Grand River Hospital Annual Report 2020/2021

Resiliency, flexibility, collaboration and courage

Joint Message from our Board Chair and President and CEO

On behalf of Grand River Hospital’s volunteer Board of Directors and the entire GRH team, we are pleased to share with you this look back at our 2020-2021 year; a year defined by resiliency, flexibility, collaboration and courage.

Thinking back to this time last year, we faced many uncertainties and challenges as we set out to define our organizational and Board of Directors priorities for the coming year. As we moved past the first wave of the COVID-19 pandemic, team members at all levels were, and continue to be, exceedingly exhausted. Hospital procedures and protocols were updated quickly, and constantly, in response to the evolving nature of the pandemic. Vaccination seemed like a distant hope rather than a reality. And most challenging for our community, many patient care services were delayed in order to allow us to care for those who needed it the most. Simply put: the immediate and long term impacts of the pandemic on the hospital’s operations and financial position was significant and the future direction of the pandemic was uncertain.

Despite the many challenges, our focus on and commitment to quality patient and family care never wavered. We remained committed to our priorities and made great strides on a number of fronts. These are but a few of the hospital’s accomplishments in 2020-21:

  • We cared for almost 500 Covid-19 positive patients; added 153 new beds; administered close to 150,000 tests and more than 127,000 vaccines; operated a program to support distribution of personal protective equipment (PPE) across the region; and assisted 21 partners with expertise and staff.
  • The experience of patients and families improved, as evidenced by our reduced time to care in our Emergency Department. Our performance was the most improved in the province and our ranking jumped from 64th to 14th out of 72 hospitals.
  • We launched two initiatives to improve the experience of patients, families and the hospital team – diversity, equity and inclusion (DEI), and patient and family engagement. The Board set the tone at the top by diversifying its own membership during the 2021 recruitment process.
  • St. Mary’s General Hospital (SMGH) and Grand River Hospital jointly started a Master Planning process aimed at delivering world class health infrastructure and care into the future through infrastructure development.
  • We grew our innovation portfolio and partnered with local technology and start up firms to solve pandemic related challenges.
  • We leveraged our new Health Information System shared with SMGH to rapidly implement patient care solutions throughout the pandemic including virtual care, testing, orders, and infection, prevention and control measures.
  • We exceeded our financial targets and ended the year with a surplus despite the financial challenges resulting from pandemic response.

These and many other achievements were a result of the exceptional leadership of the Board and Senior Leadership Team, the unwavering dedication and ingenuity of the GRH Medical and Professional Staff, hospital staff and volunteers (“our team”) throughout a relentlessly demanding year and beyond, as well as the support of our community and partners.

Inspired by our team, our partners and our community, we developed a bold Strategic Plan for 2021-25 – Aiming High. The years ahead will continue to be challenging yet inspiring. The successful implementation of our ambitious strategic plan calls for our leaders’ laser sharp focus, a principled and innovative team, and a supportive community.

We are honoured to be part of this dedicated and courageous team, and look forward to bringing to life our vision of a world-class health care system supporting healthier lives in the coming years.

Sincerely,

Ron Gagnon Web Signature
Ron Gagnon (he/him)
President and CEO Grand River Hospital
Dr. Harry Hoediono's Signature
Dr. Harry Hoediono
Chair of the GRH board of directors

GRH by the numbers

Grand River Hospital is the largest health service provider in Waterloo Region and Guelph-Wellington and provides regional services in a number of programs.

Year in Review 20/21

Bed

667
19/20 665

Patient stays

23,389
19/20 25,500

Emergency visits

57,272
19/20 67,000

Babies born

4,105
19/20 4,200

Surgeries

7317
19/20 18,400

Outpatient visits

249,762*
19/20 243,000
*This includes the COVID clinic. If excluding, outpatient visits were 125,697

Our care services

  • Cancer Care
  • Childbirth
  • Children's
  • Complex Continuing Care
  • Critical Care (ICU)
  • Emergency
  • Laboratory Medicine
  • Medical Imaging
  • Medicine
  • Mental Health and Addictions
  • Pharmacy
  • Rehabilitation
  • Renal (Kidney)
  • Stroke
  • Surgery

Our Team

Team members

4,000+

including clinical and corporate staff.

Medical team

690

Physicians, dentists, midwives and nurse practitioners credentialed through the Chief of Staff's office.

Learners

1,000+

including nursing students, medical learners, residents, and more.

Volunteers

600

with over 100 active throughout the COVID-19 pandemic.

