The Scarborough Hospital may decide next month to restrict one of its campuses, the Birchmount, to same-day surgeries, while moving more complex surgeries to its General campus.
One proposal for the hospital’s future released this week would merge Maternal Newborn and Child Care departments at the Birchmount and General campuses into a Women and Children’s Centre of Excellence, including birthing and pediatric surgery, on one campus.
“For the average hospital user, you’re not going to notice a difference,” Anne Marie Males, TSH vice president of patient experience said Tuesday, Feb. 5.
The hospital, which must erase a $17-million deficit by April 1, has also offered early-retirement packages to employees, who must decide by next Monday whether to accept them.
After six months of community meetings and messages on the inevitability of change, TSH announced a schedule of information displays and focus groups this month before the proposals reach a hospital board of directors meeting on March 5.
Merging the MNCC programs is opposed by the board’s Community Advisory Council (CAC) and by a grassroots group, Friends of The Scarborough Hospital. It is also expected to concern members of the merged programs and emergency department staff worried the move might leave them without an obstetrician or pediatrician on hand.
The TSH administration has not named a preferred site for the merged program, but a consultant’s study last July, which calculated the move will save the hospital $4-5 million a year, concluded “some individuals will be dissatisfied with whatever site is chosen.”
The study also said the status quo, with births and pediatrics on both campuses, “is likely unsustainable (for TSH) given the gradual decline in their market share of deliveries” around Toronto.
Marla Fryers, executive vice president of clinical operations, said the number of births has dropped 14 per cent at the Birchmount and 10 per cent at the General over three years because of a declining birth rate in Scarborough and competition from other birthing centres.
Current bed occupancies for the programs are around 50 to 60 per cent, partly because practices in pediatrics have changed, she said. “We try as much as possible not to keep kids in the hospital.”
Both TSH campuses could accommodate the merged program, and talks with Rouge Valley Health System, the Central East Local Health Integration Network and hospital stakeholders will help determine where the centre of excellence is housed, Fryers said.
Administrators, however, say the merger is being proposed not for its cost savings but because a larger unit should improve medical practices and results for patients. “The more often you do something, the better you get,” said Fryers.
The hospital, which previously merged the palliative care and mental health programs at the General and Birchmount into single-site operations, says the same logic applies to its proposed division of surgeries.
The Birchmount site, on Birchmount Avenue north of Finch Avenue, would keep its General Medicine Inpatient and Intensive Care units but would focus on minimally-invasive surgeries - cataracts, gallbladder, or bunion removal, for example - which have turned into operations not requiring an overnight hospital stay.
“People are in and out on the same day,” Fryers said. “That is our future. We’re excited about creating a place that has that kind of image.”
The General site, on Lawrence Avenue at McCowan Road, currently saddled with some of the oldest operating rooms in Ontario, will handle more complex surgeries such as joint replacement, vascular or breast reconstruction.
Administrators would also place its Chronic Kidney Disease and dialysis clinics at the General - though these may be relocated to a community hub in Bridlewood by around 2015 - plus a Centre for Complex Diabetes Care, and in addition an expanded Cancer Care Program still awaiting provincial approval.
Hospital staff were told of the proposals Monday.
Administrators did not say how many of the 3,400 positions may have to be eliminated to balance the books.
“We don’t have a target,” said Fryers, but she noted TSH has 750 employees who are age 55 or older. “I think all staff understand there are going to be reductions.”
There’s always some anxiety over change, but by and large the medical staff is supportive of the hospital’s proposed new directions, said Dr. Tom Chan, chief of staff.
In an interview Wednesday, Denis Lanoue, vice chairperson of the CAC said the 10-member group knows the hospital is under strong provincial pressure to cut costs.
Lanoue, a ratepayer president for his Agincourt neighbourhood who recently had a knee replaced at the hospital, said he doesn’t mind a division of surgeries between the two campuses.
He predicted, however, the board’s advisory body will continue to oppose the merger of MNCC programs, declaring close proximity to a birthing centre to be “a core service” as important to expectant mothers as an emergency room.
Lanoue, though stating he thought morale, leadership and many practices at TSH had improved in recent years, said he agrees with Friends of TSH that “we don’t want to turn the Birchmount into a Branson,” referring to a North York hospital which has become an ambulatory clinic without a 24-hour emergency department.
TSH administrators and directors, however, have repeatedly pledged proposals resulting from the hospital’s strategic plan review will not be allowed to endanger the 24-hour operations of the emergencies at either campus.
The hospital announced community information sessions with displays, a video and staff to answer residents’ questions, at the Scarborough Civic Centre from 2:30 to 4:30 p.m. and 7 to 9 p.m. next Monday, Feb. 11 as well as on Wednesday Feb. 20 during the same times.
An online survey on the possible changes was also posted on the hospital website (www.surveymonkey.com/s/StrategicPlanRefresh2013) and will continue recording opinions until Wednesday Feb. 27.
There will also be information displays from 10 a.m. to 9 p.m. at Bridlewood Mall on Tuesday Feb. 19 and at Agincourt Mall from noon to 7 p.m. on Tuesday Feb. 26.
Hospital employees met more than 800 people in past months during talks on the future of TSH and many will be informed personally about the second phase in consultations. Ten meetings with focus groups of hospital stakeholders, such as young mothers, are also planned.