[PPT] - Balanced Score Card Report Review of September 2017 Data Balanced PowerPoint Presentation

SLIDE 1

Balanced Score Card Report Review of September 2017 Data

SLIDE 2

Balanced Scorecard

Patient Access

Quality & Safety Human Resource Management Finance

Patient and Service User

SLIDE 3

Patient Access – Emergency Department

SLIDE 4

CUH 30 Day Moving Average 2017 v 2016

5

SLIDE 5

6 Hour PET & 8AM TrolleyGAR per 100 ED Attends

6

SLIDE 6

PET Monthly Comparison (Non Admitted)

SLIDE 7

PET Monthly Comparison (Admitted)

SLIDE 8

Patient Experience Time >24 Hours

50 100 150 200 250 300 350 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 320 316 264 328 85 98 68 89 136

PET >24 hours

SLIDE 9

>75 years >9 hour bed wait

50 100 150 200 250 218 199 200 215 129 120 57 108 143

>75yrs Bed Wait >9 hrs (2017)

SLIDE 10

>14 Day Target Reduction

SLIDE 11

Project Flow Improving Patient’s Hospital Experience Project Flow 2017

SLIDE 12

>14 Day Review

Weekly Meetings
193 Patients >14 Days 27th April (9,778 BDs)
137 Patients >14 days today (7,569 BDs)

– 15 patients >100 Days (3,438 BDs)

Difficulties with Nursing Home Bed Capacity
Difficulties with Home Care Provider Capacity
Plan for increased Transition Care Beds

– Clonakilty (16 beds)

SLIDE 13

Weekend Demand/Capacity

Non Invasive Cardiology

Winter Plan Submission Report average inpatient waiting time for echo / stress

Potential diagnostics as outpatient

for discussion with Radiology

Communication of bi directional capacity
Bulk text message to Medical Staff
Whiteboard capture
Delegated discharge responsibility (for action)
Friday Specialty Handover (for action)

SLIDE 14

Resource Dependant Initiatives

Transitional Care (50 Beds in

Community)

Acute Beds (Ward 2A)
Operational HUB
Flow Coordinators
Regularisation of extra unstaffed

beds

24/7 AMAU Service
ITU & HDU Capacity
Diagnostics
Point of Care (H1N1, Ketones,

Pregnancy testing)

CT Scanning
7 Day Echocardiograph
Bed Management & Acute Floor

Information Systems

Ambulatory Care Facilities /

Surgical & Cardiac Assessment

Health & Social Care

(Rehabilitation)

15

SLIDE 15

Patient Access - Outpatient Waiting Lists

SLIDE 16

Total Medical Patients to be seen by 15 Month Target

(September) (176) (23/10/2017)

86 27 22 15 8 4 3 2 2 2 2 1 1 1 10 20 30 40 50 60 70 80 90 100

SLIDE 17

Total Surgical Patients to be seen by 15 Month Target

(3078) (23/10/2017)

545 527 405 357 293 167 150 121 115 99 77 75 53 48 26 11 3 3 3 100 200 300 400 500 600

SLIDE 18

Patients Currently Waiting Longer Than 12 Months

(5080) (23/10/2017)

2495 838 559 209 194 145 123 121 109 98 51 50 36 23 9 8 6 6 500 1000 1500 2000 2500 3000

SLIDE 19

Ophthalmology Waiting List Validation

Ophthalmology Return Waiting list validation Consultant G.O.Connor E.O. Connell S.Fenton A.Cullinane Z.Idrees Total Letters sent out 737 650 444 950 468 3249 Letters left to sent out 520 486 1006 Outcomes Yes to Stay on w/l 528 230 312 678 319 2067 Request removal 25 14 12 37 11 99 RIP 4 4 8 6 22 Attended TCI 1 1 2 Query 8 2 6 7 4 27 Return Post 2 3 3 2 1 11 Diabetic Screening 16 8 14 24 17 79 No response to date 25/9/17 154 388 97 194 109 942

SLIDE 20

Patient Access - Inpatient Waiting List

SLIDE 21

Patients to be Treated by 19th October 2017

Specialty Number of Patients Breast Surgery Cardiology Cardiothoracic 3 General Surgery 63 Neurology Neurosurgery Orthopaedics Plastic Surgery 69 Respiratory Medicine Urology 43 Vascular 10 Total 188

SLIDE 22

Urology Waiting List (43)

SLIDE 23

Plastic Surgery Waiting List

SLIDE 24

General Surgery Waiting List

SLIDE 25

Scope Waiting List

SLIDE 26

Quality & Safety

SLIDE 27

ALOS All Inpatients – August 2017

G

SLIDE 28

ALOS Medicine – August 2017

29

A

SLIDE 29

ALOS Surgery –August 2017

30

R

SLIDE 30

HIPE Coverage - Prior Month - % of cases entered into HIPE(A38)

