Management Commentary and Analysis

2013/14

1

Table of ConTenTs

1. Introduction 2

2. Financial Performance 4

3. Occupancy and the Drive to 95 6

4. Human Resources 7

5. Education 9

6. Research Institute 11

7. Nursing 15

8. Health Professions 17

9. Greening Sunnybrook 19

10. Community Engagement 21

11. Digital Strategy 24

12. Improving Service for Patients and Families 26

13. Safety 28

14. e-Health 30

15. Partnerships and System Improvement 32

16. Fundraising 34

17. Financial Outlook 2014/15 35

2

1. InTroduCTIon

Sunnybrook achieved excellence in

research, teaching and patient care in

2013/14, continuing to care for more

than 1.2 million patients who count on

the Hospital be there for them when it

matters most. Despite occupancy levels

that frequently hovered at or above 100

per cent, the Hospital had world-leading

breakthroughs, welcomed learners from

all parts of the globe and extended a

compassionate and helping hand to

patients and their families.

This year, the Hospital began a new

strategic planning cycle featuring an

online engagement piece to reach

stakeholders living both close to

the three campuses and those from

across Ontario and Canada. The next

iteration of the strategic plan will guide

Sunnybrook’s direction by setting

priorities for future investment and

growth for 2015-18.

Sunnybrook welcomed a team of onsite

surveyors from hospitals across the

country for the Accreditation Canada

process, which demonstrated the high

quality services provided each and

every day, as well as an opportunity

to learn about opportunities for further

improvement. The final accreditation

status for 2013 – 2017 was Accreditation

with Exemplary Standing, the highest

level possible.

Through the course of the year,

Sunnybrook’s program and support

3

areas also worked to develop a

balanced budget. Through a significant,

organization-wide effort, a plan was

created that has had minimal impact on

staff and allowed the Hospital to provide

the same high quality care that patients

have come to expect.

The opening of the Louise Temerty

Breast Cancer Centre, the largest of its

kind in Canada, was a major highlight

from 2013/14. Sunnybrook also saw

the completion of construction on the

Canadian Simulation Centre, where the

Hospital will teach basic and advanced

surgical skills to trainees at all levels.

Sunnybrook’s skilled teams, both on

the frontline and in support services,

contribute to the high quality services

provided at the Hospital. Executive Vice

President Malcolm Moffat appeared

on Undercover Boss Canada, working

side-by-side with five Sunnybrook

employees to get a sense of their

daily responsibilities and valuable

contributions.

Unexpected challenges like the ice

storm in December 2013 occurred amid

high demand for the Hospital’s inpatient

beds due to influenza season, however,

in true Sunnybrook fashion, teams from

across the hospital persevered through

adversity and continued to provide

excellent care.

Working and volunteering at Sunnybrook

requires special people, and the Hospital

received numerous honors recognizing

the ability to attract and retain top staff

including being recognized for the fifth

consecutive year as one of Canada’s

Top 100 employers. The organization’s

dedicated staff made it possible to

achieve the best possible results for all

of those who rely on Sunnybrook to be

there for them when it matters most.

4

2. fInanCIal PerformanCe

Sunnybrook reported Revenue over

Expenses of $36.5 million for 2013/14.

As noted on the Statement of Operations

$12.7 million relates to a multi-year

post construction operating plan

(PCOP) one time funding reconciliation

with the LHIN. Excluding this item,

Sunnybrook’s reported Revenue over

Expenses would be $23.8 million or 2.4

percent of Total Revenue, that is, well

within the 2-3 percent recommended

by the Ontario Hospital Association

as needed for reinvestment in capital

equipment, facilities and working

capital requirements. Several other

factors contributed to these financial

results including success in revenue

generation initiatives and final settlement

of several prior year accruals. The latter

represents approximately $9 million of

reported Revenue over Expenses for

a normalized earnings of $15 million

or 1.5 percent. Consistent with the

past three years Sunnybrook continues

to experience increased cl inical

activity, largely from the emergency

room. Sunnybrook targets 95 percent

occupancy in order to optimize the

flow of patients but for Fiscal 2013/14

experienced approximately 100 percent

occupancy. Despite this high occupancy

rate, there were no major impairments to

patient flow as measured by the Hospital

access metrics of cancelled surgery and

Trauma closure hours.

5

Health System Funding Reform (HSFR)

continues to be advanced / rolled-out

by the Ministry of Health and Long

Term Care (Ministry). The Ministry

provided Health Based Allocation

Methodology (HBAM) results in March

2014 and Sunnybrook continues to

be a best quartile performing hospital

amongst its peer group. To date there

is insufficient information on Quality

Based Procedures QBPs to comment

on their impact on Sunnybrook funding,

but Sunnybrook remains focused on

providing high quality care, utilizing best

clinical practices to ensure the Hospital

provides such care in the most effective

and efficient manner.

Below is the chart that reflects how

Sunnybrook has used the resources

entrusted to it to provide patient care.

This chart indicates that Sunnybrook

continues to use the vast majority

of funds for direct patient care, and

continues to have one of the lowest

percentage used for administrative

costs in its hospital peer group.

fIsCal 13/14: WhaT do These exPenses buy?

