The Last Five Years at VCH: A Story of Teamwork and Triumph. Duncan Campbell March 2013

Transcription

1 The Last Five Years at VCH: A Story of Teamwork and Triumph Duncan Campbell March 2013

2 Fiscal Crisis in 2008 $42m Operating Deficit 95% of funding received committed to collective bargaining Cash less than 1 weeks payroll - $10m High admin and support costs (13%) Staff growth higher than volume growth $1 Billion Infrastructure Deficit (excluding hospitals)! Outdated technology on fire pc s! Obsolete equipment! Aging and poorly maintained facilities $50m capital projects in flight without a funding source Financial information 6 weeks late no headcount information ED congestion and hallway patients EDP4P starting to work Long wait times, and cancelled elective surgery 2

3 Staffing Growth 3.3% Twice As High As Volume Growth FTE' Analysis FTE's /6 2006/7 2007/8 2008/9 2009/ /11 Actual Projected Actual Projected 3

4 Turnaround Plan Take control of cash and stop in flight projects Get admin and support costs into line $26m and 200 staff reduction reduce from 13% to 9.2% Support Pay for Performance initiatives to change behaviours Get control over headcount Senior team approves all new hires and replacements Focus on workforce optimization to get control over the biggest cost item over 70% of costs relate to staffing (later resource optimization) Invest in staff scheduling, forecasting, decision support tools and portals Reinvest efficiency savings into quality and sustainability initiatives and replenish infrastructure 4

5 Key Elements of Our Resource Optimization Journey Forecasting Project demand and staffing requirements Business Intelligence And Data Warehousing Scheduling Deploy staff effectively Resource Optimization Back to Work Attendance Promotion, Early Intervention, and Disability Management Redesign Bed Management Maximize utilization of beds Care Management Understand patient acuity and care needs 5

6 Staff Forecasting and Staff Scheduling Lower fixed levels of staffing and increase flexibility of variable staffing Average Variable Staffing GFS Rehab Medicine Average Oct Variable 03-Nov 13, Staffing 2008 RN Aide Budget LPN Census Staff Forecasting Solution will allow the ability to forecast demand & the associated staff requirements Average Number of Staff Census Staff Scheduling Efficient & effective deployment of staff to match expected activity patterns F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T Optimizing Variable Staffing Levels

7 Electronic Staff Scheduling & Timekeeping Benefits Achieved : B e n e fi t s 2008 %2012% 19,600%employees% " All implementations completed on time and under budget by $270K " Consolidated and standardized scheduling and timekeeping under one common platform " Decreased OT and Insufficient Notice Premiums " Pay Rules applied consistently " Real time staffing data available for Managers enabling proactive scheduling " Integration with staff forecasting (Emendo) " Increased data integrity " Established Regional Staffing and Timekeeping Service " Decommissioning of Loki databases ( to be complete March 31, 2013) 7

8 CapPlan Dashboard Updated every 15 min Provides web-based real-time daily visibility Worm graph shows 3 days of information retrospectively, today and tomorrow Displays key metrics with applicable traffic light on the current status within the hospital Can display the details of each nursing unit under each planning group 8

9 9 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Percent'of'4+hour'shifts Staffing'Implications'Example'+ Richmond'2'West'Psychiatry Elevated5(>15over) Balanced5(-15to51) Insufficient5(<-15under) Safe and Efficient Staffing Levels

10 Where we are now 10

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12 VCH True North: Innovate for Sustainability 12

13 90.0 Life expectancy (years) at birth. Vancouver DTES, Vancouver HSDA and British Columbia to Vancouver DTES Vancouver HSDA British Columbia Life expectancy (years) Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit, September Data source: BC Stats, Ministry of Labour, Citizens' Services and Open Government, February

14 Hand Hygiene Improved from 20% to over 70% Hand Hygiene Percent Compliance (VGH, LGH and RH for consistent four-year trend) /09 Q4 09/10 Q1 09/10 Q2 09/10 Q3 09/10 Q4 10/11 Q1 10/11 Q2 10/11 Q3 10/11 Q4 11/12 Q1 11/12 Q2 11/12 Q3 11/12 Q4 12/13 Q1 12/13 Q2 12/13 Q3 14

15 Quality Up Mortality Rates One of 120% Best in Canada Quality Improving - Hospital Standardized Mortality Ratio Declining 100% 80% 60% 40% 20% 0% 15

16 MRSA Down MRSA Rate per 10,000 Acute Patient Days (in VCH facilities excluding PHC for consistent long term trend)

17 Admin Costs CIHI Measure VCH One of the Lowest in Canada VCH Admin Expenses as % of total expenses 2007/ / / / / CIHI % 3.072%% 17

18 Real Productivity Gain: Staffing Flat Since 2008 With Real Growth Of 1.7% FTE' Analysis FTE's /6 2006/7 2007/8 2008/9 2009/ /11 Actual Projected Actual Projected 18

19 Pay for Performance Funding reduced >1 year waitlist by 72% Top Ten Daycare Cases Waitlist Reductions at VA Apr Dec Total Waiting Waiting < 6mo Waiting 6-12mo Waiting > 1yr Reduction 27% 11% 30% 72% 19 Source: Surgical Patient Registry (Jan 15, 2013)

20 and Total Waitlist reduced by 23% 8000 Total Waitlist (All Cases) Waitlist Reductions at VA Apr Dec Total Waiting Waiting < 6mo Waiting 6-12mo Waiting > 1yr Reduction 23% 19% 8% 53% 20

21 21 Improvements in Cost per Patient Day ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '11 Cost%per%Patient%Day LGH RH Implementation

