CIHRT Exhibit P-0487 Page 1cihrt.nl.ca/exhibits/april 28 2008/p-0487_2006 minutes of eastern... · Approved Minutes of Executive Management meeting held 17 February 2006 at 9:30 a.m

CIHRT Exhibit P-0487 Page 1













Approved Minutes of Executive Management meeting held 17 February 2006 at 9:30 a.m. Conference Room "A" - Corporate Office, St. John’s. Present: George Tilley, Chief Executive Officer Chairperson George Butt, Vice President Pat Coish-Snow, Chief Operating Officer (via conference call - Clarenville) Stephen Dodge, Vice President Alice Kennedy, Chief Operating Officer Louise Jones, Chief Operating Officer Pat Pilgrim, Chief Operating Officer Fay Matthews, Chief Operating Officer Dr. Robert Williams, Vice President Susan Bonnell, Director Corporate Communications Joyce Penney, Executive Assistant Regrets Beverley Clarke, Chief Operating Officer Wayne Miller, Senior Director ------------------------------------------------------------------------------------------------------------------ George Tilley welcomed Pam Elliott to the Executive Meeting. Presentation: Clinical Safety Dr. Williams lead the discussion outlining the current environment within Eastern Health and the need for a new approach to advance our quality enhancement program. The recent visit to Calgary Health was considered beneficial. Calgary Health has invested significantly in their Quality Program. Copies of the organizational structure for Calgary Health, including the Clinical Safety structure were circulated for information. Pamela Elliott, Director Quality Enhancement circulated draft documents to guide the discussion on the proposed structure and direction for quality and risk services. Discussion on proposed draft organizational chart date February 17, 2006 included:

Administrative Policy & Procedures Executive was supportive of transferring the Administrative and Policy & Procedures to Corporate Strategy and Planning. Accreditation The pros and cons of aligning the accreditation lead within the quality portfolio was discussed. Accreditation is a tool to ensure safety. Executive was supportive of aligning the lead for accreditation into the Quality Enhancement portfolio.














Approved Executive Management 15 March 2006

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3.12 Recruitment - Vice President Quality, DI, & Medical Services -The Search Committoo (Dr. Justi Arthur, Dr. Cindy Whitman, Dr. William Pollett, Fay Matthews and George Tilley) had an initial mooting (conferen call) to review the candidates. The scheduling of interviews has boon challenged/delayed due to the availability of the candidates. It is anticipated that the initial interviews will conclude by the end of March.

The interview process for the final candidate will include a sub- group of Executive.

3.13 Child Youth Advocate Office







Executive Management Committee April 5, 2006 9 a.m. Conference Room A, Corporate Office

Present: George Tilley, CEO, Chairperson George Butt, VP, Corporate Services Beverley Clarke, COO, Community &

Children, Mental Health/Addictions Pat Coish-Snow, COO, Peninsulas by

conference Stephen Dodge, VP, People & Information

Services Louise Jones, COO, Adult Acute Care (St.

John’s) Attending:

Susan Bonnell, Director of Corporate Communications Mary Haynes, Executive Assistant The focus of this meeting is on the Budget 06/07 and the budget letters from the Deputy Minister, Health and Community Services dated March 30, 2006. As a result, the minutes of March 29 and other agenda items are deferred until the next meeting.

Action By: 1. Minutes of the Last Meeting The minutes of March 29, 2006, are deferred.

2. 3.

Business Arising from the Minutes - deferred New Business 3.1. Budget 06/07

The operating and capital budget letters have been received from the Department of Health and Community Services. Ms. Sharon Lehr, Director of Budgeting, was welcomed to the meeting to provide a high-level overview of the budget. Following a preliminary review of the budget, Executive Team identified the following concerns: o capital funding for equipment and infrastructure, specifically neurocoiling o funding for inflation and budget adjustments

Alice Kennedy, COO, Long Term Care Fay Matthews, COO, Rural Avalon Wayne Miller, Senior Director, Corporate

Strategy & Research Pat Pilgrim, COO, Cancer, Children’s & Women’s Health, Rehabilitation/Continuing

