Balanced Scorecard Quarterly Report - Horizon Health...

Balanced Scorecard Quarterly Report March 2017

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Balanced Scorecard Quarterly Report

June 9

2017Data updated to March 31, 2017


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Table of Contents Page Balanced Score Card 2 Strategy Map 3

Strategic Theme: Patient and Family Centred Care “Provide me with the best possilbe care experience”

Patient Experience Survey Results (overall rating) 4

Official Language Audit Results – Ability to continue in French 5

Hand Hygiene Audit Score 6

Emergency room wait time (from triage to seen by doctor) 7

Create Centres of Expertise

Number of Centres of Expertise established 8

Enhance Community Based Services

Hospitalization rate per 1000 population for chronic disease (COPD,CHF,Diabetes) 9

% of youth with depression or anxiety who wait for service longer than the target 10

Enhance Tertiary Care

% of NB patients receiving stem cell in province 11

Wait time for cardiac electrophysiology for low & intermediate risk 12

% of treatments that start on time for Chemotherapy 13

Redesign Delivery System

% of beds occupied by ALC patients in 5 regional hospitals 14

Strategic Theme: Financial Accountablility “Provide me with value for my tax dollars”

Cost of Horizon Health Network/ capita (inflation adjusted) 15

Average number of paid sick leave days 16

Reallocate resources based on need and evidence

% of expenditures allocated to Community Service 17

% of expenditures allocated to Tertiary Care 18

Optimize Performance Excellence

Dollars saved through Perfromance Excellence 19

Enablers (HR, IT, Performance Excellence Culture) Improved Employee and Physician Engagement

Employee Engagement Survey 20

Available Information and technology to improve delivery

% of planned technology initiatives completed to improve pt services & communication 21

Committed Leadership and Culture

% of Strategy communcation plan implemented 22

Legend for Indicator Symbols: Meets / exceeds

stretch Exceeds target /

below stretch Meets target performance

Improved performance

(between base and target)

Below base performance

Not applicable

Legend for Initiative Status Symbols:

Complete On Track Somewhat Off

Track Off Track On Hold Cancelled

Information

Required


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Owner

Reporting

Frequency

(M,Q,SA,A)

Baseline

Measure

Full Year

Target

Full Year

Stretch

Reporting

Period

Actual

Indicator

Q1

Indicator

Q2

Indicator

Q3

Indicator

Q4

Patient Experience Survey Results (overall rating) Margaret M SA74.2%

(NBHC 2013)83.0% 85.0%

77.2%

NBHC 2016

Official Language audit results - Ability to continue in French Margaret M SA 75.5% 80.0% 85.0%81.5%

(FY16/17,Q1) Hand hygiene Compliance Margaret M Q 78.8% 85% 90%

81.5%

(FY16/17)

Emergency room wait time for triage level 3 at 5 Regional

hospitals (from triage to seen by doctor) (in minutes)Geri G M 85.66 79 75

87.60

(FY16/17)

Create Centres of

ExpertiseNumbers of Centres of Expertise established John A 0 1 2 1

Hospitalization rate per 1000 population for chronic disease

(COPD, CHF, Diabetes)Jean D Q 6.51 7 6.75

6.53

(FY16/17,Q3) % of youth with depression or anxiety who receive service within

the targeted wait times (in the Moncton area).Jean D Q 62% 85% 90%

40%

(FY16/17, Q4)

% of NB patients receiving stem cell in province Geri G Q 75% 80% 90%86.4%

(FY16/17, Q3)

Wait time for cardiac electrophysiology (in days) Geri G Q 216 90 9064

(FY16/17,Q4)

% of treatments that start on time for chemotherapy Geri G Q 94% 95% 98%97.9%

(FY16/17,Q3)

Redesign Delivery Systems % of beds occupied by ALC patients in 5 regional hospitals Geri G M 24% 23% 20%24.4%

(FY16/17)

Cost of Horizon Health Network/ capita (inflation adjusted) Andrea S M $2,188 $2,260 $2,180$2,247

(FY 16/17)

Average number of paid sick leave days Andrea S M 11.08 11.0 10.811.63

(FY16/17)

% of expenditures allocated to Community ServicesAndrea S/

Jean DQ 11.1% 11.2% 11.3%

11.2%

(FY 16/17)

% of expenditures allocated to Tertiary CareAndrea S/

Geri GQ 12.4% 12.6% 12.8%

12.4%

(FY 16/17)

Optimize Performance

ExcellenceDollars saved through Performance Excellence Andrea S M $3,931,705 $3,000,000 $3,500,000

$4,325,487

(FY 16/17)

