List of Figures Painter/businessplans... · Web viewThis equates to $135,600/ year for lease cost...
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Prepared for: Dr. Marvin Painter Prepared by: Kate Morrison MBA 992 University of Saskatchewan
Transcript of List of Figures Painter/businessplans... · Web viewThis equates to $135,600/ year for lease cost...
Prepared for: Dr. Marvin PainterPrepared by: Kate Morrison
MBA 992University of SaskatchewanEdwards School of Business
June 9, 2017
Table of Contents
Health MattERs
List of Figures...................................................................................................................................i
List of Tables...................................................................................................................................ii
1.0 Executive Summary...................................................................................................................1
2.0 Introduction................................................................................................................................4
2.1 Proposed Business.................................................................................................................4
2.2 Positioning Statement............................................................................................................5
2.3 Goals and Objectives.............................................................................................................5
2.4 Mission Statement.................................................................................................................6
2.5 Vision Statement....................................................................................................................6
3.0 Industry Overview.....................................................................................................................7
4.0 Operations................................................................................................................................12
4.1 Operations Overview...........................................................................................................12
4.1.1 The What......................................................................................................................12
4.1.2 The How.......................................................................................................................13
4.1.3 The Why.......................................................................................................................13
4.1.4 The Who.......................................................................................................................14
4.1.5 The Where....................................................................................................................15
4.2 Organizational Structure......................................................................................................15
4.3 Board of Directors and Management...................................................................................16
4.4 Site Plan...............................................................................................................................17
4.5 Floor Plan.............................................................................................................................18
4.6 Development Plan................................................................................................................20
4.6.1 Phase 1..........................................................................................................................21
4.6.2 Phase 2..........................................................................................................................21
4.6.3 Phase 3..........................................................................................................................21
4.6.4 Phase 4..........................................................................................................................22
4.6.5 Phase 5..........................................................................................................................22
4.7 Work Process Plan...............................................................................................................22
4.8 Quality Control System.......................................................................................................26
4.9 Average Work Schedule......................................................................................................27
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4.10 Work Schedule of Key Tasks............................................................................................32
4.11 Suppliers and Service Providers........................................................................................32
4.12 Key Partners.......................................................................................................................34
4.13 Capital Budget by Category...............................................................................................35
4.14 Capital Expenditures Summary.........................................................................................43
4.15 Operating Expenses by Category (2020-2030)..................................................................43
5.0 Human Resources....................................................................................................................45
5.1 Job Descriptions...................................................................................................................45
5.2 Key Tasks by Job Description.............................................................................................50
5.3 Training Programs...............................................................................................................57
5.4 Salary and Wages................................................................................................................58
5.5 Employment Insurance........................................................................................................59
5.6 Canadian Pension Plan........................................................................................................60
5.7 Workers’ Compensation......................................................................................................62
5.8 Holiday Pay.........................................................................................................................63
5.9 Human Resource Strategy...................................................................................................65
6.0 Marketing.................................................................................................................................66
6.1 Demand for Emergency Medical Services & Target Market..............................................66
6.2 Segmentation, Targeting, Positioning..................................................................................69
6.3 Target Customers’ Needs and Wants..................................................................................73
6.4 Competitive Advantage.......................................................................................................74
6.5 Marketing Mix.....................................................................................................................74
6.5.1 Services.........................................................................................................................74
6.5.2 Pricing...........................................................................................................................75
6.5.3 Promotion.....................................................................................................................76
6.5.4 Place..............................................................................................................................78
6.6 Competitive Analysis...........................................................................................................78
6.7 Charitable Foundation and Volunteer Base.........................................................................80
6.8 Projections Marketing Expenses..........................................................................................80
6.9 TOWS Analysis of Health MattERs....................................................................................81
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7.0 Accounting and Financial Plan................................................................................................83
7.1 Overview of Financial Plan.................................................................................................83
7.2 Economic Variables.............................................................................................................83
7.3 Sensitivity Analysis.............................................................................................................83
7.4 Risk Analysis.......................................................................................................................87
7.5 Pro Forma Financial Statements..........................................................................................89
7.5.1 Pro Forma Statement of Surplus/Deficit.......................................................................90
7.5.2 Pro Forma Balance Sheet Statement.............................................................................91
7.5.3 Pro Forma Cash Flow Statement..................................................................................92
7.5.4 Pro Forma Cost Per Patient...........................................................................................94
7.5.5 Pro Forma Capital Budget............................................................................................94
7.5.6 Financing Budget..........................................................................................................95
7.5.7 Pro Forma Operating Expenses....................................................................................95
7.5.8 Pro Forma Total Salary and Wages..............................................................................96
7.5.9 Pro Forma Annual Earning by Position........................................................................97
7.5.10 Pro Forma Salary and Wage by Position....................................................................98
7.5.11 Pro Forma Employee Benefits....................................................................................99
7.5.12 Pro Forma Marketing Expenses..................................................................................99
7.5.13 Pro Forma Debt Amortization....................................................................................99
7.5.14 Capital Cost Allowance Schedule............................................................................100
8.0 Business Plan Summary........................................................................................................102
9.0 Acknowledgements................................................................................................................105
10.0 References............................................................................................................................106
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List of Figures
Figure 1 Emergency Department Length of Stay by Province........................................................7
Figure 2 Saskatchewan Emergency Department Visits by Main Reported Problem 2012-2013....9
Figure 3 Organizational Structure.................................................................................................16
Figure 4 Board of Directors...........................................................................................................17
Figure 5 Floor Plan........................................................................................................................20
Figure 6 Development Plan...........................................................................................................20
Figure 7 Work Process...................................................................................................................25
Figure 8 Length of Stay in Emergency Department by Age.........................................................70
Figure 9 Population by Age, 2015.................................................................................................71
Figure 10 Logo..............................................................................................................................72
Figure 11 Saskatoon Health Region Infographic Adapted to Include Health MattERs................78
Figure 12 Total Marketing Costs...................................................................................................81
Figure 13 TOWS Analysis of Health MattERs.............................................................................82
Figure 14 Cost Per Patient: Base Case, Maximum Capacity, Low Patient Case Comparison......85
Figure 15 Cost Per Patient Comparison SHR vs. Health MattERs...............................................85
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List of Tables
Table 1 Health MattERs Compared to Hospital Emergency Room, Mediclinic, and Family
Doctor’s Office......................................................................................................................12
Table 2 Canadian Triage and Acuity Scale...................................................................................24
Table 3 Template of Emergency Room Director Schedule...........................................................27
Table 4 Template of Emergency Physician Schedule...................................................................28
Table 5 Template of Radiologist Schedule....................................................................................28
Table 6 Template of Nurses (Emergency Room and Triage) Schedule........................................29
Table 7 Template of Social Workers Schedule.............................................................................29
Table 8 Template of Medical Radiation Technician Schedule......................................................29
Table 9 Template of Medical Laboratory Technician Schedule...................................................30
Table 10 Template of Registration Clerk Schedule.......................................................................30
Table 11 Template of Unit Assistant Schedule.............................................................................30
Table 12 Template of Medical Administrator Schedule................................................................30
Table 13 Template of Business Administrator Schedule..............................................................31
Table 14 Template of Security Guard Schedule............................................................................31
Table 15 Template of Janitor Schedule.........................................................................................31
Table 16 Daily, Weekly, Monthly, and Annual Work Schedule of Key Tasks............................32
Table 17 Suppliers and Service Providers.....................................................................................33
Table 18 Itemized Capital Budget by Category............................................................................36
Table 19 Capital Expenditures Summarized.................................................................................43
Table 20 Operating Expenses by Category (2020-2030)..............................................................44
Table 21 Job Descriptions and Requirements...............................................................................46
Table 22 Work Tasks for Emergency Department Director..........................................................50
Table 23 Work Tasks for Emergency Physicians..........................................................................51
Table 24 Work Schedule for Radiologists.....................................................................................51
Table 25 Work Schedule for Emergency Room Nurses................................................................52
Table 26 Work Schedule for Triage Nurses..................................................................................52
Table 27 Work Schedule of Social Workers.................................................................................53
Table 28 Work Schedule for Medical Radiation Technician........................................................53
Table 29 Work Schedule for Medical Laboratory Technician......................................................54
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Table 30 Work Schedule for Medical Administrator....................................................................54
Table 31 Work Schedule for Business Administrator...................................................................55
Table 32 Work Schedule for Registration Clerk...........................................................................55
Table 33 Work Schedule for Unit Assistant..................................................................................56
Table 34 Work Schedule for Security Guard................................................................................56
Table 35 Work Schedule for Janitor..............................................................................................57
Table 36 Salary and Wages...........................................................................................................58
Table 37 Employment Insurance 2020-2030.................................................................................59
Table 38 Canadian Pension Plan...................................................................................................61
Table 39 Workers' Compensation..................................................................................................62
Table 40 Holiday Pay....................................................................................................................64
Table 41 Target Markets................................................................................................................68
Table 42 Branding.........................................................................................................................73
Table 43 Target Customers' Needs and Wants..............................................................................73
Table 44 Fee-for-Service Physician Payment Example................................................................76
Table 45 Hour of Operation of Saskatoon Emergency Departments............................................79
Table 46 Economic Variables........................................................................................................83
Table 47 Cost Per Patient Itemized by Operating Expense for Base Case 2020...........................86
Table 48 Risk Analysis and Contingency Plan..............................................................................87
Table 49 Pro Forma Statement of Surplus/Deficit........................................................................90
Table 50 Pro Forma Balance Sheet Statement..............................................................................91
Table 51 Pro Forma Cash Flow Statement....................................................................................92
Table 52 Pro Forma Cost Per Patient............................................................................................94
Table 53 Pro Forma Capital Budget..............................................................................................94
Table 54 Financing Budget............................................................................................................95
Table 55 Pro Forma Operating Expenses......................................................................................95
Table 56 Pro Forma Total Salaries and Wages by Position..........................................................96
Table 57 Pro Forma Annual Earning by Position..........................................................................97
Table 58 Pro Forma Salary and Wage by Position........................................................................98
Table 59 Pro Forma Employee Benefits........................................................................................99
Table 60 Pro Forma Marketing Expenses.....................................................................................99
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Table 61 Pro Forma Debt Amortization Schedule........................................................................99
Table 62 Capital Cost Allowance Schedule................................................................................100
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1.0 Executive SummaryCanadian emergency rooms have been perpetually overcrowded for years, and Saskatchewan
facilities are no exception. Emergency room overcrowding is not going unnoticed. Rather,
patients who have their own horror stories of the medical care they have received in
overcrowded facilities are becoming activists (Tutton, 2017). Roy Romanow spoke of
emergency room overcrowding in the 2002 Royal Commissioner’s report on the future of health
care in Canada as the “canary in the coal mine” (Tutton, 2017). It has been 14 years since this
report was released and the pressure on these facilities has only grown due to spending restraints
and the aging Canadian patient population (Tutton, 2017). Emergency room overcrowding is
often understood by the numerical statistics and quantitative reports. However, it is important to
remember that overcrowding causes both physical and emotional pain to Canadian patients. For
this reason, above anything else, it is critical that the Government of Saskatchewan develop a
solution to provide the people of Saskatchewan with quality emergency medical healthcare
services.
This business plan provides a solution, namely, a freestanding emergency room – Health
MattERs: Emergency Room Care (Health MattERs) – that will reduce wait times for patients
requiring outpatient emergency medical services, thereby reducing overcrowding in already
existing emergency departments. Specifically, this business plan outlines the operations, human
resources marketing and financial components of Health MattERs. This report has been
developed for the Government of Saskatchewan in the proposal and approval process of a new
public healthcare facility. Most notably, this implies that the facility, if approved by the
Government of Saskatchewan, will be funded by and owned by the government.
There are three main objectives that Health MattERs aims to acheive, of which one is financial
and the other two are non-financial. The objectives of Health MattERs are:
1. Financial: Provide emergency medical care in a cost-effective way, as measured by cost
per patient indicators. This objective aims to provide emergency medical care, on a cost
per patient basis, that is lower than the current industry standard in Saskatoon.
2. Non-financial: Reduce emergency room wait times for outpatient emergency patients.
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3. Non-financial: Provide quality, patient-centered emergency medical care to all patients
seeking treatment at the Health MattERs facility
Health MattERs fills a gap in Saskatchewan’s medical market. As the population of Saskatoon
continues to grow and age, it is necessary to increase the supply of emergency medical services.
The Government of Saskatchewan has three choices in addressing emergency room
overcrowding and increasing demand: a) do nothing and face the backlash of emerging patient
activists, b) open a new hospital that has an emergency department, or c) open a freestanding
emergency room. Based on cost considerations, patient requirements and demand, the
Government would be best positioned to invest in a new freestanding emergency room.
Health MattERs will be the first freestanding emergency room in Saskatchewan. This will
require efforts to educate the public, patient population, and healthcare professionals regarding
the purpose of the facility and the services that it provides. Health MattERs will be located in the
growing Eastern suburban area of Saskatoon, to meet the service needs of the growing suburban
population in the city.
Health MattERs will be staffed by the appropriate certified professionals such as contracted
emergency physicians and radiologists, emergency room nurses, triage nurses, social workers,
medical radiation technicians, and medical laboratory technicians and auxiliary support staff.
Health MattERs has a two-year development time before it will open to the public in 2020,
which is much shorter than opening a brand-new hospital facility. This allows Health MattERs to
meet market demand for increased emergency services quickly. The floor plan design of the
facility has been developed with efficiency of patient throughput being a number one priority.
Health MattERs will not generate excess net income. Rather, it will act as a break-even
government-owned entity in which revenues are equal to the facility’s total operating expenses.
Based on current financial and patient quantity projections, the cost per patient visit is $321.02.
Mike Stensrud, Saskatoon Health Region’s President, noted that each time someone visits an
emergency room currently, it costs approximately $800 (650 CKOM, 2016). Thus, Health
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MattERs offers an affordable and cost effective approach to addressing the issue of emergency
room wait times.
Opening Health MattERs will position the Government of Saskatchewan as an innovative and
responsive government, with regard to operationalizing a solution to current emergency room
overcrowding and long wait times. Health MattERs aligns with the current goals of the
Government to reduce emergency room wait times and will positively benefit the patient
population of Saskatchewan. The successful introduction of a freestanding emergency room in
Saskatoon can serve as a medical model for other cities and provinces in Canada looking to
reduce emergency room wait times and overcrowding, and improve patient care. It is
recommended that the Government of Saskatchewan engage in a process of due diligence and
work towards approving the Health MattERs facility as a government-funded freestanding
emergency room facility.
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2.0 Introduction
2.1 Proposed Business
Health MattERs will be an independent freestanding outpatient emergency room delivering
quality patient-centered care in Saskatoon. Licensed healthcare professionals will be available
twenty-four hours a day, seven days a week to treat individuals seeking emergency care. Health
MattERs will be equipped with onsite laboratory services and diagnostic imaging. Health
MattERs will reduce emergency room wait times and help to alleviate over capacity at already
existing emergency departments in Saskatoon. Health MattERs will accept walk-in patients and
those arriving by ambulance. Patients will be triaged upon arrival based on the Canadian Triage
and Acuity Scale (CTAS). Patients who require hospital admissions, major surgery or specialty
care will be transferred to a tertiary care center that can provide higher-acuity care. Health
MattERs will diagnose and stabilize patients with cardiac arrest, stroke symptoms, breathing
problems, trauma, as well as emergencies of lower severity. Health MattERs will contract
physicians specializing in emergency medicine and radiology who will be expected to provide
professional healthcare services consistent with the standards of their professional bodies. The
physicians who provide the services will work collaboratively with a team of other healthcare
professionals and administrative support.
Freestanding emergency rooms are widespread throughout the United States. The American
College of Emergency Physicians defines a freestanding emergency room as a “facility that is
structurally separate and distinct from a hospital and provides emergency care” (American
College of Emergency Physicians, 2014). Evidence suggests that hospital overcrowding directly
impacts wait times in hospital emergency rooms (Health Quality Council Saskatchewan, 2016).
Thus, by separating the emergency room from the in-patient hospital building, individuals
seeking outpatient emergency care will be treated in a timely manner. Delivering emergency
medical care in a separate facility from a hospital will circumvent the backlog experienced by the
emergency room due to other departments in the hospital. The Government of Saskatchewan has
made it clear that reducing emergency room wait times is one of its goals. The provincial
government set a target to reduce wait times in hospital emergency departments by 60 percent by
the year 2019, with the long-term goal being an elimination of wait times altogether
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(Government of Saskatchewan, 2015). Health MattERs aligns itself directly with this goal of the
provincial government as it works towards elimination of emergency room wait times for
outpatients.
2.2 Positioning Statement
To position Health MattERs as a quality patient-centered facility providing fast and reliable
professional emergency medical care, Health Matters’ positioning statement is:
Health MattERs provides timely emergency medical care to the people of Saskatchewan, without
having to enter a hospital!
This position is unique compared to other emergency medical care providers in the province, as
no such facility currently exists.
2.3 Goals and Objectives
Health MattERs will utilize goal setting to facilitate the attainment of its positioning statement.
By working towards goals that are specific, measurable, attainable, realistic and timely, Health
MattERs can be confident that it is fulfilling its commitment to delivering quality emergency
medical care. The goals outlined below are presented in rank order, based on their urgency and
timeline.
1. To successfully gain the support of the Government of Saskatchewan by January 2019
for the development of Health MattERs (1-2 years)
2. To develop partnership agreements with the Saskatoon Health Region and/or the
consolidated Saskatchewan Health Authority by June 2019 (2-2.5 years)
3. To provide quality patient-centered emergency medical care to the people of
Saskatchewan by January 2020 (2.5-3 years)
4. To achieve 90-100 percent facility operating capacity by January 2021 (4-5 years)
5. To reduce the number of patients triaged as CTAS 3s,4s, and 5s by 20 percent in hospital-
based emergency rooms in Saskatoon by 2022 (4-5 years)
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6. To form a Health MattERs charitable foundation that organizes community fundraising
initiatives and looks for opportunities for Health MattERs’ staff to engage with the
community by 2024 (6-7 years)
7. To help achieve a Saskatoon-wide emergency wait time reduction of 80 percent by 2030
(12-15 years)
8. To convince 90 percent of freestanding emergency room sceptics in Saskatchewan that
this medical model is useful in reducing emergency room wait times by 2035 (15-20
years)
9. To serve as a model for other Canadian provinces as a method for reducing emergency
room wait times and increasing the quality of emergency medical care services by 2050
(30-35 years)
2.4 Mission Statement
The mission statement of Health MattERs outlines why the facility exists. It is meant to guide
both internal personnel and outside users of Health MattERs in understanding the importance
and value of our services.
