Happy New Year, everyone.

We’re looking forward to our next Vancouver All-Staff Forum on Wednesday, January 29, from 3 to 4 pm. Watch for our call for ideas and suggestions in your email box soon.

In the meantime, we continue to receive and answer your questions. If you’re still waiting for an answer to your question, we ask for your patience at this very busy time of year. We will answer everyone, but it just might take longer than we would like.

For past Q & As, refer to our December 5 article and previously published submissions to VCH News-Vancouver.

If you have a question you’d still like to ask, email us.

Today’s answered questions

Q. My team and I are interested in finding out the strategies in place to “develop the best workforce”, particularly related to timely hiring of staff.  At our worksite we have unfilled frontline positions across several disciplines and this situation seems to be recurrent, with positions remaining vacant for as long as months to (one position now) more than a year.  This shortage has obviously impacted existing staff.  For example my discipline team has been asked (expected) to absorb the work of 4 full time positions at various times in the last 2 years, and inevitably the increased workload has impacted our ability to provide high quality and safe care for our patients.  While management has provided work relief through casual staff where possible, this has mostly been sporadic and short term, lending itself to poor continuity of care.  We have reflected our concerns to management who tells us to “do your best”, but no sustainable solutions have been offered.  What can we as frontline staff expect in light of this recurrent scenario and what role do the current budget constraints play in prolonged vacant positions?

A. At most times in health care we have vacancies related to unfilled positions. The reason for the vacancies shifts month-to-month, year-to-year. For example, right now in home health nursing we have many vacant positions – some for months – not because we don’t want to fill them, but because we just don’t have the qualified applicants for the jobs. At other times, we may have ongoing vacancies because we’re working with EE to determine if the vacancies are appropriate to accommodate someone who has been off work for a while or for someone who needs to work in a specific setting for health or other reasons.

Currently, we have some additional vacancies directly related to our budget challenge. As vacancies arise, we review them as a team to ensure that the position in its current form is still exactly what we need now and into the future. The last thing we want to do is fill a position in an area and then realize that we actually needed a different position for that area and end up making changes impacting someone new. As you’ve experienced, this strategy has slowed down our ability to repost vacant positions in a timely manner — and one year is too long a time for any position to remain vacant. We owe it to all our staff and clients to make hiring decisions as quickly as possible in order to preserve the quality of the care we provide.

If you or your colleagues have questions about why you are seeing vacancies in your area, please connect with your manager and/or program director. They can help you to understand why the vacancy is there, and you need to let them know how it is impacting your ability to provide care to priority clients. You can then brainstorm together some ideas on how to best reduce that impact (i.e. clearer understanding of daily priorities, or how to transition clients to general primary care as quickly as possible so you are able to pull in higher priority clients).

Q. It appears that many frontline staff, mainly nursing, accumulate overtime hours by choosing to work through lunch or picking up extra shifts.  By mandating a no-overtime allowed policy throughout VCH and using the saved funds to bring on more casuals or part-time staff could money be saved?  Does VCH have exact dollar amounts of money spent paying overtime wages?  In private business owners strive to not pay overtime wages; it directly affects bottom line.

A. Can we save money by reducing OT? Absolutely! But money isn’t our only reason to minimize overtime (OT). We believe OT should be limited for the health, safety and general wellbeing of our patients and staff alike. To provide best care and to lead a healthy, fulfilling life, everyone needs some rest and relaxation.

Are we reducing OT? Yes, again. Vancouver’s Community of Care has reduced its OT by about 17% since November 2012. A number of factors contributed to this achievement, including:

• doubling the float pool to increase our staffing resources to draw upon
• using the CapPlan system to help us predict spikes in workload and staff accordingly
• engaging units to brainstorm local solutions through Lean breakthrough improvement lanes
• and, transitioning to the 37.5-hour work week, which has enabled us to deliver more quality care and service cost-effectively

We can’t eliminate OT altogether due to fluctuations in workload, but we can minimize OT and its related costs. To achieve our goal, directors and managers continue to monitor OT closely.

