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TRANSCRIPT
1
Presentation to the CE LHIN Sr. Mgt Team
Ken Tremblay, President & CEO
October 26, 2011
2
Today’s Presentation:
• Our Strategic Plan
• Strong Regional Centre
• High Quality Patient Care
• A Great Place to Work
Presentation Overview
As PRHC’s Hospital Improvement Plan (HIP) and fiscal
recovery approaches completion, our focus turns to
establishing a steady state, building a high performance
culture and focusing on the directions needed for a
sustainable future.
3
Governance / Leadership
• Accepted Berkeley Report
• Corporate Members / By-Law changes
• VP Selection Process
Strategic Planning
• Board approved Strategic Plan September 19, 2011
• Program metrics, measurement and monitoring tools in development
• Communication plan developed
• Strategic Plan on PRHC website: Vision 2014
Our Strategic Plan is about strong governance
and a sustainable future
4
Our Strategic Planning Process: Listening and Learning
Strategic Planning Retreat
• Determine planning scope
• Establish Planning team
• Develop planning process
• Revise draft Strategic Plan
• Develop draft Implementation Plan
Planning process
TemplatesRoles & Responsibilities
• Approve final Strategic Plan
PREPARE PLAN REFINE APPROVE
Engagement
InputDraft Strategic Plan
Engagement
InputConsensus
Final, approved plan
Draft implementation plansRoles & Responsibilities
• Internal planning (workshops)
• External consultations
Co
nso
lidat
e
Nov - Jan Feb - Apr May May - Jun
We followed an inclusive and transparent Planning process
5
Our Strategic Plan:
Strategy Map
6
Sustain Fiscal Recovery
Bending the cost curve
$(16,000)
$(14,000)
$(12,000)
$(10,000)
$(8,000)
$(6,000)
$(4,000)
$(2,000)
$-
$2,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
$ (
tho
us
an
ds
)
Peterborough Regional Health Centre
Net Surplus/(Deficit) from Hospital OperationsAs of June 30, 2011
2011/12 Budget 2011/12 YTD Actuals 2010/11 Actuals 2009/10 Actuals
Balanced
Source: Internal Monthly Financial Statements
7
Sustain Fiscal Recovery
• Contract awards to ONA and OPSEU PARA
• Annual cost increase ~$1.5 million
• Not in the budget
• June 2011: $900,000 in one-time payments
• Impact evaluated and options developed to ensure balanced
operating position achieved
What happened in June?
8
Sustain Fiscal Recovery
2011/2012 Q1 Performance
5,800
6,000
6,200
6,400
6,600
6,800
7,000
7,200
Total Acute & Day Surgery Weighted Cases
We
igh
ted
Ca
ses
Weighted Cases
2010/11 Actuals
2011/12 Actuals
26,000
26,200
26,400
26,600
26,800
27,000
27,200
Total Acute Patient Days
Pa
tie
nt
Da
ys
Acute Patient Days
2010/11 Actuals
2011/12 Actuals
0
10
20
30
40
50
60
70
80
90
ALC LTC Volumes ( # of patients)
Nu
mb
er
of
Pat
ien
ts
ALC Patients - LTC
2010/11 Actuals
2011/12 Actuals
9
Sustain Fiscal Recovery
Cash Flow
Q1 Apr-June Q2 July-Sept Q3 Oct-Dec Q4 Jan-March 2011/12
Actuals Actuals Forecast Forecast Forecast
Operations
Cash Receipts
CELHIN Funding 62,768 55,290 54,672 54,992 227,722
Other Revenue 5,981 6,724 5,909 5,909 24,523
Total Receipts from Operations 68,749 62,014 60,581 60,901 252,245
Cash Disbursements
Compensation (32,295) (33,105) (29,955) (32,109) (127,464)
Supplies and other (26,915) (26,694) (30,921) (34,658) (119,187)
Total Outflows from Operations (59,210) (59,799) (60,876) (66,767) (246,651)
Net Operational Cash Flow 9,539 2,216 (295) (5,866) 5,595
Capital
Cash Receipts 1,263 259 1,649 6,092 9,263
Capital Disbursements - - (4,900) (7,900) (12,800)
Net Capital Cash Flow 1,263 259 (3,251) (1,808) (3,537)
Debt repayment (1,317) (1,317) (1,317) (1,317) (5,268)
Net Cash Flow before advance 9,485 1,158 (4,863) (8,991) (3,210)
CELHIN Advance 14,000 - - (14,000) -