Improved Employee and

Physician EngagementEmployee Engagement Survey Andrea S A 54% 60% 65% NA

Available Information and

technology to improve

delivery

% of planned technology initiatives completed to improve patient

services and communication between care giver or patientAndrea S M 88% 80% 90%

90%

(FY16/17,)

Committed Leadership and

Culture% of Strategy communication plan implemented Janet H M 84% 80% 90%

94%

(FY 16/17)

Last Updated: June 9, 2017

Horizon Health Network -Balanced Scorecard 2016-17

(Updated to March 31, 2017)

Strategic Theme: Patient and Family Centred Care

"Provide me with the best

possible care experience"

Enhance Community

Based Services

Enhance Tertiary Care

Strategic Theme: Financial Accountability

"Provide me with value for

my tax dollars"

Reallocate resources based

on need and evidence

Enablers (HR, IT, Performance Excellence Culture):


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Table of Contents

Patient Experience Survey Results (overall rating)

74.2% 76.9% 80.8% 77.2% 77.2%

0%

20%

40%

60%

80%

100%

2013NBHC

May 2014Horizon

Nov 2014Horizon

May 2015Horizon

2016NBHC

Patient Experience Survey Results

Horizon

Target

Strategic Objective: Provide me with the best possible care experience

Owner: Margaret Melanson

Reporting Frequency: Annual

Definition: A Patient Experience Survey is conducted twice each year for inpatients that have stayed in a Horizon facility for at least one night. This measure reports on the overall rating question from this survey. The survey will be conducted once each year starting in 2016.

Baseline Target Stretch Actual Indicator

74.2% (NBHC 2013)

83.0% 85.0% 77.2% (2016 NBHC)

Analysis Summary: The NB Health Council (NBHC) conducts an Acute Care Patient Experience Survey every three years. Horizon

has also conducted interim surveys to guide improvement efforts. Horizon’s next internal survey will be conducted in November 2017, allowing for time to implement appropriate interventions.

Following a review engagement, Horizon is relaunching the priorities for Patient and Family Centred Care (PFCC). There will be renewed focus on providing education and communication on PFCC to all levels of staff. A comprehensive workplan will be developed over the summer for review by the Executive Leadership Team.

Patient engagement through patient advisory committees will continue to develop to ensure the contributing patients as well as the organization benefit from the experience.

Horizon conducted a pilot survey of ambulatory care services within clinics at the SJRH. The results will be disseminated to inform plans for Quality and Safety initiatives. Regional implementation of the survey will be undertaken in the winter of 2017.

SOMIA Initiatives:

Priority Initiatives/Actions Status Comments

Communication White Board

The project is well underway. We are piloting white boards on 4 inpatient units. Initial feedback is good and we are incorporating suggested changes within the pilot. It is estimated that all sites will be up and running by July. Nursing staff are receiving training on SMART goals to help them work with patients and families in setting goals which pertain to their condition.

Proactive Patient Rounding

Nursing focus groups were conducted in April & May to obtain staff feedback on proactive rounding. Currently identifying actions to be taken for improvements, based on 2016 New Brunswick Health Council data and staff feedback.


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Table of Contents

Official Languages Audit Results – Ability to Continue in French

Analysis Summary: There are no new results available as audits are yet to resume. Active Offer Dialogue sessions continue to be provided. However, it is expected that these will slow down during July and August due to employee vacation. The plan is to restart sessions in September with a focus on getting a large number done in September and October so that audits may resume later in November. Results could then be available for end of Q3 of the current fiscal year 2017-2018. SOMIA Initiatives:


Execute strategies to improve provision of services in language of choice

Active Offer Dialogue Sessions: So far, 12 sessions have been recorded and feedback received. Target number of sessions is set at 105. (**Reasoning for target: if 35 of the 50+ facilitators commit to facilitating 3 sessions this fiscal year, we can provide a total of 105 sessions.)

Café de Paris initiative in Moncton is set to launch in July 2017. Language tutor/mentor scheduled to start on July 10th, 2017. This initiative continues to capture nationwide attention and interest. Two members of the Official Languages Team have already met twice with members from the IWK and the Nova Scotia Health Authority to present the initiative and to provide support. A visit to PEI is scheduled for June 21st, 2017. Horizon is currently working on a model document/brochure that will help share our good work and also recognize Horizon’s work. This is done in partnership with Société Santé et Mieux-être en français du Nouveau-Brunswick.



Reporting Frequency: Semi-annual

Definition: Audits are conducted to assess employees’ compliance with providing an active offer (greeting in both official languages) in person and over the telephone. The audits also assess how effectively employees are able to provide service in either language. The measure reflected here is the ability to continue providing service, in person, in either official language, in the four regional facilities. Supplementary information is available to report on the active offer (over the phone & in person) as well as the ability to continue in French over the phone. To obtain data which is more statistically solid on a unit/department level, the audit methodology has been adjusted. Audits will be conducted semi-annually and results will be published at the end of Q1 and Q3 each fiscal year. This will allow Official Languages to better target improvement efforts and initiatives.