Clinical  Services    61.4%  

Lab,  Diagnos8c  Imaging  &  Pharmacy  14.2%  

Food  &  Physical  Support    10.2%  

Corporate  Support  8.9%  

Medical  Staff  &  Clinical  Educa8on  3.6%  

Other  (Insurance  &  Interest)  1.7%  

Clinical  Services      

Lab,  Diagnos8c  Imaging  &  Pharmacy      

Food  &  Physical  Support      

Corporate  Support  

Medical  Staff  &  Clinical  Educa8on      

Other  (Insurance  &  Interest)      

Direct  Care  Expenses:  61.4%          Clinical  Services    14.2%          Labs,  Diagnos8c  and  Pharmacy  75.6%          Total    

Fiscal  13/14:  What  do  these  expenses  buy?  

6

3. oCCuPanCy and The drIve To 95Sunnybrook’s Drive to 95 initiative

is aimed at reducing inpatient bed

occupancy to improve overa l l

patient flow and reduce wait times

in the Emergency Department. While

occupancy continued to be a challenge,

Sunnybrook has seen an improvement

over the past few years and has had

no closures to trauma cases. Overall,

patients at Sunnybrook were getting

to units more efficiently from the

Emergency Department, and the Odette

Cancer Centre’s Estimated Date of

Discharge initiative continued to help

streamline the transition of care for

patients, including setting a target for

the date of discharge, or “estimated

day of discharge”.

reduCIng hosPITal admIssIons from The emergenCy deParTmenT

Sunnybrook’s Rapid Referral Clinic allows

physicians in the Emergency Department

to refer patients to a general internist for

urgent outpatient assessment with the

goal of improving patient flow. Dr. Steven

Shadowitz and Dr. Graham Slaughter

shared the successes of the clinic in

a blog run by the Harvard Business

Review and the New England Journal

of Medicine. Since the clinic opened,

50 per cent of all patients were seen by

clinic physicians within 48 hours and 69

per cent within 72 hours. It is estimated

that the clinic diverts an average of

five admissions to the hospital and 18

Emergency Department referrals away

from the internal medicine admission

service every week.

a neW ClInIC offers sPeedy hearT assessmenTs

Staffed by a cardiologist and a registered

nurse, Sunnybrook’s new Rapid

Cardiology Assessment Clinic offers

rapid assessment for patients with heart

failure, low-risk chest pain or arrhythmia

who do not require urgent admission to

the Hospital. The clinic targets patients

who primarily present in the Emergency

Department and Sunnybrook Family

Practice. The focus is to improve the

overall quality of life for patients with

chronic heart conditions, while at the

same time preventing unnecessary

hospital admission and reducing wait

times.

7

4. human resourCes Sunnybrook continued to attract new

talent, and retain top employees, as

the Hospital’s 10,000-member team

worked collaboratively to impact

the lives of over 1.2 million people

relying on the Hospital each year. The

Hospital again garnered numerous

honors, including being named as

one of Greater Toronto’s Top 2014

Employers. The eighth annual Bertin

Awards for Excellence in Customer

Service recognized staff who continually

go above and beyond their usual role to

provide excellent customer service to

patients, families and their colleagues.

The RESPECT Program which aims to

create a culture of engagement, respect

and inclusiveness, launched its second

phase on bullying in the workplace.

one of The besT PlaCes To Work In Canada

Sunnybrook was selected for the fifth

year in a row as one of Canada’s Top

100 Employers for 2014. Canada’s Top

100 Employers is a national competition

to determine which employers lead

their industries in offering exceptional

workplaces for their employees.

Sunnybrook was selected for its support

for staff with families, the Leadership

Institute which improves employees’

leadership skills, employee wellness and

the “Life Stages Program” supporting

staff from being a student to parenthood

to retirement.

a CommITmenT To sTaff WITh young ChIldren

Canada’s Top Family-Friendly Employers

recognizes those organizat ions

offering the nation’s most progressive

and forward-th ink ing programs

for employees with young children.

Sunnybrook was included for its

leadership in helping employees balance

their work and family commitments.

8

The Hospital supports employees who

are new mothers with maternity and

parental leave top-up payments, as

well as support for in-vitro fertilization.

Parental top-up is also available for new

fathers and adoptive parents, as well as

a convenient onsite daycare facility for

those returning to work.

12Th annual sChulICh aWards

The Schulich Award for Nursing and

Clinical Excellence is an annual award

that recognizes and honours the clinical

work of individuals who demonstrate the

values of Sunnybrook in their daily work

with patients, families and colleagues. In

2013/14, ten individuals were selected

who provide exemplary service in the

areas of diagnostic, therapeutic and

direct clinical patient care. The awards

are made possible by a generous

donation from Dr. Seymour Schulich.