Financials

Grand River Hospital's 2020/21 revenue was $500 million. It was mainly comprised of Ontario Health funding, with other revenue sources including patient revenues, grants from our Foundation, and commercial operations such as retail pharmacy and staff, patient and visitor parking. Grand River Hospital’s 2020/21 expenses were $488 million. They were mainly attributed to compensation for over 4,000 staff, pharmaceuticals and gases, and medical, surgical and general supplies.

GRH achieved strong financial results, exceeding targets in 2020/2021. Year-end audited financial results include a surplus from operations of $3.60 M, and a bottom-line surplus of $11.20 M (after receiving a one-time Ministry of Health funds adjustment of $9.94 M) in comparison to the $0.53 M overall budget.

Grand River Hospital Summary Statement of operations
year ended March 31, 2021

(In thousands of dollars)
Revenue
2021
$
Ontario Health (78%)
389,934
Other Government (1%)
5,568
Miscellaneous revenue and recoveries (3%)
17,477
Patient revenue (5%)
23,463
Commercial (5%)
25,145
Equipment grants (2%)
8,236
Building (2%)
7,957
Other (2%)
11,793
Working capital funding (2%)
9,940
Total
499,513
GRH  2021 Revenue Pie Chart
Revenue
Expenses
Compensation (58%)
283,058
Medical staff (6%)
27,514
Supplies and other (12%)
58,762
Medical and surgical (5%)
23,538
Drugs and gases (7%)
34,198
Equipment amortization (3%)
16,085
Building amortization (2%)
10,299
Commercial (5%)
22,823
Other (2%)
12,035
Total
488,312
GRH 2021 Expenses Pie Chart
Expenses
Excess of revenue over expenses for the year
11201

Delivering on our commitments

Planning for the future: We committed to continue our work with partners to improve care delivery across the health system and plan for future priorities at GRH, improve access to and advocate for care services that our community needs and deserves, and focus on innovating the way we work and deliver care.

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  • GRH developed and approved a bold 10-year strategy with a 5-year Strategic Plan. The Strategic Plan was inspired by the communities we serve and includes our collective aspiration to become a world class organization.
  • We continue to work with our local partners to create a more connected, sustainable and accessible health system that puts the needs of patients first through the KW4 OHT (Kitchener, Waterloo, Wellesley, Wilmot and Woolwich Ontario Health Team).
  • A proposal for a Neurosurgery program is being reviewed which will increase access to vital care services for our community, in our community.
  • We continue to collaborate with our partners at St. Mary’s General Hospital (SMGH) and many others, including patients and families, to plan together for our shared future infrastructure needs.
  • The labs at GRH and SMGH were assessed and acknowledged for demonstrating a commitment to patient and employee safety, earning accreditation status for four additional years.
  • Pharmacy Services was acknowledged by the Ontario College of Pharmacists for embedding safe medication practices into their work. An assessment highlighted achievements in hazardous drug preparation and administration.
  • 35 research studies were approved in 2020/2021 while work continued on 51 other studies. These studies support our academic partners, accelerate health research and enhance care practice.
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Create exceptional experiences for patients, families and team members: We committed to put the experiences of patients, families and team members first by increasing engagement, improve care, invest in diversity, equity and inclusion and plan to continue optimizing our health information system (HIS).

  • We have increased engagements with patients and families to help us improve and plan care and processes in several areas including recruitment practices and our COVID response.
  • Wait times in our emergency department were significantly reduced ensuring that patients received care faster.
  • GRH invested in a comprehensive leadership program to develop leaders and enhance workplace experiences.
  • GRH focused on ensuring Diversity, Equity and Inclusion (DEI) through leadership training, celebrating diversity within the organization, developing a plan to address DEI priorities, and establishing key criteria for Board and Community member recruitment processes.
  • The hospital continues to invest in its Health Information System (Cerner) shared with St. Mary’s General Hospital to enhance care. Planning has begun for a patient portal to support patients and families to be involved in care.
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COVID-19 – response, recovery and renewal: We committed to support COVID efforts locally and provincially, build strategies for a stable recovery and improve care services for patients, and develop new models of service delivery.