75.5% 80.0% 85.0% 81.5% (FY16/17,Q1)


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Table of Contents

Hand Hygiene Compliance

75% 77% 78% 79% 78% 80% 81% 80% 82% 83%

0%

20%

40%

60%

80%

100%

FY 14/15Q3

FY 14/15Q4

FY 15/16Q1

FY 15/16Q2

FY 15/16Q3

FY 15/16Q4

FY 16/17Q1

FY 16/17Q2

FY 16/17Q3

FY 16/17Q4

Hand Hygiene Compliance

Horizon

Target



Reporting Frequency: Quarterly

Definition: This measure reflects the percentage of staff observed to follow the hand hygiene protocol established by the organization as part of safe practices for patients.


78.8% 85% 90% 81.5% (FY16/17)

Analysis Summary: A total of 51,074 observations have been completed in FY 2016-17 utilizing a standardized audit tool which aligns with national hand hygiene auditing practices. The audit function is an opportunity to promote the importance of hand hygiene practices by providing real-time teaching moments and on-going encouragement. Compliance signage is posted on each patient care unit providing monthly results. Physician hand hygiene compliance rates will be posted in areas visible to Physicians and work with specific unit areas, and staff / physician groups is ongoing to reinforce best clinical practice.

Based on audit results, efforts will be focused on improving compliance in areas that have been consistently lower than the Horizon average.

Facility YTD Mar 31 2017



The Moncton Hospital 76.93% Charlotte County 87.37% Oromocto 78.92%

Sackville Memorial 88.58% Sussex Health Centre 83.44% Upper River Valley 86.63%

Saint John Regional 80.01% Grand Manan Hospital 84.71% Hotel-Dieu Perth 86.28%

St Joseph's 89.77% Dr. Everett Chalmers 82.93% Miramichi Regional 81.97%

SOMIA Initiatives:

Priority Initiatives/Actions

Status Comments

Hand Hygiene Compliance Improvements

IPC is monitoring monthly hand hygiene compliance to identify units within each

facility that are not yet meeting target. Meetings are held with unit managers to identify unit specific needs and strategies to improve performance.


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Table of Contents

Emergency Room Wait Time for Triage Level 3 at 5 Regional Hospitals (from triage to seen by doctor - in minutes)

89.9 93.3 100.2 98.3

90.2 90.4 87.7 89.1 97.4

81.9 82.4 80.9 87.4 86.4 82.6

0.0

20.0

40.0

60.0

80.0

100.0

Jan… Feb… Mar… Apr… May… Jun… Jul… Aug… Sep… Oct… Nov… Dec… Jan… Feb… Mar…

ER Wait Time (Triage level 3 at 5 Regional Hospitals)

Horizon

Target

Analysis Summary: ER wait times continue to be longest at the Moncton Hospital, followed by DECRH and SJRH. DECRH and SJRH have seen significant improvement over last fiscal year; however Moncton has seen an increase in their triage level 3 wait time.

The primary area of concern is Moncton which continues to experience congestion issues. This makes improvement efforts difficult to maintain. The Moncton ER Redirect initiative is not yet showing the desired impact on the overall average wait time because it applies to a small number of patients.

SOMIA Initiatives:


Status Comments

Moncton ER Redirect The project is progressing towards its target of redirecting 10% of lower acuity cases to alternative services such as after hour clinics.

SJRH - One Board Changes in information flow and workflow are being implemented to improve efficiency based on volumes and acuity.

-10.00

40.00

90.00

140.00

Q4 FY1516 Q1 FY1617 Q2 FY1617 Q3 FY1617 Q4 FY1618

Triage Level 3 Wait Times Jan 2016- Mar 2017

DECRH

URVH

MRH

TMH

SJRH


Owner: Geri Geldart

Reporting Frequency: Monthly

Definition: The average time (in minutes) that a patient waits from the time they are triaged/registered to the time they are seen by a physician. Includes triage level 3. Excludes those patients where the seen by physician time was not documented. The five regional hospitals (TMH, SJRH, DECRH, URVH, MRH) are included in this indicator.


