June 24, 2008
Thank you for the opportunity to speak to you today. I especially appreciate the work of the Chamber in promoting Saskatoon as a place in which to work, live and play and in providing forums such as this to connect people within our community.
Tomorrow is the last day of school for most elementary schools in Saskatoon. This day marks the end of the school year, a time when children, parents and teachers look forward to the long days of summer. It usually involves issuing report cards, when results of the year’s hard work are recorded and celebrated.
It has been many years since my two sons left school, although both are now employed by universities. Ryan is an economics professor in Boston and Matthew is head coach of the men’s university basketball team at UPEI. Nonetheless, I thought my time with you today marks an appropriate occasion to issue a report card to you on how the Saskatoon Health Region is performing, where we are making good progress, and where we have room for improvement. I would also like to provide you with an update on our service alignment plan, which has been gathering considerable attention as we move forward with the next phase of implementation.
I have now been in Saskatoon for three years. I am glad I came. I love the beauty of this city and province, especially in the summer, and continue to be impressed by the warmth and sense of community of the people. My position as President and CEO of the largest health region in the province has proven to be just as challenging as I hoped and expected it would be.
Saskatoon Health Region is all about people – the people we serve and the people who serve. We are the largest health region in the province – providing services and programs to approximately 300,000 local residents in 100 cities, towns, villages, RMs and First Nations communities – from Borden and Radisson in the west to Wynyard and Wadena in the east; and from Duck Lake in the north to Strasbourg in the south.
Our nurses, physicians, other staff and managers are responsible for providing services across the continuum of care ranging from hospital and long term care, rehabilitation and palliative care, public health and home care, mental health and addictions services.
We are a provincial referral centre. On any given day, about 35% of those who receive hospital services in Saskatoon live outside of the Health Region’s geographic boundaries. Our services and programs are provided in more than 75 facilities, including 10 hospitals, 29 long term care facilities, a growing number of primary health care sites, public health centres, mental health and addictions centres, and community settings, as well as in people’s homes.
Saskatoon Health Region is a significant contributor to the local economy. We employ more than 12,000 people and have more than 750 physicians working throughout the Health Region. Approximately 1 of every 14 people in the local workforce is employed by the Health Region. Approximately 80 per cent of our expenditures go towards paying the salaries and benefits of our staff. Every two weeks, we pay our staff more than $10 million in salaries. In turn, they circulate this money back into the local economy supporting the businesses of many of those in the room today.
Our dedicated staff and volunteers include our Foundations, which with the generous support of our community, continue to raise funds to support our clinical, teaching and research activities.
As an academic health sciences centre, we partner with the University of Saskatchewan, SIAST and other educational institutions to provide learning opportunities to more than 2000 health sciences students annually. We also help build new knowledge through research.
Saskatoon Health Region was entrusted last year as stewards of more than $737 million in public funding. That was approximately $2 million a day spent to meet the health needs of individuals and communities. We ended the year with a small deficit of $1.8, equivalent to .25% or less than one day of operations.
Today I would like to give you a sense of what we are doing to ensure people of Saskatoon and Saskatchewan get good value for their money. I will discuss some of the changes we are making to ensure the health needs of our patients and clients are being met today and in the future.
In Fall of 2006, after extensive consultation with staff, physicians, patients, partners (including the Chamber) and members of the general public, the Saskatoon Regional Health Authority approved the Region’s first strategic plan. This three year plan is designed to help us achieve our vision of healthiest people, healthiest communities, exceptional service.
Our plan involves 5 broad strategic directions. The first is our commitment to transform the care and service experience. This includes a cultural change that puts patients and families at the centre of our care, recognizing them as integral members of the care team, and organizing our services to better meet their needs. We like to think that we do that for every patient, every time, but we do not. But we are making strides, often assisted by patients, clients, residents and families who tell us about their care experience. For example, several hospital units now include the patient and family when physicians and other members of the care team make their daily rounds, discuss the patient’s condition and the plan of care. Long Term Care facilities have resident councils that ensure that the residents themselves take responsibility for quality of life within the facility and many are introducing family councils.
In planning new facilities such as the Irene and Leslie Dubé Centre for Mental Health, mental health consumers were active participants in helping design a facility that will meet the needs of adults and youth.
Transforming the care and service experience includes other goals, such as improving access to care. We know that in many cases patients still wait too long. We are working hard to improve. In many cases, our ability to improve access is limited by inefficient ways in which our services are organized, and/or the availability of space, equipment or doctors, nurses and other health professionals.