Our mission at Health MattERs is to deliver quality patient-centered emergency medical care in
a timely manner to the residents of Saskatchewan.
Because here, your Health MattERs to us!
2.5 Vision Statement
The vision statement of Health MattERs will inspire and provide direction to individuals
working in our emergency room. It is meant to guide the internal processes and act as a source of
motivation for individuals working at Health MattERs.
Timely Service. Compassionate Care. Trusted Medicine.
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3.0 Industry Overview
Across Canada individuals seeking emergency medical attention have become accustomed to
waiting for hours to be seen by a doctor or other healthcare professional in one of the country’s
emergency departments. This cultural expectation in Canada is supported by recent research
which indicates that Canada has the highest proportion of patients, as compared to other
industrialized countries, who report excessively long waits in the emergency department
(Canadian Institute for Health Information, 2016). One out of three Canadians reported waiting
for four or more hours at the emergency department to be seen by a physician (Canadian Institute
for Health Information, 2016). As of 2014, Saskatchewan had some of the longest emergency
room wait times in Canada, with Manitoba being the only province reporting higher wait times
(Figure 1) (Cowan, 2014).
Figure 1 Emergency Department Length of Stay by Province
(Cowan, 2014).
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Emergency departments were originally established to treat seriously ill and injured patients
requiring immediate medical attention (Canadian Institute of Health Information, 2005). This
may have been the intention for establishing emergency departments, however in practice
emergency departments work to provide timely care to every patient regardless of their reason
for seeking medical care (Canadian Institute of Health Information, 2005). Across Canada, 57
percent of emergency department visits in 2003-2004 were categorized as less urgent conditions,
such as chronic back pain, or non-urgent conditions, such as sore throat, based on the CTAS
triage system (Canadian Institute of Health Information, 2005). In the same year, more than 80
percent of patients who were assessed in the emergency department were discharged to their
place of residence, thus defined as outpatients, rather than admitted as an in-patient to the
hospital (Canadian Institute of Health Information, 2005).
In the Saskatoon Health Region, in 2012-2013, the percent of low acuity (CTAS 4 and 5) visits
across all three emergency departments was 53.8 (Todd, 2014). In the same year, the chief
complaint reported by patients arriving at Saskatchewan emergency departments included
abdominal and pelvic pain followed by pain in the throat and chest (Figure 2) (Cowan, 2014). All
three hospital-based emergency rooms in Saskatoon are defined as teaching hospitals (Cowan,
2014). Research has found that wait times in large teaching hospitals, such as St. Paul’s, Royal
University and City Hospital in Saskatoon, tend to be longer than those in small or medium-sized
hospitals (Cowan, 2014).
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Figure 2 Saskatchewan Emergency Department Visits by Main Reported Problem 2012-2013
(Cowan, 2014).
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Typically, in Canada, emergency rooms are connected to a hospital. A few freestanding
emergency rooms exist in Canada, such as the Cobequid Community Health Centre in Lower
Sackville, Nova Scotia. However, compared to the United States, freestanding emergency rooms
are much less common. In the United States, freestanding emergency rooms first opened during
the 1970s (Harish et al., 2016). The purpose of these facilities was to provide emergency services
to rural areas that were unable to financially sustain a full-service hospital (Harish et al., 2016). It
was only more recently that freestanding emergency rooms were developed in more urban or
suburban areas (Harish et al., 2016).
Importantly, the freestanding emergency room industry is not the same as medical clinics, family
doctor’s offices, or urgent care centers (Harish et al., 2016). Freestanding emergency rooms
typically operate 24/7 with access to specialized emergency physicians, emergency nurses and
laboratory and radiology technicians (Harish et al., 2016). Unlike the other type of medical
facilities, a freestanding emergency room has the capability to provide care for the more
emergent illnesses such as heart attacks, stoke and minor traumas (Harish et al., 2016). The
biggest difference between a hospital-based emergency room and a freestanding emergency
room is the capacity of the facility for in-patient care. Hospital-based emergency rooms can
transfer patients in the emergency room to an in-patient ward for continued care. A freestanding
emergency room cannot admit in-patients, and instead must treat and discharge stable patients, or
transfer patients to other facilities if they require hospitalization.
Within the field of medicine, Emergency Medicine emerged as a medical specialty in Canada in
1981 (Canadian Association of Emergency Physicians, 2016). In Canada, public healthcare
providers must provide emergency medical services and the cost of services must be covered by
provincial health insurance. The Medicare program in Canada is divided into 13 provincial and
territorial health care insurance plans, in which the provincial and territorial governments are
responsible for the management, organizations and delivery of health care services for their
residents (Government of Canada, 2016).
Health MattERs will be a unique facility to the people of Saskatchewan, and the first of this kind
in the province. As the City of Saskatoon projects an annual growth rate of approximately 1.9
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percent in the years ahead, it is undeniable that the city will indeed require more emergency
medical services (City of Saskatoon, 2017). Health MattERs will provide a much-needed service
to the people of Saskatchewan, particularly as population growth continues, thereby necessitating
increased levels of emergency medical services.
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4.0 Operations
4.1 Operations Overview
To understand the intricacies of Health MattERs’ operations, a breakdown of the operational
plan has been completed based on the “what, how, why, who and where.” This operational
overview is intended to provide readers with a high-level perspective of the business operations
prior to outlining the specific operational details.
4.1.1 The What
Health MattERs is an independent freestanding emergency room focused on delivering quality
patient-centered care. Licensed healthcare professionals are available 24/7 to treat individuals
seeking emergency care. The facility is equipped with onsite laboratory services and diagnostic
imaging. Our team of healthcare professionals is ready to treat all outpatient emergency medical
needs. Different from a hospital emergency room, family doctor’s office or mediclinic, Health
MattERs is focused on delivering emergency healthcare in a timely manner (Table 1).
Table 1 Health MattERs Compared to Hospital Emergency Room, Mediclinic, and Family Doctor’s Office
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4.1.2 The How
This business plan has been developed as a document for use in the proposal for a freestanding
emergency room to be approved by the Government of Saskatchewan. The information provided
in the business plan addresses how Health MattERs will operate, organize its human resources,
market itself, and manage its finances. An important component of Health MattERs’ business
plan is gaining the support and approval from the Government of Saskatchewan. As public
physician-supplied healthcare delivery is integrated with Government funding for physician
services, it is integral that the Government of Saskatchewan understand the important role that
Health MattERs will hold in reducing and eliminating emergency room wait times and
increasing access to care.
4.1.3 The Why
Health MattERs will be developed to address the following four points:
1. Reduce and eliminate emergency room wait times and increase quality patient care
a. The Government of Saskatchewan has made it their goal to reduce emergency
room wait times (Government of Saskatchewan, 2015)
b. Saskatoon’s Royal University Hospital (RUH) emergency department was built in
1978 for the capacity of 22,000 patients annually (RUH Foundation, 2016)
i. In 2015, approximately 60,000 patients used this emergency room,
demonstrating the high degree of overcapacity at RUH
c. Public perception and opinions of the healthcare system are most often formed in
the emergency room (Public Auditor Saskatchewan, 2013)
i. Providing better emergency room service is anticipated to lead to
increased public approval of the healthcare system and delivery
2. Enable existing emergency rooms in Saskatoon to implement change
a. By taking patient-load pressure off the three already existing emergency rooms,
these facilities will have a greater capacity to improve and implement change
processes
3. Contribute to a team-based model of healthcare delivery in Saskatoon
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a. Health MattERs will collaborate with family physicians to provide care for
patients when family physician offices are closed
b. Health MattERs will be part of a network of health professionals across Saskatoon
through working agreements with already existing hospitals and healthcare
facilities
4. Act as a potential pilot site for a new hospital
a. Although a freestanding emergency room is proposed, if the population of
Saskatoon continues to grow and an additional hospital is required to serve the
people of Saskatoon, the Health MattERs facility can act as a potential pilot site
for the new hospital
i. Located in Saskatoon’s growing and expanding Eastern suburban area to
align with the city’s population growth
ii. A cheaper solution to over-capacity now to build only an emergency
room, but allows for flexibility if an entire hospital need to be built in the
future
4.1.4 The Who
Health MattERs is a business venture developed to gain the political and financial
support of the Government of Saskatchewan and the Saskatchewan Health Authority. Health
MattERs is intended to be a government-owned facility serving public healthcare patients under
the provincial healthcare coverage. The business plan aims to provide the Government of
Saskatchewan with the appropriate information so that key stakeholders can assess this venture.
It is the goal of this business plan to convince the Government of Saskatchewan that Health
MattERs is a necessary and valuable extension of the current emergency services provided to
Saskatchewan residents. Health MattERs will serve the Saskatchewan community, providing
quality patient-centered emergency care. The operations of Health MattERs will be supported by
a professional team of healthcare providers including: emergency physicians, radiologists,
emergency room nurses, triage nurses, medical radiation technologists, medical laboratory
technologists, social workers, and general support staff. Leadership and management of the
Health MattERs’ team will be led by the Emergency Room Director.
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It is anticipated as a base case, that Health MattERs emergency physicians will be able to see
1.875 patients per hour. Two emergency physicians will be on staff every hour, and so, it is
assumed that on average, in the base case, that 90 patients will be seen per day. Maximum
capacity at Health MattERs is defined as each emergency physician seeing 3 patients per hour, or
for two physicians on staff per hour, 144 patients per day. This maximum capacity would be
manageable by the physicians, however it would not be sustainable.
4.1.5 The Where
Health MattERs will be located in Saskatoon, Saskatchewan. Specifically, it will be in
Saskatoon’s Eastern suburban area where neighbourhoods such as Stonebridge and Rosewood
are located. Health MattERs will lease its facility space. The building location will have to meet
the city zoning requirements for a medical clinic with an ambulance station. There are multiple
zoning designations in Saskatoon that meet this requirement.
4.2 Organizational Structure
Health MattERs will be organized as a break-even, not-for-profit business corporation (Figure 3).
A contractual agreement will be signed to outline the payment of the contracted physicians
working at the facility. Health MattERs will contract physicians, who may or may not choose to
be incorporated. Registered emergency room and triage nurses, medical radiation technicians,
medical laboratory technicians, on-call social workers, a medical administrator, a business
administrator, registration clerks, unit assistants, security guards and janitors will be hired
through employee contracts with Health MattERs. Under the North American Industry
Classification System, Health MattERs will be classified by the code 621493 Freestanding
Ambulatory Surgical and Emergency Centers (NAICS, 2017).
The organizational structure of Health MattERs was formulated after discussions with
individuals who have worked in hospital emergency rooms in Saskatoon. The total number of
staff for Health MattERs is 57. The number of employees may change overtime, however to
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begin Health MattERs will consist of 12 contracted physicians and 45 additional healthcare and
support staff. Some employees will be hired full-time, whereas others will be part-time
employees. Full-time employment is defined as approximately 40-hours of work a week and
part-time is defined as 20-hours or more, but less than 40-hours, of work a week.
Figure 3 Organizational Structure
4.3 Board of Directors and Management
The board of directors will be comprised of the Emergency Room Director (President of the
Board), a physician who works for Health MattERs (Vice-President and Secretary of the Board),
and one individual appointed to the Board from the Saskatchewan Health Authority (Figure 4).
Therefore, three individuals comprise Health MattERs’ Board of Directors. The physician on the
board will represent all other physicians working at Health MattERs. A physician’s council will
meet quarterly to discuss any issues that the appointed physician should bring to the attention of
the board. Health MattERs will require that all contracted physicians be members of the
physician’s council, and that no physician should miss more than one quarterly physician’s
council meeting per year. The Board of Directors will have one annual meeting, however if any
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Health MattERs
major issues or decisions must be resolved or made by the Board following the quarterly
physician council meeting, an additional Board meeting shall be called by the appointed
physician Board member. The Board of Director positions are not paid positions by Health
MattERs. The appointee from the Saskatchewan Health Authority may receive payment from
this governing body for holding this position, but will not receive payment from Health MattERs.
Health MattERs will be managed by the Emergency Room Director. This individual will oversee
that the day-to-day operations are carried out in accordance with the standards of care
necessitated by the professional bodies governing the healthcare professionals. This individual
will also be responsible for managing Health MattERs’ relationship with the Government of
Saskatchewan. Management will use the information collected from monthly employee check-in
meetings to guide decision-making and ensure that the needs of Health MattERs’ employees are
being met and that the company’s mission is being fulfilled.
Figure 4 Board of Directors
4.4 Site Plan
The American College of Surgeons classifies emergency departments according to the services
available in the facility (Herman Miller for Healthcare, 1999). Based on the American College of
Surgeons classification system, Health MattERs is defined as a Level II emergency department
Kate Morrison
President Emergency Room
Director
Vice President & Secretary
Physician of Health MattERs
Board MemberSaskatchewan
Health Authority Appointee
17
Health MattERs
(Herman Miller for Healthcare, 1999). It offers emergency care 24 hours a day, with a minimum
of one physician who is experienced in emergency care on duty in an emergency care area.
Health MattERs has specialty consultation available within approximately thirty minutes. This
consultation is both in-house by a specializing radiologist or, through inter-hospital transfers, at
another hospital facility in the city.
Health MattERs will be situated in the Eastern suburban area of Saskatoon. The facility will be
located on the ground floor of the building. Specific site selection has not taken place, however
upon Government approval for Health MattERs, specific site selection will be investigated (See
Section 4.6 Development Plan). Based on current rates for leases in this area of Saskatoon, it is
projected that the lease rate will be $25/square-foot (SF) and the occupancy cost will be
$8.90/SF, for a total of $33.90/SF to lease the space (ICR Commercial, 2017). This equates to
$135,600/ year for lease cost or, $11,300/month for rent, based on the 4,000 SF floor plan.
4.5 Floor Plan
Health MattERs will be a 4,000 SF facility, with 50” X 80” dimensions (Figure 5). The floor
plan has been designed to increase overall emergency room efficiency and traffic flow.
Deliberate decisions were made about where each room should be located. For example, the
public washroom is located at the front entrance to the emergency room. This choice was made
so that visitors to the emergency room do not have to take up staff time asking for directions to
the washroom, but instead will see it at the time of arrival at the facility. The corridors of Health
MattERs are 8-feet wide, which will ensure that they meet the standard requirement for width of
a healthcare facility corridor. Health MattERs is a 12-bed facility with eight beds located in the
general treatment area, two in the major treatment room, one in the private exam room, and one
in the casting room. The decontamination room will have a toilet, shower and sink, and will be
used for cleaning any patient who enters the emergency room and require such care. The
Emergency Medical Services (EMS)/Police room will be used for ambulatory staff and police
officers to write paper work or to wait if they are required to do so. The major treatment room
will be for treating individuals who arrive at the emergency room and require treatment in an
isolated area such as in minor trauma cases. The equipment storage room will be used for storing
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Health MattERs
equipment that is not required to be in the treatment areas all the time. The private exam room
will be used for sensitive physical examinations, gynecological cases, and psychiatric patients
requiring isolation. The janitors’ room will be used for storing cleaning supplies and equipment.
The utility room will be used for storing daily consumable items. The utility room will be
separated to designate space for clean or unused inventory and other space for soiled inventory
requiring safe disposal or cleaning. The X-ray imaging center will house the x-ray suite and will
be used for diagnostic imaging procedures by the medical imaging technologists and
radiologists. The lab will be used by the medical laboratory technologists to culture and test
samples. The casting room will be used to cast limbs and for bone setting. The family
consultation room will be a space for healthcare professionals to use to inform families or
individuals of traumatic news or difficult diagnoses. This room will primarily be used by the on-
call social worker and by physicians. The staff room will be a place for employees to store their
belongings and relax during a break in their shift. The general treatment rooms located in the
center area of the floor plan will be for treating most medical emergency cases. The nursing
station will be the central hub of patient information and nursing communication. This room has
strategically been placed in a location that can observe both the general treatment rooms and the
observation area and triage area. The observation and triage area will be used for placing patients
who do not require a bed, but who do require further observation throughout their period of
stabilization. This area will also be used for triage assessments if a patient’s level of acuity
changes. The administration offices will be used by the medical and business administrator and
serve as a staff meeting room. The waiting area will be a location to wait prior to receiving
treatment or for family members or friends to wait while a loved one is being treated. There are
two entrances to Health MattERs; 1) a main walk-in entrance that individuals arriving on their
own to the emergency room will use, and 2) an ambulance entrance. Located beside these
entranceways will be the security guards’ station. The location will also have the main reception
desk for patients to check-in. For a patient arriving at Health MattERs, they can expect to move
around the emergency room to the right as they flow through the treatment process. This
unidirectional flow will help to eliminate confusion and make processing patients more efficient.
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Health MattERs
Figure 5 Floor Plan
4.6 Development Plan
The development of Health MattERs will be rolled out in five phases: Government Approval and
Contract Phase; Building, Equipment, and Service Contract Agreements Phase; Hiring and
Training Phase; Marketing and Relations Phase; Opening Phase (Figure 6).
Figure 6 Development Plan
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Health MattERs
4.6.1 Phase 1
The development of Health MattERs will occur over the course of two years. Health MattERs
will begin operations in 2020. The first phase of development, starting in 2018, is defined as the
Government Approval and Contract Phase. This phase is a critical step in the development of
Health MattERs. The contract negotiated with the Government of Saskatchewan is important
because this governing body will fund and own Health MattERs. The Government Approval and
Contract Phase is projected to take 6-12 months. From this point forward in the development
plan, it is assumed that government approval for Health MattERs has been acquired.
4.6.2 Phase 2
The second phase of the development plan, Building, Equipment, and Service Contract
Agreements will take six months to complete. This phase will involve signing the lease
agreement for the physical space of the freestanding emergency room, making the necessary
leasehold improvements, and preparing the space so that it is ready to function as an emergency
room with the appropriate furniture, supplies, and utilities. Phase 2 will also involve signing
contract agreements with all auxiliary services to efficiently run the emergency room. Such
services will be outlined in more detail in the Service Provider section of this paper (See Section
4.11).
4.6.3 Phase 3
Phase 3, referred to as the Hiring and Training Phase will involve the recruitment, hiring and
training of all Health MattERs employees. This phase is expected to take approximately six
months. However, on-going training will continue following this phase (See Section 5.3).
