A3 TEMPLATE - RQHR STRATEGY

Transcription

1 A3 TEMPLATE - RQHR STRATEGY Title: Financial Sustainability Strategy Which provincial hoshin/outcome does this strategy support: Better Value: Ongoing, as part of a multi-year budget strategy, the health system will bend the cost curve by achieving a balanced or surplus budget. Primary Owner (SLT Lead): Robbie Peters Team Lead(s) (Leaders of key initiatives): Senior Leadership Team Expert Advisor (if applicable): 1. Problem Statement (Current state and the reason for action.) [Explain what and how big the problem is and why strategic action is required to address it.] Overview: - All across Canada, healthcare budgets continue to be the largest user of taxpayer dollars, and it has increased exponentially over the last 15 years or so. It is not considered to be sustainable and this is no different in Saskatchewan. - Annual increases in growth in health care funding in Saskatchewan has decreased over the last few years compared to historical growth, causing significant pressures on health regions while dealing with population increases, changing and aging demographics, growth for service demand and overall escalating costs - The Region has incurred a $16.2 million deficit in 2014/15, $1.5 million deficit in 2013/14 and $19 million deficit in 2012/13 - Continued increasing health costs and increasing demand for services, combined with expectations from government and the public for access to services, will continue to impact the Region s budget pressures in 2015/16 - Bending the health care cost curve is a long-term process that is much more than a quick cost cutting exercise - Based on Ministry funding identified for 2015/16, we have estimated a potential preliminary deficit of $38 million if we remain at status quo - We are expected to contribute to bending the provincial health system cost curve by March 31, 2017, which includes balancing our budget in 2015/16 - Balancing the regions budget in requires all of us to be accountable for the dollars we spend and to share in the responsibility for sound financial management Date of Original Draft: February 20, 2014 Date Last Updated: May 10, 2015 Estimated Budget Requirements: Estimated Resource Requirements: 4. Implementation Plan (What are the high-level actions that will be taken to address the problem within the given timeframe? What actions need to be taken to achieve the future state?) [More detail can be included in a separate implementation plan.] Key Areas to Work On (fill out supporting multi-year summary as well attached) Reducing long-term cost structure through advancement of focused initiatives identified to balance the budget in 2015/16 and beyond (as outlined in Board approved direction of March 31, 2015 and submission to MoH Apr. 10). Focus areas include Provincial procurement and other contracts Surgical services realignment Utilization of reduced veterans beds at WRC Clinical appropriateness Quality and safety initiatives Patient flow initiatives Improving admissions for ambulatory care sensitive conditions, with a beginning focus on COPD Workforce optimization Improved metrics in overtime, orientation costs and sick costs (all closely connected with workforce optimization) We will make impactful transformational changes through continuous improvement initiatives, using lean tools and techniques, while engaging with all stakeholders including physicians, front line staff and patients Who Vice Presidents assigned as leads in each of these areas Leaders / KPO / KOTs and engagement by others throughout RHA Date Throughout 2015/16 with expected benefits to be realized by March 31, 2016 On-going We will continue to pursue shared services initiatives, and provincial procurement opportunities, that improve quality and reduce cost Continuation of initiatives under the Efficiencies Target Initiatives steering committee, with a focus on 1) management capacity 2) accountability frameworks 3) master roster reviews and compliance 4) overtime deep dives and 5) workforce optimization 3sHealth / RHAs / SCA Robbie Peters and Mike Higgins On-going Throughout 2015/16 with expected benefits to be realized by March 31, 2016

