MANAGING HEALTH RESOURCES: A FOUNDATION WORKSHOP GETTING STARTED • Acknowledgement of Country and Elders • Acknowledgement of Carers • Housekeeping • NSW Health CORE values: - Collaboration - Openness - Respect - Empowerment 1
SESSION OUTLINE TOPIC DURATION Introduction and goal setting 15 minutes Finance basics Activity 1 – Finance terminology 1 hour and 15 minutes Activity 2 – Principles of resource management Optional Topics 40 minutes Morning/afternoon tea 15 minutes Learning activities 1 hour 20 minutes Wrap up 15 minutes Close Total 4 hours OBJECTIVES What do you want to achieve from this workshop? 2
HEALTH FUNDING • The cost of providing health care has been steadily rising over the past few decades • A focus on efficiency and accountability is essential and will remain central to service provision in the future • The Commonwealth will continue to contribute to ABF funded services until June 2020 • Priorities for NSW Health services: - Improving patient access - Ensuring sustainability of funding - Improving the transparency of public hospital funding THE FLOW OF FUNDS ABF: Activity Based Funding Non-Admitted: eg Outpatient; Community Clinic Sub & Non-Acute Admitted: eg Rehab; Palliative Block Funding: ie. Not Activity Based Funding Interim Funding Model: eg Commonwealth contribution to the cost of Chemotherapy TTR: Teaching, Training and Research RACS: Refugee Advice and Casework Pillars: eg HETI; NSW Cancer Institute; NSW Bureau of Health Information 3
FINANCIAL TERMINOLOGY YTD, variance, favourable, ABF … Are you confident? ACTIVITY 1: FINANCIAL TERMINOLOGY Read Sally’s case study. We will then look at her cost centre’s financial report together. 4
SOME REPORTED CATEGORIES Categories are high level totals of individual “line - items.” For example, the expense category called Goods & Services might comprise the line items: • Drugs • Medical and Surgical Supplies • Food • Admin expenses • Travel • etc. THE MONTH JUST ENDED The first figures we look at are the figures for the month just ended – in this example, the month just ended is September. If we The actual expenses and do this while our memory revenues for the same of what actually happened month of the previous year in the month is still fresh, it are often listed. This allows is easier to recall and a useful comparison with explain the unexpected the month just ended. events that caused the variances. 5
THE YEAR TO DATE (YTD) We were overspent on Goods and Services To help us to (G&S) in the month of understand whether a September by $3,077, variance in the month which is roughly 11% of is just a one-off or the budgeted figure of part of a trend, the $23,073. Year To Date (YTD) However, this 87% figures are useful. unfavourable variance on G&S for the three months to date shows that the overspend in September is not just a on-off, but is part of a significant trend. ACTIVITY 1: PARTS 2 TO 3 Part 2: Review the budget then, working in your group, answer the questions in the table Part 3: Working in your groups, match the line items to the categories 6
PRINCIPLES OF RESOURCE MANAGEMENT • Ownership • Communication • Proactivity • Balance What are some practical ways to implement these principles? ACTIVITY 2: PRINCIPLES OF RESOURCE MANAGEMENT • We also need to consider NSW Health’s CORE values: - Collaboration - Openness - Respect - Empowerment 7
A – PART 1: THE STAFFING SOLUTION Question 1: What are some of the causes of overspend in employee related expenses in your cost centre? To help you consider this question it is worth first having a look at the table summarising the suggested solutions to staffing challenges and workforce issues developed for Emergency Departments … SUMMARY OF ACTION AREA/STRATEGY OPTIONS 8
COMMON CAUSES OF OVERSPEND IN EMPLOYEE RELATED EXPENSES • Increased need for services in winter • More staff sick leave in winter • Recruiting above salary allocation for a position • A person’s wages being incorrectly charged to a cost centre (e.g. if they have transferred to another department, but their wages continue to be allocated against their original cost centre) • Staff who have excess leave and must take a significant amount of time off; leading to the need to cover their shifts with agency or casual staff THE STAFFING SOLUTION Question 2: When there are staffing shortages is it better to use agency and casual staff; or ask permanent staff to work overtime? 9