85.66 79 75 87.60 (FYTD16/17)


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Table of Contents

Numbers of Centres of Expertise Established

Analysis Summary: A Strategic Leadership Council has been formed to guide the Centre of Expertise for Aging and Eldercare into the future. Other key milestones that have been met include:

Three Task Forces (Research, Education & Clinical Leadership) have been formed

These Task Forces are currently having initial meetings and developing their Year 1-2 action plans with metrics

After branding advice from HAWK Communications the “Centre of Expertise” name will be dropped in favor of “Collaborative Care – Seniors Health”

Administrative support for the Centre is being secured Additional collaboration is also being actively worked on. Going forward the key measure for the Collaborative Care – Seniors Health initiative will be measuring the amount of collaboration resulting from this initiative. SOMIA Initiatives:


Develop Centre for Aging and Eldercare Progressing as noted above.


Owner: Jean Daigle


Definition: Horizon will establish new centres of expertise that foster strong clinical leadership, improve patient outcomes and drive research activities. This measure represents the number of centres of expertise established.


0 1 2 1


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Table of Contents

Hospitalization Rate per 1000 Population for Chronic Disease (COPD, CHF, Diabetes)

D

6.38 7.80 7.34

5.53 6.37 6.51 6.98

6.34 6.53

0.00

2.00

4.00

6.00

8.00

10.00

FY 14/15 Q3 FY 14/15 Q4 FY 15/16 Q1 FY 15/16 Q2 FY 15/16 Q3 FY 15/16 Q4 FY 16/17 Q1 FY 16/17 Q2 FY 16/17 Q3

Chronic Disease Hospitalization Rate

Horizon

Target

Strategic Objective: Enhance Community Based Services

Owner: Jean Daigle


Definition: The number of patients discharged from hospital with a diagnosis of COPD, CHF or Diabetes per 1000 population. Population base for Horizon communities is 537,106. Data is available with a lag of one quarter.


6.51 7.00 6.75 6.53 (FYTD16/17,Q3)

Analysis Summary: Chronic disease hospitalization rate has remained relatively stable.

We are beginning to see promising results from the INSPIRED program. Hospitalized patients enrolled in INSPIRED are a referral source for EMP Rehab and Reablement for COPD patients over 65 years of age.

Development of a Public Awareness Campaign is underway in partnership with Vitalité. The campaign will be developed to build awareness of COPD as a chronic disease, reduce the stigma and identify the toll this disease makes on patients and families. This campaign will be launched with targeted funding from the Province before the end of the fiscal year.

SOMIA Initiatives:


Status Comments

Implement actions from CHNA

A $200,000 investment from DH will assist with prevention and early detection activities identified in the Community Health Needs Assessments.

Smoking cessation This program continues to expand across Horizon. There are strategies for high risk populations where prevalence are higher such as in-patient psychiatry, detox and methadone programs

Chronic Disease Standards

Chronic Disease Standards have been written with implementation planned throughout Horizon over the next few years. The standards address how the system should be redesigned for improved management of chronic diseases.


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Table of Contents

Percent of Youth with Depression or Anxiety Who Receive Service Within the Target Wait Times

67%

35%

49% 62%

54% 57%

42% 40%

0%

20%

40%

60%

80%

100%

FY 15/16 Q1 FY 15/16 Q2 FY 15/16 Q3 FY 15/16 Q4 FY 16/17 Q1 FY 16/17 Q2 FY 16/17 Q3 FY 16/17 Q4

% of youth with depression or anxiety receiving service within target wait time

Horizon

Target

Strategic Objective: Enhance Community Based Services

Owner: Jean Daigle


Definition: Youth, aged 19 less 1 day and younger, who are diagnosed with depression or anxiety should receive services within a targeted wait time of 90 days. This measure tracks the percentage of these patients who received the service within the target wait time in the Moncton area where the wait time has been an issue. These numbers include youths waiting for psychiatrist and/or therapist. (Note: in Q2, 2015/16, this measure was revised to state the wait time met rather than not met.)


62% 85% 90% 40% (FY16/17, Q4)

Analysis Summary: The acuity of depression or anxiety at the time of assessment impacts how quickly a client is seen. Depression and anxiety are often assessed as medium priority. High priority clients (for depression or any condition) are being seen within target times. However medium priority clients tend to wait longer.

Two new social worker and other vacant positions were filled. We were able to assign the 80 cases that were waiting beyond the target wait time. The waiting list decreased from 120 to 57 as of June 2017.

Integrated Service Delivery (ISD) is a partnership with Education, Public Safety and Social Development to develop and implement appropriate child and youth centered interventions to ensure the positive growth and development. We expect this to have a positive impact on service in the Horizon Moncton Area. We are expecting that in the fall of 2017 ISD will be implemented, with the addition of six clinical coordinators and ten clinicians. With the addition of these positions, we will be meeting the target by winter 2018.

