Strategic Plan


Contents

I. Introduction               3

A. Introduction Letter from Board Chair and CEO               3

B. Woodstock Hospital Today               4

C. Woodstock Hospital in the Future               5

II. Mission, Vision and Values               7

III. Strategic Plan Overview               9

A.               About the 2016-19 Strategic Plan               9

B.               Strategic Planning Process               9

C.               Accomplishments from the Strategic Plan 2012-2014               12

IV. Plan for the Future               13

A.               Strategic Directions 2016-2019               13

V. Context for Change               18

1. Regional Priorities               18

2. Population Profile               20

3. Financial Landscape               25

4. WH Resources               28

5. Quality and Safety Performance               36

         Appendix A: Data Tables               49

Tactical Plan               52

         Appendix B: “Former” Tactical Plan 2012-14               56

 

 

 


I. Introduction    

A. Introduction Letter from Board Chair and CEO

Letter from Ken Whiteford, Chair, Board of Directors
and Natasa Veljovic, President and Chief Executive Officer

Woodstock Hospital (WH) delivers high quality healthcare to the community in a state-of-the-art facility with exceptional healthcare providers. We hold ourselves accountable to our patients for safe, quality healthcare, while meeting the challenges of the economic realities and the growing needs of our community. We strive to continue our role as a regional support and advocate for our community and we have committed to working closely with our community and health system partners to develop an integrated health system. We have framed our strategy within the context of the Patients First: Ontario Action Plan for Healthcare to work towards a sustainable, patient centered healthcare system.

WH’s Strategic Directions for 2016-2019 are:

C:\Users\wh-munawaryusra\Desktop\WFH folder\new strat directions.png

This plan was developed with input from our patients, providers, community partners and provincial agencies. Our staff, physicians, volunteers, and Board of Directors were exceptionally well engaged, demonstrating the commitment and dedication of the people of Woodstock Hospital.  Our process was guided by the importance of transparency, ethics and fairness in decision-making.  When implementing the Strategic Directions, we must carefully balance quality, safety, access to care and financial sustainability in order to deliver effective and efficient health care.

 

The Strategic Plan 2016-19, approved by the board on January 26, 2016, is OUR plan and we must work together to successfully implement it. Every individual at Woodstock Hospital has a role in this plan, whether it is in direct patient care, administration, support services, or in a volunteer capacity. We have outstanding staff, physicians, volunteers, and leaders whose dedication and skills have created a foundation for our shared success.  Each day, we want to come to Woodstock Hospital proud of the fact that we are providing exceptional care to our patients, supporting them as they move through the health system. Our environment is evolving and the Strategic Plan 2016 to 2019 provides us with the necessary direction to continue moving forward and creating positive momentum in our organization.

Committed to Patient Safety & Quality Care
 

Ken Whiteford                                                                       Natasa Veljovic

Chair, Board of Directors                                           President & CEO

B. Woodstock Hospital Today

Opening its doors in 1895, Woodstock Hospital (WH) has evolved to become one of the major providers of healthcare in Oxford County servicing a population of at least 105,700 residents [1] .  Below is a listing of WH’s service complement:

Core Hospital Programs:

        General Medicine

        Surgery

        Emergency

        Mental Health

        Complex Continuing Care

        Rehabilitation

        Obstetrics and Gynecology

        Ambulatory Services

Regional Programs:

        Renal Program (nine chair dialysis)

        Oncology (six station regional systemic therapy satellite of London Regional Cancer Program)

        Ontario Breast Screening

Clinical Supports:

        Pharmacy

        Laboratory Services

        Diagnostic Imaging (MRI/CT Suite)

Other Services:

        Regional Support Associates

        ProResp Home Oxygen Therapy

        Woodstock Rehabilitation Clinic

        Lifeline

The Medical Office Building is comprised of additional square footage to accommodate physician turnkey offices


Woodstock Hospital is committed to delivering the highest quality healthcare for its patients and community. The hospital moved into its current state-of-the-art facility in 2011, with $25 million worth of new capital equipment, to ensure that the right tools are being used for the right care at the right time. WH is dedicated to recruiting and retaining the best talent to serve the community as the staff, physicians and volunteers of this hospital are at the core of the organization’s operations and successes. Accredited with an Exemplary Standing in 2012, the hospital will be participating in the Accreditation process once again in December 2016 with the hopes of maintaining our top rating.

WH is an organization that has enjoyed success in providing excellent quality patient care. Quality can be measured and tracked in patient wait times for services, infection rates, as well as by patient satisfaction. In areas such as laboratory and diagnostic imaging services, WH’s wait times are much shorter than the provincial average. Additionally, WH’s patient satisfaction rates are consistently higher than the provincial average, with some areas enjoying 100% satisfaction reported by patients. WH is proud of its accomplishments to date and looks forward to continued progress in providing high quality care and excellent service.


C. Woodstock Hospital in the Future

In order to accomplish its mission to deliver quality-based patient centered hospital care directly and through collaborative partnerships, some critical changes must be made to the way the hospital operates.  WH must change its current practices to adapt to the changing environment and more effectively meets its patients’ needs.  To do this, WH must change its focus. 

Measuring key performance indicators will enable WH to track its progress towards its long term vision and identify areas of improvement:

Hospital Performance Measures

Patient Access and Outcomes

Financial Health

        Patient Satisfaction

        Service volumes (e.g. ER visits, day surgery)

        Readmission rates

        Average Length of Stay

        Total margin (Return on Investment)

        Post Construction Operating Plan (monitor)

        Administration expenses as a percentage of total expense

        Current ratio

Organization Health

Innovation and Development

        Staff satisfaction

        Staff turnover

        Staff ratio (full time to part-time ratio)

        Safety record

        New capacity building

        Research collaboration

        Continued fundraising (equipment replacement)

        Number of system integration projects


Building a patient centered health system involves the structuring of all components to support the needs of the patients and their families. WH commits to a service model to ensure efficient processes and effective delivery of the quality agenda, based on the Ontario Public Service Organizational Excellence Framework :

Our Processes:

-           Designing Effective Processes

-           Ensuring Value

-           Timely Access to Information

-           Safe and Reliable

Our Planning:

-           Proactive Environmental Scanning

-           Prioritizing Resources

-           Measurement and Evaluation

Our Leadership:

-           Collaboration with Partners

-           Service Excellence

-           Participation

-           Value Creation

Our People:

-           Talent Management

-           Life Long Learning

-           Inter-Professional Respect

Our Partners:

-           Patient Focus

-           Seamless Care

-           Appropriate Navigation

Our Results:

-           Safety

-           Quality Care

-           Timely Access


WH also ascribes to the Triple Aim Framework in alignment with the quality agenda within the legislated Excellent Care for All Act (ECFAA):

Quality

Access

Sustainability

Responsiveness to community through addressing diverse needs and improving the patient experience

Learning and improving through increasing patient and employee safety standards

Investing in the quality of our staff by providing opportunities for continuous skills development

Improving access to services throughout the continuum of care, including primary care and mental health

Decreasing wait times, particularly in surgery and emergency department

Focus on that which only hospitals can do and link patients to other providers, where appropriate

Living within our means by adhering to our budget and adding value

Fostering a work environment that provides the conditions for success to all staff and physicians

Aligning with strategic directions while optimizing employee skills with needs

II. Mission, Vision and Values

The three dimensions of Mission, Vision and Values define the purpose of the organization, describe what it aspires to be and detail the guiding principles by which it strives to achieve its goals. The following are the organization’s three dimensions:

 

 

Caring

Compassion

Confidentiality

Commitment

Competence

Communication

 

Service Excellence:

The Components of Service Excellence encompass everything we do at Woodstock Hospital and are an essential part of our future vision and how we will get there. The leadership, staff, physicians and volunteers at Woodstock Hospital are all committed to the six components of Service Excellence in day to day work as well as in building towards a progressive future.


Strategic Alignment Model:

Woodstock Hospital’s Strategic Alignment Model represents the way the different components of the hospital work together to support the overall corporate strategy. It also shows how the strategy is aligned to the mission, vision and values of the hospital:

 


III. Strategic Plan Overview

A.      About the 2016-19 Strategic Plan
 

A strategic plan is required to continue moving towards our organization goals and our future state. This strategic plan will be WH’s tool with which short-term plans and courses of action are constructed.  This strategic plan will enable WH to position ourselves effectively to reach our maximum potential, while constantly adjusting according to the changing environment. The plan will also support change initiatives while strategically aligning, maximizing and sustaining resources in a fiscally challenging environment. This plan will also be used as a framework to strategically allocate WH’s resources to play a key role within the Southwest Local Health Integration Network.

WH’s vision, mission, and values are the guiding principles of success with the intent to continuously support the components of Service Excellence. The benefits of implementing these objectives/goals will be the establishment of a coordinated, accountable facility in Oxford County which provides effective and efficient patient and family focused care.

B.      Strategic Planning Process


Environmental Scanning:

Constantly scanning our surroundings allows WH to survey a variety of elements that affect our performance, and which are necessary in order to conduct subsequent pieces of the planning process. There are several specific areas that should be considered, including the overall environment, legislation, funding market share and the internal environment of the organization. The resulting consequence of regular inspection of the environment is that our organization readily notes changes and is able to adapt our strategy accordingly. WH continually addresses its environment in order to:

        Understand its market share - specifically the demand, supply and distribution of services

        Focuses on areas of greatest need and other regional disparities

        Understand unique geographic characteristics and the impact of geography on core service delivery and outcomes

        Consider known barriers and challenges

        Consider the availability of resources

        Consider the collaboration and voluntary integration opportunities with Oxford Hospitals and other service providers

        Understand primary care weaknesses and opportunities to strengthen

        Recognize provincial and regional strategies to building a sustainable, accountable healthcare system


The environmental scan conducted prior to building this Strategic Plan included the most recent organization, regional and provincial strategies, along with detailed population health data to gain an in-depth understanding of the environment in which we are operating. This information will help WH navigate the challenges of the healthcare system today and in the future.

