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J E F F
Whatta Ya Think About Dat?
Premium
join:2004-04-01
Kitchener, ON
kudos:1
Reviews:
·Rogers Portable ..

Safest Hospital in Canada

Seems that Kitchener is home to the top hospital in Canada.

»www.smgh.ca/2012/12/13/st-marys-···rtality/

Not surprising, St. Mary's is a good hospital. When my kid was sick, I took her there despite the fact you're supposed to take kids to Grand River Hospital. (which used to be in the bottom 25% in all of Canada, I think they're #82 now)

Anyway, the hospital is pretty happy about this...and nice for me since it's just down the street!
--
If you can't explain it simply, you don't understand it well enough. - Albert Einstein


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
Hospital mortality numbers are a meaningless way of determining if a hospital is "safe" to go to. There are any number of reasons why a hospital may have a higher mortality rate, not the least of which can include serving an aging population or being a centre of excellence for certain treatments which means the most critically ill - and therefore most likely to die - will go there. The fact that they tell you to take kids to Grand River sort of confirms the whole centre of excellence and critical care thing, too.

I have no doubt St. Mary's is probably a fine hospital, but to claim it is the "safest" in Canada based on this alone is absurd.


J E F F
Whatta Ya Think About Dat?
Premium
join:2004-04-01
Kitchener, ON
kudos:1
Reviews:
·Rogers Portable ..
said by Gone:

The fact that they tell you to take kids to Grand River sort of confirms the whole centre of excellence and critical care thing, too. .

Nope. The NDP changed things back in the early 1990's, no kids at St. Mary's at all. No births, no sick kids. They do take emergency patients that are kids and just say "technically you're not supposed to be here, but we don't turn anyone away".

Having used both hospitals, St. Mary's has always had their shit together, they seem to do a lot of fund raising to enhance the hospital. Grand River is something you'd find in some 3rd world country. It's crowded, with miserable and rude employee's and incredibly dirty. Although part of the problem for Grand River is that everyone from Waterloo will use it, including all the stabbed knuckleheads from U of W and Laurier, and it's location is on the main drag, about 3 minutes from downtown Kitchener and about 20 seconds from the Waterloo border.

St. Mary's is located in a residential area of homes that mostly were built for the Doctors and nurses, originally anyway. So many people around here 'forget' to go to it. Although it does have a lot more ambulance traffic because it's the cardiac centre for the area, you don't go to Grand River for strokes and heart attacks, you go to St. Mary's. Grand River does cancer care, births and crazy people.

Anyway, they worked hard for that achievement.
--
If you can't explain it simply, you don't understand it well enough. - Albert Einstein


digitalfutur
Sees More Than Shown
Premium
join:2000-07-15
BurlingtonON
kudos:2

1 recommendation

reply to J E F F
The safest hospital in Canada is the one you're not in.


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
reply to J E F F
said by J E F F:

Nope. The NDP changed things back in the early 1990's, no kids at St. Mary's at all. No births, no sick kids. They do take emergency patients that are kids and just say "technically you're not supposed to be here, but we don't turn anyone away".

Grand River is the Centre of Excellence, not St. Mary's. That was my whole point, and you just confirmed it.

said by J E F F:

Anyway, they worked hard for that achievement.

It's not an achievement to anyone who knows how those statistics are compiled or the context for which they are used. Of course, that doesn't stop marketing from using it, or for people to fall for it.

As I said, I don't doubt St. Mary's is a fine hospital. Still, to claim it is the "safest" - your exact words - hospital in Canada is, I say again, absurd.


Wolfie00
My dog is an elitist
Premium
join:2005-03-12
kudos:8
reply to Gone
There are two sides to this. What you say is absolutely right -- such statistics are so easily skewed by so many factors that they're almost meaningless. Hospital quality is a very hard thing to measure.