SOMIA Initiatives:


Integrated service delivery On track for full implementation in Moncton in Fall 2017


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Table of Contents

Percent of NB Patients Receiving Stem Cell in Province

66.7% 66.7% 66.7% 66.7%

83.3% 85.7%

100.0% 90.0% 87.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%


% of NB patients receiving stem cell in NB

Horizon

Target

Analysis Summary: From April – December 2016, there were 22 adult patients from the province of New Brunswick who received an autologous stem cell transplant within Canada. Of those patients, 19 had the procedure completed within their home province, at the Saint John Regional Hospital. Three patients from NB had the procedure out of province. SOMIA Initiatives:


Repatriate cases referred to NS Further repatriation will be discussed at the Provincial Stem Cell Advisory Committee.

Strategic Objective: Enhance Tertiary Care

Owner: Geri Geldart


Definition: Horizon has the resources and expertise to provide stem cell transplants at the Saint John Regional Hospital. Some patients are being referred out of province. This indictor tracks the proportion of adult NB patients requiring stem cell treatment who received that treatment within New Brunswick. The data is available one quarter behind because it comes from the national CIHI database.


75% 80% 90% 86.4% (FYTD16/17, Q3)


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Table of Contents

Wait Time for Cardiac Electrophysiology

418 441 500

216

92 41 52 64

0

100

200

300

400

500

600

FY 15/16,Q1

FY 15/16,Q2

FY 15/16,Q3

FY 15/16,Q4

FY 16/17,Q1

FY 16/17,Q2

FY 16/17,Q3

FY 16/17,Q4

Wait time for Electrophysiology (in days)

Horizon

Target

Analysis Summary: Wait times for access to services are tracked from the time of initial consultation with the Electrophysiolgist until the time the procedure is completed. The significant reduction in wait times for elective electrophysiology studies is the result of limiting the number of new, non-urgent referrals seen in consultation. This action was necessary due to our limited MD resources in Electrophysiology and consequently enabled the program to address the backlog of elective cases waiting in the queue. There is now a significant list of patients waiting for initial consultation; however, all are categorized as non-urgent.

All cases that are urgent in nature are prioritized to the top of the queue and are accessing services within reasonable timelines.

The official opening of the new device lab was held in November. The laboratory was fully operational in January with minor additions still required. Recruitment for a second Electrophysiologist was successful with a new physician starting on August 14, 2017. Once the new Electrophysiologist is in place we will revisit our approach to seeing non-urgent referrals.

SOMIA Initiatives:


Enhancement of electrophysiology service

The device lab was upgraded.


Owner: Geri Geldart


Definition: Patients who await cardiac electrophysiology are assessed as urgent, high, intermediate or low risk. For intermediate and low risk patients the target wait time is 90 days. This measure focuses on the average wait time for intermediate and low risk patients. The measure reflects patients who have had procedures completed. Other patients, who remain on the wait list, may be waiting longer.


216 90 90 64 (FY16/17,Q4)


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Table of Contents

Percent of Treatments That Start on Time for Chemotherapy

94.5% 96.4% 94.4% 93.2% 92.8% 94.0% 98.6% 97.5% 97.7%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

FY 14/15Q3

FY 14/15Q4

FY 15/16Q1

FY 15/16Q2

FY 15/16Q3

FY 15/16Q4

FY 16/17Q1

FY 16/17Q2

FY 16/17Q3

% on time for Chemotherapy

Horizon

Target

Analysis Summary: All areas above the target with Moncton and Fredericton areas maintaining 100% and Saint John area

at 96.2%, the highest in 7 years. Overall rate of 97.9% for also appears to be highest achieved for the same time

frame. Patients in the Miramichi area receive their first treatments at the Moncton hospital.

Two chairs were added in Saint John. The new pharmacy positions were filled and the camera equipment was installed. These changes improved patient flow and allow us to treat more patients each day.

Space remains the primary constraint in Saint John. We are still challenged to provide supportive therapy in a timely manner. SOMIA Initiatives:


Enhancement of Oncology Service

Budget for enhancement was approved as part of the 2016-2017 Regional Health and Business Plan. Recruitment is complete. Additional resources will address workload issues in several key areas, but it is unlikely to affect the wait time for chemo as space remains the critical bottleneck.


Owner: Geri Geldart


Definition: The number of patients who received their first treatment within 7 days of being ready to treat proportionate to the total number of patients who received their first treatment (outpatients).


