Campus Finch Ave East and Birchmount
• Six community-based centres
• Bridgepoint Centre Nephrology satellite
• Corporate Drive Centre
• Eglinton Avenue Centre
• Kennedy Road Centre
• Manse Road Centre
• Urban Outreach Family Health Centre

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What We Provide

• Patient care areas include
• Cardio-Respiratory Critical Care
• Emergency Urgent Care
• Family Medicine Community Services
• General Subspecialty Surgery
• Maternal Newborn Child Care
• Medicine Geriatrics
• Mental Health
• Nephrology Dialysis
• Orthopaedics Rehabilitation

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Who We Serve

• TSH delivers care to the worlds most diverse
  community
• 55 Foreign Born
• 60 Visible Minority
• Over 25 different ethnic groups multiple
  languages
• Top countries of origin Sri Lanka, India, China
• (Source 2001 Census)
• TSH delivers health care to over 600,000 people
  in Scarborough and beyond.

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TSH Evolves with the Community

• The community of Scarborough continues to change.
• 10-year growth from 1991 to 2001
• 12 in total population
• 18.6 in persons 65 and older
• 25 in lone parent families

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What We Do Matters

• Our priority is outstanding health care for our
  community
• Innovation
• TSH is one of only three Ontario hospitals
  selected by the MOHLTC to pilot the Drug Profile
  Viewer system
• TSH is one of the leaders in Canada to adopt the
  Emergency Department Management (EDM) module
• TSH is among the top 30 per cent of Ontario
  hospitals to first adopt digital, filmless
  radiology images

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What We do Matters

• In 2005-06, TSH increased cataract procedures to
  4500 and has contracted with the Ministry to
  increase this to 5264 in 2006-07 More than
  100/week!
• In 2003-04 (despite SARS) in Ontario TSH
  performed
• the 3rd highest number of bowel operations for
  cancer
• The 6th highest number of mastectomies for cancer
• The 6th highest number of radical prostatectomies
  for cancer
• The 10th highest number of hysterectomies for
  cancer
• For these four procedures combined TSH was the
  7th most active in Ontario
• TSH is Scarborough based, but does not limit care
  to Scarborough residents
• Conversely, many people in Scarborough choose to
  obtain their hospital care elsewhere

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What We Do Matters

• We understand the diverse community we serve
• Exceptional Care
• TSH is a leader in approaches and best practice
  for
• Multicultural Health Care
• Multifaith Spiritual Care

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What We Do Matters

• TSH staff demonstrate long-standing dedication
• Pride in Our Work
• TSH staff, physicians and volunteers have
  dedicated up to 45 years of service.
• We are performance and results-obsessed and
  continuously measure our work through a balanced
  scorecard approach.

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A Five Year Overview of Key Indicators
What We Do Matters
Admissions
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A Five Year Overview of Key Indicators
What We Do Matters
Patient Days
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A Five Year Overview of Key Indicators
What We Do Matters
Newborns
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A Five Year Overview of Key Indicators
What We Do Matters
Average Length of Stay
Days
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A Five Year Overview of Key Indicators
What We Do Matters
Newborn Average Length of Stay
Days
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A Five Year Overview of Key Indicators
What We Do Matters
Inpatient Surgery
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A Five Year Overview of Key Indicators
What We Do Matters
Outpatient Surgery
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A Five Year Overview of Key Indicators
What We Do Matters
Hips Knees
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A Five Year Overview of Key Indicators
What We Do Matters
Emergency Room Visits
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A Five Year Overview of Key Indicators
What We Do Matters
Dialysis
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A Five Year Overview of Key Indicators
What We Do Matters
MRI
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Where do Scarborough residents get their care?
Steeles Ave
Markham Rd
Victoria Park Ave
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Central East LHIN

• Total Population 1.459,800 (close to 1.5
  million)
• Approx. 40 (600,000) population from Scarborough
  area
• Projected population growth in CE LHIN is 6.9
  higher than provincial growth rate 5.4
• South East Corner of the LHIN is a high growth
  area economic growth in Scarborough, Markham
  expansion of 407 in Durham urban sprawl into
  Pickering, Oshawa
• MOHLTC identifies four high volume hospitals
• The Scarborough Hospital, Rouge, Lakeridge,
  Peterborough Regional

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Clinical Priority Setting Process What

