We’re moving forward
You may have heard or seen media coverage in the past few days about VCH and our budget challenge that is driving us to find efficiencies and improve productivity.
The Provincial Government has made it clear that a balanced budget is a priority and it expects organizations such as health authorities to take the same approach. That is difficult when we continue to see significant growth in demand for many of our services across VCH. Over the past year, visits to our Emergency Departments have risen almost four percent compared to last year. The number of surgical daycare procedures are up by over 10 percent, while demand for home support hours has grown by almost nine percent.
Combine this with an aging population, demand for many of our services by people outside of VCH, the impact of the negotiated wage increases for staff – as well as the reality that our funding from government has gone up an average of only two percent annually – and you can start to see where the pressures are.
Need to control deficit
Right now, VCH spends more than we have. Our run rate for the first two periods of 2013-2014 has already left us with a deficit of $1.7 million. If we don’t get this under control, our deficit will only continue to grow as the year progresses creating even more difficulties for all of us.
One of our True North goals is to “Innovate for Sustainability” and that is what we have to do – and do now – if we are to get rid of our deficit. It is essential that we look at all the services we fund and how we provide them to see if they can be offered in different or more efficient ways, or if we should even be providing them at all.
Making tough decisions
This, of course, means making tough decisions that not everyone will support or agree with. In recent weeks we have announced that funding will cease to programs such as The Arts Studio and the Mood Disorders Association in order to refocus funding on our mainstream services in mental health. We reallocated under-utilized arthritis beds at GF Strong to eliminate an obvious inefficiency.
You are going to hear of more changes in the coming weeks as we push to get our deficit run rate under control and do what we must to build a health system focused on direct care. While we will be reviewing our corporate areas for efficiencies so that we can protect funding of direct services to the benefit of our patients and clients, there is no denying that many of the changes will have a direct impact on staff in all areas of VCH.
The VCH Senior Executive Team has made a commitment to do as much as we can to tell you what kind of changes will be made and what they mean for you as far in advance as we can. Sometimes, unfortunately, this is not possible due to legal frameworks and contract obligations but we will try to overcome those barriers to transparency to keep you in the loop.
We’re not alone
For what it is worth, this is not a challenge that we face alone. All areas of VCH are involved in reducing costs and finding more efficient ways to deliver service, while other health authorities have similar issues. Our goal is to change the way VCH works to make sure that we focus on patient services that fall within our mandate of providing effective and measurable health care.
More specific communication is taking place throughout the budget process in each Community of Care and down to the unit, service and program level. Updates will be shared with you as often as possible. I also encourage you to connect `with your leaders and supervisors if you have any questions or concerns, or to share your comments via VCH News.
I know this is an unsettling time and that the coming months will not get easier. As we make changes, we will be guided by our True North goals to provide the best quality care, promote health in our communities and support the best workforce. By working together to watch what we spend, where we spend it and how we spend it, VCH can continue to be a leader in innovation and health care redesign. Again, I encourage you to share your thoughts below.
I look forward to working with you to make that happen
David
Jag
I understand that not all will agree with some of the tough decisions that were made and will soon be made, but I know that my colleagues and I do not agree with the decision to cut the Newborn Hotline which has serviced Vancouver and Richmond families for approx 20 years. As a Public Health Nurse in Vancouver who believes in prevention as a way to help control this out of control health care system, I am having a difficult time digesting the news of the Newborn Hotline. The Newborn Hotline helped to decrease and even prevent admissions to hospital emergency rooms. Not only that but it also identified underlying issues such as postpartum depression.
How is cutting this service for Richmond and Vancouver families going to help control the deficit? It’s actually just placing the deficit problem onto the Provincial Health Services Authority. In your letter you mention that “we’re not alone” and other health authorities are facing similar challenges, so how would this decision to cut the Newborn Hotline actually help all partners? We are well aware that the 811 services exists but we as Public Health Nurses are also aware that they do not have similar expertise as we provided on the Newborn Hotline. I feel we are passing the problem from one health authority to another. Does this exemplify one of our “True North goals of innovation for sustainability?”
another concerned nurse
I completely understand the need for fiscal responsibility. I also appreciate that Dr. Ostrow is in a very difficult position – i.e. having to make tough decisions – which is never an easy thing to do.