 

 

A summary of our environmental scan is as follows:

        The face of community care is changing, and we are experiencing the effects of increasing chronic disease burdens and an aging population

        There is an increased need and opportunity to improve health technology and to provide our patients with state of the art medical technology to enable safe, high quality care

        WH recently completed its Post Construction Operating Plan (PCOP) funding period and will now be receiving an increased proportion of funding from volume based funding allocations

        The Oxford Hospitals’ Joint Services Plan, which includes Woodstock Hospital, Alexandra Hospital in Ingersoll and Tillsonburg District Memorial Hospital in Tillsonburg, continues to play an important role in integrating acute services to better serve the region


Stakeholder Engagement


WH believes in the value of consulting our stakeholders to ensure effective strategic planning for the future. As part of developing this Strategic Plan 2016-19, we engaged almost 200 staff, over 40 volunteers, the Management team, our active physicians, community partners, as well as interviewing over 50 patients and their families. The Board of Directors and the leadership team were actively driving the strategic planning process, finalizing it by participating in an intensive Strategic Planning Retreat to review and evaluate the Plan. Involving all these groups in the process not only ensures our future plan is well informed, but is also well supported by those who will be doing the work to achieve our goals.

Implementation

The first step to implementing the Strategic Plan is to establish goals and initiatives with specific targets and indicators to help deliver maximum value within the organization. The “Program/Service on a Page” tool will serve this purpose. The tool is a collection of goals and objectives for each individual program or service, along with performance measures that indicate progress towards these goals. The tool provides a well-rounded view of what is happening and keeps score of the success or failure of the strategic goals. It adds insights, refocuses internal operations, energizes internal stakeholders, strengthens customer relations and improves ease of access to relevant data. 

Additionally, all further organization strategies will be informed by and aligned to the corporate Strategic Plan. The Quality Improvement Plan, developed annually for submission to the Ministry of Health and Long Term Care, the Human Resources Strategic Plan, and the I.T. Strategic Plan are just some examples.

The final Strategic Plan 2016-19 represents this organization’s commitment to delivering high quality care and excellent service. The accompanying Tactical Plan 2016-19 helps break down the high level goals into smaller tasks that are more reasonable to accomplish.

 


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C.     Accomplishments from the Strategic Plan 2012-2014

 

Woodstock Hospital’s previous Strategic Plan provided guidance for two years during which the organization enjoyed many accomplishments. As a result of the recent move into the new facility, WH was able to expand its portfolio of services offered to the community. In alignment with the Strategic Directions of the previous Plan, WH implemented many initiatives to improve care delivery:

 

Strategic Priority #1: Safe, Quality Patient Care

        WH successfully met the targets for 7 out of 10 performance indicators on the Quality Improvement Plan

        WH also publicly reports hospital acquired infection rates, which are also well below provincial benchmarks

        As of February 2014, WH is one of ten regional hospitals that are participating in the HUGO project (Healthcare Undergoing Optimization). HUGO allows the sharing of current and historical patient information within the organization and with partners, allowing for the right care at the right time.

Strategic Priority #2: Patient Centered Care

        In 2013/14, WH ranked above the 90 th percentile for our patient satisfaction ratings on overall care and likeliness to recommend to others; these ratings are consistently above the provincial average

        WH is ranked second out of 74 P4R hospitals in two categories: ED length of stay for admitted patients and time to inpatient bed from ED

        WH takes a leadership role in implementing best practices to improve patient experience, such as being the first hospital in the LHIN to introduce pharmacy technicians in the Emergency Department to support medication reconciliation

Strategic Priority #3: Leadership, Partnership & Integration

        WH was awarded Exemplary Standing by Accreditation Canada in 2012 as a result of our strong safety and care delivery practices

        WH is a partner of the Oxford Hospitals’ Joint Services Committee, providing leadership in creating an integrated health system in Oxford County

        As a leader in innovative solutions, WH’s IT staff successfully developed the i-Dot, a new platform providing real time patient information to facilitate decisive action and safe discharge for patients in a timely manner

        Along with being the first hospital facility to achieve a Silver LEED certification, WH has also been nominated as a finalist for the Ontario Hospital Association’s Green Hospital Award rewarding best practices in environmental sustainability two years in a row

Tactical Plan 2012-2014
The Tactical Plan 2012-2014 supported the Strategic Plan 2012-2014 by outlining clear action items that work towards each of the Strategic Directions. All 47 items from the Tactical Plan 2012-2014 have been successfully completed or are in progress (see:
Appendix B ). The organization is now primed and ready for a new set of initiatives to continue moving forward.

IV. Plan for the Future

A.     Strategic Directions 2016-2019
 

The strategic directions identified below were developed through an extensive process consisting of a current state assessment, environmental scan and comprehensive stakeholder engagement.  To support WH in achieving its mission, three strategic directions will allow the organization to adapt its practices and make positive changes to its operations:
 

 

Strategic Direction 1: Patient and Family Centered Care

Promoting Service Excellence at Woodstock Hospital


Patient and family centered care is a guiding principle for all Woodstock Hospital planning and operations. We recognize that our patients and their families are at the heart of everything we do here at the hospital. We will support our staff, physicians and volunteers to enable them to deliver high quality, patient-centered care.

We will support Patient and Family Centered Care by:
 

1.     Providing a patient-centered experience that focuses on the relationship with the patient and family at all points of interaction

 

2.     Continuing to build a corporate culture that focuses on service excellence and patient and family centered care

 

3.     Exploring operational efficiencies to maximize the value for money and ensure clinical sustainability

 

4.     Actively engaging patients and families on quality improvement initiatives through the Patient and Family Advisory Committee and continuing to collect and utilize feedback on their experiences

 

5.     Understanding the clinical needs of the patients and families we serve and allocating resources to those priority programs

 

6.     Fostering innovation and continuing to explore new technologies to enhance patient experience and quality of care

 

 

 


             

 

 

 

Strategic Direction 2: Safe, Quality Patient Care

Promoting Service Excellence at Woodstock Hospital


Delivering safe and high quality care is Woodstock Hospital’s primary commitment to the community. We are guided by the principles of continuous quality improvement and we continue to uphold patient safety best practices as the basic standard of care.

 

We will support Safe, Quality Patient Care by:

 

1.     Monitoring key safety and quality indicators and utilizing this evidence to identify opportunities for improvement
 

2.     Continuing to hold ourselves accountable by reporting our outcomes and targets to governance and the public 
 

3.     Working towards a “Just Culture” in the hospital to promote reporting of safety incidents and system-level incident analysis

 

4.     Engaging patients and families by providing education and collecting feedback on safety and quality improvements

 

5.     Providing patient safety education training for all staff, and enabling innovation, collaboration and sustainability in quality improvement activities

 

6.     Aligning the Patient Safety Plan with the corporate Strategic Directions and implementing the Goals and Objectives outlined in the Plan

 

 

 

 

 

 

 

 

 

 

Strategic Direction 3: Leadership, Coordination & Integration

Promoting Service Excellence at Woodstock Hospital


Woodstock Hospital recognizes the value of partnerships in creating a more accessible, integrated healthcare system for our patients. We acknowledge the positive impact of care coordination on patient outcomes and we strive to improve the transitions of care across the continuum.

 

We will support Leadership, Coordination & Integration by:

 

1.     Continuing to play a leadership role in developing opportunities for integrated care delivery at the regional level via the Oxford Hospitals’ Joint Services Committee

 

2.     Implementing standardized common care protocols and best practices through Quality Based Procedure (QBP) alignment and standardization with our LHIN partners

 

3.     Leading improvements in access to appropriate care in specialized clinical areas, such as surgical and maternal and child health, to address the growing needs of Oxford County and surrounding areas

 

4.     Continuing to partner with London Health Sciences Centre as a teaching hospital in other clinical areas, such as renal and systemic therapy, to promote access to quality patient care

 

5.     Focusing on educating our staff, patients and families on available community services and supports to ensure resources are utilized effectively

 

 


 

 

Detailed Strategic Directions

 

 

#1 Patient and Family Centered Care

#2 Safe, Quality Care

#3 Leadership, Coordination & Integration

Description

        Focus on improving the patient experience at WH

        Focus on the attributes of a successful patient (NRC Picker Dimensions*)

        Focus on developing a stronger regional support model for the community

 

        Improve and enhance our inpatient services to best practice

        Link and integrate with others to advance quality

        Link with partners to develop a stronger Senior Friendly hospital

        Monitor and assess where improvements may need to take place

        Lead partnerships for regional delivery

        Partner with leaders for services that are provided outside of WH

        Integrate with partners and provide efficiency of support services

Priorities

        Increase direct 1-on-1 care time with patients and families to establish and strengthen relationships

        Align performance and recognition to improve patient centered care

        Drive progressive improvement for the patient experience

        Actively engage patients and families in patient safety initiatives and support enabling people to manage their health.

 

        Strengthen and align surgical program through increasing capacity and partnerships

        Continue actualizing WH designation as a regional centre

        Strengthen emergency department care

        Align outpatient services to inpatient services

        Strengthen mental health services

        Strengthen women’s and children’s services

        Establish operating structures that support regional and system management with clear governance

        Integrate and leverage administrative platforms to support more effective and efficient delivery

        Strengthen clinical integration as an active leader and member of the LHIN

        Develop further relationships with the SWLHIN and SWCCAC to build capacity and support long term system delivery

 


Strategic Foundations:

The strategic directions will be supported by a clinical foundation, enabling an infrastructure framework. These will ultimately drive the organization to achieve its mission.

Foundational Enabling Services: Infection control, human resources, risk management, service departments, information technology and management and decision support.

Implementation:

This strategic plan provides context around change management and project management. It outlines a high level implementation plan which will serve as the organization’s framework from which to develop a more detailed plan. Each strategic direction has been identified with a number of initiatives as priority implementation tactics. Following these tactics will provide the organization with the momentum required to achieve WH’s mission.