The other side of it, though, is when I see a picture like the one posted in that article, with the caption "day surgery staff gather for a daily performance improvement huddle," I have to think, yes, they get it. Performance monitoring and improvement is a crucial element of what's been described as an imperfect science. We tend to think of medicine as being practiced by consummate professionals who never make mistakes, and it's anything but that. It's been shown that techniques as simple as the use of checklists -- the kind that pilots use -- can minimize errors and improve outcomes. So while it may be next to impossible to reliably measure the difference between hospitals, it is in fact possible to measure the effects of process improvements, and it does make a big difference when it's properly executed.
--
"The promoters of the global economy see nothing odd or difficult about unlimited economic growth or unlimited consumption in a limited world."
Wendell Berry


J E F F
Whatta Ya Think About Dat?
Premium
join:2004-04-01
Kitchener, ON
kudos:1
Reviews:
·Rogers Portable ..
reply to Gone
LOL...well, Grand River is a hole. Waterloo begged Kitchener to change the boundaries just so they wouldn't have that hospital on their map. They got the mayor so drunk and he agreed to it. Now it's Kitchener's legacy,
quote:
Waterloo remains the Centre of Excellence, and Kitchener can be the laughing stock for everyone in Waterloo.
The only irony is that the Waterloo people still can't find St. Mary's unless they are having a heart attack and are being sent there by ambulance.

QFT.

Now I am willing to bet you a double double that if you're visiting north of the 401 and 60 miles south-west of Toronto, you'll be searching for the other "H" in the sky.
--
If you can't explain it simply, you don't understand it well enough. - Albert Einstein


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
You do know what "Centre of Excellence" means as far as hospitals go, right? It has nothing to do with whether or not you feel that the hospital is an excellent place to visit.


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
reply to Wolfie00
said by Wolfie00:

The other side of it, though, is when I see a picture like the one posted in that article, with the caption "day surgery staff gather for a daily performance improvement huddle," I have to think, yes, they get it. Performance monitoring and improvement is a crucial element of what's been described as an imperfect science. We tend to think of medicine as being practiced by consummate professionals who never make mistakes, and it's anything but that. It's been shown that techniques as simple as the use of checklists -- the kind that pilots use -- can minimize errors and improve outcomes. So while it may be next to impossible to reliably measure the difference between hospitals, it is in fact possible to measure the effects of process improvements, and it does make a big difference when it's properly executed.

What you said here is absolutely correct, but mortality and morbidity rates are not an appropriate way to gauge this kind of performance. Claiming that a hospital is "safer" because of those measurements is a useless endeavour.

And seriously, I know nothing about either St. Mary's or Grand River or whatever other hospitals there are in Waterloo Region. Or London. Or through most of Hamilton and Toronto (I know Mac Childrens, Hamilton General and the two St. Joe's - one in Hamilton and one in Toronto, that's it). The point I am making is a simple one - you can't judge how "safe" a hospital is on mortality statistics alone, and to try and do so is folly.


J E F F
Whatta Ya Think About Dat?
Premium
join:2004-04-01
Kitchener, ON
kudos:1
Reviews:
·Rogers Portable ..
reply to Gone
No, I thought you were being literal when referring to Waterloo as it does calls itself "Centre of Excellence". Grand River is "Centre of Excellence" for cancer care and psychiatric care as well as birthing wards and general surgery. St. Mary's is "Centre of Excellence" for cardiac care and well a special surgery. It's while both are "Centre of Excellence" for ER in your reference, the ER of Grand River is not a place that any godly person should ever want to visit.

You won't find a children's ward at St. Mary's, but parents do take their kids there for ER visits because kids occasionally die on the gurney or waiting room over at Grand River.
--
If you can't explain it simply, you don't understand it well enough. - Albert Einstein


A Lurker
that's Ms Lurker btw
Premium
join:2007-10-27
Wellington N
reply to Wolfie00
said by Wolfie00:

The other side of it, though, is when I see a picture like the one posted in that article, with the caption "day surgery staff gather for a daily performance improvement huddle," I have to think, yes, they get it.

LOL - not that I don't agree with you, however, after more than a decade being involved in numerous quality systems... way too many systems say a lot (then don't do it until just before an audit).