94.0% 95% 98% 97.9% (FYTD16/17, Q3)


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Table of Contents

Percent of Beds Occupied by ALC Patients in 5 Regional Hospitals

25% 22% 24% 26% 25% 25% 25% 22%

26% 24% 24% 22% 24% 24% 25%

0%

10%

20%

30%

40%

50%

Jan2016

Feb2016

Mar2016

Apr2016

May2016

Jun2016

Jul2016

Aug2016

Sep2016

Oct2016

Nov2016

Dec2016

Jan2017

Feb2017

Mar2017

% of beds occupied by ALC patients

Horizon

Target

Analysis Summary: The new data collection process allows for more accurate reporting of ALC patients. Our ability to consistently identify the ALC patients and the barriers for discharge will enable us to identify root causes for delays and focused initiatives to address these. Vitalité Health Network has expressed interest in using our model for data collection. This would improve consistency across the province. ALC remains a significant cause of hospital congestion, particularly in Moncton and Miramichi. SOMIA Initiatives:


Standardize ALC tracking and reporting process.

Completed. We will now be able to use the report to fine tune improvement initiatives.

ALC Avoidance tool An analysis was conducted based on this set of best practices. This identified possible gaps in our current practices. Improvement initiatives will be developed based on this review.

Stakeholder Engagement Most sites have started to include representatives from the Department of Social Development and local Nursing homes in their working groups.

Strategic Objective: Redesign Delivery Systems

Owner: Geri Geldart


Definition: The percentage of beds occupied by Alternative Level of Care (ALC) patients. Includes ALC patients in all beds, regardless of bed classification, and is based on the MIS Nursing Unit functional centres. The measure includes only the five regional hospitals (TMH, SJRH, DECRH, URVH, MRH).


24% 23% 20% 24.4% (FYTD 16/17)


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Table of Contents

Cost of Horizon Health Network per Capita (inflation adjusted)

$2,160 $2,160

$2,188

$2,244

$2,226

$2,195 $2,205 $2,210 $2,214

$2,225 $2,228 $2,214

$2,247

$2,100

$2,120

$2,140

$2,160

$2,180

$2,200

$2,220

$2,240

$2,260

$2,280

Jan2016

Feb2016

Mar2016

Jun2016

Jul2016

Aug2016

Sep2016

Oct2016

Nov2016

Dec2016

Jan2017

Feb2017

Mar2017

Cost per Capita

Horizon

Target

Analysis Summary: This indicator continues to run below target for Q4. The target has increased 3.3% over the previous year as a result of the incorporation of three major union contracts which were settled during the previous year, an increase in budgeted maintenance activity, continuation of retirement allowance payout program, and normal inflationary changes. Performance in 2016-2017 follows the trend of previous years. Costs are below budget in all expense categories except benefits and other supplies. Higher than anticipated WorksafeNB costs, account for the variance in benefit costs. Other supplies are over as the result of DTI charges, for construction related work, performed on our behalf over the entire year. We continue to have significant savings on salary, drug and surgical supplies costs. SOMIA Initiatives: None at this time


Strategic Objective: Provide me with value for my tax dollars

Owner: Andrea Seymour


Definition: This measure looks at the cost of services, identified as total expense per capita. Population base for communities within the Horizon areas is 537,106.


$2,188 $2,260 $2,180 $2,247 (FY16/17)


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Average Number of Paid Sick Leave Days

11.36 10.98 11.23 11.63

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

FY 16/17 Q1 FY 16/17 Q2 FY 16/17 Q3 FY 16/17 Q4

Average number of paid sick days

Horizon

Target

Strategic Objective: Provide me with value for my tax dollars



Definition: This measure is an annualized average number of paid sick days per employee eligible to receive the benefit.


11.08 11.0 10.8 11.63 (FY 16/17)

Analysis Summary: The results are up slightly in Q4, following normal annual trends due to influenza season. In January 2017 it was announced that Horizon and Vitalité would begin to negotiate a final contract with the successful provider for the outsourcing of EVS, Food Services, Nutrition and Portering management. Past trends have identified that workforce adjustment activity announcements have a direct impact on sick usage. In addition, staff scheduling rotation challenges continue to have impacts. The draft Human Resources Strategic Plan includes a focus on Attendance Management. Initiatives are planned for the first half of fiscal 2017-2018. We expect these to have an impact on this indicator by Spring 2018. SOMIA Initiatives:


Attendance Management

There is continued focus on attendance management. Planning sessions were held and opportunities for improvement were identified; implementation plans are being developed.


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Table of Contents

Percent of Expenditures Allocated to Community Services

10.9% 11.1% 10.9% 11.2% 11.1% 10.8% 10.8% 11.1% 11.2%

0%

10%

20%

30%

40%


% of Expenditures Allocated to Community Services

Horizon

Target

Analysis Summary: Analysis Summary: The goal set out in the strategic plan is to allocate 12% of the total budget to community-based programs, an increase of 2% or approximately $23 million over 5 years. The 2016/17 Regional Health and Business Plan outlined a plan to increase community-based programs by $933,000 annualized over two years. In the current year there have been investments from new funding to enhance community services. It is important to note that our ability to redirect funding from current hospital based services to community services is difficult without approval to undertake healthcare system redesign. As such, this indicator will be modified for fiscal 2017-2018.