What I don’t understand is why those of us who actually implement the work ‘on the front lines’ have not been welcomed to be part of the change process. If we had been told of the need for budget tightening, and given the chance to offer our own solutions, we would have felt more a part of the process.
I hear from many of my colleagues that there is discouragement and anger. As a VCH employee I have always felt valued, and I have felt that decisions have been made collaboratively. This has not been the case with the current situation. I am convinced that there are creative solutions that could have been generated at the grassroots level, with the people who provide direct client care. Instead, the changes have been imposed ‘on’ us rather than being made ‘with’ us. As heath care practitioners, we know that our clients are not likely to comply with a plan of care if they are not involved in the process. Why is the same approach not taken with VCH employees to ensure success and co-operation as we move ahead?
I am committed to provide the best care I can to my clients. I have always felt that VCH has encouraged me and supported me to do this. Thankfully I work with an amazing group of supportive colleagues. But it is challenging to stay positive when we as professionals have not been included in this process. Please, would you reconsider and consult with us? We have some great solutions and we would love to have open conversation in order to arrive at solutions together.
David Ostrow
Firstly, I’m glad to hear that you feel that VCH has encouraged and supported you. Having said that, we clearly need to find ways to more actively engage staff in the redesign process as it moves forward. Your link between patients complying with their care plan and expecting staff to be engaged in changes in the workplace is compelling and certainly worth remembering. These are the kind of comments that leadership – including myself – need to be reminded of so that we can find ways to involve staff in the idea and decision-making process. Thank you for taking the time to write and I will talk to my colleagues about what we can do to improve the process so you and your colleagues feel more actively engaged.
another concerned nurse
Thank you for your response, Dr. Ostrow. It means a lot to know that you have been reading these posts.
I wonder also about the post directly after mine – about the Newborn Hotline. I realize that this is an area that many feel is duplication of care. The case could also be made that no other similar service exists in any of the other communities in our province, therefore VCH does not need to provide it. However, Vancouver has the largest population of any other community in the province, and will by nature have the highest birth rate as well, and therefore more potential for babies going to emergency if the parents don’t have the right kind of supports. Just today I was aware of one mom who took her baby to emergency on the advice of 811. I followed up and could tell that if she had spoken with a newborn hotline nurse, the advice would have been different. This happens frequently. I wonder along with Jag – is this the best use of our financial resources?
jennifer
I work at VGH – and there are many wasteful things that I observe e.g every night we receive from the lab paperwork for lab work to be done in the am – which we promptly discard in the recycling bin as none of use it – we look on line for any blood work to be done in the am- we have been told we cannot get rid of this as it is system wide.
Also we have to fax our patient diet to the kitchen 1st when they arrive and every time it is changed- I think this could be done more efficiently if done on line.
Blood work is ordered by doctors and never looked at, I believe that if everyone knew the value of the things we use that maybe more thought would be put into over using products. e.g in the utility rooms where we access some of these products maybe the cost should be added to the shelf- it might make us think twice about how we use it.
David Ostrow
Great suggestions Jennifer about how to improve efficiency so that you and your colleagues can do their jobs more efficiently. Let me look into it.
Hidy Cheung
In the past few years there has been a focus on “Lean Transformation” as the way to create more efficiency in our work, but I wonder about the efficiency of this service itself.
I’ve been part of meetings and tasks groups that use the lean process, and it always involves one (if not more) “Lean Transformation Service Coordinator(s)”. While I appreciate the intent of Lean and see its value, I find it very unproductive having to spend a substantial amount of time explaining what we already know as frontline staff or having a Lean coordinator shadow our work day (which inevitably interrupts our work).
I think key frontline staff can easily be trained on the concept of Lean and implement its principles in the everyday work we do within our teams, such that it becomes part of our work rather than an “add on/external” process – I think this peer teaching approach may generate more “buy in” from team members, create more realistic and sustainable solutions (since team members would have a much richer understanding of the issues to begin with), and moreover be more cost effective (using existing staff and our expertise rather than having almost 30 external consultants as it is now).
I would also be interested to know the measurable outcomes, both in terms of cost efficiency and health as it relates to direct patient care, that Lean Transformation Services have made since its inception.