Wolfie00
My dog is an elitist
Premium
join:2005-03-12
kudos:8

1 edit
I can see how it's easy to be cynical looking at a picture that says "and here we are learning to be the best"! The point is, though, that running those kinds of performance evaluations is a proven methodology in hospital practice (see, for instance, Atul Gawande: "Better: a surgeon's notes on performance", and "The Checklist Manifesto"). Yet even when processes to prevent medical errors might be relatively straightforward, not all hospitals promote that culture or do them well, and some can be outright hostile to them.

EDIT: Corrected a book reference. "Complications" is the more general treatment of medical practice. "Better" is the one specifically dealing with hospital performance. Both are excellent, BTW.


A Lurker
that's Ms Lurker btw
Premium
join:2007-10-27
Wellington N
Hey, I'm a big believer in continuous improvement methodologies. I worked in one plant where (the area I was in) they really worked the system. It was fantastic, and I hope one day to go into another plant that really understands how helpful it can be.

In the meantime most other companies I've observed use some of the methods well, but don't really understand the power that CI can give them. Remember too, I come from manufacturing where profit is king. Maybe in a health care scenario they might buy into the benefits.


Wolfie00
My dog is an elitist
Premium
join:2005-03-12
kudos:8
The health care environment has its own challenges. Like the surgeon who objects to performance assessments because he considers it an assault on his God-like autonomy. It's up to the hospital to establish a culture that is conducive to these methodologies. One of many differentiators. I agree with Gone See Profile that these differences are very hard to measure in absolute terms between one hospital and another. But they exist. Those are the two sides of the coin.


DKS
Damn Kidney Stones
Premium,ExMod 2002
join:2001-03-22
Owen Sound, ON
kudos:2
said by Wolfie00:

The health care environment has its own challenges. Like the surgeon who objects to performance assessments because he considers it an assault on his God-like autonomy. It's up to the hospital to establish a culture that is conducive to these methodologies. One of many differentiators. I agree with Gone See Profile that these differences are very hard to measure in absolute terms between one hospital and another. But they exist. Those are the two sides of the coin.

The dirty little secret about performance indicators is that a) they are incredibly expensive to introduce and maintain in a hospital setting and b) sometimes impossible to measure. Most hospitals are measuring low hanging fruit right now. Things like handwashing, which is easy to measure and costs nothing. True process improvement costs money, and that is not always available.

My wife helped develop and improve the 3 day knee care path, which did reduce cost, improve outcomes, and has been provincially recognized as quality of care and emulated.
--
Need-based health care not greed-based health care.


nitzguy
Premium
join:2002-07-11
Sudbury, ON
reply to J E F F
So because Health Sciences North (Formerly Sudbury Regional Hospital) is a regional hospital dedicated to serve the needs of Northeastern Ontarians who are the most sick and who also require cancer treatment, meaning that they're not the safest?
Because most northerners are above the average in terms of age, means my hospital is less safe? Hogwash.

I hate these sorts of things, I can wring any stat to twist it any way I want. WTF does HSMR mean anyways....

Stupid, of course the hospital will be happy, they'll be happy to see people donate because of this worthless study....


J E F F
Whatta Ya Think About Dat?
Premium
join:2004-04-01
Kitchener, ON
kudos:1
Reviews:
·Rogers Portable ..
My understanding is that the study considered the illness of each patient. So cancer patients have a expected life expectancy, are we above that or below it? As for this hospital, it has all the people having heart attacks and strokes, which has a pretty poor rate in general. They are simply looking for how it scores compared to other hospitals that do the same.

For example, if cancer patients are supposed to live for 7 years 60% of the time, and a hospital is producing 8 years at 80%, then they are better off then a hospital that does mainly heart procedures where expectations are 5 years of life 90% of the time and they do 5.5 years at 93%.