9

5. eduCaTIon At Sunnybrook, education matters. Under the leadership of

Dr. Ari Zaretsky, the new Vice President of Education and Elizabeth

McLaney, Director of Interprofessional Education, 2013/14 featured

a focus on technology-assisted education, as well as strong

support for patient and family education initiatives. More than 4,000

learners from over 25 health care disciplines chose Sunnybrook to

experience the best teaching and clinical experiences and work

with some of the most advanced technology in Canada.

foCus on PaTIenT and famIly eduCaTIon

With the goal of providing support

in creating new best practice patient

education materials, 14 projects were

selected from across the Hospital

to receive funding to develop print

materials. Over $13,000 will support

print brochures and posters on topics

such as mobility during a hospital stay,

staying mentally well while in hospital,

pregnancy and diabetes, post-operative

guidelines for breast reconstruction,

and a milestone map for babies in the

neonatal intensive care unit.

healTh lITeraCy 101

The f i rst ser ies of sessions on

health literacy were held to explore

its significance to practice, identify

strategies to promote health literacy

and learn practical strategies for writing

for patients and families. Participants

learned that almost 60 per cent of

Canadians have difficulty understanding

and using health information, and

were provided with practical skills to

implement in their patient and family

education teaching.

neW sImulaTIon suITe oPened

The Sunnybrook Canadian Simulation

Centre opened its new state-of-the-art

surgical skills suite. Trainees at all levels

will receive instruction in both basic and

complex surgical skills, with the centre

housing advanced medical simulation

equipment that provides trainees the

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opportunity to practice in a controlled

environment. Surgical residents will

have the opportunity to participate in

technical skills rounds once a week and

the centre will allow undergraduates and

international observers to take part in

technical aspects of surgery they would

typically only observe.

eduCaTIng our CommunITy, one TWeeT aT a TIme

To raise awareness of heart disease

during Heart Month in February, and give

the public an inside look at an operating

room, Sunnybrook live tweeted an open-

heart surgery. The live tweet included

photos, video and information in real time

by Sunnybrook’s web communications

team and staff photographer. Questions

were also fielded from the public, with

the goal of helping to demystify what

happens in the operating room. Led

by Dr. Gideon Cohen, Chief, Division

of Cardiac Surgery at Sunnybrook,

the tweet was followed by a grade five

class in Ancaster, Ontario. The students

had so many questions that Dr. Cohen

participated in a separate Skype session

with the children.

11

6. researCh InsTITuTe

The mandate at Sunnybrook Research

Institute (SRI) is to make discoveries

and achieve clinical impact. SRI’s new

structure makes this work possible,

with discovery platforms in biological,

evaluative clinical and physical sciences,

which are interlinked with the Hospital’s

clinical programs, ensuring efficient

translation of results. A continued priority

over 2013/14 was moving discoveries

into the clinical setting. A multimillion-

dollar investment into SRI from the

Federal Economic Development Agency

for Southern Ontario is allowing the

development and commercialization

of new technologies to directly impact

patient care. SRI is one of the fastest

growing research enterprises in Canada

and home to more than 1,000 scientists,

clinician-scientists, technical support

staff and trainees.

sunnybrook joIns global ImagIng ConsorTIum

Sunnybrook partnered in 2013/14 with

Elekta and Philips Healthcare to test

a new magnetic resonance imaging

(MRI)-guided radiation therapy system.

The system integrates an advanced

1.5 Tesla MRI machine with radiation

therapy, designed to enable physicians

to deliver radiation in real time under MRI

guidance for more precise treatment

of cancer. The goal of acquiring high-

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resolution magnetic resonance images

of pathology in real time as the radiation

is being delivered could have a dramatic

impact on patient health and clinical

outcomes. Sunnybrook is the fourth

member to join the consortium, which

also includes the University Medical

Center Utrecht, the University of Texas

MD Anderson Cancer Center and The

Netherlands Cancer Institute-Antoni van

Leeuwenhoek Hospital.

InnovaTIon day foCuses on CommerCIalIzaTIon

Sunnybrook Research Institute and

the Schulich School of Business

at York University hosted the first

Schulich Innovation Research Day.

The event was open to researchers

interested in moving ideas to the

medical marketplace and focused on

early stages of commercialization. A

competition featured four teams pitching

their innovations to a panel of experts,

modeled loosely after the television

show Dragon’s Den. The panel gave

input on the commercial potential,

clinical relevance of the innovations

and advice on securing funding.

fundIng suCCess for neurodegeneraTIve dIsorders

Three SRI sc ient is ts were the

recipients of grants from the Weston

Foundation, a private family foundation

wh ich suppor ts resea rch i n to

neurodegenerative disorders. These

grants are worth almost $3.7 million

for SRI, and are being administered

through the Transformation Research

in Neurodegenerative Diseases of Aging

Program. The scientists involved are

Drs. Isabelle Aubert, Sandra Black and

Kullervo Hynynen.

13

ComPeTITIon sPurs hIgh sCores

Scientists at SRI were successful

securing funding by the Canadian

Institutes of Health Research (CIHR).