Patient Experience in the Future:

As the strategic directions are implemented over time, patients and their families will begin to experience the positive impacts of those changes. Successful and timely implementation will lead to improvements in patient care and coordination, including:

        Better coordination of information and care across various providers in the regions;

        Increased interdisciplinary care and reduced visits to hospital;

        Better navigation through the health care system, ensuring that patients have the right care at the right time;

        Reduced wait times for laboratory and diagnostic results after visits;

        Increasing patient empowerment and self-management;

        New state of the art technologies and processes, connecting patients to additional supports outside of the hospital in the community.

In order for patients to realize these important benefits, WH must build momentum as we implement the strategic priorities.

Looking Beyond 2019:   In addition to the strategic directions identified in this plan, the organization has longer term aspirations beyond 2019, in two major areas:

        Focusing on chronic disease management to meet the increasing population demand that is associated with the increasing prevalence of chronic diseases and;

        Enhancing services for women and children that provide seamless navigation through various phases of care for this unique patient subset.
 

It is evident that there is a need for change within WH in light of the changing environment and population and as such, the hospital has set out its goals for the future. Concerted effort and significant work will be required from everyone in the organization to seamlessly realize the strategic directions outlined in this plan and to ultimately realize success.


V.                 Context for Change


Located in central Oxford County, Woodstock Hospital (WH) is a community hospital, which is fully accredited under the national standards of the Canadian Council on Health Services Accreditation (CCHSA). It serves the secondary care needs of 54,000 residents of Woodstock and surrounding area and provides both inpatient and outpatient care to up to 105,700 residents of Oxford County. Strategically, WH is located close to three hospital centers (Alexandra Hospital - 15 km to the west, Tillsonburg District Memorial Hospital - 35 km to the southwest and the London Health Sciences Centre - 45 km to the west).

This section will present the environmental scan that was conducted to inform the strategic planning for WH for the next three years. This current state assessment identifies expected challenges and obstacles in the areas of population demographics, financial landscape, resource capacity, and quality and safety performance over the next few years. By proactively identifying issues, WH can plan strategically to create solutions and align resources to best address them when they occur.

1.      Regional Priorities

 

The WH Strategic Plan 2016-19 is aligned to the strategies at the provincial and regional levels, an important few have been summarized below:

The Excellent Care for All Act (ECFAA): This Ontario legislation represents the government’s commitment to providing high quality care that is centered around the needs of the patients. Quality of care should be measured by patient outcomes and patient satisfaction rates, which can also be used to identify areas for improvement. Additionally, coordination and integration have been identified as top priorities by the Ministry of Health and Long Term Care.

In accordance with ECFAA, WH publishes the Quality Improvement Plan (QIP) annually with the purpose of monitoring key quality indicators and using them to assess organization performance. In September 2015, new regulation on standards for managing patient complaints was released. WH is already in accordance with these standards.

Ontario Patients First- Action Plan for Health Care: Released in 2015, this strategy is a follow up to the Action Plan for Health Care 2012 and represents the government’s continued commitment to improving the patient experience. The core of this strategy is to improve the transparency, accountability and sustainability of the health system. The high level strategic directions in this Plan are:

        Improving access to health services

        Coordinating services to deliver care closer to home

        Supporting patients through education and transparency

        Protecting the sustainability of our universal public health system

Southwest LHIN Integrated Health Services Plan (IHSP): 

The Local Health System Integration Act, passed in 2006, established the 14 LHINs across Ontario to manage health care priorities and services in their local communities and to promote better system integration in Ontario. The Southwest LHIN is one of the largest LHINs in Ontario, covering the area from Tobermory to Long Point and Stratford to Newbury. The LHIN is home to around 200 health service providers including hospitals, long-term care homes, mental health and addictions agencies, community support services, community health centres, and the South West Community Care Access Centre (CCAC).

As a Health Service Provider in the Southwest LHIN, Woodstock Hospital is accountable to the LHIN for its operations and services. As such, the Woodstock Hospital’s Strategic Plan aligns with the regional priorities identified by the LHIN. The Integrated Health Services Plan (IHSP) 2016-2019 prioritizes the following areas of focus for the Southwest LHIN:

        Mental Health and Addictions Services

        Home and Community Care

        Chronic Disease Management

        Hospice Palliative Care

        Hospital Based Care

        Primary Care

        Rehabilitation. 

Oxford Hospital Joint Services Plan (OHJSP): This Plan was developed through the collaboration between Woodstock Hospital, Alexandra Hospital and Tillsonburg District Memorial Hospital in Oxford County. The objective was to explore opportunities to integrate care between the hospitals and to create Centres of Excellence at each site. Centres of Excellence enable a hospital to develop expertise and improve the efficiency and effectiveness of the specialized procedure. According to the OHJSP, WH is working towards creating a Centre of Excellence for Paediatric and Children’s Health to service the region. The OHJSP has been successful in integrating care across multiple services such as Laboratory and Mental Health & Addictions, and is focused on creating a sustainable, quality health system in Oxford County.

Legislation changes: WH continues to stay current on changing legislation and ensuring that processes at the hospital are in accordance with regulations. The Health Information Protection Act, 2015 is currently in process in the legislature. The Act will re-introduce the Electronic Personal Health Information Protection Act , which will lay the foundation for secure sharing of patient information through the province-wide Electronic Health Record.


2. Population Profile

Like many healthcare facilities in Ontario, WH is faced with a multitude of challenges related to human resources, patient safety, primary care, wait times, rapid changes in technology, pharmaceutical management, chronic disease management and many others. These challenges and priorities figure prominently in the provincial and Local Heath Integration Network’s (LHIN) priorities.  Health Service programs, services and budgets are being impacted by changes in the community and in the health system by factors such as:

      Population growth

      Increasing ethno cultural diversity

      Aging population

      Increased transparency and accountability

      Privacy concerns with the use of new technology

      New legislative requirements

Population Challenges: 

The health care system is facing unprecedented challenges, most prominently demographic and fiscal challenges. Our population age structure is changing. We’re living longer and baby boomers are reaching the age where they’ll need more health care. Because people are living longer, it is projected that there will be increases in surgery and emergency services. Just as our education system responded decades ago to the baby boom, today’s health care system must now prepare for the demographic shift that will double the number of seniors living in Ontario over the next 20 years. Of course, the older we are, the more we depend on our health care system. The cost of care for a senior is three times higher than for the average person. Today, health care expenses account for 42 cents of every dollar spent on provincial programs. The aging of the population has become a challenge for all Ontario Hospitals, and particularly for WH. 

In review of the Statistics Canada 2013 Population Health Profile, residents of Oxford County practice poorer lifestyle habits than the average Ontarian. The prevalence of daily smoking, substance abuse, and physical inactivity is higher than that in Ontario. The level of education attainment by adults in Oxford County is lower than the rest of Ontario. Noteworthy also, are the higher rates of premature mortality and deaths in all causal categories (cancer, circulatory, respiratory, unintentional injuries, and suicides and self-inflicted injuries) per 100,000 people compared to the rest of Ontario. The following is a snapshot of the population characteristics of Oxford County:

     a higher proportion of people aged 65 and older (with fewer longer term care beds)

     a higher proportion of individuals facing increasing chronic disease management issues

     a higher proportion of individuals who practice poor lifestyle habits resulting in an increase in chronic disease illness

     a higher proportion of injury, self-injury and number of reported deaths

     a higher number of hip and knee replacements and hospitalized hip fracture event rate

     a higher 30-day stroke in hospital mortality

 

Demographic Characteristics:

Oxford County hosts 105,719 residents, as of 2011, with a population growth of 13.8% in the period between 1991 and 2011. The Oxford County Health Unit, as outlined by Statistics Canada, is host to the following communities:

 

        Norwich (Township)

        Tillsonburg (Town)

        South-West Oxford (Township)

        Ingersoll (Town)

        Zorra (Township)

        East Zorra-Tavistock (Township)

        Woodstock (City)

        Blandford-Blenheim (Township)

As WH's immediate service region, this is an area in the province with a relatively high proportion of elderly citizens. WH is also an area of the South West LHIN where the population density is high. Population density is the number of persons per square kilometre. The calculation for population density is total population divided by land area. Land area is the area in square kilometers of the land-based portions of standard geographic areas.

Population Density Summary of Oxford County

Land (Oxford County)

2,039.56 km 2 (787.48 sq mi)

Population Total

105,720

Density

51.8 persons/km 2 (134.3 persons/sq mi)

Data Source: 2011 Census Statistics Canada

The health of those who live in the more densely populated areas is of interest and concern for two reasons: (1) the large numbers of persons involved, and (2) the fact that the population density of an urban area changes the potential for both public health problems and public health solutions. The potential for problems includes increased exposure to a large number of individuals who can spread infectious conditions, larger volumes of waste products at risk of poor handling, the presence of pollutants, an apparent increase in stress, and a concentration of more serious mental health problems. Solutions are influenced by economies of scale in providing services, a more varied array of resources, and the potential for closer proximity to others with similar interests and needs.

The population and population density in Oxford County has been steadily growing, as evidenced by the results from each of the last few censuses conducted (table below). Additionally, it is noted that the median age in the County is also increasing.

Oxford County

2011

2006

2001

Population

105,719

102,756

99,270

Percentage change in population

2.9% from 2006

3.5% from 2001

2.2% from 1996

Land area

2,039.56   km² (787.48   sq   mi)

2,039.56   km² (787.48   sq   mi)

2,039.56   km² (787.48   sq   mi)

Population density

51.8   /km 2 (134   /sq   mi)

50.4   /km 2 (131   /sq   mi)

48.7   /km 2 (126   /sq   mi)

Median age

41.2
(M: 40.0, F: 42.4)

39.8
(M: 38.6, F: 40.9)

37.7
(M: 36.6, F: 38.7)

Total private dwellings

43,367

40,625

38,555

Data Source: 2001, 2006, 2011 Census Statistics Canada

 

Future Projections:

The data below presents the 2014 and 2024 population projections for Oxford County and Ontario by age group. It is estimated that the population in 2024 will be 116,874 (Source: MOHLTC Intellihealth). The most noteworthy development expected over the next 10 years will be the rise in the proportion of population made up by the elderly (over 65 years: from 17% of the total population in 2014 to 21% in 2024). The population group aged over 65 is collectively expected to increase by 36%, with the highest increase expected in the age group over 85 (43% increase).