Opening Cash & Investment Balance (534) 22,951 24,108 19,246
Closing Cash & Investment Balance 22,951 24,108 19,246 (3,745) (3,745)
Unearned PCOP funds included * 28,300 29,300 30,300 31,300 31,300
* under negotiation
2011/2012 Quarterly Cashflow Summary (in $000s)
10
Sustain Fiscal Recovery
Working Capital Deficit
(110,000)
(90,000)
(70,000)
(50,000)
(30,000)
(10,000)
10,000
00/01FY
01/02FY
02/03FY
03/04FY
04/05FY
05/06FY
06/07FY
07/08FY
08/09FY
09/10FY
10/11FY
11/12YTD
$ (t
ho
usa
nd
s)
Peterborough Regional Health Centre
Working Capital DeficitAs of June 30, 2011
Working Capital Deficit Cumulative Operating Deficit
$53M
Source: Internal Monthly Financial Statements
11
Sustain Fiscal Recovery
• Post-Construction Operating Plan Funding
Reconciliation for 2008/09, 2009/10 and 2010/11
Realignment to reflect actual and projected volumes
Support CE LHIN and PRHC strategies
• Demolition of Nicholls Building
Contract awarded to Cannington Group
Demolition underway; expected to be complete by Dec.
• Temporary Radiation Treatment Facility
Request for own funds project approved
PRHC local share is approximately $2M which PRHC Foundation has raised
• New Hospital Capital Costs and Funding
Working with CE LHIN and MOHLTC to finalize project
Timeline: Fall 2012
MOHLTC Construction Monitor awarded to Hanscomb Limited
12
Performance
Management
Information Technology
Recruiting for CIO
Integration Initiatives – IS Enabling Technologies Participation
• Home First
• GAIN
• TDIS (Timely Discharge Information System)
• cGTA (Connecting GTA) integrate electronic patient information from across the care continuum
•SUBMIT
•HOBIC Revitalization
Other IT Related Initiatives Participation with CE LHIN Partners
• MOH Information Kiosks
• Hospital IT Shared Services
• Common Sharepoint Service
• OCAN/IAR
• Health Records Transcription
13
Regional Programs
Radiation Facility:• PRHC Foundation Closer Campaign raises $3,403,212
for new cancer treatment centre expected to open in
June, 2012
NE Cluster:• MOU Draft template under review
• Hosting Senior teams for HHHS and CMH
• Signing ceremony for NE Cluster this Fall
14
Regional Programs
Home First:• In partnership with CCAC and Community Care Peterborough, Home
First philosophy is underway
• Current census results show a downward trend in PRHC ALC patients
• AON “Alternative Community Beds” program to be phased out over
next 12-18 months as a result of Home First successes
• Savings when patients are placed in nursing homes will amount to
about $500K annually. PRHC will save an estimated $200K this year
Palliative Care:• Working with community partners to provide palliative care options to
patients in a “home setting” i.e. home with outreach team, supportive
housing or retirement home
• Palliative Care proposal approved by PRHC Board in May, delivered
to CE LHIN in June, and approved by CE LHIN in August. Awaiting
next steps
15
Regional Programs
GAIN Clinic:• Part of regional program – opened in April
• July information meeting with NE Cluster CEO, COSs and CNEs
Thoracic Surgery:• Inpatient thoracic surgery transferred to Lakeridge in 2009;
thoracic surgery outpatient clinics continuing
• Funding transferred from PRHC to Lakeridge
Vascular Surgery:• Lakeridge transferred vascular surgery to PRHC in 2007
• Funding transfer methodology proposed
• Recruiting 3rd surgeon
• EVAR funding $180,000 base received, balance of funding to
sustain the service is required
PCI:• PCI Program for Cardiac Cath Lab approved by MOHLTC and CE
LHIN -- $1.1M funding awarded to provide care for acute, semi-
acute and elective cardiac patients within the Region
• Opening: January 2012
16
Regional Programs
Ontario Breast Screening Program:
• PRHC signed a Memorandum of Understanding in July with