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Health MattERs
4.6.4 Phase 4
Phase 4 is the Marketing and Relations Phase, which overlaps with the last three months of
Phase 3. The Marketing and Relations Phase will require marketing efforts to two different
segments. The first segment is the patient populations. Marketing efforts for this segment will be
focused on educating potential patient and the public about the service offered by Health
MattERs. This will also involve gaining the public’s trust by showcasing positive relations with
other reputable health institutions. The second segment is namely health institutions, clinics and
practitioners. Marketing and relationship efforts for this segment will focus on building a trusted
partnership and working relationship with other emergency departments. Additionally, it will
aim to gain the support of physicians working in their own clinics, to encourage them to refer
their patients to Health MattERs for care at times when their own clinics are closed.
4.6.5 Phase 5
With the completion of Phases 1-2 and the continuation of Phase 3 and 4 during operations,
Health MattERs will open to the public to provide emergency health services starting June 2020.
4.7 Work Process Plan
The workflow process will vary depending on the specific patient presentation of symptoms.
Patients will be classified using the CTAS system upon presentation at the emergency room
(Table 2). This scale classifies patients into five levels of which Level I-III is categorized as high
acuity and Level IV-V is categorized as low acuity (Canadian Institute for Health Information,
2012; Provincial Auditor Saskatchewan, 2013). Sunrise Clinical Manager (SCM) electronic
medical record system will be used for triaging patients. SCM is a software program that
organizes patient flow and tracks patient information throughout the workflow process, from
triage to treatment to discharge (Provincial Auditor Saskatchewan, 2013). SCM has a built-in
triage program that requires triage nurses to enter specific patient data – their primary complaint
(ex. ear ache, abdominal paint, etc.) and objective clinical data (ex. blood pressure, temperature,
etc.) – to automatically generate a CTAS level (Provincial Auditor Saskatchewan, 2013). If
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Health MattERs
triage nurses, at the time of assessment assess that the patient requires a higher CTAS level
classification, they can increase the level within the SCM system (Provincial Auditor
Saskatchewan, 2013). However, the CTAS level cannot be reduced from the level that was
automatically generated (Provincial Auditor Saskatchewan, 2013). The SCM system increases
objectivity in assigning CTAS levels to patients and will enable Health MattERs to have an
efficient triage and treatment flow process.
Although patients will be classified differently using the CTAS classification system, a general
workflow process will be followed by all patients seeking care at Health MattERs (Figure 7).
Patients will enter the emergency room by foot or by ambulance and either, a) be transferred to a
different health facility if their CTAS level requires this, b) be moved to a Health MattERs
treatment area immediately if they are a high acuity case, or c) register as a patient at the
registration desk and be triaged to receive a CTAS score. Following this, registered patients will
be moved to the appropriate treatment area or directed to the waiting room until a treatment area
space is available. Once in the treatment area, patients will be assessed by a physician and either
treated, sent to the imaging or laboratory services area, or if their condition has deteriorated and
they require an alternate level of care, they will receive an inter-facility transfer. Upon the
completion of treatment, patients will either be discharged directly or moved to the observation
area until their case has fully stabilized and they can be safely discharged.
The timeliness of the work process will depend on the CTAS score assigned to the patient as
patients will be treated based on need and not first-come-first-served basis. The CTAS system
recommends that Level I or high acuity cases be seen immediately, Level II, within 15 minutes,
Level III, within 30 minutes, Level IV, with 60 minutes, and Level V, within 120 minutes (Lee et
al., 2011). These recommended times will be used as a benchmark for patient treatment times.
However, as Health MattERs is focused on treating individuals presenting with Level III, IV, and
V cases, it is expected that the time to see a physician can be reduced as compared to a
traditional hospital-based emergency room.
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Health MattERs
Table 2 Canadian Triage and Acuity Scale
Acuity Scale Priority Level/Time to See Physician
Classification Key Features Example
HIGH ACUITY
Level I(Immediate)
Resuscitation Threat to lifeImminent risk of deteriorationRequire aggressive intervention
Cardiac arrestMajor traumaShock states
HIGH ACUITY
Level II(15 minutes)
Emergent Potential threat to life or limb
Head injuryChest painG.I. bleedingAbdominal pain with visceral symptomsNeonatal with hyperbilirubinemia
HIGH ACUITY
Level III(30 minutes)
Urgent Conditions that could progress to a serious problem necessitating emergency intervention
Mild-moderate asthma or dyspneaModerate traumaVomiting and diarrhea in patient <2 years
LOW ACUITY
Level IV(60 minutes)
Less Urgent Conditions related to patient ageDistressPotential for deterioration or complications that would benefit from assessment within 1 to 2 hours
Urinary symptomsMild abdominal painEarache
LOW ACUITY
Level V(120 minutes)
Non-Urgent Conditions where assessment or treatment could be delayed or referred to other areas of the healthcare system
Sore throatMensesConditions related to chronic diseasesPsychiatric complaints with no suicidal ideation or attempts
(Lee et al., 2011).
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Health MattERs
Figure 7 Work Process
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Health MattERs
4.8 Quality Control System
On a macroscale, Health MattERs’ quality control will be regulated by the Saskatchewan Health
Quality Council, specifically under the section, The Emergency Department Waits and Patient
Flow Initiative (Health Quality Council Saskatchewan, 2016). As well, Health MattERs will
operate in accordance with The Health Facilities Licensing Regulations, The Health Centers
(Hospital Standards Adoption) Regulations, The Hospital Standards Regulations, 1980, and The
Health Information Protection Act. The health professionals providing care at Health MattERs
will be regulated by their specific professional body code of conduct and code of ethics,
licensing requirements, and continuing medical education requirements. The operating quality-
control program will be developed by the Emergency Room Director, in collaboration with key
informants (experts in emergency medicine and healthcare administration). This quality-control
program will adhere to all relevant legislation and will ensure that Health MattERs professionals
are supported in their pursuit to provide quality patient-centered care in a timely manner.
The quality control program will include regulations regarding preventative maintenance checks
on medical equipment. As well, it will include specific requirements for data collection, so that
information can be reviewed and improvements to the work process can be made overtime based
on the collected data. A key aspect of this data collection will be the use of electronic medical
records. Data will be collected in accordance with the Canadian Emergency Department
Information System (CEDIS). CEDIS provides a minimum data set for electronic information
and tracking in the areas of demographic information, process and time elements, clinical
elements, utilization elements, critical care information, National Ambulatory Care Reporting
elements related to emergency department costing, and clinical elements specific to trauma
(Canadian Association of Emergency Physicians, 2002). The CEDIS system also provides a
Presenting Complaint List that will be utilized to categorize patients based on the type of
symptoms or chief health complaint that brought them into the emergency department (Canadian
Association of Emergency Physicians, 2012).
A Health MattERs’ clinical protocol and guideline manual will be developed by the Emergency
Room Director. This manual will be used throughout the training and will be discussed and
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Health MattERs
reviewed with employees and contracted physicians in Phase 3 of the development plan. This
manual will provide information on work process and safety protocols. Each employee and
contracted physician of Health MatERs will receive a physical and an electronic copy of this
manual. It will be an expectation of everyone working at Health MattERs to be familiar with the
protocols outlined in the manual and adhere to these protocols. End of the month check-in
meetings will look to address any concerns individuals have with the protocols and to assess
whether protocols are being followed.
4.9 Average Work Schedule
Health MattERs is open 24 hours a day, 7 days a week. Therefore, the facility is open for 168
hours per week. Shift work will be used to ensure that the appropriate level of staff is available
and working 24/7. All staff at Health MattERs will be provided appropriate breaks throughout
their shifts in accordance with the Government of Saskatchewan’s Employment Act. Employees
will be given a 30-minute meal break every five hours of work. Coffee breaks will not be
formally instituted, as this is not a requirement of the Saskatchewan Employment Act. However,
staff will be encouraged to take short coffee breaks in the Health MattERs facility when time
allows.
A template work schedule for each position at Health MattERs is outlined below (Table 3-15).
The numbers used in the template schedule reference employees. For example, 1/2 in Table 3
refers to emergency physician 1 and emergency physician 2, of the eight total emergency
physicians that work at Health MattERs.
Table 3 Template of Emergency Room Director Schedule
Emergency Room Director Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:30AM-4:30PM 1 1 1 1 1
The Emergency Room Director will work Monday-Friday, 8:30AM-4:30PM. However, this
position will have flexible scheduling. The Emergency Room Director will be expected to utilize
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Health MattERs
her discretion and be available and at the facility as needed. Therefore, the template schedule
serves as a minimum requirement, not a rigid schedule. Particularly in the first few years of
operation, the Emergency Room Director can expect to work more hours.
Table 4 Template of Emergency Physician Schedule
Emergency PhysicianMonday Tuesday Wednesday
Thursday Friday Saturday Sunday
8:30AM-4:30PM 1/2 *Extra Shift (X2) 7/8 7/8 7/8 1/2 1/24:30PM-12:30AM 5/6 5/6 3/4 3/4 /3/4 3/4 3/4
12:30AM-8:30AM 7/8 1/2 1/2 5/6 5/6 7/8 5/6
There are eight emergency physicians. There will always be two emergency physicians on shift.
This will equal one emergency physician for every six beds in the emergency room. Physicians
will work eight-hour shifts, five shifts a week for a total of 40 hours of work per week. Each
week, on a rotating basis, two physicians will work an extra shift.
Table 5 Template of Radiologist Schedule
Radiologists Monday TuesdayWednesday Thursday Friday Saturday Sunday
8:30AM-4:30PM 1 * On-call 4 4 4 1 14:30PM-12:30AM 3 3 2 2 2 2 212:30AM-8:30AM 4 1 1 3 3 4 3
There are four radiologists at Health MattERs. A radiologist will be on site for five, eight-hour
shifts per week. As the template schedule indicates, one shift per week will be worked on an on-
call basis. The four radiologists will each have one on-call shift per month.
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Table 6 Template of Nurses (Emergency Room and Triage) Schedule
Nurses Monday Tuesday Wednesday Thursday Friday Saturday Sunday8:30AM-4:30PM 1,2 1,2 1,2 1,2 1,2 5,6 5,64:30PM-12:30AM 5,6 5,6 3,4 3,4 3,4 3,4 3,412:30AM-8:30PM 7,8 7,8 5,6
8hrs O.T. X 2 nurses 7,8 7,8 7,8
There are eight emergency room nurses and eight triage nurses. Two emergency room nurses and
two triage nurses will be working each shift. Nurses will work five, 8-hour shifts per week. One
shift per week will be overtime, where nurses will be paid double their normal hourly rate. Each
nurse will work one overtime shift each month.
Table 7 Template of Social Workers Schedule
Social Workers Monday Tuesday Wednesday Thursday Friday Saturda
y
Sunday
24 hours a day *On-call *On-call *On-call *On-call *On-call *On-call *On-call
Health MattERs will employee two on-call social workers. The two social workers will split 3.5
days each of on-call service.
Table 8 Template of Medical Radiation Technician Schedule
There will be three full-time medical radiation technician positions and one part-time position.
The full-time medical radiation technicians will work four, 12-hour shifts each week. The part-
time position will work two, 12-hour shifts each week.
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MRTs Monday Tuesday Wednesday Thursday Friday Saturday Sunday8AM-8PM 1 3 3 3 1 1 18PM-8AM 4 4 2 2 2 2 3
Health MattERs
Table 9 Template of Medical Laboratory Technician Schedule
There will be three full-time medical laboratory technician positions and one part-time position.
The full-time medical laboratory technicians will work four, 12-hour shifts each week. The part-
time position will work two, 12-hour shifts each week.
Table 10 Template of Registration Clerk Schedule
There will be three full-time registration clerk positions and one part-time position. The full-time
registration clerks will work four, 12-hour shifts each week. The part-time position will work
two, 12-hour shifts each week.
Table 11 Template of Unit Assistant Schedule
There will be three full-time unit assistant positions and one part-time position. The full-time
unit assistants will work four, 12-hour shifts each week. The part-time position will work two,
12-hour shifts each week.
Table 12 Template of Medical Administrator Schedule
MedicalAdministrator
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday
8:30AM-4:30PM 1 1 1 1 1
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MLTs Monday Tuesday Wednesday Thursday Friday Saturday Sunday8AM-8PM 1 3 3 3 1 1 18PM-8AM 4 4 2 2 2 2 3
Registration Clerk Monday Tuesday
Wednesday Thursday Friday Saturday Sunday
8AM-8PM 1 3 3 3 1 1 18PM-8AM 4 4 2 2 2 2 3
Unit Assistant Monday Tuesday Wednesday
Thursday Friday Saturday Sunday
8AM-8PM 1 3 3 3 1 1 18PM-8AM 4 4 2 2 2 2 3
Health MattERs
There will be one full-time medical administrator. The medical administrator will work Monday-
Friday, from 8:30AM-4:30PM.
Table 13 Template of Business Administrator Schedule
Business Administrator Monday Tuesday Wednesday Thursday Friday Saturday Sunday8:30AM-4:30PM 1 1 1 1 1
There will be one full-time business administrator. The business administrator will work
Monday-Friday, from 8:30AM-4:30PM.
Table 14 Template of Security Guard Schedule
There will be three full-time security guard positions and one part-time position. The full-time
security guards will work four, 12-hour shifts each week. The part-time position will work two,
12-hour shifts each week.
Table 15 Template of Janitor Schedule
There will be three full-time janitorial positions and one part-time position. The full-time janitors
will work four, 12-hour shifts each week. The part-time position will work two, 12-hour shifts
each week.
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Security Guard Monday Tuesday Wednesday
Thursday Friday Saturday Sunday
8AM-8PM 1 3 3 3 1 1 18PM-8AM 4 4 2 2 2 2 3
Janitor Monday Tuesday Wednesday Thursday Friday Saturday Sunday8AM-8PM 1 3 3 3 1 1 18PM-8AM 4 4 2 2 2 2 3
Health MattERs
4.10 Work Schedule of Key Tasks
Key tasks associated with the general operations of Health MattERs will guide the organization
towards accomplishing its mission (Table 16). The execution and completion of these tasks are
essential for the normal and sustainable operations of Health MattERs.
Table 16 Daily, Weekly, Monthly, and Annual Work Schedule of Key Tasks
Time Line Key Tasks
DailyTreat patientsRefer and transfer patientsUpdate patient files
WeeklyPatient billingOperational performance review
Bi-Weekly Payroll
MonthlyFinancial reviewStaff check-in meetings
Quarterly Physician council meeting
Annually
Annual board meetingFile financial statementsAnnual report submission to the Government of SaskatchewanAnnual employee reviewsStrategic review of Health MattERs
4.11 Suppliers and Service Providers
The operations of Health MattERs will rely on many key suppliers to provide specific auxiliary
services necessary for the facility to operate efficiently (Table 17).
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Table 17 Suppliers and Service Providers
* One-time cost, not an annual operating expenseSupplier Service Provided Cost ($)/yearAllscripts(Top Advisor, 2017)
Sunrise Clinical Manager 8,400
K-Bro Linen(Pers. Comm. with K-Bro Financial Rep. Abraham)
Linen Services 13,690
SaskPowerSaskWaterSaskEnergy(Dr. Marvin Painter Operations/HR presentation)
ElectricitySewer/waterNatural gas heating
19,504975
3,291
SaskTel(SaskTel, 2016)
InternetPhoneTV
2,595
KPMG(Pers. Comm. with KPMG Partner., Gord Stewart)
Corporate auditing and filing of financial statements
15,000
Dell(Pers. Comm. with Enterprise Solutions Specialist, Moacir Souza and Account Manager, Mark Furman)
Server System 11,388*
McDougall Gauley LLP (Pers. Comm. with Lawyer)
Legal 5,000
Booth Burnett(Pers. Comm. with Licensed Insurance Broker, Aimee Voisard)
Tenant Insurance 1,500
Healthmark(Harding et al., 2015)
Pharmaceutical Medication and Drug Supplies
140,708
Schaan Healthcare Products Inc.(Pers. Comm. with Jocelyn Orb)
Medical Consumable Inventory Supplier
24,000
Supreme Basics(Pers. Comm. with Jocelyn Orb)
Office Supplier 8,000
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Health MattERs
GE Healthcare(Pers. Comm. with GE Healthcare Business Development Manager, Sherif Rashed)
Preventative Maintenance for X-ray and ultrasound equipment
52,900(full year maintenance equal to
1/10th the cost of equipment)
WESCLEAN(Wesclean, 2017).
Cleaning Supplies 6,000
PGI Printers(Pers. Comm. with Darwin Dolgopol)
Educational Print Brochures 923
Beagle Productions Ltd.(Pers. Comm. with Client Service Manager)
Website 200(first year start-up fee of 2,000)
See Marketing Section for further details
4.12 Key Partners
There are several key partnerships that must be established, through partnership agreements or
otherwise to ensure that high quality medical services are provided to Health MattERs’ patients.
These key partnerships include:
Pre-hospital (EMS) services:o Partnership agreement for inter-facility transfers
Funeral homeso Partnership agreement for deceased body pick-up
Tertiary hospitalso Partnership agreement for patient care and mortuary storage services
Family physicianso Networking and key partners in patient referrals and education
Canadian Blood Serviceso Partnership agreement for blood supply
Community Mental Healtho Partnership agreement for support of mental health patient needs
HealthLine (811)o Partnership agreement for patient education on healthcare service level
The Saskatchewan Health Authorityo Partnership agreement for buying-group privileges, healthcare services, etc.
The Government of Saskatchewano Agreement to start Health MattERs and pay annual operating expenses
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A critical partnership for Health MattERs will be with the Saskatchewan Health Authority and
the Government of Saskatchewan. These partnership agreements will help Health MattERs
leverage buying-group discounts for medications and other pharmaceuticals, medical equipment
and medical consumables. Due to the scope of this business plan, the specifics of these
partnership agreements cannot be disclosed due to confidentiality regulations within the Health
Region and the Government of Saskatchewan. Thus, the discount rate on purchased medications,
pharmaceuticals, medical equipment and supplies is not known. However, at a point in which
this business plan was to move forward from the initial proposal phase to the approval phase,
these partnerships would need to be established and the specifics would need to be worked out to
fully understand the businesses budget. For example, all medications would be supplied to
Health MattERs by the Provincial Health Authority and paid for by the Government of
Saskatchewan based on a buying group price (Pers. Comm. with Saskatoon Health Region’s
Director of Pharmacy, Patrick Robertson).