Of the Oxford population, Woodstock represents the largest and fastest growing population in all age groups. According to Statistics Canada in 2011, the population of Woodstock (37,754) has experienced a +6.4% growth.

Population projection of Oxford County [2] compared to Ontario by age group:

Age Group

Oxford

Ontario

2014

2024

 

2014

2024

 

Pop. No.

% of total

Pop. No.

% of total

% change

Pop. No.

% of total

Pop. No.

% of total

% change

0-18 years

25,303

23%

25,304

22%

0%

2,867,012

21%

3,045,167

20%

6%

19-44 years

35,303

32%

34,266

29%

-3%

4,811,552

35%

5,113,717

34%

6%

45-64 years

31,235

28%

30,587

26%

-2%

3,855,401

28%

3,937,685

26%

2%

65-74 years

10,493

9%

14,131

12%

35%

1,186,943

9%

1,684,089

11%

42%

75-84 years

6,425

6%

8,746

7%

36%

665,579

5%

989,396

7%

49%

85+

2,687

2%

3,840

3%

43%

286,231

2%

411,563

3%

44%

Total

111,446

100%

116,874

100%

5%

13,672,718

100

15,181,617

100%

11%

Data Source: Ontario Ministry of Health and Long Term Care: IntelliHealth Ontario

Socioeconomic Characteristics: Examining data about income, employment and education in Oxford County is relevant as these represent the socioeconomic determinants of health that affect our population and therefore, their use of the health system. The table below highlights the socioeconomic characteristics of Oxford County and the province of Ontario:


2013 Health Profile

Oxford County

Ontario

Variance

Unemployment

6.9%

7.8%

0.9

Low income

9.3%

14.5%

5.2

Post-secondary graduates, aged 25 to 54

55.6%

67.2%

11.6

Seniors, 65 and over, as a proportion of total population

14.1%

12.7%

1.4

Elderly dependency ratio (%) [3] (2011) [4]

28.4%

23.7%

4.7

Data Source: Statistics Canada: Oxford County Health Profile 2013

Health Characteristics: Understanding Oxford County’s population health status enables WH to anticipate the needs of the community and plan accordingly. The table below highlights relevant population health statistics with a comparison to provincial numbers:

2013 Health Profile

Oxford County

Ontario

Variance

Overweight or obese

57.5%

52.6%

4.9%

Current smoker; daily or occasional

27.1%

19.2%

7.9%

Heavy drinking

19.1%

16.9%

2.2%

Hospitalized acute myocardial infarction event rate (per 100,000 population)

265

198

67

Injury hospitalization (per 100,000 population)

513

409

104

Cancer incidence (per 100,000 population)

438.8

398.8

40

Self-injury hospitalizations (per 100,000 population)

80

63

17

Mental illness patient days (per 10,000 population)

376

547

171

Hip replacement (per 100,000 population)

135

112

23

Knee replacement (per 100,000 population)

258

192

66

Hysterectomy (per 100,000 population)

546

306

240

Data Source: Statistics Canada: Oxford County Health Profile 2013

Access to Services: Additionally, evaluating Oxford County’s population access to services helps us understand the gaps in health services within the community. The table below identifies relevant statistics that reflect the level of access to health services in Oxford County, with a comparison to provincial levels:

2013 Health Profile

Oxford County

Ontario

Variance

Doctors rate - General/family physicians
(per 100,000 population)

66

95

29

Doctors rate - Specialist physicians
(per 100,000 population)

28

99

71

Wait time for hip fracture surgery
(Proportion with surgery within 48 hours)

72.8

81.3

8.5

Caesarean section (proportion)

24.4

28.6

4.2

Patients with repeat hospitalizations for mental illness (%)

7.2%

10.7%

3.5%

Data Source: Statistics Canada: Oxford County Health Profile 2013

Key Messages:

A.      Senior’s Health

When compared to the province, the Woodstock Hospital’s catchment area (Oxford County) has a larger proportion of seniors over the age of 65. Age is the greatest predictor of increased illness and use of health care services. Seniors account for 40% of hospital discharges in Ontario, 63% of acute inpatient days, 25% of all ED visits and 75% of all ED admits (Source: MoHLTC, Health Data Branch, PDST). The average length of time that seniors stay in the hospital increases with age and subsequently, this population accounts for a higher proportion of costs. Over the next ten years, Oxford County will experience a significant increase in population within the age groups 65 and over. WH has a role in the provision of geriatric care, from the perspective of an acute care hospital. With a significant number of our inpatients being over the age of 65, it is essential that the hospital develops an elder-friendly model of care with expertise in the unique care needs of the elderly population. WH continues to work with its LHIN partners such as the SW CCAC to connect to a robust system of community care, which is part of the South West LHIN’s Integrated Health Services Plan. The hospital also has a Senior Friendly Committee that is linked with Public Health and hosts many initiatives like Falls Prevention month, Medication reconciliation awareness, etc.
 

B.      Mental Health

WH recognizes the urgent need to address the increased demands of mental health support services. The aim as a Schedule 1 mental health facility with specialized mental health supports is to ensure that appropriate services and supports are provided for people with mental health and addiction needs. Overall, strategies will be required to meet the needs of this unique and growing population where social determinant factors such as education, health (lifestyle/condition), social support and income result in a higher utilization of acute admissions. Taking into consideration the unique needs of adult and children in the areas of chronic disease management and mental health will be important components of planning for this population. Also on the rise are youth mental health issues which are expected to increase by 50% from 2009-2020 [5] . Approximately 80% of all psychiatric disorders emerge in adolescence. Sufficient resources and supports are not currently available for these children within the Southwest LHIN. 

C.      Children’s Health

Not only are adults affected by the prevalence of certain diseases, there are diseases amongst children that are increasing. The combination of unhealthy eating habits, lack of exercise, genetics and other factors have led to increased cases of childhood obesity, diabetes and other life-long diseases. Childhood obesity is particularly troubling because the extra weight often starts children on the path to health problems that were once confined to adults such as diabetes, high blood pressure and high cholesterol. It has been suggested that early preventative measures and education can significantly decrease acute admissions and promote a healthy lifestyle.  Hence, WH is taking steps to recruit a paediatrician to support a growing Maternal, Child and Women’s Health program. WH taking a greater role in paediatric care in the County of Oxford will mitigate the burden on residents having to travel to London for treatment and follow-up. Children’s health is a priority at all levels of health in Ontario.

 


3. Financial Landscape

The health sector in Ontario is currently the largest funded provincial program, comprising 42% of the total provincial budget of $120.5 billion. This amounts to $50.8 billion province-wide, of which 48% or $24.5 billion is allocated to the Local Health Integration Networks (LHINs). The LHINs distribute this funding to their local Health Service Providers such as hospitals, community support services, long term care homes, mental health and addictions agencies, and more.

The Ontario provincial government has committed to a balanced budget by 2017/18 and, as a result, levels of hospital funding in the province have been held constant for the past five years. Moving forward, funding for hospitals is not expected to increase as the government continues to reduce its deficits. At the same time, the demands on healthcare services are expected to continue to increase with the aging population and rising chronic disease rates. The challenge for hospitals over the next few years is to navigate the financial landscape while meeting the needs of their communities and maintaining a balanced budget.

Health System Funding Reform

The Ontario government’s Action Plan for Health Care is the basis for the Health System Funding Reform (HSFR), which was introduced in 2012 to drive patient focused services and ensure sustainability in a resource limited environment. The new model structures funding to follow the patient’s needs and the services they receive, evolving from the traditional provider focused or global funding model.

There are two key components to the HSFR:

The Health Based Allocation Model (HBAM) currently comprises 30% of the total funding at WH and identifies expenses based on demographics (age, gender, growth projections, socio-economic status and geography) as well as clinical data associated with complexity of care and type of care.

The Quality-Based Procedures (QBPs) make up 10% of total WH funding and are a set of clinical quality groupings aimed to accelerate quality improvement and enhance system value. Each QBP is based on types and quantities of patients that are treated using rates based on efficiency and best practices that are adjusted for each procedure. The model targets price and volumes to create an incentive for providers to adopt best practices in the care delivery model.

As of 2015/2016, the HSFR comprises 40% of the total funding envelope provided to hospitals with the remaining 60% based on global funding. The aim is to allocate 70% of hospital funding through HSFR once the funding reform is complete:

Current State (2015/16)

Future State

60% Global Funding

40% Health System Funding Reform, broken down into:

        30% Health Based Allocation Method

        10% Quality Based Procedures

30% Global Funding

70% Health System Funding Reform, broken down into:

        4 0% Health Based Allocation Method

        3 0% Quality Based Procedures


 

 

 

 

 

 

 

 

Impact on Woodstock Hospital

Multiple Quality Based Procedures have been rolled out since 2012, and WH is now being funded for these procedures based on the volumes of patients that undergo each procedure at the hospital. Each QBP requires significant planning for care delivery to meet the evidence based quality guidelines included in the QBP. The proposed QBPs that are currently in the pipeline are listed below:

Proposed Future QBPs

1.      Shoulder Surgery – Osteoarthritis Cuff

2.      Paediatric Asthma

3.      Paediatric Sickle Cell Anemia

4.      Cardiac Devices

5.      Cardiac Prevention Rehab in the Community

6.      Cancer Surgery: Breast

7.      Cancer Surgery: Thyroid

8.      Colposcopy

9.      Lower Back Pain

10. Mental Health

11. Corneal Transplants

12. Maternal and Child Newborn

13. Hysterectomy

14. Emergency Department Work


The Quality Based Procedures (QBP) model poses a challenge for the organization in aligning its resources with the QBP volume criteria. Specifically, QBP volume requirements are at odds with the service expansions at WH after our move into a new facility; they fall short of the volumes WH resources are capable of performing. As such, procedures under QBP funding have to be restricted, which not only underutilizes the manpower, but also increases the wait times for patients.

