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AHW RHA Efficiency Review
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Northern Lights Health Region
Governance and Accountability Overview Final Report
July 14, 2006
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Property of Alberta Health DeloitteWellness and Inc 2006
Governance and Accountability Overview
Key Components of Governance and Accountability
The province of Alberta uses a four part accountability framework that includes: 1) a three year Health Plan; 2) Annual Business Plans; 3)Quarterly Performance Reports; and 4) Annual Reports. This framework is to promote:
Governance and management of the health region Accountability to the Minister Keeping the public informed
For this assessment, Deloitte has focused on the three year health plan and the most recent Annual Business Plan to assess the degree to which there is demonstrable evidence that the direction is cascading to the operational level. In addition, Deloitte has applied a high level assessment of the Board's role related to:
Responsibilities and mandate Structure and organization Processes and information Performance assessment and accountability Organizational culture
Performance Assessment and Accountability Responsibilities and Mandate Organizational Culture Processes and Information Structure and Organization
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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NLHR Three-Year and Annual Plan
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Lights' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goals 1 Albertans Choose Healthier Lifestyles Legislated Responsibility 1 Promote and protect the health of the population in the health region and work towards the prevention of disease and injury
Eight corresponding strategies identified: 1.1 Promote optimal health and development of young children 1.2 Promote prevention of sport related injury 1.3 Expand breast and cervical cancer screening in partnership with ACB 1.4 Regionalize health promotion services 1.5 Healthy Eating 1.6 Customize and implement school health newsletter across Region 1.7 Tobacco reduction 1.8 Choose Well and Healthy U to staff and residents of Region The region has several population health programs in place in line with these strategies, and have developed regional coordinators to support programming on both sides of the region. The need for a broader community health needs assessment is critical to ensure the strategic and operational alignment of these initiatives to population health needs.
3 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Deloitte Observation at the Operational Level
Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Lights' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goal 2 Albertans Health is Protected Legislated Responsibility 2 Assess on an ongoing basis the health needs of the region.
Four corresponding strategies identified: 2.1 Reduce influenza outbreak severity 2.2 Minimize environmental health risks through education, monitoring, compliance and enforcement
Deloitte Observation at the Operational Level
2.3 Ensure safe and secure drinking water 2.4 Through collaboration and partnership, reduce suicide and serious injury risk through education and targeted interventions Consultation findings suggest that the region's Environmental Health service is unable meet AHW blue book standards for routine inspections, which is a significant potential risk to the region, and limits the operational ability to support these strategies. This challenge is further compounded by a large `shadow' population in the region, where the service reports heavy workload associated with the private industry camps. The need for a broader community health needs assessment is critical to ensure the strategic and operational alignment of these initiatives to needs, with corresponding resource allocation for implementation.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
2006 Deloitte Inc
Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Lights' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goal 3 Improve Access to Health Services Legislated Responsibility 3 Reasonable access to quality health services is provided in and through the health region.
Ten corresponding strategies identified: 3.1 Ensure appropriate access to services across Region 3.2 Promote aging in place through supportive living programs 3.3 Implement Local Primary Care Initiatives 3.4 Partner to implement priority components of Regional Mental Health Plan
Deloitte Observation at the Operational Level
3.5 Relocate service to community, as appropriate 3.6 Increase clinical application of telehealth 3.7 Expand service within Region, as appropriate and to meet need 3.8 Focus on acceptable wait times 3.9 Comply with Alberta Waitlist Registry requirements 3.10 Promote Health Link use The region is currently in development of primary care initiatives, but is still in preliminary stages of supporting living program development. Consultation findings suggest the need for increased focus on supportive living options, to expand community choice across continuing care, supportive housing and home care based service delivery options.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
2006 Deloitte Inc
Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Lights' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goal 3 Improve Access to Health Services
(continued)
Legislated Responsibility 3 Reasonable access to quality health services is provided in and through the health region.
Deloitte Observation at the Operational Level
The region's mental health plan is in progress, and consultation findings suggest support for planned initiatives. The region has established good telehealth infrastructure to support strategic direction, but consultation findings suggest the need for increased clinical leadership to drive the use of this technology in clinical service delivery. Operationalization of this strategy will also require consistent resource support to enable broader community health applications, as a shift from the historical grant-based funding for telehealth programs. The need for a broader community health needs assessment is also critical to ensure the strategic and operational alignment of these initiatives to needs, with corresponding resource allocation for implementation.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Light' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goal 4 Improve Health Services Outcomes Legislated Responsibility 4 Activities and strategies to improve program and facility quality.
Deloitte Observation at the Operational Level
Nine corresponding strategies identified: 4.1 Maintain regional accreditation status 4.2 Collaborate to address aboriginal health issues 4.3 Continue health needs assessment 4.4 Implement Regional Mental Health Plan 4.5 Focus on Health Quality Council of Alberta results to improve access 4.6 Focus performance improvement on findings from Health Quality Council and patient satisfaction 4.7 Establish an ethics process in Region 4.8 Improve physician access 4.9 Focus on patient safety and quality standards The region has identified the need for increased partnership with FNHIB, which is supported by consultation findings. This is especially relevant to the northwest area of the region. Physician access was identified as a challenge in communities, and consultation findings suggest the need for increased primary care access to support this strategy. The region's creation of a Patient Safety/Risk Management role will support improvements to patient safety and quality standards. The existence of two separate MACs within the region and limited physician role in service delivery leadership, however, are expected to impact the region's ability to drive forward with this initiative.
2006 Deloitte Inc
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Lights' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goal 5 Health System Sustainability Legislated Responsibility 5 Determine priorities in the provision of health services in the health region and allocate resources accordingly.
Deloitte Observation at the Operational Level
Ten corresponding strategies identified: 5.1 Provide appropriate services for a regional facility 5.2 Establish shared resource and service agreements for clinical and administrative support 5.3 Implement an integrated information system, including EHR 5.4 Implement best practices for health information management 5.5 Explore private sector partnerships for capital development and service delivery 5.6 Ensure evidence based decision-making is in place 5.7 Apply quality framework for reporting and business case development 5.8 Implement new beds to align to bed to patient ratios 5.9 Apply indicator based approach for staff management 5.10 Establish resources to support staff development The region is currently moving forward with Meditech and other IT implementations to support the creation of a regional EHR, improve health information management and enhance decision-making. Preliminary success has been achieved, as evidenced by the telehealth and PACS infrastructure in the region. Further, IT initiatives have demonstrated business case process to ensure appropriate investments. Although clinical development roles are in place to support staff development, the region is challenged by staff vacancies to effectively enable this role. Consultation findings suggest that increased focus on industry partnerships is needed to achieve strategic goals, and that senior level leadership will be a key enabler for success.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Three Year Plan
NLHR Strategy Mapping AH&W Goals & Legislated Responsibility
Deloitte's review of Northern Lights' strategies (2005 2008) mapped to health system goals and legislated responsibilities provides the following observations.
Health System Goal 6 Create Organizational Excellence Legislated Responsibility 6 Promote the provision of health services in a manner that is responsive to the needs of individuals and communities and supports the integration of services and facilities in the health region.
Thirteen corresponding strategies identified:
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 Support educational opportunities for staff. Promote and increase awareness of educational opportunities. Support teamwork and shared responsibility in workforce. Maximize effectiveness of stakeholder relationships and networks. Collaborate with key stakeholders related to staff recruitment and retention. Appropriate staff mixes will be established. Increase focus on staff safety and wellness. Partner with AH&W on health care reform. Increase modified work availability. Develop detailed action plans for leadership, respectful workplace and balance. Collaborate with Health Regions and other stakeholders in above. Promote learning and continuous improvement. Continue to implement and document innovative people management practices.
Deloitte Observation at the Operational Level
The region is investing in increased education development for staff, but will require focused efforts and resource allocation to achieve strategies, as part of a broader focus on talent management. Focus on improved physician relations and engagement will be an important enabler to support development of improved teamwork, stakeholder relations. Critical to the achievement of these strategic priorities will be a significant re-focus on HR strategies, and the need for a senior leader responsible for driving HR change efforts.
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Three Year Plan
NLHR Challenges and Opportunities Section
Deloitte's review of Northern Lights' Three Year Plan (2005-2008) provides the following observations. We concur with the identified challenges and opportunities. The extent to which opportunities have been identified for the challenges is varied. Specifically, we appreciate and support the identified relationships between many of Northern Light's pressure points:
Access, Geography, Orthopaedic Program Revenue, Recruitment and Retention, Service Levels and Sustainability Population Growth, Space Constraints, Industry Expansion and Development and Housing Service Levels, Access, and Space Constraints Continuing Care and Access Mental Health Plan and Access Regional Shared Health Information Program and Technological Advances Primary Care Networks and Access Healthy Choices, First Nations Partnerships, Primary Care, and Public Health Risks
Our consultation findings indicates that:
The region is making progress across several goals, including: Resource Allocation Based on Priorities, Achieve Organizational Excellence Although work is underway, many of the opportunities are dependent upon the completion of a regional community health needs assessment to determine appropriate direction and alignment. These include: Promote Healthier Lifestyles, Protect the Health of the Region's Population, Improve Access to Health Services, and Improve Health Service Outcomes.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
2006 Deloitte Inc
Annual Plan
Observations
Deloitte's review of Northern Light's Annual Business Plan (2005 2006) provides the following observations related to the extent to which annual direction and activities align to broader strategy.
Annual Business Plan (2005-06) demonstrates alignment and support to the Three Year Plan through the development of more supportive activities to support the respective strategies. Significant actions are identified to support goals and strategies, but planning inconsistently identifies the mechanism through which actions will occur. Although performance metrics are identified to support annual plan goals, further alignment of metrics to the significant actions identified will support improved management and reporting of activities. Identification of leadership responsibility and accountability for plan items is also suggested, to support improved action and achievement of goals.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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NLHR Governance Assessment
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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NLHR Governance Assessment
Assessment Areas and Indicators
The high level assessment of the five areas of governance responsibility included:
Responsibilities and mandate Structure and organization Processes and information Performance assessment and accountability Organizational culture
Responsibilities and Mandate Performance Assessment and Accountability Organizational Culture Processes and Information Structure and Organization
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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NLHR Governance Assessment
Responsibilities and Mandate
Performance Assessment and Accountability Responsibilities and Mandate Organizational Culture Processes and Information Structure and Organization
Areas of Assessment
Understanding of scope, authority and responsibilities (the difference between stewardship and management and setting policy vs. implementing policy) Involvement in multi-year strategic planning Involvement in annual planning and budgeting Involvement in establishing risk management process and aware of procedures to mitigate risk Ensuring management effectiveness and succession Communication with key stakeholders Board self reports and is reported to have good level of involvement in key areas of responsibility, with a focus on governance and policy. Management is given a clear mandate to respond to operational issues. The Board Chair reports an increased level of activity and commitment from Board members. Board members are familiar with their responsibilities and personal liabilities associated with their regional governance role. The Board reports minimal risk management reporting at a Board level, with no established risk management framework. Board may want to ensure stronger efforts are applied to management succession planning given the ever-present and increasing need to secure good talented managers.
2006 Deloitte Inc
Deloitte Observations
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
NLHR Governance Assessment
Structure and Organization
Performance Assessment and Accountability
Responsibilities and Mandate Organizational Culture Processes and Information Structure and Organization
Appropriate number of members and meetings
Areas of Assessment
Appropriate representation of communities Committee structure Self assessment Board self reports effective working structure for board, with monthly meetings to address regular Board work, and additional meetings to enable the Board to examine internal Board structure and organization changes. The Board currently has nine members, and reports a good mix of skills and financial knowledge among the current members. The Board is looking to expand membership to further increase Board skills and capacity. Three additional members will be added, which has been approved by AHW. The specific skill sets required of these members were determined through focused Board sessions and self-evaluation. The Board has several committees in its structure, including an Executive, Foundation, and Ethics Committee. The Executive Committee serves as the Board's Finance Committee, and the full Board serves the role of Audit Committee. The Board is also in the process of establishing two new committees, including the Stakeholder Relations Committee (including the CHCs), and Resources Committee (including Finance, Audit, Capital Planning and Risk Management) As of February 2006, the Board has initiated full Senior Management attendance at all at Board meetings.
Deloitte Observations
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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NLHR Governance Assessment
Processes and Information
Performance Assessment and Accountability
Responsibilities and Mandate Organizational Culture Processes and Information Structure and Organization
Areas of Assessment
Board identification of information needs and receives required reporting Board meetings considered to be appropriate structured (length, frequency, advance circulation of materials, attendance, management ability to respond to enquiry) Documentation of meetings Identification of required skill sets / competencies for board members Formal orientation; ongoing education / development Board related policies (roles/responsibility; code of conduct; conflict of interest; ...) Board self reports good information flow between management and Board, however notes that current management resource constraints limit the availability of evidence and analysis to support decision-making. Board reporting does not currently meet the Board's information needs to effectively govern the region. To resolve this issue, the Board has established a Resource Committee to identify the most appropriate type and level of reporting (e.g. monthly and quarterly reporting, regular updates to community health needs assessment, performance indicators and quality reporting). Formal orientation process for new Board Members Ongoing development opportunities for Board Members Board specific policies are in place to direct board management, and the Board has been holding separate monthly Board sessions to work on NLHR's Board policies and terms of reference. The Board also works closely with the Health Boards of Alberta to align by-laws and policies across regional Boards.
2006 Deloitte Inc
Deloitte Observations
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
NLHR Governance Assessment
Performance Assessment and Accountability
Performance Assessment and Accountability
Responsibilities and Mandate Organizational Culture Processes and Information Structure and Organization
Process to assess and monitor organization performance related to financial management, operations, people management, risk and safety
Areas of Assessment
Process to monitor achievement of strategic directions Self assessment of board performance Board understanding of liability issues Process to routinely assess performance of CEO/President Board compliant with required reporting. Strong financial reporting and control mechanisms are reported, but the Board notes a need for increased performance indicator reporting across all areas. Scorecard reporting for organization priorities and operations is not currently in place, but the Board is considering a scorecard approach to Board, Chair and CEO evaluations. The Board has a structure process in place for annual evaluation of the Board, Chair and CEO. As of February 2006, the Board is having monthly reports from the Chair, CEO and other Senior Management. Given this potential for increased information, the Board may want to consider adopting established metrics for tracking and reporting related to other key areas of reporting (e.g. strategy, people, operations).
Deloitte Observations
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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NLHR Governance Assessment
Organization Culture
Performance Assessment and Accountability Responsibilities and Mandate Organizational Culture Processes and Information Structure and Organization
Board involvement in setting organization's values and philosophies
Areas of Assessment
Diverse representation from communities within Region Board serving role as policy advocates with government and key stakeholders Fosters effective board / management relations Board self reports significant involvement in value setting and strong relationship with management Board has secured diverse representation through its 6 Community Health Councils including a focus on both Metis Settlements and First Nations but recognizes the need for increased community engagement through these Councils. Further, the new CEO has had meeting with each CHC to further promote engagement of these community groups. To further strengthen the regional perspective of the Board, and access to the Board by stakeholders from across the region, the Board has initiated a process by which Board meetings will alternate across the west and east sides of the region on a monthly basis. The decision-making processes and accountability structure within management roles is not optimal. Given the elapsed time since re-regionalization, the Board may want to direct the incoming CEO and management team to review current role structure, decision-making and accountabilities.
Deloitte Observations
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Concluding Comments
NLHR
Strengths to build on include... Strengths to build on include...
Alignment of three-year plan to Alignment of three-year plan to provincial directions, and provincial directions, and supporting alignment of the supporting alignment of the annual business plan annual business plan Development of Patient Development of Patient Safety/Risk Management role. Safety/Risk Management role. Continued revitalization of the Continued revitalization of the organization's information organization's information systems systems Identification of need for new Identification of need for new focus on Health Human Resources focus on Health Human Resources as a strategic priority as a strategic priority Increased focus on building Increased focus on building regional culture through Board regional culture through Board and CEO efforts and CEO efforts Increased recognition of the need Increased recognition of the need to grow and build external to grow and build external partnerships partnerships
Areas for further development Areas for further development and assessment... and assessment...
Number of goals NLHR can Number of goals NLHR can undertake in support of its undertake in support of its strategic priorities strategic priorities Delineation of strategic vs. Delineation of strategic vs. operational goals to further focus operational goals to further focus leadership efforts leadership efforts Overall timing for implementation Overall timing for implementation of three-year plan of three-year plan Strategic approach to resource Strategic approach to resource allocation to meet overall allocation to meet overall implementation timeline, and for implementation timeline, and for ongoing operations post ongoing operations post implementation implementation Senior level Human Resources Senior level Human Resources leadership to support strategic leadership to support strategic directions directions Completion of a regional Completion of a regional community health needs community health needs assessment to ensure alignment assessment to ensure alignment of priorities of priorities
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Deloitte & Touche LLP and affiliated entities. Deloitte, one of Canada's leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 6,100 people in 47 offices. Deloitte operates in Qu bec as Samson B lair/Deloitte & Touche s.e.n.c.r.l. The firm is dedicated to helping its clients and its people excel. Deloitte is the Canadian member firm of Deloitte Touche Tohmatsu. Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms, and their respective subsidiaries and affiliates. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other's acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names "Deloitte," "Deloitte & Touche," "Deloitte Touche Tohmatsu," or other related names. Services are provided by the member firms or their subsidiaries or affiliates and not by the Deloitte Touche Tohmatsu Verein. 20 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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AHW RHA Efficiency Review
Northern Lights Health Region
Findings and Opportunities Final Report
July 14, 2006
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Property of Alberta Health2006 Deloitte Inc and Wellness
Table of Contents
Project Overview Clinical Resource Management Acute Care Continuing Care Community Health Services Physician Findings and Opportunities Clinical Support and Allied Health Corporate and Support Services Operational Trending and Key Metrics Human Resources Infrastructure Cluster 1 Opportunities Moving Forward: Opportunity Prioritization and Mapping
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Project Overview
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Project Overview
Scope, Objectives and Business Drivers
Scope: Alberta Health and Wellness is undertaking an RHA Efficiency Review to identify potential efficiencies and opportunities for improvement within each of the RHAs in the province. To achieve this purpose, this Review is focusing its scope on improvements to deployment across five key dimensions:
Increases to productivity Improvements to patient flow Improvements to patient outcomes Improvements to financial stewardship Exploration of province-wide opportunities
The review does include voluntary organizations, but will not be reporting to the voluntary boards. Project Objectives There are three primary objectives that direct the activities of this Review:
Identify performance improvement issues and opportunities. Identify productivity and performance improvement strategies and solutions. Provide recommendations to optimize: available resources, operational efficiency, service delivery, safety and quality.
3 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Project Overview
Approach and Timelines
The diagram below outlines the project approach, and key activities of the review. The review started in December 2005, and was completed in June 2006.
AH&W Launch
Phase 0:
AH&W Contract Management and Risk/Benefit Assessment
RHA Cluster Efficiency Review Activities by Phase
Phase 1:
Project Launch
AH&W Closure
Phase 6
Project Evaluation and Go-Forward Risk/Benefit Assessment with AH&W
Phase 2:
Global High Level Review
Phase 3:
Opportunity Identification and Preliminary Reporting
Phase 4:
Opportunity Prioritization Support
Phase 5:
Recommendations and Final Report
Administrative and Support Services Allied Health and Clinical Support Services Clinical Nursing Services Clinical Resource Management Governance and Performance Management Technology
Workstreams
Scope Definition, Workplan and Information Collection
Project KickOff Meeting with Steering Committee
Qualitative Analysis, Profile Review, Data Analysis Consultation On-Site Consultation Integrated Collect Data Review to and Develop Information Comprehensive Regional Findings Conduct Risk Assessment Quantitative Analysis and Benchmarking Comparison
Region Assessment Overview
Opportunities Prioritized
Insights from Phases 2 and 3
Final Report and Recommendations
Opportunity Identification Workshops
Working Session with each RHA to Identify Priorities for Action
Final Report
AH&W Project Evaluation and GoForward Risk Assessment Workshop
Infrastructure
RHA Cluster Observations
Opportunity Prioritization from Phase 4
Deliverables
Project Management, Quality and Risk Management, Knowledge Management and Transfer, Stakeholder Engagement and Communication
Project Scope Project Contract Risk/Benefit Assessment Project Workplan Stakeholder Consultation Plan
Current State Assessment Governance Performance Management Diagnostic Technology Assessment
RHA High-Level Opportunities RHA Cluster HighLevel Opportunities
Project Evaluation Prioritized Opportunities Final Report with Recommendations Go-Forward Risk/Benefit Assessment
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Project Overview
Reporting
This report presents the findings and opportunities identified through the region's review. Findings and opportunities are organized into 10 categories of reporting:
1. 2. 3. 4. 5. 6. 7. 8. 9.
Clinical Resource Management Acute Care Continuing Care Community Health Services Physician Findings and Opportunities Clinical Support and Allied Health Corporate and Support Services Operational Trending and Key Metrics Human Resources
10. Infrastructure
Following the identification and validation of findings and opportunities for each region, two additional activities were completed for this review, which are summarized in the final two sections of the report:
Identification of opportunities at a cluster / provincial level. An opportunity prioritization and mapping exercise to support regional planning and goforward monitoring.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Clinical Resource Management
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Clinical Resource Management
Overview Clinical resource management analysis includes CIHI analysis (internal trending of complexity and utilization data and external comparison of utilization data for each program) and the results of the MCAP review. In conducting an internal review of the complexity and utilization data, a drilldown approach is used to understand changes in utilization efficiency (volume, complexity and utilization efficiency).
Analysis is based on 2003-04 and 2004-05 data.
In conducting an external comparison of utilization data, the goal is to identify potential opportunities to improve utilization in relation to CIHI ELOS and peer performance.
A drill-down approach is utilized, which begins with a "gross" assessment of utilization and potentially "conservable days" opportunities by comparing NLHR's acute ALOS by CMG to the CIHI acute ELOS. The analysis is based on the 2004-05 data. This analysis is then fine tuned to determine the more realistic opportunities related to improved utilization management. A filter is applied that specifies the number of cases required and the minimum variance in ALOS required before an opportunity can be considered realistic. For example, if there were fewer than 10 cases or the conservable days for the CMG are less than .5, it is not considered to be a realistic opportunity.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Top 10 Patient Services (2003-04 to 2004-05) CIHI Abstract Data (Region)
The Top 10 Patient Services accounts for the 98% of the region's total caseload. Comparison over the past three fiscal years suggests a fairly consistent distribution of key patient services: General Medicine represents 30%, Obstetrics/Newborns represents 37%, Paediatrics represents 12%, and General Surgery represents 9% of current volume
Patient Service General Medicine Newborn Obs Delivered Paediatric Medicine General Surgery Gynaecology Obstetrics Antepartum Psychiatry Orthopedics Alternate Level of Care Top 10 Patient Services Total Other Patient Services Total Region Patient Services Total
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2003-04 2,173 1,269 1,263 931 767 292 263 217
2004-05 2,210 1,266 1,259 874 686 302 287 214 197
Variance 1.7% -0.2% -0.3% -6.1% -10.6% 3.4% 9.1% -1.4%
90 7,256 147 7,403
97 7,392 172 7,564
7.8% 1.9% 17.0% 2.2%
2006 Deloitte Inc
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Patient Volume, Weighted Cases and Patient Acuity (Region)
8000 7000 6000 5000 4000 3000 2000 1000 0 Patient Volume
6000 5000
2003-04 2004-05
4000 3000 2000 1000 0 Weighted Cases
2003-04 2004-05
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 Patient Acuity
Regional inpatient volume increased by 2.2%.