4.13 Capital Budget by Category
The development and continued operations of Health MattERs will require investments in capital
equipment and projects such as leasehold improvements to the facility, furniture, business
electronic equipment, medical equipment, and net working capital (Table 18). To understand the
capital requirements of Health MattERs, each capital category has been itemized to showcase the
specific details. An equipment list from Saskatoon’s Royal University Hospital emergency
department was used to inform the necessary medical equipment for Health MattERs facility, as
well as conversations with professionals in the industry. Personal communications were often
used with many companies to obtain the most accurate costs estimates. For example, personal
communications with Sherif Rashed, Business Development Manager at GE Healthcare
informed the decision to get the high-quality Discovery XR656 Plus X-Ray unit (GE Healthcare,
2017). Mr. Rashed suggested this type of unit that is ceiling mounted for an emergency room
setting as it provides the technicians with great flexibility in how the system can be used,
particularly when the patient population at an emergency room is often in a more critical state
and hard to mobilize. Additionally, Mr. Rashed provided a standard estimate for a service
contract of GE Healthcare equipment, for preventative maintenance, to be 1/10th the cost of the
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Health MattERs
equipment purchased. The information gained through personal communications with industry
experts provides credible and reliable cost estimates for Health MattERs to use in its budget.
Table 18 Itemized Capital Budget by Category
Item Cost ($) Source
Leasehold Improvements900,000
(Vetter, 2015)(225/SF)
Furniture 18,913
60X Armless Guest Chair – Black 5,609 (Clinical Supplies Canada, 2017)
Bush Business 82’ Oval Conference Table, Cappuccino Cherry and Graphite Gray
369 (Staples, 2017)
7X Adjustable Laptop Cart 672 (Wayfair, 2017)
3X Bestar Flare L-Shape Desk with Hutch, Tuscany Brown 1,197 (Staples, 2017)
2X Step Stool – 9.5” Height 104 (Clinical Supplies Canada, 2017)
13X Fabric Task Chair, Black 1,677 (Staples, 2017)
3X Monarch Specialties Computer Desk, Cappuccino 522 (Staples, 2017)
2X Changing Station, Vertical 568 (Zoro Canada, 2017)
Office Star Pneumatic Height Adjustable White Dry-Erase Top Table, Black Steel Frame
349 (Staples, 2017)
Banquet Table with Folding Legs, 60”, Dark Wood 89 (Staples, 2017)
16X Lack Side Table 160 (Ikea, 2017)Linnmon/Alex Table 124 (Ikea, 2017)
Top Freezer Refrigerator 749 (Saskatoon Appliances, 2017)
Bjursta.Vilmar Table and 4 chairs 489 (Ikea, 2017)
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Health MattERs
Master Chef 0.7 Cu.Ft. Microwave 89 (Canadian Tire, 2017)
Hamilton Beach 2-Way Deluxe Coffee Maker 129 (Canadian Tire, 2017)
Bekant Conference Table 420 (Ikea, 2017)
6X Lakeside 18” Round Lien Hamper with Tilt Lid- Foot Operated 1,614 (Universal Medical Inc., 2017)
Lack Coffee Table 34 (Ikea, 2017)Knislinge Sofa 499 (Ikea, 2017)12X Storage Shelves 948 (Home Depot, 2017)
12X Overbed Tables 2,502 (Surgo Surgical Supply, 2017)
Business Electronic Equipment and Server 30,718
Generac Standby Generator 3,499 (The Home Depot, 2017)
Lexmark MX810de3,499
Photocopier (Printer, Scanner, Fax) (Lexmark, 2017)
16X HP 21.5” All-in-One PC Computer, Mouse, Keyboard 11,184
(Best Buy, 2017)
Sony 60” Smart 1080p LED TV 999
Insignia 47”-80” Tilting TV Wall Mount 149
Dell Server System 11,388(Pers. Comm. with Enterprise Solutions
Specialist, Moacir Souza and Account Manager, Mark Furman)
Medical Equipment Total 1,190,861X-Ray Unit 423,362
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DiscoveryXR656 Plus –High quality ceiling mounted X-Ray system 400,000
(Pers. Comm. with GE Healthcare Business Development Manager, Sherif
Rashed)
Wolf MG-7 Single Panel X-Ray Illuminator 489 (Surgo Surgical Supply, 2017)
Mobile Lead Shield (24’X48”) 443 (Z&Z Medical, 2017)
Sterlie Multipurpose Scatter Radiation Protective Drape 155 (Universal Medical Inc., 2017)
Film -Digitizer 17,000 (Salazar et al., 2011)
3X X-Ray Protective Clothing
(Universal Medical Inc., 2017)
Lead Apron 840
MX30 Radiation Glasses 387
Thyroid Shields 34Lead Gloves 684Patient Shields 640
Cassette Film Cart 720 (Universal Medical Inc., 2017)
2X X-Ray Wall Mounter Peg Style Lead Apron Racks 60 (Universal Medical Inc., 2017)
X-Ray Cassettes 750 (Z&Z Medical, 2017)
2X X-Ray LED Deluxe Flood Style Safelight 1,160 (Z&Z Medical, 2017)
Ultrasound Unit 183,400
6X GE Logiq P5 ultrasound system 129,000 (Block Imaging, 2017)
6X Ultrasound Transducer 54,400 (Clarius, 2017)Medication Dispenser 170,000
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2X Pyxis MedStation Automated Medication Dispensing Machine 170,000
(Pers. Comm. with Saskatoon Health Region Pharmacy Director, Patrick
Robertson)
General Medical Equipment 414,099
12X Alaris 7130 Infusion Pump 6,300 (Pacific Medical, 2017)
12X BpTRU BPM100 Automatic Blood Pressure Monitor White Coat Device 11,820 (Surgo Surgical Supply, 2017)
12X Standard BpTRU Mobile Stand with Baskket 3,228 (Surgo Surgical Supply, 2017)
12X Mindray DPM4 Patient Monitor 73,560 (Surgo Surgical Supply, 2017)
2X Seiler Sxs820 Binocular Microscope 2,032 (Surgo Surgical Supply, 2017)
Calorimeter 6,500 (Alibabe, 2017)
Lifespin 6D Physician’s Centrifuge 523 (Surgo Surgical Supply, 2017)
2X CardioChek Plus Analyzer Cholesterol, Lipid & Glucose Monitor 2,190 (Surgo Surgical Supply, 2017)
Haemoglobinometer, electronic 1,657 (Indiamart, 2017)
2X Analytical Balance 4,260 (Cole-Parmer, 2017)Revco Blood Bank Refrigerator, 115V Model 13,860 (Laboratory-Equipment, 2017)
Blood Cell Counter, electric 3,000 (Made-in-China.com, 2017)
4X Healthometer Mechanical Physican Beam ScALE Model 402KL 1,220 (Surgo Surgical Supply, 2017)
2X Hot Air Oven 1,864 (Hach, 2017)Bilirubin Meter 5,500 (WHO, 2011)
2X Digitally Controlled Mechanical Convection Incubator 5,927 (Cole-Parmer, 2017)
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2X Oakton PC700 Benchtop Meter with Electrode Stand pH Meter 2,461 (Cole-Parmer, 2017)
3X Vaccine Transport Box 150 (Alibaba, 2017)3X 5 Liters Stable Temp Digital Utility Water Baths 2,202 (Cole-Parmer, 2017)
Pretreatment Deionizer for Thermo Scientific Barnstead Mega-Pure Distillation Systems
3,334 (Cole-Parmer, 2017)
2X Erlenmeyer Flask Starter Set, Glass 150 (Cole-Parmer, 2017)
2X Low-Form Glass Beaker Starter Set 109 (Cole-Parmer, 2017)
2X Hand Tally Counter 26 (Staples, 2017)2X IKA RW 20 Digital Dual-Range Mixers 3,772 (Cole-Parmer, 2017)
2X Enduro Gel XL Horizontal Electrophoresis System 1,894 (Cole-Parmer, 2017)
2X Digital Count Pen 86 (Cole-Parmer, 2017)Yamato Vertical-Loading Laboratory Autoclave 12,800 (Cole-Parmer, 2017)
6X Resuscitator bag valve and mask (adult) 240 (CPR Savers, 2017)
4X Resuscitator bag value and mask (pediatric) 84 (AED Superstore, 2017)
4X Cardiac Science PowerHeart AED G3-Automatic 12,436 (Surgo Surgical Supply, 2017)
12X Temple Touch Adtemp Thermometer 207 (Stethoscope.ca, 2017)
12X Choicemmed MD300-D Finger Pulse Oximeter 719 (Stethoscope.ca, 2017)
12X Schuco-Vac 330A Aspirator Suction Unit 5,460 (Surgo Surgical Supply, 2017)
12X MedPro Compressor Nebulizer 1,800 (Surgo Surgical Supply, 2017)
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Bionix Otoclear Spray Wash Kit Ear irrigation and cerumen removal equipment
90 (Surgo Surgical Supply, 2017)
2X Elite100 5 Mhz Probe, Vascular Doppler 1,290 (Surgo Surgical Supply, 2017)
2X Adult and Pediatric code cart 2,196 (Sedation Kit, 2017)
2X ECG Machine 7,362 (Surgo Surgical Supply, 2017)
2X Cardiac Compression Board 180 (CPR Board, 2017)
12X Treatment Bed Stryker Epic 2 ICU Bed 35,400 (Beta Medical Inc., 2017)
6X Exam Table with Side Step 9,570 (Surgo Surgical Supply, 2017)
3X Transport Stretcher 119M 12,504 (Surgo Surgical Supply, 2017)
6X Standard Laryngoscope set 2,145 (Surgo Surgical Supply, 2017)
30X Pocket Pal II Kit 379 (Stethoscope.ca, 2017)
16X Woven tape measure 60 (Stethoscope.ca, 2017)
20X Littmann cardiology IV Stethoscope 3,810 (Stethoscope.ca, 2017)
12X Mayo Stand 2,147 (Surgo Surgical Supply, 2017)
6X Mobile Tables for Instruments 4,136 (Cole-Parmer, 2017)
Infant weigh scale 925 (Surgo Surgical Supply, 2017)
4X Wheel chair adult 984 (Surgo Surgical Supply, 2017)
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13X Reister Integrated System 14,302 (Surgo Surgical Supply, 2017)
12X Taylor Percussion hammer 80 (Surgo Surgical Supply, 2017)
4X Cervical collar 47 (Surgo Surgical Supply, 2017)
DreamStation BiPap Auto Machine 1,639 (Cpap, 2017)
Cast cutter 2,154 (Surgo Surgical Supply, 2017)
Welch Allyn Complete Illumination System for Endoscopy 1,375 (Surgo Surgical Supply, 2017)
2X Transfer belt 12 (Vitality Medical, 2017)
2x Walker 154 (Surgo Surgical Supply, 2017)
6X Bed Pan 2,820 (Surgo Surgical Supply, 2017)
2X Boom Articulating 44,000 (Meditek, 2016)Voyager Portable Ceiling Lift 4,248 (RehabMart, 2017)
2X Summit SA3RMD Undercounter Medical Refrigerator 1,306 (Tovatech, 2017)
2X Verathon GlideScope 19,650 (JEMS, 2008)
Pedigo Blanket Warming Cabinet 3,400 (Universal Medical Inc., 2015)
2X Bair Hugger 1,526 (Medical Price, 2017)Lakeside Fluid Warmer – 16L Capacity – Glass Door 6,127 (Universal Medical Inc., 2015)
Belmont Rapid Infuser 20,700 (Belmont Instrument Corporation, 2013)
20X Sharps Container – 5.1L 380 (Uline, 2017)20X Glove Dispenser –Triple 900 (Uline, 2017)12X Flowmeter -Air 6,298 (Cole-Parmer, 2017)12X Flowmeter – Oxygen 676 (AliExpress, 2017)
Personal Protective Equipment Cabinet 821 (QEC, 2017)
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Dialysis Machine 6,935 (Medical Price, 2017)
Net Working Capital 296,683
Total Capital 2,437,175
4.14 Capital Expenditures Summary
Capital expenditures have been summarized to indicate the total of all the items needed for
Health MattERs’ capital budget (Table 19). Purchasing contracts with suppliers will be
negotiated on a 45-day payment schedule. Thirty days’ worth of inventory will be kept on-hand.
Table 19 Capital Expenditures Summarized
Item Cost (2020)Leasehold Improvements 900,000Furniture and Fixtures 18,913
Business Electronic Equipment 30,718
Medical Equipment 1,190,861Net Working Capital 296,683Total Capital 2,437,175
4.15 Operating Expenses by Category (2020-2030)
The operating expenses of Health MattERs have been categorized and projected for the eleven
years of operations (Table 20). The rate of inflation used to project operating expenses into the
future was determined to be 2.0 percent. Employer paid benefits will include health and dental
coverage that is equal to 10 percent of the staff member’s annual salary or wage.
Table 20 Operating Expenses by Category (2020-2030)
Operating Expenses 2020 2021 2022 2023 2024 2025 Legal 5,000 5,100 5,202 5,306 5,412 5,520
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Marketing and Advertising
3,123 1,145 1,168 1,192 1,216 1,240
Lease Cost Building 100,000 102,000 104,040 106,121 108,243 110,408 Occupancy Cost 35,600 36,312 37,038 37,779 38,535 39,305 Water and Sewage 976 996 1,015 1,036 1,056 1,078 Electricity 19,504 19,894 20,292 20,698 21,112 21,534 Natural Gas Heating 3,292 3,358 3,425 3,493 3,563 3,635 Linen Service 13,690 13,964 14,243 14,528 14,818 15,115 Tenant Insurance 1,500 1,530 1,561 1,592 1,624 1,656 Auditing/Accounting 15,000 15,300 15,606 15,918 16,236 16,561 Medical Supplies 24,000 24,480 24,970 25,469 25,978 26,498 Cleaning Supplies 6,000 6,120 6,242 6,367 6,495 6,624 Office Supplies 8,000 8,160 8,323 8,490 8,659 8,833 Pharmaceutical Supplies
456,457 465,586 474,898 484,396 494,083 503,965
Sunrise Clinical Manager
8,400 8,568 8,739 8,914 9,092 9,274
Capital Cost Allowance 134,854 242,675 195,519 159,914 132,270 107,371 Interest 25,852 23,566 21,218 18,806 16,329 13,786 Employer Paid Benefits 1,204,925 1,226,956 1,248,567 1,270,590 1,292,948 1,315,753 Preventative Maintenance
54,900 55,998 57,118 58,260 59,426 60,614
Internet, Phone, TV 2,596 2,648 2,701 2,755 2,810 2,866 Employee Salary and Wages
8,264,733 8,430,027 8,598,628 8,770,600 8,946,012 9,124,933
Misc. Variable Cost % Employee Salary/Wage
157,030 160,171 163,374 166,641 169,974 173,374
Total Operating Expenses
10,545,432
10,694,384
10,850,513
11,022,224
11,205,919
11,396,569
Table 20 Continued
Operating Expenses 2026 2027 2028 2029 2030 Legal 5,631 5,743 5,858 5,975 6,095 Marketing and Advertising
1,265 1,290 1,316 1,342 1,369
Lease Cost Building 112,616 114,869 117,166 119,509 121,899 Occupancy Cost 40,091 40,893 41,711 42,545 43,396 Water and Sewage 1,099 1,121 1,144 1,166 1,190 Electricity 21,965 22,404 22,852 23,309 23,775 Natural Gas Heating 3,707 3,781 3,857 3,934 4,013 Linen Service 15,726 16,040 16,361 16,688 Tenant Insurance 1,689 1,723 1,757 1,793 1,828
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Auditing/Accounting 16,892 17,230 17,575 17,926 18,285 Medical Supplies 27,028 27,568 28,120 28,682 29,256 Cleaning Supplies 6,757 6,892 7,030 7,171 7,314 Office Supplies 9,009 9,189 9,373 9,561 9,752 Pharmaceutical Supplies 514,044 524,325 534,812 545,508 556,418 Sunrise Clinical Manager 9,460 9,649 9,842 10,039 10,240 Capital Cost Allowance 90,354 80,994 71,062 53,673 47,223 Interest 11,174 8,491 5,736 2,906 - Employer Paid Benefits 1,339,014 1,362,740 1,386,941 1,411,625 1,436,804 Preventative Maintenance 61,826 63,063 64,324 65,611 66,923 Internet, Phone, TV 2,924 2,982 3,042 3,102 3,165 Employee Salary and Wages
9,307,431 9,493,580 9,683,451 9,877,120 10,074,663
Misc. Variable Cost % Employee Salary/Wage
176,841 180,378 183,986 187,665 191,419
Total Operating Expenses
11,583,977
11,814,254
12,033,009
12,248,861
12,480,295
5.0 Human Resources
5.1 Job Descriptions
The staff job title positions and number of employees/positions are estimates based on a
projected need and conversations with industry professionals who are currently managing
emergency rooms and healthcare facilities in Saskatoon (Table 21). These industry experts
include Jocelyn Orb, Manager of Student Health Services at the University of Saskatchewan and
past emergency room nurse; Dr. Ian Sunderland, Cosmetic and Reconstructive Plastic Surgeon
working at a private clinic; Dr. James Stempien, Emergency Medicine Department Head for the
Saskatoon Health Region; and numerous experts attending and speaking at the University of
British Columbia’s Continuing Education Conference, hosted in Saskatoon, on Western
Emergency Department Operations.