AGENCY, CASUAL OR PERMANENT STAFF? To calculate these costs: • Assume an average annual salary of $100,000 (i.e. an RN8) • To calculate part time, do not change the base figure • To calculate overtime, add 100% to the base figure • To calculate casual staff, add 15% to the base figure • To calculate agency staff, add 25% to the base figure (for agent’s fees) Remember cost is only one of the factors we need to consider. Other factors must include: • What is the best for the patients, and • What is the best for the staff? THE STAFFING SOLUTION Question 3: What can you do if you are consistently exceeding your budget for employee related costs? 10
EXCEEDING EMPLOYEE RELATED COSTS • Review the rosters and staff mix • Create a casual pool or relief pool • Review your training and recruitment strategies • Consider when annual leave occurs • Temporarily redeploy staff to meet patient needs • Fully utilise employees on workers compensation • Obtain additional staff – build a business case • Ask for professional advice from finance manager A – PART 2: REFLECTING ON STAFFING CHALLENGES If you were taken ill tomorrow … 11
Question 1 If a member of your team suddenly needed leave for a week, how would you cover their workload? What if they needed indefinite leave – how might that change your approach? What if you were the one who needed leave? Question 2 What challenges (if any) have you had with maintaining adequate staffing numbers in the last year? Are there any trends? Question 3 How could you delegate responsibilities and give junior staff opportunities to learn new skills without compromising patient safety? A – PART 3: THE BENEFITS OF TRAINING Could we do things better if we up-skill? 12
“A local podiatrist visits our hospital monthly to attend to the foot care of our patients. This costs $1,100 per month. Often we have a list of 20 or more patients waiting for this service, but the podiatrist can only see 15 or so. We then escort individual patients to the podiatrist’s premises, at a cost of $85 per appointment. A local training company offers a ‘Basic Foot Care for Nurses’ course at a cost of $210. This would allow a nurse to complete basic foot care services for patients. Then only the complex or high risk patients would need to be seen by a podiatrist.” “In our maternity ward the usual antenatal care process involves blood testing at regular specific times during the 40 weeks of pregnancy for healthy well women. Early last year we identified the pathology costs for outpatients were steadily increasing. On further investigation we realised the pathology forms were not being filled out correctly: a small tick box was not checked and a patient signature not included. Pathology tests were being charged to the antenatal clinic rather than to Medicare. Educating our staff on how to complete these forms correctly could potentially save us $15,026 each year.” 13
A – PART 3: THE BENEFITS OF TRAINING Do you have an example of how engaging in training contributed to positive outcomes in your workplace? ACTIVITY B: STRATEGIC SUPPLIES AND CONSUMABLES This activity will share NSW Health examples of cost saving through changing the way stock and supplies are managed. 14
B: STRATEGIC SUPPLIES AND CONSUMABLES SWOT analysis: • Strengths • Weaknesses • Threats • Opportunities B: STRATEGIC SUPPLIES AND CONSUMABLES Strengths: • Will there be a cost saving? • Will there be a benefit to patient care? • Will there be increase in staff well-being? • Will it develop a more effective process? • Will it reduce waste? • Will it save time? 15
B: STRATEGIC SUPPLIES AND CONSUMABLES Weaknesses: • Will there be an expense? • What is the time required to research, plan and implement? • Does it require staff retraining and engagement? • Will it lead to negotiating supplier agreements? B: STRATEGIC SUPPLIES AND CONSUMABLES Opportunities: • Skill development? • Cost re-distribution? • Try or use potentially superior resources? • Improve standards? • Inter-departmental collaboration? • Staff empowerment? • Is the recommended solution based on contemporary evidence and agreed best practice? 16
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