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