David Ostrow
Thanks Hidy. Yes, sometimes we can’t see the forest for the trees when it comes to some of the work that we do. Innovation is happening across many parts of VCH. Some of this relates to LEAN. Some of it is simply due to teams of people constantly looking for ways to do things better to help the people they care for. Different areas of VCH have experienced success through LEAN (the Birthing Unit at Richmond Hospital is an obvious example) but I make sure that we get more details and share concrete examples in the near future.
Jackie Pinksen
As I read this I start to feel a little frustrated. As a dietitian, I feel that so many of the acute/urgent care issues arise out of poor nutrition and lifestyle behaviors. Heart disease, diabetes, kidney disease and other obesity related conditions. We (health care) have known for a long time that it is not only personal choice that impacts behaviors, but the system in which people live. We also know that Poverty is the number 1 indicator for increased mortality. What frustrates me though is that in time of cuts, emphasis is placed on acute care and direct care, versus prevention.
I think there needs to be a focus on expanding the role of primary care and increase teams to be multidisciplinary in nature, physicians, counselors, addictions workers, social workers, physios and dietitians working together in community to support individuals and families who are struggling with their health and to be healthier. While also having a prevention team to work at higher policy and system levels to make environments healthier so the struggling people we work with have supportive environments for health and making the healthy choice is the easiest one.
When we need to make difficult decisions to streamline programming to reduce health care costs, we need to start looking at direct care prevention and placing money here and programming here. Until the health care system does, it will continue to have a growing population relying on acute care services. As this population did not receive the help that was required when in the community and ambulatory, because there were no services or the services available were so limited that individuals and families could not easily receive the support needed. In turn, they show up in the acute care system due to complications and cost so much more money.
so my suggestion save money for health care is to invest in primary care and prevention, continue to have people work on the policy and environmental level make our environment healthier. Prevent and reduce people form entering the acute care setting and we will save money. It is doable, it is achievable, it just means we have to have a paradigm shift in health care, one that is needed now more than ever before.
David Ostrow
These are great suggestions. Thank you Jackie for taking the time to share them.
Anon
This announcement comes as no surprise with the government in power. The hypocrisy coming from this government is overwhelming. Wasting money on mega-projects that destroy the environment, while sacrificing physical and mental health programs is insanity. Education, the social safety net and decent jobs are needed for a strong ‘economy’ and society. We need people like you, Dr. Ostrow, to take a stand against this destructive agenda. We need Heroes.
Oh please!!
I would echo this comment and say that I don’t believe for a moment that there isn’t enough money for health care. If among other things our premier can give herself and her cabinet the kind of raise that she just did in this time of “fiscal restraint”, I think that it is quite laughable to say there is a lack of money for health services.
The kinds of cuts that are taking place don’t just impact us as health care workers – causing us stress but also cause great suffering to those who are most vulnerable such as people with mental health issues (closing of the Art Studio). Certainly the government will move their numbers around and make it look justifiable but those of us on the ground know that the loss of these kinds of services are hurting real people who are already hurt and will not be replaced in any substantial way.
What we need is a government with ethics!
Marc Leblanc
I do not understand how it was reported demand for home support hours rose 9%. Certainly provision of hours did not rise, in my limited experience.
David Ostrow
Actually Marc, data from our Decision Support team shows that the number of home support hours VCH provided in 2012/2013 was 2,720,248 which was 8.89 percent higher than that previous fiscal year.
Marc Leblanc
That is information I could not see from this level. Thanks!
David Brewster
It certainly will take innovation to help manage the budget pressure. Unfortunately it is rather challenging for front line staff to share innovations and ideas that may suddenly strike them. In the last year I have had a number of conversations with co-workers that come up with some great ideas for improvement……and, in the absence of an easy forum to share them, they have been lost.
It would be fantastic if there were an email address (or simple webform) that suggestions for improvement could be sent to. Or, if one does already exist, it could be better advertised.