The HBAM funding model uses an evidence based funding formula that estimates future expenses based on past service levels and population health information. WH’s volume and service expansions over the past few years are expected to result in favourable HBAM funding estimates due to the formula’s reliance on past volume levels.

Post Construction Operating Plan

The Post Construction Operating Plan (PCOP) provided limited time funding for WH as the result of an agreement with the ministry and the LHIN to support WH after the move into the new facility. The PCOP supports the hospital through volume and service expansions by setting target volumes for funding eligibility. WH is expected to successfully complete the target volumes for 2015/16, which is also the final year of PCOP funding. WH not only dealt with the challenges of meeting these target volumes, but will also have to address the increased costs of our Public-Private Partnership (also known as P3) Agreement. WH entered into a P3 Agreement with Ellis Don as the builder of our new facility and Honeywell for the maintenance.

Integrated Funding Model

In May 2015, Ontario announced the Roadmap to Strengthen Home and Community Care, a 3 year plan to improve and expand care in this area. As part of the plan, the bundled care approach was prioritized and the Integrated Funding Model (IFM) was introduced. This is an initiative to implement innovative approaches to integrate funding over a patient's episode of care. Hospitals will partner with other health care providers to determine a single payment to cover all the care needs of an individual patient's hospital and home care. The aim is to enhance the coordination of care from hospital to home care, ensure collective accountability and deliver patient centered care.

The first wave of IFM has been selectively rolled out to 6 teams and is currently in the implementation and evaluation phase. Results from these evaluations will inform the policies of the Integrated Funding Model across the province and how it will affect Woodstock Hospital in the future.

 

 


4. WH Resources
 

        Woodstock Hospital has many assets, including a state-of-the-art physical space, automated technology systems and exceptionally skilled and dedicated health human resources and physicians.

        The volume of patients and the community of Oxford County is growing with specific needs, primarily an aging population with chronic diseases, a special needs population requiring supports in mental health and addiction, and children’s health. WH must account for this when planning for a sustainable future.

        Existing partnerships are strong, but there are opportunities to further strengthen them and to re-establish new relationships with key organizations to improve collaboration across the region.

        WH can continue progress by leveraging better use of data and resources to enable healthcare organization growth opportunities.

        WH should continue to incorporate new partnerships and strengthen existing partnerships with Fanshawe College and the University of Western of Ontario to increase medical student volumes.


Human Resources at WH:

As of October 6 th 2015, Woodstock Hospital employs 919 staff, of which 488 are full time, 386 are part time, and 45 are casual staff. A significant proportion of WH staff are members of one of three unions: the Ontario Nurses’ Association (ONA), Unifor Service Workers and Unifor Clerical Workers. About 31% of WH staff is non-unionized. WH continues to maintain good relations with its labour unions. The Unifor Clerical group was most recently unionized in November 2014 and ratified their collective agreement in November 2015. The collective agreement for ONA will expire in March 2016 and local negotiations will begin prior to that in January. The Unifor Service collective agreement will expire in March 2017 and the HR team will be heavily involved in that process as well.

The following represents the breakdown of union affiliation but excludes employees on disability:

 

Staff Recruitment and Retention:

Recruiting and retaining the best talent is a challenge for any organization. WH continues to have a very strong and much respected reputation as a community hospital.  It brings together a tradition of excellence in clinical care and a commitment to innovation and delivering the highest standard of care to patients. HR Services supports the recruitment of talent in a variety of ways, such as through the facilitation of Strategic Workforce Planning, which is a very complex activity, especially when it is multidisciplinary and involves formalizing the assessment of need, skill mix, and numbers for a given service. The HR department utilizes an approach to workforce planning with line managers and service heads that is aligned with Accreditation Canada standards, departmental goals and objectives, and hospital-wide opportunities for improvement, while being aligned with the corporate Strategic Directions of WH. WH routinely updates its website, job application processes, staff information and student information. WH continues to be in growth mode and will remain so until all 178 beds are opened.

Over the past year, WH’s focus has continued to be primarily on retention and wellness. The HR Services team has continued efforts to improve retention and recruitment practices and is continually investigating innovative ideas to improve the quality of work life. WH’s ongoing initiatives include monthly Charge nurse meetings, introductions of Nursing Orientation for preceptorship and mentorship roles, orientation pathways and revised manuals. 

Employee Separations:

The aging workforce presents a significant challenge for the health care system.  The workload issues for physicians, nurses and other allied health staff will become more prominent as the workforce ages. The aging workforce trend for nursing aged 60 and above has more than doubled since 1999 [6] . WH recognizes that in order to build capacity to accommodate the growing number of patients, HR must strategically recruit to offset the number of retirees.

In 2014, the average age of WH employees was 41.6 years, with the average age decreasing by one year annually. The average age of a health care worker in Ontario is 44.8 years. The average length of service at WH is 9.08 years, which has decreased from 9.43 years. Currently, 16% of our workforce is eligible to retire, comparable to 31.4% in health care organizations province wide [7] . In the current year of 2015, 136 WH staff are over the age of 55 and eligible for retirement. The additional staff eligible for retirement over the next few years are as follows:

The graph below shows the breakdown of employees over the age 55, and therefore eligible for retirement, over the next few years. The graph does not show employees that will actually retire and leave the organization as employees may choose to retire at different ages.

In 2014, the general turnover rate experienced was 10.96%. The highest reason for turnover for full time staff continues to be retirement (44%) with the completion of work term/contract (24%) as the second highest reason. On the other hand, the turnover rate for part time staff is mostly due to personal reasons (42%), with lack of availability (15%) and employment elsewhere (14%) as the second and third highest reasons. The following graph estimates the projected separations over the next few years, based on the current turnover rate of around 11%:

Culture and Wellness:

The HR team at WH is committed to creating a strong culture around the four core components and associated standards of Service Excellence- communication, confidentiality, commitment & competence and caring & compassion. The 2014 Employee Engagement survey indicated a high level of job satisfaction and commitment, validating the focus on a supportive and collaborative approach. WH has been a proud recipient of the Ontario Hospital Association Quality Workplace Silver Award for 3 years in a row. The standards for achieving a Silver award have risen every year and WH has successfully met these challenges by continuing to focus and improve upon quality of work life initiatives.

Moving Forward:

The following strategies are under active development, or in some cases, have been implemented to address the human resources challenges associated with recruitment, retention and separations:

University/College Collaboration: The hospital has established contracts with several colleges and universities to establish opportunities for nursing, practical nursing, prospective nursing students, medical residents and public policy residents to complete the work practicum portion of their programs at the hospital.  A complete list of partner schools can be found in Table A.

WH is also a member of the Southwestern Ontario Student Placement Agreement (SWOSPA) between WH, Fanshawe College, Lambton College, St. Clair College, University of Western Ontario, and the University of Windsor. This allows participating students to gain exposure to, and experience in a hospital setting. This collaboration with universities and colleges facilitates recruitment of new medical staff at WH to various departmental positions that may become vacant due to retirements or departmental needs.

New Graduate Initiative: The hospital has used this initiative to provide new nursing graduates with the opportunity to gain experience and exposure to the hospital.

RPN’s Scope of Practice: The hospital has undertaken a program of skill enhancement for its RPNs in order to broaden their scope of practice. This program enables the staff to perform a broader range of activities, thereby allowing the hospital to alter its staff mix on several care floors. The net result is the hospital has a broader pool of health care providers with the right skills within the community to recruit from.

Provincial/National Recruiting: The hospital is working with many of the provincial/national bodies of healthcare professionals both to advertise for healthcare professionals and to identify opportunities to attract these personnel to Oxford County.

Health Force Ontario: The hospital continues to post and receive information of medical manpower to address its future needs. HFO’s website allows WH to post physician, nurses and all regulated health care professional positions.

The WH Human Resources Department plays an integral role in preparing and implementing the HR strategic plan, which is evaluated annually by HR and by the Board.

Table A: Complete list of schools WH is in partnership with:

List of partner schools

Bloomberg University of Toronto

Brantford Medix College of Healthcare

Cambrian College

Canadore College of Applied Arts and Technology

Canadian Hospital Association

Centennial College

Conestoga College

Confederation College

Fanshawe

Fleming (Sir Sandford) College

Georgian College

Humber College

Lambton College

Laurentian University

McGill University

McMaster University

Medix - London

Medix Kitchener

Medix London

Mohawk College

Northern College

Ryerson University

Sault College

Saybrook University

St. Clair

St. Francis Xavier university

The Canadore College/Nipissing University (North Bay)

Trent University

Trios College

University of Calgary

University of California

University of New Brunswick

University of Toronto

University of Waterloo

University of Waterloo (Renison College)

University of Western Ontario

University of Windsor

Westervelt College

Wilfrid Laurier University

York University

 


WH Facility: Woodstock Hospital is located within an open, spacious and accessible facility that opened after relocation in November 2011. The hospital is equipped with state of the art medical and diagnostic technology, including Oxford County’s first and only MRI. Some of the most notable accomplishments of the new hospital facility have been on the environmental sustainability front. WH has been one of the top five finalists for the Ontario Hospital Association’s Green Hospital Award for two years in a row. Additionally, WH was awarded the Recycling Council of Ontario (RCO) Silver Award in 2015 for achievements in recycling and waste diversion.

WH’s leadership in environmental stewardship has been ingrained into the construction of the new facility, resulting in WH being awarded the first LEED Silver Certification by a hospital in Canada. Using equipment such as high efficiency boilers and heat recovery ventilators allows the facility to conserve energy usage in its operations. WH continues to excel in reducing the environmental impact of healthcare through various Green initiatives such as diverting plastic waste by transitioning surgical wraps to reusable sterilization wraps and a paperless recruiting process through the HR department.