  • GRH cared for 492 COVID positive patients (42 from out of Region), assisted 21 partners by providing expertise and staff, opened 153 new beds, and hired 1,200 new team members.
  • GRH paused 2,200 elective procedures/surgeries to redirect resources. We have been working to address this backlog as quickly as possible.
  • We worked collaboratively with regional hospitals to increase access to diagnostic imaging services for residents.
  • We implemented new care options to support the continuity of safe care, seeing 5,920 patients virtually. GRH also implemented a virtual care program to support before and after surgery appointments for patients having a hip or knee surgery, with overwhelmingly positive feedback.
  • GRH collaborated with St. Mary’s General Hospital, McMaster University and the University of Waterloo to activate 24 new research studies focused on the management of COVID-19.
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Sustainability: We committed to provide person-centered care with a focus on sustainability and a view to future needs.

  • GRH achieved strong financial results, exceeding targets in 2020/2021. Year-end audited financial results include a surplus of $3.60 M, and a bottom-line surplus of $11.20 M (after receiving a one-time Ministry of Health funds adjustment of $9.94 M) in comparison to the $0.53 M overall budget.
  • The KW Pension Plan moved to an even stronger position in 2020/2021.
  • GRH led and managed a Personal Protective Equipment (PPE) distribution HUB program for the local health system. 24.2 million pieces of PPE were distributed to organizations in need across Waterloo Wellington, ensuring that resources were available throughout the system.

Address critical infrastructure: We committed to work with our partners to ensure we have the facilities and programs that we will need today and tomorrow to care for our growing communities.

  • A new MRI has been approved with construction and installation to come.
  • GRH has secured Ministry of Health (MOH) funding for a MOH/Nuclear Medicine project.
  • The hospital has developed a strategy for a new more efficient, safe and innovative approach for parking.
  • GRH started work on a joint master planning initiative with St. Mary’s General Hospital, which will address the infrastructure needs of both hospitals, today, tomorrow and in the future.
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Feature: A year of courage and partnerships

These are the experiences and accomplishments that have shaped our past year. They have built resiliency and flexibility, strengthened partnerships and collaboration, and have forever changed the ways that we work together. We will use what we have learned to look forward, and plan for the future of health care in Waterloo Region, together.

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Creating exceptional experiences: GRH reduces emergency department waits in 2020

Over the last year, Grand River Hospital’s emergency department team worked to improve patient experiences and outcomes, and reduce the amount of time that patients wait to receive care, earning the hospital a ranking better than the Ontario average on every measurement. In our emergency department, patients are provided with the care they need faster. For some, that means going home faster – and for those who need to stay in hospital, they are moved to an inpatient bed sooner, thanks to the efforts of our emergency department and inpatient teams.

Staff from many programs and services from across the hospital collaborated to make a number of improvements over the past year:

  • The emergency department team worked to significantly improve the patient experience for those who need care, but are not facing a severe or life-threatening event. In streamlining processes, the team reduced wait times for these patients to receive care.
  • Staff from emergency, pharmacy, laboratory, medical imaging, and stroke further improved the hospital’s response to potential stroke patients through a “code stroke” protocol. Code stroke signals key staff from different areas of the hospital to come together to assess potential stroke patients and provide them with the tests and medication they need for a good outcome, quickly. “Code stroke” was introduced in the summer of 2019, and these teams have continued to adapt and improve as the pandemic affected the ways that care is provided.
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  • Emergency department staff worked with teams from other areas to ensure that patients who need to stay in hospital for care, are moved to a bed quickly and are well supported after they leave the hospital. Part of this work includes a trial program the team has introduced to keep patients healthy after they leave the hospital. An emergency department geriatric nurse will visit elderly patients who are at risk of re-admission to the hospital, to put resources in place to support a smooth transition home, including a follow up call after they leave. Collaborative team efforts like this help to keep patients healthy at home and ensure beds are available for the next patient.

"We are exceptionally proud of our staff, physicians and leadership who focus on the needs of patients and families every day," says Bonnie Camm, Executive VP of patient care services at GRH. "However, we are particularly proud of these accomplishments, which significantly improved care experiences for our community during some of the most challenging times faced by those in health care today."

Read more here.

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COVID-19 Response, Recovery and Renewal: An incredible Regional response

While COVID-19 has changed realities around the globe for everyone, those on the front lines of health care have remained at the centre of the public health crisis, managing care and support through a constant state of change. Over the last 19 months, staff at all Waterloo Region hospitals partnered to continually shift, pivot, adjust and re-adjust to accommodate new information, needs, practices and priorities, and support regional COVID-19 efforts, collaboratively.

In 2020/2021, these efforts continued in waves two and three from prevention, to treatment, vaccination and ongoing care needs.

