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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
Director/Director 16/17 FTE
Budget 16/17 Budget
(million’s)
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
Vice PresidentSharon Garratt
Executive AssistantAndrea Deregowski
Integrated Health Services
Surgical KOT DirectorBrent Kitchen
June 1, 2016
Director SpecializedAmbulatory CareKidney Program
Diane Kozakewycz
Director SpecializedAmbulatory Care
Ambulatory Care & MedicalOutpatientsBev Alfano
Clinical ManagerHemodialysisShelley Stamm
Business ManagerHemodialysis &
Ingetrated RenalProgramsLisa Cairns
Manager, IntegratedRenal ProgramsEdward LeBlanc
ManagerEye Centre, EnterostomalTherapy & Dermatology
Karen Kimpton
ManagerAmbulatory Care RGH & PH &
Infectious Diseases ClinicSusan Jackiw
Manager – Endoscopy, GIUnit & HTPN
Brenda Johnson
Executive DirectorSurgical ServicesSandy Euteneier
DirectorPerioperative Services
Pam Hawkins
Director Surgical Access &Inpatient Services
Barb Neumann
Manager - ORRGH - Lois Schatz
PH – Ginette Marchildon
ManagerPre-Admission Clinic
Tom Stewart
Manager - Surgical PatientInformation Management
Emilie Jewett-Curley
Project ManagerFaye Matthews
Utilization AnalystDmytro Rukas
Manager – Day SurgeryRGH – Debra McCabe
PH – Janelle Mazur
Manager - Surgical ClinicalPathways
Lilyans Zelada
Manager – Short StayRGH – Deb Kosabek
PH – Connie Fiorante
Manager – Unit 5A RGHJodi Foley
Manager – Unit 5F RGHRyan Purdue
Manager – 6A RGHDeb Kosabek
Manager – 4C PHBlair Broadfoot
Manager – 4D PHConnie Fiorante
Manager - PACURGH – Debra McCabe
PH – Janelle Mazur
DirectorSurgical Support
Sheryll Inkson
ManagerSpecial ProjectsJennifer Erickson
Business ManagerKevin Krepakevich
Confidential AssistantShayna Klein
Executive DirectorWomen’s & Children’s
HealthNicki Bayfield-Ash
Confidential AssistantKatelyn Forsythe
ManagerPediatrics, RGHLorie Kinneberg
Manager, Labour & BirthPerinatal Outreach Pgm
Michelle Downton
ManagerNICU
Tom Sorensen
Manager, Mother/BabyUnit & Maternity Visiting
ProgramMyrna Weisbrod
ManagerWomen’s Health CentreFetal Assessment UnitRawlco Centre Hostel
Jacki Shannon
ManagerChildren’s Program WRC
W&C Social WorkKim Woycik
Site ManagersRGH
Stacey CortesCharolette Bater
Monica GretchenDeborah Huys
PHBrenden Wallace
Victoria Case,Delasi Essien
Deborah Huys
ManagerTrauma Program
Jamie Appel
ManagerPediatric Homecare &Pediatric Outpatients
RGHTamara McDermit
Confidential AssistantTerena Palmer
DirectorClinical Quality &
Professional PracticeGillian Oberndorfer
Confidential AssistantSuann Wolf
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
0
20000
40000
60000
80000
100000
120000
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Ambulatory Care & Medical Outpatient
Visits
Ambulatory Care RGH & PH: Surgical
Procedures; Infusion/Transfusions; Cast Clinic;
Physician Consultation
Infectious Diseases Clinic RGH: Diagnosis
& ongoing Therapeutic care, Strong Research
focus
Eye Centre PH: Diagnostics & Therapeutics;
Low Vision Clinic; Eye Bank; Orthoptics
Clinic
Enterostomal Therapy PH & RGH
(community consultation support): Ostomy
Care, Wound Care
Dermatology PH: Phototherapy & other
treatments; Allergy patch testing
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
0
5000
10000
15000
20000
25000
30000
35000
40000
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Hemodialysis Treatments
Integrated Renal Program
0
100
200
300
400
500
600
700
800
HomeHemodialysis
PeritonealDialysis
Chronic KidneyDisease
TPE Organ & TissueDonors
Integrated Renal Program
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
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
0
1000
2000
3000
4000
5000
6000
Fetal Assessment Unit Visits
Fetal AssessmentUnit
Maternal FetalMedicine
Pregnancy &Diabetes Clinic
0
2000
4000
6000
8000
10000
12000
Women'sHealthCentre
Labour &Birth -
outpatients
Labour &Birth -
deliveries
MotherBaby Unit(patientdays)
NICU(patientdays)
Perinatal & Women's Health Activity
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
Children’s Health
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
PediatricOutpatient Unit
WRC - Children'sProgram
Pediatrics - 4F(patient days)
Children's Health
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
Women’s & Children’s Health
Successes:
• Early Pregnancy Clinic set up in Women`s Health Centre, redirected 54
women experiencing early pregnancy complications from the ED in June
2016.