SOMIA Initiatives:


Community Health Needs Assessment The last six assessments were completed in the third quarter.

Strategic Objective: Reallocate resources based on need and evidence

Owner: Andrea Seymour/Jean Daigle


Definition: Proportion of overall expenditures incurred by Community Services including Extra Mural, Community Mental Health and Addictions, Public Health, Community Health Centres, Corporate Admin for VP Community, population health and clinics. (Excludes addictions and psychiatry inpatient services. Data included for community services does not include outpatient services that are hospital based, such as outpatient physiotherapy or diabetes clinics.).


11.1% 11.2% 11.3% 11.2% (FY 16/17)


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Percent of Expenditures Allocated to Tertiary Care

12.1% 12.6% 12.7% 12.3% 12.3% 12.6% 12.4% 12.5% 12.4%

0%

10%

20%

30%

40%


% of Expenditures Allocated to Tertiary Services

Horizon

Target

Analysis Summary: The goal set out in the strategic plan is to increase the percent of expenditures allocated to tertiary care by 2% over 5 years. It is anticipated that expenditures will increase in the second half of the current year. Recruitment of specialists is currently under way and we anticipate increased investment in tertiary care in the second half of the current fiscal year as a result.

Increased investment in the NB Heart Centre is the first major targeted change to the funding in tertiary services. Overall expenditures are up over previous quarters in this measure. Costs in the NB Heart Centre, combined medical/surgical ICU continue to climb, and oncology has shown a slight increase as well. Total expenditure on tertiary care increased by 1.6% ($122,889,531 to $124,886,492) SOMIA Initiatives:


Specialist recruitment in NB Heart Centre

Currently underway.

Strategic Objective: Reallocate resources based on need and evidence

Owner: Andrea Seymour/Geri Geldart


Definition: Proportion of overall expenditures incurred by tertiary services including Oncology, Heart Centre, Trauma, Stem Cell, Stan Cassidy, Critical Care (ICU, CCU, Neonatal ICU, NeuroICU, Peds ICU) and Interventional Radiology. Expenses exclude medical compensation and depreciation.


12.4% 12.6% 12.8% 12.4% (FY 16/17)


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Dollars Saved Through Performance Excellence

Analysis Summary: Q4 was a strong quarter with several large projects reporting for the end of the year. Patient Flow initiatives, particularly around the Inspired Program tracked strong soft savings. The first two projects at the NB Heart Centre, in partnership with Medtronics began reporting monthly savings in Q4. The projects have resulted in increased throughput in the Operating rooms, generating soft savings from reduced wait times. Hard savings totalled $478,100 while soft savings from productivity improvements, cost avoidance and reduced waste resulted in over $3.8M for the year.

SOMIA Initiatives:


Staff Scheduling Progressing with shift rotation plans. A software bug has caused some delays.

Joint Services RFP - Environmental, Food and Portering

Contract negotiations continue.

NB Heart Centre initiatives Progressing on schedule. Projects to optimize OR and reduce patients’ average length of stay have been successfully implemented. New projects are starting in May.

Patient Flow initiatives Various initiatives to address inpatient congestion are expected to result in savings as well

Strategic Objective: Optimize Performance Excellence



Definition: This measure will track the hard and soft savings through process improvement. Savings include: reduction in spending, cost avoidance, revenue generation, and savings in productivity and efficiency as a result of continuous improvement including Lean Six Sigma projects, waste walks and other continuous improvement activities.

Baseline Annual Target Stretch Actual Indicator

$3,931,705 $3,000,000 $3,500,000 $4,325,487.01 (FY 16/17)


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Employee Engagement Survey

Strategic Objective: Improved Employee and Physician Engagement



Definition: A formal survey was conducted in November 2014 with employees and physicians. The survey consisted of 12 categories: Communication, Customer Focus, Engagement, Goals and Objectives, Health and Safety, Job Autonomy, Job Challenge, Leadership, Management, Quality and Resources, Teamwork and Collaboration, and Training and Development. A 54% favourable aggregate score is used as the baseline.


54% 60% 65% NA

Analysis Summary: The last staff engagement survey was completed in 2014. The 2014 survey highlighted deficiencies in both the survey tool selected, and in the process followed. Major initiatives including revamp of the orientation program, introduction of values workshops, introduction of workplace violence program and creation of the Bravo! program have had a positive impact. A new engagement survey will be undertaken in the fall of 2017. Managers and staff have been engaged to provide input into the new Human Resources Strategic Plan. The plan will include focus on employee engagement. SOMIA Initiatives:


Staff Engagement Strategy Development and Implementation.

