Creating a sustainable future for a small rural hospital

Small rural hospitals across Ontario continue to struggle with the challenges of delivering efficient and effective high quality health services in an increasingly technological and complex health system. As a result of this changing reality, small rural hospitals, like Markham Stouffville Hospital’s Uxbridge site, must adapt in order to continue to serve as cornerstones of these rural communities.

“The Uxbridge community feels strongly about the hospital and about the services it provides,” says Neil Walker, Chief Operating Officer, Markham Stouffville Hospital. “With that in mind, we wanted to look at ways of keeping our hospital vibrant and current. In order to do that, we worked with our community partners to create a new vision of a ‘renewed’ Uxbridge hospital.”

Knowing the community and foreseeing future needs

The Uxbridge site is a small facility currently offering select ambulatory clinics and minor procedures, diagnostic imaging and a 20 bed inpatient medical unit.

Located in a primarily rural community about an hour northeast of Toronto, the Uxbridge site of Markham Stouffville Hospital serves a community with an aging population. More than 13 per cent of the population is over the age of 65 and this is expected to increase over the next eight years. Specifically, the 65 to 74 and over 85 demographics are expected to grow by 53 per cent and 47 per cent respectively in this area of the province.

“It’s well known that as a population gets older, there is a higher risk for frailty and as result we see more seniors who require services from our hospital,” says Julia Scott, Vice President and Chief Nursing Executive, Markham Stouffville Hospital. “There are numerous challenges to serving an aging population; however there are also many opportunities. In looking at the best way that our Uxbridge site can serve the community, we needed to find a balance of serving our seniors while continuing to provide care to everyone in the community.”

Considering the changing landscape of rural healthcare

“There are a number of complex and inter-related issues when you look at providing care in a small hospital. Add to this a population that is aging and we must shift our approach to providing care,” says Walker.  This is why the hospital considered the following issues in today’s health care environment when beginning the renewal process.

•    The impact of “chronicity” and an aging population on the health-care system is well documented. This impact, however, is even more dramatic in rural communities where health services that are often an alternative to hospital care have not been well established. Small volume facilities must constantly manage the need to provide a high standard of clinically competent care in the absence of critical mass. Small volume does not mean “less complex”.

•    The ability to access and share information quickly has supported the new age of informed health care consumers – individuals who understand and are accountable for their health and health issues and make informed choices accordingly. These individuals access the services they want, regardless of distance and even cost.

•    New health service models for the delivery of best practice care have influenced referral and ambulance patterns resulting in many patients now “bypassing” their closest hospital to take a patient to a specialized centre, resulting in a significant decline in ambulance visits.

•    With escalating health care costs, many hospitals have merged or amalgamated to create larger multi-site hospital corporations. Often with these mergers comes the consolidation of services in order to ensure the delivery of high quality care delivered efficiently.

Forming a renewed vision for the Uxbridge site

Similar to many small rural communities, Uxbridge citizens are interested and involved in the activities of the local hospital. Recently, the local government established the Uxbridge Council Health Care Committee in order to participate in the planning and integration of local health services in their community.

The hospital also has a very dedicated Foundation that continues to fundraise for the facility. This commitment made them a highly valued advisory group along with other community leaders to come up with a renewed vision for the campus.

The vision involved supporting the site in establishing expertise in rehabilitative practices and geriatrics to develop the site as a “Centre of Excellence” in both ambulatory and inpatient care.

This new specialized focus on seniors care established a platform for discussion about the possibilities of a broader role for Uxbridge in the future. The vision immediately generated discussion and excitement among the staff, physicians and key stakeholders, all of whom could now envision the campus becoming an important component within the Markham Stouffville Hospital framework.

Making the vision a reality

To make the vision a reality, a number of changes were implemented. The changes included altering the staffing mix at the hospital and enhancing allied health resources to include a dietician, rehabilitation assistant, occupational therapist, physiotherapist and others to assist with the rehabilitation of inpatients. One of the most significant changes was the consolidation of long-term specialty rehabilitation beds, referred to as Complex Continuing Care beds, at the Uxbridge site. In order to care for this patient population, additional capital equipment, such as ceiling lifts, was purchased through the Foundation’s fundraising efforts.

The site is now equipped to care for patients from either the Markham or Uxbridge site who require this level of care, as well as patients from across Durham and York Region.

By February 2012, the first long-term rehabilitation patient was transferred to the Uxbridge campus from Markham. The transfer of the first patient was the culmination of a great deal of effort, change and education.

“The first transfer represented a huge milestone,” says Scott.  “It really showed us what could be accomplished and how the site could fulfill a very necessary role for our community. This really is about providing the right care, to the right person in the right place.”

The Uxbridge Campus continues to evolve as a centre for specializing in geriatrics and rehabilitation while supporting the health-care needs of the community.