Table 21 Job Descriptions and Requirements
Table 20 Abbreviated Terms:CFPC: College of Family Physicians of CanadaCPSS: College of Physicians and Surgeons of CanadaBSN: Bachelor’s of Science in Nursing
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NP: Nurse PractitionerCCPA: Certified Canadian Physician Assistant SAMRT: Saskatchewan Association of Medical Radiation TechnologistsCAMRT: Canadian Association of Medical Radiation TechnologistsSSMLT: Saskatchewan Society of Medical Laboratory Technologists
Job Title/Position
RequiredAcademic Credentials
Key Competencies
License Requirements
Position on the Board of Directors
Job Responsibilities
Emergency Room Director, Emergency Physician (1)
MDMBA
LeadershipOrganizationEmergency MedicineManagement
Full-time CFPCORFull-time CPSS
President Communicate with the Gov. of Sask.Board dutiesManage ERTreat patients
Physiciansa).Emergency (8)b).Radiologist (4)
MD Clinical SkillsOrganizationTime ManagementFlexibilityEnthusiasmTeam-oriented
a).Full-time CFPCORFull-time CPSSb).Full-time CPSS
One physician
Vice President and Secretary
Treat PatientsWork with other members of the healthcare teamProvide feedback on ER efficiency and operationsParticipate at physician’s council meetingsBoard duties(one physician)
Registered Nurses(Emergency) (8)
BSN
Emergency Nursing Advanced Certificate
Clinical SkillsOrganizationTime ManagementER experienceTeam-orientedFlexibility
RN of Sask. N/A Patient prepEquipment and treatment assistanceManage patient informationCommunicate with members of the healthcare teamProvide feedback on ER efficiency and operations
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Registered Nurses (Triage)(8)
BSN Clinical SkillTeam-orientedTime ManagementOrganizationFlexibilityER experienceTriage experience
RN of Sask. N/A Triage patients and preparationsInitiate patient transfersManage patient informationCommunicate with members of the healthcare teamProvide feedback on ER efficiency and operationsManage patients in observation area
Social Worker(2)
BSW CompassionCommunication SkillsFlexibilityHealthcare setting experience
SASW N/A Provide compassionate care to grieving patients or their familiesProvide therapeutic techniques to patients and families to manage difficult news and deathProvide programming resources to individuals
Medical Radiation Technician (MRT)(3.5)
MRT Diploma
Pass CAMRT certification exam
Imaging experienceTime ManagementOrganizationTeam-oriented
Full-time SAMRT license
N/A Prepare patients for CT, X-Ray examsPrepare equipment for each examOperate machinesProvide report to Radiologist
Medical Laboratory Technician
MLT Diploma
Laboratory experienceTime
Full-time membership to SSMLT
N/A Collect and handle lab specimens
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(MLT)(3.5)
ManagementOrganizationTeam-orientedAttention to detail
Analyze specimensReport laboratory findings to appropriate healthcare provider
Medical Administrator(1)
Medical Office Management Diploma
Data and file managementComputer skillsBasic knowledge of medical terminologyBookkeepingBusiness communicationHR managementScheduling managementBilling and codingE-HealthSupply managementTeam-oriented
N/A N/A Medical supply managementManage communication and marketing with other health facilities and servicesManage E-health technologyQuality assurance managementWork closely with Business AdministratorScheduling of staff
Business Administrator (1)
Business Admin. Certificate
Basic bookkeeping/accounting knowledgeHR managementComputer skillsBusiness communicationBilling and codingSupply managementTeam-oriented
N/A N/A Office supply managementManage patient billing servicesBookkeepingWork closely with Medical AdministratorPayrollConduct monthly employee check-ins and report to Emergency Room Director
Registration Clerk
Medical Admin.
ReliableBasic
N/A N/A Patient wait time
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(3.5) Diploma knowledge of medical terminologyCustomer serviceTelephone and email communicationsComputer skillsTeam-orientedTime management
managementPatient service at ER entranceAnswer phones, emails, faxEnsure steady flow of patientsHelp to coordinate patient transfers to alternate level of care facilities
Unit Assistant(3.5)
Medical Admin. Diploma
Basic knowledge of medical terminologyCustomer serviceTelephone, fax, and email communicationsComputer skillsTeam-orientedOrganized
N/A N/A Submit order entriesWatch for incoming fax, telephones, or other important informationLocate patient’s families
Security Guard(3.5)
N/A Experience in medical setting securityCommunication SkillsFlexibleTeam-oriented
N/A N/A Provide onsite security servicesCoordinate with Saskatoon Police Services when necessary
Janitor(3.5)
N/A Janitorial skills in a medical settingTeam-oriented
N/A N/A Provide janitorial services to the entire buildingClean the building up to standard with clinical-based settings
In the first year of operation, as with all years, patient data will be collected to identify any
necessary changes to staff requirements. Ideally, the outlined staff projections will meet the
needs of Health MattERs’ patient population without wasting resources. Thus, no formalized,
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planned additions to staffing is projected over Health MattERs’ projected period of operation.
Instead, data will be continuously collected and staffing adjustments will be made accordingly to
match the needs of the patient population. This data will be organized by the medical
administrator, through conversations with all other staff members and through patient quantity
data and quality surveys. The medical administrator will discuss, collaborate and recommend to
the Emergency Room Director about staffing additions or deletions.
5.2 Key Tasks by Job Description
The Emergency Room Director will be the CEO of Health MattERs and a licensed emergency
physician in Saskatchewan. The Emergency Room Director will be President of the Board of
Directors. This position requires that the individual have a Master of Business Administration
from a university and as well, be an accredited emergency doctor. Accreditation will be
recognized based on the holding of a full-time license to practice emergency medicine in
Saskatchewan from either CFPC or CPSS. One other emergency physician will be the Vice-
President and Secretary of the Board of Directors. This position will be selected by a blind-vote,
in which all 12 physicians vote for this representative. The daily, weekly, monthly, and annual
tasks of each job position will act as a roadmap for individuals working in each position to
follow and reference for clarification regarding their responsibilities (Table 22-35)
Table 22 Work Tasks for Emergency Department Director
Time Line Key Tasks
DailyEnsure daily operation quality standards are metAttend to any ER management issues
WeeklyAsses patient flow dataConduct operating performance review using weekly ER efficiency and operations reportsReview weekly financials
MonthlyReview monthly employee check-ins with Business AdministratorReview monthly financial reportsReview and produce marketing material for Health MattERsWork towards establishing Health MattERs
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foundationAnnually Attend and chair annual board meeting
File financial statementsSubmit annual report to the Government of SaskatchewanConduct strategic review of Health MattERsAnnual staff performance assessment and review
Table 23 Work Tasks for Emergency Physicians
Time Line Key Tasks
DailyAssess, diagnose and treat patientsRefer and transfer patientsUpdate patient files
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
Annually
Board physician (Vice President and Secretary), if an emergency physician, attend annual board meetingTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 24 Work Schedule for Radiologists
Time Line Key Tasks
DailyAssess and diagnose patientsRefer and transfer patientsUpdate patient files
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in reportBoard physician (Vice President and Secretary), if a radiologist, attend annual
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Annually board meetingTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 25 Work Schedule for Emergency Room Nurses
Time Line Key Tasks
DailyPrep patients, assess patientAssist with equipment use and treatmentManage patient file information
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 26 Work Schedule for Triage Nurses
Time Line Key Tasks
Daily
Conduct patient CTAS evaluationTriage patientsPrep patientsAssist with patient transfersManage patient file information
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
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Table 27 Work Schedule of Social Workers
Time Line Key Tasks
Daily
Counsel patients and familiesProvide appropriate external resources to patientsCommunicate information regarding a patient’s condition or disease state
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 28 Work Schedule for Medical Radiation Technician
Time Line Key TasksDaily Prepare patients for CT, X-Ray exams
Prepare equipment for each examOperate machinesProvide report to Radiologist
Weekly Provide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
Annually Take part in annual staff performance assessment and review process
Table 29 Work Schedule for Medical Laboratory Technician
Time Line Key TasksDaily Collect and handle lab specimens
Analyze specimensReport laboratory findings to appropriate
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healthcare providerWeekly Provide weekly feedback to Medical
Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
Annually Take part in annual staff performance assessment and review process
Table 30 Work Schedule for Medical Administrator
Time Line Key Tasks
DailyUpdate and manage suppliesUpdate patient files through E-health systemQuality assurance assessment
Weekly
Receive and compile weekly ER efficiency and operation reportsPlace weekly supply order with supplierCommunicate with other healthcare facilitiesQuality assurance assessment
Monthly
Meet with business administrator for monthly staff check-in reportReview and produce marketing material for Health MattERsQuality assurance assessmentStaff scheduling
Annually
Take part in strategic review of Health MattERs as requested by Emergency Room DirectorQuality assurance assessmentTake part in annual staff performance assessment and review process
Table 31 Work Schedule for Business Administrator
Time Line Key TasksDaily Update office supply file
Update patient billing information
WeeklyPrepare weekly financial reportSubmit patient billing informationBi-weekly payroll
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Provide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly
Prepare monthly financial reportPlace monthly office supply orderConduct monthly employee check-ins and report to Emergency Room DirectorWork towards establishing Health MattERs foundation
AnnuallySubmit annual financial statements to Emergency Room DirectorTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 32 Work Schedule for Registration Clerk
Time Line Key Tasks
Daily
Manage health records databaseRegister patientsLead role in patient transfers
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 33 Work Schedule for Unit Assistant
Time Line Key Tasks
Daily
Place all order entriesWatch for incoming faxes, phone calls, emails of significant importanceLocate patient filesRoutine station maintenance and prepProvide weekly feedback to Medical
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Weekly Administrator and/or Emergency Room Director regarding ER efficiency and operations
Monthly Meet with business administrator for monthly staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 34 Work Schedule for Security Guard
Time Line Key Tasks
Daily
Provide onsite security servicesManage relations and communications with EMS staff and police force
WeeklyN/A
Monthly Meet with business administrator for monthly staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
Table 35 Work Schedule for Janitor
Time Line Key Tasks
Daily
Provide onsite cleaning services of the entire facilityManage treatment area cleaning, as necessary, between patientsOrganize linen for external linen services
WeeklyProvide weekly feedback to Medical Administrator and/or Emergency Room Director regarding ER efficiency and
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operationsMonthly Meet with business administrator for monthly
staff check-in report
AnnuallyTake part in strategic review of Health MattERs as requested by Emergency Room DirectorTake part in annual staff performance assessment and review process
5.3 Training Programs
As part of Phase 3 of the development plan, all staff members will undergo specific training to
ensure that they are properly prepared to work together to maintain a safe, efficient and patient-
centered emergency room. Training will take place prior to the opening of the emergency room,
to ensure that all staff members can attend training together. The training will take place at
Health MattERs emergency room in order to practice procedural methods in the workspace and
to have staff become knowledgeable with the specificities of the emergency room. The employee
contracts will stimulate that attending and successfully completing this training is a mandatory
job requirement. The training will emphasize efficient patient flow methods. It will utilize
information provided in the Patient Flow Toolkit developed by the Saskatchewan Health Quality
Council. The training will also focus on communication, compassionate care, and team building.
Outside of the initial training, all staff will be expected to maintain their accreditation with their
respective professional accreditation organizations. Required, continuing medical education
training and programs will be paid for by the staff members themselves. Job positions that are
not regulated by a professional body and do not have required continual education requirements
will not be expected to complete ongoing training. However, if a valuable opportunity for
training arises related to their position, it would be approved by the Emergency Room Director
and may be paid for by Health MattERs.
5.4 Salary and Wages
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All Health MattERs employees will be paid per hour except the Emergency Room Director,
emergency physicians, radiologists, and on-call social workers, who will instead be paid an
annual salary (Table 36). Wage rates were determined by analyzing current industry standards
and by speaking with individuals working and managing the field. Over the projection period
from 2020-2030 wage rates have been adjusted to reflect a 2.0 percent inflation rate.
Table 36 Salary and Wages
Wage/Salary 2021 2021 2022 2023 2024 2025Emergency Room Director 100,000 102,000 104,040 106,121 108,243 110,408Emergency Physician 400,000 408,000 416,160 424,483 432,973 441,632Radiologist 500,000 510,000 520,200 530,604 541,216 552,040Emergency Nurse 45.00 45.90 46.82 47.75 48.71 49.68Triage Nurse 42.00 42.84 43.70 44.57 45.46 46.37Social Worker 30000 30,600 31,212 31,836 32,473 33,122Medical Radiation Technician 32.00 32.64 33.29 33.96 34.64 35.33Medical Laboratory Technician 30.00 30.60 31.21 31.84 32.47 33.12Medical Administrator 25.00 25.50 26.01 26.53 27.06 27.60Business Administrator 25.00 25.50 26.01 26.53 27.06 27.60Registration Clerk 22.00 22.44 22.89 23.35 23.81 24.29Unit Assistant 20.00 20.40 20.81 21.22 21.65 22.08Security Guard 17.00 17.34 17.69 18.04 18.40 18.77Janitor 17.00 17.34 17.69 18.04 18.40 18.77
Table 36 Continued
Wage/Salary 2026 2027 2028 2029 2030
Emergency Room Director112,61
6 114,869117,16
6 119,509 121,899
Emergency Physician450,46
5 459,474468,66
4 478,037 487,598
Radiologist563,08
1 574,343585,83
0 597,546 609,497Emergency Nurse 50.68 51.69 52.72 53.78 54.85Triage Nurse 47.30 48.24 49.21 50.19 51.20Social Worker 33,785 34,461 35,150 35,853 36,570Medical Radiation Technician 36.04 36.76 37.49 38.24 39.01Medical Laboratory Technician 33.78 34.46 35.15 35.85 36.57Medical Administrator 28.15 28.72 29.29 29.88 30.47
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Business Administrator 28.15 28.72 29.29 29.88 30.47Registration Clerk 24.78 25.27 25.78 26.29 26.82Unit Assistant 22.52 22.97 23.43 23.90 24.38Security Guard 19.14 19.53 19.92 20.32 20.72Janitor 19.14 19.53 19.92 20.32 20.72
5.5 Employment Insurance
Employment insurance was calculated based on a base rate of 1.63 percent of annual salary plus
an additional 40 percent contribution (Table 37). The annual maximum insurable earnings in
Saskatchewan is $51,300. Any employee earning more than $51,300 annually will receive the
maximum employer contribution of $1,171 (Payworks, 2017).
Table 37 Employment Insurance 2020-2030
Employment Insurance 2020 2021 2022 2023 2024 2025Emergency Room Director 1,17
11,171 1,171 1,17
11,171 1,171
Emergency Physicians 1,171
1,171 1,171 1,171
1,171 1,171
Radiologists 1,171
1,171 1,171 1,171
1,171 1,171
Emergency Nurse 1,171
1,171 1,171 1,171
1,171 1,171
Triage Nurse 1,171
1,171 1,171 1,171
1,171 1,171
Social Worker 685 698 712 727 741 756Medical Radiation Technician 1,17
11,171 1,171 1,17
11,171 1,171
MRT P.T. 911 930 948 967 986 1,006Medical Laboratory Technician 1,17
11,171 1,171 1,17
11,171 1,171
MLT P.T. 854 871 889 907 925 943Medical Administrator 1,17
11,171 1,171 1,17
11,171 1,171
Business Administrator 1,171
1,171 1,171 1,171
1,171 1,171
Registration Clerk 1,171
1,171 1,171 1,171
1,171 1,171
Registration Clerk P.T. 627 639 652 665 678 692
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Unit Assistant 1,143
1,166 1,171 1,171
1,171 1,171
Unit Assistant P.T. 570 581 593 604 617 629Security Guard 954 973 993 1,01
31,033 1,054
Security Guard P.T. 476 485 495 505 515 525Janitor 954 973 993 1,01
31,033 1,054
Janitor P.T. 476 485 495 505 515 525
Table 37 Continued
Employment Insurance 2026 2027 2028 2029 2030
Emergency Room Director1,17
1 1,171 1,1711,17
1 1,171
Emergency Physicians1,17
1 1,171 1,1711,17
1 1,171
Radiologists1,17
1 1,171 1,1711,17
1 1,171
Emergency Nurse1,17
1 1,171 1,1711,17
1 1,171
Triage Nurse1,17
1 1,171 1,1711,17
1 1,171Social Worker 771 786 802 818 835
Medical Radiation Technician1,17
1 1,171 1,1711,17
1 1,171
MRT P.T.1,02
6 1,047 1,0681,08
9 1,111
Medical Laboratory Technician1,17
1 1,171 1,1711,17
1 1,171
MLT P.T. 962 981 1,0011,02
1 1,041
Medical Administrator1,17
1 1,171 1,1711,17
1 1,171
Business Administrator1,17
1 1,171 1,1711,17
1 1,171
Registration Clerk1,17
1 1,171 1,1711,17
1 1,171Registration Clerk P.T. 706 720 734 749 764
Unit Assistant1,17
1 1,171 1,1711,17
1 1,171Unit Assistant P.T. 641 654 667 681 694
Security Guard1,07
5 1,096 1,1181,14
0 1,163
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Security Guard P.T. 536 546 557 568 580
Janitor1,07
5 1,096 1,1181,14
0 1,163Janitor P.T. 536 546 557 568 580
5.6 Canadian Pension Plan
Canadian Pension Plan (CPP) was calculated based on annual earnings less the annual basic
exception of $3,500 multiplied by the CPP contribution rate of 4.95 percent (Table 38)
(Payworks, 2017). For employees earning more than the annual maximum pensionable earnings
of $55,300, CPP contribution was determined by the annual maximum CPP employed
contribution of $2,564 (Payworks, 2017).
Table 38 Canadian Pension Plan
CPP 2020 2021 2022 2023 2024 2025
Emergency Room Director2,56
4 2,564 2,5642,56
4 2,564 2,564
Emergency Physicians2,56
4 2,564 2,5642,56
4 2,564 2,564
Radiologists2,56
4 2,564 2,5642,56
4 2,564 2,564
Emergency Nurse2,56
4 2,564 2,5642,56
4 2,564 2,564
Triage Nurse2,56
4 2,564 2,5642,56
4 2,564 2,564
Social Worker1,31
2 1,341 1,3721,40
3 1,434 1,466
Medical Radiation Technician2,56
4 2,564 2,5642,56
4 2,564 2,564
MRT P.T.1,80
4 2,564 2,5642,56
4 2,564 2,564
Medical Laboratory Technician2,56
4 2,564 2,5642,56
4 2,564 2,564
MLT P.T.1,68
0 1,717 1,7551,79
3 1,833 1,873
Medical Administrator2,40
8 2,459 2,5122,56
4 2,564 2,564
Business Administrator2,40
8 2,459 2,5122,56
4 2,564 2,564
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Registration Clerk2,55
4 2,564 2,5642,56
4 2,564 2,564
Registration Clerk P.T.1,18
6 1,213 1,2411,26
9 1,298 1,327
Unit Assistant2,30
6 2,355 2,4062,45
7 2,510 2,564
Unit Assistant P.T.1,06
2 1,087 1,1121,13
8 1,164 1,191
Security Guard1,89
7 1,938 1,9802,02
3 2,067 2,112Security Guard P.T. 858 879 900 922 943 966
Janitor1,89
7 1,938 1,9802,02
3 2,067 2,112Janitor P.T. 858 879 900 922 943 966
Table 38 Continued
CPP 2026 2027 2028 2029 2030
Emergency Room Director2,56
4 2,564 2,5642,56
4 2,564
Emergency Physicians2,56
4 2,564 2,5642,56
4 2,564
Radiologists2,56
4 2,564 2,5642,56
4 2,564
Emergency Nurse2,56
4 2,564 2,5642,56
4 2,564
Triage Nurse2,56
4 2,564 2,5642,56
4 2,564
Social Worker1,49
9 1,533 1,5671,60
1 1,637
Medical Radiation Technician2,56
4 2,564 2,5642,56
4 2,564
MRT P.T.2,56
4 2,564 2,5642,56
4 2,564
Medical Laboratory Technician2,56
4 2,564 2,5642,56
4 2,564
MLT P.T.1,91
4 1,956 1,9982,04
2 2,086
Medical Administrator2,56
4 2,564 2,5642,56
4 2,564
Business Administrator2,56
4 2,564 2,5642,56
4 2,564
Registration Clerk2,56
4 2,564 2,5642,56
4 2,564Registration Clerk P.T. 1,35 1,388 1,419 1,45 1,483
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7 1
Unit Assistant2,61
8 2,674 2,7312,78
9 2,849
Unit Assistant P.T.1,21
8 1,246 1,2741,30
3 1,333
Security Guard2,15
8 2,204 2,2522,30
1 2,350
Security Guard P.T. 989 1,012 1,0361,06
0 1,084
Janitor2,15
8 2,204 2,2522,30
1 2,350
Janitor P.T. 989 1,012 1,0361,06
0 1,084
5.7 Workers’ Compensation
Workers’ Compensation was calculated at a rate of 0.23 percent of annual earnings (Table 39).