Investment in Technology at WH: As part of the commitment to safe, quality care, WH employs the latest medical technology to enable care delivery at the front line. Over the past few years, the hospital participated in a large scale project to enable access to patient information across care partners through Healthcare Undergoing Optimization (HUGO). Additionally, the hospital is one of the first six sites in Canada using CareLink nursing carts. WH has invested in 50 of these advanced nursing carts that ensure safe and secure medical administration to the right patient at the right time. Most recently, in November 2015, WH also launched new advanced IV infusion pumps on the nursing units to support patient safety at the hospital. These new “Smart Pumps” are programmed to reduce errors and to ensure safe medication dosages to patients. Moving forward, WH hopes to utilize the ability of these pumps to upload patient information to the electronic patient record in real time.

WH is also a partner and leader in the Southwest LHIN, with membership in the group of London area hospitals that share the medical information system contract. WH is also a leader in this group through the implementation of new cutting edge projects such as the Single Sign-On feature on all computers in the facility. This feature supports staff in focusing on safe, quality care while protecting patient privacy and enhancing ease of workflow by enabling staff to log in to their virtual workstation from any computer in the hospital.

Innovation at WH: WH works diligently to support the effective use of technology at the hospital and often finds innovative solutions to the challenges faced in care delivery. With the help of our clinical team, the IT department created the Interactive Discharge on Time, or i-Dot, platform to facilitate efficiency during discharge rounds. This platform provides access to up-to-date patient information for enhanced communication and decision making by care providers. The i-Dot has played a key role in facilitating smooth preparation for discharge and ensuring barriers to discharge have been addressed by all members of the multidisciplinary team. Additionally, the development process is underway for the i-Flow, which facilitates efficient patient flow in the hospital by showing a real time summary of patient beds. This platform will also assist in maintaining shorter lengths of time to admission from the Emergency Department, or what is known as time to inpatient bed.


Operating and Capital Resources:


5. Quality and Safety Performance


WGH continues to strengthen its leadership role as the main provider of acute services for the County of Oxford.  In order to achieve its goals in wait times, patient satisfaction, quality improvement, and overall excellent quality care, the hospital needs to continue to make investments in many supporting areas. These areas include partnerships and collaboration with neighboring hospitals, medical education, information technology, human resources, facility management and financials.  Without the attention to these areas, we will not realize the organization’s strategic directions. Hence, the focus is translating strategy into action. Our new goals will: drive the strategic planning; focus energy and resources; strengthen operations; ensure that stakeholders are working towards a common purpose and; access and adjust WH’s direction in response to a changing environment.

Key Factors for Consideration:

     Patient centered care and service excellence are key strategies within the WH Strategic Plan. Patient and family advisors will provide an approach to care delivery that is grounded in our values

     An aging population with ailing chronic diseases requires a commitment of adequate resources to the hospital’s emergency department, senior friendly care, diabetes management, medication management and primary care in order to effectively address alternative level of care needs and to avoid readmissions

     Women and Children’s health has unique needs where prevention and education will need to play a greater role in overall health. Anticipated growth in this area will require additional resources and system planning.

     WH will need to work collaboratively with our partners to strengthen mental health and addiction services and supports in the community

     Investments must be made to train our future health care providers and leaders.

     Future development opportunities must align with our resources and enhance our performance
 

Leadership:

WH is strongly positioned to expand its support role as a regional hospital. With the guidance of the Strategic Plan 2016-19, WH will continue to lead, partner and collaborate on integrated services in the South West region. WH will create further efficiencies and coordinate services more effectively while focusing on key clinical areas to promote client safety and quality health outcomes. In addition, WH will continue to serve the growing demands associated with women and children’s health.  In other clinical areas such as mental health, surgical services, renal care, rehabilitation and geriatrics, WH will continue to partner with London Health Sciences Centre and other community health care organizations within the South West LHIN. To ensure that the transition of services and care is managed appropriately, partnerships will be developed carefully with the community and other organizations. Establishing strong relationships and communications with partners will also allow WH to ensure that any gaps are addressed.  The key is helping with the navigation of patients to the appropriate setting for care.

Strategic Foundations:

Effective delivery of care requires a set of strategic foundations – clinical supports, enabling services, and infrastructure.  These support the strategic directions and priorities in a variety of capacities and support the organization in achieving its mission. WH has excellent services in each of the three areas, including exceptional diagnostic imaging, lab services and pharmacy, which provide support to all clinical areas of the hospital.  Such services are essential to the successful operation of the hospital and to high quality patient care. WH also reports very low infection rates, due to the strong infection control program and environmental services supporting the program within the organization. Investments in strategic foundations will be guided by:

        Benchmarking our performance and striving to be “best in class”

        Alignment to our strategic directions and priorities

        Partnering where appropriate or integrating where opportunities exist.


The table below represents our Strategic Foundation:

Clinical Supports:

Enabling Services:

People:

Diagnostic Imaging

Laboratory Services

Pharmacy

Ambulatory Care

Diabetes

Surgical Services

Infection Prevention & Control

Education Services

Facility Services

Information Management & Technology

Medical Education

Interprofessional Learning & Continuing Education

Talent Management

Recruitment & Retention

 

Woodstock Hospital Market Share

1.      Acute Care:

Market share is a critical indicator of hospital utilization and WH's market share target is 85% or more for the core acute care services. A summary of the acute care services is presented in Graph 1(a). This graph clearly shows that family practice and internal medicine have been meeting the target over the past five years. The market share for Family Practice remained stable at a high market share, reaching 96% in 2014-15, while Internal Medicine experienced growth, reaching 93% market share in 2014-15. General Surgery has remained fairly stable over the years, with a 75% market share in 2014-15. Both Obstetrics/Gynecology and Orthopedic Surgery have experienced overall growth over the years, reaching 75% and 55%, respectively in 2014-15. Otolaryngology was newly offered at WH in 2012-13 and reached a market share of 41% in 2014-15. Finally, Urology’s market share shows decline, however, WH recently recruited two urologists and the market share is therefore expected to grow again in the next few years. Overall, the 2014-15 market share for acute care services is 84%, which is consistent with previous years. Please refer to Appendix 1-A for a detailed breakdown of where Woodstock residents are receiving acute care services. 


Graph 1(a): Percentage Woodstock Residents treated as acute care patients at Woodstock Hospital in the last five years.

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario (Acute Care Service)

It is also noteworthy to consider the Woodstock residents that have travelled outside of the city to receive acute care services that WH does not offer. Identifying the need for these services will enable WH to expand and potentially offer them in the future. As shown in Table 1(a), the highest need is for Cardiology services and the number of patients is seen to grow over the years.

Table 1(a): Adult Services not available at Woodstock Hospital

ACUTE CARE- ADULT

2010-11

2011-12

2012-13

2013-14

2014-15

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

DOCTOR SERVICE

#

#

#

#

#

CARDIAC SURGERY

27

32

40

41

32

CARDIOLOGY

71

84

68

71

90

NEPHROLOGY

21

34

19

20

27

NEUROLOGY

14

11

17

23

26

NEUROSURGERY

38

51

37

53

54

PLASTIC SURGERY

26

25

31

21

20

THORACIC SURGERY

38

24

35

54

34

VASCULAR SURGERY

28

45

43

29

35

OTHER [8]

142

89

126

152

128

TOTALS

405

395

416

464

446

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

 

Although WH is currently seeking to recruit a paediatrician, most paediatrics patients are redirected to the tertiary care center in London for medical care. The number of patients in this category is expected to decrease once a paediatrician is successfully recruited at WH. The actual number of paediatric patients travelling outside Woodstock to access services is shown below in Table 1(b).  

Table 1(b): Paediatric Services not available at Woodstock Hospital

ACUTE CARE- PAEDIATRIC

2010-11

2011-12

2012-13

2013-14

2014-15

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

DOCTOR SERVICE

#

#

#

#

#

CARDIOLOGY

2

9

8

5

5

GASTROENTEROLOGY

0

1

3

6

1

GENERAL SURGERY

7

5

8

10

11

HEMATOLOGY/ ONCOLOGY

3

20

12

0

0

NEPHROLOGY

1

3

2

0

0

NEUROLOGY

0

1

0

0

0

NEUROSURGERY

0

0

0

1

0

OPHTHALMOLOGY

0

2

1

0

0

ORTHOPEDIC SURGERY

0

3

3

4

1

OTOLARYGOLOGY

0

0

1

0

1

PLASTIC SURGERY

0

0

0

3

0

PSYCHIATARY

0

0

0

1

0

PAEDIATRICS

160

160

133

141

145

TOTALS

173

204

171

171

164

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

2.      Day Care:

A summary of day care services for Woodstock residents is presented in Graph 2(a). The target market share of day care services performed at WH is 85% or above. Of the twelve day care services presented in this graph, three services reached the market share target in 2014-15; they include General Surgery (91%), Dentistry (85%) and Registered Nurse Flexible Sigmoidoscopy (92%). Registered Nurse Flexible Sigmoidoscopy or RNFS was recently introduced as a new service at WH in 2013. Market share in Internal Medicine, General Surgery and Dentistry has remained stable over the past five years, while it has decreased in Obstetrics/Gynecology, Urology and Ophthalmology. Market share has been increasing, on the other hand, in Orthopedic Surgery and Otolaryngology reaching 70% and 34% in 2014-15, respectively. Overall, day care services at WH have a market share of 78% in 2014-15, which remains comparable to the previous years. Please refer to Appendix 2-A for a detailed breakdown of where Woodstock residents are receiving day care services. 


Graph 2(a): Percentage of Woodstock Residents treated as day care patients in Woodstock in the last five years .

 

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

Once again, an understanding of the day care service needs of Woodstock residents that are not currently being met by WH is relevant and is shown in Table 2(a). These patients travel outside the city to receive their care, and there is potential for WH to expand its services according to need in the future. As seen from the table below, there is an identified gap for day care Gastroenterology services and it is seen to be growing over the years. There is also need for Plastic Surgery and Thoracic Surgery services, although the need has not grown over the past five years.

