Message from the Board Chair, President & Chief Executive Officer and Chief of Staff

It was another year of change in our hospital sector, with a new provincial government bringing with it initiations of health care sector reform, and the ongoing challenges of improving our own efficiency and positioning ourselves for the future, while continuing to live up to our vision of providing Outstanding Care, No Exceptions! We are proud to say that once again, our team here at Windsor Regional Hospital rose to the many challenges and, thanks to their collective input and efforts, brought continuous improvements to the organization and the community we serve.

System Reform

It was a substantial year of change in the hospital sector, with a new government at Queen’s Park embarking on an ambitious agenda of health system reform, including plans to consolidate a number of agencies, including the 14 Local Health Integration Networks, Cancer Care Ontario, eHealth Ontario and Trillium Gift of Life Network, under a new Ontario Health banner. It is not the first time that our hospital organization, or our region here in Windsor-Essex, has been a witness to systems change. Proactively, WRH was among a number of partners locally who began discussions on how to work collaboratively on an exciting partnership opportunity between the Province of Ontario and Windsor and Essex County to truly embrace and create a Regional Strategy for Healthcare Planning and Administration, with a focus on improving Patient Experience and Outcomes.

We continued to make major strides in addressing a top concern in the hospital sector across the province and one also highlighted by the new government – ending hallway medicine. Our admitted patients benefitted from work being done to improve transfer times to a hospital bed, thanks to the work of Medicine Patient Flow project teams and hospital leadership. As a part of continuous improvement, attention was placed on the earliest phase of an inpatient’s journey – the time they were admitted to the hospital in the Emergency Department (ED), to the time they arrived in an inpatient bed. There are numerous processes that occur as a part of this transfer, and every effort is made to ensure that this transfer happens as timely as possible.

Focus was also stronger on “Admit No Bed” patients who wait three hours or longer to arrive at a Medicine inpatient bed. With support from the SOP department, when cases like this happen the transfer is analyzed to understand what contributed to the delay. Doing so allows the team to identify the challenges and assist in developing ways to improve the process. The patient-centered goal is to have the transfer to the unit happen as quickly as possible and eliminate or minimize any delays in this transfer process. The expectation is that patient transfers occur long before a red flag needs to be raised. The 3-hour delay marker serves as that red flag that lets us know that an ED to unit transfer has not occurred in the manner expected. In the Command Centre there are tools used such as VIBE, which helps to manage the transfer. Other efforts to assist in a timely transfer include the use of a wheelchair for patients whose medical and mobility status allow it.

Patients directly benefit from these improvements, as it minimizes their length of stay in the ED and allows their care plan to be started sooner because of timely arrival to the appropriate inpatient unit. Staff have worked very hard to achieve excellent results so far, and their efforts will help ensure these results can be sustained long-term.

A significant change this past winter over the prior winter was our census. Over the previous four years, daily census announcements were common – we would send out daily notices to the community about extreme volumes in our hospital, which reached as high as 115% occupancy. This year, we did not need to send out these emails. It wasn’t a matter of lower patient volumes – in fact, volumes were higher and the acuity of our patients also increased. The difference this year was improved patient flow processes and standardization between our campuses.

Patient Safety

This past year, massive improvements continued to be made in patient flow and care across the organization, from the creation of the command centres to ongoing gains in the Patient Harm Index. In December 2018, we continued this with the new Oculys - Stay Track boards launched for use in our care rounds across the Medical-Surgical units at both campuses. Standard unit leads worked with the Oculys team to improve and streamline these new care round boards. Previously units were using an Excel spreadsheet to run and record the daily patient care rounds.

The new Stay Track boards are updated automatically any time our admitting department receives and enters a new admission, discharge or transfer. In the past, when a patient was transferred to another unit, the information shared during care rounds was lost and the new unit had to populate the board, losing the plan of care for the patient. Now, this information follows the patient keeping the plan of care consistent as discussed by the health care team. This helps to improve the continuity of care and prevents “Grey Days,” when planned interventions are not completed.

Financial Stability

From a financial perspective, WRH and the Erie St. Clair Local Health Integration Network commenced a process called Optimization Review in June 2018, aimed at helping justify an increased budget in the short term, and position us for the future funding requirements over the longer term as we move towards a new state-of-the-art acute care hospital. This collaborative and voluntary Optimization Review has been examining whether Windsor Regional Hospital has been sufficiently funded since our realignment of hospital services in October 2013 – one of the most extensive hospital transformations that has ever taken place in our province. It has also been identifying anticipated funding requirements as we work towards a new state-of-the-art acute care hospital and urgent care centre just a few years from now.

We received word early in the new fiscal year that the Government of Ontario and the Ministry of Health and Long Term Care agreed that our hospital should receive additional financial support. Even with this support, WRH identified an additional $7.3M in cost savings to move the hospital towards a balanced operating position for the 2019-20 fiscal year. This is approximately a 0.8% reduction in expenses. While cost improvement actions are never easy, we carefully identified savings opportunities which will not impact direct patient care. The cost improvements were expected to result in approximately 80 staff reductions. We recognize this will have an impact on a number of non-clinical areas. However, we have made every effort to avoid reductions in direct patient care and will attempt to accomplish as many as

possible by attrition and retirements. To maintain a balanced operating position on a go-forward basis, WRH will look to identify additional cost improvements as well as the additional funding actions recommended in the Optimization Report, including:
  • (a) Ongoing one-time payments of $5M per year for a total of $25M to offset the present working capital deficit. These funds to not be used to balance or operations; plus
  • (b) $16.4M in increases to the base operating budget over the next four fiscal years. This assumes an annual 1% funding increase. 

Looking Ahead

We were excited to learn of the commitment made by the new Ontario government to approve funding and give us the go-ahead to introduce a PET CT scanner to Met Campus. Plans were well underway near the end of the fiscal year for its installation adjacent to the Cancer Centre. We look forward to serving hundreds of patients per year with this state-of-the-art diagnostic imaging technology starting in late spring 2019. Many thanks are owed to the Windsor Cancer Centre Foundation for helping support patients who had to travel out of town for these procedures.

We also began preparations for Accreditation 2019. Phase one focused on self-assessments, and was completed before the fiscal year ended. Going into the new fiscal year, we have been developing action plans for areas that need improvement and we are reviewing Required Organizational Practices, or ROPs. The Accreditation Canada surveyors will be coming to WRH for the onsite survey November 25-29th, 2019 and we look forward once again to receiving great third-party recognition for all of our operational efforts.

We continue to plan and advocate for the new Windsor-Essex Hospitals System, including plans for a new state-of-the-art acute care hospital and a satellite emergency care facility for the downtown area. WRH employees and professional staff were asked to share their visions for the future, and give examples of how the current aging infrastructure negatively affects hospital patients and visitors. This is not to say every employee or professional staff supports the location proposed for the new hospital; we said from the start 100% agreement by 400,000 regional residents on any issue are not possible, especially one of this magnitude. However, just like our community, a massive majority of employees and professional staff to support it, and the status quo is not sustainable. We look forward to continuing on this journey towards significant infrastructure improvements to serve our region for decades to come.