Each year, as part of our accountability agreement with the Ministry of Health, we commit to target volumes and wait times for selected services. Here is how we did last year. We met 97% of our MRI target volumes and 92% of CT volumes. We met 98.5% of targeted surgical volumes. We have made progress in reducing the amount of time patients wait for CT and MRI and this will continue to improve with the addition of new state of the art equipment. Although we are providing lots of service, we still need to improve how long patients wait for that care. For example, only 60% of our highest priority (non-emergency) surgeries were done within the 3 week target. Waits are longest for high volume procedures such as hip and knee replacements.
We are working hard to reduce waits in our Emergency Department and time to transfer patients from the Emergency Department to a bed when they need to be admitted. The SHR has partnered with the provincial Health Quality Council on a quality improvement project using lean design methodology to reduce wait time from the decision to admit a patient in the ED to the patient’s arrival and placement in an inpatient bed. We are also participating in a provincial collaborative to improve the discharge process for cardiology patients. This project includes identifying and meeting an estimated date and time of discharge, so patients and their families can be well prepared to go home. The bed is then more readily available for the next patient who needs it.
We are improving critically ill patients’ access to intensive care beds. We recently added two ICU beds at RUH and opened a new 4 bed ventilator unit at SPH for longer stay patients who depend on a ventilator (breathing machine). Plans are underway to add more critical care beds to the system.
Not all of our patients need to be admitted to hospital. In January we opened a new stroke prevention clinic which assists with the assessment, education and follow-up of patients who have had strokes or heart problems.
On the community side, we have increased access to services. By introducing a new program that allows some patients to have their sleep tests done at home, we have reduced the wait time for in-hospital overnight sleep testing by six months.
Another of our goals to transform the care and service experience relates to enhancing the safety and quality of our care. We have made patient safety a big priority throughout the Saskatoon Health Region. We are participating in a national initiative called Safer Healthcare Now! which helps health organizations adopt evidence-based practices to enhance the safety of their care. We are starting to see some amazing results.
Our cardiac team is striving for consistent application of a bundle of care practices, what they refer to as “Perfect Care” for all patients referred to hospital after a heart attack. In December, after only 6 months of their quality improvement work, this team achieved the following:
- 100% appropriate prescribing of medication on admission and discharge
- Smoking Cessation counselling for all patients improved from 60% to 100%
- Treatment in the cardiac cath lab within 90 minutes for “clot busting” (what we refer to as “door to balloon time”) improved from 60% to 92% .
These practices are saving lives and we have not had a single in-hospital death for a heart attack patient since the team has adopted these “Perfect Care” practices.
In our ICUs, we have adopted a set of practices (such as raising the head of the bed 30 degrees) to reduce the risk of pneumonia for patients on ventilators, a condition which poses a very high risk to these critically ill patients.
In our community, a team focused on improving the safety of home care patients, many of whom are at risk because they are on many medications. Home care staff worked with a pharmacist and family physicians, to identify highest risk patients. The pharmacist found an average 4 medication issues per high risk client and made recommendations for changes to the family physicians. 75% of these recommendations were then implemented by the family physician, a wonderful example of teamwork.
Given the demographics of our population, there is a large and growing burden of illness associated with chronic diseases such as cancer, heart disease respiratory disease, diabetes and mental illness. We are seeing some impressive outcomes from our work on chronic disease management. For example, programming changes to improve care for chronic obstructive pulmonary disease (e.g. bronchitis and emphysema) has resulted in a 44% decrease in emergency visits and a 56% decrease in hospital admissions for patients in this program.
Increasingly, health care is looking to other industries to help us improve, using tools such as Lean Design, known sometimes as the Toyota Production System. We are seeing early success using Lean Design to improve our work processes and patient flow in our lab, ICU and other patient care areas.
You can probably tell how excited I am by these developments. I believe they are truly making a difference and helping us transform the quality and safety of our care. They are helping us save lives and they are transforming the patient and family experience.
None of this work can be done without the dedication and support of our staff and physicians. That is why our second strategic direction is transforming with work experience. This part of our strategic plan focuses on creating a safe work environment where teamwork is the norm, and we have the right people with the right skills to do the right work.
A lot of our focus has been on recruitment of new nursing staff. Currently, there are 185 posted positions for RNs throughout the Region. Our successful trip to the Philippines resulted in hiring 105 Philippino nurses, the first of whom will start work here in mid-August. We have aggressively recruited local nursing graduates, with great success. We have already hired more than 75% of the April UofS nursing graduating class and we are still hiring. We are optimistic that the new collective agreement for nurses will help attract new nurses and retain the experienced nurses we already have.