Waterloo Region hospitals support COVID-19 Testing

All three local hospitals played a pivotal role in preventing the spread of COVID-19 across Waterloo Region by facilitating testing, with the joint Grand River and St Mary’s lab processing results.

In September 2020, the joint lab implemented new technology that increased the number of COVID-19 tests processed, twentyfold; from 66 to 1500 swabs per day. This change also meant that most of the Region’s COVID tests, submitted by local test facilities and hospitals are processed locally, and sooner, reducing the amount of time it takes to get a result.

Img 20200714 Covid Lab Carol Kris Training

In June 2020, Grand River Hospital opened the Region’s only drive-thru COVID-19 test site, to support testing already happening at Cambridge Memorial and St. Mary’s General hospitals. The drive-thru has since administered more than 160,000 swabs, or 30% of tests completed in Waterloo Region.

“All of these efforts have helped to share the workload with a single goal of reducing the spread of COVID-19 in our community,” explains Grand River Hospital’s COVID test site lead Tal Kleiman. “Health care organizations are working together across the Region to ensure residents can be tested and have their results sooner, so that they have the information they need to protect others and reduce the spread. We are extremely proud to play our role in this important part of our COVID response.”

Drive Thru Covid Testing

Enhancing partnerships and sharing resources in the fight against COVID-19

Throughout the pandemic, Ontario hospitals have been challenged to reimagine hospital space to accommodate increasing volumes of patients with acute, and isolation needs. Locally, this required a collaborative approach to focus as much hospital space as possible on the care of critically ill patients. Grand River Hospital provided space at its Freeport Campus to accept lower acuity patients from Waterloo Region hospitals, to enable area hospitals to use available space and resources to care for patients with critical needs. This increased capacity available locally became especially important as many out-of-region hospitals began to experience extreme capacity pressures, and transfer their patients to Waterloo Region hospitals for care.

Wave three also brought extreme pressures to front-line health care staff across Ontario. Grand River Hospital organized the redeployment of staff and physicians to hospitals outside of Waterloo region, to provide relief for those hardest hit by waves two and three of the pandemic.

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"I want to extend my profound gratitude on behalf of everyone at Osler for accepting our most ill patients in transfer, and for deploying physicians to shore up our resources,” says Dr. Frank Martino, Chief of Staff at William Osler Health System. “It means the world to us and even more to the families and patients who are battling for their lives. The load sharing of the burden during this wave of the pandemic has provided enormous relief to our teams. The addition of the skilled physicians working side by side with our staff has made a tremendous difference, helping to lighten the load that threatens to exceed our capacity. Thank you for demonstrating what generosity and compassion look like.”

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COVID-19 – Hope, Vaccinations and Teamwork

In late December 2020, Grand River Hospital opened the Region’s first vaccination site with support from volunteers and staff from Cambridge Memorial and St. Mary’s General hospitals to protect those most vulnerable. This clinic served the province’s priority 1 groups (health care workers, Indigenous people, and the elderly), and delivered more than 25,000 doses of vaccine. In March, the clinic moved the team to a larger location in Cambridge to continue work to support the Region’s vaccine strategy. To date, the Pinebush Clinic has provided more than 210,000 doses of COVID-19 vaccine to our community.

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“I’m incredibly proud to work with the Region of Waterloo as part of our COVID-19 response,” says vaccine clinic manager and Grand River Hospital manager, Lisa Anstey. “This is definitely the highlight of my career and I want to thank the Region and each and every member of the team who has stepped up to support our community when it was needed the most. From our humble beginnings in the basement of the Kaufman Building, to becoming the biggest vaccine clinic in the region, we have evolved to not only administer vaccine but also hope, kindness and healing.”

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COVID-19 Research

Grand River also joined St Mary’s and many other Ontario hospitals in COVID-19 research and academic partnerships that will continue to enhance knowledge and learnings of COVID-19 treatments, including the use of antibodies, and potential therapies.

“None of these accomplishments would have been possible without the phenomenal team we have at Grand River Hospital, staff and leadership from Cambridge Memorial and St. Mary’s General hospitals, and the community joining together,” says Ron Gagnon, Grand River Hospital President and CEO. “COVID has really required us all to think differently about the ways that we work together to support and protect our community and those across the province. Our community has stepped up to support us in so many ways, from funding supplies and equipment, to providing meals and coffee for staff. I am immensely proud to work with this team, in this community and acknowledge all that we have accomplished together.”