Ontario Breast Screening Program (OBSP) to provide enhanced
screening services through PRHC’s Breast Assessment Centre
(BAC)
Trillium Gift of Life:
• Now expanding its implementation of notice and consent
provisions in TGLN to include additional designated facilities,
including PRHC
• Going live October 28
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Quality Improvement
Plan
Quality Improvement
• This publically reported Quality Improvement Plan (QIP) is part of
PRHC’s overall comprehensive quality strategy and is directly linked
to our strategic direction of “high quality patient care”
• Our corporate strategy for quality consists of three themes:
• Patient Flow and Access
• Patient Safety
• Patient Satisfaction
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Safety: Hand hygiene compliance
Peterborough Regional Health Centre Hand Hygiene Compliance By Type of Indication
0
20
40
60
80
100
Dec-
09
Jan-10 Feb-
10
Mar-
10
Apr-
10
May-
10
Jun-10 Jul-10 Aug-
10
Sep-
10
Oct-10 Nov-
10
Dec-
10
Jan-11 Feb-
11
Mar-
11
May-
11
Jun-11
Co
mp
lia
nc
e (
%)
Before initial patient/patient environment contact (Moment 1) After patient/patient environment contact (Moment 4)
Target Moment 1 (95%) Target Moment 4 (96%)
Quality Improvement
Plan
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Safety: Avoid new pressure ulcers
Incidence of Pressure Ulcers
0%
5%
10%
15%
20%
25%
2006 2007 2008 2009 2010 2011% o
f F
acility
Acquired P
ressure
Ulc
er
Rate
Facility Acquired Pressure Ulcers Target
Quality Improvement
Plan
20
Access: Reduce wait times in ED
ED- 90th Percentile LOS - Admitted Patients
0
10
20
30
40
50
60
09/10 Q1 09/10 Q2 09/10 Q3 09/10 Q4 10/11 Q1 10/11 Q2 10/11 Q3 10/11 Q4 11/12 Q1
90th
Perc
entil
e L
OS
(hrs
)
Admitted Time (hrs) Target
Quality Improvement
Plan
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Patient-Centred Care: Improve patient satisfaction
Patient Satisfaction - PRHC
86
88
90
92
94
96
98
100
102
% p
os
itiv
e r
es
po
ns
e t
o
ov
era
ll q
ua
lity
of
ca
re r
ec
eiv
ed
PRHC-Corporate 94.4 93 94 94.8 96.7 95.9 96.2 96.9 98 93.7 93.2 95.3
Ont Community Average 92.5 92.5 92.7 92.7 93.1 93.1 93.3 93.3 93.4 93.4 93 93
Highest Performing Hospital 100 100 100 100 100 100 100 100 100 100 100 100
Target 96 96 96 96 96 96 96 96 96 96 96 96
Apr 08-Jun
08 (n=154)
Jul 08-Sep
08 (n=159)
Oct 08-
Dec08
(n=186)
Jan 09-M ar
09 (n=165)
Apr 09-Jun
09 (n=162)
Jul 09-Sep
09 (n=152)
Oct 09-
Dec09
(n=162)
Jan 10-M ar
10 (n=134)
Apr 10-Jun
10 (n=148)
Jul 10-Sep
10 (n=134)
Oct 10 -
Dec 10
(n=150)
Jan 11 - M ar
11 (n=134)
Quality Improvement
Plan
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Human Resources Plan
• While still in layoff/hiring freeze situation, PRHC is
recruiting for specialized and part-time positions
• Following two executive-level retirements in April, Jayne
White is currently acting as interim Chief Nursing
Executive and Dr. Peter McLaughlin accepted expanded
role as interim Vice President/CMO
• Work is currently underway on organizational structure
to ensure PRHC is positioned to build on its regional
role -- expected to be finalized this Fall
• New Chief of Laboratory Medicine Selected; Search
underway for Chiefs of ED, Medicine
• 10% Executive Offices challenge -- complete
23
Hospitalist Program
• Long-term target: build service to full complement: 8-9
hospitalists utilizing an Integrated Nurse Practitioner model
• Hospitalist contract is in place; 5.5 full-time hospitalists currently
signed on new model
• Working with recruitment firms to achieve full complement
A New Model: Family Medicine/Nurse Practitioners
• Dr. Hardy Friesen, Chief of Family Medicine, working with family
medicine physicians on plan of care for post-acute patients.
