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Evolution of the Models

Since 2012, MAHC has continued to carefully examine a variety of models for future health care service delivery.  It is a requirement to explore all potential models, even if they are unpopular, to show the Ministry of Health and Long-Term Care that we have done our due diligence. 

In 2014 and 2015, there was significant work done to explore models, which led to the identification of a preferred one acute care site model in 2015.  Please scroll down the page to review this work from 2014 and 2015 in more detail.

2017: A New Chapter (Stage 1)

In approving MAHC to move to the next stage in the planning process (Stage 1), the Ministry directed MAHC to continue consideration and exploration of the models, and a fuller consideration of the use of one or both of the current sites to ensure access to health care is maintained.  MAHC's Capital Plan Development Task Force that is overseeing the next stage of planning agreed to further review all three models.  This further review is occurring with hospital clinicians and community health care providers, municipalities and others. The following is a high level summary of each of the models currently under consideration.  As the planning work proceeds, clarity and more detail into these models will be provided.

Two Sites (not status quo)

This model would maintain two sites with Emergency Departments, recognizing the need to further consolidate programs and services across the two sites. Recent examples of single sited services include Gynecological Surgery, Ophthalmology (cataract surgery), and Chemotherapy.  Service siting would be based on clinical needs and service co-location requirements to create greater efficiencies, larger volumes and critical mass, and reducing duplication of staffing and equipment.

One Site Inpatient / One Site Outpatient

This model would maintain two facilities with emergency care.  One site would have a primarily outpatient focus (few or no beds) and could include services such as some day surgery, specialty diagnostics (such as MRI), clinics (such as Dialysis), etc.  The other site would have a primarily inpatient focus (majority of beds)and could include inpatient services such as medical/surgical care, intensive care and obstetrics.

One Hospital (centrally located)

This model would provide all programs and services on a single hospital site.  Comprehensive work would be done to determine the role of potential vacated building(s) including the ability to support local urgent and primary care needs, community services, Health Hub development, or other alternative models.  This exploration will include determining best ways to support access for urgent care needs.


Below provides a chronological description of the work that occurred to develop the models MAHC explored prior to 2017.

May 2014: Introduction to Planning for the Future

In May 2014, we introduced our communities to the planning work underway at MAHC. A slide presentation was given at each of the three community information sessions.

August 2014: Development of Preliminary Options Models

At the August 2014 Community Information Sessions, MAHC presented three preliminary models for providing care in the future for input and feedback.  The sessions also included a slide presentation and backgrounder.  The preliminary models considered:

Option 1 - One Acute Care Site

Options 2 & 3 - Ambulatory Site / Acute Care Site - this model was subsequently removed from consideration and led to the exploration of the Centres of Focus (Hybrid) model.

Option 2: was SMMH Site as the Acute Care Site and HDMH Site as the Ambulatory Site

Option 3: was HDMH Site as the Acute Care Site and SMMH Site as the Ambulatory Site

Option 4: Two Acute Care Sites

September 2014: Feedback Received

Following the August 2014 information sessions, a great deal of feedback was received, including:

  • Discussions with staff at the District of Muskoka regarding municipal servicing of the different models;
  • Preliminary information from a cost estimator that demonstrated the range in size and cost of the potential redevelopment models;
  • Comprehensive architectural and engineering reports;
  • Estimates of the 24% local share that must be borne by the community and an understanding from our Foundations of the challenges of fundraising the required local share while continuing to raise money for ongoing capital needs;
  • Advantages and disadvantages of the different models from members of the public, hospital staff and physicians.

November 2014: Committee Directs Development of New Model

In November 2014, based on the feedback received on the options/models presented in August 2014 referenced below, the Steering Committee overseeing this planning work recommended additional analysis and investigation into a new model that blends the benefits of each model into a solution that meets the needs of the community and MAHC.  An internal working group of clinical leaders and physicians were tasked with developing a Centres of Focus model that focused on objectives such as:

  • Sustainability, increased efficiency and developing on centres of focus and specialty, resulting in reduced duplication;
  • Maintaining Emergency Departments in each community;
  • Considering the impact of the Ministry of Health and Long-Term Care's funding reform on operating costs;
  • Closing the cost gap between the most and least expensive model;
  • A model that could be phased-in affordably.

March 2015: Engagement on Models (Pre-Capital Submission)

At Community Information Sessions in March 2015, a slide presentation proposed three models for providing care in the future for input and feedback.  Advantages and disadvantages of each of the models, as well as the key points, were also been presented in the Models on a Page.  Three models were considered:

Two "Full Service" Acute Care Sites (Not Status Quo)

This model proposed redeveloping the two existing hospitals as two acute care hospital sites. Recognizing that the status quo is not an option, there would have continued to be changes to the programs and services across the two sites.  Advantages, disadvantages and key points were identified. 

Centres of Focus (Hybrid)

This model proposed to maintain two acute care hospitals with Emergency Departments in the existing communities.  Some programs and/or services would be offered only at one site or the other site to create efficiencies and larger volumes for critical mass.  It would have reduce duplication and the need for expensive technology and equipment in both sites. Advantages, disadvantages and key points were identified.

One Acute Care Site (Central Location)

This model constructs one new acute care hospital on a single site with programs and services in one location.  Advantages, disadvantages and key points were identified.