22 22 Improvements in Hours per Patient Day * 2011* 2011* 2011* 2011* 2011* 2011* 2011* 2011* 2011* 2011* 2011* 2011* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2012* 2013* 2013* 2013* 2013* 2013* 2013* 2013* 2013* 2013* 2013* 2013* Hours&Per&Patient&Day LGH RH Implementation

23 Develop Agile Financial and Operating Processes Period End close and reporting less than 7 days Lower Mainland Consolidation financial and operating reporting Financial Policies Agile and regional internal audit function developed 2 cases handed over to RCMP for fraud prosecution Risk management introduced and now used in budgeting and risk processes Comprehensive Whistleblower Policy introduced Real time analytics and portals developed Pay for Performance funding Operating Room costing project completed 23

24 Reporting: Balanced Scorecards Currently over 20 scorecards created Two versions for external and internal view External Internal 24

25 Goals: One Stop for your information needs Easy to Use requires no training Reporting: Portals Created for COCs & Regional Programs: Developed in consultation with users PORTAL belongs to entity/ program with Decision Support as facilitators. Include information from warehouse & other sources 25

26 Data Linkages across the Patient Continuum What is a Patient Continuum? Facilitates longitudinal patient tracking across the entire health authority according to criteria and measurements such as time, space, visits, facilities and type of care Why Build a Patient Continuum? Standardizes joins between fact tables Provides a means of analyzing patient movement Improves data quality Enables easier data mining Vancouver-Coastal-Healths-Patient-Continuum-Increases- Insights html Award Winner of the 2012 Innovation Solution Award for BI/Analytics 26

27 Contract Innovation: Linen Utilization Programs GUP & GRUMP In addition to negotiating lower unit prices ($/lbs.) for linen processing, BISS implemented innovative gain-share utilization programs with 2 main vendors GUP & GRUMP programs employ proprietary data management technology and systems to monitor and report real time linen usage statistics Detailed, up-to-date linen intelligence is then used to identify high utilization hotspots for targeted linen handling & change management education Savings achieved are shared on a graduated basis with vendors Impacts: # Reduced linen use by 8% # Financial savings of $2.0M annually Savings from reduced use: $2.0M / yr. Savings from lower unit prices: $0.15M / yr. 27

28 LMC Bending the Cost Curve Trend analysis above shows the actual pre-lmc growth curves and post-lmc LMC is having 2 types of savings impacts direct budget reductions ($68M to date) & slowing growth ( from 5.67% to 1.74% annually) The total estimated LMC savings from direct budget reductions and absorbed 28 growth will total ~$116.4M by year end 12/13

29 Real Focus on Reducing Food Waste from 44% to <10% 29

30 Hostess Model at LGH All floors launched as of Feb 2012 Patient satisfaction has increased by 10.7% since April 2011 and 6.0% since April

31 VCH Recycling Diversion Rates Waste Diversion Rate: Recycle % of total recycle & landfill Percent Diverted 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 UBC Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 RH LGH Feb-12 Mar-12 Apr-12 May-12 Jun-12 VGH Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Goal = 35% Implemented at 7 acute and 9 residential care sites since Feb 2011 At Nov 2012, 278,476 lbs per month (139 tons) diverted from the landfill 31

32 4-Year Trend of Continuous Risk Reduction

33 Improved privacy protection while facilitating legitimate info sharing Provided staff with encrypted USB drives VCH-wide privacy audit program 17 new IT security policies Doubled privacy education Hosted Ultimate Privacy Challenge conference in 2012 PARIS access model change & other initiatives designed to facilitate info sharing to improve care Roll out of enhanced Whistle Blower policy 33

34 Led development of province-wide General Health Information Sharing Agreement (GHISA) (includes all HAs and MOH) Provincial ehealth Viewer ISA Panorama ISA Perinatal Registry ISA PDIV ISA Cardiac Registry ISA MOH Data Access Agreement GHISA 34

35 Bending the Cost Curve while Improving Quality Over the years, key BISS strategies have driven down costs while enhancing quality management Strategies include tightening performance management, innovative contract terms, strengthening contract & project management skills / capacity and organizational streamlining By consolidating admin, negotiating lower base contract costs, placing caps on future annual increases, and incentivizing high levels of quality, BISS has flattened growth in contract costs while maintaining service levels Outsourcing, LMC savings and avoided costs are estimated at ~ $10M annually 35

36 RBS By the Numbers Provide Consolidated Financial Reporting for LMC leaders More than 3 million lines of G/L code and almost 2 million lines of budgets > 5,000 employees have been migrated as part of Lower Mainland Consolidation A new Signing Authority Policy introduced that was hard Casual Accountability Policy tool to reduce scheduling/call-in cost (~$300 per employee per year) Paperless Leave Entitlement Report to replace a ~5000 page, bi-weekly paper report The easi project consolidated seven time capture systems into one and ~18,000 employees migrated Electronic Health Authority Reporting Process (eharp) Reporting-3days to 1 hour 36

37 .together we have shrunk the iceberg $70m Operating Surplus in 2012/13 Set aside for Clinical Systems Transformation Cash more than 25 weeks payroll - $250m Paid off all long term debts including $50m HBT liabilities Lowest admin and support costs in Canada Real productivity gain zero staff growth and 1.7 volume growth Quality metrics improves (mortality, bugs and safety) Infrastructure deficit reduced! Replaced over 10,000 pc s! Invested in quality and sustainability initiatives No capital projects in flight without a funding source Innovative approach to replacing Richmond Lions Manor, Olive Devaud Month End close and reporting 6 days to management and Pay for Performance funding improved wait times, flow and need for long term care beds we now have a less scary challenge!!! 37

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39 The A Team 39

40 Senior Executive & Board Support 40

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