The Last Five Years at VCH: A Story of Teamwork and

Triumph Duncan Campbell

March 2013

2

Fiscal Crisis in 2008 $42m Operating Deficit •  95% of funding received committed to collective

bargaining •  Cash less than 1 weeks payroll - $10m •  High admin and support costs (13%) •  Staff growth higher than volume growth

$1 Billion Infrastructure Deficit (excluding hospitals)

!  Outdated technology – on fire pc’s !  Obsolete equipment !  Aging and poorly maintained facilities

•  $50m capital projects in flight without a funding source

•  Financial information 6 weeks late no headcount information

•  ED congestion and hallway patients – EDP4P starting to work

•  Long wait times, and cancelled elective surgery

3

Staffing Growth 3.3% Twice As High As Volume Growth

FTE' Analysis

1600017000180001900020000

FTE'

s

Actual Projected

Actual 16083 16683 17452 18043 17932 17932

Projected 16083 16683 17452 18063 18695 19349

2005/6 2006/7 2007/8 2008/9 2009/10 2010/11

4

Turnaround Plan •  Take control of cash and stop in flight projects

•  Get admin and support costs into line – $26m and 200 staff reduction –reduce from 13% to 9.2%

•  Support Pay for Performance initiatives to change behaviours

•  Get control over headcount – Senior team approves all new hires and replacements

•  Focus on workforce optimization to get control over the biggest cost item –over 70% of costs relate to staffing (later resource optimization)

•  Invest in staff scheduling, forecasting, decision support tools and portals

•  Reinvest efficiency savings into quality and sustainability initiatives and replenish infrastructure

5

Key Elements of Our Resource Optimization Journey

Scheduling Deploy staff effectively

Back to Work Attendance Promotion, Early Intervention,

and Disability Management Redesign

Care Management Understand patient acuity

and care needs

Bed Management Maximize utilization of beds

Business Intelligence And Data Warehousing

Forecasting Project demand and staffing requirements

Resource Optimization

6

Average Variable StaffingGFS Rehab MedicineOct 03-Nov 13, 2008

0

5

10

15

20

25

30

35

40

F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

Ave

rag

e N

um

ber

of

Sta

ff

52

54

56

58

60

62

64

66

68

70

72

Cen

sus

RN LPNAide CensusBudget

Staff Forecasting and Staff Scheduling •  Lower fixed levels of staffing and increase flexibility of variable staffing

Average Variable Staffing

Staff Forecasting Solution will allow the

ability to forecast demand & the

associated staff requirements

Optimizing Variable Staffing Levels

Staff Scheduling Efficient & effective deployment of staff to match expected

activity patterns

7

Electronic Staff Scheduling & Timekeeping

2008……………%2012%

Benefits Achieved :

"  All implementations completed on time and

under budget by $270K "  Consolidated and standardized scheduling and

timekeeping under one common platform "  Decreased OT and Insufficient Notice Premiums "  Pay Rules applied consistently "  Real time staffing data available for Managers

enabling proactive scheduling "  Integration with staff forecasting (Emendo) "  Increased data integrity "  Established Regional Staffing and Timekeeping

Service "  Decommissioning of Loki databases ( to be

complete March 31, 2013)

Benefits

19,600%employees%

8

CapPlan Dashboard • Updated every 15 min

• Provides web-based real-time daily visibility

• Worm graph shows 3 days of information – retrospectively, today and tomorrow

• Displays key metrics with applicable traffic light on the current status within the hospital

• Can display the details of each nursing unit under each planning group

9

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2011

-01

2011

-02

2011

-03

2011

-04

2011

-05

2011

-06

2011

-07

2011

-08

2011

-09

2011

-10

2011

-11

2011

-12

2011

-13

2012

-01

2012

-02

2012

-03

2012

-04

2012

-05

2012

-06

2012

-07

2012

-08

2012

-09

2012

-10

2012

-11

2012

-12

2012

-13

2013

-01

2013

-02

2013

-03

2013

-04

2013

-05

2013

-06

2013

-07

2013

-08

2013

-09

2013

-10

2013

-11

Percen

t'of'4

+hou

r'shifts

Staffing'Implications'Example'+ Richmond'2'West'Psychiatry

Elevated5(>15over)

Balanced5(-15to51)

Insufficient5(<-15under)

Safe and Efficient Staffing Levels

10

Where we are now

11

12

VCH True North: Innovate for Sustainability

13

71.3 70.4

71.4

75.6

79.5

77.2 77.5

79.6

81.6

83.3

78.0 78.6

79.8

80.8

82.0

60.0

65.0

70.0

75.0

80.0

85.0

90.0

1987-1991 1992-1996 1997-2001 2002-2006 2007-2011

Life

exp

ecta

ncy

(yea

rs)

Vancouver DTES Vancouver HSDA British Columbia

Life expectancy (years) at birth. Vancouver DTES, Vancouver HSDA and British Columbia 1987-1991 to 2007-2011

Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit, September 2012. Data source: BC Stats, Ministry of Labour, Citizens' Services and Open Government, February 2012.

