Board Approval of Plans - Regina Qu'Appelle Health Region · MoH Dedicated Funding $ 7,600,000 Life...
Transcript of Board Approval of Plans - Regina Qu'Appelle Health Region · MoH Dedicated Funding $ 7,600,000 Life...
Board Approval of Plans
Keith Dewar
President and CEO
Our Purpose
Why we are here
Slide 2
Strategic Hierarchy
Government of Saskatchewan
Ministry of Health
Regina Qu’Appelle Health Region
Provincial Health System Patient,
Staff and Physician
Input
Patients, Clients, Residents and Families
Patients, Clients, Residents and Families
Slide 3
Strategic Planning Inputs
• To inform the development of plans, internal
and external inputs were considered: – Provincial outcomes and targets
– Patient, staff and practitioner feedback
– Clinical best practices
– CIHI data
– Accreditation standards
– Budget (provincial and RQHR)
– Other e-scan data (internal and external)
– Risks, gaps and challenges
Slide 4
RQHR Strategic Areas of Focus
Quality and Safety - Everyone has a right to expect safe, quality health.
Access/Patient Flow - Access to the right care, in the right place, at the right time, by
the right provider is a cornerstone of high quality care.
System Sustainability - Using our people, infrastructure, and financial resources
responsibly to build a strong health care foundation now, and
into the future.
Slide 5
RQHR Strategic and Business Plan
The Strategic Plan directs the
Region’s effort and provides focus
as we work towards achieving our
Vision.
The Business Plan is the Region’s
one‐year operational work plan that
guides us towards achieving the
goals and targets that have been
approved by the Board in the
Strategic Plan.
Slide 6
Formal Approval
Recommendations:
• THAT the Board approve the RQHR Strategic
Plan (Appendix A)
• THAT the Board endorse the RQHR 2016-17
Business Plan (Appendix B)
Slide 7
2016-17 RQHR Operating Budget
Slide 8
Recap of April 6th
Board Meeting – 2016-17
Preliminary Budget
• Limited funding to support increasing costs due to substantial growth
in our population and demographics is challenging
• Budget process started with a $30M estimated deficit, assuming a 0%
base funding increase
• Submitting a deficit budget is not an option; our target is a balanced or
small surplus budget
• The operating and capital budgets are established to support achieving
our one-year Business Plan
• The budget process supports our daily operations and the outcomes
established for the provincial health system
Slide 9
Highlights of June 1st
Provincial Budget -
2016-17 Operating Funding Impact
• RQHR’s MoH funded base operating grant increased by 3.5 per
cent to $936 million this year
• Funding highlights:
• $17.8M compensation funding to address collective bargaining
increases
• $9.247M inflation funding
• $4.7M for amounts previously received as special payments now
included in our base operating grant
• Direction to reallocate $1.464M from Administration spending to front
line Long Term Care spending
• New targeted funding of $20M provincially to increase surgeries and
decrease wait times (RQHR portion unknown at this time)
• Commitment to maintain the targeted funding for reducing ED waits
• Other targeted funding for specific programs still to come
Slide 10
Update to 2016-17 Operating Deficit Estimate
Prior to Deficit Reduction Initiatives
Regina Qu'Appelle Health Region
2016-17 Operating Deficit Estimate Prior to Deficit Reduction Initiatives
In $000's
2015-16 Carry Forward Deficit 15,201$
Adjust for One-Time Items (WCB, $2M revenue, vacation liability, stat holidays) (2,650)$
Known Incremental Costs (physician services, laundry contract) 3,312$
Inflation Expense Estimate 3,854$
Population and Demographics Changes: Net Impact 3,830$
Inflation Funding (net of funding reductions) (9,247)$
Est. Operating Deficit Estimate Prior to Deficit Reduction Initiatives 14,300$
Slide 11
Population and Demographic Changes
Require Strategic Investments
Strategic Investments Required to Address Population/Demographic
and Other Service Pressures
Planned Immediate Investments:
• Quality and safety improvements supported by:
• Information technology investments
• Analytical resource investments
• Advancement of primary health care service delivery
• Accreditation and regulatory requirements
• Appropriateness
Pending Investments:
• Infrastructure sustainment
• Addressing inpatient bed number pressures
Slide 12
Update to 2016-17 Operating Budget
Regina Qu'Appelle Health Region
2016-17 Operating Budget
In $000's
2015-16
2016-17B
(July 20)
Revenue
Ministry of Health Funding - Base 899,121 934,665
Ministry of Health Funding - Other 52,829 28,763
Other Gov't & Agency Revenue 27,076 23,908
Patient & Service Fees 24,889 24,447
Other Revenue 35,575 30,275
Total Revenue $1,039,490 $1,042,058
Expenses
Salaries & Benefits 688,175 668,796
Medical Remuneration 90,380 92,459
Operating Grants 70,160 71,447
Medical Supplies 88,795 91,472
Infrastructure 49,114 47,487
Clinical & Operational Supports 55,821 56,757
Admin & Other 12,246 13,640
Total Expenses $1,054,691 $1,042,058
Surplus (Deficit) ($15,201) $0
B - Budget
Slide 13
2016-17 Operating Deficit Reduction
Initiatives
Regina Qu'Appelle Health Region
2016-17 Operating Deficit Reduction Initiatives
In $000's
2016-17 Preliminary Operating Deficit Estimate 14,300$
Deficit Reduction Target Areas
Annual Productivity Improvement Target (roughly 1% of operating budget) 10,700$
One time PST Rebate Revenue 1,900$
One time GST Rebate Revenue 1,200$
Real Estate Revenue Opportunities 500$
Total Deficit Reduction Target 14,300$
-$
Slide 14
Productivity Improvement Target
Initiatives
Regina Qu'Appelle Health Region
2016-17 Operating Deficit Reduction Initiatives
In $000's
Productivity Improvement Target Initiatives 10,700$
The Region expects that it will achieve efficiencies and reductions to its cost structure each
year from engaging in quality improvement activities, participating in shared service opportunities
and focusing on diligent daily management.
