Annual Report 2016

2015 – 16

ANNUAL REPORT

Implementing all that we set out to do in Year One of our ambitious three-year Strategic Plan is now complete.

It hasn’t been without its hurdles, but then again, nothing worth doing is, which is why we are incredibly proud of how much St. Michael’s has achieved this past year. Inside, we’ve highlighted a story in each of our patient-focused priority areas – we hope you find them as forward-looking as we do.

One major challenge we faced was a reminder of our aging infrastructure. A burst pipe forced us to close our Emergency Department and many labs due to flooding. The event had a major impact on patients, families and staff, but the extraordinary efforts of St. Michael’s staff in prioritizing patient safety were heartening to witness. It was a chaotic few days that we overcame with the tireless support of our staff as well as Toronto Paramedic Services and neighbouring health-care partners.

On a more positive note, we’ve made great strides in engaging with patients and our community.

We established a residents’ health services panel comprised of local residents within our local geography who provide input on how to improve health services in our area.

Tom O’Neill Chair, Board of Directors St. Michael’s Hospital

We also began recruiting for the St. Michael’s Patient and Family Advisory Council, the goal of which is to get feedback on how to improve the patient experience.

The events of the past year have strengthened our organization and crystallized our commitment to working with our patients to serve them better. We look forward to continuing on our growth trajectory during Year Two of the Strategic Plan as well as the physical growth of our hospital – continuing the St. Michael’s 3.0 redevelopment project.

No matter how difficult a day or situation may seem, there is always something to be thankful for. We are particularly grateful to our St. Michael’s family of staff, physicians and volunteers, and community of donors and partners for your steadfast support.

Just as we rose above the challenges of the past year with you in our corner, celebrating the successes was much more enjoyable and growth possible because of your involvement. Thank you.

Robert Howard President and CEO St. Michael’s Hospital

Annual Report 2015 – 16 I 2

FAST FACTS 2015–16 463

Approximately

560

$73 million

volunteers

in research funding

acute adult inpatient beds

330,070

507,825

3,977

ambulatory visits

students trained

diagnostic, therapeutic and other visits

25,137

inpatient visits

investigators (scientists & associate scientists)

209 812 physicians 1,689 registered nurses 837 Health Disciplines clinicians

30,025 surgeries

2,764 babies born

6,066 staff members

April 1, 2015 to March 31, 2016

OVER 2 MILLION

square feet of property and growing!

73,750

emergency visits

STRATEGIC PLAN

2015-18

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Comprehensive care for our entire urban community St. Michael’s Residents’ Health Services Panel

We set out this year to find new ways to engage our local community to help us identify gaps in health services and recommend ways we can address them. Twenty-eight resident advisers, representative

of our community, were selected to make up St. Michael’s Residents’ Health Services Panel. On behalf of the residents of mid-east Toronto, they have created a set of guiding values and key local health-care

issues, and will be working with us throughout the year to inform specific projects. We hope this process will inform future engagement initiatives and possibly serve as a model across the LHIN.

Annual Report 2015 – 16 I 4

Advance systems of care for disadvantaged patients Carefully seLected and Easily Accessible at No charge Medications CLEAN Meds project

Dr. Nav Persaud, a physician in our Department of Family and Community Medicine, launched a research project to see how better access to life-saving medications for people with low incomes might

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improve health and control disease. Patients who can’t afford medication can suffer serious problems that could have been avoided with relatively inexpensive medication. This project will look at the effect of providing primary care

patients with free and convenient access to a set of essential medicines.

Watch a video by Dr. Persaud and Dr. Mike Evans about medication access.

As a centre of excellence in mechanical ventilation, St. Michael’s intensive care units have access to interprofessional experts, such as (from left to right) Lu Chen, post-doctoral research fellow; Orla Smith, manager of the Critical Care Research Unit; Unmesh Edke, clinical fellow; Laurent Brochard, critical care physician and scientist; Orest Shklar, registered respiratory therapist; and Connie Martins, registered respiratory therapist.

Excel in the care of critically ill patients Personalizing mechanical ventilation

Acute respiratory distress syndrome (ARDS) usually happens in people who are already critically ill. Patients with ARDS need mechanical ventilators to help them breathe because they suffer severe shortness of breath. In most critical care centres, the ventilator is set up

the exact same way for every patient with ARDS. As a centre of excellence in mechanical ventilation, St. Michael’s researchers and clinicians have developed technology that can be used at the bedside to better analyze the individual needs of our

sickest patients and then develop personalized plans to improve supportive breathing for each patient. The team also measures patient progress, which researchers feed back into the technology so that it’s continually fine-tuned.

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BUILDING

ST. MICHAEL’S 3.0 In April 2015, the hospital broke ground on our new patient care tower, celebrating the beginning of a redevelopment project that includes a new patient care tower to care for critically ill patients and renovations that will double the size of the Emergency Department.