14

Hand Hygiene Improved from 20% to over 70%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

08/09 Q4

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

11/12 Q2

11/12 Q3

11/12 Q4

12/13 Q1

12/13 Q2

12/13 Q3

Hand Hygiene Percent Compliance (VGH, LGH and RH for consistent four-year trend)

15

Quality Up – Mortality Rates One of Best in Canada

0%

20%

40%

60%

80%

100%

120%

Quality Improving - Hospital Standardized Mortality Ratio Declining

16

MRSA Down

0.00

2.00

4.00

6.00

8.00

10.00

12.00

MRSA Rate per 10,000 Acute Patient Days (in VCH facilities excluding PHC for consistent long term trend)

17

Admin Costs – CIHI Measure VCH One of the Lowest in Canada

•  VCH Admin Expenses as % of total expenses

2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 13.20 11.00 9.70 9.11 9.34

CIHI 2010-2011% 3.072%%

18

Real Productivity Gain: Staffing Flat Since 2008 With Real

Growth Of 1.7% FTE' Analysis

1600017000180001900020000

FTE'

s

Actual Projected

Actual 16083 16683 17452 18043 17932 17932

Projected 16083 16683 17452 18063 18695 19349

2005/6 2006/7 2007/8 2008/9 2009/10 2010/11

19

1009

599

211 199

734

531

148

55

0

200

400

600

800

1000

1200

Total Waiting Waiting < 6mo Waiting 6-12mo Waiting > 1yr

Top Ten Daycare Cases Waitlist Reductions at VA

Apr01 2012

Dec31 2012

Reduction 27% 11% 30% 72%

Source: Surgical Patient Registry (Jan 15, 2013)

Pay for Performance Funding reduced >1 year waitlist by 72%

20

6836

4617

958 1261

5239

3757

885 597

0

1000

2000

3000

4000

5000

6000

7000

8000

Total Waiting Waiting < 6mo Waiting 6-12mo Waiting > 1yr

Total Waitlist (All Cases) Waitlist Reductions at VA

Apr01 2012

Dec31 2012

23% 19% 8% 53% Reduction

… and Total Waitlist reduced by 23%

21

Improvements in Cost per Patient Day

205

210

215

220

225

230

235

240

245

250

25520

11'01

2011

'02

2011

'03

2011

'04

2011

'05

2011

'06

2011

'07

2011

'08

2011

'09

2011

'10

2011

'11

2011

'12

2011

'13

2012

'01

2012

'02

2012

'03

2012

'04

2012

'05

2012

'06

2012

'07

2012

'08

2012

'09

2012

'10

2012

'11

2012

'12

2012

'13

2013

'01

2013

'02

2013

'03

2013

'04

2013

'05

2013

'06

2013

'07

2013

'08

2013

'09

2013

'10

2013

'11

Cost%per%Patient%Day

LGH

RH

Implementation

22

Improvements in Hours per Patient Day

5.40

5.60

5.80

6.00

6.20

6.40

6.60

6.80

7.00

7.20

7.4020

11*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2011

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2012

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

2013

*…

Hours&Per&Patient&Day

LGH

RH

Implementation

23

Develop Agile Financial and Operating Processes

•  Period End close and reporting less than 7 days •  Lower Mainland Consolidation financial and

operating reporting •  Financial Policies •  Agile and regional internal audit function

developed – 2 cases handed over to RCMP for fraud prosecution

•  Risk management introduced and now used in budgeting and risk processes

•  Comprehensive Whistleblower Policy introduced •  Real time analytics and portals developed •  Pay for Performance funding •  Operating Room costing project completed

24

Reporting: Balanced Scorecards •  Currently over 20 scorecards created •  Two versions for external and internal view

Internal

External

25

Reporting: Portals Goals:

•  “One Stop” for your information needs

•  Easy to Use – requires no training

Created for COCs & Regional Programs:

•  Developed in consultation with users

•  PORTAL belongs to entity/program with Decision Support as facilitators.

•  Include information from warehouse & other sources

26

Data Linkages across the Patient Continuum

http://www.information-management.com/news/Vancouver-Coastal-Healths-Patient-Continuum-Increases-Insights-10023644-1.html

What is a Patient Continuum? •  Facilitates longitudinal patient tracking

across the entire health authority according to criteria and measurements such as time, space, visits, facilities and type of care

Why Build a Patient Continuum? •  Standardizes joins between fact tables •  Provides a means of analyzing patient

movement •  Improves data quality •  Enables easier data mining Award •  Winner of the 2012 Innovation Solution

Award for BI/Analytics

27

Contract Innovation: Linen Utilization Programs – “GUP” & “GRUMP”

•  In addition to negotiating lower unit prices ($/lbs.) for linen processing, BISS implemented innovative gain-share utilization programs with 2 main vendors

•  “GUP” & “GRUMP” programs employ proprietary data management technology and systems to monitor and report real time linen usage statistics

•  Detailed, up-to-date linen intelligence is then used to identify high utilization “hotspots” for targeted linen handling & change management education

•  Savings achieved are shared on a graduated basis with vendors

Impacts:

#  Reduced linen use by 8%

#  Financial savings of $2.0M annually

Savings from reduced use: $2.0M / yr.