This rate is from the S12-05 rate code provided by the Saskatchewan Workers’ Compensation
Board for medical offices and laboratories (Saskatchewan Workers’ Compensation Board, 2017).
Table 39 Workers' Compensation
Workers' Compensation 2020 2021 2022 2023 2024 2025Emergency Room Director 230 235 239 244 249 254Emergency Physicians 920 938 957 976 996 1,016
Radiologists1,15
0 1,173 1,1961,22
0 1,245 1,270Emergency Nurse 237 242 247 252 257 262Triage Nurse 222 226 231 235 240 245Social Worker 69 70 72 73 75 76Medical Radiation Technician 184 188 192 196 199 203MRT P.T. 92 94 96 97 99 101Medical Laboratory Technician 173 176 180 183 187 191MLT P.T. 86 88 90 91 93 95Medical Administrator 120 122 125 127 130 132Business Administrator 120 122 125 127 130 132Registration Clerk 127 129 132 134 137 140Registration Clerk P.T. 63 64 66 67 68 70Unit Assistant 115 117 120 122 125 127Unit Assistant P.T. 57 59 60 61 62 63
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Security Guard 96 98 100 102 104 106Security Guard P.T. 48 49 50 51 52 53Janitor 96 98 100 102 104 106Janitor P.T. 48 49 50 51 52 53
Table 39 Continued
Workers' Compensation 2026 2027 2028 2029 2030Emergency Room Director 259 264 269 275 280
Emergency Physicians1,03
6 1,057 1,0781,09
9 1,121
Radiologists1,29
5 1,321 1,3471,37
4 1,402Emergency Nurse 267 273 278 284 289Triage Nurse 250 255 260 265 270Social Worker 78 79 81 82 84Medical Radiation Technician 208 212 216 220 225MRT P.T. 103 106 108 110 112Medical Laboratory Technician 195 198 202 206 211MLT P.T. 97 99 101 103 105Medical Administrator 135 138 141 143 146Business Administrator 135 138 141 143 146Registration Clerk 143 146 148 151 154Registration Clerk P.T. 71 73 74 75 77Unit Assistant 130 132 135 138 140Unit Assistant P.T. 65 66 67 69 70Security Guard 108 110 113 115 117Security Guard P.T. 54 55 56 57 58Janitor 108 110 113 115 117Janitor P.T. 54 55 56 57 58
5.8 Holiday Pay
Holiday pay is calculated at 6 percent of annual income, considering the mandatory three weeks
of vacation time (Table 40) (Government of Saskatchewan, 2017). This rate of 6 percent will
increase to 8 percent once employees have worked at Health MattERs for 10 years. Holiday pay
is calculated for all wage-based employees.
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Table 40 Holiday Pay
Holiday Pay by Position 2020 2021 2022 2023 2024 2025
Emergency Nurse6,19
5 6,318 6,4456,57
4 6,705 6,839
Triage Nurse5,78
2 5,897 6,0156,13
5 6,258 6,383
Social Worker1,80
0 1,836 1,8731,91
0 1,948 1,987
Medical Radiation Technician4,80
8 4,904 5,0025,10
2 5,204 5,308
MRT P.T.2,39
6 2,444 2,4932,54
3 2,594 2,646
Medical Laboratory Technician4,50
7 4,597 4,6894,78
3 4,879 4,976
MLT P.T.2,24
6 2,291 2,3372,38
4 2,432 2,480
Medical Administrator3,12
9 3,191 3,2553,32
0 3,386 3,454
Business Administrator3,12
9 3,191 3,2553,32
0 3,386 3,454
Registration Clerk3,30
5 3,371 3,4393,50
8 3,578 3,649
Registration Clerk P.T.1,64
7 1,680 1,7141,74
8 1,783 1,819
Unit Assistant3,00
5 3,065 3,1263,18
9 3,252 3,318
Unit Assistant P.T.1,49
8 1,528 1,5581,58
9 1,621 1,653
Security Guard2,50
9 2,559 2,6102,66
3 2,716 2,770
Security Guard P.T.1,25
0 1,276 1,3011,32
7 1,354 1,381
Janitor2,50
9 2,559 2,6102,66
3 2,716 2,770
Janitor P.T.1,25
0 1,276 1,3011,32
7 1,354 1,381
Table 40 Continued
Holiday Pay by Position 2026 2027 2028 2029 2030
Emergency Nurse 6,9767,11
6 7,258 7,403 10,068Triage Nurse 6,511 6,64 6,774 6,910 9,397
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1
Social Worker 2,0272,06
8 2,109 2,151 2,926
Medical Radiation Technician 5,4145,52
3 5,633 5,746 7,814
MRT P.T. 2,6982,75
2 2,807 2,864 3,895Medical Laboratory Technician 5,076
5,177 5,281 5,387 7,326
MLT P.T. 2,5302,58
0 2,632 2,685 3,651
Medical Administrator 3,5233,59
4 3,666 3,739 5,085
Business Administrator 3,5233,59
4 3,666 3,739 5,085
Registration Clerk 3,7223,79
7 3,873 3,950 5,372
Registration Clerk P.T. 1,8551,89
2 1,930 1,969 2,677
Unit Assistant 3,3843,45
2 3,521 3,591 4,884
Unit Assistant P.T. 1,6871,72
0 1,755 1,790 2,434
Security Guard 2,8262,88
2 2,940 2,998 4,078
Security Guard P.T. 1,4081,43
6 1,465 1,494 2,032
Janitor 2,8262,88
2 2,940 2,998 4,078
Janitor P.T. 1,4081,43
6 1,465 1,494 2,032
5.9 Human Resource Strategy
Monthly, all staff members will report to the business administrator for their staff check-in. This
check-in will be approximately 15 minutes in length per staff member. Therefore, approximately
17 hours of the business administrator’s time will be allocated to these check-in meetings at the
end of each month. These meetings will have a structured feedback form that staff members
complete as well as an in-person conversation to discuss any other successes, failures, ideas, or
problems. The business administrator will submit a monthly report to the Emergency Room
Director summarizing these check-ins and will meet with the Emergency Room Director to have
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a monthly briefing and check-in. These check-ins will not be used to evaluate performance or for
punitive measures. They will be used as a formalized time to check-in with staff and work out
any issues that are arising for staff members. Another aspect of the human resource strategy is to
include, as needed, all staff positions in the strategic review of Health MattERs.
6.0 Marketing
6.1 Demand for Emergency Medical Services & Target Market
A 2005 poll found that 74 percent of Canadians are concerned about extended emergency room
waits times and the associated deterioration in service quality (Wait Time Alliance, 2005).
Prolonged wait times for emergency services is a national epidemic across Canada (Wait Time
Alliance, 2005). For each individual patient who is kept in an emergency room bed or stretcher
waiting for an in-patient bed on a hospital ward, another four patients per hour are denied access
to treatment in the emergency department (Canadian Association of Emergency Physicians,
2017). This represents an opportunity to develop an appropriate treatment site for individuals
seeking emergency care who do not require in-patient continual or follow-up care. Health
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MattERs is the type of facility that will fill this gap by targeting patients requiring outpatient
emergency care. An important aspect of this targeted marketing is educating the public on what
type of emergency medical situations are classified as outpatient cases. This educational
component has been critical to the opening of urgent care centers in Winnipeg, following the
closure of two of the cities hospital-based emergency departments (CBC News, 2017). Initial
educational information for the urgent care centers highlight how they were for non-life-
threatening concerns that still required immediate attention (CBC News, 2017). For example,
fever and flu symptoms, factures or sprains, minor burns, headaches, earaches, nosebleeds,
rashes, sore throat, urinary problems, and vomiting (CBC News). Through successful education
and awareness campaigns, Health MattERs can redirect lower acuity patients from the hospital-
based emergency rooms to its outpatient emergency service center.
Health MattERs has one paying customer, namely the Government of Saskatchewan and its tax-
payer base. Thus, a key component of Health MattERs’ initial marketing plan will be providing
the Government of Saskatchewan and taxpayers with the appropriate information to support the
development of this freestanding emergency room. Therefore, the primary target market of
Health MattERs is the Government of Saskatchewan and its taxpayer base (Table 41). The
secondary target market is people living in Saskatoon and surrounding communities who are
seeking outpatient emergency room services (Table 41).
The Government of Saskatchewan has been struggling to reduce wait times and manage
overcapacity at the major emergency departments in the province (Lough, 2017). In 2015, the
health ministry committed to reduce wait times by 60 percent by 2019 (Lough, 2017). In March
of 2017, the Government announced that it will spend $12 million of the healthcare budget to
reduce hospital emergency room wait times (Lough, 2017). $4-5 million of the $12 million has
been earmarked for expanding the Accountable Care Unit model that was pilot site tested at
Regina’s Pasqua Hospital (Lough, 2017). However, Health Minister Jim Reiter stated that the
remaining $7-8 million will go towards community care centers (Lough, 2017). Health MattERs
has the potential to fit this classification as a community care center, as the Government has yet
to define what this type of center would provide. Health MattERs will act as a community center
providing outpatient emergency care. Health MattERs will be strategically located in
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Saskatoon’s growing Eastern suburban area to meet the needs of Saskatoon’s growing
population. Specifically, this location will allow Health MattERs to meet Saskatoon’s growing
population where it is growing, namely in these Eastern suburban neighbourhoods. As Health
MattERs fits the role of a community care center, it can benefit from the $7-8 million in
Government funding for reducing emergency room wait times.
The secondary target market is defined as individuals living in Saskatoon and the surrounding
communities, spanning all age ranges, including all genders, and not segmenting based on
income. The secondary target customers are defined as any person seeking outpatient emergency
care This includes, but is not limited to, treatment for headaches, fever and flu, pneumonia,
bronchitis, allergic reactions, abdominal pain, blood clots, migraines, asthma, sinus infections,
skin rashes, dehydration, chest pain, strep throat, concussions, sprains, dislocations, seizures,
insect bites and strings, burns, broken bones, lacerations, animal bites, and sport injuries. As
well, Health MattERs will provide onsite services for ECG, cardiac monitoring, ventilation and
intubation, x-rays, ultrasounds, dialysis, splits, slings, crutches, orthopedic boots, and strep,
mono, and flu tests.
Table 41 Target Markets
Government of Saskatchewan Outpatient emergency patients
Target Customer Features
Investing funds to reduce wait times
Looking for cost savings Aiming to improve patient
satisfaction
Want reduced wait times Seeking quality and reliable
medical care Need an easy to understand
definition of an outpatient
Value Proposition
Provide an investment opportunity for the Government of Saskatchewan to aid in the reduction of emergency room wait times for outpatient emergency patients
Provide quality outpatient emergency medical care in a timely
manner by trusted healthcare professionals
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Advertising Media
Direct personal communications and meetings with Health Minister and other key government stakeholders
Academic reports, business reports, and case studies
Word-of-mouth Family physician referral
information Informational brochures and
presentations Newspaper features Sports medicine professional
referrals Website
The advertising required to reach the primary target customer, the Government of Saskatchewan,
is heavily focused on direct personal communications and in-person meetings with the Health
Minister and other important government stakeholders. To support these personal
communications, another important aspect of working with the Government of Saskatchewan
will include the use of academic reports, business reports and case studies that will provide
valuable information highlighting the benefits of a freestanding emergency room for the province
of Saskatchewan.
The advertising media that the secondary target customers will encounter is restricted by federal
and provincial statutes that outline the ways in which health care products and services can be
marketed (McMillian, 2010). Therefore, most of Health MattERs advertising and associated
target customer education will take place through word-of-mouth methods, family physician and
sports medicine professional networking and referrals, informational brochures and
presentations, newspaper articles, and the Health MattERs website. Health MattERs will be
restricted from making any false claims in its advertising material and as such will focus its
advertising efforts on providing educational material on the type of conditions and diseases that
are classified as outpatient cases that can be treated at Health MattERs. As Saskatoon emergency
rooms have been operating at overcapacity for most of their recent history, demand for Health
MattERs services is not a main concern. Emergency room visits have been growing at an annual
rate of 5 percent year after year (Saskatoon Health Region, 2015). Combined, all three Saskatoon
emergency departments see just over 10,000 patients per month, or 120,000 patients per year
(Pers. Comm. with Saskatoon Health Region’s Director of Pharmacy, Patrick Robertson).
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The most important aspect of Health MattERs success will depend on gaining public trust for the
healthcare services provided by Health MattERs’ professionals. This will be done by
continuously providing quality and timely healthcare service delivery, networking with
influential health professionals in Saskatoon, and aiming to receive positive media attention for
this new healthcare model. Trust will also be gained by informing the public that the emergency
physicians providing care at Health MattERs are part of a rotating group of emergency
physicians that work in all of Saskatoon’s emergency departments (Pers. Comm. Dr. James
Stempien). Therefore, the public can be assured that the quality of training is the same across all
of Saskatoon’s hospital-based emergency departments and Health MattERs.
6.2 Segmentation, Targeting, Positioning
The primary customer segment will not be further segmented as it represents a single customer,
namely the Government of Saskatchewan. Segmentation of the secondary market was evaluated
first by location and secondly by patient age. Length of time spent in the emergency department
is positively correlated with increases in age (Figure 8) (Canadian Institute of Health
Information, 2015). As one of Health MattERs’ main goals is to reduce emergency room wait
times, it will target younger segments of individuals seeking outpatient emergency treatment.
This target segment aligns well with the fact that Saskatoon has the youngest population in
Canada, with a median age of 34.8 years compared to the country median age of 40.5 years
(Statistics Canada, 2016). Thus, there are several younger individuals to target as patient
clientele for Health MattERs. In 2015, the proportion of Saskatoon’s population between the age
of 0-14, 15-64 and 65+ was 17.5, 70.5 and 11.9 percent, respectively (Figure 9) (Statistics
Canada, 2016). In summary, Health MattERs will target the 0-64-year-old population in
Saskatoon and surrounding communities who are seeking outpatient emergency medical
attention.
Health MattERs will serve all individuals covered under Saskatchewan Health Insurance.
However, by location, it will target individuals living in the Eastern suburban area of Saskatoon.
These individuals will live within walking distance of the facility. Health MattERs is looking to
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improve healthcare access for these individuals, particularly those who fall within the age range
of 0-64.
Figure 8 Length of Stay in Emergency Department by Age
(Canadian Institute of Health Information, 2015).
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Figure 9 Population by Age, 2015
(Statistics Canada, 2016).
Health MattERs will be identified by its logo (Figure 10). The logo indicates Health MattERs’
full descriptive name, Health MattERs: Emergency Room Care. The use of the full name in the
logo is to make clear that Health MattERs provides emergency medical care services. The design
of the logo includes a red ECG figure that acts as a clear identifier image of the logo’s
connection to medical practices. The logo will help to brand Health MattERs to the public and
other healthcare professionals (Table 41). The Health MattERs’ brand is described in the
following positioning statement:
“Health MattERs provides timely emergency medical care to the people of Saskatchewan,
without having to enter a hospital.”
To live out the brand promise, Health MattERs will place significant emphasis on its operational
efficiencies to continually reduce wait times. Health MattERs will have a significant advantage
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to improving its operational efficiency, as it can streamline processes for CTAS 3s, 4s, and 5s
patients (Pers. Comm. Dr. James Stempien). There will be a reduction in the heterogeneity of
medical case type, as compared to the hospital-based emergency departments which treat
patients triaged at any of the five levels of the CTAS system. Although Health MattERs will
encounter all CTAS levels during its operations, it will target those individuals with lower CTAS
levels or those who are defined as outpatients. This distinction from hospital-based emergency
departments will allow, over time, for Health MattERs to develop processes to streamline
treatment procedures and processes for repeat cases that it typically sees. This will help with
Health MattER’s overall operational efficiency, thereby positively reinforcing its goal to reduce
wait times for outpatients.
Staff will be trained and expected to always treat patients with a focus on customer services and
welcoming demeanors. Health MattERs will not subscribe to the “staff are too busy to be nice”
philosophy. Rather, it will pride itself on a culture of quality customer services and patient care.
To promote the Health MattERs’ brand, both direct and indirect branding actions will be relied
upon (Table 42). Through positive patient experiences with Health MattERs’ healthcare services,
it is anticipated that organic brand promotion will occur through word-of-mouth processes.
Figure 10 Logo
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Table 42 Branding
Methods
Direct Branding Promotion
Patient interactions with quality customer service Positive media publicity Public placement of positive Health MattERs patient
satisfaction surveys Government of Saskatchewan’s endorsement for Health
MattERs’ trusted health servicesIndirect Branding Promotion
Satisfied patients’ word-of-mouth Physician and hospital referrals based on quality care
6.3 Target Customers’ Needs and Wants
The target customers of Health MattERs are the Government of Saskatchewan and the taxpayers
of Saskatchewan. For Health MattERs to have the necessary financial support to operate, it must
meet the needs and wants of its customer base (Table 43). Although the needs and wants of the
target customers are outlined in this business plan, it is essential that these customers are asked
regularly about their needs and wants to ensure that Health MattERs is meeting and
accommodating any changing needs and wants.