David Brewster
Maureen Malanchuk
Not sure where you work, David, but in Richmond, we recently introduced an email address for staff, physicians and volunteers to share ideas for improvement. Since it was launched, 25 people have submitted 55 ideas, and they’re all being reviewed and investigated to determine if it’s feasible to implement them. You’re right, it’s a quick and easy way to submit ideas, and I thought I’d take this opportunity to promote it again . . . Richmondideas@vch.ca
Anon Richmond
I must have missed the announcement of this ‘idea exchange’ effort. Do you have anymore information on this please?
Maureen
Well, it’s pretty simple actually. Any staff, physicians or volunteers who have an idea to address our budget deficit and use our resources more wisely by cutting unnecessary costs, identifying spending efficiencies, or improving processes are invited to send them to richmondideas@vch.ca
All of the ideas are reviewed and investigated, and those that prove to be feasible will be implemented.
You can find out more here . . . http://vchnews.vch.ca/richmond/2013/06/27/staff-share-dozens-of-bright-ideas/
Neva
Maureen,
Will staff be getting feedback and find our if any of the ideas are utilized? It would encourage more people to make further suggestions/
David Ostrow
Thanks David for the excellent suggestion and we are looking into a simple way for staff to share suggestions and ideas across all of VCH. I hope to have some news on that one soon.
one little nurse
It’s time we start looking at how our emergency departments are being utilized and start looking at how health authorities can be leaders in providing primary care and not just for the most vulnerable but for everyone.
More primary care clinicians, less walk-in clinics and a re-shaping of how nurses and NPs are utilized to provide these services. Let the doctors do what they do best – provide complex medical care to those who need it most. Let nurses and NPs provide care to those who are less complex and can use some prevention and early intervention – thus keeping them out of the ER. I had a client recently who went to the ER for a pregnancy test? This had to be the most expensive pregnancy test ever…but it’s because she didn’t know where else to go. Or the client that has chronic knee pain and is managed by emergency room visits because she can’t get a timely appt with her family doctor. It’s time to stop using the ER as primary care…but this means reshaping how we do primary health care. And this means thinking outside the box and taking some risks.
I think it was Alberta that opened up “walk-in” urgent care clinics next to the ER dept where patients could go for their urgent but not emergency care. Staffed mainly with nurses and NPs, patients were assessed and treated for minor ailments (ie. minor stitches, abdominal pain, headaches, UTIs, fevers etc). Once the patients were assessed, they could be transferred to ER if warranted, they were treated in a more timely and cost-effective manner. Something to think about as the ARNBC and CNA embark on their RN and primary care campaign.
Karen LeBeau
Dear Dr Ostrow,
I appreciate your sincere and well articulated message.
I want to mention that I also value and appreciate the hard work of the senior executive team ( and all leadership in general) who work for Vancouver Coastal Health Authority. I have been impressed that there seems to be a heart felt effort to open the lines of communication across the health care teams to all levels of leadership. In a large organization this can be very difficult.
I was happy that your article in the VCH News mentioned the True North Goals and discussed the fact that most decisions made, even if difficult, tie in with the strategy of VCH. For some time I have felt that this is not mentioned nearly enough, especially in light of the many impactful decisions that have been made by the senior executive team, and then rolled out by various layers of leadership as of late.
Based on conversations I have had over the past year, I must say that I do wonder how many front line staff (and maybe other as well) are truly aware of the True North Goals and what they really mean. Perhaps this has never been presented as a concept, or possibility they just do not have time to review the intranet on a consistent basis.
There may be benefit in encouraging review, making time for discussions at the unit level, or develop initiatives for staff to understand this vision moving forward since as you mentioned, many more changes and cuts, in light of the current demographic projections and fiscal realities, are sure to come.
I also wonder if there may not be benefit in sharing some of the data at the front line level you mentioned to show trends in utilization, projections and costs to underscore the need to cut particular services in order to make way for streamlined and better utilized options. I do feel that in doing these things, sharing data, and sharing decisions made in alignment with the goals of the organization ( ie: Restructuring in Home Health ( elimination of nine day fortnight, increasing regular hours, increasing staff on weekends) aligns with this goal- ‘Innovate for Sustainability’ -optimize (staff) capacity, resource utilization and productivity’.
I believe that this approach may pave the way for less anger, encourage reality based perceptions, and foster much more support for the organization and leadership at all levels as we move forward.