2003-04 2004-05
Overall patient acuity has remained relatively consistent (a small decline is noted), however, which results in a marginally higher Weighted Case volume.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Patient Volume, Weighted Cases and Patient Acuity by Plx (Region)
5000 4000 3000 2000
Cases by Plx
2003-04 2004-05
Weighted Cases by Plx
3000 2003-04 2000 2004-05
1000
1000 0 Plx Level I/II Plx Level Plx Level IX III/IV Acuity by Plx
0 Plx Level I/II Plx Level III/IV Plx Level IX
4
3
Majority of Region's patients are Plx level I/II and Plx IX. Volume increase is most noted at the Plx I/II levels. Plx III/IV is the only group of patients with a significant acuity change (9%), which drives a corresponding 10% increase in weighted cases for this group.
Given the relatively low volume in Plx III/IV, however, this increase has marginal impact on total weighted cases (an increase of only 64 cases).
2003-04
2
2004-05
1
0
Plx Level I/II Plx Level III/IV Plx Level IX
Note: Plx further refines case mix groups to reflect additional diagnoses that influence a patient's overall medical condition. Cases are assigned to one of four Plx Levels. Level 1 denotes the absence of co-morbid conditions, while Level 4 denotes the presence of co-morbid conditions that may be potentially life threatening.
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Acuity is decreasing slightly for Plx I/II and Plx IX groups (0.4% and 4.5% respectively).
2006 Deloitte Inc
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Import/Export Inpatient Volumes for NLHR
By Complexity for 2004-05
As a % of Total Cases for each Plx % Imports % Exports 2004-05 Plx I/II 5% 23% Plx III/IV 4% 57% Plx IX 1% 10% Total 3% 19%
In examining the impact of import/export on inpatient volumes for 2004-05, an overall average of 3% of patients were imported into NLHR in 2004-05:
Further examination suggests that imported patients are from a number of other regions, with Capital Health providing the largest % of imports (38%), followed by Aspen Regional Health Authority (23%).
Overall, 19% of inpatient volumes were exported from NLHR in 2004-05
Plx III/IV patients demonstrated the highest level of export, at 57% Further examination suggests that 81% of exported patients are sent to Capital Health Region
Although not demonstrated here, analysis suggests that imports/exports as a % of total cases has not changed significantly for NLHR over 2003-04 and 2004-05.
Further the proportion of import/export by Plx level has also been comparable over the two-year period.
Source: Alberta Health & Wellness CIHI DAD, 2003-04 and 2004-05 11 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Average Length of Stay vs. Expected Length of Stay
as a Region
Northern Lights Health Region 5 4 3 2 1 0 2003-04 Average ALOS 2004-05 Average ELOS
Length of Stay analysis reveals that NLHR's average length of stay (ALOS) is consistently higher than the CIHI expected length of stay (ELOS). NLHR is working to close the gap. We see a small decrease in the gap over the two years reviewed (from 1.0 to 0.7 days). The chart below shows that the patients in Plx I/II and III/IV are driving the ALOS ELOS gap.
ALOS to ELOS gap in Plx Level I/II has remained relatively constant ALOS to ELOS gap in Plx III/IV has demonstrated good progress in reducing gap The region has shifted Plx IX patients to be slightly below ELOS.
PLx Level I/II Fiscal Year ALOS ELOS
Plx Level III/IV
Plx Level IX
ALOS
ELOS
ALOS
ELOS
2003-04 2004-05
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4.8 4.6
3.2 3.3
20.9 17.7
10.7 13.5
3.0 2.7
3.0 2.8
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Average Length of Stay vs. Expected Length of Stay
By Site
2004-05 5 4 3 2 1 0 Northern Lights RHC Average ALOS Northwest HC Average ELOS St. Theresa
Both Northwest Health Centre and St. Theresa General Hospital demonstrated an overall ALOS that is below ELOS, although opportunities across individual CMGs may still exist. This suggests that the regional gap in ALOS to ELOS is driven by the Northern Lights Regional Health Centre in Fort McMurray.
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Top 10 CMGs by Potential Days Savable in 2004-05
as a Region
CMG CMG Description Other Factors Causing Hospitalization Other Specified Aftercare Diabetes Renal Failure without Dialysis Simple Pneumonia and Pleurisy Psychoactive Substance Dependence Chronic Obstructive Pulmonary Disease (COPD) Alcohol Induced Organic Mental Disorders without Axis III Diagnosis Other Respiratory Diagnoses Signs and Symptoms Total Cases 185 63 108 26 224 14 49 28 79 19 795 6,769 7,564 Total Acute Days 1,969 1,034 791 378 1,087 216 456 228 337 186 6,682 22,977 29,659 Average Length of Stay 10.6 16.4 7.3 14.5 4.9 15.4 9.3 8.1 4.3 9.8 CIHI Expected Length of Stay 2.9 8.0 4.4 5.9 4.1 4.4 6.7 3.8 2.9 4.5 ALOS ELOS Gap 7.79 8.45 2.96 8.65 0.77 11.03 2.59 4.30 1.33 5.31 Potential Days Savable 1,442 532 320 225 173 154 127 120 105 101 3,300 1,522 4,822
851 847 483 521 143 783 140 781 147 842
Top 10 Region CMGs Total Other 268 Region CMGs Total Total Region CMGs
Leading CMGs for savable days are "Other Factors" and "Other Specified Aftercare". Coding improvements are required to identify appropriate strategy. Remaining days savable are scattered across range of CMG's.
The savable days calculation includes only those cases where the gap between actual length of stay was greater than 0.5 of a day, and the number of cases per CMG was greater than 10.
14 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Beds Savable in 2004-05
as a Region
Cumulative Beds Savable 25
2
20
Comparison of NLHR ALOS to CIHI expected length of stay suggests that the Region could save as many as 13 beds. When compared to peers, using the filter process, the region's potential bed saving reduces to 6 beds, all of which are located at NLHRC.
6
15
21 1
10
13
5
11
0 CIHI Comparison Without Filter CIHI Comparison With Filter Peer Comparison Without Filter Peer Comparison With Filter
Northern Lights RHC
Northwest HC
St. Theresa
Note: The filter excludes cases where the gap between actual length of stay was less than 0.5 of a day, and the number of cases per CMG was less than 10. Estimated bed savings are based on 100% occupancy.
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Top 10 CMGs by Peer Potential Days Savable in 2004-05
at NLRHC
CMG 851 847 781 483 777 770 766 140 784 751 CMG Description Other Factors Causing Hospitalization Other Specified Aftercare Alcohol Induced Organic Mental Disorders without Axis III Diagnosis Diabetes Schizophrenia and Other Psychotic Disorders w/o ECT or Axis III Diagnosis Bipolar Mood Disorders, Manic without ECT without Axis III Diagnosis Depressive Mood Disorders without ECT without Axis III Diagnosis Chronic Obstructive Pulmonary Disease (COPD) Psychoactive Substance Abuse Septicemia Total Cases 82 45 11 83 18 11 48 30 23 12 363 4,610 4,973 Total Acute Days 1,928 992 178 692 390 245 667 334 121 149 5,696 17,386 23,082 Average Length of Stay 23.5 22.0 16.2 8.3 21.7 22.3 13.9 11.1 5.3 12.4 CIHI Expected ALOS Length of Stay ELOS Gap 15.2 14.3 4.8 7.1 16.2 13.5 12.1 8.9 2.5 7.2 8.3 7.8 11.4 1.3 5.5 8.7 1.8 2.2 2.8 5.2 Potential Days Savable 683 349 125 105 98 96 87 67 64 63 1,737 556 2,294
Top 10 NLRHC CMGs Total Other 251 NLRHC CMGs Total Total NLRHC CMGs
At NLHRC, the leading CMGs for savable days are "Other Factors" and "Other Specified Aftercare", equivalent to approximately 3 beds. Coding improvements are required to identify appropriate strategy. Remaining days savable are scattered across range of CMG's, although Mental Health shows another cluster of opportunity.
The savable days calculation includes only those cases where the gap between actual length of stay was greater than 0.5 of a day, and the number of cases per CMG was greater than 10.
16 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
MCAP Review
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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MCAP Overview
Process
An MCAP review was conducted to:
Gain a better understanding of patients' required levels of care and their specific care needs and the impact these needs have on inpatient bed utilization Identify system issues why patients are not at appropriate level of care.
MCAP is a utilization management tool that uses rigorous scientifically researched and validated criteria to review the intensity of services required for any given patient and determine the appropriate level of care required. The tool uses a "service-driven methodology" and focuses on the treatment plan/services ordered for that day. By avoiding the placement of patients at too high or low of a care level, health care managers can be assured that patients will receive the highest possible care quality and will move through the health care system in the shortest possible time. The review was conducted by Registered Nurses certified in MCAP. They reviewed the charts of all admitted inpatients in the Acute Care settings between January 30 February 2, 2006. Using the MCAP criteria, the following three key questions were answered for each admitted patient:
Does the patient require the level of care (i.e. Long Term Care, Acute Care, Intensive Care, etc.) they are receiving? If not, what level of care does the patient require? Why is the patient not at the level of care they require?
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Patient Profile
NLHR Acute Care
99 patients were reviewed at the acute care sites within the Northern Lights Health Region. This represents 72% of the total number of acute care bed capacity (148) within these sites.
Northern Lights RHC had 83% occupancy, while NWHC and St. Theresa General Hospital had 35% and 27% occupancy, respectively.
The average age of patients was 52 years. Northern Lights Regional Health Centre, with an average age of 51, clearly drives this average, as the other two sites represent an average age of 55 59 years. 57% of patients were female and 43% were male.
Total Number of Beds Number of Beds Reviewed
St. Theresa General Hospital Northwest 7% Health Centre 7%
Site
Northern Lights Regional Health Centre Northwest Health Centre St. Theresa General Hospital Grand Total
102
85
20
7
Northern Lights Regional Health Centre 86%
26 148
7 99
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Patient Profile by Site and Service
NLHR Acute Care
Site Patient Service Number of Beds Reviewed Site Patient Service Number of Beds Reviewed 1 6 40 7 2 7 22 85 99
Northwest Health Centre
Combined Medical/ Surgical
ER Observation 6 Intensive Care 1 7 Medicine Northern Lights Regional Health Centre Obstetrics Paediatrics
Obstetrics Northwest Health Centre Total
St. Theresa General Hospital
Combined Medical/ Surgical
7
Psychiatry Surgical
St. Theresa General Hospital Total
7
Northern Lights Regional Health Centre Total Grand Total
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Patients With Insufficient MD Documentation
NLHR Acute Care
Northern Lights Regional Health Centre
70 15
Site
% with Insufficient Documentation 18% 0% 14% 16%
Northern Lights RHC
Northwest Health Centre (High Level) St. Theresa General Hospital (Ft. Vermillion)
0
7
Northwest HC St. Theresa Total for Region
6 1
20
40
60
80
Sufficient Documentation
Insufficient Documentation
Overall, 16 of 99 reviewed patients (or 16%) had insufficient MD documentation. Where insufficient MD documentation exists, our clinical team is unable to appropriately determine if the patient meets clinical criteria for admission. This percentage of patients with insufficient MD documentation suggests opportunity for improvement in physician charting.
21 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Patients Who Meet Clinical Criteria for Admission
NLHR Acute Care
Percent at Appropriate Level 73% 86% 83% 75%
Northern Lights Regional Health Centre
51
19
Site
Northwest Health Centre (High Level)
Northern Lights RHC
6 1
Northwest HC
51
St. Theresa General Hospital (Ft. Vermillion)
0
St. Theresa Total for Region
10 20 30 40 50 60 70
Meet Admission Criteria Do Not Meet Admission Criteria
For those patients with sufficient documentation for our clinical team to determine if they met clinical criteria for admission to the service they were on, 62 out of the 83 patients (or 75%) reviewed met criteria. In comparison to our experience with other regions and hospitals in Canada, these results suggest that NLHR is in line with peers, although still has opportunity for additional improvement. The observed average for other Canadian sites is approximately 65-75% of patients in the most appropriate care setting.
22 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Patients Who Meet Clinical Criteria for Admission
Northern Lights Regional Health Centre Acute Care
Medicine Surgical Obstetrics Intensive Care Psychaitry Paediatrics ER Observation
0
1 1 4 3 4 6 1 16 20 2 12
Service
Percent Meeting Clinical Criteria for Admission 100% 100% 100% 89% 86% 63% 43% 73%
ER Observation Intensive Care Paediatrics Surgical
5
10
15
20
25
30
35
Obstetrics Medicine Psychiatry Total
Meet Admission Criteria Do Not Meet Admission Criteria
Further examination of the Northern Lights RHC revealed that overall, 51 out of the 70 patients (73%) reviewed patients meet the clinical criteria for admission demonstrating an opportunity for improvement. Psychiatry and Medicine have the lowest percentage of patients meeting the clinical criteria for admission.
23 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Patients Identified as Requiring a Different Level of Care
NLHR Acute Care
Northern Lights Regional Health Centre St. Theresa General Hospital 1 (Ft. Vermillion) Northwest Health Centre (High 1 Level) 0 Identified 5
14
5
Site
Percent Identified as Requiring a Different Level of Care 74% 100% 100% 76%
Northern Lights RHC Northwest HC St. Theresa
10
15
20
Total for Region
Not Identified
Of the 21 patients who did not meet clinical criteria, 16 (76%) of this group were already identified by the facilities as requiring a different level of care. The 5 patients requiring a different level of care but not identified as such were located at Northern Lights Regional Health Centre. This suggests an opportunity for Northern Lights RHC to improve in the early identification of when patients require a different level of care.
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Required Level of Care for Patients not Requiring Acute Care NLHR
Northern Lights Regional Health Centre 9 3 2 4 1 19 1 1 Northwest Health Centre 1 St. Theresa General Hospital 1
Required Level of Care
Total
Continuing Care Home Home care Outpatient Psychiatry Palliative Care Grand Total
11 3 2 4 1 21
Of those patients who did not meet clinical criteria for acute care admission, the most frequently observed levels of care required were Continuing care and Outpatient Psychiatry.
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Reasons Patients Did Not Meet Clinical Criteria
NLHR Acute Care
Of the 21 patients who did not meet clinical criteria, 43% were due to challenges in accessing different levels of care or resources within the region. The second most common reason (23%) was due to sociodemographic factors.
Northern Lights Regional Health Centre St. Theresa General Hospital (Ft. Vermillion) Northwest Health Centre (High Level) 0
8
4
4
3
1
1
5
10
15
20
25
30
Access to Internal RHA Resources Sociodemographic
Inappropriate Admission Delay in Discharge Planning
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Acute Care Profile Summary: February 6 17, 2006
Met Clinical Criteria for Admission Continuing Care
11
62
Outpatient Psychiatry Beds Reviewed
4
Did Not Meet Clinical Criteria for Admission
99
Home Care
Acute Care Bed Capacity
21
2
143
Insufficient MD Documentation
Home
3
16
Palliative Care
1
Beds Not Reviewed
44
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Clinical Resource Management Opportunities
Opportunities Findings Based on the CMG analysis relative to peers, NLRHC has an opportunity to reduce length of stay across several CMGs, particularly in mental health. MCAP review indicated several inpatients who required continuing care or outpatient treatment, which suggests the need for additional nonacute resources. Increasing transient/shadow population can make timely discharge problematic. Analysis identified that 73% of patients at NLRHC Acute Care met clinical criteria for admission. 2.Examine NLRHC admission/ discharge criteria Psychiatry and Medicine had the greatest opportunities for improvement. Improved awareness of, and education on admission best practices to staff will support the realization of this opportunity. Analysis identified CMG 851 (Other Factors Causing Hospitalization) and CMG 847 (Other Specified Aftercare) as having the highest potential days savable to both ELOS and peers. The high presence of these CMGs suggest additional coding and abstracting focus is required to help the region more discreetly identify and manage this patient volume.
2006 Deloitte Inc
1.Realize length of stay savings at Northern Lights Regional Health Centre
3.Improvements to Regional Coding and Abstracting
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Clinical Resource Management Opportunities
Opportunities Findings The MCAP review found 16% of inpatient charts could not be not assessed for eligibility for admission due to insufficient physician documentation. 4.Improve MD Where this occurs, there is a heavy requirement and reliance on verbal Documentation communication between physician and team to support care management. in Inpatient Charts The heavy reliance on verbal communication has potential risk issues for patient outcomes, and potential for increased length of stay without clear discharge direction. The MCAP review found a large number of patients in NLRHC that required 5.Explore options continuing care services. to increase continuing care This was supported by Hospital Management who reported that a separate module has been created on the medical unit to care for overflow capacity in Fort continuing care patients, using a more cost effective and appropriate McMurray model of care.
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Clinical Program Review
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Clinical Program Review
Introduction
Our review of the clinical programs and facility-based care across NLHR has focused on identifying key findings and opportunities related to service delivery and staffing. Clinical programs and services will be reported on in the following order:
Clinical Programs and Facilities NLRHC Medicine and Critical Care Services NLRHC Surgery and Perioperative Services NLRHC Obstetrics, Neonatal and Paediatric Services NLRHC Emergency Department and Ambulatory Care Services Regional Mental Health Services Northwest Health Centre St. Theresa General Hospital Rainbow Lake Health Centre Regional Continuing Care Services Regional Home Care Services Regional Population Health Services Regional Environmental Health Services
31 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Clinical Program Review
Nursing Staffing Process Overview
The relative efficiency of patient/resident care services was assessed based on a comparative analysis of staffing levels and skill mix for each inpatient care unit using three key inputs:
GRASP Systems International Database (using the Canadian section of the database) Deloitte Peer Database Unit Staffing Schedule/Pattern
As an indicator of variance from the benchmark, the difference in hours per patient day (HPPD) is reflected using an FTE estimate for illustrative purposes. To gain an understanding of the clinical requirements and environment on each unit, profiles were completed and consultation was conducted with clinical leadership. For each patient care unit, the following analysis was then conducted:
Total nursing unit producing personnel (UPP) worked hours per patient day/visit (HPPD). Nursing UPP Worked Hours include direct patient care hours provided by RNs, RPNs, and certain percentage of Health Care Aides. UPP hours include regular worked, relief, and overtime, and exclude benefit hours (i.e., vacation and absenteeism). HPPD were calculated using actual worked hours (not budgeted) for 2004-05 and 2005-06 YTD (Sept 30th), and then compared to comparable peer units based on the profiles completed by each program/unit. All units are shown at the 50th percentile. In some units, adjustments have been made to better reflect patient mix/care requirements.
Staffing opportunities are identified based on comparative analysis and the clinical team's understanding of minimum staffing requirements. Staffing opportunities are not stand alone, however, and need to be considered in the context of other opportunities identified for each clinical area.
32 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
NLRHC Medicine and Critical Care
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Peer Staffing Comparative Analysis
Northern Lights Regional Health Centre Medicine and Critical Care Opportunities Findings
Utilization analysis and MCAP findings suggested opportunities 1. Conduct a review of in Medicine to reduce length of stay, improve coding, and shift Medicine unit admission patients into alternative levels of care. practices and policies to improve alignment of care Consultation findings further suggested challenges in bed practices to care needs. utilization, driven by a mix of admission and discharge practice challenges and off-service patients. 2. Consider potential staffing investment on Staffing comparison suggests that Medicine has a potential Medicine to align to peer staffing investment of 3.9 FTEs to align to peers, based on levels. 2005-06 YTD staffing levels. 3. No staffing opportunity identified in ICU. Staffing comparison indicates that the ICU is in line with peer staffing.
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Medicine ICU/CCU
28.9 14.4
32.8 13.4
4.1 15.6
3.8 15.6
4.3 15.6
3.9 -
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database 34 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
NLRHC Surgical and Perioperative Services
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Peer Staffing Comparative Analysis
Northern Lights Regional Health Centre Surgical Nursing Unit Opportunities Findings
Staffing comparison suggests that the Surgical Unit had an staffing investment opportunity relative to peers, based on 2004-05 staffing levels. Projected 2005-06 YTD HPPD suggests an increased level of staffing, however, which would position the surgical unit above peer levels. Anecdotal reporting suggests that patient days may not be accurate, however, with respect to where surgical overflow activity is captured. It is important to differentiate between team nursing and stronger mentoring approach. Planned implementation of stronger team approach (within nursing) may create issues related to accountability and continuity of care.
1. Monitor 2006-07 staffing levels and patient days to determine alignment to peer levels.
2. Review plans for changing the model of care delivery.
3.Consider converting 2 beds Epidural pain management is nursing intensive and a potential to step-down beds with risk area. enhanced staffing levels.
Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Surgical Nursing Unit
36
19.0
22.1
4.8
5.4
5.2
(0.6) See Above
2006 Deloitte Inc
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Northern Lights Regional Health Centre Perioperative Services Opportunities Findings
Consultation findings for the OR indicate challenges in OR booking, scheduling, equipment availability, cases starting late and running late, use of evening hours for non-emergency cases, are key issues. High overtime hours for OR staff supports the running over issue. An OR review was performed several years ago, of which only some of the recommendations were implemented. Based on projected 2005-06 staffing levels, comparison suggests that the OR/PACU/SDC has a small staffing savings opportunity relative to peers at the 50th percentile, however given the findings identified above, it is suggested that the region focus on opportunity to increase throughput instead of staffing reductions.
1.Improve OR utilization, equipment flow and reduce overtime through implementation and adherence to booking policies.
2. Ensure a culture of Nurses report that professional relationships are at time difficult, interdisciplinary respect which is impacting patient care delivery. and collaboration 3. Implement patient safety No deliberate policies and procedures related to ensuring patient policies, including surgical safety. pause.
Unit/Area Description Actual FTEs 2004-05 Actual FTEs 2005-06 YTD Actual HPPD 2004-05 Actual HPPD 2005-06 YTD Recom'd HPPD Recom'd FTE (Effic.)/ Re-Invest. 2005-06
OR, PACU & SDC
37
13.5
18.4
7.5
8.3
8.2
(0.3) See Above
2006 Deloitte Inc
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
NLRHC Obstetrics and Pediatrics Services
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Peer Staffing Comparative Analysis
Northern Lights Regional Health Centre Obstetrics/LDRP Opportunities
1. Develop a targeted recruitment and retention strategy for Obstetrics to ensure continued sustainability of NLRHC obstetrics services, as part of a broader regional HR strategy. 2. Monitor 2006-07 staffing levels to ensure that Obstetrics is adequately staffed to be in line with peers.