I do believe they are comparing apples to apples and oranges to oranges.
--
If you can't explain it simply, you don't understand it well enough. - Albert Einstein

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON

1 edit
reply to DKS
said by DKS:

The dirty little secret about performance indicators is that a) they are incredibly expensive to introduce and maintain in a hospital setting and b) sometimes impossible to measure.

You forgot (c) hospital administrators are master manipulators of statistics and you will never get a true reflection of performance.

On the other hand thousands of people in eastern Ontario will dive to Lindsay or Cobourg instead of the shiny new half billion dollar Peterborough Regional Health Centre run the last couple years by Ken "the weasel" Tremblay.

I'll go with the gut instinct and experiences of thousands of people.


LazMan
Premium
join:2003-03-26
canada
When you start with the desired result, it's easy to generate statistics to prove it... You just exclude everything from the data-set that doesn't fit your goal.

I kid you not - I worked with one project manager, in a multi-billion dollar company, that presented a stat of "Jobs Completed on time*" of 100% every month - wasn't until someone started digging a little, that the "*" - referred to the foot note of something like " of on-time completions" - so he was measuring completed jobs towards the target of completed jobs... no wonder it was perfection.

It would be a peice of cake to have a hospital with a zero % mortality rate... But the number of transfers to other hospitals would be through the roof - but if that's not the stat you're reporting, who cares?

"Nobody dies here" would be a hell of a slug-line for the marketing materials, wouldn't it?

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON
said by LazMan:

I kid you not - I worked with one project manager, in a multi-billion dollar company, that presented a stat of "Jobs Completed on time*" of 100% every month - wasn't until someone started digging a little, that the "*" - referred to the foot note of something like " of on-time completions" - so he was measuring completed jobs towards the target of completed jobs... no wonder it was perfection.

Let me take a wild crazy no chance in hell guess...Bell?

jaberi

join:2010-08-13
reply to digitalfutur
how true.....hospitals are some of the dirtiest places out there....you see health care staff riding public transport in their uniforms, lugging backpacks that are tossed on the floor, and everywhere, and off to work they come...

there was an article written not too long ago, how filthy the tools in the OR are, because they are not sanitized properly....also they contract most work to cleaning tech's who cant get into every crevice of the tool to clean it out, because they were not trained by manufacturers of these tools....people have died of contracting an infection and it is prevalent with knee surgeries, where the tools have dried blood and miniscule bone shrapnel from a previous patient....

the curtains in the room is a wonderful thing for privacy, but the biggest breathing bacteria place...the nurses wash their hands prior to pulling it across but do not wash their hands again before they touch the patient.....


LazMan
Premium
join:2003-03-26
canada
reply to peterboro
said by peterboro:

Let me take a wild crazy no chance in hell guess...Bell?

I can neither confirm, nor deny...


ErrorError

@start.ca
reply to jaberi
said by jaberi:

there was an article written not too long ago, how filthy the tools in the OR are, because they are not sanitized properly....also they contract most work to cleaning tech's who cant get into every crevice of the tool to clean it out, because they were not trained by manufacturers of these tools....people have died of contracting an infection and it is prevalent with knee surgeries, where the tools have dried blood and miniscule bone shrapnel from a previous patient....

I have a hard time believing that. Many hospitals are now using disposable tools, and surgical tools are sterilized via an autoclave, gamma rays or some sort of "sterilizing gas". Even if the techs screw up on the scrubbing off blood and whatnot, its still non infectious as the actual sterilizing process are exceedingly hard to screw up (its wrap tools, put in tray, close door and press start).

Whats more likely is that the OR itself isn't cleaned properly. Many Canadian hospitals have the tendency of not cleaning properly because they skimp on cleaning staff. You can clean all the instruments you want, that operating table is dirty? you're gonna have a bad time.

The article is also rather insulting to research hospitals like SickKids, they do terrific work and they save children every day. Funding is always needed and articles like this doesn't help at all.

jaberi

join:2010-08-13
" the likely causes of infection were the two surgical tools – an arthoscopic shaver and an inflow/outflow cannula – which, when inspected using tiny video cameras, were found to have traces of human tissue and blood caked onto them.