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Research and Innovation Courage: Leading the local transformation of research and innovation into application

Exciting work happened locally to open the door for research and innovation to become transformed into actual practice and care at Grand River Hospital. Through this, Grand River Hospital is becoming a place where new technology and practice will benefit patients here, and around the world.

“We are excited to contribute to innovation and provide better care for the patients of today and tomorrow. GRH is where innovation becomes application,” says Carla Girolametto, Director of Innovation and Research and Clinical Trials.

In 2020-2021, part of this work directly supported the hospital’s COVID-19 response by increasing clinical trials, research studies, and innovative initiatives related to the virus, treatment methods, and the local and global impact on the health system and resources.

35 new studies reviewed and approved, 24 of which were COVID-19 related while work continued on 51 studies that were already approved.

The hospital's office of Innovation and Research also developed new partnerships that enabled GRH team members to participate in innovation and research activities to impact the patients of today, and tomorrow by advancing our knowledge of science, and enhancing future pandemic planning.

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GRH partnered with the Accelerator Centre (AC), a local award-winning startup organization, to launch the Plexus MedTech Program. Companies in Plexus are near or ready to scale their product and are invited to test their solutions in a health care setting.

Through a partnership with CAN Health Network, Grand River Hospital also supported promising Canadian health-tech companies within the CAN Health Network to test their products and theories within the hospital. Companies use their experiences to plan for widespread adoption of their invention in Canada and globally to benefit patients around the globe. Through this initiative, small and medium-sized enterprises and start-ups are able to collaborate and refine Canadian medical technologies that are market-ready.

“This is an exciting time to be a part of innovation and research in health care,” explains Ron Gagnon, GRH CEO and president. “The spirit of innovation that exists in this region is both infectious and inspiring. We’re blessed with having very strong partners in this region, whether in academic or tech sectors. We’re able to give people an opportunity to test out their ideas in a local test bed and discuss the problems we face to seek solutions. It gives us the ability to innovate together, not just for the benefit of our individual organization, but for our region, our province, and our country.”

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Looking ahead: Moving forward, together

Planning for the future: We are pleased to acknowledge the achievements of the past year, and use the experiences gained as a springboard to planning our future. We are excited to share how our next steps will position us to deliver exceptional, compassionate health care experiences, driven by inspired people focused on quality, partnerships and innovation to deliver world class health care.

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When we looked to the future, we viewed our path with the broader lens of what we see in our community. This work will take us into the next ten years, and we are are dedicated to seeing our vision through to reality.

When we looked to the future, we viewed our path with the broader lens of what we see in our community. This work will take us into the next ten years, and we are are dedicated to seeing our vision through to reality.

The plan for our future has been shaped by thousands of voices – patients, families, our hospital team members, partners and community leaders. It has also benefited from the experiences of the last couple of years, the launch of a new hospital information system with our partners at St. Mary’s General Hospital, and the changing delivery of health care through Ontario Health Teams.

Through a new, bold, direction Grand River Hospital will focus on key priorities over the next year to:

Deliver a world class experience for patients, families and team members: We value people above all else and our aim is to make a positive difference in their lives every day. We will put the experience of patients and their families, our team members, and our partners at the very top of our agenda.

Partner to create a world class health system: We will be an engaged partner working with our partners, patients and their families to co-develop a truly world class system to advance the health and health outcomes of people in our community.

Innovate and transform healthcare delivery: We will leverage the collective talents and strengths of GRH, our community, and our partners to innovate and accelerate the transformation of health care delivery.

At the core of every world class community are people who care – people who care about the work they do, the community they live in and the chance to make a difference. At Grand River Hospital Foundation we share that passion and dedicate ourselves to our great community by working in partnership with people from all walks of life to make every health care experience exceptional.

Everyone in Waterloo Region will come through the doors of Grand River Hospital at some point in time. We’re the largest and most comprehensive community hospital in our region – the hub for cancer treatment, childbirth, pediatrics and neonatal intensive care, mental health, clinical research, kidney and dialysis treatments, stroke, emergencies and critical care. The kind of hospital we need close to home when it matters most - the kind where care never stops.

Learn more about Grand River Hospital Foundation

Learn more about what the Foundation does and how you can be involved, and download a copy of the 125th Anniversary commemorative piece that explores all of what embodies Grand River Hospital through stories, poems, songs, pictures and more.

Grand River Facts

GRH has improved emergency department length of stay by 12 per cent while seeing a nine per cent increase in volumes. More than 65,000 emergency patients are treated at GRH every year.