• The Scarborough Hospitals clinical services
  planning
• Consultative, collaborative and team-focused
  planning process. NOT an economic exercise
• Updates planning done in 2001
• Informs our long term clinical service plan and
  defines TSHs clinical priorities over the next
  five to ten years
• This Clinical Priority Setting Process (CPSP) was
  initiated in 2004

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Clinical Priority Setting Process Why

• Ensure resources are being utilized to best meet
  the evolving needs of the community we serve
• TSH to move forward as one unified, thriving,
  balanced system providing high quality patient
  care.
• To develop areas of clinical focus for each acute
  care Campus create Centres of Excellence.
• To create critical mass in programs to sustain,
  recruit and retain health human resources.
• To position TSH positively with the Ministry and
  within the Central East LHIN

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Clinical Program Steering Committee (CPSC)
Mandate

• Develop an evidence based plan of action for TSH
  that
• Supports the mission, vision and values of the
  Hospital
• Aligns with the health care needs of our
  community
• Creates a unified hospital within the larger
  health care sector
• Has 2 emergency departments operating 24 hours
  per day, 7 days per week
• Includes the new Emergency and Critical Care
  Centre at the General Campus

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Current Status
Blue indicates service is provided at one
campus only, it does not imply that theprogram
serves both campuses
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CPSC Recommendations

• Two 24/7 Full Service Emergency Rooms
• Two ICUs New spectacular E.C.C.C. at General
  Campus
• Two General/Medicine/Geriatrics programs
• Family Practice at both campuses Urban Outreach
  health centre at General campus

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CPSC Recommendations

• Stroke Unit - sited at General Campus
• Evidence for model of care
• Service delivery model best supported at General
• MRI access necessary (General)
• Orthopaedics and Rehabilitation - Integrated
• Develop Joint Replacement Centre of Excellence at
  Grace
• Supports Emergency Services at both campuses

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CPSC Recommendations

• Maternal Newborn Child IntegratedPaediatrics
• Consolidate Inpatient Paediatrics
• Consolidate Paediatric Same Day Surgery
• Obstetrics
• Obstetrics at each campus on budget
• Neonatal/perinatal services of paediatricians at
  both campuses
• Maintain and enhance ambulatory Paediatrics at
  both campuses
• Gynaecology
• Gynaecology at both campuses
• Gynaecology Oncology developed at General Campus
  (with Cancer Focus/Womens Health)

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CPSC Recommendations

• Mental Health
• Consolidate Inpatient Psychiatry at the Grace
  with enhanced ambulatory programs at both
  campuses plus in the community
• Enhanced co-ordination with Rouge Valley and
  Community agencies
• Cataract Surgery
• Increased Volume, consolidated for maximum
  efficiency at the Grace campus

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CPSC Recommendations

• Cancer Care
• Develop Comprehensive Cancer Program with
  increased screening and co-ordinated follow-up
  services
• Increase availability of lung and gynaecologic
  cancer surgery
• Consolidation of Palliative Care at the General
  Campus in enhanced surroundings with the same
  number of total beds. Enhanced consult service
  for both campuses and greater co-ordination with
  community agencies

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CPSC Recommendations

• Regional Dialysis Program to be significantly
  increased due to demand
• Convert flourishing Vascular Surgery program to
  full Regional Program
• Maintain Sexual Assault/Domestic Violence Service
  at Grace Campus
• General Surgery and Endoscopy both campuses
• ENT/Oral Surgery consolidated at Grace campus,
  Plastic Surgery at the General campus

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Mental Health
Site TBD
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Conclusions

• Total Health Care provided by all sites of TSH
  has grown and evolved dramatically in the past 5
  years
• All services currently provided will continue at
  least at their current levels at TSH
• Selective, prudent growth will occur in areas of
• Demonstrated need
• Priority areas identified by Ministry, LHIN
  and/or TSH internal processes
• Where TSH has a demonstrated advantage or niche
• Feedback throughout this process has been
  invaluable. All has been considered and important
  changes made in response to it

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Conclusions

• TSH will continue to evolve with its community,
  with changes in health care, with technologics
  advances in an innovative and efficacious way
• TSH is determined to be a leader not a follower
  and not a also ran
• Would the people of Scarborough want or expect
  any less?

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Discussion

• Specific questions?
• Comments?