According to a report from the Center for Public Integrity (CPI), dirty surgical tools are not uncommon – and the more technologically advanced these tools become, the harder they are to clean."

jaberi

join:2010-08-13

1 edit
reply to ErrorError
here you are read all 3 pages of the article

»www.menshealth.com/health/infect···ospitals


J E F F
Whatta Ya Think About Dat?
Premium
join:2004-04-01
Kitchener, ON
kudos:1
Reviews:
·Rogers Portable ..
reply to A Lurker
I worked at Revenue Canada for a contract position during the busy season, we collectively decided it would be a competition to see how much faster we could be than the other branches, in our department. We ended up being 3 weeks ahead of the second fastest office, and about 2 hours behind for requests. Ended up having people outside our service area calling us because "they heard" that we were fast.

Only sad part was that we lost our jobs because we never got behind, and once the busy season was over, that was it. But it was still a lot of fun.
--
If you can't explain it simply, you don't understand it well enough. - Albert Einstein


A Lurker
that's Ms Lurker btw
Premium
join:2007-10-27
Wellington N
said by J E F F:

Only sad part was that we lost our jobs because we never got behind, and once the busy season was over, that was it. But it was still a lot of fun.

Oddly enough, when doing lean manufacturing scenarios the first thing you do is eliminate WIP (work in process) and bottlenecks. This usually results in some of the participants standing to the side and watching the 'employees' make the same number of pieces with fewer people. Companies can say what they want to the trainees, but generally a true lean project is judges on how many heads they eliminate.


DKS
Damn Kidney Stones
Premium,ExMod 2002
join:2001-03-22
Owen Sound, ON
kudos:2
reply to peterboro
said by peterboro:

You forgot (c) hospital administrators are master manipulators of statistics and you will never get a true reflection of performance.

On the other hand thousands of people in eastern Ontario will dive to Lindsay or Cobourg instead of the shiny new half billion dollar Peterborough Regional Health Center run the last couple years by Ken "the weasel" Tremblay.

I'll go with the gut instinct and experiences of thousands of people.

You give the administrator too much credit. People do the same thing in our hospital corp. They drive to Meaford or Wiarton or Markdale because they think the wait times are shorter than Owen Sound or that their treatment is better. It may or may not. I have been in and out of the Owen Sound hospital ER in 15 minutes, from start to finish. I have heard of long waits at Southampton, because they are chronically understaffed, especially in the summer. And I remember the days of the ICU at Peterborough Civic when it was in a thirty year old mouldy portable. Then there were It the days when people would go to St. Joseph's Emergency instead of Civic because they believed the quality of care was better at St. Joe's. Give people a choice and they will take it, based on their prejudices.
--
Need-based health care not greed-based health care.

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON
reply to A Lurker
said by A Lurker:

said by J E F F:

Only sad part was that we lost our jobs because we never got behind, and once the busy season was over, that was it. But it was still a lot of fun.

Oddly enough, when doing lean manufacturing scenarios the first thing you do is eliminate WIP (work in process) and bottlenecks. This usually results in some of the participants standing to the side and watching the 'employees' make the same number of pieces with fewer people. Companies can say what they want to the trainees, but generally a true lean project is judges on how many heads they eliminate.

The problem is that lean management techniques and industrial processes don’t adapt well to the health care sector and don't always produce the best results for patients.

The UK were early adapters of lean in health care and now readmission rates have gone up 78 per cent in the 2000s. But as long as lean managers aka “tool-heads” put on a great show to justify their sunshine club status here in Ontario we are stuck with this until the next fad comes along.

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON
reply to DKS
said by DKS:

You give the administrator too much credit. People do the same thing in our hospital corp.

Except the next time and thereafter they leave town for treatment and pass this along to their family and friends who do the same.

A survey released last year had 90% of responding staff reported they don't feel the Peterborough Regional Health Centre value their work or give them recognition for good work.

Surprise, surprise the latest NRC Picker Canada survey has been suppressed by administration at PRHC.