Table 2(a): Adult Day Care Services not available at Woodstock Hospital

DAY CARE - ADULT

2010-11

2011-12

2012-13

2013-14

2014-15

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

DOCTOR SERVICE

#

#

#

#

#

ANESTHESIOLOGY

2

2

4

2

-

CARDIAC SURGERY

1

-

1

-

-

CARDIOLOGY

3

7

11

8

19

CARDIOTHORACIC SURGERY

0

0

2

8

-

CRITICAL CARE MEDICINE

0

0

1

4

5

EMERGENCY MEDICINE

-

-

-

1

-

GASTROENTEROLOGY

171

162

207

250

219

GYNECOLOGIC ONCOLOGY

1

1

1

-

1

NEUROSURGERY

4

7

11

13

8

PLASTIC SURGERY

67

69

73

58

68

RADIATION ONCOLOGY

-

-

1

2

-

RESPIROLOGY

18

7

14

17

13

THORACIC SURGERY

18

18

31

40

31

VASCULAR SURGERY

6

3

8

7

8

TOTALS

291

276

365

402

372

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

There is a small number of paediatric patients (fewer than 50 per year) that have to travel outside of the city to receive treatment through specific day surgical procedures. WH will continue to monitor these numbers by year to identify potential high needs in the future.

3.      Market Share Over Time:

Tables 3(a) and 3(b) represent the WH market share over the past five years of acute and day care services, respectively. WH held a steady market share of 65% in acute care services until 2014-15, when there was a slight dip to 63%. The share of day care volumes at WH has decreased slightly over the time period, with 50% of day care services for Woodstock residents being performed at WH in 2014-15.

Table 3(a):   Percentage and total number of Acute Care breakdown by residence region.

Acute Care Breakdown by Residence Region (excluding Newborn)

2010/11

2011/12

2012/13

2013/14

2014/15

#

%

#

%

#

%

#

%

#

%

Woodstock

2,610

65%

2,541

65%

2,900

65%

3,074

65%

3,200

63%

External

1,382

35%

1,348

35%

1,555

35%

1,656

35%

1,907

37%

Total

3,992

100%

3,889

100%

4,455

100%

4,730

100%

5,107

100%

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

Table 3(b) : Percentage and total number of Day Care breakdown by residence region

Day Care Breakdown by Residence Region

2010/11

2011/12

2012/13

2013/14

2014/15

#

%

#

%

#

%

#

%

#

%

Woodstock

3,278

56%

3,281

53%

3,524

54%

3,461

51%

3,375

50%

External

2,600

44%

2,901

47%

3,018

46%

3,267

49%

3,343

50%

Total

5,878

100%

6,182

100%

6,542

100%

6,728

100%

6,718

100%

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

4.      Service Volumes Over Time:

Table 4(a) presents the change in volume of services provided by WH over the past five years. From this data, it can be seen that the volume of acute care services has increased over the past four years, with an 8% year over year increase in 2014-15. Additionally, Rehabilitation services were offered at WH for the first time in 2011-12 and experienced strong growth in volumes during expansion and increased by 13% from the previous year in 2014-15. Total inpatient services increased by 10% last year (628 case increase) while day care services have seen an average 3% growth in the past four years with stable numbers last year. When analyzing the total growth of services over the given period, there was an average of 5% growth every year from the previous year.

 

 

 

 

 

Table 4(a) WH Services over the past five years:

Woodstock Hospital Service Volumes

2010/11

2011/12

2012/13

2013/14

2014/15

#

%

#

%

#

%

#

%

#

%

Acute Care

3,992

36%

3,889

34%

4,455

35%

4,730

36%

5,107

38%

Newborns

631

6%

691

6%

833

7%

790

6%

845

6%

Chronic Care

175

2%

191

2%

189

1%

138

1%

189

1%

Mental Health

414

4%

437

4%

476

4%

399

3%

517

4%

Rehabilitation

0

0%

4

0%

139

1%

211

2%

238

2%

Total Inpatient Services

5,212

47%

5,212

46%

6,092

48%

6,268

48%

6,896

51%

Total Daycare Services

5,878

53%

6,182

54%

6,542

52%

6,728

52%

6,718

49%

Total

11,090

100%

11,394

100%

12,634

100%

12,996

100%

13,614

100%

Source: Ontario Ministry of Health and Long-Term Care: IntelliHealth Ontario

5.      Support Services:

In addition to the three hospitals in Oxford County, the population of Oxford County is serviced by the South West Community Care Access Centre (CCAC), nine long term care facilities (excluding one in Norfolk), two family medical centres, one community health centre and several community support services and mental health/addiction services and facilities. The following Table 5(a) lists the current long term care homes within Oxford County.

Table 5(a): Long Term Care Home in Oxford County:

Organization Name

Facility ID

Bed Type

City

10/11 LTC Beds

15/16 LTC Beds

Caressant Care Woodstock

NH2623

NH

Woodstock

156

163

Maple Manor Nursing Home

NH1707

NH

Tillsonburg

102

107

PeopleCare Tavistock

NH1705

NH

Tavistock

100

100

Secord Trails Care Community

NH1698

NH

Ingersoll

80

80

The Maples Home for Seniors

NH1706

NH

Tavistock

43

43

Woodingford Lodge Ingersoll

HF4455

HF

Ingersoll

34

34

Woodingford Lodge Tillsonburg

HF4454

HF

Tillsonburg

34

34

Woodingford Lodge Woodstock

HF4674

HF

Woodstock

160

160

Bonnie Brae Health Care Centre

HF1703

HF

Tavistock

80

0

 

 

 

Total Beds

789

721

Source: Provided by the Southwest LHIN on November 11, 2015


Recommended by the Health Services Restructuring Commission’s final report, Looking Back, Looking Forward: A Legacy Report (2000) , the target number of beds recommended is 99.1 beds per 1,000 of the population that is age 75 and over. Currently, there are 721 long term care beds available within Oxford County for a population of 8,400 (and growing) that is aged 75 and over.  Based on this ratio, there is a shortage of beds for the population that exists when looking at the current data. Using the HSRC recommendations, there should be 832 long-term care beds available, meaning there is a current shortage of 111 beds in Oxford County. This number will continue to rise as the population aged 75 and over increases over the coming years. Since the previous Strategic Plan was written, Oxford County lost around 8% capacity, mostly due to a loss of 80 beds from the village of Tavistock. Additionally, there are no reliable projections of future long term care beds available as the Ontario healthcare environment is predicted to undergo significant change in the community care sector in the near future, with little known about what the changes will look like. Thus, WH faces a significant challenge in caring for the elderly with support from limited community resources.

6.      Medical Manpower Resources:

The recruitment of physicians for WH is a key focus for the organization as it enables the hospital to expand its services and better meet the needs of the community. The Medical Manpower Committee (MMP), comprised of senior management and physician leadership from various parts of the hospital, strategically plans the recruitment needs of WH. Additionally, WH is a partner in the Oxford County Physician Recruitment Committee, which is focused on recruiting family physicians to set up community practices in Oxford County. Table 6(a) below highlights the current and future physician recruitment needs, along with current levels of practitioners:

Table 6(a): Medical Manpower Plan *as of December 8, 2015 MMP Committee Meeting                                           

Doctor Service

Current Practitioners

2015/16

2016/17

Active

Part-Time

Locum/Other

Recruitment Need

Recruitment Need

Family Practice

12

1

4

6-8

6-8

Emergency Medicine

8 (1)

10

2

0

0

Internal Medicine

3

0

5

1

1

General Surgery 

5

0

3

0

0

Anaesthetists

4

1

8

0-1 (2)

0-1 (2)

Urology

2

0

0

0

0

Psychiatry

2

3 (3)

0

2

2

Orthopedic Surgery

4

0

0

0

0

Obstetrics/Gynecology

5

0

8

0

0

Pathology

3

0

1

0

0

Radiology

3

0

4

0

0

Ophthalmology

2

0

0

0

0

Physiatry (4)

1

0

0

0-1

0

Hospitalist (5)

3

2

9

3

3

Paediatrics

0

0

1

2

2

ENT

1

0

0

0

0

Total

58

17

45

18

17

Source: Provided by Heather Scherer on December 9, 2015

Please note, there are over 100 physicians with privileges in different categories; however, they are not all full-time practitioners.

1)                  Emergency Medicine: We now have 8 full time equivalents, plus part-timers and locums

2)                  Anaesthetists: Depending on circumstances and service expansion

3)                  Psychiatry: 3 Psychiatry Sub-Specialists have clinics on a weekly or monthly basis

4)                  Physiatry: Recruitment is for locum Physiatrist              

5)                  Hospitalist: Continue recruiting for 3 full-time Hospitalists

Woodstock Hospital Current Performance

Current Profile of WH:

The following table provides a current profile of the volume and efficiency of services provided at Woodstock Hospital:

Key Facts & Figures of Woodstock Hospital (2014/15)

Volumes in 2014/15

Outpatient:

12,214 visits

Diagnostic Imaging: 69,551 visits

Emergency:

39,042 visits

Inpatient:

6,909 visits

Bed Mix

Total: 161 beds

Acute/Med/Surg: 61
(22,259 days)

Maternal Child/Women’s: 14 (1,666 days – 850 births)

Chronic Care: 33
(11,648 days)

Rehab: 22  
(6,710 days)

Mental Health: 19
(4,527 days)

ICU/Critical Care: 12
(2,511 days)

Staff Mix

        Over 900 staff                                    

        Monthly average of 139 volunteers

        Approximately 125 physicians on staff

WH Average Length of Stay

(Source: WinRecs CIHI)

CARE TYPE

2010/11

2011/12

2012/13

2013/14

2014/15

Acute

5.5

5.6

5.2

5.1

4.7

Complex Care

44.8

39.5

47.8

62.5

49.4

Mental Health

11

9.7

8.5

11.7

8.06

Rehabilitation

N/A

14.5

25.7

22.3

28.2

Emergency (90th percentile- hrs) [9]

5

5.3

5.6

5.2

5.2

Quality –Safety

        Wait times in most care areas are currently lower than the provincial rate, but are expected to increase from the impact of volume restrictions

        The rate for all infection rates are all lower than the provincial rate (C. Difficile, MRSA, VRE)

Hospital Services

        Emergency Department with Fast Track area and a clinical decision unit

        Diagnostic Imaging Department with MRI/CT services

        Palliative Care unit of 6 beds including a family unit

        Satellite Dialysis unit with 9 active chairs and the capacity for 12 chairs

        Mental Health CRISIS team implemented in 2014/15 to enhance access in the ED

        Satellite Systemic Therapy unit with 6 stations

 

Quality Measures Summary

The following scorecard measures strong indicators aligned with the quality dimensions described in the Excellent Care for All Act. The scorecard also offers a snapshot of quality performance at WH. Of particular note are the excellent patient satisfaction rates at WH that consistently exceed provincial peer averages.

