The document summarizes an interview with Joe Carrelas, the print shop manager at University Health Network (UHN) in Toronto. It discusses the challenges of consolidating printing operations during mergers of hospitals into UHN. It describes Carrelas managing over 2,000 forms and transitioning to online ordering, which increased revenue and volume. It highlights maintaining quality and turnaround times to remain a valuable service for the hospitals' medical advancements.

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2. VICTORIA GAITSKELL
Running a Healthy In-plant
H
ealth is one of three major factors that
ranked Canada sixth of 187 countries
on the November 2011 United Nations
Human Development Index.And although
our country’s publicly funded health-care
system leaves room for improvement com-
pared to the systems of other wealthy na-
tions, 69 percent of Canadians still told a
2010 Angus Reid poll they were prouder of
it than the state of our democracy.A Janu-
ary 2010 report by Statistics Canada shows
nearly 2-million people are employed by
the country’s health-care and social-assis-
tance systems, accounting for around 10
percent of national employment.
Often forgotten behind the scenes are
crucial in-plant printing operations which
produce and secure critical documents.
In late May, I visited the in-plant opera-
tion at University Health Network (UHN)
in downtown Toronto to gain a better un-
derstanding of this unique printing envi-
ronment. UHN is one of our country’s
largest treating, research and teaching hos-
pitals, affiliated with the University of
Toronto Faculty of Medicine. It resulted
from a cost-saving restructuring of hospi-
tals and other provincial health services,
legislated by the former Progressive Con-
servative government of Premier Mike Har-
ris and carried out from 1996 to 2000 by an
unelected Health Services Restructuring
Commission. Joe Carrelas, UHN’s Print
Shop Manager,who has worked for 23 years
in the same in-plant,located inside Toronto
General Hospital (TGH) at 200 Elizabeth
Street, saw the whole process take shape
from the inside.
After studying offset printing at George
Brown College,Carrelas began his career at
TGH as a press operator,then applied for a
promotion when a supervisor’s job became
vacant. Eventually he was promoted to
manager.As it turned out,TGH was one of
the first two hospitals and the largest to be
amalgamated into what eventually became
UHN.In 1986,TGH,a 400-bed facility that
began as a military hospital in a small shed
during the War of 1812, merged with
Toronto Western Hospital,a 236-bed com-
munity hospital that began in a pair of
rented semi-detached houses.
“At first, when TGH merged with
Toronto Western, I took over running the
other hospital’s print shop along with
TGH’s, but eventually it was closed down
and all printing was moved to TGH,” re-
calls Carrelas. Together the two merged
hospitals took on the new name The
Toronto Hospital.
Next, in 1998, when Princess Margaret
Hospital, a 130-bed, internationally recog-
nized cancer treatment facility, joined the
amalgamation, the hospital’s printing op-
erations were consolidated in similar
stages. In 1999, the new corporate entity
comprised of all three hospitals was re-
named University Health Network, which
in 2011 came to include the Toronto Reha-
bilition Institute. Many of the practical lo-
gistics of this most recent merger are still
being worked out.
Organizing the network
Based on his past experiences,Carrelas says
it can take several years for staff to adjust to
working together as a network rather than
as separate hospitals. For him personally,
some of the biggest challenges arose during
the amalgamation’s two episodes of renam-
ing and rebranding,each of which required
significant revisions of things like name
and logo to vast amounts of printing.
Perhaps Carrelas’s greatest challenge
during and after amalgamation, however,
was consolidating management of some
2,000 forms that are essential to a large hos-
pital’s operation. His seven staff include
one dedicated Forms Manager whose job
is to provide centralized control,coordina-
tion, barcoding, and improved efficiency
for all of UHN’s 2,000 separate forms.“Be-
sides hospitals and other health-care insti-
tutions, forms management is also critical
for the insurance companies and banks,”
explains Carrelas. “But it’s especially im-
portant for UHN, an organization of
14,000 people, to reduce duplication and
the amount of forms and paper flow.”
Besides forms, other typical printing
jobs for UHN include brochures, flyers,
training materials, and posters. Addition-
ally, for the last 17 years, the print shop has
done directional sign engraving,a task for-
merly assigned to the hospital’s Facilities
Management Department.
The print shop runs a hybrid system
using Konica Minolta toner devices plus
two offset presses, an AB Dick 385 and a
Multilith 1250 for quantities of 20,000 and
up, as well as a full bindery. They run EFI’s
MicroPress and Digital StoreFront software
systems to preflight, distribute, and track
work among the toner presses.For deliver-
ies, the print shop has its own hospital
truck that travels between sites twice a day.
The single item they print in largest
quantities is a two-sided, lined, barcoded
form, designed for medical staff to record
clinical notes whenever they see a patient,
typically run in batches of 800,000. But
Carrelas says in general his customers are
tending toward smaller print quantities
and, therefore, have an increasing require-
ment for toner-based printing. Variable
data printing is also in demand, especially
for personalized fundraising mail for
UHN’s four foundations, and the Human
Resources Department when it issues an-
nual benefit statements to more than
10,000 employees.
He says their biggest rush job consists
of packages of critical information for the
voluntary board of 21 elected members
who govern UHN. The information they
require often arrives at the last minute and
must be printed the same day and couri-
ered to board members before their next
meeting.“The packages aren’t easy,because
they involve things like covers,tabs,inserts,
and a mixture of colour and black and
white, but they’re what the board needs to
make crucial decisions about the finances
and running of the hospitals,”says Carrelas.
Another challenge Carrelas faces is op-
erating in a limited physical space: “Space
is a big issue for hospitals right now and it
creates a problem for us. For example, I
would love to get large-format equipment
to print our own posters,but we don’t have
the space.We also have to receive our paper
in partial shipments,because we don’t have
a large amount of storage.”