The Improvement Target is allocated to initiatives that the Region is currently working on as follows:
Compensation Related Initiatives: 7,750$
Reduce Sick Time 500$
Reduce Orientation: 1,000$
Reduce Turnover
Create Consistent Orientation Programs
Reduce Overtime 1,000$
Optimizing Use of Our People Resources: 5,250$
Match Capacity (Resources) with Demand
-Correct staffing models, models of care, benchmarking and standards, reduce variations in service
Effective Management of Work Units
Consistent Work Standards for Leaders
Supply Savings Initiatives: 2,950$
Appropriateness - reduce and standardize tests, Antimicrobial Stewardship 500$
Inventory and Procurement Management 1,000$
Product Standarization 750$
3sHealth Procurement Savings 700$ Slide 15
Risks to Achieving a Balanced Budget
• Did not achieve targets for compensation reductions in 2015-16; risk of not
achieving results in 2016-17 is high
• Complex environment limits timely ability to reduce paid hours
• Diligent daily management requires organizational focus; reduction in
Administrative spending may reduce resources required to achieve savings
• Due to continued population growth and changing demographics, acute care
bed needs are projected to increase in 2016-17
• Anticipated savings from 3sHealth business cases have not been verified, and
in some cases is resulting in increased costs
• Unknown impacts from provincial transformation discussions
Slide 16
Formal Approval
Recommendation:
• THAT the Board approve the RQHR Operating
Budget (Slide #13 )
Slide 17
2016-17 RQHR Capital Budget
Slide 18
Risks and Challenges
Chronic Capital Funding Shortfalls
IT Capital Projects and Infrastructure
• Information Technology Plan recommends $10M+ annual project budget plus
increased operational budget, based on % of total region spend
Capital Equipment (Clinical and Non-Clinical)
• Equipment depreciation recorded in 2015-16 was $15.2M; annual planned replacement
should be at least this amount
Facilities Projects and Infrastructure
• Benchmarked annual maintenance & repair should be $50M based on 3rd party facility
assessments; shortfall of $32M
• Benchmarked annual capital asset renewal should be $24M based on our current asset
value; shortfall of $18M
• No allowance for capital expenditure required to address renovations for additional
medicine beds; funding request pending with MoH
Slide 19
2016-17 Capital Budget
Capital Cash Flows
2014-15
Audited Actual
2015-16
Audited Actual
2016-17
Budget
SUMMARY OF CASH INFLOWS
Provincial Funding:
Clinical Capital Equipment 3,368,840 3,716,598 2,780,000
Tertiary Capital Grant 1,000,000 1,000,000 1,000,000
Designated Capital Funding 500,000 500,000 500,000
Life Safety/Emergency & Infrastructure Funding 6,016,182 5,415,095 7,890,000
Facilities:
Project_ Regina Hospital Electrical Renewal 6,100,000
Project_Master Service Plan 1,500,000
Project _ RGH Heliport 830,021 - -
Project _Regina LTC Replacement Strategy 1,000,000 - -
Project _Regina Dementia Assessment Unit - 1,100,000 -
Project _RGH - 5B On Call Room Renovation 1,250,000 - -
Foundations/Donations 8,015,651 5,242,652 2,259,000
Transfer from Operating Fund 471,843 514,175 449,895
Transfer from Restricted Fund (81,100) 328,000
Mortgage Subsidies 346,358 314,853 356,199
Other (specify) _Other/Trust 2,949,218 310,162 165,000
Other (specify) _Endoscopy Project 130,000
Total Capital Cash Inflows 25,667,013$ 18,441,535$ 23,130,094$
SUMMARY OF CASH OUTFLOWS
Capital Equipment 13,933,131 9,654,154 5,194,000
IT Equipment and Capital Projects 4,688,000
Facilities:
Project _VFA, Life Safety and various Reno/Construction 4,406,161 7,089,564 11,719,409
Projects_Other funding sources 946,000
Project _Master Service Plan - - 1,500,000
Project _LTC Replacement Strategy - - 808,387
Project _Regina Hospital Electrical Renewal - - 6,100,000
Minor Renovations 502,338 455,316 2,714,685
Mortgage Principal and Interest Payments 1,184,875 827,761 762,887
