Troubled Scarborough Hospital turns
– After years of posting poor mortality rates, deficits and tense
community relations, the Scarborough Hospital is now making a dramatic
turnaround, according to a report by a government-appointed supervisor.
Nearly 14 months ago, Rob Devitt (pictured on left), president and CEO of Toronto East
General Hospital, took over, on behalf of the Ontario health ministry,
as supervisor of the embattled Scarborough Hospital.
According to the Toronto Star, parts of the General hospital were
crumbling, there was a backlog of patient complaints, staff was fighting
with management, the hospital was financially in the red and some female
patients filed lawsuits and publicly complained about the treatment they
received at the hands of Dr. Richard Austin, an obstetrician and
“These issues didn’t bubble up overnight, they were years in the
making,” Devitt told The Star.
Earlier this month, Devitt sent his 337-page progress report on the
turnaround of Canada’s largest urban community hospital to Health
Minister David Caplan.
Devitt pointed out that the hospital has faced a number of significant
issues over the last decade, more than most others in the province –
including what he calls a poorly implemented merger, and the SARS
outbreak, which originated at the Grace site.
“I’m confident in what we’ve done and that we have turned the corner,”
he said. There are new hospital bylaws, a new administration headed by
Dr. John Wright (pictured on right), and, a stricter medical staff credentialing process.
“The bottom line is the hospital is in a very different place today than
it was 14 months ago,” said Devitt.
Last November, when national hospital death rates were released,
Scarborough General had one of the highest scores in the city, at 127
out of 100, excluding palliative care. The rate is now 65, Devitt said.
“We’ve cut it in half. This probably makes Scarborough one of the most
improved hospitals in the province,” said Devitt.
The hospital standardized mortality ratio was established in the U.K. as
a way of improving patient care. The calculation looks at 65 diagnoses
that make up 80 percent of in-hospital deaths such as pneumonia and
strokes. A score above 100 means the hospital is above the national
average. If it’s below, it reflects a lower mortality rate.
To get the numbers down, a big patient safety push began. Hospital
officials did an extensive review of patient charts to identify system
level trends. They reviewed patient documentation and coding practices
and adopted all six initiatives outlined by Safer Healthcare Now! – a
campaign to make hospitals safer places for patients. Safer Healthcare
Now! is spearheaded in Canada by the Canadian Patient Safety Institute,
based in Edmonton.
Another initiative was getting the rates of hospital infection down.
Last month, Ontario began mandatory reporting of rates of C. difficile,
a deadly form of infection diarrhea that killed hundreds in Quebec.
While the Ontario numbers are only available for August, Scarborough
General has a rate of 2.01 per 1,000 patient days and had 17 cases in
August. At Grace, the rate was zero in August.
In the summer, hospital officials asked the University Health Network’s
Dr. Michael Gardam to make recommendations on how to get the General’s
numbers down. By the end of last month, all of Gardam’s recommendations
were implemented, the report notes. The hospital is installing new sinks
and has hired 18 new cleaners.
When Devitt arrived at TSH, he found 315 outstanding patient complaints.
“A process that is slow, unresponsive or perceived as secretive will
leave the complainant unsatisfied and further erode the organization’s
reputation,” the report said.
Devitt beefed up the complaints process and there are now only 36
complaints outstanding, he said.
Other improvements include:
• Last year TSH reduced the deficit by half and this year even has a $1
million budget surplus. “Over the years of having run deficits, the
hospital accumulated sizable debt. It sits right now at $34 million.
This is important to us to be able to start to replenish our equipment
and upgrade the facilities,” said Devitt.
• The hospital submitted a plan for redevelopment of operating rooms to
the health ministry. “What this organization has lacked is a long-range
plan of the redevelopment of the two campuses,” he said. “It’s important
organizations this complex know what all the capital needs are.”
• In September, Dr. John Wright, formerly of UHN, was appointed the CEO
and president, the first action of a new board.