He says in the last 10 years UHN’s ad-
ministration has supported supplementing
their analogue system with toner-based
Inside the University Health Network’s printing operation.
JUNE 2012 • PRINTACTION • 15
Joe Carrelas, Print Shop Manager at the
University Health Network.
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Continued on page 32

3. 32 • PRINTACTION • JUNE 2012
PRINTING EQUIPMENT
equipment since the move has lowered
their costs greatly. For toner equipment
purchases, Carrelas needs a flexible sup-
plier: “We presently have 230 copiers scat-
tered throughout our organization, but
when hospital services are reduced, some
of the copiers are not needed any longer.In
2001, we chose Konica Minolta out of 13
different vendors because no other com-
pany was willing to take back the equip-
ment and release us from the contract
without penalty on machines that were too
old and run down or that we didn’t use any
more. Konica Minolta also charged us
nothing for the first six months to help us
pay off penalties from a previous supplier.
“We worked with IT to update the print
queues with new drivers and to network
the machines to make full use of their
multifunctions as copiers, printers, fax
machines,and scanners,so both the num-
ber of devices and cost per copy [at less
than two cents] are lower than with our
former supplier.”
Carrelas says for any equipment with
digital components, UHN’s IT depart-
ment will not support any contract over
three years.“In 2013/2014, we’ll go to the
market again to see what’s out there.
Going to tender is a huge process for ven-
dors,but it’s worthwhile for the companies
that are bidding, because UHN has a lot
of buying power right now.In our last deal
our purchasing department bought
equipment for 13 different hospitals in the
Greater Toronto Area.”
Adopting new procedures
A huge move to efficiency occurred in
April 2010 when UHN adopted Web-to-
print technologies.“By then 90 percent of
our work was submitted electronically via
email attachments, or, if the files were too
big, by disks or USB flash drives. These
devices worked fine for staff at TGH but
not so well for staff at other locations,
who had to wait up to two days for their
files to reach us by inter-office mail,”
recounts Carrelas.
He says it took several years to build the
site and enter all the products and forms
one by one on top of all their regular du-
ties. Then they chose their biggest clients
to pilot-test the system for five months to
help them tweak the system before they felt
ready to launch it.
Carrelas says online ordering has en-
abled his shop to capture more of the work
that was formerly going outside UHN: “In
our downtown location, we are sur-
rounded by competition from small store-
front printers, chains, and franchises, so
offering clients a better method of submit-
ting orders to us really gave us an edge.
“Within 10 months of implementing
the system, the print shop’s revenue went
up $72,000 and our volume of impressions
went up a million copies.”
Some of Carrelas’s customers still work
from old-fashioned hard copies, so, for
these clients, he has started a free service
of scanning their documents as PDF files
in hopes they will submit their orders on-
line next time. He and his staff also strive
constantly to educate their customers in
best practices, aided by the e-learning
videos available on UHN’s Website to
show staff how to place various types of
orders online.
Like a commercial business, Carrelas’s
operation bills and receives payment from
its customers,although they are all internal
staff within one of the departments of each
hospital comprising UHN.“We’re only re-
covering costs, not making a profit,” ex-
plains Carrelas. “Our system cuts costs by
making people responsible for their
spending and showing them the value of
what they print.
“Before online ordering, we logged
every order manually on a spreadsheet,
which made cost recovery slow. Done
manually, the process sometimes took two
days, but now it only takes a matter of
minutes.”
Carrelas says sometimes, owing to cut-
backs, when staff leave UHN they are not
replaced.Often the results include reduced
services and longer wait times for patients.
“But so far the print shop has been fortu-
nate,because we haven’t suffered any losses
of staff, and we keep gaining internal cus-
tomers.
“I believe one reason is that our in-
plant stays relevant in serving the needs of
the hospital. We run it like a business and
keep stats on everything we do – especially
volumes, which help justify the staff,
equipment, service contracts, and re-
sources that we have.When we divide shop
costs by number of impressions,we can see
if we’re upgrading efficiently.”
Carrelas explains that his operation tries
to follow the “three Cs” of in-plant print-
ers: Cost, convenience and confidentiality.
“We have to be careful of the quality of
work we do here and upgrade our equip-
ment regularly to maintain our value to
the hospital.I keep reminding our employ-
ees of the importance of running the op-
eration like a business, tracking costs, and
keeping a customer-friendly focus. We ei-
ther do the job right or someone else will
do it for us. I’ve seen situations where fa-
cility management took over in-plants if
the service was not good.
“We perform Quality Assurance every
month by checking the dates on which or-
ders came in and went out to assess our
turnaround times. Our standard for meet-
ing target deadlines is high at 98 percent,
but in the last fiscal year we exceeded the
standard with 99.5 percent. We know this
level of excellence in our service is appre-
ciated from the feedback and emails of
thanks we receive from customers.”
Support from Carrelas’s print shop has
assisted the advancement of medical tech-
nologies at UHN’s member hospitals,
whose impressive series of world firsts in-
clude single- and double-lung transplants,
deep brain simulation to treat depression,
the discovery of stem cells, and the inven-
tion of the Cobalt machine,the technology
that allowed modern radiation therapy to
develop. In the last fiscal year, providing
this support required the print shop to
print 13-million impressions and the copy
fleet to produce 4,674,000 copies for a
grand total of 17,674,000 impressions.“It’s
a busy place here,” he laughs.
Victoria Gaitskell is keen to exchange ideas
with readers at victoria@printaction.com
Gaitskell
Continued from page 15