• High acuity care transitioned from Medical Intensive Care Unit to the
Pediatric Unit April 2016 after extensive training.
• Peds SIM Lab Program implemented
• NICU Transport Team performed its first isolette and team transport to
southern SK via STARS
Challenges:
• Pediatric Home Care Program has had a number of staffing challenges
which have impacted their ability to support children and families.
• Pediatric Outpatient Unit, Pediatric Inpatient Unit and Emergency
Departments require renovations in order to safety and effectively meet the
needs of the children and families they serve.
Children’s Centre Vision
Surgical Care
Surgical Cost Savings
Mar 2015 Mar 2016
YTD YTD Decrease
Surgical Access & In-Patient Units 40,553,282 38,448,193 2,105,089
OR & Perioperative Units 60,367,845 54,176,453 6,191,392
KOT, Trauma, Admin, units 6,605,031 6,049,601 555,430
Total 107,526,158 98,674,247 8,851,911
Successes:
• Patient satisfaction with Hip & Knee Clinic experience is spreading and growing the demand.
• Stroke Prevention Clinic used lean quality improvement tools to decreased
number of days waiting by 50%
• Medical Device Reprocessing Department has installed new sterilizers,
cartwasher, washer disinfectors and work tables which will significantly
improve instrument flow at both sites.
Surgical Care
Challenges:
• Increasing number people waiting >3 months due to increase in demand
• Growing infrastructure (OR electrical challenges) and equipment needs
• Need to streamline supply chain management from procurement to storage to
reprocessing to right equipment in OR for right case at the right time
• Bariatric Surgical Program waitlist is ~3 years. Work is underway to make
program changes to improve
RQRHA Dashboard – Indicator Glossary As of 14/07/2016
Focus Area: System Sustainability
Measure: # of Surgical Cases Waiting Greater than Three Months
WHAT IS BEING MEASURED?
Indicator: The number of patients waiting greater
than 3 months.
Definition: Surgical time is the time from when the
patient is waitlisted until offered a surgical date or
has surgery performed.
Calculation: Number of Surgical Patients waiting greater than 3 months
Data Source: MoH Surgical Patient Registry
WHY IS THIS OF INTEREST?
Patient’s quality of life may be affected adversely
while waiting for surgery
WHAT IS THE TARGET?
Reduce the number of patients waiting more than 3
months for surgery. As of March 31, 2016 RQHR
has 1934 patients waiting greater than 3 months for
surgery.
HOW ARE WE DOING?
As of May 22, 2016 there are 2,065 patients waiting
longer than 3 months for surgery. We are on track
to provide the target number of surgeries based on
anticipated MoH funding. However, based on the
current mismatch between funded volumes and
increasing demand, we are projecting a minimum
3,500 patients will be waiting longer than 3 months
by end of the fiscal year.
WHAT ACTIONS ARE WE TAKING?
Work with MoH to finalize 16-17 target volume
and funding. Continue monthly meetings to keep
MoH informed of increasing demand.
Allocate available Operating Room (OR) time to
meet funded volume, adjusting In Patient (IP)/
Out Patient (OP) mix to equalize wait times.
Review and adjust OR allocation quarterly based
on demand.
Meet bi-weekly to address long-waiters.
Review emergency cases to ensure they are
appropriate.
Review IP cases to identify opportunities to shift
to OP.
Explore strategies to optimize use of Hip and
Knee Clinic
Performance is less than
100% of target; Action
Planned
Improvement Target Actual
No <1934 2065
!
RQHR Performance Dashboard – Indicator Glossary As of 14/07/2016 4