Findings
NLHRC has a small and unpredictable volume of births with unpredictable census, which is a challenge to manage efficiently. Despite this, 2005-06 YTD staffing levels were below peer levels. Consultation findings indicate that a critical issue facing Obstetrics is the planned departure of 8 nurses (50% of the unit's staff) to resign this summer. This will result in a significant shortage of Obstetrics staff, and is a risk to the organization's ability to continue service delivery in this area. Staffing comparison suggests that the unit was in line with peers for 2004-05 staffing. In 2005-06 YTD staffing indicates the region may be below peer levels, however consultation findings indicate that surgical overflow days may be included in these numbers. Staffing should be targeted at an average 9.5 HPPD, and so the organization should continue to monitor 200506 staffing levels to ensure alignment to peers.
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Obstetrics/LDRP
12.5
11.9
9.8
7.1
9.5
4.0 See Above
2006 Deloitte Inc
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database 39 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Northern Lights Regional Health Centre Pediatrics Opportunities Findings
Risk issues due to the crowded and outdated physical space (crash cart and team would not fit in room, parents have to put their cots under the cribs when staying with child). NLRHC Pediatrics nurses are cross-trained and frequently assist on the adjacent Surgical unit when the pediatric census is low. Ambulatory procedures are performed on the unit during the day shift. Staffing comparison suggests Pediatrics has a potential small savings opportunity, based on 2004-05 and 2005-06 staffing. Three key issues are impacting clarity of this comparison, however: 1) cross-coverage of Pediatrics nurses of the surgical unit may be impacting staffing levels; 2) workload related to ambulatory volumes which could not be captured; and 3) facilities challenges which could impact ability for additional throughput.
1. Improve tracking of staffing and workload across Pediatrics. 2. Given the need for new physical space for the Pediatrics service in NLRHC, consider locating Pediatrics adjacent to Obstetrics and cross training staff.
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Pediatrics
6.7
5.8
8.4
8.4
7.3
(0.7) See Above
2006 Deloitte Inc
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database 40 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
NLRHC Emergency Department and Ambulatory Care Services
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Emergency Department Volumes by Triage Level
NLRHC
Triage Level 2004-05 NLRHC Emergency Visits 32 476 5,496 18,598 26,118 8,916 0 % of Total NLRHC Emergency Visits Volume 0.1% 0.8% 9.2% 31.2% 43.8% 15.0% 0% CTAS National Averages: Weekday 0.4% 9.9% 37.9% 41.9% 9.5% 0.0% 0.4% CTAS National Averages: Weekend 0.2% 8.5% 38.9% 45.3% 6.7% 0.0% 0.4%
I II III IV V IX
Resuscitation Emergency Urgent Semi-Urgent Non-Urgent Unavailable
Left without Being Seen
Source: Alberta Health & Wellness ACCS Database
A review of 2004-05 triage levels suggests that 75% of NLRHC's emergency department visits are distributed across the lower acuity levels of Semi-Urgent and Non-Urgent, which is out of line with national averages. The proportion of triage level III volumes is also out of line with what is nationally observed, which is approximately 38-39% of volume. Further, the level of patients in the triage level IX is significantly above national standards, and suggests need for improved rigour around use of CTAS in emergency patient management and/or the fact that some ambulatory care patients are registered inappropriately as emergency visits. This analysis could not be completed for NWHC and STGH, due to a lack of CTAS use.
42 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
NLRH Emergency Department and Ambulatory Care
Findings and Opportunities
Opportunities
1. Review Emergency Department physician care delivery model and staffing.
Findings
Physician staffing levels are significantly lower than what is typical for either an emergency department or an ambulatory walk-in clinic. This poses a significant risk to the organization and needs to be addressed. Consultation findings and analysis suggest that the increased volume of low acuity triage V patients 2. Explore opportunities to increase suggests that there may be opportunity to shift primary care and home care access volumes out of the ED into a primary care setting. to patients in FMM, in alignment to a broader regional community Similarly there is an opportunity to shift some volume health needs assessment. to home care as patients are seen and treated in emergency, due to a lack of after hours home care. 3. Examine options to shift outpatient registration and waiting areas outside of the ED and reassess physical design for ER operations. Outpatient registration and ED registration was recently consolidated in the ED, which has created significant congestion of patients in the ED. Waiting space for both outpatients and emergency patients is combined, with some space not visible by the triage nurse. This lack of line-of-site visibility of Refer to the Infrastructure for further information on this opportunity. the waiting area by ED clinical staff is a significant risk to the organization.
4. Ensure that there is capability in The only room with the capacity to operate as a the ED to accommodate patients negative pressure room is not set up to provide acute with respiratory conditions care and is instead used as a safe room for mental requiring negative pressure, in line health clients. with national standards and recommendations.
43 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
NLRH Emergency Department and Ambulatory Care
Findings and Opportunities
Opportunities Findings
Examination of CTAS scoring suggests an increasing number of emergency patients are not being coded 5. Develop program to improve CTAS with a CTAS score, as seen by increased number of use and scoring in the ED, with Triage IX visits. consideration of required resources, education support, and policies and Anecdotal reporting suggests varied compliance to procedures required to standardize CTAS recording, a lack of use of CTAS as a use across the region. quality/risk management tool in the ED, and the need for increased education. 6. Improve the separation of statistical There are challenges in separating current reporting reporting across the ED and of visits statistics across these two areas. Ambulatory Care Clinics at NLRHC. Staff report that Physicians regularly accept noncritical patients from LaLoche Saskatchewan on a regular basis, causing difficulty and expense in transfer when patient is discharged. Although this has not been fully investigated by the consultants, it suggests the need for further review.
7. Review NLRHC policies regarding acceptance of non critical out-ofprovince patients.
Stakeholders report that approximately 6 procedures per day are un-booked and direct 8. Establish and adhere to guidelines referrals from physicians, causing additional related to booking and scheduling in unplanned workload and overtime. ambulatory care. Although this has not been fully investigated by the consultants, it suggests the need for further review.
44 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Northern Lights Regional Health Centre Emergency and Ambulatory Care Opportunities
9. Explore options to decant ambulatory volumes from the ED, and then consider staffing investment opportunity relative to align to true ED volumes and recommended HPPD. 10. Monitor ambulatory care staffing levels in alignment with ED review and primary care capacity building in FMM.
Unit/Area Description
Findings
Staffing comparison of the NLRHC Emergency Department shows a potential staffing investment opportunity of 12 FTEs to bring the department to a peer standard. This low level of staffing is a potential risk to the region given the high level of emergency volumes, and the increased presence of industry camps that are expected to drive higher trauma volumes. However, anecdotal reporting suggests that a high level of ambulatory volume is currently seen in the ED, which may be impacting these numbers. The ED should focus on staffing investment that supports the recommended HPPD for true ED volumes. Staffing comparison is in line for 2004-05, but is low in projected 2005-06 YTD, suggesting the need for an investment of 2.1 FTEs. The region should consider this opportunity from the perspective of building ambulatory care capacity, but in alignment with broader need for a review of overall ambulatory activity across the ED and clinics and the development of increased primary care capacity in the community.
Actual FTEs 2005-06 YTD Actual HPPD 2004-05 Actual HPPD 2005-06 YTD Recom'd HPPD Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Actual FTEs 2004-05
Emergency Ambulatory Care
45
20.6 11.4
26.6 10.3
0.6 1.2
0.6 1.0
0.9 1.2
12.0 2.1
2006 Deloitte Inc
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Mental Health
46
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Mental Health Outpatient Activity
NLHR Overview
As presented below, NLHR Enrolments increased by 15% between 2002-03 and 2004-05, while Events increased by 41% for the same period Enrolments have increased most significantly at High Level between 2002-2003 and 2004-05, while Fort McMurray and High Level demonstrate the most significant increases for Event volumes over the same period Where variances between Event and Enrollment increases across the site exist (e.g. Fort McMurray and La Crete), this may be due, in part, to information capture capacity, but may also speak to changes in programming.
Enrolments Clinics 2002-03 2004-05 3-Year Variance 6% 37% 36% -9% 15% Events 3-Year Variance 71% 14% -34% -35% 41%
2002-03
2004-05
Ft. McMurray Mental Health Clinic High Level Mental Health Clinic La Crete Mental Health Clinic Fort Vermilion Mental Health Clinic Rainbow Lake Mental Health Clinic
Grand Total
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752 291 44 107 2 1,196
800 398 60 97 22 1,377
7,975 2,278 1,785 707 1 12,746
13,667 2,604 1,182 463 59 17,975
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Mental Health Outpatient Activity
Events by Type
Type of Event Type of Activity Assessment Face-to-Face Consultation Group Work Therapeutic Intervention Face-to-Face Total Telephone Videoconference Not Specified Grand Total
Source: ARMHIS Database 2002-3 to 2004-05
2002-03 914 335 626 8,256 10,131 552 2,063 12,746
2003-04 658 283 568 9,046 10,555 466 1 5,948 16,970
2004-05 664 212 519 10,412 11,807 464 1 5,703 17,975
3-Year Variance -27% -37% -17% 26% 17% -16% 176% 41%
As demonstrated above, outpatient mental health activity in NLHR has been increasing over the past three years by 41% - driven primarily by face-to-face therapeutic interventions, and events where the activity type is "Not Specified". Group work as a type of activity has seen a significant decline in volume, although this may, in part be due to some group activity being coded as therapeutic interventions. From an information capture perspective, this supports opportunity for improved mental health event coding in the region.
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Mental Health Outpatient Activity
Top 10 Diagnoses Driving Enrolments Year over Year
Diagnoses Major Depressive Disorder, Recurrent, Moderate Unspecified Mental Disorder (non-psychotic) Generalized Anxiety Disorder Parent-Child Relational Problem Posttraumatic Stress Disorder (PTSD) Partner Relational Problem Dysthymic Disorder Major Depressive Disorder, Recurrent, Severe Without Psychotic Features Adjustment Disorder With Depressed Mood Adjustment Disorder With Mixed Anxiety and Depressed Mood Top 10 Diagnoses Total NLHR Total 2002-03 59 2 39 48 23 40 43 27 29 25 335 1,196 2003-04 65 39 51 33 29 53 37 63 28 34 369 1,177 2004-05 68 64 62 59 47 45 42 40 25 25 477 1,377 3-Year Variance 15% 3100% 59% 23% 104% 13% -2% 48% -14% 0% 42% 15%
The top 10 diagnoses driving enrolments have increased by approximately 42% over the past three years, and represent approximately 35% of total enrolments in 2004-05. Notable increases are observed for PTSD (104%), Generalized Anxiety Disorder (59%), and Major Depressive Disorder (48%), An increase in "Unspecified Mental disorder" may highlight a coding issue for submitting clinics.
Source: ARMHIS Database 2002-3 to 2004-05 49 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Mental Health Outpatient Activity
Top 10 Referral Sources
The top 10 referral sources for mental health enrolments in NLHR represent almost 99% of total enrolments. From these top 10 sources, the main referral source for Mental Health enrolments in NLHR was Self-Referral, at 34% in 2004-05 Overall regional average time between referral and intake call for NLHR in 2004-05 was 5.1 days, which is a significant increase from 2003-04. This increased intake time is observed across all clinics in the region between 2003-04 and 2004-05. The time between intake call and initiation of services is not available. Referral source data for this analysis was only available for 2003-04 and 2004-05.
NLHR Top 10 Enrolment Referral Sources
RHA Child and Community Family Services and Outpatient 1% Services Other 3% Government 1% Self 34%
Mental Health Clinics Ft. McMurray Mental Health Clinic Fort Vermilion Mental Health Clinic High Level Mental Health Clinic La Crete Mental Health Clinic
Average Days Between Referral & Intake Call 2003-04 4.2 4.1 1.2 2.9 0.0 3.3 2004-05 6.3 4.4 3.5 3.3 1.1 5.1
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Other Agency 3% Physician 3% RHA Hospital 7%
Physician / Psychiatrist 13%
Educational Facility 16%
Source: ARMHIS Database 2003-04 and 2004-05 50
Significant Other 19%
Rainbow Lake Mental Health Clinic NLHR Average
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
NLHR Mental Health Program
Findings and Opportunities
Opportunities Findings
Mental health services in NLHR are considered a regional program, 1. Continue current and the region has recently developed a 2005-08 mental health 2005-08 Mental plan that is designed to address a number of key challenges in the Health Plan to region, including: expand mental Improved linkage between inpatient services in NLRHC and the health service northwest area of the region. availability in the Further alignment of community mental health services to community region, in health needs. alignment with Consultation findings suggest that mental health services needs are broader regional increasing in the region due to an increasing need in the `shadow' community health population. This population is specifically driving an increased need needs assessment. for addiction supports services, suggesting the need for increased regional partnerships with other service providers (e.g. AADAC). 2. Continue to build external partnerships with other mental health service providers (e.g. AADAC) and community social agencies. Utilization analysis identified a number of mental health CMGs with potential days savings, which was further supported by the MCAP review that identified a number of inpatients required outpatient treatment, supporting the need for further alignment of community mental health services to needs. Examination of mental health outpatient activity suggests that although overall activity is increasing, clients are facing longer intake times, which is a challenge to care delivery.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
NLHR Mental Health Program
NLHR Psychiatry Peer Staffing Comparative Analysis
Opportunities Findings
Staffing comparison suggests that the inpatient psychiatry unit at NLRHC has a staffing investment opportunity of 0.7 FTEs, based 3. Monitor 2006-07 on 2005-06 YTD staffing levels. In addition, however, hours of the staffing levels to crisis nurse are assigned to a different cost centre, and since these ensure alignment to individuals frequently cover short staffing on the inpatient unit, the recommended HPPD, actual HPPD is likely higher than 4.5. and ability to maintain crisis nurse Access to the 24-7 Crisis Nurse service is at times challenged services. when these individuals are required to cover short staffing on the inpatient psychiatry unit. Recruitment and retention efforts should be focused on ensuring an adequate supply of staff to maintain an HPPD of 4.9, using unit staff.
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Psychiatry
8.6
9.1
4.4
4.5
4.9
0.7
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database 52 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Northwest Health Centre
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Peer Staffing Comparative Analysis
Northwest Health Centre (High Level) Opportunities Findings
The NWHC Emergency Department does not currently have a triage function or physical facility for the function. Consultation findings suggest that triage and the use of CTAS as a risk and patient care management tool has not historically been part of organizational culture in NWHC, although the new Director is in process of introducing this function and related training to staff. NWHC has recently initiated the MORE OB program, and is in the process of offering CTAS and TNCC education to nursing staff.
1. Support implementation of a formal patient triage and CTAS function at NWHC.
2. Continue to institute clinical education and standards
Consultation findings suggest that NWHC nursing management 3. Explore options to are often supporting care delivery, due to absenteeism, and a reduce staffing impact lack of staff available for short term replacement. and premium salary costs associated with high sick Analysis suggests a high level of sick and overtime at NWHC, and overtime usage at which impacts staff workload and results in higher premium NWHC. salary costs for the organization.
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Peer Staffing Comparative Analysis
Northwest Health Centre (High Level) Opportunities Findings
On average, the HPPD is appropriate given the volume of emergency department visits, OR procedures, obstetrical, medical, surgical and psychiatric patients. However the unpredictable nature of surgical and obstetrical volumes, and the difficulty of finding replacement staffing makes it a 4.There is space for an challenge to ensure adequate staffing during peak periods. additional 10 beds at the Northwest Health Centre. The hospital has approximately 360 deliveries per year, providing an essential and cost effective service to residents of Increases in volume this part of the region. would result in greater economies of scale in Cross training of staff is appropriate and supports efficient and both quality and cost. quality care delivery. Greatest opportunity for efficiency would come through increased volumes in NWHC, as the region would achieve improved economies of scale relative to minimum staffing requirements.
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Recom'd FTE (Effic.)/ Re-Invest. 2005-06
Combined Inpatient Acute, ED, Obs and OR
20.1
22.1
10.2
9.2
10.0
2.0 See Above
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database 55 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
St. Theresa General Hospital
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Peer Staffing Comparative Analysis
St. Theresa General Hospital
Opportunities
Findings
St. Theresa General Hospital is an aged physical plant, and the region is currently in capital planning for replacement.
1. Conduct a role review of St. Potential for retirements among current physician resources Theresa General Hospital in suggests that the region may face challenges in maintaining the context of a broader sustainable physician service in the near future. regional community health needs assessment, to inform Proximity of the facility to High Level suggests opportunity for current capital planning. the region to consider an alternative service delivery model, to potentially change the balance of the continuum of services provided in the northwest area. 2. Explore options to reduce staffing impact and premium Analysis suggests a high level of sick and overtime at STGH, which creates impact on staff workload and higher premium salary costs associated with salary costs for the organization. high sick and overtime usage at STGH. 3. Support implementation of a formal patient triage and CTAS function at STGH Similar to NWHC, the STGH Emergency Department does not currently have a triage function. Under the leadership of the Director at High Level, this function and related staff training should be developed for STGH.
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
St. Theresa General Hospital Opportunities Findings
On average, the HPPD is appropriate given the volume of emergency department visits, obstetrical, medical, surgical and psychiatric patients. However the unpredictable nature of obstetrical volumes, and the difficulty of finding replacement staffing makes it a challenge to ensure adequate staffing during peak periods. Cross training of staff is appropriate and supports efficient and quality care delivery. Given need for minimum staffing levels to maintain service at STGH, greater opportunity for regional efficiency could be considered through a realignment of service delivery models across the northwest area of the region.
4. No staffing opportunity identified for STGH. Consider staffing with respect to broader role review opportunity.
Unit/Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HPPD 2004-05
Actual HPPD 2005-06 YTD
Recom'd HPPD
Recom'd FTE (Effic.)/ ReInvest. 2005-06
Combined Inpatient Acute, ED & Obs.
21.7
20.4
11.1
7.7
8.4
1.9 See Above
Source: NLHR 2004-05, 2005-06 Sept YTD Payroll, Deloitte Database, Grasp Database 58 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Rainbow Lake Health Centre
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Rainbow Lake Health Centre
Findings and Opportunities
Opportunities Findings
Rainbow Lake is a nurse practitioner station staffed by 2 NPs, 1 casual RN and 1 Community Health/Home Care RN. 1. Engage stakeholders in a conducting a role review of Rainbow Lake with respect to clinical programs, service delivery hours and staffing, in alignment with broader regional community health needs assessment. Volumes and care delivery model are not what would be expected with this level and type of nurse staffing. The clinic sees patients primarily between the hours of 9 11 a.m. and 1 4 p.m., Monday-Friday. After hours service is provided on an on call basis, and triaged through HealthLink. Statistics are kept manually and not trended by reason or type of visit. In January 2006, a total of 345 visits were logged not all of these required the services of an NP, although on-call service is available 24-7. Limited health promotion and disease prevention services provided (e.g. smoking cessation, prenatal education) Accountability framework does not support the expected goals for this facility.
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Rainbow Lake Health Centre
Findings and Opportunities
Opportunities
2. Opportunity to develop an collaborative practice model between nursing and medicine. 3. Examine staffing patterns to identify options for reductions in overtime premium costs.
Findings
Consultation findings suggest limited collaboration between the clinical staff and physicians for Rainbow Lake, and the site lacks clear physician leadership, both of which are likely impacting patient care quality, effectiveness and efficiency.
Rainbow Lake shows a high level of overtime, which suggests opportunity for overtime premium costs savings.
4. Investigate cost of `shadow' Rainbow Lake currently serves a large `shadow' population population and determine from industry camps. Consultation findings suggest that the billing options to ensure region is not currently able to recover costs for services cost recovery for services provided to this population, so should be examined further. provided by Rainbow Lake.
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Regional Continuing Care Services
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Continuing Care Activity Analysis
NLHR Weighted Cases by Facility
As depicted below, NLHR had 5,618 continuing care weighted cases in Spring 2005, which represents an overall increase in weighted cases by 5% from Fall 2002.
Regional continuing care beds remained relatively constant for the same period.
3
3
2
Thousands
2
1
1
0
High Level General Hospital
St Theresa General Hospital Fall 2002
La Crete Health Centre Spring 2005
Northern Lights Regional Health Centre
Fall 2003
Source: Alberta Health & Wellness LTC Database 63 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Continuing Care Activity Analysis
NLHR Weighted Cases by Classification
Classification Spring 2005 Continuing Care Weighted Cases 31 432 477 419 358 3,259 641 5,618 Spring 2005 Proportion of Total Cases 1% 8% 8% 7% 6% 58% 11% 100% Proportion Variance Fall 2002 to Spring 2005 -5% 6% 90% -37% -62% 9% 90%
Proportion of Weighted Cases by Classification
A G 11% 1% B 8% C 8% D 7% E 6%
A B C D E F G NLHR Total
F 58%
Source: Alberta Health & Wellness LTC Database
75% of NLHR's continuing care weighted cases are distributed across classifications E, F and G as of Spring 2005.
Overall proportion of F and G weighted cases has increased from 59%in Fall 2002 to 69% in Spring 2005, while E weighted cases have declined significantly. A similar decline is also observed in classification D weighted cases. Although the region has reduced its facility-based residents in classification A, an increase in residents classified as B and C is observed. Increases in residents classified in F and G have been the primary drivers of an overall increase in the region, supporting the trend of overall increases in weighted cases and resident acuity.
64 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
NLHR Continuing Care
Findings and Opportunities
Opportunities Findings
An overall increase in continuing care weighted cases is observed in the region, although lower acuity resident 1. Conduct a regional review of volumes are still increasing within facilities, suggesting need supportive housing for additional supportive housing/lodge facilities. requirements to determine In La Crete, a lodge exists but is reported as being full, which optimum alignment of care may suggest need for additional supportive housing resources. opportunities. 2. Identify and explore Given interest of the local community in La Crete in health service partnership opportunities to delivery, opportunity exists to explore partnership opportunities fast track supportive with the community for the collaborative development of additional supportive housing capacity. housing developments. 3. Continue with and accelerate efforts to establish a continuing care facility in Fort McMurray. Consultation findings and MCAP analysis suggest the need for additional continuing care capacity, including a stand-alone facility in Fort McMurray. It is not ideal, from both a cost and a quality/programming perspective to have continuing care beds within a hospital, suggesting that planning for this initiative should be accelerated.
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NLHR Continuing Care
Findings and Opportunities
Opportunities
4. Monitor 2006-07 total care team staffing levels across NLHR continuing care units to ensure alignment to recent AHW target of 3.4 HPRD, with consideration of appropriate staffing allocations across acute and continuing care units.
Site
Findings
NLHR facilities demonstrate significant variation in staffing levels across sites. Although not shown below, variation in 2004-05 and 2005-06 staffing levels are also observed. Recent AHW announcements suggest that regions should target an average level of 3.4 total paid hours per resident day (HPRD) of combined nursing and personal care staffing, for facilities with an average CMI of 100. Staffing comparison to this recommended HPRD suggests that all NLHR continuing care units have potential staff savings opportunities for 2005-06 YTD. Year-over-year staffing variation may be a result of changes to staffing allocations across the acute and continuing care units of some of these facilities, however, which needs to be explored further by the region to understand this potential opportunity. Given the trend for increasing involvement of rehabilitation and recreation therapy disciplines in continuing care service delivery, however, the region should examine total care team staffing levels in determining appropriate alignment to the AHW 3.4 HPRD.