Legend :                                                                                                                                            

No comparator available

 

Tracking positively              

 

Tracking around/similar to comparator

 

Tracking unfavorably against comparator

 

No data available

 

Improving

Diminishing

Stable

±

                           

Quality Dimension

Indicator

Woodstock Hospital Trend

2014/15

Source

Provincial

Peer Average

LHIN Average

Hospital

Performance

2013/14

Work life

Occupational Incidents

138

WH Human Resources

N/A

N/A

142

Safety

OB Trauma with Instrument

26.6

WH Health Records:

2013/14 Your Health System (CIHI)

14.4

12.9

29.9

In-hospital Sepsis

1.2

4.4

3.3

2.5

C-Difficile Rates +

0.23

WH Infection Control

 

2015/16 QIP

 

^=Quarterly

~=Annually

+=Monthly

 

0.27

-

0

MRSA Rate ^

0

0.015

-

0

VRE Rate ^

0

0.004

-

0

Central Line Infection ^

0

0.27

-

0

Ventilator Associated Pneumonia ^

0

1.09

-

0

Hand Hygiene Compliance – Before ~

77.26%

87.51%

-

83.39%

Hand Hygiene Compliance – After ~

86.95%

91.58%

-

89.65%

Effective

Hospital Standardized Mortality Ratio

89

WH Health Records:

2014/15 (CIHI)

 

 

 

83

89

85

Medical Readmission Rates

13.2%

13.6%

14.1%

12%

Timely & Efficient

ED Left Without Being Seen

3.0%

-

-

2.6%

ED Wait Time – Admission to Left ED (90%)

5.36 hrs

-

-

5.6 hrs^

Wait Time-CT

43 (Target: 28)

Ontario Wait Time

90 th %ile

CCO iPort

2014/15

60

66

34

Wait Time –MRI

84 (Target: 28)

91

110

85

Wait Time-Hip Replacement

151

195

231

251

Wait Time-Knee Replacement

260

215

225

366

Wait-Time –Cataract Surgery

120

160

193

134

Efficient

Cost Per Standard Hospital Stay

$5,084 (2013/14)

CIHI(2014/15)

$5,283

 

$5,256 (2012/13)

Continuity of Service

ALC as a % of Total Patient Days

5

9.46

14.44

9.1

Population Centered [10]

Patient Satisfaction-ED

91.4%

 

WH Health Records:

April 2014- March 2015

SHoPPS

57.7%

-

93.4%

Patient Satisfaction-Med/Surg

97.8%

74.5%

-

97.7%

 

Patient Satisfaction-Maternity

100%

74.6%

-

98.7%

 

Patient  Satisfaction-Daycare

99.6%

83.6%

-

99.5%

 

Patient Satisfaction-Rehab

100%

96.7%

-

100%

 

Patient Satisfaction-Complex Care

100 %

96.7%

-

N/A

 

 

Efficiency & Effectiveness: How do we compare with other Oxford Hospitals?

The following data outlines the clinical workload activity for Woodstock Hospital (WH) in comparison to the two other hospitals located in Oxford County: Alexandra Hospital (AHI) in Ingersoll and Tillsonburg District Memorial Hospital (TDMH) in Tillsonburg.

Oxford Hospital Utilization Report Comparison (2014/15):

Indicator

684- AHI

824-TDMH

890-WH

Total Revenue

2014/15 Revenue Reported

$17,771,189

$27,038,026

$99,636,164

2014/15 Full-Time Equivalent Staff

116

206

641

Total Beds Staffed and in Operation 2014/15

Total Beds

26

45

161

Medical/Surgical

17

30

61

Maternal Child

-

-

9

LBRP (Labor Birth Recovery Postpartum)

-

-

5

Critical Care

4 (Special Care)

5

12

Rehabilitation

-

-

22

Mental Health

-

-

19

Complex Continuing Care

5

10

33

Surgical Services 2014/15

Inpatient Surgical Cases

13

118

1,707

Outpatient Surgical Cases

706

2,279

10,194

Total Surgical Cases

719

2,397

11,901

Ambulatory Care 2014/15

Emergency Face-to-face In house Visits

17,427

30,020

39,042

Day/Night Face-to-face In House Visits

 

4,990

9,283

Clinic Face-to-face In House Visits

5,476

2,836

56,296

Total Ambulatory Face-to-face In House Visits

22,903

37,846

104,621

Chronic Care 2014/15

Chronic Care Inpatient Days

1,667

3,518

11,667

Costs (Activity Measures) 2014/15

Inpatient Food Expense per Patient Day

$62.83

$62.45

$43.25

Inpatient Cost Per Patient Day

$481

$395

$422

Operating Expense/Worked Hours

$80

$74

$94

Average MOS & UPP Hourly Rate

$47

$43

$44

Administration %

12.8%

11.0%

7.9%

Equipment Expenditures %

6.8%

8.7%

7.5%

Hotel/Occupancy %

16.0%

16.1%

13.9%

Support %

2.6%

3.9%

3.2%

2014/15 data source- HSMI through HIT tool by Maria Foster, Health Records Analyst on October 21, 2015

Accessibility: Wait Times

WH continues to monitor wait times for the various diagnostic imaging and surgical procedures. The following wait times were abstracted from the Ontario Wait Times website of the Ministry of Health and Long Term Care for 2014/15 (wait times measured in days). The hospital continues to explore strategies to increase access to services in an environment of limited resources.

Service Area

Provincial Target

Provincial Average
(90 th percentile)

Woodstock Hospital (90 th percentile)

Diagnostic Imaging

MRI [11]

28

98

85

CT

28

92

50

Surgical Services

Ophthalmic Surgery- Cataract

182

164

121

Surgical Services

Hip Replacement

182

210

168

Knee Replacement

182

224

263

Knee Arthroscopy

182

141

79

Surgical Services

Breast

84

51

32

Digestive-Colorectal

84

51

41

Genitourinary

84

65

19

Prostate

84

88

N/A

Wait Times by Service Area and Hospital (2014/15) Source: Ontario Wait Times

 


Patient Safety and Quality of Care at WH

WH takes pride in the quality of staff, physicians and volunteers that work at the hospital. Each member of the WH team has excellent skills and experience to contribute to the overall success of the organization.

Quality Improvement Plan:

As per ECFAA guidelines, WH annually updates the Quality Improvement Plan (QIP) and publicly reports on certain quality indicators. The QIP monitors indicators within the domains of safety, effectiveness, integration, access and patient centeredness. It is aligned with the Strategic Plan by focusing on Service Excellence initiatives that support our Strategic Directions. As an organization, WH believes in continuous quality improvement; the practice of which means that significant results are the result of many smaller improvements over time.

        WH has successfully collaborated with partners in the Southwest LHIN by participating in working groups such as the Regional Stroke Steering Committee, Wound Care Committee, and Pay for Results ED.

        WH continues to invest in technological solutions that enhance the safety and quality of patient centered care at the hospital, working towards the goal of a comprehensive electronic patient record.

        A focus on evidence based decision making and performance tracking throughout the hospital is facilitated by the sharing of relevant data to monitor and sustain performance.

        Front Line Improving Performance (FLIP) initiatives have worked to standardize processes to enhance efficiency and reduce waste.

        WH has made infection control a key priority for investment and therefore, hospital acquired infection rates are consistently lower than the provincial averages.

Patient Safety Scorecard:

In addition to the legislated QIP, WH has developed a comprehensive Patient Safety Scorecard that evaluates indicators under safety, access, patient and family centered care, and sustainability. Please refer to the attached Patient Safety Plan for more information. 

Summary:

WGH continues to strengthen its leadership role as the main provider of acute services for the County of Oxford.  In order to achieve its goals in wait times, patient satisfaction, quality improvement, and overall excellent quality care, the hospital needs to continue investing in its people and complementary services to support continuous quality improvement. These areas include collaboration in the areas of regional acute care, medical education, information technology, human resources, facility management and financial planning. By focusing our attentions on these areas, we will be able to realize the organization’s strategic directions. Hence, the focus is translating strategy into action. Our new goals will focus our energy and resources, strengthen operations, ensure that stakeholders are working towards a common purpose and adjust WH’s direction in response to a changing environment.


APPENDIX A: Data Tables

 

Appendix 1-A: Percentage of Woodstock Residents treated as acute care patients at Woodstock Hospital and the surrounding area

ACUTE CARE

2010-11

2011-12

2012-13

2013-14

2014-15

WH

LONDON

OTHER

WH

LONDON

OTHER

WH

LONDON

OTHER

WH

LONDON

OTHER

WH

LONDON

OTHER

DOCTOR SERVICE

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

FAMILY PRACTICE

95%

1%

5%

94%

1%

5%

96%

1%

3%

96%

1%

3%

96%

1%

3%

INTERNAL MEDICINE

85%

4%

11%

90%

5%

5%

86%

8%

7%

89%

8%

7%

93%

3%

4%

GENERAL SURGERY

81%

11%

7%

77%

14%

9%

78%

10%

12%

79%

10%

9%

75%

12%

12%

OBS/GYN

70%

20%

11%

67%

19%

14%

79%

11%

10%

74%

11%

10%

75%

14%

11%

ORTHO-SURGERY

48%