Includes deployment of nurse practitioners across post-acute
units; now ready to implement
• Recruitment is underway for additional nurse practitioners to
increase MRP capacity of hospitalists in acute care units
• Dr. Derek Krete, a physiatrist, has accepted role of Interim
Medical Director, Rehab/CCC and Seniors Health Care and will
support us in plans for that area
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Overall
• PRHC work force is in transition.
Change impacting many employees.
We continue to monitor various
components of our work force to
improve and maintain our employee
satisfaction and engagement.
• Layoff process is almost complete
with 5 layoffs accepted and 8 layoffs
still in progress. Attrition, 206
Layoffs in
process, 8
Layoffs
accepted, 5
Attrition
Layoffs in process
Layoffs accepted
25
Overtime Reduction Targets
• Overtime hours are trending upwards. This has been identified and a
working group has been struck to review OT on a department by department
basis. Staffing levels, schedules and workforce analysis are being used to
examine trends and facilitate solutions.
26
Absenteeism Reduction Targets
• Managers continue to work with employees, utilizing the tools and
processes in our Attendance Support program as well as encouraging
use of EAP program
• Absenteeism rates continuing to decrease. Employees should be
congratulated for helping to achieve this target
• We are dealing with employees who have poor attendance and
recognizing those who have had perfect attendance
• If the trend continues, annual average absent days per employee will
be 9.8 days, achieving our target of less than 10 days per eligible
employee. This presents a significant reduction from 2009/2010
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Absenteeism Reduction Targets
Paid Sick Hours - Year over Year Trend
15000
30000
45000
60000
75000
90000
105000
120000
2009 2010 2011 2012
Month
Ho
urs
2012 Target
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Health & Safety Targets
• Health & Safety Targets are progressing as planned
• Seeing a decreasing trend in lost time incidents over past 4 years as
well as significant decrease in number of lost time to WSIB in last 5
years
• On target to achieve goal of less than 26 lost time incidents in 2011
• In departments where injuries are a concern, our Health and Safety
Officer, Kinesiologists, leadership and department staff strategize how
to improve safety outcomes in that area
• Our NEER index is now in rebate position for first time in many years
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Lost Time Review 2007-2011 (as @ Aug. 31)
0
5
10
15
20
25
30
35
40
45
2008 2009 2010 2011 (YTD)
# of Incidents
NEER Performance Index - Annual Surcharge /
Rebate Amount
(1,000,000.00)
(800,000.00)
(600,000.00)
(400,000.00)
(200,000.00)
0.00
200,000.00
2006 2007 2008 2009 2010 2011
Year
Do
llars
Health & Safety Targets
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Health & Safety Management Systems
• Safety Group Audit of Health and Safety Management System
process continues. Process mandated by OHA Safety Cluster -- audit
was completed in May
• Continual Improvement Plan developed based on audit results
Healthy Hospital Initiative• With guidance of Dr. Graham Lowe, have developed a plan to help to
improve staff engagement. Three broad areas to be addressed are:
– Communication
– Health & Wellness
– Training & Development
• These were all areas for improvement identified by staff in latest NRC
Picker survey
• Communication from this group will come out as “Our Healthy
Hospital” to acknowledge that we are working together
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PRHC Transformation Office
Opened January 10, 2011-- initiatives include:
Providing staff members with support and assistance during
their transition to new roles and processes
Facilitating LEAN initiatives hospital-wide
Partnering with Lakeridge Health, PCCHU, Fleming and Trent
to provide leadership development programs
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