Actual FTEs 2005-06 YTD Actual Total Paid HPRD 2005-06 YTD AHW Recom'd 3.4 HPRD @ 100 CMI Recom'd FTE (Effic.)/ Re-Invest. 2005-06
NLRHC Continuing Care Northwest Health Centre Continuing St. Theresa Continuing Care La Crete
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26.8 9.8 7.8 19.9
5.2 5.4 4.4 8.8
2.9 2.9 3.0 3.2
(12.9) See Above (4.5) See Above (2.7) See Above (12.8) See Above
2006 Deloitte Inc
Source: NLHR 2004-05, 2005-06 Oct YTD Payroll, Deloitte Database AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Regional Home Care Services
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Home Care Staffing and Activity
Opportunities Findings
Home care is a regional service that is coordinated across a Manager in Fort McMurray and a Manager in the northwest. Home care is currently provided only 5 days/week for most services, with limited evening/night/weekend service available on-call only. This is out of line with peer practice, and impacts the Region's ability to meet client care needs. In Fort McMurray, clients are typically seen on a next-day basis, which may be impacting increased same-day workload in the ED. The practice of seeing patients in ED for after hours IV medications and dressings is inappropriate and inconsistent with peer practice. No standard approach or guidelines for service provision. Frequently and length of service is based on individual assessment of professionals. This impacts management's ability to understand operational trends and client needs.
1. Conduct a regional review of home care services to align service model, resources, hours of service delivery, and access times to community health needs.
2. Implement the RAI-HC, to ensure a standardized approach to assessment and ensure the collection of standardized volume and visit statistics across the region.
Statistics FTEs Visits Attendance Days New Referrals
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2003-04 37.9 25,638 722
2004-05 38.2 32,927 32,333 1,053
2005-06 Projected 38.7 27,910 32,710 1,006
Variance 2003-04 to 2005-06p 2% 9% 39%
2006 Deloitte Inc
Source: NLHR GL 2003-04, 2004-05, 2005-06 Sept YTD AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Population Health
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Population Health Staffing and Activity
Health Promotion & Education And Disease & Injury Prevention Opportunities
1. Conduct a regional review of population health services to align service programming, resources, and use of telehealth in service delivery to community health needs.
Statistics FTEs Visits Telephone Visits Group Sessions General Health Assess. (Initial/Subsequent) General Health Workshop Attendees
Source: NLHR GL 2003-04, 2004-05, 2005-06 Sept YTD 70 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Findings
The region has many population health programs in place, and has demonstrated fairly stable staffing and activity over the past three years. Improvements are observed in statistics reporting, as group sessions and assessment activity is being tracked as of 2005-06. This will support improved workload management. Opportunity exists to further leverage the region's investment in telehealth infrastructure to support chronic disease management and other population health programming. Given the requirement for a regional community health needs assessment, however, determination of overall alignment of population health services to need is difficult to determine.
2003-04 58.7 27,217 2004-05 60.5 27,538 7,801 2005-06 Projected 61.5 26,972 8,100 1,450 154 1,468 Variance 2003-04 to 2005-06p 3% (1%) -
Population Health Staffing and Activity
Health Promotion & Education And Disease & Injury Prevention Opportunities
2. Implement nurse led clinics with nurses functioning under medical directives in the areas of sexual health, well women, and STI in High Level.
Findings
Alberta STI rates are consistently higher than national rates for gonorrhea and chlamydia, and are rising. Fort McMurray has one of only three clinics in Alberta providing STI services, on a drop in and appointment basis, staffed by nurses operating under medical directives. In the northwest, sexual health and STI services are limited and physician led, which does not meet the needs of the young population and are not consistent with peer practice.
3. Consider realignment of community programs in the northwest under one umbrella.
In the northwest, while staff in community programs (mental health, health promotion, home care, public health and rehab services) support and provide coverage for one another, they report to different individuals.
Source: NLHR GL 2003-04, 2004-05, 2005-06 Sept YTD 71 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Environmental Health
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Environmental Health Staffing and Activity
Opportunities
1. Conduct a regional review of Environmental Health services to align service programming and resources to increasing community health inspections needs and to meet minimum provincial standards. Statistic FTEs Visits Complaints Communicable Diseases Animal Bites Water Reports Special Events
Source: NLHR GL 2003-04, 2004-05, 2005-06 Sept YTD 73 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Findings
Environmental health is a regional service with largely separate programs that serve Fort McMurray and the northwest areas of the region. Projected staffing for 2005-06 indicates a potential increase by 20% from 2004-05. For this same period, activity is projected to decrease by 5%. This change in activity may be due to improve statistics reporting and breakdown by activity type, however, so should be monitored. Given the region's current staffing, Environmental Health is unable meet AHW blue book standards for routine inspections, which is a significant potential risk to the region. This challenge is further compounded by a large `shadow' population in the region, where the service reports heavy workload associated with the private industry camps. Given the population growth in this region, increasing presence of private industry camps and the need for a community health needs assessment for NLHR, further review of Environmental Health is needed to determine appropriate resource alignment. 2004-05 6.7 2005-06 Projected 7.9 1,532 286 7,706 72 108 4,992 328 -5% Variance 2003-04 to 2005-06p 20%
Physician Findings and Opportunities
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Physician Findings and Opportunities
Introduction
The review process incorporated several direct consultations with physicians, which have yielded a number of findings and opportunities. Physician-related findings and opportunities have been clustered into the following four key areas, which also have linkage to opportunities identified across other areas of the region:
Physician Governance and Leadership Physician Human Resources Planning and Management
Quality, Risk and Performance Management
Physician Findings and Opportunities
Program Review and Organization
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Physician Findings and Opportunities
Governance and Leadership
Findings
The region currently has two separate MACs, representing the Fort McMurray and northwest part of the region. As a result, consolidated medical leadership does not exist for the region, with the exception of the Medical Director role although challenges have prevented the Medical Director from having active presence in the northwest part of the region. The combined role of the Medical Director to also serve as the Medical Officer of Health is a large portfolio, but the role is currently only part-time. Limited support resources for the portfolio compounds related challenges to having sufficient overall physician leadership and support for the region. Consultation findings suggest that gaps in physician accountability related to adherence with by-laws and medical policies/procedures currently exist across both MACs, which are causing challenges in overall physician governance and leadership in the region. Further, variation in leadership roles and definitions suggests a need for greater alignment between current physician leadership structures/supports and requirements of the region.
Opportunities
1. Conduct an external review of MAC governance structure/mechanisms for the region, with specific attention to by-law adherence/alignment. 2. Conduct an alignment review of physician leadership requirements across all services and roles. 3. Examine the Medical Director portfolio to consider role re-alignment, overall organization structure, and support resources required to support strategic HR focus on physician recruitment, retention and management.
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Physician Findings and Opportunities
Physician Human Resources
Findings
The region is facing several significant physician recruitment/retention issues and staffing shortages (i.e. Internal Medicine, Emergency, Surgery, Psychiatry, Family Medicine, Radiology). Requirements for physician human resources are expected to continue to grow, given the rapid population expansion in the region associated with growth in the Oil & Gas industry. A broader physician HR strategy is lacking that ensures alignment of physician skill mix with care and service delivery priorities for the region, and considers alternative remuneration strategies to attract and retain physicians. Physician recruitment is reported as being often done without consideration of physician impact on other clinical services (i.e. nursing, clinical support and allied health), space availability and bed capacity, equipment requirements, IT/IS requirements, etc. The region has a dedicated physician recruiter, but this role does not currently report to the Medical Director.
Opportunities
1. Engage physicians and regional leadership in the development of a regional Physician Human Resource Strategy that is linked to the broader regional HR strategy, to address Physician resource gaps, skills management and education, alignment/realignment of current resources to core service delivery needs, remuneration and recruitment/retention. 2. Explore alternative payment models for physicians in the region, with an objective to improve resourcing, and linkage to care/service delivery model. As part of this opportunity, explore alternate staffing models in the consideration of physician AFP options e.g. APN/NP model in ER and community health clinics. 3. Develop a consistent regional Physician Impact Assessment process that is used for physician recruitment needs planning, and in assessment when new physicians are being considered.
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Physician Findings and Opportunities
Quality, Risk, and Performance Management
Findings
The region is currently lacking an assessment framework for MD quality, performance, or competencies; which is further compounded by a lack of required funding or resources available to maintain education and certification. There is a need for greater physician accountability related to developing and maintaining consistent standards of practice throughout the region. Further, there is need for a physician risk management framework to assess and proactively manage physician-related issues and risks at the service, site, community and regional levels. Stakeholders report a relationship gap between Regional Administration and physicians across the region, which is a potential risk to physician retention and ongoing clinical service delivery. Specific challenges exist in the northwest with respect to physician connection to the region and clinic facilities issues.
Opportunities
1. Create an accountability framework with evaluation and quality/risk/performance management tools for Physicians, which is integrated into a broader regional framework. 2. Develop a regional approach and support for CME for both Canadian-trained and foreigntrained medical graduates, based on a sustainable business model, and integrated with the physician recruitment and retention strategy and broader regional education function. 3. Develop a clinical adoption strategy for standardized, peer reviewed protocols and care maps for key conditions (e.g. pneumonia, cellulitis, congestive heart failure, and MI management). 4. Engage physicians to identify methods to improve the perceived challenges in regionphysician relations (e.g. physicians clinic facilities issues, physician involvement in broader regional planning and community health needs assessment, senior team representation on Board, etc.).
78 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Physician Findings and Opportunities
Clinical Program Frameworks and Review
Findings
Consultation findings suggest that the region's facilities and many of their respective services operate in silos, and that several programs are not regional. Further, communication and coordination of services across the region continues to be a challenge for select areas suggesting a need for greater integration region-wide. Observed challenges across the region suggest a need for a greater regional focus across various services to: Define scope of service for current and future community/regional needs. Ensure congruence of site/regional services with functional planning exercises. Assess and determine current/future capacity requirements/constraints. Specific clinical program challenges in Emergency, Internal Medicine and Surgery services suggest the need for a more in-depth review that examines the role, function and resourcing required of these areas as regional programs.
Opportunities
1. Conduct external reviews of Emergency, Internal Medicine and Surgery services as regional programs, with focus on developing a coordinated and sustainable strategy for each of these programs to address needs of the respective communities served. 2. Enhance communication between respective facilities by leveraging Telehealth technology in a structured approach for coordination of service, information sharing of leading practices, CME and professional support. 3. Re-examine role of facilities and programs across the region in the context of human resource requirements and community health services needs.
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Clinical Support and Allied Health Services
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Clinical Support and Allied Health Services
Peer Staffing Comparison Process Overview
To understand the relative efficiency of the Clinical Support and Allied Health services, we conducted a comparative analysis with a number of comparable health regions from Alberta, British Columbia, Manitoba, and Saskatchewan Fiscal 2004-05 data for NLHR was used for peer comparison, as this represents a full year of staffing, but reference to observed 2005-06 YTD staffing levels are also provided The efficiency analysis assessed peer staffing based on a comparison of actual total paid hours per adjusted patient day (HAPD) for each "discipline" within the organization (based on MIS functional centre alignment).
Although many of the allied health disciplines in the region are aligned to clinical program, an MISbased alignment for comparison was used to ensure an `apples-to-apples' comparison to peers.
The adjustment factor increases the base of inpatient clinical activity to better reflect the span of inpatient, outpatient, continuing care and community clinical activity. The results across the comparator group were considered with the following "rules" applied at the departmental level:
Values among the comparator group that were well outside the range (e.g. outliers) were eliminated from the analysis. For Clinical Support and Allied Health Services, the FTE efficiency opportunity was identified compared to the 50th percentile to reflect a more realistic level of clinical resourcing to support patient care needs.
Staffing opportunities are identified based on comparative analysis and the team's understanding of minimum staffing requirements. Staffing opportunities are not stand alone, however, and need to be considered in the context of other opportunities identified for each area. The benchmarking information should be used as input to management decision-making, rather than as a decision in and of itself.
81 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Clinical Support and Allied Services Areas Reviewed
MIS Primary Account 71410 71415 71435 71440 71445 71450 71455 71460 71470 71485 Departments and Disciplines Clinical Laboratory Diagnostic Imaging Respiratory Therapy Pharmacy Clinical Nutrition Physiotherapy Occupational Therapy Audiology And Speech/Language Pathology Social Work Recreation
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Peer Staffing Comparative Analysis
Clinical Laboratory
As Laboratory services are outsourced, a peer staffing comparison analysis was not conducted; however, key findings and associated opportunities are discussed here. Opportunities
1. Establish a region-wide Lab Advisory Council, comprised of regional stakeholders with a DKML representative, which sets standards and monitors ongoing utilization. 2. Through the Lab Advisory Council, engage stakeholders in the design and implementation of consistent region-wide lab utilization and standards, with a mechanism for ongoing monitoring by the region. 3. Modify the current Meditech implementation to improve controls over the creation of adhoc lab order sets.
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Findings
Lab services are outsourced to DKML, which provides service in both Fort McMurray and northwest area of the region. The region currently does not have a consistent process in place to monitor lab utilization, although a region-wide Lab Advisory Council is in development to set common standards and utilization practices. Implementation of the new Meditech system has resulted in physicians' ability to create customized order sets for lab testing. Although this is convenient for physicians, it has created an increase in lab orders, and is a risk to increased lab costs for the organization in the absence of a utilization monitoring process.
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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Peer Staffing Comparative Analysis
Diagnostic Imaging
Opportunities
1. Monitor 2006-07 staffing levels to confirm achievement of film library staff reductions to address staffing opportunity. 2. Continue to explore recruitment strategies for DI to reduce reliance on premium overtime costs, as part of broader regional HR strategy. 3. Continue development of region-wide coordination of DI services, with regular regional monitoring and evaluation to ensure alignment of inhouse and DKML provided services.
Area Description Actual FTEs 2004-05 24.9
Findings
Diagnostic Imaging is currently provided through two separate service delivery models in NLHR. Fort McMurray services are provided in-house, while services in the northwest have recently changed to be provided by DKML, due to shared CXLT staffing with the outsourced lab services. In conjunction with the shift to DKML service provision, the region is working on the harmonization of policies, procedures, roles and protocols for region-wide DI services. Implementation of a common PACS for the region is facilitating this process. Analysis suggests that overtime costs for DI are high, and represent a potential savings opportunity. Consultation indicates the need for increased coverage of X-Ray and CT to reduce overtime and callback costs, however the region is faced with staff shortages in these areas. Staffing comparison suggests that DI has a small potential staff savings opportunity, however the department has identified a reduction in film library staff in late 05-06 with the implementation PACS, which should address this opportunity.
Actual Alberta Alberta HAPD Peer Peer HAPD 2004-05 HAPD MIN MAX 0.27 0.09 0.63 National Peer 50th Percentile HAPD 0.26 Potential FTE (Effic.)/ Re-Invest. (0.5)
2006 Deloitte Inc
Actual FTEs 2005-06 YTD 27.9
Diagnostic Imaging
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Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Respiratory Therapy
Opportunities
1. Monitor 2006-07 staffing levels to ensure continued alignment to peers. 2. Continue to explore recruitment strategies for RT to reduce reliance on premium overtime costs, as part of broader regional HR strategy. 3. Explore options to expand RT scope of practice in NLRHC, with consideration of corresponding staffing implications on RT and nursing, as part of broader regional HR strategy. 4.Explore and define potential role of Respiratory Therapy services in the northwest area of the region, in alignment with a broader community health needs assessment.
Findings
Staffing comparison suggests that Respiratory Therapy in NLHR has a staffing investment opportunity relative to peers at the 50th percentile, based on 2004-05 staffing levels. Projected 2005-06 YTD staffing suggests that the region is now in line with peers, however, so this should continue to be monitored. Consultation findings suggest, however, that several challenges are being faced by the discipline: The amount of direct hours available for patient care is challenged due to a high proportion of administrative workload on the clinical staff. Analysis indicates that RT has a high level of overtime costs, suggesting opportunity to reduce this premium costs. Further, Respiratory Therapy scope of practice in NLRHC could be expanded to include cardiac stress testing, a function currently performed by nursing. While this shift in function could relieve some pressures on nursing resources, it is only achievable with an increase in Respiratory Therapy staffing. There is no Respiratory Therapy support in the northwest area of the region, in part due to historical service patterns. As with many other services, the adoption of common practice standards, particularly in community settings, is constrained by lack of resources in this area of the Region.
Area Description Respiratory Therapy
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Actual FTEs 2004-05 4.7
Actual FTEs 2005-06 YTD 5.6
Actual Alberta Alberta HAPD Peer HAPD Peer HAPD 2004-05 MIN MAX 0.05 0.01 0.12
National Peer Potential FTE 50th Percentile (Effic.)/ ReInvest. HAPD 0.06 1.0
2006 Deloitte Inc
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Pharmacy
Opportunities
1.Establish a common structure and process for monitoring regional drug utilization, medication errors and standardizing related policies and procedures. 2. Work with RSHIP to assess cost/benefit of implementing required improvements to pharmacy module in Meditech.
Findings
Pharmacy has been developed as a regional function for one year, and so standardization of regional policies, procedures and protocols in still underway. The region currently has two separate Pharmacy and Therapeutics Committees one in Fort McMurray and one for the northwest with a need for improved coordination. Implementation of the new Meditech system has resulted in a `step backwards', as the new system has created challenges in inventory management, dose range checking and other decision support functionality, which is a potential risk to the organization.
3. Develop a business case to Pharmacy currently uses manual unit dose in Fort McMurray, but this is not explore the costs and benefits in place in the northwest. of implementing automated Limited technology supports Pharmacy operations in the Region (e.g. unit dose and other Pharmacy automated unit dose, PIXIS in the ER/OR), and a business case has not technologies to support efficient been developed to explore these technologies. operations across the region. 4. Monitor 2006-07 staffing levels to confirm continued alignment to peers. Staffing comparison suggests that NLHR is in line with peers at the 50th percentile for 2004-05. Projected FTEs for 2005-06 YTD suggest an increase in staffing, however.
Area Description Pharmacy
Actual FTEs 2004-05 11.1
Actual FTEs 2005-06 YTD 13.6
Actual HAPD 2004-05 0.12
Alberta Peer HAPD MIN 0.07
Alberta Peer HAPD MAX 0.20
National Peer 50th Percentile HAPD 0.12
Potential FTE (Effic.)/ Re-Invest. -
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 86 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Clinical Nutrition
Opportunities Findings
Staffing comparison suggests that Clinical Nutrition staffing is in line with peers at the 50th percentile. Consultation findings suggest that there is an opportunity for an alternative staff mix, however, which includes increase use of technologists for some patient care activities, in the northwest area of the region. Functions of Clinical Nutrition are appropriately focused in the clinical realm, yet activities related to intervention are mostly approached with an individual or group focus. Although the importance of shifting the focus to more communitybased services is recognized by the region, there is a perception that staffing is inadequate to support a shift in the model of care.
1. Review staffing mix of Registered Dietitians and Clinical Dietary Technologists for the region.
2. Consider realignment of clinical nutrition services to strengthen linkages with the evolving Primary Care and Chronic Disease initiatives, in alignment with a broader regional community health needs assessment.
Clinical Nutrition has been impacted by the transition to Meditech 3. Assess the cost/benefits of and a corresponding lack of functionality to support operations. improving current systems support for Clinical Nutrition and Food This is reported to create significant downstream manual work for Services, as part of broader regional Clinical Nutrition, and presents a potential risk of increased error IT infrastructure and planning. rates in food delivery. Actual FTEs 2004-05 4.3 Actual FTEs 2005-06 YTD 4.7 Actual HAPD 2004-05 0.05 National Alberta Alberta Peer 50th Peer HAPD Peer HAPD Percentile MIN MAX HAPD 0.01 0.06 0.05 Potential FTE (Effic.)/ Re-Invest. -
Area Description
Clinical Nutrition
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 87 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Physiotherapy
Opportunities
1. Monitor 2006-07 staffing levels to determine remaining staffing investment required to align to peer levels. 2.Explore options to expand regional Physiotherapist staffing, with focus on community-based services in the northwest area of the Region, in alignment with broader regional community health needs assessment.
Actual FTEs 2004-05 Physiotherapy 8.3
Findings
Staffing comparison suggests that Physiotherapy has a staff investment opportunity of 6.9 FTEs at the peer 50th percentile, based on 2004-05 staffing levels. Projected 2005-06 staffing suggests that region has achieved some of this opportunity. Consultation findings support the analysis, suggesting a limited amount of physiotherapy services are available in the northwest area of the region. This gap in service is a significant constraint on the adoption of common practice standards across the region and a consistent approach to providing care in the community, particularly in supporting Home Care programs. The expansion of physiotherapist services in the region, should also consider the development of additional leadership infrastructure to support the expanded service.
Actual FTEs 2005-06 YTD 9.6 Actual HAPD 2004-05 0.09 Alberta Peer HAPD MIN 0.09 Alberta Peer HAPD MAX 0.30 National Peer 50th Percentile HAPD 0.16
Area Description
Potential FTE (Effic.)/ Re-Invest. 6.9
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 88 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Occupational Therapy
Opportunities Findings
Staffing comparison suggests that Occupational Therapy staffing is in line with peers at the 50th percentile. 1. Conduct broader Occupational Therapy service planning, to ensure alignment to a broader regional community health needs assessment. Recruitment difficulties in the northwest area of the Region, as well as the practice of using facility-based staff to respond to community referrals, however, are reported to be a challenge to meeting service delivery needs outside of acute care (e.g. therapy support for home care programs, swallowing issues in the long term care population). Occupational Therapy has developed a wait-list and priority setting process according to need/expected outcome to help manage this identified service gap, however a broader community health needs assessment has not been completed to ensure alignment of services and identify unmet demand.
Actual FTEs 2005-06 YTD 8.8 Alberta Peer HAPD MIN 0.07 Alberta Peer HAPD MAX 0.17 National Peer 50th Percentile HAPD 0.10 Potential FTE (Effic.)/ Re-Invest. -
Area Description
Actual FTEs 2004-05
Actual HAPD 2004-05 0.10
Occupational Therapy
9.1
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 89 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Audiology & Speech Language Pathology
Opportunities Findings
1.Conduct broader Audiology Staffing comparison suggests that Audiology & Speech Language Pathology have a staffing investment opportunity and SLP service planning to of 2.3 FTEs relative to peers at the 50th percentile. inform appropriate Consultation findings suggest that recruitment challenges alignment of identified are the primary driver of this staffing shortage, although staffing investment 2005-06 projected numbers suggest that the region has opportunity to community health needs, as part of a had some gains in staffing. broader regional Dysphagia services are not currently offered in the community health needs northwest area of the Region due to limited access to staff assessment. and training.
Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD 8.2
Actual HAPD 2004-05
Alberta Peer HAPD MIN 0.04
Alberta Peer HAPD MAX 0.21
National Peer 50th Percentile HAPD
Potential FTE (Effic.)/ Re-Invest.
