Frank questions. Straight answers

Since leading Vancouver’s All-Staff Forum, we’ve answered more than 15 interesting, insightful and often thought-provoking staff questions.  Today, we’re pleased to answer five more. Over the coming weeks we’ll continue answering your questions, and we thank you for your patience.

If you have a question about delivering quality health care services while tackling our budget challenge, email VancouverAll-StaffForum@vch.ca. Previously published answers can be read in our August 15, August 8 and August  1 articles. To learn more about our plans and direction; consult our interactive Vancouver Strategic Plan.

Today’s answered questions

Q. Why don’t we cut the payslips? Can they not be emailed to us?

A. VCH would like to eliminate paper pay stubs and move to a paperless system. In order to do so, all VCH employees are required to have an active email account. A business case is currently underway to provide every staff member with both an active directory account as well as an email address. This will not only improve employee communication but also enable VCH to email pay stub information to employees. Enabling all employees with a VCH email address and emailing them their pay stub information is a large and complex undertaking, but it is very much under consideration at this point.

Q. Approximately $2,910 was spent per person in 2011 in the Downtown Eastside. This seems very high, what are the plans to reduce this spending?

A. Reducing spending in the Downtown Eastside (DTES) is not a priority for VCH. Even in this time of financial restraint, our priority isn’t cost-cutting. Our priority is helping DTES residents live longer, healthier lives. Let me explain:

Thanks to our staff and health agency partners, the DTES is healthier than it was 15 years ago, when a public health emergency was declared. HIV infection rates and heroin overdoses have fallen dramatically, but chronic conditions like chronic obstructive pulmonary disease (COPD) and hepatitis C have emerged and require different approaches to care. High rates of mental illness and addiction persist.

The time has come to revisit our work in the DTES. We began this work in 2012 when we held the first in a series of roundtable discussions with DTES health agencies, our partners in care, to look at ways to improve service delivery, accountability and health outcomes. (Read the original VCH News story.) These discussions were built on the results of a third-party environmental assessment of the DTES through the eyes and ears of our agency partners, stakeholders and residents. The resulting report is available in full on the VCH public website. More than 80 staff interviews and additional informal conversations have supplemented this research to add the perspectives of our people to the conversation.

VCH consultations with a variety of health, city and community partners continue, and over the coming year we will evaluate all our services in the DTES. Our aim is to build on our strengths and to ensure we’re providing the right services for the community’s changing needs, and that we’re delivering these services efficiently and — most importantly — effectively.

Q.  Why are there no specifics around phrases such as “maximize staff potential so they can do their best every day” or “strengthen management and leadership capacity”? Does strengthening management mean yet even more of an hierarchical/top-down structure?

A. On page 8 of our Vancouver Strategic Plan, we list our desired outcomes of developing the best workforce, including those outcomes highlighted in your question. The four outcomes we’re striving to achieve are:

• maximized staff potential so employees can do their best every day
• a culture of respect, engagement safety and accountability
• strengthened management and leadership capacity
• partnerships with physicians to improve quality and implement performance accountability

On page 15 of our Vancouver Strategic Plan, we’ve identified four courses of action we’re taking to achieve these outcomes, and they are:

• develop and implement People First Survey (Gallup Engagement and Safety Survey) action plans
• educate and coach staff using Lean, and embed Lean management at the unit/program level
• provide a mechanism for feedback and coaching support for management and leaders
• improve communication with physicians using information about quality

Does “strengthened management” mean we’re striving for a more “hierarchical/top-down structure”? Absolutely not.

Our aim is to realign our management and leadership processes to support a culture of continuous improvement and staff recognition and engagement. We aim to support, equip and free our leaders from having to focus on daily crisis management. Instead, we’re striving for a culture where our leaders work more collaboratively with frontline staff to develop and implement innovative solutions to provide best care and achieve our goals.

Q.  Why do areas looking to save money only look at their own budget and not the big picture? Many times saving money for one department causes additional money or labour for another department. The overall savings is negative but the initiating department gets congratulated for their efforts.

A. Trimming budgets is never easy and we don’t make any decision lightly. Protecting patient/client safety is our top priority, which is why we do look at all potential cost savings from a number of angles. We do our best to determine whether there are “downstream” implications within a department, across departments/programs and across sites.

Having said this, we aren’t perfect and sometimes decisions lead to unintended consequences. Fortunately, this doesn’t happen frequently and, when it does, the issue generally comes to our attention because Vancouver directors and managers regularly meet to review their programs and raise new or developing issues. If you have a concern that you believe we should be aware of, please feel free to tell us more at: VancouverAll-StaffForum@vch.ca.

Q.  How is “engaging and creating a safe environment for staff” a component of developing the best workforce?

A. Our VCH People First strategy recognizes that staff and patient safety are inextricably linked and that the creation of healthy healthcare workplaces is foundational to the provision of safe, sustainable, quality patient care. VCH has long recognized this linkage – If you’re not safe, your patient isn’t safe.  Eliminating risks and hazards in healthcare is not easy but we’re committed to making sure that everyone goes home at the end of their shift safe and healthy. Some examples of VCH health and safety initiatives are:

• We were the first health authority to include safety questions in our Safety and Engagement Survey and were thrilled to find that units with high levels of employee engagement also had high ratings for safety.  We encouraged our managers to work with their staff on action plans that focused on safety or engagement recognizing that improvements in safety would result in greater engagement and greater engagement would create a better safety climate. As a result of VCH’s leadership, standardized safety questions were included in every health authority’s employee survey this year and we look forward to learning from the results and developing benchmarks that will drive improvements.
• Musculoskeletal injury is the leading cause of WorkSafeBC claims and the rate in residential care was twice that of acute care. VCH has spent millions on ceiling lifts to address the risk posed by moving patients and recently launched a campaign to cut the MSI rate in the residential care sector in half in two years. At the end of Year 1 we exceeded our target and are heading into Year 2 with many new and creative ideas on creating safer workplaces for staff and residents, including an exciting partnership with the Emily Carr School of Design. Stay Safe is an innovative campaign designed to empower frontline staff to create conversations and community around safety to benefit all.
• Violence and aggression is a sad reality in many sectors. We recognize that the people we serve are often in pain, fearful and may not always act in a manner that makes them easy to care for. VCH has invested in a multimillion dollar campaign to provide violence prevention training and complete violence risk assessments in our high risk areas of psychiatry, emergency departments and residential care facilities to provide staff with knowledge, tools, equipment and environments that minimize the risks of violence and enable them to respond to incidents of violence and aggression with confidence to prevent escalation and injury.
• Exposure to occupational illnesses such as TB are another risk to staff and VCH implemented a new model of nursing care for staff bringing vaccination clinics and TB skin testing to your workplace.  We recently supplemented our outreach clinics with a mobile service targeting units with higher risks of exposure to communicable disease.  Our goal is to make it easy for you to be protected from vaccine preventable illnesses that pose a risk to you and your family.  Check out the Workplace Health Intranet page for our clinic schedule. 
• Where staff are injured or ill – either at work or elsewhere – VCH has been a leader in a new model of care for staff reaching out within a few days of absence to offer assistance and support to speed recovery and enable return to work as soon and as safely possible. The literature is clear that people who stay at work or return to work quickly after illness or injury recover faster and more completely than those who don’t and we want to make sure that all VCH employees have the best outcomes possible.

We are proud of the investments VCH has made and is making in healthy healthcare workplaces.  For more information please check out the Workplace Health Intranet.