By March 2016, construction of the Peter Gilgan Patient Care Tower reached a third of its 17 storeys. Columns to support the bright and spacious new lobby were poured.

Watch how far the building’s come along.

The project also includes renovations to existing parts of the hospital, including the upper floors of the Donnelly Wing. In March 2016, the staff in the hospital’s Pre-Admission Facility prepared to welcome patients to their new, renovated space on the 10th floor.

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QUALITY IN

ACTION We asked our patients, families, staff, physicians and leadership about how to improve quality at St. Michael’s. This year, we focused on four areas: falls prevention, hand hygiene, medication reconciliation and smoother transitions.

Click on the icons to watch how we did in 2015-16.

FALLS PREVENTION

HAND HYGIENE

Falls rate per 1,000 patient days

Current: 4.66

Number of times that hand hygiene was performed before initial patient contact during the reporting period

2015-16 target: 4.09

Current: 63.6 per cent

We did not achieve our target, but there was an improvement in the corporate rate. In addition, the work on our General Internal Medicine unit has resulted in a significant 17 per cent reduction in its falls rate.

2015-16 target: 65 per cent

We are continuing to work to reduce our falls rate by focusing on new interventions for two units that have higher than expected falls rates.

Hand hygiene continues to be a priority. Although we did not meet our target, we achieved an improvement of six per cent in our Moment 1 compliance rate. We are proud of this improvement and will continue to build off lessons learned as we continue our work on hand hygiene.

MEDICATION RECONCILIATION

SMOOTHER TRANSITIONS

Total number of patients with medications reconciled in the Mental Health Program as a proportion of the total number of patients admitted to the Mental Health Program (inpatient only)

90th percentile Emergency Department length of stay for admitted patients

Current: 84.1 per cent 2015-16 target: 80 per cent The key success factors in surpassing our target were defining the roles and responsibilities of the medication reconciliation process for each clinician, education on how to do a quality Best Possible Medication History and improving accessibility of the patient’s BPMH information.

We will continue to monitor the progress we have made and look for other opportunities to improve current workflows.

Current: 23.1 hours 2015-16 target: 21 hours We believe that in order to have a positive patient experience, our patients should be able to get the care they need with as short a wait as possible. Transitioning a patient from the ED to an inpatient bed in 21 hours is an ambitious goal, but we are striving to achieve our target by improving flow and throughput across the hospital. For example, improving the discharge process means shorter waits in the ED and better support when patients are discharged home.

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VISION World leadership in urban health

VALUES Our values represent the philosophy and beliefs of our organization, guiding all of our decisions and actions.

Human Dignity We value each person as a unique individual with a right to be respected and accepted.

Excellence We value quality in care, work life, education and research.

Compassion We value a quality of presence and caring that accepts people as they are and fosters healing and wholeness.

Social Responsibility We value integrity and the promotion of the just use of resources entrusted to us for the enhancement of human life.

Community of Service We value a work climate of mutual trust and harmony to enable healing, collaboration and the fulfilment of human potential.

Pride of Achievement We value our colleagues, our work and our accomplishments and take pride in bringing our rich tradition of hope and healing to every person in our care.

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OUR VALUES IN

ACTION The Pride of Achievement Award

The Community of Service Award

Marisa Cicero, manager, Collaborative Practice and Education

Paulo Freire, co-ordinator, Clinical Equipment, Supply Chain and Support Services

The Human Dignity Award

The Compassion Award

April Murray, project co-ordinator, Research Facilities

Patti Lou Cheatley, apheresis nurse

Every year, we recognize individuals and teams across the hospital for their exemplary demonstration of our core values. This past year we celebrated the following award winners.

Click the images to view each story.

The Social Responsibility Award Prescription Care Centre

The Excellence Award Scotiabank Health Sciences Library

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Financial Statement 2016 $

2015 $

140,936 38,323 3,898 7,907

149,611 42,035 3,821 6,191

191,064

201,658

Restricted investments

85,942

76,955

Long-term receivable

97,558

-

Employee future benefits asset

32,285

31,002

Property, plant and equipment

541,112

442,637

947,961

752,252

102,134 1,000 33,423

98,690 1,000 37,036

136,557

136,726

3,553

4,349

97,302

-

387

532

Employee future benefits liability

27,000

24,364

Deferred capital and other contributions

367,962

273,606

Deferred research and trust contributions

84,425

78,856

Net Assets

230,775

233,819

947,961

752,252

Assets Current Assets Cash and cash equivalents Accounts receivable Inventories Prepaid expenses and other assets

Liabilities Current liabilities Accounts payable and accrued liabilities Long-term debt Deferred capital and other contributions