Audiology & Speech Language Pathology
7.2
0.08
0.10
2.3
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 90 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Social Work
Opportunities
1. Explore and define the potential role of Social Work services in the region to inform appropriate alignment of identified staffing investment opportunity to community health needs, as part of a broader regional community health needs assessment.
Findings
Social Work in NLHR is currently a limited function, with less than 1 FTE supporting the region. Staffing comparison suggests that Social Work has a staffing investment opportunity of 2.4 FTEs to align to peers at the 50th percentile.
Area Description
Actual FTEs 2004-05 0.3
Actual FTEs 2005-06 YTD 0.5
Actual HAPD 2004-05 0.003
Alberta Peer HAPD MIN 0.003
Alberta Peer HAPD MAX 0.04
National Peer 50th Percentile HAPD 0.03
Potential FTE (Effic.)/ Re-Invest. 2.4
Social Work
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 91 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Recreation
Opportunities
1. Explore options to increase access to Recreation Therapy services, in alignment with a broader regional community health needs assessment.
Findings
Recreation Therapy is currently provided in the Medicine and Continuing Care units at NLRHC, and is reported as being also provided in NWHC, STGH and LCCC in the northwest area of the region. Staffing comparison suggests that Recreation Therapy has a staffing investment opportunity of 4.1 FTEs to align to peers at the 50th percentile.
Area Description
Actual FTEs 2004-05 4.9
Actual FTEs 2005-06 YTD 5.2
Actual HAPD 2004-05 0.05
Alberta Alberta National Peer Peer HAPD Peer HAPD 50th Percentile MIN MAX HAPD 0.03 0.11 0.10
Potential FTE (Effic.)/ Re-Invest. 4.1
Recreation
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 92 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Corporate and Support Services
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Corporate and Support Services
Peer Staffing Comparison Process Overview
To understand the relative efficiency of the Corporate and Support Services, we conducted a comparative analysis with a number of comparable health regions from Alberta, British Columbia, Manitoba, and Saskatchewan Fiscal 2004-05 data for NLHR was used for peer comparison, as this represents a full year of staffing, but reference to observed 2005-06 YTD staffing levels are also provided The efficiency analysis assessed peer staffing based on a comparison of actual total paid hours per adjusted patient day (HAPD) for each "department" within the organization (based on MIS functional centre alignment). The adjustment factor increases the base of inpatient clinical activity to better reflect the span of inpatient, outpatient, continuing care and community clinical activity. The results across the comparator group were considered with the following "rules" applied at the departmental level:
Values among the comparator group that were well outside the range (e.g. outliers) were eliminated from the analysis. Given the northern geographic challenges faced by the region, the FTE efficiency opportunity for all Corporate, Support, Clinical Support and Allied Health Services was identified compared to the peer 50th percentile level of staffing performance.
Staffing opportunities are identified based on comparative analysis and the team's understanding of minimum staffing requirements. Staffing opportunities are not stand alone, however, and need to be considered in the context of other opportunities identified for each area. The benchmarking information should be used as input to management decision-making, rather than as a decision in and of itself.
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Peer Staffing Comparative Analysis
Corporate and Support Services Areas Reviewed
MIS Primary Account 71105, 71110, 71205, 71305, 71405, 71505 71115 71120 71840 71125 71135 71145 71150 71153, 71155, 71165, 71175 71190, 71180, 71130 Departments General Administration and Nursing Administration Combined (Combined to ensure comparability to peer reported data) Finance Human Resources/Personnel and Occupational Health & Safety Education Systems Support Regional IT Materiel Management (includes all CSR for the region) Housekeeping Laundry And Linen Plant Operations, Maintenance and Biomedical Engineering Combined (Combined to ensure comparability to peer reported data) Health Records, Registration and Telecommunications Combined (Combined to ensure comparability to peer reported data) Patient/Resident and Non-Patient Food Services Combined (Combined to ensure comparability to peer reported data)
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71195, 71910
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
General and Nursing Administration Combined
Opportunities Findings
1. Monitor 2006-07 Staffing comparisons suggests that General and Nursing Admin has a staffing levels to savings opportunity relative to peers at the 50th percentile, based on determine savings 2004-05 staffing. opportunity for the Projected FTEs for 2005-06 suggest an increase by 8.6 FTEs from General and 2004-05, which would potentially increase this savings opportunity. In comparison to peers, NLHR also demonstrates the highest % of Nursing Admin expenses in its Corporate Services, which includes General and areas to align to Nursing Administration. peer staffing levels. There is a centralized staffing office in Fort McMurray, with responsibility for replacing vacation, sick calls, etc. Refer to the Human There is float team of RNs, LPNs and Unit Clerks, staffed with full time Resources section and casual staff, but due to vacancies and the high number of for opportunity. replacement requests, is not sufficient to meet all the needs.
For example, of 8 approved FT ER/CCU float positions, 7 of the 8 are vacant at the current time.
Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD 50.8
Actual HAPD 2004-05 0.44
Alberta Alberta National Peer Peer HAPD Peer HAPD 50th Percentile HAPD MIN MAX 0.09 0.44 0.39
Potential FTE (Effic.)/ Re-Invest. (3.0)
General & Nursing Admin. Combined
42.2
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 96 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Finance
Opportunities
1.Monitor 2006-07 staffing levels, mix and experience to determine remaining staff savings opportunity for Finance, with consideration of further evolving Decision Support functionality in the region. 2.Identify anticipated operational efficiencies as a result of Meditech system implementation, and develop an action plan to achieve them.
Area Description Finance
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Findings
Finance has had significant turnover but has recently re-staffed to full complement, and is currently in role re-alignment. The department has a high proportion of junior staff, and so several staff are still in a learning mode. Finance reports limited role in broader Decision Support function and business case development for the region, but does provide financial analysis. This is primarily due to junior experience of staff, and the region expects that this function will evolve within current staffing complement as staff move through learning curve. Components of Decision Support as a function are also currently provided through Health Records, and so improved coordination across these areas may facilitate planning and management decisionmaking. Staffing comparison suggests that Finance has a 4.2 FTE savings opportunity at the 50th percentile. The region will need to consider staff mix and experience with respect to its ability to achieve this opportunity. In comparison to peers, NLHR also demonstrates the highest % of expenses in its Corporate Services, which includes Finance.
Actual FTEs 2005-06 YTD 17.5 Actual HAPD 2004-05 0.19 Alberta Peer HAPD MIN 0.05 Alberta Peer HAPD MAX 0.19 National Peer 50th Percentile HAPD 0.14 Potential FTE (Effic.)/ Re-Invest. (4.2)
2006 Deloitte Inc
Actual FTEs 2004-05 17.5
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Human Resources/Personnel
Opportunities Findings
Human Resources is a regional service managed by a regional Director of HR, with staff in both FMM and High Level. The region previously had a VP of HR, but this position was eliminated, such that HR now reports to the VP Corporate Services. HR and OH&S have recently implemented a number of regional programs to support the organization (e.g. attendance management, work accommodation), but they are still in process of gaining traction in the region. Staffing comparison suggests that HR (including OH&S) has as a staff savings opportunity relative to peers at the 50th percentile. Given the need for maintaining site presence in the northwest area of the region, however, no staffing change is recommended. Recommended focus for HR is on the broader regional need for refocus of HR as a strategic priority, and the development of an education function that supports regional learning and development needs.
Alberta Peer HAPD MIN 0.03 Alberta Peer HAPD MAX 0.13 National Peer 50th Percentile HAPD 0.07 Potential FTE (Effic.)/ Re-Invest. (3.4) See Above
2006 Deloitte Inc
Please refer to HR section for additional opportunities.
Area Description Human Resources / Personnel
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Actual Actual FTEs Actual FTEs 2005-06 HAPD 2004-05 YTD 2004-05 9.9 12.0 0.11
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Education
Opportunities Findings
NLHR currently has 1 Clinical Instructor in High Level and 1.5 FTE Clinical Instructor in Fort McMurray. 1. Continue with plans to expand clinical These individuals provide education such as orientation development within the (limited to 2 days per person), CPR and back care. Fort McMurray site, with a Two additional new educator positions have recently been priority given to developing approved (1 for acute and 1 for critical care). an enhanced orientation Although staffing comparison indicates that NLHR is in line and preceptorship program. with peers for education, given the overall organization need Please refer to HR section to refocus on HR and education, support should be given to for additional opportunities. staffing expansion to support overall change and mentorship activities.
Area Description
Actual Actual FTEs Actual FTEs 2005-06 HAPD 2004-05 YTD 2004-05 3.5 3.5 0.04
Alberta Peer HAPD MIN 0.01
Alberta Peer HAPD MAX 0.06
National Peer 50th Percentile HAPD 0.04
Potential FTE (Effic.)/ Re-Invest. -
Education
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 99 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Systems Support
Opportunities
1. Consider IT staffing levels with respect to broader regional IT and RSHIP implementation management. Please refer to Technology section for additional opportunities
Findings
Staffing comparison suggests that IT has a staff savings opportunity at the peer 50th percentile. Given the current RSHIP initiative and associated resources, however, it is suggested that the region consider broader IT staffing requirements relative to implementation and ongoing operations maintenance and support of the Meditech system before exploring this potential staffing opportunity further.
Area Description
Actual FTEs 2004-05
Actual FTEs 2005-06 YTD
Actual HAPD 2004-05
Alberta Peer HAPD MIN 0.04
Alberta Peer HAPD MAX 0.17
National Peer Potential 50th Percentile FTE (Effic.)/ HAPD Re-Invest. (0.8) See Above
Systems Support
6.4
6.8
0.07
0.06
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 100 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Materials Management, Housekeeping, Laundry & Linen, and Food Services
Opportunities Findings
Materials Management is a regional function centrally managed from NLRHC. Product standardization is underway across the region, but existing contracts and information systems changes are reported as slowing this process. NLHR participates with other rural RHAs in a GPO, which has contributed to the region having low medical/surgical, drug and food supply costs. CSR is managed and delivered by Materials Management in NLRHC, but by nursing in the northwest area of the region. This has resulted in a lack of standardized policies, procedures, and trays. Property management in the region is currently managed by both Housekeeping and Materials Management. Preliminary discussions have started to explore consolidating this function under the Facilities department, which will ensure alignment of services and management.
1. Continue efforts to drive product standardization across the region. 2. Develop regional standards for policies, procedures, risk and safety protocols, and equipment trays for CSR services.
3.Conduct a role review of functions and accountability for property management services in the Region, to determine most appropriate operations alignment.
4.Develop a contingency plan for Consultation findings indicate that the region's aging laundry laundry services, including equipment has frequent breakdowns, which is a high potential risk to preparation for pandemic planning. the delivery of clinical services. 5.Conduct a cost-benefit assessment of Further, reports of limited Maintenance support on the weekends, laundry equipment as part of the coupled with the additional stress of higher throughput following the development of a long range service recent shift to 7-day service will reduce the life span of the current plan. equipment. 6. Assess the cost/benefits of improving current systems support for Clinical Nutrition and Food Services, as part of broader regional IT infrastructure and planning.
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Food Services has been impacted by the transition to Meditech and a corresponding lack of functionality to support operations. This is reported to create significant downstream manual work for Food Services, and presents a potential risk of increased error rates in food delivery.
2006 Deloitte Inc
AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Materials Management, Housekeeping, Laundry & Linen, and Food Services
Opportunities Findings
Staffing comparison suggests that Materials Management and Housekeeping 7. Monitor 2006-07 staffing levels have staffing savings opportunities relative to peers at the 50th percentile, for Housekeeping, Laundry & while Laundry & Linen and Food Services have a potential investment, based Linen and Materials on 2004-05 staffing levels. Management to alignment to Given that the region's Housekeeping and Laundry functions are managed peer levels, with consideration by a common leadership structure, and that laundry and food distribution is of minimum on-site staffing completed in part by Materials Management (MDC), staffing opportunities requirements in the northwest. for these areas need to be considered together. For 2004-05, there is a net 8. Conduct a support service role investment opportunity of 9.5 FTEs across these four areas. review across these functions Projected 2005-06 staffing suggests an overall increase across these three to determine potential functions, such that total staffing would be in line with peer levels. realignment of roles, and to Housekeeping and Materials Management also demonstrate a high level of explore the feasibility of a sick time, and all areas report challenges in aide staff recruitment and support services float pool in retention given market wage competition, which are contributing to staffing NLRHC. challenges. Area Description Materiel Management Housekeeping Laundry & Linen Pt. & Non-Pt. Food Services Combined
102
Actual Actual FTEs FTEs 2005-06 2004-05 YTD 29.5 57.4 12.9 39.8 32.5 60.6 13.2 42.0
Actual HAPD 2004-05 0.32 0.62 0.14 0.43
Alberta Peer HAPD MIN 0.06 0.24 0.07 0.14
Alberta National Peer Peer HAPD 50th Percentile MAX HAPD 0.43 0.62 0.21 0.79 0.19 0.59 0.19 0.65
Potential FTE (Effic.)/ Re-Invest. (12.2) See Above (2.9) See Above 4.4 See Above 20.2 See Above
2006 Deloitte Inc
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Peer Staffing Comparative Analysis
Health Records, Telecom and Patient Registration Combined
Opportunities
1. Monitor 2006-07 staffing levels to determine level of staff savings opportunity for Health Records, Registration and Telecom relative to peers, with consideration of minimum staffing requirements in the northwest sites. 2. Consider opportunity to shift some Health Records resources into a regional Decision Support function to support broader analysis and planning.
Findings
Health Records, Registration and Telecommunications are regionally managed services, with Registration and Telecommunications staff in combined roles in the northwest of the region, but separate in NLRHC. Health Records has limited involvement in Decision Support functionality, although do provide some support for business planning. The department has had staffing challenges due to turnover and vacancies, which have impacted efficiencies. Projected 2005-06 staffing suggests that an overall increase of 5 FTEs has occurred since 2004-05, however. Health Records is currently examining optical scanning technology to support business operations, through which some efficiencies may be gained. Staffing comparison suggests that Health Records has a staff savings opportunity of 3.5 FTEs relative to peers at the 50th percentile. This opportunity needs to be considered relative to the observed increase in projected 2005-06 staffing levels, and maintaining minimum staffing requirements in the northwest sites of the region.
Actual Actual FTEs 2005HAPD 06 YTD 2004-05 48.5 0.48 Alberta Alberta National Peer Peer HAPD Peer HAPD 50th Percentile MIN MAX HAPD 0.14 0.49 0.44 Potential FTE (Effic.)/ Re-Invest. (3.5)
Area Description Health Rec., Telecom Pt Reg. Combined
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Actual FTEs 2004-05 44.4
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Peer Staffing Comparative Analysis
Plant Operations, Maintenance and Biomedical Engineering Combined
Opportunities
1.Monitor 2006-07 staffing levels to ensure continued alignment to peer staffing levels. Please refer to Infrastructure section for additional opportunities.
Findings
Facilities Operations is a regional service but managed locally at each of the sites. The region is starting an energy audit to identify further utilities cost savings. Staffing comparison suggests that Facilities (including Biomedical Engineering) is in line with peers 50th percentile for 2004-05 staffing levels, but an increase is observed in projected 2005-06 staffing.
Area Description
Actual FTEs 2004-05 24.4
Actual FTEs 2005-06 YTD 25.9
Actual HAPD 2004-05 0.26
Alberta Peer HAPD MIN 0.21
Alberta National Peer Peer HAPD 50th Percentile MAX HAPD 0.42 0.26
Potential FTE (Effic.)/ Re-Invest. -
Plant Ops, Maint., and Biomed.
Source: Alberta H&W MIS 2004-05, Deloitte Benchmarking Database 2003-04 & 2004-05, NLHR Payroll Data 2004-05 104 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness 2006 Deloitte Inc
Operational Trending and Analysis
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Introduction
Through the peer staffing comparison, this review has already explored opportunities for efficiency and effectiveness across approximately 70% of the organizations operational spending. Other key cost drivers for consideration include:
Sick and Overtime Premium Costs Non-Salary Discretionary Supplies and Sundries Medical/Surgical Supply Costs Drugs and Medical Gas Supply Costs Food Supply Costs
Further examination of each of these costs will be presented over the following slides. In addition, an overall review of where the region is investing its operating dollars across the continuum of care will be presented relative to peers.
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Sick Time and Overtime Summary
Service Area Sick Time Sick Time Potential Total FTEs % of Total % of Total FTE Savings 2004-05 Paid Paid 2004-05 2004-05 2005-06 281 344 101 129 2.6% 3.2% 1.4% 2.8% 3.0% 3.3% 1.4% 2.9% 1.2 2.4 0.2 0.4 Potential $ Savings 2004-05 $25,246 $376,651 $142,351 $45,680
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Sick time and over time rates increased across most areas from 2004-05 to 2005-06. By examining the region's internal sick and overtime averages by service area, opportunities for improvement can be realized by shifting departments to perform at the area-specific sick and overtime averages. Analysis suggests a potential for up to 4.2 FTEs in sick time improvement, and almost $590,000 in overtime premium cost savings, which would need to be explored within a broader HR framework for change.
Administration & Support Services Nursing Allied Health Community & Social Services
Service Area
Overtime Overtime Total FTEs % of Total % of 2004-05 Paid Total Paid 2004-05 2005-06 281 344 101 129 2.3% 4.7% 2.9% 0.9% 2.5% 5.3% 2.1% 1.0%
Administration & Support Services Nursing Allied Health Community & Social Services
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Source: NLHR Payroll 2004-05, 2005-06 Sept YTD. AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Non-Salary Discretionary Supplies and Sundries
An analysis of non-salary discretionary accounts was conducted to identify spending variations as well as to understand the large increase in sundry expenses. Discretionary accounts are identified as those non-salary costs that are not directly related to patient care, and over which management is able to exert a degree of control. Overall, 2005-06 Projected data suggests that non-salary discretionary costs may increase by as much as $2.2 million, or 52%, between 2003-04 and 2005-06 Projected.
The main drivers of the increase include Travel Expenses, Insurance, and Public Relations & Advertising. Although these cost drivers are driven by the geographic size and widely-dispersed population base of the region, they should continue to be monitored as part of a potentially growing cost of business for the region.
Continued management monitoring of these costs to compare year-end 2005-06 actuals to projected numbers is suggested. Where year-end actual costs demonstrate similar spend levels, the organization will need to evaluate the balance of non-salary discretionary spending relative to core service delivery.
Account Travel Expenses Office & General Supplies Insurance Professional Fees Public Relations & Advertising Data Processing
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2003-04 $1,051,209 $716,260 $273,148 $477,380 $80,250 $30,406
2004-05 $1,742,698 $796,198 $316,535 $580,337 $191,977 $267,354
2005-06 Projected $2,321,452 $845,009 $599,052 $578,268 $291,585 $203,915
Variance 2003-04 to 2005-06 Projected 121% 18% 119% 21% 263% 571%
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Source: NLHR General Ledger 2003-04, 2004-05, 2005-06 Oct YTD. AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Med/Surg, Drugs and Food Supply Costs
Medical/Surgical, Drugs and Food Supply expenses were examined relative to adjusted patient days for NLHR and other rural RHAs in Alberta. In comparison to Alberta peers, NLHR was found to have the second and third lowest Medical/Surgical Supplies and Drugs and Medical Gases Expenses per APD, respectively, in 2004-05. For Food and Dietary Supplies, NLHR was found to have the lowest costs/APD among the rural Alberta RHAs.
Supply Costs as a % of Total Expenses
2004-05 Actual Expenses $1,807,901 $1,248,705 $757,732
2004-05 Expense/APD
Alberta Peers Expense/APD MIN $10.11 $5.13 $5.23
Alberta Peers Expense/APD MAX $29.32 $19.92 $14.35
Medical/Surgical Supplies Drugs and Medical Gases Food and Dietary Supplies
Source: AHW MIS Database 2004-05
$12.47 $8.62 $5.23
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Financial Profile Across the Care Continuum
A financial profile of NLHR relative to other regions in Alberta is presented below, which examines the % of total expenses currently being allocated across different dimensions of the organization. As observed through this analysis, NLHR has the highest % of total operating expenses in its Corporate Services, which supports potential staffing efficiency results noted in the comparative staffing analyses. NLHR also has the highest % of total operating expenses in Telehealth, Allied Health, Marketed Services, and Undistributed expenses. For Telehealth, this supports the region's investment in this technology and support infrastructure as a business enabler. Conversely, NLHR is currently spending the lowest % of total operating expenses on Residential Nursing, and is the third lowest among peers with respect to Acute Nursing spending as a % of total expenses. Components of Regional Operational Expenses Corporate Services Support Services Acute Nursing Residential Nursing Emergency, Day and Ambulatory Services Telehealth Allied Health Community Health Services Marketed Services Undistributed
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2004-05 % of Total Expenses 12.4% 17.8% 21.3% 4.6% 6.6% 0.3% 17.8% 12.5% 1.2% 5.6%
Alberta Peers % of Total Operating Expenses MIN 6.3% 15.6% 14.9% 4.6% 4.4% 0.0% 13.8% 10.9% 0.0% 2.1%
Alberta Peers % of Total Operating Expenses MAX 12.4% 22.2% 26.2% 18.2% 8.2% 0.3% 17.8% 15.9% 1.2% 5.6%
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Source: NLHR General Ledger 2003-04, 2004-05, 2005-06 Oct YTD. AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Human Resources Strategy and Management
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Human Resources Overview
Talented people or shortage of talented people can make or break any organization's strategy. In the past, health care in general has taken the people and talent issues for granted. Our people plans including plans to hire and / or workforce deployment were tactical issues to be addressed once the business strategy was finalized. This approach can no longer stand up to the growing and increasingly complex demands of the health care workforce. What was once tactical has now become strategic. Coming into this review, Deloitte expected that the Health Regions would share the following common healthcare workforce challenges:
Critical shortage of numerous professional and non-professional roles Retention issues as staff leave health care industry for other better paying opportunities Retention issues as staff go to other healthcare organizations for better pay or perceived better role Aging workforce Increased casualization of the workforce Reliance on foreign graduates and the corresponding need for higher level of organizational support for these individuals Need for incentives to recruit and retain Restrictive labour contracts and requirements
Our goal was to assess the extent to which the Region understands these issues and has developed strategy to respond. Specifically, we are looking to see the degree to which the Human Resource Strategy and roles are well positioned to support the growing complex world of people management.
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Human Resources Overview
Our findings are based on a review of relevant documentation and consultation. From these, we will identify opportunities for Regions to consider. Our model for review, findings reporting and opportunity identification follows a four part framework: Talent Management the integration of processes,
programs, technologies and staff to Develop, Deploy and Connect workforce. Develop builds individuals' capabilities as required by organization either currently or for the future.
Connect cultivates high quality work relationships and culture that fosters engagement, productivity and innovation.
Human Resources Re-focus efforts to enhance
HR capacity and capability to support service and management priorities of the Region.
Re fo HR cu si ng
Deploy ensures candidates are attracted, and recruited to roles and that recruitment is well aligned to strategic and operational needs.
HR Transformation Strategy Process
Te gy R H olo n ch
Human Resources Technology focuses on the
extent to which technology supports the HR capacity and consistency in practice across Region.