2 Enhancing our financial support corporate model and how finance supports the organization s decision makers through education, tools and information flow, value added analysis and reporting. Consideration of resource investment opportunities in areas such as internal audit, contract management, project managers, financial analysts. Robbie Peters, Darlene Rorbeck, and Lorrie Davidowich July, Root Cause Analysis (What is causing the problem and what evidence can be provided to support the analysis?) [Highlight baseline data and analysis that helps clarify the magnitude of the problem statement and narrows the focus for the future state section. What are the barriers impeding change or success?] 5. Metrics (How will you know whether the project is successfully moving towards the future state? How will you know a change has been an improvement?) [Identify both outcome and process metrics that will help indicate the project success and include balancing measures to ensure the project doesn t negatively affect other metrics. These should relate to the actions noted above in the implementation plan section] - High cost of staffing, impacted by wage driven premiums, inability to sometimes manage workforce due to employment agreements and other factors. Wages and benefits accounts for approximately 73% of total spending - Patient flow can significantly impact spending if not able to move patients in a timely manner to the appropriate places for their needs - Unnecessary treatments or procedures; appropriateness - High reliance on acute services and facilities; lower use of Primary health care services - New technologies are often expensive and desired by influencers - Population and demographic changes - Significant internal churn, or staff movement, causing large orientation costs and decreased productivity. Front line manager turnover is very high an particularly problematic when it comes to daily management of resources. - Inability of Region to make significant decisions on service delivery changes without the approval of government (public expectations) - Provincial shared services, led by 3sHealth and the RHAs, are significant with over $100M in anticipated cumulative savings identified to date. Ability to achieve savings and goals are at risk as it will be difficult to implement the various business cases, funding sources have not been finalized, and successful implementation relies heavily on existing people resources that are already running thin and face burn out and the challenges around project and change management. - Bending the health care cost curve is a long-term process that is much more than a quick cost cutting exercise Provincial health system outcomes and targets that RQHR is expected to contribute towards: Outcome: - Ongoing, as part of a multi-year budget strategy, the health system will bend the cost curve by achieving a balanced or surplus budget. Targets: - All health system partner organizations will be in a balanced or surplus year-end financial position in Shared services activities will produce $10M net new savings in RQHR Measures: - meeting or exceeding balanced budget targets for 2015/16, monitored on a monthly basis by comparing actual results to budgeted

3 3. Target Statement (Describe the future state by March 31, 2017.) 6. Engagement (How is this plan informed by the principles of Patient and Family Centred Care and how are patients and families being engaged in the work? Please also explain how physicians are being engaged as well as any other necessary stakeholder.) March 31, 2016: Balanced budget March 31, 2017: Balanced budget Our strategic plan and related financial sustainability plan is centred around 4 main focuses and is supported by our Board of Directors: Quality and safety Patient flow Enhanced focus on primary health care Diligent daily management Many of our actions and initiatives in these areas involve key stakeholders described above.

4 Multi-year Summary Which provincial hoshin/outcome does this strategy support: Better Value/Cost Financial Sustainability - Ongoing, as part of a multi-year budget strategy, the health system will bend the cost curve by achieving a balanced or surplus budget. Improvement Targets: RQHR will be in a balanced financial position in Plan Elements Lead / Support Plan Elements Lead / Support Further refinement and development of specific action plans on the focused initiatives to balance the budget in On-going monitoring and reporting on progress/success of these plans. Vice Presidents Plan Elements Lead / Support Plan Elements Lead / Support Continued development and delivery of initiatives under the Efficiencies Target Initiative (ETI). On-going monitoring and reporting on progress/success of these plans. Peters and Higgins / ETI steering committee Active participation and support for shared services and shared procurement opportunities with other health partners (3sHealth, RHAs, SCA) Will be various resources provided depending on business case

5 Be viewed as the EXPERTS who deliver results. Development of a portfolio service delivery plan and commitment by all portfolio staff to provide exceptional service to our customers through timely, pro-active and expert support and advice. Our team needs to be thoroughly aware of Regional priorities and focuses and to be pro-active and creative in how we support these priorities, including, but not limited to, RQHR and Provincial strategic priorities and targets Focused initiatives to balance the budget in and beyond (development of a monitoring and reporting process for each of these) Efficiencies Targets Initiatives (ETI) Daily management expectations Paid hours analysis Financial leadership team Analysis of current financial support model, gap assessment, and development of a structure that will adequately support the organization s growing financial management functions (analysis to include any new resources required such as finance managers / analysts / internal audit / contract management / project management, etc.) Peters/Rorbeck

6 Enhance how we support the organization s decision makers through improved financial education, tools, information flow, reporting, value added analysis. A current state assessment to be done in each of these areas, identifying gaps and improvement opportunities and action plans to address. Finance leadership team / Budget Working Group Develop plan for lean initiatives in portfolio. Finish visibility walls, kanban, 5s, RPIW opportunities. Finance leadership team / Brenda Jamieson