Work is continuing in the areas of Leadership and new employee On-Boarding.

Workplace Violence Prevention Program Implementation

Code White project is rolling out to each facility. Pilots in community settings have been completed. The program is now being operationalized.

CaRES – (Caring, Respect, Excellence and Service)

This program for new employee orientation is being rolled out across Horizon.

Smoking Cessation Initiative Nearly 700 employees have taken advantage of support resources to quit smoking.

Years of Service and Retirement Recognition

An enhanced approach to recognizing years of service and retirement has been well received by staff and managers.


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Percent of Planned Technology Initiatives Completed to Improve Patient Services and Communication between Caregiver and Patient

INDICATOR

Row Labels Q1 Q2 Q3 Q4 Grand Total

Dictation 1 7 6 14

Patient Wireless (Ph2) 1 1 2 3 7

OBS Documentation System (Watch Child) 1 2 6 9

Grand Total 2 4 15 9 30

Milestone Achieved in Quarter 2 3 13 4

Cumulative Milestones Achieved 2 5 19 27

% Milestone in Expected Quarter Achieved 100% 75% 80% 56%

% Cumulative Milestones Achieved to Date 100% 83% 90% 90%

% of planned technology initiatives completed to improve patient services and

communication between care giver or patient

Strategic Objective: Available Information and technology to improve delivery



Definition: A list of Information and Technology projects will be identified for completion, or progress, in this fiscal year, with target milestones. This measure will track the percent of those milestones that were met (include list here when available). Projects are: Dictation Project, Patient Wireless Project (Phase 2), and the new Electronic Fetal Monitoring and Documentation System (Navicare WatchChild) in Moncton.

Baseline Target Stretch Actual Q1 Indicator

88% 80% 90% 90%

(FY16/17,Q4)

Analysis Summary: The Dictation project has been successfully implemented.

Patient wireless was implemented in all but 2 inpatient hospitals (final planning is underway).

A fetal monitoring and electronic documentation system went live in Moncton in Q3. Ongoing enhancements and modifications are occurring post implementation to address operational complexities.

Significant effort was expended to drive these three projects. We continue to be challenged by the lack of available IT resources within Horizon and insufficient resources within Service NB.

SOMIA Initiatives:


Development of an IT Strategy for Horizon

Complete replacement of dictation system

The next area of focus for this platform will be (1) upgrade to the new version; and (2) front end dictation for other physician groups to improve timeliness of access to patient information.

Renew IT Operating Structure Increase IT Business Resources within Horizon


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Percent of Strategic Communication Plan Implemented

FY16/17, Q1 FY16/17, Q2 FY16/17, Q3 FY16/17, Q4

Scheduled for completion 8 8 7 12

% Achieved 86% 88% 100% 100%

% Cumulative Achieved 86% 87% 91% 94%

Strategic Objective: Committed Leadership and Culture

Owner: Janet Hogan


Definition: This measure will track the percentage of tasks completed specific to the communication plan. This includes initiatives to improve corporate communication and community engagement; support strategic priorities; and manage risks to corporate brand and reputation.


84% (FY15/16)

80% 90% 94% (FY16/17)

Analysis Summary: Communications established 35 milestones for completion this year, 12 (or 34%) of which were scheduled for completion in the fourth and final quarter. A significant portion of these milestones are in support of strategic initiatives, as well as internal communications and community engagement goals. As new strategic or operational initiatives were identified, Communications continued to evaluate and prioritize communications plans in support of these projects.

SOMIA Initiatives:


Create engagement opportunities to better condition general public for change

Two projects have been identified under this priority. These two public awareness initiatives were both completed on schedule in Q4.

Promote greater awareness of Horizon Strategic Plan

Four initiatives have been identified under this priority, with milestones that span through the last three quarters of the year. The final two initiatives were scheduled for completion in Q4, and both were on schedule.

Support ELT priorities by developing communications plan and materials, and providing advice and expertise for internal and external communications objectives

Approximately 43% of Communications’ projects this year were in support of ELT priorities, and all three (or 100%) of the milestones slated for completion in the fourth quarter have been completed.

Minimize risk through consistent Corporate Reputation Management

Approximately 46% of the Department’s communications projects are in support of this initiative. This priority deals specifically with Horizon’s ability to engage with staff and stakeholders effectively and consistently. Of the five milestones scheduled for completion in Q4, all five (or 100%) have been completed.

Balanced Scorecard Quarterly Report - Horizon Health...

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