Healthy Work Environment encompasses the
physical work environment and psychosocial work environment. Healthy work environment practices exist where culture and practices converge to create improvements for staff that cascade to the patient and community level.
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H En W ea vi o lth ro rk y nm en t
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M
t n t en le m Ta ge a an
Human Resources Findings and Opportunities
HR Refocusing
Findings
NLHR is facing a significant shortage of management, staffing and physician resources, driving the need for Human Resources strategy and management to be a top corporate priority. Region has several unique northern health human resources pressures that will also drive a realignment of HR operations focus to support the region. Performance management processes have been developed, however are not well understood and in use throughout the organization. Cascading of performance management processes is not yet part of personal evaluation at Executive/Director/ Manager levels for most areas of the organization. Directors/Managers challenged to complete performance management processes given high workload.
M t nt n le me T a ge a an R ef HR oc us in g
HR Transformation Strategy Process
Opportunities
1. Re-focus regional priorities to recognize and drive Human Resources strategy and initiatives as a top corporate priority. 2. Examine need for HR department roles and focus realignment once a new HR Strategy and Plan are developed for the region. 3. Further develop the performance management focus and function in the region to drive increased accountability, monitoring and evaluation, with a clear accountability framework that cascades down to manager and frontline staff levels.
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Human Resources Findings and Opportunities
Talent Management - Develop
Findings
As noted in previous findings, the region needs a regionwide education function both to mitigate potential risks through lack of knowledge transfer, and to attract, retain and build employee knowledge throughout the organization. Specific education roles for the function could include coordinated orientation and preceptorship, management capacity building, infection control policies and procedures, quality and risk management, and maintenance of certification across staff disciplines. Although the region has a central education fund available to management and staff, this is not well communicated or used by the organization. Need for education was also observed in the physician review, and suggests that a coordinated function that supports both organization and physician education would best serve the region.
M nt en le m Ta ge a an R ef H oc R us in g
En
t
HR Transformation Strategy Process
gy R H olo n ch Te
Develop Deploy
Opportunities
1. Develop a coordinated education strategy and function that supports the full human resource base of the organization executive, management, staff, and physicians and which incorporates organization-wide learning and training, support for quality and risk management, support for maintenance of certification across staff and physician disciplines, with associated resources to enable the education strategy and function.
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H E n W ea v i o lth ro rk y nm en t
H e W a vi o lthy r o rk nm en t
c Te
R g H olo hn y
Connect
Human Resources Findings and Opportunities
Talent Management - Deploy
Findings
Region has difficulty in retaining professional staff, in particular with nursing. A significant contributor is the lack of affordable housing. Market wage rates for unregulated and support service staff are creating significant competition for these positions. Current union contracts limit region's ability to compete on direct wages, although the region has already implemented additional monthly stipends as one strategy but additional alternate strategies are required. The region faces similar challenges with respect to physician recruitment and retention, where creative strategies are needed to address physician challenges around geography, facilities, balance of Canadian-trained vs. foreign-trained MDs, alternative funding models.
M nt en le m Ta ge a an R ef H oc R us in g
t
HR Transformation Strategy Process
gy R H olo n ch Te
Develop Deploy
Opportunities
The region needs to develop a comprehensive HR Strategy and Plan that is aligned to the business needs and operating realities of the north, and considers a number of key dimensions: significant population growth in the north, high level of market competition for resources and compensation, resourcing strategies and staffing models, partnerships with industry, broader community health focus across care providers. Physician planning needs to be an integrated component of this plan, so that the region has a consolidated plan that focuses its efforts on talent management to support current and future core service delivery. 2. The region needs to explore alternative strategies to HR planning to position the region for success in recruiting and retaining staff in the north a staff housing strategy is one such example. 3. To support broad talent management, the region needs a structure approach to succession planning that is integrated across key human resources - including executives, management, professional and support staff, and physicians.
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1.
Human Resources Findings and Opportunities
Talent Management - Connect
Findings
Consultation findings suggest that the regional reorganization over the past three years has resulted in some degree of change fatigue, and fear of further change. To support the development of high quality work relationships, productivity and innovation throughout change, the region needs to create a dedicated change management focus that supports staff and physicians through change. Communication was also noted as a challenge by some stakeholders, further impacting ability for the region to effect change and leverage the benefits of regionalization.
M nt en le m Ta ge a an R ef H oc R us in g
HR Transformation Strategy Process
gy R H olo n ch Te
Develop Deploy
Opportunities
1. Develop clear change management function and support within HR that is linked to the broader HR strategy and education function, and which provides broad organization support to engage stakeholders in change initiatives. This will be a critical function to enable broader organization opportunities for change and to support ongoing work in regionalization. 2. Develop a communications plan and strategy that promotes the benefits of regionalization, engages stakeholders in change initiatives, increases executive engagement, and reports back on resulting improvements from change initiatives.
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H E n W ea v i o lth ro rk y nm en t
H E n W ea v i o lth ro rk y nm en t
Connect
t
Connect
Human Resources Findings and Opportunities
HR Technology
Findings
The organization currently uses QHR and EPS to support HRIS functionality. Consultation findings suggest opportunity to further leverage EPS functionality to support advanced staff scheduling support, but further investigation of relative costs/benefits of this functionality would need to be assessed within a broader assessment of regional HRIS needs. From an education perspective, the region has opportunity to further leverage e-learning as a cost effective resource. Given the telehealth infrastructure in the region, this resource should be further leveraged to provide both regional HR and OH&S support and education opportunities to reduce staff travel requirements.
M
t nt n le me Ta ge a an
R ef HR oc us in g
HR Transformation Strategy Process
Opportunities
1. Develop strategy to address HRIS needs, which aligns HR technology enablers to support the organizations HR re-focus, and is part of the broader regional IT Strategic Plan development. 2. Examine HR service delivery options to increase use of existing telehealth infrastructure for HR and OH&S support across the region. 3. Explore options for increased e-learning and tele-learning to improve existing education for staff through a cost-efficient mechanism. 4. Develop online performance management processes for management and staff to enable improved performance measurement and management capabilities in the organization.
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Human Resources Findings and Opportunities
Healthy Work Environment
Findings
Consultation findings indicated several work environment challenges currently being faced by the organization, including:
Management and staff burnout due to staffing shortages. Change fatigue from re-regionalization. Need for consistent senior leadership, given turnover at Board and CEO level. Relationship challenges across cultural differences of foreigntrained physicians. Disengagement of physician stakeholders from regional operations.
M t nt n le me Ta ge a an ef HR oc us in g
R
HR Transformation Strategy Process
H En W eal vi o thy ro rk nm en t
En
H e W a vi o lthy ro rk nm en t
1. Develop a targeted healthy work environment strategy as part of the region's HR re-focus, with corresponding infrastructure, support, and organization alignment (where necessary). 2. Create forums for management, staff and physicians to identify workplace challenges, and contribute to the development of strategies to address challenges. 3. Develop a communication and stakeholder engagement strategy and plan to re-engage management, staff and physicians in regional planning and programs to promote an engaged, healthy work environment.
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R H olo n ch Te gy
y R g H olo n ch Te
Opportunities
Infrastructure
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Regional Infrastructure Alignment
Introduction
Our review of regional infrastructure is intended as a high level assessment of how well infrastructure is aligned to support operations. Where there are opportunities for improvement to infrastructure, these opportunities will be identified for the region's consideration. The review has focused on the key high level opportunities across two dimensions of regional infrastructure, with findings and opportunities based on consultation, document review and related analysis:
Facilities and Equipment Technology
Regional Infrastructure Findings and Opportunities
Alignment to Support Operations
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Facilities and Equipment
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Facilities and Equipment
Overall Observations
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities Findings
Consultation findings indicated that NLHR has had good infrastructure investment with respect to equipment. 1. No opportunity identified. Partnerships with private industry and other fundraising initiatives have enabled the region to maintain updated equipment infrastructure across a number of areas, including:
Beds and Lifts Monitors Diagnostic Imaging Telehealth
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Facilities and Equipment
NLRHC Overall Facility
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities Findings
Consultation findings indicated that NLHRC has several facilities challenges that are impacting patient flows and care delivery, staff and physician workflows, and efficiency. 1. Conduct a facilities review of NLRHC to identify current and future care and service delivery requirements, in alignment with a regional community health needs assessment. Although not examined by the consultants, the region has identified significant population growth over the past few years, and an expectation for continued population expansion. This population growth is currently beyond the volume for which NLRHC was originally designed, which causes challenges to operations and patient care. NLHRC is also reported to be further challenged due to a lack of regional access to available land in FMM for facility expansion. Where a facilities review confirms the need for additional physical capacity for NLRHC, partnerships with AHW and other provincial ministries will be important to enable regional access to available land in the community.
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Facilities and Equipment
NLRHC Emergency Room
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities Findings
The current NLRHC Emergency Department was originally designed for significantly lower volumes than current levels. 1. Relocate NLRHC outpatient registration out of the Emergency Department to reduce impacts on patient flow. From a facilities perspective, the ED faces two specific issues that are further compounding the issues of departmental volumes:
Outpatient registration and ED registration are currently both completed in the ED. This has created significant challenges in patient flow, and a high volume of ambulatory clinic patients waiting in the ED. Waiting space for both outpatients and emergency patients is combined, with some space not visible by the triage nurse. This lack of line-of-site visibility of the waiting area by ED clinical staff is a significant potential risk to the organization.
Consultation findings suggest that outpatient registration was previously located in the main hospital lobby of NLRHC, and that this space still exists such that outpatient registration could be relocated to this area, as one option for consideration.
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Facilities and Equipment
NLRHC Paediatrics Unit
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities
1. Given the need for new physical space for the Pediatrics service in NLRHC, consider re-locating Pediatrics adjacent to Obstetrics and cross training staff.
Findings
The current NLRHC Paediatrics Unit physical facilities are insufficient to support care delivery, suggesting the need for redesign or re-location of the unit. Observations of peer practice suggests opportunity for the region to consider cross-training Paediatrics nursing staff with Obstetrics, which if explored would suggest the need to relocate Paediatrics in close proximity to Obstetrics.
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Facilities and Equipment
NLRHC Laundry Equipment
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities
1.Conduct a cost-benefit assessment of laundry equipment to determine the most appropriate timeline for replacement. This assessment should be conducted as part of the development of a long range service plan for laundry services in FMM that is tied to the clinical service needs identified through the broader regional health needs assessment.
Findings
Consultation findings indicate that the region's aging laundry equipment in FMM has frequent breakdowns, which is a high potential risk to the delivery of clinical services. A recent shift to 7-day laundry service in FMM, in support of clinical service delivery requirements, is further anticipated to reduce the life span of the current equipment.
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Facilities and Equipment
NLRHC Parking and Helicopter Pad
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities Findings
Consultation findings indicate that NLRHC currently lacks sufficient parking for patients and staff, which is reported to impact patient access to services. Consultation also identified challenges with the helicopter pad at NLRHC, which is reported to not meet current code requirements. Where patients or service providers have barriers to access due to physical facilities, this creates potential risks to the region. The potential cost for enhancing these facilities issues is significant, suggesting need for partnership with AHW, Alberta Infrastructure and others to explore options for addressing facilities needs.
1. Conduct a cost-benefit assessment of the current parking and helicopter pad facilities challenges at NLRHC, and collaborate with AHW, Alberta Infrastructure and private industry to identify options for resolution.
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Facilities and Equipment
Northwest Health Centre Triage
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities
1. Examine infrastructure requirements and costs related to the recommendation for increased use of CTAS triaging in the NWHC emergency department.
Findings
Consultation findings indicate the need for increased CTAS triage use as a care and risk management tool in the NWHC emergency department. Development of this suggested triage function has a potentially significant facilities infrastructure implication, which needs to be examined by the region.
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Facilities and Equipment
St. Theresa General Hospital
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities Findings
St. Theresa General Hospital is an aged physical plant, and the region is currently in capital planning for replacement. 1. Conduct a role review of St. Theresa General Hospital in the context of a broader regional community health needs assessment, before proceeding further with current capital planning. Analysis and consultation findings indicate that the facility typically runs a low acute occupancy for an annual average of 10 of 26 beds filled. Proximity of the STGH to High Level suggests opportunity for the region to consider an alternative service delivery model, to potentially change the balance of the continuum of services provided in the northwest area. Given that the region plans to conduct a regional health needs assessment in 2006-07, it is suggested that a role review of STGH be a part of that assessment, before further capital planning proceeds.
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Facilities and Equipment
High Level Physicians' Clinics
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities Findings
Consultation findings with regional management and physicians indicate significant challenges with the need to relocate the High Level physicians' clinic onto regional hospital grounds. Although the region and physicians report support for this initiative, broader stakeholder buy-in is a challenge. The continuation of these challenges is expected to result in significant potential risk to physician retention and future recruitment in the area. From a regional perspective, the broader implications of this risk include:
Risk to the sustainability of health services in High Level, if physician retention becomes an issue. Potential risk for increased operational costs if the current physicians leave the region, and are replaced by physicians with a lower obstetrical skill set (e.g. cost of Medi-vacs for high risk obstetrics cases).
1. Engage key stakeholders to develop an action plan to address High Level physicians' clinic issues, with consideration of broader clinical sustainability of health service delivery in the northwest.
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Facilities and Equipment
Regional Telehealth
High-level consultation findings, on-site observations, and analysis of availability Alberta Infrastructure data for regional facilities and equipment identified the following key findings and opportunities: Opportunities
1. Engage clinical stakeholders to develop a regional strategy and resource plan to further leverage use of telehealth in clinical service delivery. 2. Expand current clinical partnerships with other regions to support increased telehealth clinical service delivery. 3. Develop a structured telelearning program as part of a broader regional HR and education strategy.
Findings
The region has developed extensive telehealth infrastructure and supporting resources to support the use of this technology as an enabler. Currently, telehealth technology is primarily used to facilitate meetings, although the region does have several clinical programs currently in place. Stakeholders have identified additional opportunities for increased use of telehealth in clinical service delivery, but the region is currently lacking physician champions to drive increased use of telehealth in clinical service delivery.
Further, challenges in partnering with other regional clinicians for telehealth service delivery are also identified by stakeholders.
The region also has opportunity to explore telehealth as a tool in additional education provision.
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Technology
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Leveraging the Value of Information Technology through IT Governance
Information and the Technology that supports it often represent the most valuable but least understood asset in an organization. The essential elements of IT governance are to ensure that value is received from spending on technology and then to control and safeguard information. The purpose of an IT governance framework is to institutionalize good practices that ensure an organizations IT investment supports business objectives. These objectives are identified through the Northern Lights Health Region's mission statement of Improving health and promoting wellness
And may be directly linked to three of your values: Shared Responsibility ensuring senior management and frontline providers are involved in determining the direction and goals of the IT department Accountability and Sustainability evaluation of service delivery from two perspectives, the total cost of technology operations and monitoring of project outcomes Continuous Improvement ongoing support and maintenance intended to safeguard the value of existing assets and knowledge in the regional facilities.
Available IT resources, including infrastructure, applications, information and people, should be optimized according to these values.
Organizations such as yours need to satisfy the quality, fiduciary and security requirements of your IT information and infrastructure as you do for all other assets.
To discharge these responsibilities, as well as to achieve your objectives, you must know the status of your evolving enterprise architecture.
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What is IT Governance?
IT governance consists of leadership, organizational structures and processes that are designed to support an organization's strategies and objectives to increase stakeholder value. Clear responsibility for the direction of IT requirements is necessary to successfully deliver services that support the enterprise's strategy. Monitoring success in delivering against business requirements, requires that management put a framework in place to measure achievements against goals. IT governance transforms business goals into IT objectives through consideration of value, risk and control.
Value IT Objectives
IT Governance
Business Goals ...
Risk
Control
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Determination of IT Activities
Align Business Goal and IT Objectives
Organizational Strategic Plan
Defines
Define IT Strategy
Translate IT objectives into specific initiatives
Business Priorities for IT
Defines
Assess resource suitability and gaps
IT Objectives
Identify IT Resources
Infrastructure Applications Information People
Determine ability to fill gaps through acquisition, training, realignment etc. Determine extent to which business priorities for IT can be met
Communicate results and manage expectations
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Technology
Findings and observations for the technology workstream are intended to identify the degree to which IT investments and resulting initiatives support the goals of the region, and the degree to which they are executed efficiently and effectively. The following key documents were reviewed in support of the Technology review for NLHR:
Facility Profiles Northern Lights Facilities Facility Profiles Northern Lights IT Interview notes 2006-2007 budget for IT Organization Chart
Information has been summarized in five key focus areas: Technology Categories Business Alignment Key Questions Is the IT strategy aligned to support the business? Is there a clear understanding of how IT is supporting the RHA's business objectives? Is the RHA achieving optimum use of its IT resources? Is the RHA investing in the appropriate IT resources? Does the RHA perceive value from their IT investments? Is IT delivering the promised benefits? Are IT risks understood and being managed? Is the quality of IT systems appropriate for business needs? Is there a framework within which to measure the achievement of IT goals?
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Resource Alignment Value Delivery Risk Management Quality Management
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1. Business Alignment
Leading Practice Attributes The organization focuses on ensuring the linkage of business and IT plans; on defining, maintaining and validating the IT value proposition; and on aligning IT operations with enterprise operations.
NLHR does not currently have a full IT plan. A full IT strategic plan is currently in development for the region, however, and will be completed in May/June 06. Through the RSHIP Meditech implementation, and provincial PACS implementation, NLHR is maintaining good alignment with regional counterparts and other provincial initiatives. Ongoing communication is reported as a continuing success factor to keeping business users aware of the RSHIP and other implementations. Business users across the organization report a high level of awareness of IT initiatives, with specific focus on the RSHIP Meditech implementation. Awareness of Information Management as a concept is still developing. IT department coordinates with other areas with significant IT systems to ensure ongoing alignment. Functionality of Meditech has been reported as a challenge to business process in some areas. For example, ability of the new system to enable end-users to create lab order sets outside of standard lab controls is a challenge to lab utilization and cost containment. Further, several stakeholders identified the need for improved document management as an additional functionality that needs support from IT.
Deloitte Findings and Observations
1. Once developed, conduct an annual realignment of the IT plan to the organization's business objectives and strategies. Potential Opportunities 2. Incorporate further use-case testing as part of implementation to ensure that IT systems align to end-user requirements of business process owners.
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2. Resource Alignment
Leading Practice Attributes The organization is focused on the optimal investment in, and the proper management of, critical IT resources: applications, information, infrastructure and people including the optimization of knowledge and infrastructure. The majority of the IT department is centrally located at NLRHC, with some resource support at the NWHC. Given the current Meditech implementation, the NLHR Project Management Office, responsible for the implementation, has a low level of resources. CIS team members have cross-trained staff due to team size, to enable cross coverage of key IT operations areas. As a result, the team is highly trained across operational processes. The region is involved in provincial initiatives related to both RSHIP and PACS, and is leveraging opportunities to share provincial or cross-regional resources e.g. Security Systems Analyst, Meditech helpdesk support. For the RSHIP Meditech implementation, business resources have been seconded from operations to support the implementation through a number of activities, including providing input into system requirements, working with cross-regional counterparts in setting standards, and will be involved in supporting internal training efforts. Although business users from most areas report good involvement in the Meditech implementation, they also note the challenge of the corresponding strain on their resources available for daily operations. 1. Where business resources continue to support business functions during assignment to IT initiatives, a formal arrangement should be documented to ensure project team resource availability and identify clear roles and accountabilities.
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Potential Opportunities
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2. Resource Alignment (continued)
Leading Practice Attributes The organization is focused on the optimal investment in, and the proper management of, critical IT resources: applications, information, infrastructure and people including the optimization of knowledge and infrastructure. The region is currently the highest among the non-metro Alberta RHAs with respect to IT department spending as a % of total expenses. Given that NLHR was the first to initiate the Meditech implementation as part of RSHIP, this is in line with expectations. A 24 hour helpdesk (phone or email access) is available to ensure that service is available when required. This ensures less downtime for resources across the region. The RSHIP regions provide collaborative support for Meditech modules. Teams include Technical/ network; Conversion; Clinical Standards; Financial Standards; Interface; DI/PACS etc. These teams address both system development and support issues. NLHR has leveraged its IT resources with some outsourcing support, including IT strategic planning and some implementation support with IBM. The region is investigating opportunities with PCHR to integrate components of IT services, in order to achieve efficiencies and build on skill sets available to both regions.
Deloitte Findings and Observations
2. Ensure that cross-training occurs between RSHIP resources and local IT support resources to allow a continuum of service following the completion of the implementation phase for Meditech. Potential Opportunities 3. Continue exploration of IT integration with PCHR, with specific assessment of potential costs, benefits, risks and implementation considerations associated with integration.
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2. Resource Alignment (continued)
Leading Practice Attributes The organization is focused on the optimal investment in, and the proper management of, critical IT resources: applications, information, infrastructure and people including the optimization of knowledge and infrastructure. MAGIC and Project/ Task Lists are used to optimize staffing requirements and skill mix. Additional resources are able to be brought in during peak periods (testing, training and go-live activities). Impact to non-RSHIP IT support has been reported due to current RSHIP focus. The effect should be mitigated as the RSHIP initiative advances and more support resources become available.
Deloitte Findings and Observations
Potential Opportunities
4. NLHR should ensure an enterprise-wide view of resource allocation to minimize impact of large initiatives on the business unit(s), and to ensure ongoing IT support outside of those initiatives.
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3. Value Delivery
Leading Practice Attributes The organization executes the value proposition throughout the delivery cycle, ensuring that IT delivers the promised benefits against the strategy, concentrating on optimising costs and proving the intrinsic value of IT. The majority of NLHR business users anticipate improved IT value creation through the implementation of the new Meditech system. Further, NLHR has reported that "As a result of the RSHIP program we have seen a significant increase in the collaboration and sharing of resources/ knowledge among the RSHIP regions." As NLHR has already implemented some components of Meditech, business users report a sufficient level of training and ongoing support from IT for system operations. Limitations of Meditech's capacities to meet needs of certain departments have been reported. In some cases, significant additional manual workload has been necessary to fulfill business needs after Meditech went live. This is a risk to enduser uptake of new systems, and is reported to impact operational efficiency and effectiveness. A challenge to the overall RSHIP implementation in NLHR is that an overall benefits framework is lacking, which prevents clear identification, communication and realization of business process benefits as a result of the implementation. 1. Establish a benefits realization framework for the Meditech implementation that identifies, promotes, monitors and assesses benefits realization for each key department as Meditech implementation continues. 2. Consider options for business process transformation as part of benefits realization framework for the Meditech implementation, and other regional IT initiatives. 3. Ensure communication to business areas about the benefits of new system initiatives is realistic as to expected benefits and impact to users and business processes.
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3. Value Delivery (continued)
Leading Practice Attributes The organization executes the value proposition throughout the delivery cycle, ensuring that IT delivers the promised benefits against the strategy, concentrating on optimising costs and proving the intrinsic value of IT. A challenge to the overall RSHIP implementation in NLHR is that an overall benefits framework is lacking, which prevents clear identification, communication and realization of business process benefits as a result of the implementation. NLHR has developed a business case approach for internal IT initiatives to ensure the identification and follow-up realization of benefits:
For example, through reduced film use, NLHR has started to be realized in PACS, even before its full implementation by March 2006.