Care & Professional Development Robert Williams, VP, Quality, Diagnostic &

Medical Services


Executive Management Committee Minutes April 5, 2006 2

o MDS/RAI funding o training for skill mix in long-term care (potential for reallocation) Issues for consideration: o is the projected deficit of $2.8 million realistic o does this budget allow the organization to provide the same level of service

it provided in 05/06 o strategies to balance the budget o potential debt repayment and development of contingency fund to cover

unexpected pressures o will increase the organization’s credibility o requires savings and cost reductions

o pursue savings and position the organization to enable debt repayment o clarification of cost variance and volume or efficiency variance o administrative savings to be achieved this year - $2 m annualized o WHSCC savings potential for a portion to be allocated to health and safety

to ensure premiums are kept to a minimum and further reduced The Budget Analysts have been requested to recommend how the budget should be allocated to the programs and departments, as well as allocate a contingency fund to cover unexpected issues. Ms. Lehr began with a review of the approved funding ($25.2m) versus requested funding ($37.2m). Our original submission included a prior year’s debt repayment of $7.5 million. Budget 2006-07 makes no provision for the repayment of accumulated operating deficits; however, we are asked to make best efforts to begin this process. Therefore, for comparative purposes, the $37.2 million request is reduced to $29.7 million. Based on this allocation, Eastern Health will be challenged to meet a projected shortfall of $3.7 million on current operations. This will necessitate continued fiscal restraint to keep our operating expenses in line with available funding and limiting expenditure growth where possible. One known area of expenditure growth that has not been funded relates to cancer patients who will travel out of province for radiation therapy.



Budget Pressures 06/07 Negotiated salary increases assumed they will be funded Permanent funding for CYFS temporary positions - $1.3 m (not included in the base) Ms. Clarke indicated that the Department confirmed this funding, plus 4 additional positions and is expected to be addressed in a separate letter. 3. Previously submitted proposals (CYFS, Minimum Data Set/Resident Assessment) $3.9 m. Funding received for Breast Screening. Ms. Kennedy advised that Government has indicated that funding for MDS/RAI may be provided through an alternate means. As indicated earlier, Ms. Clarke advised Government has confirmed funding for CYFS positions. However, there will be space issues related to these new positions. 4. Utilization/Growth - $2.8 m requested. Funded $756,855 for Dialysis Growth. Funding for growth in other areas (Ambulatory, Angio and Occupancy) may have to come from $.4.5 m in funding for general pressures. 5. Utilization/Workload - $6.6 m requested. Received $2.1 for home support growth, $1.1 for home support wait list and 18 additional public health nurses. 6. Patient Safety - $1.1 m requested. No funding received. 7. New Drugs - $5 m requested. Received $1.5 m for Herceptin and $6.3 m (provincially) for other cancer drugs 8. Maintenance/Renovations - $2 m requested not funded. 9. Equipment Repairs - $0.7 m requested not funded. 10. Good Clinical Practice - $6.8 m requested not funded. 11. Provincial Strategic Priorities - $3.9 m requested - $158,700 funded for All Hazards Emergency Preparedness. Funding for Communicable Disease Control is addressed in the additional Public Health Nurse positions. Mental Health Strategies - $1 m (provincially). 12. Provincial Programs/Legislative Changes $1.9 m requested. Funded: Interns/Residents - $450,000, Operational Costs CT in Burin - $175,000, support for devolved programs - $116,000 13. Decision Support - $2.5 m requested. $111,700 funded for Waitlist Management 14. Recruitment - $0.4 m requested not funded.

1. 2.



Ms. Lehr also identified budget adjustments received but not included in original request. Items which were omitted from the schedule and not annualized for 06/07 are: o o o o o o

Herception 05/06 - $560,000 Mental Health Initiatives - $273,700 Wellness Initiatives - $183,400 Detoxification Services - $677,062 Ambulance Programs - $43,500 Audiology Cochlear Implants - $45,000

The budget decisions (provincial) not on the schedule but which Eastern Health will receive a share of were also reviewed. A number of budget decisions for Eastern Health which are not on the schedule were noted. Specific reference was made to $350,000 for Invitro Fertilization. This was approved by Government as a result of lobbying by a physician. Executive Team expressed concern with budget decisions being made without Executive Team involvement and the impact this has on other programs/departments, as well as the broader budget. Capital Equipment - $18m requested - $5.7 approved $3.3 of which is for bunkers. Capital Projects - requested $82 m funded $4.9 m

Due to a prior commitment, Mr. Miller withdrew from the meeting. Discussion:

The presentation concluded, and the following issues and concerns were identified:

o difficulty in identifying funding o confusion related to outstanding provincial issues and allocation of funding

for items not requested o targeted funding restricts how funding can be used o lobbying by staff without involvement of Executive Team o a provincially driven operational and strategic plan and targeted budget

does not address critical regional issues o caution on approach to Government o analysis of the financial impact of budget decisions.



o development of key internal messages and strategies o in consultation with the Department, the need for the development of a

framework for budget submission (may be a reflection of where the organization is in its development)

o balancing FMM money while finding efficiencies will create tension and anxiety for managers

o assuming that Government has limited discretion and in the absence of additional funding for space or capital, we will need to focus on efficiencies and how resources are allocated.

Following discussion, Executive Team agreed that the budget is positive and issues of importance have been recognized. However, the full allocation to Eastern Health is as yet unknown. Outstanding issues will have to be resolved and may require limiting growth or pursuing savings within the organization. Growing the organization through integration and dealing with consolidation at the same time has added additional pressures not anticipated last year. The issue of priorizing the major items not addressed in the budget was raised, i.e. capital funding, patient safety, home infusion, renovations, tertiary care utilization pressures, impact of rate increase for personal care homes and eligibility, general budget pressures, etc. It was agreed that items be priorized by Executive Team as a group rather than by portfolio. Specifically, concern was noted as follows: o increases in positions without increases in program budgets, i.e. space,

supplies, etc. o consolidation of administrative services while growing the organization Follow up: o Mr. Butt and Ms. Lehr will follow up on the accounting/financial issues

related to budget omissions o specific issues will be referred to the appropriate COO o a list of the concerns and issues will be provided by the COOs o Mr. Tilley will respond to the Deputy Minister focusing on:

o the budget omissions o targeted funding means efficiencies will need to be pursued to fund

budget omissions

Butt/Lehr

COOs Tilley















































Executive Management 21 November 2006 2

The following points were raised during the presentation: The organization cannot speak publicly on the findings and recommendations of the Review because there is currently a class action law suit ongoing. This information is protected under the evidence act. Discussion ensued regarding the need to share the experience with the other pathologists within the province. Dr. Howell and Dan Boone to discuss further prior to making any discussion to discuss the Reviewers report with the provincial pathologists. There is no National Laboratory Accreditation process for Immunohistochemical Laboratories. Ontario and the Western provinces have provincial accreditation programs, however the Atlantic provinces do not. Prior to 1995 the Laboratory was accredited under the broad blanket of CCHSA accreditation. Participation in an Accreditation Program is a high priority on multi levels. Dr. Howell to inquire further regarding provincial and national accreditation programming for Laboratories. We have to position ourselves appropriately so that the public has confidence in the laboratory and that the people who have been waiting for information to have confidence and understanding of the events related to ER/PR testing. A sub-group will be established to identify key messages to be delivered and develop a strategic communication plan. Dr. Howell in conjunction with Susan Bonnell to lead a Sub-Group to develop the communication strategy. The importance of stabilizing the workforce in the laboratory cannot be emphasized enough. It was noted however that there are currently vacancies in pathology. Dr. Howell advised that efforts to recruit for the vacancies in pathology is ongoing. The organization needs to establish a date when it will return to "testing mode". Returning to "testing mode" requires the confident of the oncologists and medical staff. Executive agreed to extend ER/PR testing at Mount Sinai for another month. The Medical Advisory Committee is a key group that confidence will need to be restored. The MAC has a major quality role and a direct line for reporting to the Board. Dr. Howell to follow-up with MAC. Quality & Risk Management are confident that that the appropriate processes are in place. Heather Predham advised that there are some recommendations from the Review that have yet to be implemented. It is important to ensure that quality assurance monitoring processes are in place and can be sustained and monitored into the future. Documentation is of paramount importance and must be monitored and reviewed. The Director and Clinical Chief are directly accountable for the laboratory. Dr. Howell agreed to develop a proposal re the leadership component for further discussion at Executive.

In conclusion George Tilley thanked Dr. Denic and his team for the comprehensive presentation.







Documents

CIHRT Exhibit P-0487 Page 1cihrt.nl.ca/exhibits/april 28 2008/p-0487_2006 minutes of eastern... · Approved Minutes of Executive Management meeting held 17 February 2006 at 9:30 a.m