We continue to target our Aboriginal community as a source of new talent. Our Step Into Health Careers program recently received a Training for Excellence Award for Promotion of Aboriginal Participation from the Saskatchewan Labour Market Commission. Although awards are nice, what really excites us is the fact that in 2008, 100 percent of the graduates of this 11 week program completed the program and have advanced to employment or additional training within SHR. Eleven of the fourteen participants were of Aboriginal descent.
We recently partnered with Saskatchewan Indian Institute of Technologies to train special care aides, an area where we have significant vacancies, particularly in our home care and long term care programs.
We continue to focus on the health of our workforce. Traditionally health care workers have higher sick time rates than other industries. This is certainly true in our Region. Despite a concentrated effort to create safer work environments and work practices, sick time among our staff is currently 4.8% of paid hours. This is the equivalent of approximately 337 staff who are not available for work on any given day. This high sick time is a result of many factors. In some cases, but not all, it relates to heavy workloads and high rates of overtime. We continue to experience steady growth in overtime, but hope to see reversal of this trend as our recruitment efforts, especially for nurses, start to pay off. We have focused on safe lifting, transferring and repositioning of patients and equipment, a frequent cause of injury in health care. We have also focused on flu immunization for our staff and were pleased to achieve a 25% increase in vaccination rates. This year’s staff immunization rate of 66% is not yet at our target of 80% but is moving in the right direction.
I will speak briefly about progress we are making on the remaining three strategic directions in our plan.
We have committed to partner for improved Aboriginal health. We continue to develop relationships with First Nation and Métis leaders, agencies and communities. We have adopted a theme of “Strengthening the Circle”. As part of this work, Saskatoon Health Region signed an agreement with Kinistin First Nation and the Central Urban Métis Federation Inc. (CUMFI) to work together to improve the health of Aboriginal people living within Saskatoon Health Region, both on and off reserve. The partners are working to jointly develop an Aboriginal health strategy that targets important health issues within the Aboriginal community.
Another strategic direction for SHR is fostering research, learning and innovation. Our VP Research and Innovation, Dr. Beth Horsbourgh who holds a joint position with the University of Saskatchewan, is leading a province wide consultation with researchers, government, health professionals and the business community to develop a shared vision to advance research and innovation. In 2007/08 the Health Region approved 128 new research studies and currently 271 research studies are underway.
The final strategic direction I want to address is our commitment to developing a sustainable, integrated health system. There are many aspects of this work, including our investment in new facilities such as the new mental health centre, new district hospital and health centre in Humboldt and planning for expansion of Oliver Lodge and the maternal child centre.
This part of our plan also focuses on our Building Health Equity Team which was initiated in January 2007 in response to the findings of our health disparities study. As part of this initiative to improve health status of residents in the poorest neighbourhoods in Saskatoon, we enhanced public health services in the inner city. We opened a new health clinic at WP Bate Community School. We partnered with St. Mary’s School and the University to provide pediatric clinics at St. Mary’s School. We have particularly focused on increasing immunization of children under 2 years of age. This year, 72 % of children in the Region received the appropriate immunizations but we estimate that only 50% of children in the inner city received their shots - clearly we need to find ways to increase rates for these children at risk.
A big piece of developing a more integrated and sustainable health system is our ongoing work to realign acute care services among the three hospitals in Saskatoon. The existing facilities and arrangement of acute care hospital services in our three hospitals in Saskatoon do not meet our current or future needs.
Duplication of services at three sites has led to inefficiencies, inequities in access, and problems in providing physician and other clinical coverage across all sites. Beds sometimes sit empty at one hospital while another hospital is bursting at the seams. This causes overcrowding in emergency rooms, cancelled surgery, waits for treatment, ambulance redirects, disrupted care and frustrated staff.
Experience with previous consolidation efforts in the Health Region and in other jurisdictions where service alignment has occurred, improved the patient care experience, decreased the need to transfer patients/clients between sites, increased the volume and efficiency of ambulatory services, and assisted in recruitment and retention of specialized health care providers and other staff members.
Planning related to service alignment has been ongoing for years. Although some changes were made, such as consolidation of obstetrics at RUH and the Eye Centre at SCH, our three acute care hospitals have largely functioned as silos, with many services such as orthopaedic surgery duplicated at all three sites.