Other Capital Cash Outflow (specify) Capital Expenses 1,188,823 450,023 294,922
Total Capital Cash Outflows 21,215,328 18,476,817 34,728,290
CASH INFLOWS MINUS OUTFLOWS 4,451,685$ (35,282)$ (11,598,197)$
Capital Expenditures Funded with Carry-Forward Funds 12,141,403$
Surplus/(Deficit) 543,206$
Slide 20
Capital Equipment Outflows
Capital Equipment Outflows and Funding Sources Detail
Outflows:
Fluoroscopy Unit 1,200,000$
Equipment Purchases from Prior Year's Funding 1,200,000$
Rural Trust Equipment Purchases 165,000$
HRF Committed Purchases 1,612,000$
Equipment Contingency 1,017,000$
Total 5,194,000$
Funded From:
HRF 2,259,000$
MoH Dedicated Equipment Funding 553,000$
MoH Clinical Capital/Tertiary Grant Funding 1,017,000$
Rural Trust Funds 165,000$
Carry Forward Funds from Prior Years 1,200,000$
Total 5,194,000$
Capital equipment recommendations, prioritizations and approvals are made per the
Clinical Equipment Committee and/or Rural Trust Committees
Slide 21
IT Equipment and Capital Project
Outflows
IT Capital Expenditures are prioritized and recommended by the IT/IM Steering Committee
and approved by the Senior Leadership Team
IT Equipment and Project Outflows and Funding Sources Detail
Outflows:
Hardware and Network Infrastructure 1,050,000$
Computerized Provider Order Entry 1,472,000$
Lab System Module 12,000$
Completion of Registration Replacement 850,000$
Carryforward and SunRise Clinical Manager projects 401,000$
Endoscopy System 903,000$
Total 4,688,000$
Funded From:
Deferred Revenue 130,000$
MoH Clinical Capital Equipment Funding 2,143,000$
Carry Forward Funds from Prior Years 2,415,000$
Total 4,688,000$
Slide 22
Facilities Projects Outflows
Facilities Projects are prioritized and recommended by the Facility Infrastructure
Committee and approved by the Senior Leadership Team
Facilities Projects Outflows and Funding Sources Detail
Outflows:
Regina Hospitals Electrical Upgrade 6,100,000$
Master Service Plan 1,500,000$
LTC Replacement Strategy Planning 808,387$
5B On Call Renovation 217,000$
Dementia Unit Renovation 365,000$
Other miscellaneous funded renovations 399,000$
Endoscopy Renovation 328,000$
Capital Renovation Contingency 350,000$
Nurse Call Systems 400,000$
HVAC Systems 2,950,000$
Elevator Upgrages 1,490,000$
Roof Replacements (Capital Expense) 995,000$
RPV & Grenfell Renovations 1,972,500$
VFA Projects In Progress 4,400,000$
Transfer to Affiliates 126,016$
Other Projects 1,682,500$
Total 24,083,403$
Funded From:
MoH Dedicated Funding 7,600,000$
Life Safety & Emergency Infrastructure Funding 7,890,000$
MoH Tertiary Capital Grant 350,000$
Carry Forward Funds from Prior Years 8,243,403$
Total 24,083,403$ Slide 23
Alignment with Strategic Priorities - Expected
Outcomes of Capital Expenditure Decisions
Quality and Safety • Addressing critical facility needs to ensure stabilized, continued operations of RQHR
facilities
• Priority safety investment in failing and obsolete patient care systems e.g. nurse calls
• Building code upgrades for elevators and fire safety systems
• Electronic ordering for clinicians will result in safer patient centred care
• Priority IT projects are consistent with the plan to implement an electronic patient record
Access/Patient Flow • Facilities projects designed to mitigate interruptions to service and infrastructure damage
due to failures e.g. plumbing and sewers
• Critical replacement of aging information technology and communications systems to
avoid service disruption e.g. Registration, Endoscopy, servers, phones
System Sustainability • Planned equipment replacements to avoid higher cost of emergency replacements
• Planned upgrades to avoid failures and increased mitigation cost for highest value
infrastructure obsolesce ( HVAC, Roof repair, electrical systems)
• IT projects will result in savings and cost avoidance due to fewer duplicate tests and
shorter lengths of stay Slide 24
Formal Approval
Recommendation:
• THAT the Board approve the RQHR Capital
Budget (Slide #20 )
Slide 25