G

SLIDE 31

Cancer KPI – Breast-Lung-Prostate

January – September 2017

SLIDE 32

Chemotherapy Patients In/Out of Target - September

33

In Target, 36, 86% Outside Target, 6, 14%

SLIDE 33

Reason for Treatment Delay - September

34

0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Personal Choice Medical Reasons Capacity Data Missing Other Total 1 5

SLIDE 34

Radiotherapy Patients In/Out of Target - September

35

IN TARGET, 39, 52% OUT OF TARGET, 36, 48%

IN TARGET OUT OF TARGET

SLIDE 35

Consultants Reasons for Out of Target - September

36

1 2 3 4 5 6 7 8 9

Dr Faisal Jamaluddin (Locum RO)

Dr. Aileen Flavin (RO)
Dr. Bolanle Ofi (Locum RO)
Dr. Carol McGibney (RO)
Dr. Frederik Vernimmen (RO)
Dr. Paul Kelly (RO)

1 1 2 3 2 3 1 2 3 6 5 1 3 3

Personal choice Medical Capacity Data Missing Other

SLIDE 36

Risk Management – September KPI data

Serious Reportable Events reported CUH -1
Medication Safety Incidents reported - 24
Complaints – 7 complaints raised in July with 42% closed

within 30 day timeframe

New claims notified to hospital – 75

Risk Register

Risk Register updated in June– one new risk added

SLIDE 37

Quality and Safety

Pressure Ulcer To Zero

Continue to roll out PUTZ initiative – ward 3B and ICU

SWARTZ Round

2nd round scheduled for 31st October

National Patient Satisfaction Survey

CUH – 55% response rate
Emerging theme is the Discharge Process
Workshop at Group level to review results of the survey

Staff Quality Survey Completed

Vision
Mission Statement

SLIDE 38

National Patient Survey Key areas for Improvement & Nationally

Discharge Planning

– Need for information on discharge – Danger signs, what to look out for – Written information, medication information

Care on the Ward

‾ Nutrition ‾ Worries and Fears

Examinations/diagnosis/Treatment
Need for information
Improved communication

SLIDE 39

Quality and Safety

Vision

Delivering Safe, Effective, Person- Centred care, Every time Mission Statement All CUH staff are committed to delivering the highest level of Quality Care achievable. We will work with you, our service users in enhancing services that are safe, clinically effective and delivered in a clean environment.

40

5 top priorities 20 additional priorities

SLIDE 40

Human Resource Management

SLIDE 41

CUH Sick Leave 2016 v 2017- CHANGE

4.65 4.59 4.53 3.91 3.39 4.27 3.78 3.77 3.94 4.04 4.08 4.98 4.77 3.84 3.92 4.22 4.17 3.9 3.65 3.98

2 4 6

Jan Feb Mar April May June July August Sept Oct Nov Dec

%

CUH – Total % Sick Leave 2016 v 2017

2016% 2017% % Target

40.76 35.76 38.81 32.49 41.8 43.96 44.55 34.55 37.35 31.14 28.89 44.15 40.05

10 20 30 40 50

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17

WTE’s

CUH Long Term Sick Leave – WTE’s

SLIDE 42

EWTD Compliance –January - August 2017

SLIDE 43

Capital Projects

Project Status Paediatric Unit Phase 1 - build programme completed Phase 2 – funding received – proceed to Design Stage Radiation Oncology Unit  Builder commenced on site on Monday 20th February Education and Training Centre Draft Statement of Need completed and discussion

ngoing with UCC

Meeting held with UCC Blood Sciences Project Design Team appointed Infrastructural works are near completion Oncology Service  Expansion of Day Unit – plan signed off – submitted for Philanthropic funding (ACT)  Refurbishment of Ward 2D – capital funding in place  Medical Oncology Centre – developing Statement of Need Ophthalmology Transfer – Phase 2  Project group in place  Application for planning permission submitted  Tender Pack being prepared Helipad Meeting held with the IAA Ground Level Helipad the agreed option

SLIDE 44

Finance

SLIDE 45

Finance Report – August 2017

CUH Actual outturn YTD 2017 PAY & NONPAY

Gross pay & non pay budget €268.2m (2016 :€256.4m)
Actual pay & non pay €277.8m (2016: €263.9m)
Actual Deficit €9.6m (-3.6%) (2016 :€7.5m/-2.9%)

Less Adjustments €5.4m Increase in Bad debts provision €2.7m PCRS Drugs €0.7m LRA Restoration unfunded €1.7m Living out allowance €334k Adjusted Deficit €4.2m(-1.55%) (2016 :€3.5m/-1.4%)