Savings from lower unit prices: $0.15M / yr.

28

LMC – Bending the Cost Curve

•  Trend analysis above shows the actual pre-LMC and post-LMC growth curves

•  LMC is having 2 types of savings impacts – direct budget reductions ($68M to date) & slowing growth ( from 5.67% to 1.74% annually)

•  The total estimated LMC savings from direct budget reductions and absorbed growth will total ~$116.4M by year end 12/13

29

Real Focus on Reducing Food Waste from 44% to <10%

30

Hostess Model at LGH

•  All floors launched as of Feb 2012 •  Patient satisfaction has increased by 10.7%

since April 2011 and 6.0% since April 2012

31

VCH Recycling Diversion Rates

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Jan-

11

Feb-

11

Mar

-11

Apr

-11

May

-11

Jun-

11

Jul-1

1 A

ug-1

1 S

ep-1

1 O

ct-1

1 N

ov-1

1 D

ec-1

1 Ja

n-12

Fe

b-12

M

ar-1

2 A

pr-1

2 M

ay-1

2 Ju

n-12

Ju

l-12

Aug

-12

Sep

-12

Oct

-12

Nov

-12

Perc

ent D

iver

ted

Waste Diversion Rate: Recycle % of total recycle & landfill

VGH

At Nov 2012, 278,476 lbs per month (139 tons) diverted from the landfill

UBC LGH RH

Goal = 35%

Implemented at 7 acute and 9 residential care sites since Feb 2011

32

4-Year Trend of Continuous Risk Reduction

2009 2013

33

Improved privacy protection while facilitating legitimate info sharing

•  Provided staff with encrypted USB drives

•  VCH-wide privacy audit program

•  17 new IT security policies

•  Doubled privacy education

•  Hosted “Ultimate Privacy Challenge”

conference in 2012

•  PARIS access model change & other initiatives

designed to facilitate info sharing to improve

care

•  Roll out of enhanced Whistle Blower policy

34

Provincial eHealth Viewer ISA

PDIV ISA

Panorama ISA

Cardiac Registry ISA

Perinatal Registry ISA

MOH Data Access Agreement

GHISA

Led development of province-wide General Health Information Sharing

Agreement (GHISA) (includes all HAs and MOH)

35

Bending the Cost Curve while Improving Quality

•  Over the years, key BISS strategies have driven down costs while enhancing quality management

•  Strategies include tightening performance management, innovative contract terms, strengthening contract & project management skills / capacity and organizational streamlining

•  By consolidating admin, negotiating lower base contract costs, placing caps on future annual increases, and “incentivizing” high levels of quality, BISS has flattened growth in contract costs while maintaining service levels

Outsourcing, LMC savings and avoided costs are estimated at ~$10M annually

36

RBS By the Numbers •  Provide Consolidated Financial Reporting for LMC leaders

More than 3 million lines of G/L code and almost 2 million lines of budgets

•  > 5,000 employees have been migrated as part of Lower Mainland Consolidation

•  A new Signing Authority Policy introduced… that was hard

•  Casual Accountability Policy tool to reduce scheduling/call-in cost (~$300 per employee per year)

•  Paperless Leave Entitlement Report to replace a ~5000 page, bi-weekly paper report

•  The eASI project consolidated seven time capture systems into one and ~18,000 employees migrated

•  Electronic Health Authority Reporting Process (eHARP) Reporting-3days to 1 hour

37

….together we have shrunk the iceberg

$70m Operating Surplus in 2012/13 •  Set aside for Clinical Systems Transformation •  Cash more than 25 weeks payroll - $250m •  Paid off all long term debts including $50m HBT liabilities •  Lowest admin and support costs in Canada •  Real productivity gain – zero staff growth and 1.7 volume

growth

Quality metrics improves (mortality, bugs and safety) •  Infrastructure deficit reduced

!  Replaced over 10,000 pc’s !  Invested in quality and sustainability initiatives

•  No capital projects in flight without a funding source •  Innovative approach to replacing Richmond Lions Manor,

Olive Devaud •  Month End close and reporting – 6 days to management

and •  Pay for Performance funding improved wait times, flow

and need for long term care beds … we now have a less scary challenge!!!

38

39

The A Team

40 Senior Executive & Board Support

41