Friday, 26 August 2016

Supporting Patients Through Medical Assistance in Dying

This month's blog has been prepared by Dr. Jan Goossens, Chief of Staff at Muskoka Algonquin Healthcare.

Dr. Jan Goossens,
Chief of Staff
Medical assistance in dying is one of a number of choices that can be considered in end-of-life care at Muskoka Algonquin Healthcare.

End-of-life care planning is very personal, and is designed to be respectful of your personal values and beliefs and to ensure that you and your family are treated with dignity.

Since medical assistance in dying became legal in June 2016, a great deal of work has occurred at MAHC to ensure that our patients have access to all aspects of end-of-life care, including medical assistance in dying, and that our staff and physicians have a framework that  guides them in this new practice. There are two ways in which this medical assistance in dying can ultimately occur:

  • A doctor will provide the patient with a prescription for a fatal dose of medication to end his/her own life, or
  • A doctor administers medications to the patient that ends the patient’s life. This is also known as voluntary euthanasia.

Requests for medical assistance in dying must come from a capable and competent adult who meets all of the eligibility criteria, without pressure from others. Substitute Decision Makers, Powers of Attorney and/or family members cannot make this decision and advance directives cannot be used to request medical assistance in dying. To qualify for medical assistance in dying, you are required to meet all of the following criteria:

  • Eligible for health services funded by a government of Canada
  • At least 18 years of age
  • Capable of making decisions about your health care
  • Suffer from a serious and incurable illness, disease or disability
  • Are in an advanced state of irreversible decline that is causing enduring physical or psychological suffering that is intolerable
  • Natural death is reasonably foreseeable
  • Give informed consent in writing

It is important to consider details like where you wish to die, the way in which you wish to die, who you would like present at your death, whether you wish to have your pet(s) present, whether you wish to have music playing or someone reading to you, and how you would like your loved ones supported following your death.

At any point, if you change your mind you can withdraw your consent to proceed with medical assistance in dying.

MAHC is committed to ensuring patients will receive high-quality palliative and supportive care throughout the process of requesting medical assistance in dying or any approach to end-of-life care. Visit our website for more information.

Thursday, 14 July 2016

Your Values as a Patient are Important to Us


A hospital stay is almost never planned. But when it happens, we want you to know you’re in good hands at Muskoka Algonquin Healthcare. Your health care team is committed to putting patients and families first by ensuring quality care in a respectful and compassionate environment. It is important to us that your experience at MAHC is centered around you. We don’t want to simply meet your expectations, we want to exceed them.


Establishing expectations is the first step in working toward meeting and exceeding them. We are pleased to unveil our new Patient Declaration of Values. I truly believe it reflects what is most meaningful to our patients and families and the expectations that they and our communities at large have of their health care experience at MAHC. It also will help identify the role you can play as a partner in your care. The Patient Declaration of Values demonstrates the rights you have as a patient that we will work to foster and protect by motivating us to achieve our vision of providing Outstanding Care that is Patient and Family Centered.


Through consultative focus groups, I personally received valuable input from patients and their family members about the values they expect our staff to demonstrate, and similarly the values or behaviours that our staff and physicians should expect of our patients. This feedback was essential to shaping our Patient Declaration of Values that is now widely displayed across our two sites.


Values under Quality of Care, Respect, Privacy & Confidentiality, Compassion and Partnership are defined in detail in our Patient Declaration of Values as well as the responsibilities of patients and their family members. I encourage you to review the document on our website or below and look forward to partnering with you as we all do our part to make your visit at MAHC the best it can possibly be.

MAHC's Patient Declaration of Values
MAHC's Patient Declaration of Values

Monday, 13 June 2016

Time is brain when it comes to strokes

This month's blog has been prepared by Dr. Jan Goossens, Chief of Staff at Muskoka Algonquin Healthcare.


There are an estimated 50,000 strokes in Canada each year. It’s hard to imagine, but that’s one stroke every 10 minutes. With over 14,000 Canadians dying from stroke every year, it’s the third leading cause of death in Canada.

Early access to expert stroke care is essential to ensure the best possible outcomes. For every minute delay in treating a stroke, the average person loses 1.9 million brain cells. Each hour in which treatment does not occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging.

Strokes are common, preventable and treatable. They key is knowing the signs of stroke during the initial onset and not ignoring them. There is a limited window of time from the onset of a stroke to administering a drug that could drastically increase the chance of survival and reduce and in some cases even reverse the effects of a stroke. This drug, called tPA, can only be used within 3.0 hours(and sometimes up to 4.5 hours) of the onset of symptoms, making it extremely important to note the time that the first signs of stroke occurred, call 911 and to the hospital.

June is Stroke Month, so what better time to remind ourselves of the warning signs and symptoms and act FAST. There is a tendency for some people to shrug off the symptoms of a stroke, so it’s important to know and remember the FAST acronym and pay attention to the symptoms. 

