REGINA QU’APPELLE REGIONAL HEALTH AUTHORITY July 20, 2016 ____________________________________________________________________________________________________________________ Integrated Health Services – Executive Summary Sharon Garratt, Vice President Our Integrated Health Services portfolio has 1344 FTE’s and a total operating budget of $187. 7 million. It includes the following five service lines, a Kaizen Operating Team and RGH and PH site managers. Portfolio Executive 16/17 FTE 16/17 Budget (million’s) Director/Director Budget Surgical Care Services Sandy Euteneier 658 $100.8 Women’s and Children’s Health Nicki Bayfield-Ash 405 45.9 Integrated Renal Program Diane Kozakewycz 125 18.4 Ambulatory Care and Medical Outpatients Bev Alfano 147 21.4 Clinical Quality & Professional Practice Gillian Oberndorfer 7 0.8 Successes: The Medical Diagnostic Reprocessing Department transitioned from IHS-Clinical Support to the Surgical Service Line effective April 2016. The Operating Rooms are MDRD’s largest customer , so the realignment creates considerable opportunity to improve processes and gain efficiencies. With Marlene Smadu’s retirement Clinical Quality and Professional Practice moved to our portfolio in order to sustain senior nursing/clinical leadership. Surgical Services delivered the surgical volume funded by MoH in 15-16, and spent $8.9million less than 2014-15. Financial managers developed a tool to assist managers in understanding and monitoring their staffing budgets on a daily basis. In 15-16 the vigilance by managers helped us achieve a positive variance of $3.3million; decrease paid hours by 1.25%, overtime by 9.6% and orientation by 21.4% compared to previous year. KOT supported all service lines to implement daily visual management and daily/weekly huddles. Challenges: Most of the programs are faced with pressures from growing demands. Surgical demand grew by >13% last year, resulting in considerable increase to the number of people waiting >3 months in spite of delivering on the funded surgical volume. Aging infrastructure at RGH & PH has the potential to affect our ability to safely provide services e.g. electrics challenges in OR’s, reprocessing area in Endoscopy does not meet standards. Insufficient capital equipment funding and ineffective prioritization processes have resulted in considerable deficits in equipment that may affect our ability to meet accountability targets in a number of areas. The steps underway to improve the processes should help to target available resources more effectively. We need to implement the Open Family Presence Policy in a way that support patients and families while maintaining safety and security for all patients and staff. Effective implementation of the Business Plan is dependent on front line managers and we are working to outline realistic expectations and provide the supports they require to be successful. Prepared by: Sharon Garratt, VP, Integrated Health Services Date: July 8, 2016
Integrated Health Services Vice President Sharon Garratt Executive Assistant Surgical KOT Director Andrea Deregowski Brent Kitchen Director Specialized Director Director Specialized Executive Director Executive Director Ambulatory Care Clinical Quality & Ambulatory Care Women’s & Children’s Ambulatory Care & Medical Surgical Services Professional Practice Kidney Program Health Outpatients Sandy Euteneier Gillian Oberndorfer Diane Kozakewycz Nicki Bayfield-Ash Bev Alfano Manager Clinical Manager Confidential Assistant Ambulatory Care RGH & PH & Suann Wolf Hemodialysis Manager Director Surgical Access & Director Director Infectious Diseases Clinic Project Manager Site Managers Shelley Stamm Pediatrics, RGH Inpatient Services Perioperative Services Surgical Support Susan Jackiw Faye Matthews RGH Lorie Kinneberg Barb Neumann Sheryll Inkson Pam Hawkins Stacey Cortes Charolette Bater Manager, Integrated Manager, Labour & Birth Manager Monica Gretchen Manager Renal Programs Manager - OR Perinatal Outreach Pgm Manager – Unit 5A RGH Business Manager Eye Centre, Enterostomal Deborah Huys Trauma Program Edward LeBlanc RGH - Lois Schatz Michelle Downton Jodi Foley Kevin Krepakevich Therapy & Dermatology PH Jamie Appel PH – Ginette Marchildon Karen Kimpton Brenden Wallace Manager Victoria Case, Business Manager Manager NICU Delasi Essien Utilization Analyst Manager - PACU Manager – Unit 5F RGH Hemodialysis & Deborah Huys Special Projects Tom Sorensen Manager – Endoscopy, GI Dmytro