You asked. We answer!
During Vancouver’s All-Staff Forum, we answered as many questions as we could in our limited time together. Unfortunately, many questions remained unanswered at the end of the forum — and we’re committed to responding. Last week, we began publishing answers to your questions and, below, we have six more.
Over the coming weeks we’ll continue answering submitted questions in VCH News, and we thank you for your patience as we do our homework to give you accurate and thoughtful responses.
Today’s answered questions
Q: Escorting inpatients to appointments is not very reliable. Sometimes inpatients can be in our department for 3 hours due to escort issues. This is costly as it affects patient care and the efficiency/productivity of our department. We have an escort in our department, but they are not replaced when off-duty, creating a back log. How can we address this?
A: The centralized escort pool used by the majority of VGH is dispatched using an automated transport tracking system. This system automatically prioritizes and dispatches our patient escort staff. However, if units are experiencing delays to service, they can call dispatch in order to escalate a request. Dispatch has the ability to manually override the automated system.
Our escort service standards are:
- For scheduled trips (appointments booked through the centralized patient escort service), patients are brought to appointments 15 minutes prior to the start of their appointment.
- For return trips, patients are picked up within 30 minutes of the completion of their appointment.
There are times when the workload exceeds the demand for service, resulting in service delays. When this occurs and there are more than 15 trips pending pick up, workload is called in to respond.
To maintain these standards, escort staff are backfilled when they are taking vacation, planned leaves or when they call in sick. Departments that use escort/care aide staff (such as Diagnostic Imaging and the OR) are responsible for arranging for their own backfill and/or workload of escort staff. We hope this answers your question, but if you need more information specific to your area, email us at VancouverAll-StaffForum@vch.ca.
Q: How does the blog, for example those entries written by Clay Adams with a compensation package in the $200k range, reflect LEAN thinking?
A: The VCH blog, “Up for Discussion,” is a staff engagement tool modelled on a business best practice. Blogs enable leaders to engage in less formal but open communication reflecting a mix of their business ideas and insights into who they are. Staff, in turn, can post their own ideas and comments and engage in conversation with their leaders — about LEAN or any number of other topics. Blogs have been proven to be highly effective in terms of staff engagement and retention. At VCH, “Up for Discussion” has attracted over 50,000 visitors, 130,000 page views, and 720 comments in the past year alone, which suggests many employees enjoy its content and find it a useful engagement tool. Clay Adams is a contributor to the VCH blog along with several of his Senior Executive Team colleagues, but it is only one of his many responsibilities as VP of Communications & Public Affairs. That some of his blogs many not be of interest to everyone is part of the blog’s unique and award-winning formula. If you feel that his, or any of the authors’ posts don’t appeal to staff, we encourage people to post their thoughts directly to the blog and submit ideas for topics that might be of interest to others.
Q: I have worked in both non- profit and health authorities and the difference in evaluation is lacking grossly in health authorities. In non-profit you must prove you are doing what you say you are doing with the dollars you have (which is much less). I think quality care comes from evaluating service continuously. Is there any plan to involve real evaluation of our work and show program outcomes so that services provided are streamlined and so money is managed responsibly?
A: As a publicly funded health care system we have both a duty and a moral obligation to deliver quality care in a fiscally responsible manner. That is why we set new targets every year to track our performance and outcomes in a number of areas.
As an organization, we aim to be transparent, and we report on our outcomes on an ongoing basis. Visit our VCH public website’s Accountability page and you’ll find our organization’s:
- annual reports
- budget and financial reports
- quality care report cards
- public health service report cards
In Vancouver, we have our Vancouver True North targets, many a subset of our VCH-wide goals. Vancouver’s senior leaders review our outcomes every two weeks to track our progress, identify opportunities and, if necessary, discuss areas in need of attention.
Q: Recently, we were mandated to move to a 37.5 work week from 35 hrs. As we all know labour cost is usually the biggest expense. Why not save money and go back to 35 hrs?
A: We’ve redesigned rotations to increase service without increasing costs. A consistent 37.5-hour work week has allowed us to achieve a more consistent level of staffing each day and reduce our need for backfilling. More importantly, we’ve improved patients’ and clients’ access to service
Our new rotations have resulted in approximately 26 more days of service per year. As a result, more than 200 units have increased service on evenings, weekends or during the week. Our patients and clients now have better, faster access to the services they depend on us to deliver.
Q: Why is the government making us cut corners with patient safety and quality care and cut programs in order to fund Cerner? Why are they not funding it themselves? Do our Leaders really believe this is the right thing to do?
A: To answer your first question, it’s important to recognize that replacing our aging and inadequate clinical information systems is only one of many financial pressures we’re facing. There are many other reasons VCH is facing a budget gap, including:
- growing demand for services
- increasing complexity and acuity of patient/client population
- rising costs of services
- rising utilization of supplies, tests and medications coupled with lack of standard procedures and protocols
- increasing labour costs
Having said that, VCH leadership and government feel strongly that we need a major upgrade in our clinical information systems. In fact, we believe we can’t afford not to. Here’s why:
Many of our information systems are more than 20 years old, and vendors provide only minimal levels of support to keep them running (ie: fix breaks). We have limited ability to make system enhancements and, in a large, complex health care system, our systems don’t speak with one another. Staff, physicians and patients have expressed frustrations about our old, broken information systems — that’s what we heard loud and clear in the 2011 People First (Gallup) Survey. We’ve been listening, and we believe investing in the Clinical and Systems Transformation Initiative (CST), including Cerner, is a much-needed investment in our future.
In addition, we believe we can find efficiencies without compromising quality health care. We can’t be all things to all people, and we’ll have to make some difficult decisions, but we have a history of innovation and meeting difficult challenges. Thanks to our people, we’ve succeeded and we’ll continue to succeed implementing solutions that not only save the system money, but also enhance care and service. We’ve done it before and we can do it again.
To learn the latest about CST and Cerner, read the August issue of CST News.
Q: How much are the “optics” of doing something “creative” and different to manage health care needs and spending, otherwise known as “True North” costing?
A: We introduced our True North goals in October of 2012 (see the VCH News story), and they’re about much more than sustaining our health care system and balancing our budget. Our VCH True North encompasses four goals — and at the heart of our True North is our goal to provide best care. True North goals are interdependent and balancing them as a whole is essential. To provide best care in a fiscally challenging environment, we must focus even more on innovating for sustainability.
That is why we’re communicating our True North within existing budgets and at a cost less than $10,000. To make sure we gained maximum value for that money, few elements were produced as “stand alone” communication tools. Instead, we made use of existing meetings and web sites and used in-house talent to write the video script, produce the screen savers, and take all the photos (many of which were voluntarily taken by a VCH employee on his own time due to his personal interest in photography.) There were no staff forums and meetings held exclusively for the True North. The VCH Senior Executive Team renamed the existing “Strategic Implementation Forum”, a quarterly meeting for leaders to get face-to-face updates on VCH-wide business and financial progress, to the “True North Forum”.
Got a question on your mind?
If you have a question about delivering quality health care services while tackling our budget challenge, email VancouverAll-StaffForum@vch.ca. 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.