Since Vancouver’s All-Staff Forum, we’ve answered 29 staff questions, and we thank you for keeping the conversation alive. Our latest answers can be read below. For earlier answers, refer to our August 29 article and previously published submissions to VCH News-Vancouver.

To learn more about our plans and direction; consult our interactive Vancouver Strategic Plan.

If you have a question about delivering quality health care services while tackling our budget challenge, we encourage you to email VancouverAll-StaffForum@vch.ca. It’s never too late to ask a question.

Today’s answered questions

Q. I wonder if you would be interested in learning about a “push/pull accountability process” for frontline managers/ PCC/RCC that does not cost extra (LEAN) & more about targeting our efforts/work processes? Do you feel confident that hospitalized elderly “residential” clients are being “pushed” back to their residential beds from acute sites in a timely manner?

A. Would we be interested in learning how we can mitigate residents’ need for inpatient hospitalization and improve patient flow? Absolutely! We’re always interested in new ideas and innovations, especially when they come from our staff and physicians (more on this below).

Regarding the hospitalization of residential care clients, it’s important to put things in perspective. According to data provided by Decision Support Services, VGH and UBCH combined have the highest number of ED visits per resident across VCH. However, residential care clients represent less than two per cent —1.7 per cent, to be exact — of ED visits. About 55 per cent of these visits — 1,215 visits in 2012 — resulted in acute care admission.

To improve patient flow among residential clients, we are (or soon will be) working on:

• mitigating residential clients’ need for hospitalization through integrated primary and community care
• developing a pull strategy from acute care to residential care to improve the timeliness of hospital discharge
• strengthening communication and collaborations between community and acute care staff to improve the overall patient experience

Of course, helping more people remain at home and avoid or defer residential care in the first place, and for as long as it’s safe to do so, is the best-case scenario. Through our Home First initiative, we’re providing frail seniors opportunities to remain in the comfort of home and secure the time to make life-changing decisions, when needed.

We’d also like to add that work is underway in several forms to improve patient flow in acute care. For example, our iCARE & ITH initiative has succeeded in freeing 40 beds per day, and is now rolling out across surgical units. Additional work has just begun to delve deeper into the reasons why patients (non-residential care clients) remain in acute care beds longer than they should. The reasons are varied and often complicated but we’re asking the why’s to find the how-to’s. In the meantime, everyone can help us prevent hospital-acquired infections which needlessly extend patients’ stay.

Last but not least, please do send us your ideas. Email us at VancouverAll-StaffForum@vch.ca. We look forward to hearing from you again.

Q. What is the logic around lowering FTE counts? Each FTE earns different amounts. Are we focusing on decreasing FTEs that get paid more or on those that get paid less? When we reduce FTE counts…eg: let go of an admin. person (1 FTE) who makes 45K compared to an FTE that makes 80K (1 FTE) … are they viewed the same way and given the same weighting, i.e. 1 FTE equivalent? We reduced 1 FTE but we did not really decrease cost appropriately because the higher paid person makes twice as much.

A. To minimize the impact on patients, clients and staff, our priority is finding savings through efficiencies — not job loss. Before reducing staffing, we first exhaust our options to achieve savings by efficiencies, including:

• reviewing and renegotiating contracts (eg: service providers, supply providers)
• managing sick time and overtime
• consolidating and restructuring services where it makes sense
• increasing productivity through LEAN work

Unfortunately, we can’t always avoid job loss. When it’s clear we must adjust staffing, we consider the unique characteristics and needs of the service or program. Our decisions are driven first and foremost by what will have the least impact on direct patient/client care, rather than salary.

Q. How will you ensure that staff members will have the necessary time and resources to find and implement new improvement ideas?

A. There are only so many hours in a day and there are many demands on staff to do more. We recognize that we can’t just keep adding layers of work onto people’s already demanding schedules, which is why we’re committed to supporting our teams in making conscious decisions about what to continue, what to pause and what to stop altogether. We need to remain focused on our priorities of quality improvement and patient safety, as summarized in Vancouver’s Strategic Plan. And, we need to tackle some compelling challenges.

Refer to page 18 of Vancouver’s Strategic Plan and you’ll find how we see everything fitting together. Our daily work — representing about 80 percent of our time and effort — includes our standard work and the efforts we undertake to improve the quality and delivery of our care and services. Yes, we have a lot of initiatives underway, but they’re designed as incremental enhancements to our current standard work. They represent a change in how we deliver care or services, not necessarily an addition of work. Take, for example, the new Falls Prevention Toolkit at VGH or advancing our Home is Best work.

We’ll use the other 20 per cent of our collective time and effort to focus on our two breakthrough strategies:

1. aligning capacity and demand
2. engaging our teams

Here, too, we’re aiming to implement solutions in ways that shape our daily work, although the change in work, depending on your role, may feel more substantial. And, we hope, the benefits and outcomes for patients, clients and staff will feel just as substantial. We fully expect the results will be well worth the effort and “pay dividends” for us for some time to come. To learn more about our breakthrough strategies, refer to pages 11 to 15 of Vancouver’s Strategic Plan.