Seven SRI researchers were awarded

operating grants totaling $2.6 million

over the next five years:

• Dr. Juan Carlos Zuniga-Pflucker

was awarded $769,770 to continue

research on T cell development in the

thymus, an organ where white blood

cells from bone marrow-derived stem

cells mature, multiply and become

T cells

• Dr. Richard Aviv was awarded a one-

year grant worth $77,402 to study the

relationship between cortical disease

and cognitive impairment among

people with multiple sclerosis using

a new magnetic resonance imaging

technique

• Dr. Brian Cuthbertson was

awarded $84,627 to support work

on understanding and improving early

physical rehabilitation in patients on

life support in the intensive care unit

• Dr. Gregory Czarnota was awarded

$706,608 to investigate and optimize

the use of microbubbles to enhance

the effects of radiation in preclinical

tumour models

• Dr. Liisa Jaakkimainen was

awarded $448,802 to measure

wait times in primary care and

community-based services, with the

goal of helping health planners in

their decision-making about providing

additional health resources and

services to patients in these areas

• Dr. Jeffrey Kwong was awarded

$228,197 to determine how well

influenza vaccines work to protect

people from being hospitalized or

dying from flu

• Dr. David Spaner was awarded

$377,124 to determine the most

effective ways to improve the results

of steroid therapy for the treatment of

chronic lymphocytic leukemia

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CIhr reCognIzes neW InvesTIgaTors

CIHR also awarded Drs. Benjamin Goldstein and Harindra

Wijeysundera each a new investigator salary award worth

$300,000 over five years. Dr. Goldstein will investigate

whether specific markers in the blood can help doctors

better understand the increased risk of heart disease

in adolescents and adults with bipolar disorder. Dr.

Wijeysundera will study why patients with stable heart

disease are sometimes treated with only medications,

and in other situations undergo procedures such as

angioplasty or open-heart surgery. The aim of the research

is to understand the causes of this variation and the impact

on health care costs, quality of life and survival.

15

7. nursIng

At Sunnybrook, more than 2,900 nurses

provide care in a diversity of clinical

settings and are integral members of

health care teams. Again in 2013/14,

the Hospital ’s nurses exercised

leadership in all areas of the health

care system and, in addition to direct

clinical care, fulfilled roles as educators,

researchers, policy-makers and senior

executives. The Hospital’s nurses deliver

compassionate, evidence-based care

and are developing and implementing

innovative roles to further enhance

quality care and services for patients

and their families.

nursIng Takes on soCIal medIa

Sunnybrook nurses, supported by the

Hospital’s web communications team,

participated in two social media events

to raise awareness and educate the

community. An ovarian cancer “twitter

chat” was held in May, the result of a

partnership between Sunnybrook and

Ovarian Cancer Canada, and featured

Advanced Practice Nurse Larissa Day

answering questions from the public.

During Nursing Week, a “day in the

life” of two Sunnybrook nurses was

live-tweeted.

16

laTe Career nurse InITIaTIve

Twenty Sunnybrook nurses participated

in the HealthForceOntario Late Career

Nurse Initiative, which provides nurses

55 years of age and older with the

opportunity to spend part of their time

engaging in less physically demanding

nursing roles such as mentoring other

nurses and patient education. Roles

created within this initiative align with

current patient care improvement

priorities including mobility, end-of-life

care, discharge transitions and workload

measurement.

a neW nursIng model for general InTernal medICIne

A new nursing staffing model, which

includes both Registered Nurses

and Registered Practical Nurses was

implemented on three of the General

Internal Medicine patient care units (D-

2, C-4 and D-4). The model features

a focus on person-centred care,

supporting best practices to improve

the patient experience and team

communication processes.

besT Care for PaTIenTs reCeIvIng anaesThesIa

Nurses led the development of the

“PeriAnaesthesia Care Pathway”,

implemented across multiple clinical

settings at Sunnybrook. The pathway

improves the assessment, monitoring,

eva luat ion, documentat ion and

continuity of care for patients who

receive anaesthesia. Information for

elective surgical patients along the

continuum of care from the pre-

admission clinic, same day surgery,

postanaesthesia care unit, and through

to ambulatory outpatient procedures

and inpatient clinical care areas, can

now all be found in one comprehensive

booklet.

17

8. healTh ProfessIons

Interprofessional care is well recognized

as an enabler for improving patient

care and alleviating the demands on

the health system. The Ministry of

Health and Long-Term Care has made

interprofessional care a key component

of the HealthForce Ontario strategy to

ensure a high functioning and stable

health care workforce. Sunnybrook

believes that an interprofessional

approach to health care best meets

the complex needs of the Hospital’s

population.

reneWed vIsIon and sTraTegy

Over 2013/14, Sunnybrook developed

an interprofessional care vision and

strategy, resulting in the creation of an

Interprofessional Advisory Committee.

The group has representatives from

medicine, quality and patient safety,

frontline staff, students and a patient

representative. Tracey DasGupta

assumed a new role as Director of

Interprofessional Practice, providing

l e a d e r s h i p t o f u r t h e r e m b e d

interprofessional approaches in

research, practice and education within

Sunnybrook.

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a Team aPProaCh To managIng ChronIC PaIn

Each profession in the Veterans

Centre contributes to the assessment

and management of chronic pain,

an approach so successful that

Accreditation Canada named the

team-based approach as a Leading

Practice. The team has created a pain

questionnaire and documentation guide

for staff, in addition to incorporating

pain as an agenda item at rounds and

discussing pain issues during each unit’s

interprofessional team rounds.

sPIrITual Care eduCaTIon day

Almost 90 spiritual care providers from

Toronto, Ottawa and Thunder Bay

participated in the Sunnybrook Spiritual

Care Education Day in June 2013.