Long-term debt Long-term obligations Provision for sick leave benefits

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2016 $

2015 $

Ontario Ministry of Health and Long-Term Care/Toronto Central Local Health Integration Network/Cancer Care Ontario Other funded programs Preferred accommodation In-patient Out-patient Sales and other revenue Interest Amortization of deferred contributions Grants and donations for research and other purposes

483,142 20,130 3,018 6,083 17,854 49,714 5,053 13,035 67,189

486,905 19,474 3,508 6,241 17,194 47,777 2,355 10,693 68,083

Toronto Central Local Health Integration Network - Casey House

6,930

5,024

672,148

667,254

430,488 51,285 41,679 94,750 1,068 204 26,476 22,312 6,930

424,392 54,558 41,207 88,960 1,103 238 25,052 21,786 5,024

675,192

662,320

Excess of revenues over expenses for the year Net assets - Beginning of year

(3,044) 233,819

4,934 228,885

Net assets - End of year

230,775

233,819

Revenues

Expenses Salaries and employee benefits Medical and surgical supplies Drugs Other supplies Bad debts Interest accretion Amortization of property, plant and equipment Other funded programs Toronto Central Local Health Integration Network - Casey House

Financial fluency benefits not only our hospital but the whole health care system.

Watch how St. Michael’s is improving cost awareness and efficiency while still delivering high quality care.

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Medical Advisory Committee

Non-voting members

As at March t31, 2016

Other appointments:

Voting members

President and chief executive officer Executive vice-president and chief nursing executive Vice-president, Research Vice-president, Education

Chair Vice-chair President, Medical Staff Association Vice-president, Medical Staff Association

Dr. Thomas Parker Dr. Glen Bandiera Dr. Aaron Hong Dr. Ralph George

Dr. John Laffey Dr. Andrew Baker Dr. Karen Lee Dr. Glen Bandiera Dr. Karen Weyman Dr. Victor Tron Dr. Tim Dowdell Dr. Thomas Parker Dr. Michael Geary Dr. Linn Holness Dr. David Wong Dr. Jennifer Anderson Dr. Michael Sgro Dr. Vicky Stergiopoulos Dr. Ori Rotstein

Other appointments: Executive vice-president and chief medical officer

Dr. Douglas Sinclair

Program medical directors: Diabetes Comprehensive Care Program Heart and Vascular Program Inner City Health, Core Services Specialized Complex Care Program Mobility Program Trauma and Neurosurgery Program Perioperative Services

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Ella Ferris Dr. Arthur Slutsky Dr. Patricia Houston

Medical directors:

Department chiefs: Anaesthesia Critical Care Dentistry Emergency Medicine Family and Community Medicine Laboratory Medicine Medical Imaging Medicine Obstetrics and Gynecology Occupational Health Ophthalmology Otolaryngology Pediatrics Psychiatry Surgery

Dr. Robert Howard

Dr. Jeffrey Zaltzman Dr. Michael R. Freeman Dr. Philip Berger Dr. Jerry Teitel Dr. Earl Bogoch Dr. Andrew Baker Dr. James Mahoney

Quality and Patient Safety Clinical Informatics

Dr. Chris Hayes Dr. Michael R. Freeman

Board of Directors

Executive Committee

July 1, 2015 to June 30, 2016

As at March 31, 2016

Dr. Richard Alway Nora Aufreiter Dr. Glen Bandiera Wayne Barwise Hazel Claxton John Cruickshank Ruth daCosta William A. Etherington, vice-chair, St. Michael’s Hospital Board Ella Ferris Ralph George Dr. Vivek Goel Peter Gordon Anthony R. Graham Doug Guzman Dr. Aaron Hong Dr. Robert Howard, president and CEO, St. Michael’s Hospital Colleen Johnston Claude Lamoureux Mary McConville Noella Milne Tom O’Neill, chair, St. Michael’s Hospital Board Kerry O’Reilly-Wilks Dr. Thomas Parker John Ruetz Harcharan (Harry) Singh Frank Techar, chair, St. Michael’s Foundation Board Darryl White Dr. Trevor Young

Ella Ferris, Executive vice-president, Programs, chief nursing executive and chief health disciplines executive Dr. Patricia Houston Vice-president, Education Dr. Robert Howard President and chief executive officer Alayne Metrick President, St. Michael’s Foundation Dr. Thomas Parker Chair, Medical Advisory Committee Dr. Douglas Sinclair Executive vice-president and chief medical officer Dr. Arthur Slutsky Vice-president, Research Anne Trafford, Vice-president, Quality, Performance, Information Management, and chief information officer

Annual Report 2015 – 16 I 14

30 Bond Street, Toronto ON, M5B 1W9 Canada Fully affiliated with the University of Toronto

www.stmichaelshospital.com

Please support St. Michael's through our Foundation www.stmichaelsfoundation.com Design and photography by Medical Media Centre, St. Michael’s Hospital