Deloitte Findings and Observations
Regional initiatives have focused on cost reduction and automation as a means of optimizing resources, where possible. The telecomm infrastructure has been moved to IP Telephony. NLHR reports an annual estimated savings of $200,000 that has been realized in benefits from the initiative. The IP Telephony infrastructure has been leveraged to improve IT department efficiency by maximizing use of videoconferencing and other communication tools instead of travel between the region's sites. More than half of the program areas expressed the need to have scheduling as a necessary functionality of ESP.
4. Continue use of business case approach for internal IT initiatives to ensure ongoing business alignment and benefits realization. Potential Opportunities 5. Review the current ESP function and distribution through the organization, to determine feasibility and associated resources for expansion.
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4. Risk Management
Leading Practice Attributes The organization requires risk awareness by senior corporate officers, a clear understanding of the enterprise's appetite for risk, understanding of compliance requirements, transparency about the significant risks to the enterprise, and embedding of risk management responsibilities into the organization.
Risks around the RSHIP implementation with respect to resource requirements are understood and being managed such that the region is still able to move forward with other IT initiatives (e.g. telecom). Risks on new initiatives are considered within the planning and business case approach, where risks and benefits are assessed as part of the decision process to move forward with an IT initiative. Inadequate resources in the NLHR Project Office to implement all of the desired Deloitte functionality resulting in a limiting of benefits from implemented systems, and Findings and inadequate acceptance tests for example: Observations "Current timelines are set to proceed with development and implementation at a rate which out measures our resources." "Meditech operating room module delayed due to lack of resources." IT department is working to increase support automation instead of staffing where possible, leveraging resources provided through RSHIP, and exploring opportunities to integrate components of IT services with PCHR. 1. Review current utilization of the staff to determine staffing level requirements in alignment with the new IT Strategic Plan, with consideration of maintaining the current Meditech implementation and other key NLHR IT initiatives. Potential Opportunities 2. Ensure that the risk management and project plans for the Meditech implementation address required alignment between resources and deliverables, and establish a process to identify, manage and communicate potential project plan delays.
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4. Risk Management (continued)
Leading Practice Attributes The organization requires risk awareness by senior corporate officers, a clear understanding of the enterprise's appetite for risk, understanding of compliance requirements, transparency about the significant risks to the enterprise, and embedding of risk management responsibilities into the organization. IT department incorporates cross-training to ensure adequate support, and to maintain knowledge in the organization through staff turnover. Meditech user training is clearly planned, and end-users report good support through existing implementation work. NLHR has a change management process in place with regard to Meditech, and reports good traction. Parts of the region do not have adequate computers for users, which is a risk to end-user uptake, timelines and costs for training.
Deloitte Findings and Observations
3. Assess the capacity across the region in both hardware and user skill sets to respond to new initiatives. Build these gaps into the project risk assessment, training and procurement plans. Potential 4. As a mechanism to improve end-user buy-in and uptake to new systems, Opportunities ensure that staff charged with cross training of staff members have an appropriate appreciation of the business processes in which the trainee is involved.
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5. Quality Management
Leading Practice Attributes The organization utilizes a system of performance measurement to track and monitor strategy implementation, project completion, resource usage, process performance and service delivery, using, for example, balanced scorecards that translate strategy into action to achieve goals measurable beyond conventional accounting. NLHR's IT department uses a structure business case approach for all initiatives, with clearly identified benefits, outcomes and an anticipated ROI. Total cost of ownership is considered, with respect to full SDLC costs, including training and change management. Assessments are completed post-implementation to confirm achievement of business case objectives. The IT department is engaged in high level peer learnings and best practice research. NLHR works closely with RSHIP to identify and maintain system standards during Meditech implementation. NLHR works with RSHIP, for all new IT initiatives, to confirm if a suitable Meditech application exists, and if not, to determine if other potential systems can be integrated into Meditech, with associated costs and resource implications. The department uses a pilot-approach to many initiatives to confirm success before rolling out more broadly across the region. 1. As part of ongoing quality management and IT support to the organization, NLHR should maintain an enterprise wide view of IT to ensure that nonRSHIP related processes remain supported.
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Deloitte Findings and Observations
Potential Opportunities
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Cluster 1 Opportunities
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Cluster 1 Opportunities
Introduction
Having reviewed three regional health authorities concurrently, we have identified opportunities that are common across the three regions. We have identified these as `Cluster Opportunities', and they are based on of the following three criteria:
Where the opportunity requires a solution larger than 1 Region's capacity (as it may require cross-region collaboration, provincial collaboration or investment). ` Where a cross region collaboration and solution development will deliver greater value (either qualitative or quantitative) than if pursued by 1 Region independently. Where individual regions are without the current resources or talent and/or will have challenge attracting and recruiting individuals or securing resources independently.
Further, Cluster Opportunities may become `Provincial Opportunities', where the opportunities will have application to more than the three northern regions. These Cluster Opportunities have been accepted by AHW, although a timeline for moving forward has yet to be determined by the province.
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Cluster 1 Opportunities
Reporting Framework
Cluster 1 Opportunities are identified in five key areas of reporting, which have been aligned to the project workstreams, as shown below:
Leadership, Governance, Accountability and Performance Management
Governance and Performance Management
Administrative and Support Services Allied Health and Clinical Support Services Clinical Nursing Services Clinical Resource Management Infrastructure (Technology and Equipment) Resource Optimization
Human Resources Strategy and Management Physician Leadership and Management Risk and Quality Management
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Cluster 1 Opportunities
Resource Optimization
I. Develop strategy to promote expanded clinical application and adoption of Telehealth to respond to growing clinical needs (strategy to include sourcing clinical expertise external to regions to support Telehealth delivery). Adopt a stronger standardized approach to Chronic Disease Management, supported by clinical expertise and links to Telehealth, which can be customized within Regions.
II.
III. Explore shared service model for core corporate services as a strategy to enhance effectiveness, avoid cost, and achieve efficiency: Finance and Decision Support Human Resources (includes physician issues) Information Systems and Support Supply Chain Services Management and Leadership Training IV. Develop and implement workload measurement and caseload tracking and reporting for home care to enable management decision-making and cross-regional comparisons. V. Develop and implement workload measurement and reporting for Population Health and Environmental Health to enable management decision-making and cross-regional comparisons.
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Cluster 1 Opportunities
Leadership, Governance, Accountability and Performance Management
I. Strengthen capability and resource allocation to position Health Human Resource (HHR) Strategy and Management as top priority for organization. (See next section.)
II. Collaborate in the development or procurement of leadership and management development and training based on identified need or gaps. III. Increase attention and effort to creating board awareness and education on responsibilities and liabilities. IV. Enhance broad regional reporting requirements to include ongoing monitoring of IT strategic initiatives, to ensure ongoing alignment of IT to business priorities and objectives. V. Develop a Northern Response Strategy for the three Regions that includes:
Increasing effort on building and growing external partnerships, primarily focused on industry and academia, focused on attraction, recruitment, retention, housing and reimbursement. Reviewing the accountability framework and interface requirements between regional governance model and appropriate operational structure given the size and geography of Northern Regions. Developing alternative funding mechanisms that attracts and retains critical workforce segments (physicians, registered nurses, pharmacists, ...) and high talent management pool. Determining the appropriate funding / resource support for the growing service delivery pressures in the North as well as the impact of rapid industry growth (high population growth, transient and shadow population). Support for the more frequent requirement to conduct a community health needs assessment to be able to respond to the dynamic and growing challenges in the North.
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Cluster 1 Opportunities
Human Resources Strategy and Management
I. Explore northern collaboration for comprehensive Health Human Resources (HHR) strategy development that includes HR refocus, talent management, HR technology and a focus on healthy work environments. Ensure that HHR strategy, management and implementation includes the physician component and is focused on: Workforce/resource gaps, skills management and education; Alignment/realignment of current resources to core service delivery needs; Attraction/recruitment/retention of a talent workforce; and Enhanced business case approach to cost impact analysis related to physician recruitment and service repatriation. III. Define talent strategy to ensure effective leadership in place (from governance to front line delivery) to support change in complex environment. IV. Review current agreement language and requirements in the AHW-AMA-RHA Agreement and staffing union labour agreements, which limit the Regions' ability to provide service in an increasingly challenged environment. V. Explore concept of establishing stronger rural academic centres across the three Northern regions as a mechanism to ensure steady human resource stream (includes physicians, nurses and other health care disciplines).
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II.
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Cluster 1 Opportunities
Physician Leadership and Management
Our observations and identified opportunities reflect common and emerging physician practice across the country. Where these five opportunities are seen as desirable by AHW, the province will have to explore different remuneration models that support and lever physician behaviour and desired change. I. II. Review MAC governance structure and mechanisms with specific attention to by-law adherence and alignment. Develop a medical leadership accountability framework and leadership requirements (which includes examining current organizational and reporting structures, and current /potential roles and responsibilities for Chiefs in the management and decision-making process at the site and regional levels).
III. Create a Physician accountability framework with evaluation and quality/risk/performance management tools for Physicians which is integrated into the broader regional performance management framework. IV. Explore alternative payment models for physicians with the objective to improve resourcing and linkage to care/service delivery model. (As part of this opportunity, explore alternate staffing models in consideration of physician AFT options e.g., APN/NP model in ER and other primary care models.) V. Develop a comprehensive Physician Impact Assessment process for physician recruitment related to needs planning and service expansion.
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Cluster 1 Opportunities
Risk and Quality Management
I. Increase awareness, commitment and focus on risk management as a key requirement for operations and decision-making across clinical and non-clinical service areas. Sample areas of focus include: II. Evaluation/quality/risk/performance management tools for physicians Regular community heath needs assessment Stronger and consistent adoption of CTAS Increased education for Board members
Develop a benefits realization approach for RSHIP to ensure investments are aligned to intended outcomes.
III. Increase collaboration and partnership with industry to address increasing environmental health workload and associated risks.
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Regional Opportunity Map and Reference Guide
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Regional Opportunity Map and Reference Guide
Introduction
A reference guide has been developed for the opportunities identified in the region's report. Opportunities have been filtered to facilitate discussion and planning. Filter 1: The overlap of cluster and regional opportunities is one filter. Cluster-Related Opportunities
Cluster Opportunities will be driven by a separate process through a collaboration of AHW and the Cluster 1 regions, and so have not been prioritized in the region's opportunity map. Where Cluster and regional opportunities overlap, the cluster-related regional opportunities have been identified in this reference guide, but not included in the prioritization and sequencing process.
Regional Opportunities
Opportunity Consolidation
Filter 2: Like / related opportunities have been consolidated to facilitate planning and action. Opportunities for Prioritization
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Opportunity consolidation is based on interdependencies and linkages, which are highlighted in the reference guide.
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Regional Opportunity Map and Reference Guide
Opportunity Alignment
To facilitate prioritization, opportunities are aligned across five areas, shown in framework below.
Regional Initiatives
This framework will be referenced to facilitate an understanding of the different types of opportunities for prioritization. Also important will be an understanding of how broader system goals and initiatives, and other regional initiatives impact opportunity prioritization.
Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
He alt h Go Syst als em
m ste Sy th tives al He nitia I
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Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Resource Optimization Opportunity Name Opportunity Description Finance Staffing Health Records Staffing IT Staffing IT Integration HR Staffing HR Telehealth
Monitor 2006-07 staffing levels to determine remaining staff savings opportunity for Finance, with consideration of further evolving Decision Support functionality in the region. Consider opportunity to shift some Health Records resources into a regional Decision Support function to support broader analysis and planning. Consider IT staffing levels with respect to broader regional IT and RSHIP implementation management. Continue exploration of IT integration with PCHR, with specific assessment of potential costs, benefits, risks and implementation considerations associated with integration. Examine need for HR department roles and focus realignment once a new HR Strategy and Plan are developed for the region. Examine HR service delivery options to increase use of existing telehealth infrastructure for HR and OH&S support across the region. Engage clinical stakeholders to develop a regional strategy and resource plan to further
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Clinical Telehealth leverage use of telehealth in clinical service delivery.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Resource Optimization Opportunity Name Opportunity Description Telehealth Partnerships Coordination via Telehealth Homecare Workload
Expand current clinical partnerships with other regions to support increased telehealth clinical service delivery. Enhance communication between respective facilities by leveraging Telehealth technology in a structured approach for coordination of service, information sharing of leading practices, CME and professional support. Implement the RAI-HC, to ensure a standardized approach to assessment and ensure the collection of standardized volume and visit statistics across the region.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Leadership, Governance, Accountability and Performance Management Opportunity Name Regional Performance Management Succession Planning Opportunity Description
Further develop the performance management focus and function in the region to drive increased accountability, monitoring and evaluation, with a clear accountability framework that cascades down to manager and frontline staff levels. To support broad talent management, the region needs a structure approach to succession planning that is integrated across key human resources - including executives, management, professional and support staff, and physicians.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Human Resources Strategy and Management Opportunity Name Opportunity Description HR Re-Focus
Re-focus regional priorities to recognize and drive Human Resources strategy and initiatives as a top corporate priority. The region needs to develop a comprehensive HR Strategy and Plan that is aligned to the business needs and operating realities of the north, and considers a number of key dimensions: significant population growth in the north, high level of market competition for resources and compensation, resourcing strategies and staffing models, partnerships with industry, broader community health focus across care providers. Physician planning needs to be an integrated component of this plan, so that the region has a consolidated plan that focuses its efforts on talent management to support current and future core service delivery. The region needs to explore alternative strategies to HR planning to position the region for success in recruiting and retaining staff in the north e.g. a staff housing strategy. Develop a coordinated education strategy and function that supports the full human resource base of the organization executive, management, staff, and physicians and which incorporates organization-wide learning and training, support for quality and risk management, support for maintenance of certification across staff and physician disciplines, with associated resources to enable the education strategy and function. Develop online performance management processes for management and staff to enable improved performance measurement and management capabilities in the organization. Develop a structured tele-learning program as part of a broader regional HR and education strategy.
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HR Strategy
HR Recruitment
Education Strategy Performance Management Tele-Learning
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Human Resources Strategy and Management Opportunity Name Opportunity Description Physician HR Strategy
Engage physicians and regional leadership in the development of a regional Physician Human Resource Strategy that is linked to the broader regional HR strategy, to address Physician resource gaps, skills management and education, alignment/realignment of current resources to core service delivery needs, remuneration and recruitment/retention. Develop a regional approach and support for CME for both Canadian-trained and foreigntrained medical graduates, based on a sustainable business model, and integrated with the physician recruitment and retention strategy and broader regional education function. Develop a targeted healthy work environment strategy as part of the region's HR refocus, with corresponding infrastructure, support, and organization alignment (where necessary)
Regional CME Healthy Work Environment Strategy
Healthy Create forums for management, staff and physicians to identify workplace challenges, and Workplace Forums contribute to the development of strategies to address challenges. Healthy Work Environment Communication Plan HRIS Strategy
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Develop a communication and stakeholder engagement strategy and plan to re-engage management, staff and physicians in regional planning and programs to promote an engaged, healthy work environment. Develop strategy to address HRIS needs, which aligns HR technology enablers to support the organizations HR re-focus, and is part of the broader regional IT Strategic Plan development.
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Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Physician Leadership and Management Opportunity Name MAC Review Physician Alternative Payment Models Physician Impact Assessment Physician Accountability Framework Opportunity Description
Conduct an external review of MAC governance structure/mechanisms for the region, with specific attention to by-law adherence/alignment. Explore alternative payment models for physicians in the region, with an objective to improve resourcing, and linkage to care/service delivery model. As part of this opportunity, explore alternate staffing models in the consideration of physician AFP options e.g. APN/NP model in ER and community health clinics. Develop a regional Physician Impact Assessment process that is used for physician recruitment needs planning, and in assessment when new physicians are being considered. Create an accountability framework with evaluation and quality/risk/performance management tools for Physicians, which is integrated into a broader regional framework.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Risk and Quality Management Opportunity Name NWHC CTAS STGH CTAS Opportunity Description
Support implementation of a formal patient triage and CTAS function at NWHC. Support implementation of a formal patient triage and CTAS function at STGH. Establish a benefits realization framework for the Meditech implementation that identifies, promotes, monitors and assesses benefits realization for each key department as Meditech implementation continues. Identify anticipated operational efficiencies as a result of Meditech system implementation, and develop an action plan to achieve them. Value Delivery: Consider options for business process transformation as part of benefits realization framework for the Meditech implementation, and other regional IT initiatives. Value Delivery: Ensure communication to business areas about the benefits of new system initiatives is realistic as to expected benefits and impact to users and business processes. Value Delivery: Continue use of business case approach for internal IT initiatives to ensure ongoing business alignment and benefits realization. Risk Management: As a mechanism to improve end-user buy-in and uptake to new systems, ensure that staff charged with cross training of staff members have an appropriate appreciation of the business processes in which the trainee is involved.
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RSHIP Benefits Realization
Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Cluster-Related Regional Opportunities
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
The following regional opportunities are directly related to cluster opportunities.
Risk and Quality Management (continued) Opportunity Name Clinical Lab IT Pharmacy IT Clinical Nutrition IT Opportunity Description
Modify the current Meditech implementation to improve controls over the creation of ad-hoc lab order sets. Work with RSHIP to assess cost/benefit of implementing required improvements to pharmacy module in Meditech. Assess the cost/benefits of improving current systems support for Clinical Nutrition and Food Services, as part of broader regional IT infrastructure and planning.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Strategy, Partnerships, and Planning
Opportunity Name Change Mgmt Function Internal Communication Strategy NLHR Clinical Development Continue Building Mental Health Partnerships Community Program Realignment Medical Director Portfolio Continuing Care Capacity
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Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Opportunity Description
Develop clear change management function and support within HR that is linked to the broader HR strategy and education function, and which provides broad organization support to engage stakeholders in change initiatives. This will be a critical function to enable broader organization opportunities for change and to support ongoing work in regionalization. Develop a communications plan and strategy that promotes the benefits of regionalization, engages stakeholders in change initiatives, increases executive engagement, and reports back on resulting improvements from change initiatives. Continue with plans to expand clinical development within the Fort McMurray site, with a priority given to developing an enhanced orientation and preceptorship program. Please refer to HR section for additional opportunities. Continue to build external partnerships with other mental health service providers (e.g. AADAC) and community social agencies. Consider realignment of community programs in the northwest under one umbrella. Examine the Medical Director portfolio to consider role re-alignment, overall organization structure, and support resources required to support strategic HR focus on physician recruitment, retention and management. Explore options to increase continuing care capacity in Fort McMurray.
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Regional Opportunity Map and Reference Guide
Strategy, Partnerships, & Planning (continued)
Opportunity Name Rainbow Lake Shadow Population Billing MD Leadership Alignment Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Rainbow Lake Health Centre: Investigate cost of `shadow' population and determine billing options to ensure cost recovery for services provided by Rainbow Lake. Conduct an alignment review of physician leadership requirements across all services and roles.
Engage physicians to identify methods to improve the perceived challenges in region-physician relations (e.g. physicians clinic facilities issues, physician Improved MD Relations involvement in broader regional planning and community health needs assessment, senior team representation on Board, etc.).
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Regional Opportunity Map and Reference Guide
Service Delivery Model
Opportunity Name Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Re-examine role of facilities and programs across the region in the context of human resource requirements and community health services needs. Conduct a facilities review of NLRHC to identify current and future care and service delivery requirements, in alignment with a regional community health needs assessment. NW Health Centre: There is space for an additional 10 beds at the Northwest Health Centre. Increases in volume would result in greater economies of scale in both quality and cost. St. Theresa General Hospital: Conduct a role review of St. Theresa General Hospital in the context of a broader regional community health needs assessment, to inform current capital planning. St. Theresa General Hospital: No staffing opportunity identified for STGH. Consider staffing with respect to broader role review opportunity. Rainbow Lake Health Centre: Opportunity to develop an collaborative practice model between nursing and medicine.
Facility Role Review
OR Utilization Patient Safety & Surgical Pause
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Improve OR utilization and reduce overtime through implementation and adherence to booking policies. Implement patient safety policies, including surgical pause.
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Regional Opportunity Map and Reference Guide
Service Delivery Model (continued)
Opportunity Name CSR Improvements Paediatrics & OBS Co-location Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Develop regional standards for policies, procedures, risk and safety protocols, and equipment trays for CSR services. Given the need for new physical space for the Pediatrics service in NLRHC, consider locating Pediatrics adjacent to Obstetrics and cross training staff. Conduct a regional review of supportive housing requirements to determine optimum
Supportive Housing alignment of care resources. Review & Partnerships Identify & explore partnership opportunities for supportive housing developments. Home Care Review Population Health Review Nurse-Led Clinics
Conduct a regional review of home care services to align service model, resources, hours of service delivery, and access times to community health needs. Conduct a regional review of population health services to align service programming, resources, and use of telehealth in service delivery to community health needs. Implement nurse led clinics with nurses functioning under medical directives in the areas of sexual health, well women, and STD in High Level.
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Regional Opportunity Map and Reference Guide
Service Delivery Model (continued)
Opportunity Name Emergency Department External Review Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Conduct external review of Emergency as a regional program, with focus on developing a coordinated and sustainable strategy to address needs of the respective communities served. Review Emergency Department physician care delivery model and staffing. Explore opportunities to increase primary care and home care access to patients in FMM, in alignment to a broader regional community health needs assessment. Ensure that there is capability in the ED to accommodate patients with respiratory conditions requiring negative pressure, in line with national standards and recommendations.
ED Model & Management
Examine options to shift outpatient registration and waiting areas outside of the ED. Review NLRHC policies regarding acceptance of non critical out-of-province patients. Improve the separation of statistical reporting across the ED and Ambulatory Care Clinics at NLRHC. Establish and adhere to guidelines related to booking and scheduling in ambulatory care. Explore options to decant ambulatory volumes from the ED, and then consider staffing investment opportunity relative to align to true ED volumes and recommended HPPD.
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Regional Opportunity Map and Reference Guide
Service Delivery Model (continued)
Opportunity Name Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Explore and define potential role of Respiratory Therapy services in the northwest area of the region, in alignment with a broader community health needs assessment. Explore options to expand RT scope of practice in NLRHC, with consideration of corresponding staffing implications on RT and nursing, as part of broader regional HR strategy. Explore options to increase access to Recreation Therapy services, with focus on the northwest area of the region, in alignment with a broader regional community health needs assessment. Consider realignment of clinical nutrition services t o strengthen linkages with the evolving Primary Care and Chronic Disease initiatives, in alignment with a broader community health needs assessment. Explore options to expand regional Physiotherapist staffing, with focus on communitybased services in the northwest area of the Region, in alignment with broader regional community health needs assessment. Conduct broader Occupational Therapy service planning, to ensure alignment to a broader regional community health needs assessment. Conduct broader Audiology and SLP service planning to inform appropriate alignment of identified staffing investment opportunity to community health needs, as part of a broader regional community health needs assessment. Explore and define the potential role of Social Work services in the region to inform appropriate alignment of identified staffing investment opportunity to community health needs, as part of a broader regional community health needs assessment."