Sincerely,
Karen LeBeau
David Ostrow
Thank you Karen for your thoughtful message. We have tried to roll out our True North goals and strategies across VCH but you clearly point out that we have a lot more work to do in that area. I will make sure that our Communications & Public Affairs team is aware of your comments. As for your suggestion of sharing more data and information about what and how VCH is doing, I will certainly do what I can to encourage that. I’m a strong believer in accountability and transparency as I believe that if people have more information about their organization and what it does, they can play a more active part in making it stronger, more efficient and – even more importantly – come up with ideas and innovations to improve things. VCH is one of the only health authorities in BC to share a public report card on our website but I will certainly look at what else we can do.
Office Manager
I would respectfully submit that there be a LEAN program implemented into the HSSBC process for VCH purchases.
Thank you.
David Ostrow
Thank you for the suggestion. It has been brought to my attention by others as well that some of our purchasing practices are not as cost-effective or efficient as they could be. We are following up with HSSBC and are hopeful that some of the concerns around process and potentially further cost savings can be put into place.
A mistreated minion
Why is it that all the cuts have to come at the lower levels and it seems that VCH is getting more and more top heavy. There are more and more people being hired at the corporate level (making more than 75,000 dollars per year) but lower level front line staff are always the ones that have to make concessions (lay offs, fewer vacation days, fewer sick days, no raises, chipping away of our benefits). I would like it noted that I make less per hour now than I did when I started here 13 years ago, but more and more work gets heaped on front line staff. What the heck is up with that. How does that seem fair. If I have to hear congratulations on one more corporate bigwig being hired to oversee some new or existing program I am frankly going to toss my cookies.
David Ostrow
Thanks for taking the time to share your views and for your honesty. You are not the only person to comment on administrative or corporate staffing numbers. However, VCH’s administration costs are among the lowest in the country for a health care organization of its size and we continue to look at how we can reduce that cost even more.
Joan
HOME HEALTH REDESIGN
We all acknowledge that financial resources are tight and we need to re- think how we do things.
“Home is best” slogan is great only if the financial resources are re-allocated to the community.
We will not be able to keep people at home if the financial resources are not there to do so.
If a person requires more than 8 hours of day of Home Support, it is cheaper to keep them in a residential care bed of course there are waiting list for the beds and people remain stuck in the hospital waiting for placement.
Solution: build more residential care beds; Short term pain / long term gain
anon
The over concern with deficits during this recession is largely an excuse to downsize public services, keep labour in line, and enhance the power of the 1% who don’t need public medicine or education, have no problem with unemployment themselves, prefer not to pay taxes, and are unconcerned with the erosion of the social contract. I think it is unfortunate but hardly surprising that many physicians and executives form a part of this group( not to say that they have easy jobs).One might sarcastically suggest that we expand the sales of the naming of lecture halls, buildings etc. to corporations and benefactors like Jimmy Pattison or the Diamonds. Perhaps another Olympics or G20 meeting or selling our F35 fighter planes would help.
Anon
Well said anon. the 1% seem all to content to destroy the environment and the social contract for their own benefit.
Minnie Minion
How can we change the focus, and get out of this rabbit hole, of rising deficits in health care, band aid solutions? The focus needs to be on health and prevention. Nurses and doctors treat symptoms. They do not advocate for the patient to change his or her lifestyle. More people are treated only for symptoms, medication so easily prescribed. I am 59. On a recent trip to my dentist, he looked at my chart and said “not on any medications/ wow, that is unusual. So many are on something now”. I’m ONLY 59!! Why should I be on meds? We need to take more responsibility for our own health! Focus on empowering the patient. If we are overweight, sedentary, eat the wrong foods, etc. we WILL have problems eventually, and end up in emergency. Then, with the present system, we will be given meds to control blood pressure, cholesterol , etc. Inevitably more problems arise, and it becomes about ‘managing’ disease and illness, instead of HEALING. Some people do all the right things, and still need medical intervention. True. But keep looking further…what is it in their emotional lives, possibly hindering healing. Hollistic approaches, counseling about nutrition and exercise, meditation…should be a focus. Doctors and nurses do their best, given the confines of their professions. But it will be a revolving door of illness and disease, if we don’t stop the ‘ magic pill’ mentality, endorsed by the companies who make them. Quite a feat to change these ways, but the world IS changing. Pesticides are being banned in communities and Provinces, holistic practices are more popular…slowly, we are learning to take care of ourselves, each other, and this planet. It’s a fight at times, as some big players would like to continue their enormous profits. The imbalance is shameful. Let’s tip these scales, and keep the beds empty for those who truly are in need. Let’s re-visit what our slogan..”PEOPLE FIRST” means!