Participants explored the importance of

evidence-based spiritual care and how

to get involved in research.

shoWCasIng sunnybrook’s InTerProfessIonal exCellenCe

In June 2013, the fourth annual

Interprofessional Education and

Interprofessional Care Showcase was

held. Knowledge was shared among

teams and health care providers

through eight oral presentations and

19 poster presentations. Two posters

entitled “Caring for individuals who are

dying and their families – Exploring the

experience of interprofessional health

care providers” and “Exploring attitudes

of Canadian radiation oncologists,

radiation therapists, and physicists

regarding interprofessional teaching and

learning” won podium awards.

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9. greenIng sunnybrook

The annual Earth Matters Showcase,

a Bike to Work Day and the fifth

year as one of Canada’s Greenest

Employers were highl ights from

2013/14 as Sunnybrook demonstrated

an ongoing commitment to creating

a more environmentally sustainable

environment. Staff pitched in to help

clean the Bayview campus with the

20 Minute Makeover garbage cleanup,

collecting 60 pounds of garbage, 15

pounds of which was separated out for

recycling. The Hospital’s Smart Energy

Actions Program was launched to

implement energy projects to help use

energy more efficiently.

smarT energy

The Hospital’s Smart Energy Actions

Program included the implementation

of ENBALA Grid Balancing. Sunnybrook

partnered wi th ENBALA Power

Networks to provide real-time regulation

services, known as Grid Balance™, to

the Ontario electricity grid. Traditional

demand response programs require

an electricity customer to curtail their

energy use for hours at a time, not

something that is easily achievable for

a hospital. Grid Balance™ requires

real-time power adjustments for short

periods of time, usually less than

15 minutes. Sunnybrook is one of

the inaugural large electricity users

participating in the program and is the

only health care organization.

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summer energy savIngs

Sunnybrook’s new Energy Use Web

Portal displays the Hospital’s real-time

energy demand. The information is

particularly useful during hot summer

weather when it is important to try to

reduce the Hospital’s peak electricity

demand. Reducing energy on summer

days that have a temperature higher

than 30 degree Celsius impacts the

Hospital’s electricity costs for the

following year, alleviates strain on the

Ontario Electricity Grid and reduces the

risk of a critical energy loss situation.

Cool roof for The hosPITal

The cool roof initiative continued with

the completion of a cool roof installation

for A and C wings. Sunnybrook added

an additional 15,600 square feet of cool

roofing to reflect the visible wavelengths

of the sun, as opposed to absorbing it,

reducing heat transfer to the building

and the need for cooling.

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10. CommunITy engagemenT

Community engagement is weaved

into how Sunnybrook approaches new

projects and initiatives impacting the

Hospital’s patients and community,

and 2013/14 was no exception. From

consultations on the strategic planning

process, to town halls, to the patient

navigation initiative, the Hospital strived

to ensure stakeholders were informed

and given opportunities for input and

discussion. In addition to the bi-annual

Sunnybrook Magazine, the organization

continued to produce Sunnyview

segments with health tips and medical

news by former CTV health reporter

Monica Matys.

sTraTegIC Plan CommunITy engagemenT

Sunnybrook encouraged stakeholders

to provide input on the future direction of

the Hospital through an online strategic

plan community consultation. Strategic

Plan 2014-17 will guide the Hospital’s

direction for the next three years by

setting priorities for future investment

and growth. To ensure inclusivity,

stakeholder engagement was opened

to all members of the community via the

Hospital’s website through animated

slideshows, each telling a different part

of the strategic planning story.

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globe and maIl serIes

Sunnybrook partnered with The Globe

and Mail to explore challenges at the

Hospital and discover what patients,

doctors, nurses and the community

believe needs to be done to improve

the hospital experience. Beginning

in September 2013, journal ists,

photographers and videographers were

given access to everything from the

Emergency Department to surgical

suites to specialized units. The series,

in print and online, highlighted initiatives

at Sunnybrook that are helping to build

a better health care system.

PaTIenT navIgaTIon

Paul Taylor, former health editor with

The Globe and Mail, joined the Hospital

as the Patient Navigation Advisor.

Relying heavily on medical experts at

Sunnybrook, the Ask Paul blog provides

advice to the public on how to access

health services and the health care

system. The blog is posted on the

Sunnybrook website, appears in the

Your Health Matters newsletter and is

also syndicated on HealthyDebate.ca.

dIalysIs ToWn hall

A town hall meeting for dialysis patients

and families was held to share plans

for Sunnybrook’s Kidney Care Centre.

Over 60 patients and family members

attended the meeting to hear an update

on the new space being developed at

the CNIB building, about half a kilometre

away from the Bayview campus. The

new space will allow for 24 treatment

stations for stable dialysis patients.

suPPorT for ICu famIlIes

Sunnybrook has made it a priority

to provide more support material for

family members who have relatives

in Sunnybrook’s Intensive Care Units.

Work started on a research project

entitled “Therapeutic Alliance in the

ICU: Enhanced information to facilitate

decision making” and also on a mobile

web site that would increase family and

patient access to information.