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Allied Health Services Review
Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Service Delivery Model (continued)
Opportunity Name Environmental Health Review Dietician and Technologist Staffing Mix Property Management Accountability Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Conduct a regional review of Environmental Health services to align service programming and resources to increasing community health inspections needs and to meet minimum provincial standards. Review staffing mix of Registered Dietitians and Clinical Dietary Technologies for the Region. Conduct a role review of functions and accountability for property management services in the Region, to determine most appropriate operations alignment. Conduct external review of Internal Medicine services as a regional program, with focus on developing a coordinated and sustainable strategy to address needs of the respective communities served. Conduct external review of Surgery services as a regional program, with focus on developing a coordinated and sustainable strategy to address needs of the respective communities served.
Medicine External Review
Surgery External Review
Review plans for changing the surgical team model of care delivery. Consider converting 2 surgical beds to step-down beds with enhanced staffing levels.
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Regional Opportunity Map and Reference Guide
Clinical Resource Management and Practice
Opportunity Name Admission/ Discharge Criteria and Practice Opportunity Description
Examine NLRHC admission/ discharge criteria
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Conduct a review of Medicine unit admission practices and policies to improve alignment of care practices to care needs. Improvements to Regional Coding and Abstracting
Improved Coding Improved MD Documentation Clinical Protocol Adoption
Improve MD Documentation in Inpatient Charts Develop a clinical adoption strategy for standardized, peer reviewed protocols and care maps for key conditions (e.g. pneumonia, cellulitis, congestive heart failure, and MI management). Establish a region-wide Lab Advisory Council, comprised of regional stakeholders with a DKML representative, which sets standards and monitors ongoing utilization. Through the Lab Advisory Council, engage stakeholders in the design and implementation of consistent region-wide lab utilization and standards, with a mechanism for ongoing monitoring by the region. Establish a common structure and process for monitoring regional drug utilization, medication errors and standardizing related policies and procedures.
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Regional Lab Advisory Council
Drug Utilization
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Resource Alignment
Opportunity Name Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Consider potential staffing investment on Medicine to align to peer levels. Develop a targeted recruitment and retention strategy for Obstetrics to ensure continued sustainability of NLRHC obstetrics services, as part of a broader regional HR strategy. Monitor 2006-07 staffing levels to ensure that Obstetrics is adequately staffed to be in line with peers.
NLRHC Acute Nurse Staffing
Monitor 2006-07 staffing levels to ensure that Surgical Care is adequately staffed to be in line with peers. Improve tracking of staffing and workload across Pediatrics. Monitor 2006-07 Psychiatry staffing levels to ensure alignment to recommended HPPD, and ability to maintain crisis nurse services. Monitor ambulatory care staffing levels in alignment with ED review and primary care capacity building in FMM.
Continuing Care Nurse Staffing
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Monitor 2006-07 total care team staffing levels across NLHR continuing care units to ensure alignment to recent AHW target of 3.4 HPRD, with consideration of appropriate staffing allocations across acute and continuing units.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Resource Alignment (continued)
Opportunity Name Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Explore options to reduce staffing impact and premium salary costs associated with high sick and overtime usage at NWHC.
NWHC, STGH and RLHC Nurse Staffing
Explore options to reduce staffing impact and premium salary costs associated with high sick and overtime usage at STGH. Examine staffing patterns to identify options for reductions in overtime premium costs at Rainbow Lake Health Centre. Monitor 2006-07 DI staffing levels to ensure continued alignment to peers. Continue to explore recruitment strategies for DI to reduce reliance on premium overtime costs, as part of broader regional HR strategy. Monitor 2006-07 RT staffing levels to ensure continued alignment to peers.
NLHR Allied Health Staffing Continue to explore recruitment strategies for RT to reduce reliance on premium
overtime costs, as part of broader regional HR strategy. Monitor 2006-07 Pharmacy staffing levels to confirm continued alignment to peers. Monitor 2006-07 PT staffing levels to determine remaining staffing investment required to align to peer levels.
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Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Regional Opportunity Map and Reference Guide
Resource Alignment (continued)
Opportunity Name Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Monitor 2006-07 staffing levels to determine savings opportunity for the General and Nursing Admin areas to align to peer staffing levels. Monitor 2006-07 staffing levels for Housekeeping, Laundry & Linen and Materials Management to alignment to peer levels, with consideration of minimum on-site staffing requirements in the northwest.
Corporate and Support Staffing
Conduct a support service role review across these functions to determine potential realignment of roles, and to explore the feasibility of a support services float pool in NLRHC. Monitor 2006-07 staffing levels to ensure continued alignment to peer staffing levels. Monitor 2006-07 staffing levels to determine level of staff savings opportunity for Health Records, Registration and Telecom relative to peers, with consideration of minimum staffing requirements in the northwest sites.
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Regional Opportunity Map and Reference Guide
Infrastructure
Opportunity Name Laundry Equipment Business Case Pharmacy Technology Business Case NLRHC Parking & Helicopter Pad Northwest Physicians Clinic Opportunity Description
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
Develop a contingency plan for laundry services, including pandemic planning. Conduct a cost-benefit assessment of laundry equipment as part of the development of a long range service plan. Develop a business case to explore the costs and benefits of implementing automated unit dose and other Pharmacy technologies to support efficient operations across the region. Conduct a cost-benefit assessment of the current parking and helicopter pad facilities challenges at NLRHC, and collaborate with AHW, Alberta Infrastructure and private industry to identify options for resolution. Engage key stakeholders to develop an action plan to address High Level physicians' clinic issues, with consideration of broader clinical sustainability of health service delivery in the northwest.
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Regional Opportunity Prioritization
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Regional Opportunity Prioritization
Introduction
Based on a facilitated working session with the Region's Senior Managemetn Team, the Project Team have developed an Opportunity Sequence Map. Opportunity prioritization has focused on sequencing, using four key factors:
Opportunity Inter-Dependencies Resource Requirements (Leadership, People, Financial, External Support) Identified Risks Timeline Feasibility Priority Level to the Region
The opportunity mapping (timeline) has four phases of effort:
Phase 1: 0-6 months Phase 2: 6-12 months Phase 3: 12-18 months Phase 4: 18-24 months
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Regional Opportunity Prioritization
Introduction (continued)
During the working session with the region's Senior Management Team, opportunities were reviewed by phase of effort to discuss the appropriateness and feasibility of the preliminary prioritization. Throughout the discussion, a "go forward determination" was also assigned to each opportunity to establish if phasing needs to be changed, deferred and / or not pursued: Priority Opportunities that are considered priorities for achievement by the region over a two year period. Deferred Opportunities which must be deferred at this stage, but which will be re-considered for pursuit in the future. Not Pursued Opportunities which are not considered as regional priorities, and so will not be pursued. The following slide presents the opportunity prioritization map, based on those opportunities identified as priorities by the region. Supporting this opportunity map is an overview of the regional lead, required resources, and priority assignment for each regional opportunity.
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Regional Opportunity Prioritization Map
Regional Initiatives
Cluster-Related Cluster-Related Strategy, Partnerships and Planning Strategy, Partnerships and Planning
Service Service Delivery Delivery Model Model
Clinical Clinical Resource Resource Management Management and Practice and Practice
Resource Resource Alignment Alignment
Infrastructure Infrastructure
He alt h Go Sys als te m
stem Sy s lth tive Hea itia In
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Regional Opportunity Prioritization
Phase 1 Senior Leads and Resources
Project Resources Opportunity Name Change Management Function Internal Communication Strategy Community Health Needs Assessment NLHR Clinical Development Continue Building Mental Health Partnerships Human Resources Plan
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Prioritization
Not Pursued
Responsible Senior Lead
Additional External Internal Financial Resource Priority Deferred Resources Support Support
Bernie Blais
Lorraine Lynch
Pat Furey Bernie Blais / Pat Furey / Valetta Lawrence / Nell Vrolyk Valetta Lawrence
Valetta Lawrence
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Regional Opportunity Prioritization
Phase 1 Senior Leads and Resources (continued)
Project Resources Opportunity Name OR Utilization Patient Safety & Surgical Pause CSR Improvements Regional LAC Improved MD Relations Drug Utilization Northwest Physician's Clinic Property Management Laundry Equipment Business Case
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Prioritization
Not Pursued
Responsible Senior Lead Pat Furey Pat Furey Pat Furey / Linda Metz Valetta Lawrence Bernie Blais / Dr. Nicholson Valetta Lawrence Bernie Blais / Nell Vrolyk Linda Metz Linda Metz
Additional External Internal Financial Resource Priority Deferred Resources Support Support
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Regional Opportunity Prioritization
Phase 1 Senior Leads and Resources (continued)
Project Resources Opportunity Name Improved Coding Improved MD Documentation Emergency Department External Review Rainbow Lake Shadow Population Billing Responsible Senior Lead Linda Metz Dr. Nicholson Bernie Blais / Dr. Nicholson Linda Metz / Nell Vrolyk Prioritization
Not Pursued Additional External Internal Financial Resource Priority Deferred Resources Support Support
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Regional Opportunity Prioritization
Phase 2 Senior Leads and Resources
Project Resources Opportunity Name Facility Role Review Community Program Realignment Supportive Housing Review & Partnerships Home Care Review Environmental Health Review Population Health Review Continuing Care Capacity
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Prioritization
Priority Deferred Not Pursued
Responsible Senior Lead
Additional External Internal Financial Resource Resources Support Support
Bernie Blais Nell Vrolyk / Pat Furey / Valetta Lawrence Pat Furey / Nell Vrolyk Pat Furey / Nell Vrolyk Pat Furey Pat Furey / Nell Vrolyk Pat Furey
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Regional Opportunity Prioritization
Phase 2 Senior Leads and Resources (continued)
Project Resources Opportunity Name Responsible Senior Lead
Additional External Internal Financial Resource Resources Support Support
Prioritization
Priority Deferred Not Pursued
ED Model & Management Medical Director Portfolio MD Leadership Alignment Admission/ Discharge Criteria and Practice
Dr. Nicholson / Valetta Lawrence / Pat Furey Bernie Blais / Dr. Nicholson Bernie Blais / Dr. Nicholson Pat Furey / Valetta Lawrence / Nell Vrolyk / Dr. Nicholson
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Regional Opportunity Prioritization
Phase 3 Senior Leads and Resources
Project Resources Opportunity Name Responsible Senior Lead Bernie Blais / Dr. Nicholson / Pat Furey Bernie Blais / Dr. Nicholson / Pat Furey Dr. Nicholson / Valetta Lawrence / Pat Furey Pat Furey / Valetta Lawrence / Nell Vrolyk Nell Vrolyk Prioritization
Not Pursued Additional External Internal Financial Resource Priority Deferred Resources Support Support
Surgery External Review Medicine External Review Clinical Protocol Adoption Allied Health Services Review NWHC, STGH and RLHC Nurse Staffing
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Regional Opportunity Prioritization
Phase 3 Senior Leads and Resources (continued)
Project Resources Opportunity Name Responsible Senior Lead Prioritization
Not Pursued
Additional External Internal Financial Resource Priority Deferred Resources Support Support
Continuing Care Nurse Staffing NLRHC Parking & Helicopter Pad Pharmacy Technology Business Case
Pat Furey / Nell Vrolyk Linda Metz
Valetta Lawrence
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Regional Opportunity Prioritization
Phase 4 Senior Leads and Resources
Project Resources Opportunity Name Responsible Senior Lead Prioritization
Not Pursued
Additional External Internal Financial Resource Priority Deferred Resources Support Support
NLRHC Acute Nurse Staffing Corporate Services Staffing
Pat Furey / Valetta Lawrence Linda Metz
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Deloitte & Touche LLP and affiliated entities. Deloitte, one of Canada's leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 6,100 people in 47 offices. Deloitte operates in Qu bec as Samson B lair/Deloitte & Touche s.e.n.c.r.l. The firm is dedicated to helping its clients and its people excel. Deloitte is the Canadian member firm of Deloitte Touche Tohmatsu. Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms, and their respective subsidiaries and affiliates. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other's acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names "Deloitte," "Deloitte & Touche," "Deloitte Touche Tohmatsu," or other related names. Services are provided by the member firms or their subsidiaries or affiliates and not by the Deloitte Touche Tohmatsu Verein. 190 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
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AHW RHA Efficiency Review
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Northern Lights Health Region
Performance Management Overview Final Report
July 14, 2006
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Performance Management Overview
Key Components of Performance Management
The framework below is used to assess performance management alignment. There are seven components used in this assessment.
Leadership
Vision and Strategy
Organization Structure People Infrastructure
Measurement
Operating Processes
Opportunities
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1. Leadership
Leading Practice Attributes
Visible leadership; vision and strategy focused; systems thinking and planning; Transparent and timely management processes related to decision-making; Demonstrated commitment to standardization; Role mentorship and succession planning; Multi-stakeholder relationships management
Findings Documentation Review
3 Year Health Plan; Annual Business Plan; Annual Report Organization Charts
Stakeholder Feedback
Board Chair and CEO Leadership in the region has had turnover over the past year, which has resulted in some initiatives being on hold. Staffing shortages and large portfolios have impacted managers' ability to focus beyond daily `fire-fighting' to broader strategic and operational planning. The new Board Chair has driven efforts to establish a stronger role in both the west and east side of the region, which has been supported by new CEO, Two MACs in the region cause a challenge to consistent physician leadership.
The geography of the region has created a challenge for leadership to maintain Senior Management across the regional geographic divide. This may suggest the need for refocused attention on leadership structure to support the west and east sides of the region. Strained physician relations in High Level suggest the need for greater leadership focus to create better regional connection and resolve existing risks. Deloitte Turnover of Board and CEOs appears to have halted strategic action, such that leadership focus has, in part, been on `fighting fires' instead of effecting significant change during the Observations CEO's absence. Although the new Chair has identified a number of planned partnerships, there has historically been a lack of multi-stakeholder partnership and relationship management especially given presence of private industry in regions suggesting the need for focused leadership to support this area
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2. Vision and Strategy
Leading Practice Attributes
Clearly articulated Mission, Vision, and Value Statements (or Guiding Principles) Current Strategic Plan with supportive structure and processes to cascade to operational level; prioritization process to focus organizational initiatives and decision-making Performance management processes and structure aligned to support strategy; Focused on direction; Cross RHA collaboration; integration mindset.
Findings
Documentation Review Stakeholder Feedback
The region's mission, vision and strategy were revisited and confirmed through a Fall 2005 planning exercise, with good Board, management and CHC involvement. Strategies are in place, but broader health human resource strategy is needed. Quarterly reports to Board and AHW update progress towards regional objectives and strategies.
3 Year Health Plan; Annual Business Plan; Annual Report,
Deloitte Observations
The region has a clearly articulated mission, vision and principles, which are supported by the three-year plan and annual business plan. Three-year plan and annual business plan show alignment to AHW requirements, and performance indicators are in place to track progress to plans. Regional service plans also show alignment to key strategic priorities. The region has a large number of initiatives identified in planning, which may pose challenges to achieving them within the identified three-year timeline. Further delineation of strategic vs. operational initiatives may support this planning. An overall implementation timeline for the three-year plan is needed, to ensure balanced approach to resource requirements to support each initiative.
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3. Organization Structure
Leading Practice Attributes
Organizational structure reflects unique requirements of organization, service delivery; supports changing service and people requirements; Supports timely decision-making and efficient work flow; role accountability and communication Minimizes role duplication and confusion Strategic portfolios instead of service management ones
Documentation Review
Findings Stakeholder Feedback
Senior Management is identified as being extremely thin, with broad portfolios that limit capacity for planning and programming. Medical Director and MOH positions have been combined, and although there are physician chief roles, they are reported as being not actively involved in operations. Although regional managers are in place, the geographic distance is challenge to maintaining connection to staff in the rural communities. The organization's choice to not replace the VP Human Resources has resulted in reduced Senior Management focus on this area.
Organization Structure / Charts Role descriptions (select management roles)
Deloitte Observations
The overall organization structure of NLHR is challenged by the geography of the region, which suggests the need for additional role alignment and accountabilities for the management structure in the West to support operations, with corresponding review of the most appropriate alignment of staff to regional vs. site-based management. Given the challenges currently faced by the region, and the need for a creative approach to address northern issues, a VP level focus is suggested for Human Resources, and External Partnerships. The geographic divide in the region suggests the need for designated senior Medical leadership for the East and West. Although the current model of one MOH for the region is appropriate, this role needs to be separate from Medical Director
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4. People
Current Human Resources Strategic Plan; HR planning and management from a regional perspective (move from local to central)
Leading Practice Attributes
Standardized performance review process with regular application Identified competencies for roles particularly at leadership level Sufficient HR staffing support across organization to support management and staff Supportive staff development and education program / process in place / career paths / laddering opportunities
Findings
Documentation Review
HR Recruitment and Retention Plan Organization Structure
Stakeholder Feedback
The organization's choice to not replace the VP Human Resources has resulted in reduced Senior Management focus on this area. Given the need for increased focus on recruitment, a full-time position was recently created. Although staff shortages have caused delays to role updates, competencybased role descriptions are in place.
Although an HR plan exists, the region needs consider a more strategic and creative approach to address northern health HR issues, supported by senior level leadership for HR. The recent creation of a dedicated recruitment support in HR will support this initiative, although senior leadership to drive recruitment efforts is needed. Given resource challenges, the region should consider further partnerships with other Deloitte regions to leverage pre-existing program/material development. Observations Additional RN recruitment options exist, where improved connection with local colleges is needed to create more placement positions, and thereby maintain a higher level of local talent. A performance management review process, exists, but is not consistently in place.
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5. Infrastructure
Current and integrated information management, technology and facility plans Sufficient and appropriate technology to support efficient and effective operations
Leading Capital replacement plan (current and integrated); Facility development processes and plans to support care requirements and efficient operations Practice Attributes Metrics to assess value of investment (economic and social value, linking service to
infrastructure) Assessment of new business models to enable infrastructure investment
Findings
Documentation Review Stakeholder Feedback
Good funding exists for capital equipment, driven in part through private industry relationships. IT planning documents Capital Redevelopment Submissions The region's IT initiatives are resource-intensive but are expected to provide a good information foundation for operations. Challenges in data reporting through the first phase of implementation have impacted information capture in 2005-06. Availability of land in FMM is a barrier to development of new care delivery space, due to competition with private industry. In FMM, leadership should explore inter-Ministry partnerships to obtain land for housing and facilities development. Given the need for a regional community health needs assessment, the region should pause capital redevelopment planning until alternative service delivery models are Deloitte considered in key areas (e.g. St. Theresa, La Crete). This should be further combined with the exploration of community and agency partnerships to support alternative service Observations delivery models. IT infrastructure re-development needs to consider physician IT in current strategic planning, so that the region is well-positioned to fully leverage the benefits that can be driven through the Meditech implementation.
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6. Measurement
Existence of a comprehensive performance management system in place (people, financial, operations, satisfaction, and other key processes)
Leading Practice Attributes
Development of performance metrics and targets to manage care and service; linkage of measurement to action and communication; Consistent, standardized measures Performance measurement linked to quality and risk management
Findings
Documentation Review
3 Year Health Plan; Annual Business Plan; Annual Report, Annual Reports
Stakeholder Feedback
Performance is measured on a quarterly basis to track to organization plans and goals, with linkage to CQI initiatives. Performance goals and indicators are established in planning, and department-level actions are in place to support. Individual performance management processes are in place, but are inconsistently applied.
The region has performance management in place through the three-year and annual planning processes.
Deloitte Observations
A more comprehensive performance management system/framework is suggested that uses a scorecard approach to focus the cascading of regional goals to all levels of the organization and physicians, and enables regular monitoring and evaluation. Further, performance management, clinical service utilization, and clear roles, responsibilities and accountabilities for physicians is needed to support regional strategy, operations, care delivery and risk management.
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7. Operational Processes
Leading Practice Attributes
A formal, organization-wide risk identification and management process is in place; Established processes in place to support standardization and development of practice Established processes, initiatives to support standardization of care and service Established resources to support initiative implementation and monitoring Assessment of new or different business models to support service delivery and integration Management processes that support accountability
Findings
Documentation Review
Stakeholder Feedback
The region has established 10 Quality Improvement teams consisting of frontAnnual Business Plan line staff, management, and community members to address quality issues on a monthly basis. Accreditation Report Care documentation (charts) A new Patient Safety/Risk Management role has been established to support broader risk management. Policy/Procedure Process standardization is underway across the region. Risk Management EMS service response times are a potential risk, but are operated by the Framework municipalities.
The region should continue efforts to standardize policies, procedures, roles, etc., with consideration of geographic and operating differences between sites. The presence of two MACs in the region, with limited coordination between each, is a challenge to clinical practice standardization. Deloitte Further partnership development with the municipalities is needed to support emergency Observations service delivery across the region. The region needs to engage in a community health needs assessment with a focus on exploring alternative service delivery models to support care delivery, especially given geographic limitations that prevent patient flow between the East and West sides of the region.
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Summary Remarks
Strengths to build on include: Strengths to build on include:
Good alignment between the Good alignment between the three-year plan and annual plan three-year plan and annual plan The establishment of a Patient The establishment of a Patient Safety/Risk Management role to Safety/Risk Management role to support the region. support the region. Progress in Meditech Progress in Meditech implementation and implementation and demonstrated leadership across demonstrated leadership across non-metro RHAs non-metro RHAs Renewed focus on creating Renewed focus on creating regional culture under leadership regional culture under leadership of new Board Chair and CEO of new Board Chair and CEO Leadership recognition to Leadership recognition to establish and grow external establish and grow external partnerships with industry partnerships with industry related related
Areas for further consideration: Areas for further consideration:
Development of an overall Development of an overall implementation timeline and plan implementation timeline and plan for strategic priorities that links for strategic priorities that links resources and organization resources and organization change capacity change capacity Continued examination of Continued examination of organization structure to ensure organization structure to ensure portfolio balance and alignment portfolio balance and alignment across East-West geographies across East-West geographies Separate Senior Leadership focus Separate Senior Leadership focus on Human Resources and External on Human Resources and External Partnerships Partnerships Integration of Physician IT as part Integration of Physician IT as part of broad IT strategic planning of broad IT strategic planning
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AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
2006 Deloitte Inc
Deloitte & Touche LLP and affiliated entities. Deloitte, one of Canada's leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 6,100 people in 47 offices. Deloitte operates in Qu bec as Samson B lair/Deloitte & Touche s.e.n.c.r.l. The firm is dedicated to helping its clients and its people excel. Deloitte is the Canadian member firm of Deloitte Touche Tohmatsu. Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms, and their respective subsidiaries and affiliates. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other's acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names "Deloitte," "Deloitte & Touche," "Deloitte Touche Tohmatsu," or other related names. Services are provided by the member firms or their subsidiaries or affiliates and not by the Deloitte Touche Tohmatsu Verein. 10 AHW RHA Efficiency Review Northern Lights Health Region Property of Alberta Health and Wellness
Member of Deloitte Touche Tohmatsu 2006 Deloitte Inc