It’s been a privilege to answer your questions over the past months. Thoughtful and thought-provoking, they often convey just how much you share our passion for providing best care.

Looking back on 2013, we couldn’t help but notice that some questions — or versions of them — came up again and again. So, in this last issue of 2013, we’re recapping five of the most frequently asked questions we’ve answered … just in case you missed our reply the first time.

Our next Vancouver All-Staff Forum will be held on January 29, 2014, from 3 to 4 pm at VGH. We’ll be in touch again in the new year for your input on the agenda. In the meantime, you can still email us your questions – we welcome them.

Our top five most frequently asked (and answered) questions

 Editor’s note: The following has been edited from the original for brevity.

Q. Will there be more displacements and, if so, where and when?

A.  As Mary Ackenhusen put it so well at Vancouver’s All-Staff Forum (ASF), we wish we could say there will be no more displacements, but we can’t. In Vancouver, we continue to look for opportunities to better align our services with patient needs in both the acute and community sectors. Unfortunately, we can’t provide further details at this time, and we want to explain why.

Our system has a number of checks and balances built into it to ensure service delivery changes are thoroughly reviewed and assessed before they’re implemented – and this is a good thing. It ensures clients’ and patients’ best interests remain at the centre of all decisions, and it ensures the problem and solution are examined from every possible angle. Before any plans are considered final we require approval from Vancouver Coastal Health’s Senior Executive Team and, in some cases, we also have a duty to consult the Ministry of Health.

Another reason we can’t always share details is that we are bound to honour our collective agreement and, specifically, section 54 on the displacement notice process. Timelines for consultation with affected unions must be met before we can inform affected employees. When – and only when – we’ve fulfilled all these responsibilities can we share details about displacements. And, when we can share, our first priority is to inform those immediately affected.

We recognize that it’s difficult to live with uncertainty, and so we want you to know that it’s our hope that staff displaced will find positions elsewhere in our organization. Employee Engagement, VCH’s Human Resources department, works hard to provide employees with opportunities for placement into vacancies and bumping options according to their union contracts. We don’t want to lose skilled and experienced employees, so we’re making every effort to find displaced employees an alternative position, and in some cases offering additional training.         

While we’re unable to provide specifics about potential displacements, we hope that we’ve provided some insight into the complexities and limitations behind answering this important question.

Q. Why must we reduce our budget?

A.  VCH is primarily funded by B.C. taxpayers — people just like us. Our taxes provide the B.C. government the funds it needs to deliver public services and about 40% of all government revenues is spent on health care. As a health authority, we receive our public funding directly from the Ministry of Health.

The B.C. government has made a commitment to a balanced budget — in other words, it doesn’t want to spend more money than it brings it. The Ministry of Health has in turn directed all B.C. health authorities to do the same.

Historically, VCH has operated within its annual budget — and we aim to do so again this year. We are not in debt, nor have we been in debt, but this year we risk running a deficit if we don’t achieve our targeted savings by the end of the financial year on March 31. (Deficit is defined as the amount by which spending exceeds revenue during one budget year.) We‘re at risk of running a deficit because we’ve projected our costs and it’s clear that they’re rising faster than the pace of government funding increases. In addition, we need to invest in our future by replacing outdated information systems.

Over the course of a year, our spending has its ups and downs, and when we spend more money than we bring in, the actual cash comes from VCH working capital, which is reserves that all have businesses have — basically, savings from past years when we may have been in surplus. If we use too much of our working capital (think of it as out rainy day fund), we won’t have enough money to cover the peaks and valleys of our spending. In the most extreme case, we wouldn’t have enough cash to meet our payroll obligations — but don’t worry, we won’t ever let ourselves get to that point!

In the end, if we’ve spent more than what we brought in over the course of the financial year, we will have run a deficit. If VCH were to run a deficit, we would be placing the Ministry of Health in a deficit position as well. And when the B.C. government accrues deficits, it accumulates debt. (Debt is defined as a build-up of annual deficits.) The government must then borrow money to pay the bills — and that’s how provincial and federal governments end up in debt. How do we pay off the debt? There are only two ways: reduce spending and/or increase taxes. Either way, it comes down to the B.C. taxpayer — people just like us.

Q. How are you adjusting services to meet the changing needs of community clients? What information are you basing your decisions on?

A.  It’s a complex task to determine the needs of each of our communities based on the populations we serve.  We’ve been lucky to partner with many folks who can help us to answer exactly the questions you posed. This includes information we receive from UBC researchers, and the outcomes of research projects such as Chez Soi, which was recently undertaken by the Mental Health Commission of Canada. The City of Vancouver is also a great source of data, as is BC Housing. But, most importantly, VCH staff – both frontline and management – are also well versed in community demographics and have been a great source of information upon which we have based our decisions.

Q. How will you seek input from us who work in mental health regarding ideas, strategies for coping/planning in light of the budget restraints and how to manage mental health demands in the community?

A.  We need staff input and everyone’s collective wisdom if we’re to tackle the growing demand for mental health and addiction services in the community.

To this end, MH&A directors Anne McNabb and Andrew MacFarlane are already pulling together facilitated sessions for early Spring 2014. These sessions will be held at VGH and will likely be focused on how the MH&A teams and units are working together to meet the needs of clients and families. Time will also be dedicated to brainstorming around ideas and opportunities around addressing our budget challenge.

On a broader note, Gallup (People First survey) just asked whether or not staff feel as if they’re listened to. We want you to know that we’re all ears. We’re always open to receiving your feedback and ideas directly.

So, please, the next time you see one of us on one of our Gemba walks, introduce yourself and offer-up your suggestions. We look forward to opening the lines of staff communication further.

Q. How has the 37.5-hour work benefitted clients/patients — and at what cost to staff?

A.  We recognize that this has been a difficult adjustment for some, but we’re also pleased to report that the shift to a 37.5-hour work week is accomplishing our first and foremost goal: expand patient and client access to service.

Across VCH, a total of 359 — that’s 80% of units requiring a rotation change — have improved access by smoothing their service hours through the week so patients/clients experience consistent service hours each weekday.  Of these 359 units, 10% also increased evening staffing and an additional 10% also increased weekend staffing, providing options for those at work or in school 9 to 5.

Within Vancouver, the numbers break down as follows:

• Vancouver Community: 135 units (79% of units requiring rotation change) have improved patient and client access to services
• Vancouver Acute: 94 units (60% of units requiring rotation change) have improved patient and client access to services

With respect to mental health services, program interlinks with acute services have improved as there’s now full access and staffing five days a week instead of four – and this means we’re enhancing the continuum of care for our mental health patients/clients.

As we’ve said before, we recognize that the shift has been difficult, but we also have faith in our staff, their professionalism and their commitment to provide best care. A 37.5-hour work week allows our teams to deliver more quality care and service cost-effectively.