SLIDE 46

CUH –Pay & Non pay Budget Surplus/(Deficit) %

SLIDE 47

CUH – Patient Income Budget Surplus/Deficit %

SLIDE 48

49

CUH AGENCY WTE 2014-7

Jul-14 Sep-14 Dec-14 Jan-15 Mar-15 Jun-15 Sep-15 Dec-15 Jun-16 Sep16 Oct 16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual

Radiotherapist 9.40 4.00 4.87 2.78 0.95

0.9

Radiographer

0.09 0.05 0.06

Labs

12.04 13.40 11.0 12.19 1.0

Cardiac Techs

3.80 3.80 1.0

Physio

1.60 1.50

Pharmacy

2.00 1.00

Admin

23.40 9.08 9.36 14.1 9.3

Nursing

46.20 33.0 34.7 37.8 40.0 30.4 28.6 26.1 31.6 27.6 29.6 31.5 25.5 33.3 33.3 32.7 31.7 34.3 37.3 44.8 41.3 42.0

HCA

34.80 16.2 22.7 23.2 24.4 29.8 30.8 38.2 38.4 52.1 56.9 32.1 17.7 26.1 25.3 34.5 34.5 33.9 36.6 41.6 35.7 39.4

House-Keeping 10.40 0.16 Physics

4.30 2.6 1.6 1.09 0.92 0.75 0.66 0.46 0.83 0.83 0.83 0.83 0.83 0.83 0.83 0.23

Catering

3.00 8.5 2.0 2.7 1.8 6.9 3.9 0.9 1.2

Social Work

1.00 0.5

Occ Therapy

1.00 0.37

Dietician

0.50 0.3 1 1 1 1 1 1 1 1 1 1 1 1 1

Medical

11.00 5.27 4.77 4.4 6.35 5.86 7.97 15.73

Consult

0.25 0.38 1.62 0.6 0.34 2.9 3.94

NCHD

2.47 6.7 2.99 2.84 1.87 1.82 2.83 2.94 2.15 2.34 1.54 0.8 1.18 3.04 164.5 99.7 91.1 98.26 84.7 74.6 71.9 81.4 76.75 88.23 91.70 69.89 46.9 63.05 63.26 71.37 69.95 71.88 76.4 91.1 83.12 85.44

SLIDE 49

CUH AGENCY COSTS €k 2015 - 2017

SLIDE 50

Acute Nursing Agency WTE 2015 to 2017 Acute HCA Agency WTE 2015 to 2017

51

SLIDE 51

CUH Average Nursing & HCA Agency WTE’s per Week 2015-17 CUH Average Specials /Other Nursing & HCA Agency WTE’s per Week 2016-17

SLIDE 52

53

CUH Nonpay-Budget v Actual YTD September 2017

Budget Actual Variance Actual YTD 2016 Diff 2017-16

Medicines 24,434 25,731

(1,298)

23,448

(2,283)

Medical & Surgical 22,174 23,023

(849)

21,698

(1,325)

Blood 3,705 4,273

(568)

3,824

(449)

Medical Gases 313 338

(25)

319

(19)

Medical equipment 3,358 3,703

(345)

3,513

(190)

Radiology 4,123 4,497

(374)

4,008

(489)

Provisions 1,538 1,600

(62)

1,493

(107)

Catering 369 336 33

384

48 Cleaning/Waste 2,847 3,182

(335)

2,894

(287)

Laundry 1,370 1,380

(9)

1,382

2 Energy 2,305 2,353

(48)

2,400

46 Bedding/ clothing 308 358

(50)

324

(33)

Furniture 137 191

(54)

204

13 Pathology 7,835 7,873

(38)

8,677

804 Maintenance /Grounds 547 673

(126)

614

(59)

Transport /staff travel 1,414 1,436

(22)

1,517

81 Office expenses 1,473 1,666

(193)

1,465

(201)

Telecommunications 350 371

(20)

354

(17)

Computer 888 809 78

905

96 Administrative expenses 5,568 8,722

(3,154)

5,617

(3,105)

Staff recruitment/training 557 526 31

540

14 Miscellaneous 1,218 944 273

1,290

345 TOTAL NON-PAY 86,830 93,986

(7,156)

86,871

(7,115)

Less Bad debts

938
3,455

2,517

3,511
(56)

NON-PAY excl Bad Debts 85,892 90,531

(4,639)

83,359

(7,172)

SLIDE 53

CUH Actual Non-pay expenditure €k August 2017 v 2016

SLIDE 54

CUH Bed Occupancy 2017 v 2016

147 145 139 151 128 130 120 123 125 117 120 108 115 113 111 114 110 111 107 117 119 100 110 120 130 140 150 160 jan feb mar apr may jun jul aug sep

ct

nov dec

CUH Bed Occupancy 2017 v 2016

2016 2017

SLIDE 55

Patient Income 2015 –2017

SLIDE 56

C U H Ot her Income Y TD Sept ember 2 0 17 Income B udget € k A ct ual € k V ariance € k R ent al income 3 3 5 72 2 3 8 7 B equest s/ D onat ions 117 13 9 2 2 R esearch grant s 2 2 8 16 3