Table 43 Target Customers' Needs and Wants
Needs Wants
Government of Saskatchewan
Cost effective healthcare solutions
Innovative healthcare solutions
Quality healthcare services Reduced wait times Set the standard for emergency
medicine in CanadaSaskatchewan Tax Payers
Cost effective healthcare solutions
Accessible emergency medicine
Quality healthcare services Reduces wait times Compassionate and
understanding healthcare professionals
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6.4 Competitive Advantage
Health MattERs’ chief competitive advantage will be its first to market strategy in Saskatoon
with the freestanding emergency room model. Although this will also act as an educational
hurdle for Health MattERs’ to explain to the patient population the services that are provided,
once adopted it will serve as the only freestanding emergency room in the city. Health MattERs’
competitive edge will be created by adding value to patients through improved customer services
and the delivery of timely emergency medical services. As the younger generation is becoming
more accustomed to faster and more efficient services in all aspects of their lives, they will also
see the value of increasing efficiencies during their emergency room visits. Nowhere else can
patients receive outpatient services from emergency physicians in Saskatoon without being
connected to a hospital. This means that individuals with relatively simple, but still important,
medical emergencies are being tied up in a system trying to accommodate both outpatient and
inpatient needs in one facility. By separating the facility to focus only on outpatients, individuals
can receive quick and appropriate care that is not possible at any of the present medical facilities
already established in Saskatoon. Thus, Health MattERs provides a similar service as other
emergency departments, however it is designed to better suit the needs of those defined as
outpatients seeking emergency medical services.
6.5 Marketing Mix
6.5.1 Services
The main service provided to Health MattERs’ single paying customer, the Government of
Saskatchewan, will be to provide outpatient emergency medical treatments to the residents of
Saskatoon and surrounding community. The patient population will receive medical services, as
deemed necessary by the healthcare professionals providing their care. This may include some
combination of physical medical treatment for low acuity emergencies, prescription services,
laboratory services, diagnostic imaging, casting, and counseling support. The diagnostic services
available at Health MattERs will include X-ray and ultrasound. Additionally, Health MattERs
will coordinate inter-facility transfer services when the patient should not be treated at the
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facility. Through partnership agreements, Health MattERs will also coordinate funeral home
services and mortuary storage service for deceased patients.
As mentioned previously, Health MattERs will provide the appropriate medical service to treat
headaches, fever and flu, pneumonia, bronchitis, allergic reactions, abdominal pain, blood clots,
migraines, asthma, sinus infections, skin rashes, dehydration, chest pain, strep throat,
concussions, sprains, dislocations, seizures, insect bites and stings, broken bones, lacerations,
animal bites and sport injuries. Medical treatment services will be supported using cardiac
monitoring, ECGs, ventilation and intubation, splits, slings, crutches, and orthopedic boots.
6.5.2 Pricing
Healthcare services are priced based on the rates determined by the Government of
Saskatchewan. As end users of the emergency medical services will not pay out of pocket, they
will not interact with the pricing model of Health MattERs. Only users requiring ambulatory
services to assist in an inter-facility patient transfer will owe the ambulance payment for the
transfer service provided. However, this payment will not go through Health MattERs and is thus
irrelevant to its pricing model.
The pricing model of Health MattERs will depend on the Government of Saskatchewan’s
payment structure for the contracted Health MattERs’ physicians. The Government of
Saskatchewan has a few payment structure options that it can choose from to pay for the services
provided by the contracted physicians. These payment structures include, a) an alternative
funding model where physicians are paid an hourly rate, b) an alternative funding model where a
percentage is paid for attending the shift and a percentage is paid based on the acuity of the
patient the physician treats, c) an annual salary that is predetermined, d) a fee-for-service model
(Table 44). The Saskatchewan Medical Association provides detailed fee guides and services
codes for each medical service that a physician can provide (Saskatchewan Medical Association,
2017). As the services that can be provided by Health MattERs’ emergency physicians and
radiologists is extensive, the exact price for each service is not provided in this report.
Regardless of the payment structure used by the Government of Saskatchewan to pay for
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physician services, all such costs will be incurred by the Government. For budgetary purposes,
this business plan has used the average annual salary of an emergency physician and radiologist
in Saskatchewan to estimate the total income that the physicians will receive from the
Government of Saskatchewan for the culmination of services provided. Based on current job
listings in Saskatchewan, an emergency physician in Saskatoon can expect to make an annual
salary ranging from $371,982-$420,181 and a radiologist can expect to make an annual salary of
approximately $500,000 (Saskdocs, 2017; Indeed, 2017). Health MattERs has budgeted
emergency room physician salaries at $400,000 for 2020 and radiologist’s salaries at $500,000
for 2020.
Table 44 Fee-for-Service Physician Payment Example
Service Code Price
Laboratory MedicineRoutine urinalysis includes: bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrates, pH, protein, specific gravity, & urobilinogen
132V $14.20
Diagnostic RadiologyChest technical and interpretation
150X $97.00
Emergency MedicineComplete assessment: pertinent family history, patient history, history of present complaint, functional enquiry, examination of all parts and systems diagnosis – assessment, necessary treatment, advice to the patient and record of the service provided
73B $138.00
6.5.3 Promotion
Promotion of Health MattERs will be focused on educating the public, specifically the target
market, about the appropriate time and conditions to seek medical attention at the facility. This
will require a multipronged approach through various avenues of communication and
information dissemination. For example, The Saskatoon Health Region publishes helpful
infographics to their website and social media accounts that outline what a person should do and
who to contact based on their state of health (Figure 11). By joining forces with allied health
facilities and the Saskatchewan Health Authority, Health MattERs can be incorporated into these
infographics and into the HealthLine’s protocol for referring patients to the appropriate level of
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care when they call for support. This will be central to increasing public awareness of the
services that Health MattERs offers and for building trust with the community regarding the
quality and level of care provided.
Promotion of Health MattERs to the direct user population will take place through educational
brochures and presentations that are disseminated to the public. These brochures and
presentations will explain when individuals should seek medical care at Health MattERs, instead
of at a hospital-based emergency room. Additionally, Health MattERs will work closely with
The Saskatchewan College of Family Physicians and the existing emergency departments in the
city to inform patients of the services that Health MattERs provides and promote the facility to
patients. The Health MattERs website will include a list of health conditions that should be
treated at the facility that patients can consult. This should help promote the appropriate use of
the facility by the general population. This list of conditions will also be shared with the
Saskatchewan Health Authority and hospitals in Saskatoon. Patients may be redirected based on
the list of conditions from hospital-based emergency rooms to Health MattERs. Health MattERs
will also use a wait time display on its website, to promote the short wait times and encourage
individuals to seek care at the facility for quick treatment options.
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Figure 11 Saskatoon Health Region Infographic Adapted to Include Health MattERs
6.5.4 Place
The services provided by Health MattERs’ healthcare professionals will be offered at the
physical emergency room site in Saskatoon. Individuals will be able to access this site through
their own ambulation, i.e. walk-ins, or by transportation services, i.e. ambulance. Healthcare
professionals working at Health MattERs will only provide healthcare services in the emergency
room facility. They will not make home visits or provide treatment during an inter-facility
patient transfer.
6.6 Competitive Analysis
As Health MattERs aims to join the team of healthcare facilities and professionals working to
provide Saskatoon and surrounding communities with emergency medical services, it does not
view any other healthcare provider as a competitor. Rather, other healthcare facilities are allies in
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a shared vision for reduced emergency room wait times and improved patient care. The three
already existing emergency departments in Saskatoon will be key partners in providing
emergency medical services (Table 45). It is a goal of Health MattERs to reduce the number of
CTAS 3, 4, and 5 level patients entering the hospital-based emergency rooms in Saskatoon.
Health MattERs will work with the existing emergency departments to redirect a portion of
CTAS 3, 4, and 5s.
Table 45 Hour of Operation of Saskatoon Emergency Departments
Hospital Hours of OperationRoyal University Hospital Emergency Department
24/7Pediatric emergency: 8AM-12AM (future
Children’s Hospital)St. Paul’s Hospital Emergency Department
24/7
City Hospital Emergency Department 9:30AM- 8:30PM
Health MattERs will be a freestanding emergency room owned by the Government of
Saskatchewan. A privately owned freestanding emergency room is, currently, not legal in
Saskatchewan. Thus, present legislation mitigates the competitive threat of other freestanding
emergency departments opening in Saskatoon. Thus, the threat of direct competition from other
freestanding emergency room does not need to be considered now. This is unlike the healthcare
model for freestanding emergency rooms in the United States, where private funding of
healthcare is accepted and more common than in Canada.
Under the government-provision of healthcare services, it is accepted that healthcare facilities
are developed to reflect the needs of the population with regard to healthcare service delivery.
This business plan argues that Health MattERs, as a freestanding outpatient emergency room, is
needed in Saskatoon and will work synergistically alongside hospital-based emergency
departments, community mediclinics, and family doctors’ offices. Thus, these healthcare services
are not viewed as competitors but rather as key allies necessary in the delivery of appropriate and
efficient medical care.
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6.7 Charitable Foundation and Volunteer Base
By 2024, Health MattERs will establish its own charitable foundation and volunteer program.
These aspects of Health MattERs will not be developed initially, as it is not essential or
necessarily advantageous to the organization. However, within five years of operations it will be
necessary for a separately governed Health MattERs’ charitable foundation to exist, primarily to
commit volunteer time to fundraising initiatives to help fund the purchase of new and innovative
medical equipment and updated facility features. Additionally, this Health MattERs foundation
will be an agent for which Health MattERs can gain a presence in the community through staff
volunteer initiatives and through supporting local causes that align with the overall objectives of
Health MattERs. For example, the Health MattERs’ foundation may support elementary and high
school workshops that promote the health benefits of cycling while educating students on the
safety components of riding a bicycle. This is an initiative that Health MattERs’ foundation may
support since many emergency room visits each year are due to bicycle-related injuries.
Health MattERs will also develop a volunteer base for the facility. These volunteers will help
with general tasks throughout the emergency room. Specifically, retired healthcare professionals
and students looking to pursue a career in healthcare will be targeted to fill volunteer positions.
Volunteers will be accepted through an application process that will be developed by the
Emergency Room Director and Business Administrator. Part of this application will require that
all volunteers have a clear criminal record, including vulnerable sector screening.
6.8 Projections Marketing Expenses
The marketing costs for Health MattERs consist of two components: the print costs for
informational brochures and the set-up and hosting fee for the website (Figure 12). The
informational brochures will be supplied by PGI Printers for $923. This will amount to
approximately 5000 brochures annually. The website set-up and hosting will be managed by
Beagle Productions Ltd. Website set-up fee is $2000, accompanied by a $200 yearly hosting fee.
The projected marketing costs have been adjusted for the projected 2.0 percent inflation on
service fees.
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Figure 12 Total Marketing Costs
6.9 TOWS Analysis of Health MattERs
To understand the strengths, weaknesses, opportunities, and threats, and how to maximize the
positive aspects and mitigate any negative aspects of Health MattERs a TOWS analysis has been
performed (Figure 13).
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Figure 13 TOWS Analysis of Health MattERs
Opportunities
Reduce emergency room wait times for CTAS 3s, 4s, 5s
Become trusted facility by patient population for outpatient emergency medicine
Threats
Not receiving government approval and funding
Backlash from healthcare professionals who oppose this model
Strengths
First to market in Saskatoon for freestanding emergency room model
Cost effective model
Strengths to Leverage Opportunities
Utilize first to market presence to develop and build trusted relationship with the patient population
Use focused facility model of treating CTAS 3s, 4s, and 5s, to optimize processes and procedures to reduce wait times
Strengths to Mitigate Threats Demonstrate the cost
effectiveness of this model to gain government approval and funding
Work with healthcare professionals in developing and operationalizing the business to gain buy in from these key stakeholders
Weaknesses
Patient population have not used this model before – require education
Lack of previous facilities in Canada to base the business plan on
Weaknesses that Inhibit Leveraging on Opportunities
Patients who have not been educated on the services provided may not trust the facility for medical care
No previous model in Saskatchewan, and minimal throughout Canada, may lead to unforeseen consequences of aiming to reduce emergency room wait times for CTAS 3s, 4s, and 5s
Weaknesses that Heighten the Risks of Threats
Uneducated and uniformed patient population may not see need to put pressure on the government to approve and fund this facility
A lack of previous Canadian freestanding emergency room models may elevate the risk of skeptical healthcare professionals who do not support this facility model
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7.0 Accounting and Financial Plan
7.1 Overview of Financial Plan
The financial component of Health MattERs includes both the capital cost and annual operating
expenses. If approved, the annual operating expenses of Health MattERs would be covered by
the Government of Saskatchewan. Based on budgetary projections, the Government of
Saskatchewan would provide the facility with a lump sum payment that must be managed by
those operating the facility to cover all operating expenses. As such, Health MattERs will not
generate revenue, however, depending on how the budget is managed each year the facility may
generate a surplus or deficit, that would carry forward to the next year. The capital budget, in the
first year of operations, would be financed with a mixture of 39 percent debt and 61 percent
equity. As of 2025, it is expected that the Health MattERs foundation will help to cover the costs
of purchasing new equipment or furniture.
7.2 Economic Variables
The financial model is based on estimated economic variables (Table 46). Namely, the annual
rate of inflation, over the 2020-2030 projection period, is assumed to be two percent.
Additionally, the cost of debt was assumed to be equal to the prime rate of 2.7 percent. This
lower cost of debt has been assumed because the debt would be government-backed debt.
Table 46 Economic Variables
Economic Variables
Annual Inflation 2%
Cost of Debt 2.7%
7.3 Sensitivity Analysis
The sensitivity analysis was conducted on a cost per patient basis to determine the base case,
maximum capacity case, and low patient case scenarios. The cost per patient value is useful for
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understanding the efficiency at which the facilities resources are being used. Regardless of the
number of patients that visit Health MattERs, the overall cost to operate the facility will not
change. The base case has been defined as each emergency physician treating 1.875 patients per
hour. Each hour, two emergency physicians are scheduled to be working, therefore it is
anticipated as the base case that 3.75 patients will be treated per hour, or 90 patients a day. The
maximum capacity case has been determined to be each emergency physician treating three
patients per hour, or 144 patients per day. The low patient case scenario is based on each
emergency physician treating 1.5 patients per hour, or 72 patients per day. Although the actual
rate at which the emergency physicians can treat individual patients each hour will depend on the
type of medical cases that arrive at the facility, the scenarios are based on an average rate. The
cost per patient is lowest under the maximum capacity case, at $200.64 in 2020, followed by the
base case at $321.02, and the low patient case at $401.27 (Figure 14).
The Saskatoon Health Region’s Board President, Mike Stensrud, commented that it typically
costs approximately $800 per patient visit to the emergency department (650 CKOM, 2016). The
details of how this cost per patient was calculated are not available. However, in comparing it to
Health MattERs’ base case cost per patient, a difference of $478.98 exists between the Saskatoon
Health Region’s cost per patient and Health MattERs (Figure 15). This is a substantially lower
cost per patient outcome at Health MattERs as compared to the Saskatoon Health Region’s
reported cost. This supports the statement that Health MattERs provides a cost-effective solution
to providing emergency room medical services to the people of Saskatchewan.
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Figure 14 Cost Per Patient: Base Case, Maximum Capacity, Low Patient Case Comparison
Figure 15 Cost Per Patient Comparison SHR vs. Health MattERs
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Finally, the Government of Saskatchewan can examine the cost per patient of each itemized
operating expense (Table 47). For the base case in the first year of operation, the cost to pay for
employee’s salaries and wages is the biggest cost per patient visit at $251.59. This information
can be compared to the information that the Government of Saskatchewan has on other
emergency departments to validate the cost-effectiveness of this model.
Table 47 Cost Per Patient Itemized by Operating Expense for Base Case 2020
Operating Expenses Base Case Cost per Patient for Year 2020 Legal $0.15 Marketing and Advertising $0.10 Lease Cost Building $3.04 Occupancy Cost $1.08 Water and Sewage $0.03 Electricity $0.59 Natural Gas Heating $0.10 Linen Service $0.42 Tenant Insurance $0.05 Auditing/Accounting $0.46 Medical Supplies $0.73 Cleaning Supplies $0.18 Office Supplies $0.24 Pharmaceutical Supplies $13.90 Sunrise Clinical Manager $0.26 Capital Cost Allowance $4.11 Interest $0.79 Employer Paid Benefits $36.68 Preventative Maintenance $1.67 Internet, Phone, TV $0.08 Employee Salary and Wages $251.59 Misc. Variable Cost % Employee Salary/Wage $4.78 Total Operating Expenses $321.02
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7.4 Risk Analysis
Health MattERs has four identifiable risk factors that should be considered and mitigated
through the implementation of a contingency plan to ensure the most successful operations of the
facility (Table 48). However, the overall risk of Health MattERs has been identified as quite low,
assuming it is accepted and financially supported by the government.
Table 48 Risk Analysis and Contingency Plan
Market Technological Government/Legal Operational
Risk Patient acceptance of medical model
Obsolescence Changes to legislation
Recruit & retain qualified personnel
Unmitigated Risk Factor
8 6 5 5
Contingency Plan
• Marketing• Education
public• Live out brand
promise
• Raise funding for new equipment with Health MattERs Foundation
• Gain public support for medical model
• Form strong working relationship with government
• Maintain industry standard wages and salaries
• Foster positive work culture
• Provide adequate staffing to meet demand
Mitigated Risk Factor
5 3 3 3
The biggest risk factor is whether the patient population will accept and utilize this freestanding
emergency room medical model. This was identified as a risk because this model is new to
Saskatoon and its patient population. Since patients have not been exposed to this model of
receiving emergency medical treatment, they may be hesitant to seek care at this facility. This
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was identified as a risk factor 8, on a 10-point scale. The contingency plan involves a focus on
marketing, particularly through educating the public on the services offered at purpose of Health
MattERs. As well, it will be important for staff of Health MattERs to live out the brand promise,
of providing quality and timely patient-centered medical care. By living out the brand promise, it
is anticipated the word-of-mouth positive reviews of the facility will start to spread, encouraging
others to seek treatment at the facility when they find themselves in an emergency. Upon
implementing the contingency plan, the risk factor lowers to a 5. Notably, this risk factor will
remain in the middle of the risk factor scale, pointing to the importance of meeting the needs of
the patient population to operate Health MattERs successfully.
The second biggest risk factor for Health MattERs is related to technological obsolescence. This
was identified as a risk factor equal to 6. Although similar facilities will also be faced with the
challenge of keeping up with the latest medical technology, Health MattERs will employ a
contingency plan to lower the impact that obsolescent technology could have on the facility. The
contingency plan is to establish and raise funds through the Health MattERs foundation. This
will allow Health MattERs to have a separate stream of financing from the government to
purchase new equipment with. By raising funds through the Health MattERs foundation, the risk
of obsolesces is reduced to a 3.
Another risk factor of Health MattERs is the potential for change in government regulation and
legislation that could impact the competitor landscape or operating capacity of Health MattERs.