Two years ago, after extensive consultation with sixteen Clinical Program Groups composed of SHR staff and physicians, Saskatoon Health Region approved a model for distribution of acute care services among Saskatoon City Hospital (SCH), Royal University Hospital (RUH) and St. Paul’s Hospital (SPH).
Our planning considered current and future utilization of services, demographic changes. For example, we project that the age group 60-69 will almost double between 2004-2021. The age group 70-79 will increase more than 40%. The age group under 1 year of age will increase almost 10%. This means we need to plan now for additional space, beds and other resources to meet the needs of a growing and aging population. We will need an additional 78 acute care beds by 2021.
This number would increase by an additional 163 beds if we do not aggressively pursue operational efficiencies. Even if we could afford these additional 163 beds, it is unlikely we could staff them given the scarcity of health human resources. Our planning included comparing the efficiency of our services compared to our peers across Canada - for example our admission rates, lengths of stay, day surgery rates and provision of care in clinics or community rather than hospitals. Our analysis confirmed that there are many opportunities to better organize our services, to avoid duplication, improve efficiency, patient flow and patient access. These improvements will help us limit the need for more hospital beds and optimize the resources we have.
Our plan defines the future roles of our three urban hospitals. Saskatoon City Hospital will be a centre piece - representing the hospital of the future. Increasingly, care is provided on an outpatient or ambulatory care basis. Currently over half of our surgical hours are for day surgery. This means that patients are admitted, have their surgery and go home the same day. New developments in surgical procedures, anaesthetics and other technology improvements make this a much safer and efficient way to deliver care. It is also much better for the patient and family. In our service alignment model we will base most of our day surgery at SCH, which allows us to fully utilize the best ORs in the city. Some of you may have seen recent announcement of plans in Regina to build a new $14 M surgi-centre to help address the anticipated 30-per-cent increase in the demand for day surgery procedures over the next 10 years. In Saskatoon we do not need to build a new surgi-cenrte. SCH will be our showcase for this.
SCH will also be the location for most of our outpatient clinics and a broad range of diagnostic services. Again, the facility is perfectly designed to serve this role. These new ambulatory programs will reflect a very different way of delivering care. Some of you may have visited or at least heard of the Mayo Clinic or Lahey Clinics in the US, highly specialized ambulatory care centres where care is exquisitely coordinated, provided by highly skilled interdisciplinary teams, and supported by state of the art technology, including electronic health records and diagnostic equipment.
We will, for example, build upon the wonderful Les and Irene Dubé Centre of Care for breast health at SCH to develop a more comprehensive approach to management of breast cancer. Our orthopaedic surgeons have proposed that we develop a world class joint replacement centre that includes the high volume of hip and knee surgery already based at SCH. Discussions are underway regarding developing a women’s health centre that would provide a more woman- and family-centred approach to gynaecological care, allowing us to move some procedures currently done in the cold, sterile environment of an operating room into a much more warm and welcoming ambulatory care environment. These are just some examples of what will be possible for Saskatoon City Hospital. Our community needs such a dynamic new hospital service environment.
SCH will also include a significant inpatient component that will serve a growing population that we currently do not serve well. We will build upon our rehabilitation and geriatrics programs to address the needs of complex continuing care patients who still need to be in hospital but require a different care environment than currently found on busy medical and surgical wards. We are planning to focus and further develop the Region’s geriatric rehabilitation services at SCH. This may include a dedicated stroke unit (evidence confirms patient outcomes increase dramatically where there is a defined stroke unit).
All this means SCH will be an extremely busy hospital, and yes we will need to build a new parkade to accommodate this increased level of activity.
SPH and RUH will be the two sites for inpatient acute care, including surgery requiring hospital admission, medical beds, critical care, emergency departments and related diagnostic and support services. RUH is the future site for both the new mental health facility and the new maternal child centre (which will include a new and expanded Emergency Department).
This plan will be implemented over 5-10 years. Some service changes can be done sooner, while the timing of other changes will depend on government approval and funding for new construction (such as our maternal child centre) or renovated space (for example, ground floor at RUH and the addition of more beds at SPH).
Even with development of our plan, we were in a holding pattern until a decision was made by government related to the location of the future site of our new children’s hospital within a hospital, As you are aware, government announced last year that the location for the children’s hospital would be at Royal University Hospital. With that decision, we were able to begin moving forward with the initial stages of realigning services and programs.
Over the past year, we completed the first phase of service alignment by concentrating pre-scheduled orthopaedic surgery at SCH and trauma orthopaedic surgery at RUH. We consolidated general surgery at RUH and SPH. We learned a great deal during the planning and implantation of these changes and benefited from the advice and expertise of the many staff involved in delivering these services and related support services.