( 6 5)

C arpark 1,73 1 2 ,2 13 4 8 2 D rug rebat es / PC R S 7,8 2 1 7,8 9 5 74 M isc 116 10 5

( 11)

10 ,3 4 8 11,2 3 7 8 8 9 C U H R ecoupment s and R ef unds Y TD Sept ember 2 0 17 Income B udget € k A ct ual € k V ariance € k R ecoupment s Pay 6 8 7 79 2 10 5 R ef unds- Pay 13 0 10 6

( 2 4 )

R ef unds- Ot her 18 1 8 8

( 9 3 )

U nclassif ied 153 14 2

( 11)

1,151 1,12 7

( 2 4 )

SLIDE 57

CUH Debtor Days Consultant Claims

September 2017

SLIDE 58

59

Cost Containment Initiatives update at 30/9/17

TARGET

JAN/F EB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

ACTUAL

Unrostered overtime-DIT 250 50 50 50 50 50 2 Reduction in Medical agency 300 30 30 30 30 30 30 30 30 30 30 236 99 53

43
45

117

24
4

82 3 Drug savings 4 Procurement (NDC) one-off & recurring 600 60 120 120 120 180 5 Reduce Waste costs 30 5 5 5 5 5 5

105
39
26
40

6 Reduce Energy costs 30 5 5 5 5 5 5 8 7 7

6

7 Reduce Bad debts 8 Blood science savings 1,000 100 100 100 100 100 100 100 100 100 100 905 74 70 165 162 40 100 152 142 9 Additional cafe income 330 140 110 10 10 10 10 10 10 10 10 229 4 9 38 170 20 7

18

10 Recode Clinical trials expenditure 100 100 100 100 11 Recode Donated funds expend 200 200 12 Replace pressure relieving mattresses 75 75 13 Additional non patient income 482 482 TOTAL-Target 2,840 270 240 140 240 150 260 320 320 320 580 TOTAL- Actual 1,930 177 132 160 117 327 164 136 717

SLIDE 59

MGH - Finance Report – September 2017

Mallow YTD September 2017 outturn

Gross pay & non pay budget €15.16m (2016:€13.4m)
Actual pay & non pay €15.54m (2016:€13.5m)
Actual deficit €389k (-3%)

Less Adjustments €324k increase in Bad debts provision €223k LRA Restoration unfunded €85k living out allowance €16k Adjusted deficit €65k (-0.4%) (2016:€87k/-0.7%) Mallow Income outturn

Income budget €2.67m (2016:€2.57m)
Actual Income €2.74m(2016:€2.42m)
Actual surplus €66k (3%) (2016:Deficit €150k/-6%)

SLIDE 60

BGH - Finance Report – September 2017

Bantry YTD September 2017 outturn

Gross pay & non pay budget €15.57m
Actual pay & non pay €16.11m
Actual deficit €535k (-3.4%)

– Less Adjustments €355k – Increase in Bad debts provision €92k –

St. Josephs ward €168k

– LRA Restoration unfunded €78k – Living out allowance €14k – Waiting list initiative €2k

Adjusted deficit €180k (-1.16%)

Bantry Income outturn

Income budget €2.7m
Actual Income €2.7m
Actual surplus €6k (0.2%)

SLIDE 61

Capital Projects

Project Status Paediatric Unit Phase 1 - build programme completed Phase 2 – funding received – proceed to Design Stage Radiation Oncology Unit  Builder commenced on site on Monday 20th February Education and Training Centre Draft Statement of Need completed and discussion

ngoing with UCC

Meeting held with UCC Blood Sciences Project Design Team appointed Infrastructural works are near completion Oncology Service  Expansion of Day Unit – plan signed off – submitted for Philanthropic funding (ACT)  Refurbishment of Ward 2D – capital funding in place  Medical Oncology Centre – developing Statement of Need Ophthalmology Transfer – Phase 2  Project group in place  Application for planning permission submitted  Tender Pack being prepared Helipad Meeting held with the IAA Ground Level Helipad the agreed option

SLIDE 62

Key Issues

Structured Overtime Pay controls clearly working Need for change in accounting for PCRS funded drugs Bad Debts

PF17 working well Challenge with complex discharges Ophthalmology service risk CAMHS Pharmacy Review Quality Strategy National Quality Survey Unscheduled Care Process Day Surgery Unit

INMO relations working well Implementation of change programme in Catering/Housekeeping Sick Leave Focus HR recruitment workload Grading of staff must be addressed

Finance Patient Access Quality & Safety

Patient and Service User

Human Resource