Becky Lynn Brechin
Idea Regarding Hip Fracture Prevention
Perhaps the Lion’s Gate Hospital Foundation could start a Getting Hip for your Hip Fund whereby we could raise funds, and awareness for persons in the community at large to help purchase Hip Protectors.
According to Dr. Fabio Feldman, of Fraser Health, this could save millions of dollars. The average cost to help repair a person’s hip fracture, aside from the personal strife and suffering, is around $400,000. Hip Protectors cost around $70.00 to $100.00 a pair depending, and the new ones are actually sewn into clothing fibres. This would also save valuable OR time etc.
David Ostrow
Thanks Becky for your suggestion. We will look into the idea and see what we can do. Anything that can reduce costs while improving patient care is always a plus.
Dedicated
It is shocking that the important services we have built over many years in VCH are being dismantled because the Provincial Government has overspent on megaprojects. If we looked at what was right we would question their commitment to the health of BC residents and refuse to cancel services. Prevention and health promotion is easy to dispense with in times of rhetoric around “fiscal restraint”. In the long run children and families suffer. We have the highest child poverty rate in Canada. We know how negatively this impacts health. Shame on those who want to cut our valuable help for families.
Home Health Clinician
As one of several front line staff at Pacific Spirit CHC who are being asked to voluntarily reduce our FTE s in order to offset the increased cost of the new contracts, I am curious as to whether executive & management staff have been asked to do likewise.
As well, returning some clinical duties to the Clinical Resource Therapists & Practice Leadership Team would offset the higher workloads facing the remaining front line clinicians
It is very frustrating to hear about the wage increases recently given to the new BC government when we are being asked yet again to do more with less.
David Ostrow
Yes, like all parts of VCH, the corporate areas have not been immune from budget changes and redesign. Positions have been eliminated in areas like Employee Engagement, Communications & Public Affairs and Finance and we continue to look at all parts of VCH for further efficiencies and cost savings. Our priority is to meet government expectation of a balanced budget with as little impact on direct patient care as possible.
Minion
I understand the budget and what is required to balance the books. Every organization has financial constraints that they must face.
One question:
You said that if we have any questions to ask either our leader or supervisor. We don’t have one at the moment due to the reshuffling of staff we are a ship without a captain. No one from the corporate level has seen the aftershocks of the decisions due to axing our manager and the staff here are trying to function on some level of sanity.
There are three departments without a manager now and who is carrying the workload and problem solving on a daily basis? WE ARE. Maybe some recognition to staff (not the corporates) would be welcome.
David Ostrow
Have you spoken to Employee Engagement or perhaps another leader or supervisor about your concerns? While changes in structure and programs can be unsettling and not always perfect, there should be supports in place to that staff know who they report to and who they can seek leadership from. If you prefer, you can always email me directly with your work location and I can look into it for you.
Gillian Coates PT GFS
I am very concerned with the Government’s cuts of health care, I hope very much that VCH and other authorities are pushing back, and I would encourage you, in your leadership role, to speak out against this.
As you say, we have some great programs and services and huge and increasing demands on us. We are the people who are seeing daily the needs of people, and the impact when good services, like the Arts Studio are cut. We need to speak loudly and firmly to the government to say, these cuts are unacceptable, people’s lives are being negatively impacted, and the health of BC will go down.
Thank you for rthis opportunity to comment.
David Ostrow
Thank you Gillian for taking the time to comment and for also being the first to do so. In terms of government funding, it is more a case of it not keeping pace with the demand in growth, our aging population and other cost pressures than being “cut”. I certainly agree that we have some great programs and great staff and physicians providing them. Unfortunately, we have to make to some tough decisions to try and maintain a balanced budget which means that VCH can no longer support some programs. In doing so, we will try as hard as we can to stop any impact on direct patient care.