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sunnybrook sPeaker serIes

Since 2004, the free community Speaker

Series events have educated the

community on topical health care issues

from all eight Hospital programs. The

events, held from May to September,

provide helpful medical information

and an opportunity for the community

to hear from and ask questions of

Sunnybrook’s experts. This past year,

eight events were held and can be

viewed at sunnybrook.ca:

• Targeted Care for Breast Cancer: The

Future is Here

• Recognizing and Managing Early

Dementia

• Much to do About Pain: Management,

Preparing for Surgery and Who is

Affected

• Diabetes Guidelines 2013: Your

Essential Guide

• Joint Health: Preventing Problems

and Living Well With Arthritis

• Hearing Loss: Causes, Prevention

and the Latest Trends in Amplification

Technology

• Wi l l a Stat in a Day Keep the

Cardiologist Away? The Latest Topics

in Heart Care

• All About Stroke: The Latest Lifesaving

Information

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11. dIgITal sTraTegy

Sunnybrook’s social media presence

thrived in 2013/14 as the Hospital

used Facebook, Twitter and YouTube

to improve the patient experience,

spread news about the organization’s

research and innovations, engage with

the community and leverage health

expertise for patient education. A

number of Twitter chats were organized,

including a live chat on anxiety and

obsessive compulsive disorder and one

to mark Colorectal Cancer Awareness

Month. The statistics are impressive:

12,062 Twitters followers and 6,033

Facebook ‘likes’. A member of the

social media team is always available to

follow and respond almost immediately

to Twitter comments posted by patients

and family members. Sunnybrook’s

use of social media to improve the

patient experience is now recognized

as a leading practice by Accreditation

Canada.

your healTh maTTers blog

The Your Health Matters blog was

launched, which is a new magazine-

style website featuring healthy living tips

by Sunnybrook experts. The new blog

was designed for desktop computers

and mobile devices and leverages

content from slideshows, videos and

blog posts. The blog is the ‘home’ for

much of the patient education content

that Sunnybrook shares on social media.

hearT surgery In 140 CharaCTers

In February 2014, Sunnybrook live-

tweeted a heart bypass surgery to mark

Heart Month and educate the hospital’s

community about heart disease

and cardiac surgery. The live tweet

included posting photos, video and

information in real time by Sunnybrook’s

web communications team and staff

photographer. Sunnybrook was one of

the most talked about topics on Twitter

that day across the country. In three

days, the Hospital gained 5,500 new

Twitter followers, and a six second clip

of the beating heart has been viewed

more than 85,000 times.

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sunnybrook has klouT

Klout is a website and mobile app that

uses social media analytics to rank

its users according to online social

influence via the “Klout Score”, which is

a numerical value between 1 and 100.

As of March 2014, Sunnybrook’s score

was 69, the highest of any Toronto-

area hospital or hospital foundation.

The Hospital has the most-watched

YouTube channel among Canadian

hospitals with 1.4 million views.

TImely resPonse To Issues

The web communications team not only

shares Sunnybrook’s innovations, the

team also provides timely responses to

issues. When CBC’s “Rate my Hospital”

report was issued, a short video of

Sunnybrook leaders’ concerns with

the ranking methodology used in the

report was posted online. During the

power outage in December 2013, social

media was used to answer questions

from concerned patients.

26

12. ImProvIng servICe for PaTIenTs and famIlIes Sunnybrook staff from clinical, support

and administrative areas work every

day to continually improve the patient

and family experience. The last year

marked the opening of new clinics, a

renewed Office of the Resident and

Family Experience at the Veterans

Centre and the opening of the Louise

Temerty Breast Cancer Centre. A new

study also found that three years after

Sunnybrook’s Neonatal Intensive Care

Unit moved from an open bay design to

a single-family room model of care, there

are significant improvements in clinical,

operational and satisfaction outcomes.

Canada’s largesT breasT CanCer CenTre oPens

Sunnybrook opened its new Louise

Temerty Breast Cancer Centre, providing

tailored care to thousands of patients.

The 28,000-square-foot facility offers

specialized clinics and unique programs,

including rapid assessment and next-

day diagnosis for individuals with an

abnormality on a mammogram, breast

ultrasound or a clinical finding that is

highly suspicious of breast cancer. The

centre offers screening and genetic

counseling for individuals at high risk

including individuals with hereditary

breast cancer, as well as programs

focused on breast reconstruction and

young women living with breast cancer.

27

neW Care aPProaChes for PaTIenTs WITh develoPmenT dIsabIlITIes

People with development disabilities (DD)

are more likely to visit the Emergency

Department, and more likely to have

repeat visits than the general population.

With this in mind, Sunnybrook began

to offer a new approach by enabling

people with developmental disabilities

to be more involved in their care. Called

“DD CARES”, the initiative provides

communication aids for patients, new

department protocols and discharge

packages for patients.

helP for moThers WITh hIgh-rIsk PregnanCIes

The 4P Clinic, the first of its kind in Toronto,

opened to help new mothers lower

their risk of developing cardiovascular

disease. A multidisciplinary team,

including Dr. Karen Fleming and a

dietitian, run the 4P Clinic. The clinic

addresses pre-pregnancy, pregnancy,

post-pregnancy and pediatrics, aiming

to bridge an information gap by

collaborating with community health

care partners to reduce the risk of

developing cardiovascular disease.