In 2008/09, we will implement the next phase of our service alignment. Discussions are being initiated with staff and physicians to consolidate adult critical care at SPH and RUH. This means that the ICU at SCH will merge with and relocate to the ICU at SPH. At this point we do not know the timelines for these changes and there are many details to be sorted out regarding how the care will be provided and the implications for the involved staff.
There are many reasons for moving forward on a 2- site critical care model at this time. We need to add more critical care beds to meet the needs of our patients. Our plans include adding 3 critical care beds at RUH and increasing capacity at SPH, where we already have available space to expand in the existing ICU.
By adding beds on these sites we will reduce the number of critically ill patients currently being transported from RUH and SPH to SCH. Since realignment of orthopaedic and general surgery, more than three quarters of the ICU patients at SCH have been transferred by ambulance from the other two hospitals. We need to put patients first and locate our critical care beds where patients need them most.
We have a shortage of critical care nurses and can best use these valuable staff by clustering them in 2 not 3 locations. There will be many operational efficiencies from running fewer, larger units. This will help us standardize our care practices to ensure safer care and better patient outcomes.
Over the next year, we will continue to work with the Department of Surgery and other staff regarding consolidation of urology at SPH. This is a good fit with the Nephrology Centre of Excellence at that site.
Our planning indicates the need for an additional 200 LTC beds in Saskatoon. Currently we have 50 or more patients in acute care beds waiting for admission to long term care. These beds are not available for more critically ill patients, who often land up waiting in the Emergency Department or having their surgery cancelled. The patients awaiting LTC are spread throughout all three hospitals and we do not provide the appropriate staffing or programming they need. The ideal solution is to add more long term care, home care and other community services to avoid these patients residing in hospital. In the short term we will consolidate patients awaiting LTC at City Hospital, where we will provide an enhanced care environment.
The biggest and perhaps most challenging part of service alignment this year will be the move to a 2 site inpatient medical model. This means that the inpatient medical beds at SCH will be closed and transferred to SPH and RUH. Over time, we expect to add more medical beds at RUH and SPH to meet growing needs of our community for non surgical inpatient care.
We are committed to work closely with the affected staff, physicians and unions in implementing these changes. I realize that no matter how we plan and implement these changes, not everyone will be happy or agree with the changes. But we will do what we believe is best for this community - the people who need care now and in the future.
In conclusion, I can certainly say it has been a busy and challenging year for Saskatoon Health Region. We are making progress on the strategic directions established in our strategic plan. Moving forward, I anticipate the following challenges:
- We need to further enhance access and decrease waiting times for acute care, mental health and community services. This will require reorganizing and improving the efficiency of our care to improve patient flow throughout the region;
- We need to continue our work on reducing infections, medication errors, falls and other patient safety risks throughout the Health Region, with an aim to be have the safest hospitals, home care and community programs, and long term care facilities in the country;
- We need to focus on engaging our staff, helping them better understand, accept and be part of the many changes we need to make;
- We need to continue to focus on recruitment of physicians, nurses and other health professionals;
- We need to work with government to address the poor condition of many of our buildings and to prioritize investment of scarce capital improvement dollars;
- As part of a provincial 10 year capital plan, we need to secure government’s approval to proceed with the next stage of planning for the new maternal child centre, redevelopment of the ground floor at RUH and other high priority facility improvements;
- We need to move forward on investment in an electronic medical record;
- We need to develop plans and strategies to ensure sustainable health services in our rural communities, recognizing changing demographics, staff shortages and aging facilities in rural Saskatchewan;
- We need to look at innovative new ways of creating more long term care beds in Saskatoon to meet the changing demographics;
- We need to continue to work with others to improve the health of our community, which the Canadian Institute for Health Information recently confirmed has among the highest rates of obesity, smoking and physical inactivity in the country;
- We need to improve communications with the community, as part of our accountability to you, regarding what we are doing, how and why.
Saskatoon Health Region has a proud story to tell. We are transforming the care and service experience for our patients, clients and residents. We are transforming the work experience for our valued staff members and physicians. We are partnering with our aboriginal community to improve health. We are fostering research, learning and innovation in the Health Region. And we are building a high quality, sustainable health care system for those we serve today and those we will serve tomorrow.
Maura Davies, President and CEO
Saskatoon Health Region
Saskatoon Health Region
“Healthiest people, healthiest communities, exceptional service.”
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