Face – is it dropping?

Arms – can you raise both?

Speech – is it slurred or jumbled?

Time – to call 9-1-1 right away

Here in Muskoka, timely stroke care is provided through the Simcoe/Muskoka Acute Stroke Protocol and the District Stroke Centre at MAHC’s Huntsville site. This means that a patient with stroke symptoms anywhere in Muskoka and East Parry Sound is treated in Huntsville by the specialized stroke team. The region is also fortunate to have a District Stroke Nurse who provides community education about stroke and stroke care.
We at MAHC are proud to be part of a regional stroke program under the Central East Stroke Network, one of 11 regional areas across the province working toward fewer strokes and better outcomes.

Monday, 9 May 2016

Smoke-Free and Vape-Free Grounds are Coming June 1

The countdown is on.

Muskoka Algonquin Healthcare properties in Bracebridge and Huntsville are less than one month away from become entirely smoke free. Effective June 1, 2016, both hospital properties will become smoke-free grounds. This means smoking and vaping (e-cigarettes) is not allowed anywhere on MAHC property, including all driveways, parking lots, gardens, walkways and forested areas.

A Smoke-Free Grounds Working Group has been working to develop the necessary policies and procedures to support our smoke-free grounds. The policies will apply to anyone on MAHC property, including patients, visitors, staff and other health care providers.

We understand that this change at our hospitals may be difficult for those who smoke and we recognize that changing habits is never easy. We are not telling anyone they can’t smoke. We are informing them where they can and cannot smoke as per the Smoke-Free Ontario Act and our own smoke-free policy, which includes vaping.
MAHC Smoke-Free Grounds branding

Nicotine Replacement Therapy, such as the patch, gum, or inhaler will be a large component of how MAHC will support smokers during their hospital stay with us. An informational brochure will have information for patients, staff and visitors, and maps that show the boundaries of the properties will be available at both sites.

As a health care organization, MAHC has an important role to play in promoting health and wellness in the communities we serve. A smoke-free environment helps to create a healthier and safer place, and encourages and supports both patients and families and staff in making healthy choices.

Smoking cessation resources and incentives are broadly available in our communities for people who want to quit smoking. You can call the Smoker’s Helpline at 1-877-513-5333 or the Simcoe Muskoka District Health Unit Health Connection at 1-877-721-7520 to help connect with the best support for you. As well, many health care providers in the community like Family Health Teams, Nurse Practitioner Clinics and even the Canadian Mental Health Association offer smoking cessation programs.

There is no safe level of exposure to second-hand smoke, and we are looking forward to doing our part to protect our community and all users of the hospital properties with cleaner, healthier air.

Friday, 8 April 2016

Volunteers are the Roots of Vibrant Hospitals

Volunteers are the roots of strong communities. They are also the roots of vibrant hospitals. National Volunteer Week is April 10-16, an annual celebration to acknowledge the generous contribution of our volunteers. As Volunteer Canada puts it with this year’s theme: “Just like roots are essential for trees to bloom, volunteers are essential for communities to bloom. Thanks to volunteers, our communities grow strong and resilient. Even the tiniest volunteer effort leaves a profound and lasting trace in a community, much like tree rings that appear over time.”

At Muskoka Algonquin Healthcare, we couldn’t agree more. Across the two hospitals, we are blessed to have more than 300 volunteers, easily recognizable by their green smocks and big smiles, supporting our community hospitals in Bracebridge and Huntsville through the Auxiliary to South Muskoka Memorial Hospital and the Huntsville Hospital Auxiliary.

Our volunteers are hardworking and caring individuals who are dedicated to supporting local hospital care. They assist patients, staff and visitors in nearly every area of our hospitals, promote awareness in the community, offer educational scholarship programs to both local students and hospital staff, and raise money to help purchase much-needed equipment. Their work is essential to our operation, and because of their support, we are closer to achieving our vision to provide outstanding care that is patient and family centered.

National Volunteer Week is a platform for us all to say thanks to the many volunteers who help make our hospitals stronger, and to let them know their efforts and commitment are appreciated, not only during volunteer week, but every day of the year.

To all of our volunteers, I cannot overstate your role and your contribution to safe, high-quality care. Each and every one of you makes a difference – not only to our patients needing care of one type or another, but to our Board of Directors, leadership team, staff and physicians. On behalf of all the people that come through our doors, I sincerely thank you and I hope that you feel a deep sense of satisfaction in knowing that you make enormous contributions to improving patient care at MAHC.

Natalie Bubela
Chief Executive Officer

Tuesday, 9 February 2016

Future Health Care Model Presented at Huntsville/Bracebridge Joint Council Meeting


Charles Forret, Chair of the MAHC Board of Directors
Charles Forret,
Board Chair
This blog has been prepared by Charles Forret, Chair of the MAHC Board of Directors

The Muskoka Algonquin Healthcare Board of Directors recognizes the work that went into the proposal presented at the Huntsville/Bracebridge Special Joint Council Meeting on Monday, February 1. There has been a great deal of dialogue and commentary in the community from individuals like Ken Black, Dr. David Mathies and others demonstrating a growing understanding in the community of the potential risks and benefits of the different models that have been discussed for the future delivery of acute care.