ImProvIng exPerIenCe afTer a sTroke

The Stroke “ABLE” (Achieving Best

Life Experience) guidelines launched in

2013/14 to improve the experience of

those living in the Veterans Centre after

a stroke. The guide helps staff make a

difference in the lives of residents by

working with them to restore the abilities

that allow them to enjoy day-to-day

life. By implementing a restorative care

approach, each resident’s individuality

is respected while attending to both

physical comfort and emotional needs.Care Planning Guide

Achieving Best Life Experience

SunnybrookV E T E R A N S

Restoring Abilities

After a Stroke

28

13. safeTy

Sunnybrook continued to use new

ev idence-based pract ices and

processes to ensure the highest quality

care for patients and their families. The

Hospital’s Quality Improvement Plan is

one of the tools used by Sunnybrook

to track performance in a selection of

high-priority areas, including patient

safety and satisfaction, access to care

and building an integrated health system

with the Hospital’s community partners.

aPProPrIaTe and TImely anTIbIoTIC TreaTmenT

Sunnybrook is a leader in Antimicrobial

Stewardship, a mult idiscipl inary

approach to infectious diseases with

appropriate and timely antibiotic

treatment. A recent Sunnybrook

study revealed that on any given day,

“superbugs” like MRSA and C. difficile

affect one in 12 Canadian adult patients,

with most cases being health care

acquired. In response, Sunnybrook has

a web-based database that identifies

patients and monitors and tracks

pharmacy and microbiology changes

for patients.

esCalaTIon of Care During a hospital stay, a patient’s

condition may change for a number

of reasons. It is important to identify

clinically deteriorating patients early,

followed by a prompt and effective

response. The Escalation of Care

policy was developed to enhance early

recognition of clinical deterioration

and to enable a prompt and effective

response. The policy encourages a

focus on early detection of clinical

deterioration, clear identification of

whom to call and when to escalate,

prioritization of communications and

resolving low priority issues.

geTTIng PaTIenTs movIng

Recognized as a Leading Practice by Accreditation

Canada, Sunnybrook’s Senior Friendly work addresses

patient mobilization and documenting patients’ mobility

level. Staff and students are expected to assess patients

for their mobility capacity within 24 hours of admission

to the Hospital. Focus is now on additional interventions

to manage responsive behaviors due to dementia.

29

ImProvIng CommunICaTIon durIng PaTIenT handovers

By transferring responsibility of care

for a patient, the handover process

relays critical information to ensure high

quality care and ensure patient safety.

A team at Sunnybrook boosted patient

safety in 2013/14 by developing a

formal handover process during patient

transfers from the cardiac operating

room to the Cardiac Intensive Care

Unit. Staff from both teams gather at

the patient’s bedside to review how

each patient’s surgery went, allergies,

any infection precautions to be observed

and past medical history.

30

14. e-healTh

Technology changes the way that

Sunnybrook views and manages

operational and strategic information,

for both the Hospital’s staff and patients.

The last fiscal year was no exception,

with advances in SunnyCare, which

won a Canada Health Infoway LEADing

Practice Award, MyChart and additions

to the iLead program.

sunnyCare

SunnyCare was a key technological

innovation over the past year. By creating

a “one-stop-shop” for clinical information,

the need is reduced to search between

different systems. SunnyCare Mobile

gives clinicians access to patient lists,

lab results, radiology reports, EKG

reports, Echocardiogram reports and

transcribed notes on their secure tablet

or smartphone. In 2013/14, the system

also securely provided all electronic

patient records, with the SunnyCare

desktop integrating e-Signout and

eDischarge applications to facilitate

seamless discharge medicat ion

reconciliation.

myCharT ConTInues leadershIP

The last year showed continued

innovation in improving access to

MyChart, with a Medic Alert partnership

and enhanced support for mental health

patients and clinicians. MyChart can

support Medic Alert services with quick

access to clinical and personal health

information, emergency contacts and

information through shared patient

access to enhance service support.

A pilot project was also launched

with Dr. Ari Zaretsky examining the

benefits of online access with the mental

health community. Patients can now

log their daily moods, medications

and symptoms and share access with

psychiatry providers, through a safe,

private and confidential environment.

31

alerTIng famIly PhysICIans

Sunnybrook made advances in

improving communication with primary

care physicians by sending automated

alerts to primary care offices when

their patients arrive, finish their health

business and have a change in status

while at the Hospital. By leveraging

information from the corporate Patient

Registration System, the alerts support

quicker initiation of follow-up care and

support communication between

Sunnybrook and primary care offices.

ilead

The iLead Program aims to engage staff in

sustaining and improving patient safety and quality

at Sunnybrook, including the development of

standardized quality and safety dashboards and

reports. The latest phase added new indicators for hand hygiene, Antibiotic-Resistant

Organisms, contact precautions, venous thromboembolism, prophylaxis and mobility.

iLead

myEducation

myEducation

myEducationmy Education

my Education

my E ducation

myEducation

myEducation

myEducation

myEducation

myEducation

myEducation concepts Mar.2012

32

15. ParTnershIPs and sysTem ImProvemenT

Sunnybrook continued to build relationships to further strengthen research, education

and teaching and patient care offered at the Hospital.