Q.  I don’t know if anyone has asked this, and unfortunately, I have not heard the latest forum, but here it goes.  Are researchers willing or ready to create a flu vaccine that is 100% natural and organic, 100% effective and 100% safe?  Also, has VCH considered going green with medical supplies like organic & biodegradable medical masks and other paper products?  I like the green initiatives I’ve seen in VCH so far, but there’s so much we can do.

Personally, I use 90% biodegradable coffee filters in our keurig machine at work.  I also take my garbage to pacific centre to recycle soft plastics & other things the city of Vancouver won’t accept.  There’s also Styrofoam recycling every third week on the west and east sides of Vancouver.  These are some things that VCH may want to consider in its effort to Go Green!

A. We admire your commitment to the environment! And, we agree. There’s always more we can do and we think you’ll be pleased to learn about the many initiatives underway. Here are just a few examples of how we’re going green:

• Reducing organic waste:  All kitchens in VCH facilities have implemented a collection program to reduce the amount of organic waste we send to the landfill. Business Initiatives and Support Service (BISS) has plans for an additional organics collection program to ensure we comply with Metro Vancouver’s organics ban by 2015 — all organic materials (including food scraps) will be banned from Metro Vancouver garbage.

• Purchasing sustainable products: While our housekeeping and food services partners provide paper napkins made from recycled paper, Health Shared Services BC (HSSBC) manages our supply chain and the purchasing of other sustainable paper products, including business cards made of 30% post-consumer recycled content, and envelopes and white paper certified by reputable organizations such as the Forestry Stewardship Council and the Sustainable Forestry Initiative.

For more — much more — on how VCH is working on being green, refer to our new and first-ever Environmental Accountability Report produced by the department of Lower Mainland Facilities Management. This report outlines the joint efforts of VCH, PHC, Fraser Health and Provincial Health Services to support energy and environmental sustainability.

Regarding the flu vaccine, we aren’t aware of any research to create an “organic” vaccine. Having said that, much effort goes into making the vaccine effective and safe. Vaccines are held to much higher safety thresholds than therapeutics, and they perform superbly well on the safety spectrum. Producing a 100% effective vaccine, however, is like seeking perfection — impossible. That’s not because researchers can’t make effective vaccines, but because researchers don’t have control over the random mutation of influenza viruses, often in response to many unpredictable and as yet unmeasurable evolutionary factors. When all is said and done, vaccines continue to offer better protection against severe illness or death than no vaccine at all.

Q. My understanding is that hundreds of millions of dollars in savings are being allocated to CST. Given this, can you provide us with an update on CST? Does progress to date indicate that the platform will meet current expectations and future needs?

A. Clinical & Systems Transformation (CST) is one of the largest health care projects in British Columbia’s history. The project’s mission is to contribute to the transformation of health care delivery by connecting our patients and network of world-class health professionals with timely, accurate and relevant clinical information so we can provide seamless, personalized care of the highest quality.

As of November 2013, the project has successfully completed the initial planning phase called Strategy and Verification (S&V) and is now entering the Design, Build and Integrate (DBI) phase. DBI is estimated to take about 18 months.

Designing the system will include:

• assessing how we are doing things now by going into our care settings and other departments to look at and understand our current workflows and processes
• determining how we want to do these things in the future based on leading practices
• using this information to set requirements for what goes into the system (e.g. leading practices for order sets, clinical documentation, protocols, processes and procedures).

Next, we’ll build an electronic clinical information system to house this information, ensuring it’s easily accessible and equally reflects the needs of the three participating health authorities: VCH, PHC and PHSA. The final stage of DBI is to integrate. This is about testing the system from various angles to ensure it is accurate, meets the requirements outlined during the design process and supports our network of world-class healthcare professionals.

A significant number of skilled clinical, informatics and technical professionals, including physicians, from within our organizations will be involved in DBI, as our professionals know the needs of our patients, residents and caregivers best.

It’s still early days, but CST has always been and continues to be about one central goal: providing best care. We all feel the ever-increasing demands for our services, and this investment in our future will help us address numerous patient-care needs and quality of care challenges for the long term.

For more on CST, refer to the November 21, 2013 article in VCH News.