Rukas RGH – Debra McCabe Ryan Purdue Ingetrated Renal Jennifer Erickson Unit & HTPN PH – Janelle Mazur Programs Brenda Johnson Manager, Mother/Baby Lisa Cairns Unit & Maternity Visiting Confidential Assistant Manager – 6A RGH Confidential Assistant Katelyn Forsythe Program Manager – Day Surgery Deb Kosabek Shayna Klein Myrna Weisbrod RGH – Debra McCabe Confidential Assistant Terena Palmer PH – Janelle Mazur Manager Manager – 4C PH Women’s Health Centre Manager – Short Stay Blair Broadfoot Fetal Assessment Unit RGH – Deb Kosabek Rawlco Centre Hostel PH – Connie Fiorante Jacki Shannon Manager – 4D PH Manager Connie Fiorante Manager - Surgical Patient Children’s Program WRC Information Management W&C Social Work Emilie Jewett-Curley Kim Woycik Manager Pre-Admission Clinic Manager Tom Stewart Pediatric Homecare & Pediatric Outpatients RGH Manager - Surgical Clinical Tamara McDermit Pathways June 1, 2016 Lilyans Zelada
Integrated Health Services Sharon Garratt Regina Qu’Appelle Regional Health Authority Board Presentation July 20, 2016
Portfolio Overview • Surgical Care Services • Women’s and Children’s Health – RGH & PH Site Managers • Integrated Renal Program • Ambulatory Care & Medical Outpatients • Clinical Quality and Professional Practice • Kaizen Operating Team
Ambulatory Care & Medical Outpatients Ambulatory Care RGH & PH: Surgical Procedures; Infusion/Transfusions; Cast Clinic; Physician Consultation Infectious Diseases Clinic RGH: Diagnosis & ongoing Therapeutic care, Strong Research Ambulatory Care & Medical Outpatient focus Visits Eye Centre PH: Diagnostics & Therapeutics; Low Vision Clinic; Eye Bank; Orthoptics 120000 Clinic 100000 Enterostomal Therapy PH & RGH 80000 60000 (community consultation support): Ostomy 40000 Care, Wound Care 20000 Dermatology PH: Phototherapy & other 0 treatments; Allergy patch testing 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Home TPN PH, RGH & Community: Parental nutritional teaching inpatient followed to home support GI/Endoscopy: Gastroenterology endoscopy; Bronchoscopy; Cystoscopy; Capsule Endoscopy; and various diagnostics
Ambulatory Care & Medical Outpatients Successes: • Replacing current end of life Endoscopy Electronic Health record • Increased Anesthetist support to GI/Endoscopy patients requiring deep sedation during procedures • Colonoscopy CO2 insufflation improves patient comfort • Provincial/RQHR Cost Per Procedure contract for specialized Endoscopy equipment throughout RQHR Challenges: • Not meeting accreditation standards in reprocessing area Endoscopy - renovations pending • Recruitment of fully qualified/credentialed personnel for specialty programs • Ongoing replacement of aging equipment such as scope high level disinfectant reprocessors • Allocation of clinic time for physicians given limited resources/space • Increasing volumes of patients especially in Transfusions to reduce patient visits to Emergency.
Integrated Renal Program Hemodialysis Treatments 40000 35000 30000 25000 20000 15000 10000 5000 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Integrated Renal Program Integrated Renal Program 800 700 600 2010/11 500 2011/12 400 2012/13 2013/14 300 2014/15 200 2015/16 100 0 Home Peritoneal Chronic Kidney TPE Organ & Tissue Hemodialysis Dialysis Disease Donors
Integrated Renal Program Successes: • Implemented a Patient and Family Advisory Committee • Introduced primary care model in Hemodialysis Unit • Implemented draft policy on routine reporting of all deaths to Transplant Program, researched impact • Cross trained Home Dialysis staff which eliminated duplication of on-call staff. Challenges: • Align staffing model with Saskatoon Health Region (SRNA/SALPN challenges affect) • Transplant Program will respond to revisions in Human Tissue and Gift Act
Perinatal and Women’s Health Perinatal & Women's Health Activity 12000 10000 8000 2010/11 6000 2011/12 2012/13 4000 2013/14 2000 2014/15 2015/16 0 Women's Labour & Labour & Mother NICU Health Birth - Birth - Baby Unit (patient Centre outpatients deliveries (patient days) Fetal Assessment Unit Visits days) 6000 5000 Fetal Assessment 4000 Unit 3000 Maternal Fetal Medicine 2000 Pregnancy & 1000 Diabetes Clinic 0
Children’s Health Children's Health 10000 9000 8000 7000 2010/11 6000 2011/12 2012/13 5000 2013/14 4000 2014/15 3000 2015/16 2000 1000 0 Pediatric WRC - Children's Pediatrics - 4F Outpatient Unit Program (patient days)
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