ImProvIng organ donaTIon raTes

Sunnybrook is working with the

Trillium Gift of Life Network to improve

its notification and conversion rates,

and is taking steps to improve timely

notification of potential organ and tissue

donation cases. Staff and physicians

at Sunnybrook are working diligently to

create a strong culture of donation so

that organ and tissue donation saves

more lives.

meeTIng ComPlex PaTIenTs’ needs

Through the North East Toronto Health

Link, Sunnybrook is sharing its “Top 100

list” of patients with the highest number

of admissions and visits to the Hospital’s

Emergency Department. Partners such

as the Toronto Central Community

Care Access Centre are able to locate

their most complex patients on this

list, allowing clinicians to target those

who may require more enhanced or

coordinated care. The top five diagnoses

of these patients are congestive heart

failure, chronic obstructive pulmonary

disease, pneumonia, myocardial

infarction and fracture.

33

ParTnerIng To ImProve aCCess To vasCular servICes

The Joint Vascular Services Program is a

new partnership between Sunnybrook,

North York General and Mackenzie

Health to ensure timely access to care

and improved outcomes for patients

requiring vascular surgery services in

the Central Local Health Integration

Network. Sunnybrook is a recognized

leader in elective endovascular aneurysm

repair, and is providing emergency

coverage to the two hospitals when

the local vascular surgeon is away. The

partnership also ensures that vascular

surgeons at all three organizations have

tri-site surgical privileges.

odeTTe CanCer CenTre ParTners To ImProve endoCrIne surgery servICes

The Hospital’s Odette Cancer Centre

partnered with Toronto East General

Hospital in Endocrine Surgery. The

initiative will feature the establishment

of a standalone multidisciplinary clinic,

which will include surgery, endocrinology

and radiology to assess nodular disease

of the thyroid and focus on thyroid

malignancy. The aim is to provide a

care delivery model of excellence in

endocrine neoplasia that will allow the

Odette Cancer Centre to focus more on

tertiary and quaternary activity, leading

to further collaboration and improved

wait times for patients with thyroid

disease.

34

16. fundraIsIng

Donors provide sustainable philanthropic

support for the priorities that are crucial

to the achievement of Sunnybrook’s

vision. Looking back at 2013/14, it

is apparent that the work of the

Sunnybrook Foundation is important

to the Hospital’s success.

slaIghT CenTre for Image-guIded braIn TheraPy and rePaIr

A $10 million donation from The Slaight

Family Foundation had made possible

The Slaight Centre for Image-Guided

Brain Therapy and Repair. It is at the

heart of Sunnybrook’s efforts to create

therapies that will halt the steady

advancement of dementia, prevent

stroke and regenerate damaged brain

tissue.

youTh menTal healTh

More than $6 million was raised to

support youth mental health programs,

such as specialized care and research

for young people with bipolar disorder.

That figure also includes over $1.2

million raised for the Family Navigation

Project through the inaugural RBC Run

for the Kids, a two-day event that far

exceeded expectations. Because of

tremendous community support and a

strong partnership between RBC and

Sunnybrook, the project is now actively

helping families by connecting teenagers

suffering mental illness or addictions to

the right care at the right time.

“a” grade for sunnybrook foundaTIon

For the past four years, Sunnybrook

Foundation has been recognized

with an “A” grade by MoneySense

magazine’s Canada’s 100 biggest

charities report. The grade was awarded

for the Hospital’s efficient use of donor

funds and strong governance. Making

the most of every donor dollar is a

responsibility the Foundation takes very

seriously.

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17. fInanCIal ouTlook 2014/15Sunnybrook has entered into a new

Hospi ta l Serv ice Accountabi l i ty

Agreement (H-SAA) with the LHIN.

It includes a balanced budget but

in absence of confirmed Ministry

fund ing re f l ec ts Sunnybrook ’s

assumptions for both Health Based

Al locat ion Program and Qual i ty

Based Procedures funding. These

assumptions are consistent with prior

years. Due to the election in progress

Sunnybrook expects further delays

in Ministry funding announcements

and therefore is not anticipating

confirmation unti l summer. Once

funding is confirmed Sunnybrook will

reassess its plan in order to meet the

H-SAA balanced budget criteria.

The Government of Ontario is facing

long-term financial constraints and an

aging population demographic. Ongoing

fiscal restraint policies point to relatively

small funding increases, consistent with

the past three years. This will impact all

hospitals but adds an incremental level

of uncertainty to Sunnybrook’s plan. For

Fiscal 2014/15 Sunnybrook will seek to

build on its recent success in increasing

non-Ministry revenue, and further improve

efficiency in order to maintain service

levels and its commitment to high quality

care. Sunnybrook continues to be actively

engaged with the Toronto Central LHIN on

its Health Links strategy as the lead role

for the North East Toronto Health Link.

36

noTes

Management Commentary and Analysis

2014