While we understand our communities wish to preserve two acute care sites, the Board continues to believe a One-Hospital model best ensures safe, high-quality and sustainable health care for future generations. The Board is responsible for defining a long-term vision for acute care within the hospital setting, which is only one component of the concept presented by the municipalities focused on widespread health system reform. The Board also emphasizes that status quo is not an option within today’s provincial financial state and objective to transform and shift health care to more community-based care.

The model presented at the Joint Council Meeting builds on MAHC’s Centres of Focus or “Hybrid” model. There is merit to a Centres of Focus model in the shorter term as the Board feels that eliminating duplication of services and concentrating patient volumes by rationalizing services at one site is the only way to survive within today’s funding formula and ensure that programs and services we have today are retained and available in Muskoka. Movement towards a Centres of Focus type of model in the shorter term is inevitable without dramatic changes to the funding for MAHC.

The Board looks forward to further dialogue with our municipal partners, the North Simcoe Muskoka LHIN and the Capital Planning Task Force to better understand the implications of the model and if and how this model will be broadly supported by the residents and visitors in Muskoka and East Parry Sound.

The Muskoka Algonquin Healthcare Board of Directors strongly supports a more integrated local health system and coordinated patient- and family-centered care with the hospital/acute care sector as a key partner in a the region. The Board is open to working with the Hospital Retention Working Group, the municipalities and consultants behind each of the models to address specific questions to better understand the proposal and move forward on a solution that is sustainable for the future and that we all agree will provide the best quality and safe patient care for our communities.

Wednesday, 13 January 2016

Consultant Report is Directional

Ontario hospitals are required by law to balance their budgets on an annual basis. At Muskoka Algonquin Healthcare, this is becoming more and more challenging under the provincial funding formula for hospitals through the Ministry of Health & Long-Term Care.

Each year, MAHC prepares an operating budget for the upcoming fiscal year, and each year since 2012 that budget is prepared knowing that there will be no increase in funding to hospitals despite inflationary pressures we experience with salaries and wages, the cost of drugs and other supplies, and even heat and hydro. This is something that I refer to as deficit funding. We are expected to absorb all cost increases and produce a balanced budget. This means that for an organization the size of MAHC we have to absorb upwards of $1 million in cost increases annually or find cost-saving initiatives to allow us to balance the budget each year.

With great difficulty, MAHC has balanced the annual budget for the past five consecutive years by implementing unpopular changes. We have adjusted operations to eliminate redundancy and to match services to demand. We have reduced beds in both acute and complex continuing care. However a point is reached when there are no longer any cost-saving initiatives, and no longer any ability to absorb cost increases. It appears we have hit that wall, as many other hospitals throughout Ontario are also experiencing.

As custodians of public money, it is incumbent on us to always look for efficiencies, and to match the performance of our peer hospitals. We need to look carefully at our operations to understand what services we can continue to provide and how those services may be reconfigured so that we can live within the province’s funding formula.

So as we faced yet another budgeted deficit in the 2015-16 fiscal year, MAHC brought in an outside consultant with expertise in health care operations to take a fresh look at the efficiency of two of our care areas and recommend ways we can operate more efficiently. 

The Hay Group’s operational assessment reviewed our Surgical Services and Emergency Departments at both sites because we recognized the costs of running these two departments was higher than the funding we receive from the province to operate these services. The report includes various recommendations – some that pertain to staffing models, and others that suggest restructuring services. I want to assure you that no decisions have been made regarding the recommendations in the Hay report.

The report is directional in that it points us to areas that we can further investigate the feasibility and appropriateness of implementing the Hay recommendations to achieve cost savings. Our frontline staff and physicians in the Surgical Services and Emergency Departments are reviewing and evaluating the recommendations and investigating other strategies that may generate efficiencies. I recognize that some recommendations may be concerning. These are highly complex and difficult issues that can potentially affect our services and thus impact our patients, communities, physicians and staff. It is not our intention to create alarm in the community, but this is the harsh reality of where we are. MAHC has reached the point where service consolidation may be considered if the budget is to be balanced. Please keep in mind that consolidating services at one site or the other to concentrate volumes and maximize our efficiency is not new at MAHC. There are a number of services that for years have been available at only one of MAHC’s sites, such as urology and dialysis. There are also certain diagnostic tests that are performed at only one site because it is simply not practical to have two of every piece of equipment. Service consolidations may be small or large, but the goal is the same; to create one combined unit that is efficient and cost effective and that provides quality care. Service consolidation is not about eliminating services; it is about retaining services in Muskoka and delivering them in a different way.