Vancouver All-Staff Forum: let’s keep talking

Thank you, everyone, for making Vancouver’s first True North All-Staff Forum a success. Altogether, about 600 Vancouver Acute and Community staff and physicians participated. We know you’re busy people and we’re grateful you could take part.

Planning future forums with you

When polled, most participants said attending Vancouver’s All-Staff Forum was a good use of their time, and we’re committed to holding more. The next Vancouver All-Staff Forum will be held on October 30, and we’ll continue conducting these forums on a quarterly basis. We also want your input and suggestions for building the next forum’s agenda. Watch for more information in the fall on how you can contribute.

You can still experience the forum

We’ve had many requests for our PowerPoint and we’re pleased to share — just click on this link: Vancouver ASF PowerPoint.

The forum’s recorded webcast is also available for viewing at the following links (Classic Viewer version is compatible with older browsers):

And, if you haven’t had a chance yet, visit Vancouver’s True North site and look up our interactive Strategic Plan with links to videos and much more.

Answering your questions

Much of the forum’s success rests with your readiness to ask questions — yes, even the frank and difficult questions. We answered as many as we could in our limited time together, but we recognize that many people who submitted questions prior to the forum, and even during the forum, are still in need of answers. Starting today, we’re answering submitted questions (see below), and over the coming weeks we’ll continue answering submitted questions in VCH News.

Today’s answered questions:

Q. Please explain the rationale behind making all programs and all staff work a 7.5-hour day for 5 days per week? VCH runs many one-of-a-kind programs and this does not reflect the specific needs of the various patient groups and their needs.

VCH does not require all staff in all programs to deliver services based on a 7.5-hour shift length, 5 days per week. But where it makes operational sense, and we can enhance our patients’ and clients’ access to quality care and services, extended shift lengths have been approved by a committee of senior operational leaders. There are 21 areas in VCH where it makes sense to do this, as well as in almost every area of Medical Imaging. Since VCH began redesigning shift rotations in early summer, we have seen more than 200 units where we have increased service on evenings, weekends or during the week through the smoothing of staffing hours. And, we accomplished these service enhancements without increasing costs.

Q: What do the numbers on slide 17 of your presentation mean?

A: The numbers on slide 17 tell a great story. Here’s why:

The column on the right shows Vancouver’s year-end balance for the fiscal years 2005/06 to 2012/13. (Our fiscal year runs April 1 to March 31.) For five straight years — from 2005/06 to 2009/10 — Vancouver ended the year with a deficit (that’s why those numbers are in parentheses). In other words, we spent more than we had. In 2005/06, for example, we had a deficit of $11.9 million. In 2009/10, our deficit rose to $12.4 million.

But, thanks to a lot of hard work and innovation on the part of staff and physicians, we turned this situation around. Since 2010/11, Vancouver has ended the year in a positive financial position. While enhancing the quality of care and services we deliver, we’ve transformed Vancouver’s financial position. We’ve demonstrated that we can deliver quality care, even enhance care and services, and operate within our budget. With your help, we’re confident we can do so again.

Q: Why do HSSBC items cost so much? For example, I found a Zebra LP 2844 Thermal Bar Code Printer for $129.99 online, yet the HSSBC website price is $772.92. And that cost doesn’t include the $280.35 deployment charge on new orders and a $390.88 deployment charge on refreshing orders.

A: The provincial government requires most government agencies and health authorities to participate in a province-wide contract with IBM for desktop services, including computers and printers. The rationale is that this contract will result in a cost-effective solution for the taxpayer due to standard architecture, standard operating/maintenance procedures and experienced management (through IBM). We are not privy to the overall cost comparison for the province so we trust that this is true, even though it may feel like we are paying more than we should at times.

As you’ve probably discovered, we don’t have the option to “opt out” but we’re working, and will continue to work, with HSSBC to ensure that the service is as effective as possible within the contract terms.

Q: I would like to know why physicians in Vancouver (and elsewhere in B.C.) have the control to do most immunizations?

A: In B.C., immunizations can be given by physicians, public health nurses and (for some vaccinations) pharmacists. In urban centres, family physicians give most childhood vaccinations and flu shots while in rural communities public health nurses give most of these shots. In addition, several immunizations given in school-based clinics are delivered exclusively by public health nurses.

Several analyses have been done in B.C. to determine whether having immunizations given only by public health nurses, as in some provinces, would be less expensive and improve quality. All have concluded that it would not and that the current mixed system is best.

In terms of cost to the system, physicians are the least costly of the three groups who immunize. This is because the physician fee code for giving a vaccination to a child is less than $5 (about the same for flu shots to adults), and from this physicians must pay their overhead costs and the cost of the supplies needed, including the needle and syringe, vaccine fridge, etc. When physicians give vaccinations to patients who are seeing them for other reasons, they can’t bill anything extra for the shot beyond the visit fee. In the end, physicians aren’t making money by providing this service to their patients, but are doing it to provide good care.

The cost to the public system for a public health nurse to give a childhood immunization includes their salary (most public health clinic visits are 15-30 minutes in length, and the salary costs are more than the $5 a physician receives), the cost of supplies and the overhead for running the clinic, including rent. Independent analysis has found these costs to be higher than the cost of physician-delivered vaccinations.

The MSP fee code available to pharmacists for giving a vaccination is higher than the physician fee code.

The reality is that we need both family physicians and public health nurses to participate in giving immunizations to maintain a robust system.

Q: Why is Omnicell in the VGH ER not programmed to have both generic and trade names cross-referenced?

A: Work is underway to add the brand names for medications, such as dimenhydrinate (Gravol equivalent) and diphenhyramine (Benadryl equivalent). We have started with the PCIS database and are working on Omnicell, but we have been confronted with a few technical issues.We’re currently working at the regional level to resolve these issues.

Got a question on your mind?

If you have a question you haven’t submitted yet, it’s not too late. Email VancouverAll-StaffForum@vch.ca and send us your question about about delivering quality health care services while tackling our budget challenge. We ask for your patience as we do our homework to provide you accurate and thoughtful responses.

In the meantime, visit Vancouver’s True North site and look up our interactive Strategic Plan with links to videos and much more.