For example, if a new government is elected that no longer supports a freestanding emergency
room, and imposes restricting legislation, the operations of the facility would be at risk.
However, as starting this project relies on government approval, this risk is not viewed to be that
significant. It was defined as a risk factor 5. The contingency plan for this is to gain public
support for this medical model, so that the current and any future governments are pressured to
continue to allow for its operations. The second aspect of the contingency plan is for Health
MattERs, particularly the Emergency Room Director and the Board of Directors, to form a
strong working relationship with the government. By forming a relationship built on trust and
mutual understanding, it will be easier for the Health MattERs to work with the government and
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continue to garner their support. By employing this contingency plan, the mitigated risk factor
will be low.
Finally, the fourth risk factor identified for Health MattERs relates to the continued need to
recruit and retain qualified personnel. As some of the positions at Health MattERs require
individuals to be highly trained, it will be essential for the facility to be able to recruit and retain
personnel that meet the qualification standards. Unmitigated, the risk of not recruiting and
retaining qualified personnel has been determined as a 5, on the 10-point scale. The contingency
plan relied on maintaining industry standard wages and salaries for employees, fostering a
positive work culture, and providing adequate staffing to meet the demands of the patient
population. By providing adequate staffing the risk of staff burnout is reduced, which should
help to retain personnel. By implementing this mitigation strategy, the risk factor is reduced to a
low 3.
7.5 Pro Forma Financial Statements
The pro forma financial statements for Health MattERs are provided in below (Section 7.5.1-
7.5.14). These pro forma statements mirror the information provided in the Excel Financial
Model and have been provided in this report for ease of access.
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7.5.1 Pro Forma Statement of Surplus/Deficit
Table 49 Pro Forma Statement of Surplus/Deficit
Statement of Surplus/Deficit
For the year ended 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Government Payment for Health Services 10,545,432
10,694,384
10,850,513
11,022,224
11,205,919
11,396,569
11,583,977
11,814,254
12,033,009
12,248,861
12,480,295
Operating Expenses
Legal 5,000 5,100 5,202 5,306 5,412 5,520 5,631 5,743 5,858 5,975 6,095
Marketing and Advertising 3,123 1,145 1,168 1,192 1,216 1,240 1,265 1,290 1,316 1,342 1,369
Lease Cost Building 100,000 102,000 104,040 106,121 108,243 110,408 112,616 114,869 117,166 119,509 121,899
Occupancy Cost 35,600 36,312 37,038 37,779 38,535 39,305 40,091 40,893 41,711 42,545 43,396
Water and Sewage 976 996 1,015 1,036 1,056 1,078 1,099 1,121 1,144 1,166 1,190
Electricity 19,504 19,894 20,292 20,698 21,112 21,534 21,965 22,404 22,852 23,309 23,775
Natural Gas Heating 3,292 3,358 3,425 3,493 3,563 3,635 3,707 3,781 3,857 3,934 4,013
Linen Service 13,690 13,964 14,243 14,528 14,818 15,115 15,726 16,040 16,361 16,688
Tenant Insurance 1,500 1,530 1,561 1,592 1,624 1,656 1,689 1,723 1,757 1,793 1,828
Auditing/Accounting 15,000 15,300 15,606 15,918 16,236 16,561 16,892 17,230 17,575 17,926 18,285
Medical Supplies 24,000 24,480 24,970 25,469 25,978 26,498 27,028 27,568 28,120 28,682 29,256
Cleaning Supplies 6,000 6,120 6,242 6,367 6,495 6,624 6,757 6,892 7,030 7,171 7,314
Office Supplies 8,000 8,160 8,323 8,490 8,659 8,833 9,009 9,189 9,373 9,561 9,752
Pharmaceutical Supplies 456,457 465,586 474,898 484,396 494,083 503,965 514,044 524,325 534,812 545,508 556,418
Sunrise Clinical Manager 8,400 8,568 8,739 8,914 9,092 9,274 9,460 9,649 9,842 10,039 10,240
Capital Cost Allowance 134,854 242,675 195,519 159,914 132,270 107,371 90,354 80,994 71,062 53,673 47,223
Interest 25,852 23,566 21,218 18,806 16,329 13,786 11,174 8,491 5,736 2,906 -
Employer Paid Benefits 1,204,925 1,226,956 1,248,567 1,270,590 1,292,948 1,315,753 1,339,014 1,362,740 1,386,941 1,411,625 1,436,804
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Preventative Maintenance 54,900 55,998 57,118 58,260 59,426 60,614 61,826 63,063 64,324 65,611 66,923
Internet, Phone, TV 2,596 2,648 2,701 2,755 2,810 2,866 2,924 2,982 3,042 3,102 3,165
Employee Salary and Wages 8,264,733 8,430,027 8,598,628 8,770,600 8,946,012 9,124,933 9,307,431 9,493,580 9,683,451 9,877,120 10,074,663
Misc. Variable Cost % Employee Salary/Wage
157,030 160,171 163,374 166,641 169,974 173,374 176,841 180,378 183,986 187,665 191,419
Total Operating Expenses 10,545,432
10,694,384
10,850,513
11,022,224
11,205,919
11,396,569
11,583,977
11,814,254
12,033,009
12,248,861 12,480,295
Net Surplus (Deficit) - - - - - - - - - - -
Accumulated Surplus (Deficit) - - - - - - - - - - -
7.5.2 Pro Forma Balance Sheet Statement
Table 50 Pro Forma Balance Sheet Statement
Balance Sheet
Year 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Current Assets
Cash 70,491 220,263 320,411 382,422 414,189 436,387 420,827 393,094 352,540 261,631 499,763
AR 317,003 323,344 329,810 336,407 343,135 349,997 356,997 364,137 371,420 378,848 386,425
Inventories 40,640 41,453 42,282 43,128 43,990 44,870 45,768 46,683 47,617 48,569 49,540
Total Current Assets 428,135 585,059 692,504 761,957 801,314 831,255 823,592 803,914 771,577 689,049 935,728
Non-Current Assets
Leasehold Improvements 900,000 900,000 900,000 900,000 900,000 900,000 900,000 900,000 900,000 900,000 900,000
Furniture and Fixtures 18,913 18,913 18,913 18,913 18,913 20,913 20,913 20,913 20,913 20,913 22,913
Business Electronic Equipment
30,718 30,718 30,718 30,718 30,718 60,718 60,718 60,718 60,718 90,718 90,718
Medical Equipment 1,190,861
1,190,861
1,190,861
1,190,861
1,190,861
1,240,861 1,240,861 1,240,861 1,240,861 1,240,861 1,290,861
Accumulated CCA
(134,854) (377,530) (573,049) (732,963) (865,233) (972,604)
(1,062,958)
(1,143,952)
(1,215,014)
(1,268,687)
(1,315,910)
Total Non-Current Assets 2,005,638
1,762,962
1,567,443
1,407,529
1,275,259
1,249,888 1,159,534 1,078,540 1,007,478 983,805 988,582
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Total Assets 2,433,772
2,348,022
2,259,947
2,169,486
2,076,573
2,081,143 1,983,127 1,882,455 1,779,055 1,672,853 1,924,310
Liabilities
Accounts Payable 60,960 62,180 63,423 64,692 65,986 67,305 68,651 70,024 71,425 72,853 74,310 Long Term Debt 872,812 785,842 696,524 604,794 510,588 413,838 314,475 212,430 107,630 - -
Total Liabilities 933,772 848,022 759,947 669,486 576,573 481,143 383,127 282,455 179,055 72,853 74,310
Equity
Government Capital Grant 1,500,000
1,500,000
1,500,000
1,500,000
1,500,000
1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
Health Matters Foundation - - - - - 100,000 100,000 100,000 100,000 100,000 350,000
Accumulated Surplus (Deficit) - - - - - - - - - - -
Total Equity 1,500,000
1,500,000
1,500,000
1,500,000
1,500,000
1,600,000 1,600,000 1,600,000 1,600,000 1,600,000 1,850,000
Total Liabilities & Equity 2,433,772
2,348,022
2,259,947
2,169,486
2,076,573
2,081,143 1,983,127 1,882,455 1,779,055 1,672,853 1,924,310
7.5.3 Pro Forma Cash Flow Statement
Table 51 Pro Forma Cash Flow Statement
Cash Flow Statement
For the year ended 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Operating Cash Flow
Net Surplus/Deficit - - - - - - - - - - -
CCA 134,854 242,675 195,519 159,914 132,270 107,371 90,354 80,994 71,062 53,673 47,223
Operating Cash Flow 134,854 242,675 195,519 159,914 132,270 107,371 90,354 80,994 71,062 53,673 47,223
Changes in Working Capital
Inventories (40,640) (813) (829) (846) (863) (880) (897) (915) (934) (952) (971)
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AR (317,003) (6,340) (6,467) (6,596) (6,728) (6,863) (7,000) (7,140) (7,283) (7,428) (7,577)
Accounts Payable 60,960 1,219 1,244 1,268 1,294 1,320 1,346 1,373 1,400 1,428 1,457
Total Change in Working Capital (296,683) (5,934) (6,052) (6,173) (6,297) (6,423) (6,551) (6,682) (6,816) (6,952) (7,091)
Investment Activities
Leasehold Improvements (900,000) - - - - - - - - - -
Furniture and Fixtures (18,913) - - - - (2,000) - - - - (2,000)
Business Electronic Equipment (30,718) - - - - (30,000) - - - (30,000) -
Medical Equipment (1,190,861) - - - - (50,000) - - - - (50,000)
Total Investment Activities (2,140,492) - - - - (82,000) - - - (30,000) (52,000)
Financing Activities
Long Term debt 872,812 (86,970) (89,318) (91,730) (94,206) (96,750) (99,362) (102,045) (104,800) (107,630) -
Government Capital Grant 1,500,000 - - - - - - - - - -
Health Matters Foundation - - - - - 100,000 - - - - 250,000
Total Financing Activities 2,372,812 (86,970) (89,318) (91,730) (94,206) 3,250 (99,362) (102,045) (104,800) (107,630) 250,000
Net Cash Flow 70,491 149,772 100,148 62,011 31,766 22,198 (15,560) (27,733) (40,554) (90,909) 238,131
Cash Bal Beg of Year - 70,491 220,263 320,411 382,422 414,189 436,387 420,827 393,094 352,540 261,631
Cash Bal End of Year 70,491 220,263 320,411 382,422 414,189 436,387 420,827 393,094 352,540 261,631 499,763
7.5.4 Pro Forma Cost Per Patient
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The pro forma cost per patient refers to the base case of patient per day (Table 52). The growth rate is equal to the projected growth
rate for the city of Saskatoon (City of Saskatoon, 2017).
Table 52 Pro Forma Cost Per Patient
Cost Per Patient 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Number of Patients/day 90 92 93 95 97 99 101 103 105 107 109
Number of Days/year 365 365 365 365 365 365 365 365 365 365 365
Average Cost/Patient $321.02 $319.48 $318.10 $317.11 $316.38 $315.77 $314.98 $315.25 $315.10 $314.77 $314.74
Total Cost
10,545,432
10,694,384
10,850,513
11,022,224
11,205,919
11,396,569
11,583,977
11,814,254
12,033,009
12,248,861
12,480,295
Growth Rate Number of Customers
1.9% 1.9% 1.9% 1.9% 1.9% 1.9% 1.9% 1.9% 1.9% 1.9%
7.5.5 Pro Forma Capital Budget
Table 53 Pro Forma Capital Budget
Capital Budget 2020 2021 2022
2023 2024 2025 2026 2027 2028
2029 2030
Leasehold Improvements 900,000 Furniture and Fixtures 18,913 2,000 2,000 Business Electronic Equipment 30,718 30,00
0 30,000
Medical Equipment 1,190,861
50,000
50,000
Total 2,140,492
- - - - 82,000
- - - 30,000 52,000
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7.5.6 Financing Budget
Table 54 Financing Budget
Financing Budget 2020 2021 2022 2023
2024 2025 2026 2027 2028 2029 2030
Long term Debt 39% 957,495 - - - - - - - - - - Government Capital Grant 61% 1,500,000 - - - - - - - - - - Health Matters Foundation - - - 100,000 - - 250,000 Total 2,457,495 - - - - 100,000 - - - - 250,000
7.5.7 Pro Forma Operating Expenses
Table 55 Pro Forma Operating Expenses
Operating Expenses 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Legal 5,000 5,100 5,202 5,306 5,412 5,520 5,631 5,743 5,858 5,975 6,095
Marketing and Advertising 3,123 1,145 1,168 1,192 1,216 1,240 1,265 1,290 1,316 1,342 1,369
Lease Cost Building 100,000 102,000 104,040 106,121 108,243 110,408 112,616 114,869 117,166 119,509 121,899
Occupancy Cost 35,600 36,312 37,038 37,779 38,535 39,305 40,091 40,893 41,711 42,545 43,396
Water and Sewage 976 996 1,015 1,036 1,056 1,078 1,099 1,121 1,144 1,166 1,190
Electricity 19,504 19,894 20,292 20,698 21,112 21,534 21,965 22,404 22,852 23,309 23,775
Natural Gas Heating 3,292 3,358 3,425 3,493 3,563 3,635 3,707 3,781 3,857 3,934 4,013
Linen Service 13,690 13,964 14,243 14,528 14,818 15,115 15,417 15,726 16,040 16,361 16,688
Tenant Insurance 1,500 1,530 1,561 1,592 1,624 1,656 1,689 1,723 1,757 1,793 1,828
Auditing/Accounting 15,000 15,300 15,606 15,918 16,236 16,561 16,892 17,230 17,575 17,926 18,285
Medical Supplies 24,000 24,480 24,970 25,469 25,978 26,498 27,028 27,568 28,120 28,682 29,256
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Cleaning Supplies 6,000 6,120 6,242 6,367 6,495 6,624 6,757 6,892 7,030 7,171 7,314
Office Supplies 8,000 8,160 8,323 8,490 8,659 8,833 9,009 9,189 9,373 9,561 9,752
Pharmaceutical Supplies 456,457 465,586 474,898 484,396 494,083 503,965 514,044 524,325 534,812 545,508 556,418
Sunrise Clinical Manager 8,400 8,568 8,739 8,914 9,092 9,274 9,460 9,649 9,842 10,039 10,240
Capital Cost Allowance 134,854 242,675 195,519 159,914 132,270 107,371 90,354 80,994 71,062 53,673 47,223
Interest 25,852 23,566 21,218 18,806 16,329 13,786 11,174 8,491 5,736 2,906 -
Employer Paid Benefits 1,204,925 1,226,956 1,248,567 1,270,590 1,292,948 1,315,753 1,339,014 1,362,740 1,386,941 1,411,625 1,436,804
Preventative Maintenance 54,900 55,998 57,118 58,260 59,426 60,614 61,826 63,063 64,324 65,611 66,923
Internet, Phone, TV 2,596 2,648 2,701 2,755 2,810 2,866 2,924 2,982 3,042 3,102 3,165
Employee Salary and Wages 8,264,733 8,430,027 8,598,628 8,770,600 8,946,012 9,124,933 9,307,431 9,493,580 9,683,451 9,877,120 10,074,663
Misc. Variable Cost % Employee Salary/Wage
157,030 160,171 163,374 166,641 169,974 173,374 176,841 180,378 183,986 187,665 191,419
Total Operating Expenses 10,388,402
10,694,384
10,850,513
11,022,224
11,205,919
11,396,569
11,599,394
11,814,254
12,033,009
12,248,861
12,480,295
7.5.8 Pro Forma Total Salary and Wages
Table 56 Pro Forma Total Salaries and Wages by Position
Total Salary and Wage by Position 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Emergency Room Director 100,000 102,000 104,040 106,121 108,243 110,408 112,616 114,869 117,166 119,509 121,899
Emergency Physician 3,200,000 3,264,000 3,329,280 3,395,866 3,463,783 3,533,059 3,603,720 3,675,794 3,749,310 3,824,296 3,900,782
Radiologist 2,000,000 2,040,000 2,080,800 2,122,416 2,164,864 2,208,162 2,252,325 2,297,371 2,343,319 2,390,185 2,437,989
Emergency Nurse 825,943 842,462 859,311 876,497 894,027 911,908 930,146 948,749 967,724 987,078 1,006,820
Triage Nurse 770,880786,29
8 802,024 818,064 834,425 851,114868,13
6 885,499 903,209 921,273 939,698Social Worker 60,000 61,200 62,424 63,672 64,946 66,245 67,570 68,921 70,300 71,706 73,140
Medical Radiation Technician 240,384245,19
2 250,096 255,097 260,199 265,403270,71
1 276,126 281,648 287,281 293,027MRT P.T. 39,936 40,735 41,549 42,380 43,228 44,093 44,974 45,874 46,791 47,727 48,682
Medical Laboratory Technician 225,360229,86
7 234,465 239,154 243,937 248,816253,79
2 258,868 264,045 269,326 274,713
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MLT P.T. 37,440 38,189 38,953 39,732 40,526 41,337 42,164 43,007 43,867 44,744 45,639Medical Administrator 52,143 53,186 54,249 55,334 56,441 57,570 58,721 59,896 61,094 62,316 63,562Business Administrator 52,143 53,186 54,249 55,334 56,441 57,570 58,721 59,896 61,094 62,316 63,562
Registration Clerk 165,264168,56
9 171,941 175,379 178,887 182,465186,11
4 189,836 193,633 197,506 201,456Registration Clerk P.T. 27,456 28,005 28,565 29,137 29,719 30,314 30,920 31,538 32,169 32,812 33,469
Unit Assistant 150,240153,24
5 156,310 159,436 162,625 165,877169,19
5 172,579 176,030 179,551 183,142Unit Assistant P.T. 24,960 25,459 25,968 26,488 27,018 27,558 28,109 28,671 29,245 29,830 30,426
Security Guard 125,450127,95
9 130,519 133,129 135,792 138,507141,27
8 144,103 146,985 149,925 152,923Security Guard P.T. 20,842 21,258 21,684 22,117 22,560 23,011 23,471 23,940 24,419 24,908 25,406
Janitor 125,450127,95
9 130,519 133,129 135,792 138,507141,27
8 144,103 146,985 149,925 152,923Janitor P.T. 20,842 21,258 21,684 22,117 22,560 23,011 23,471 23,940 24,419 24,908 25,406
Total 8,264,733 8,430,027 8,598,628 8,770,600 8,946,012 9,124,933 9,307,431 9,493,580 9,683,451 9,877,120 10,074,663
7.5.9 Pro Forma Annual Earning by Position
Table 57 Pro Forma Annual Earning by Position
Annual Earning by Position 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Emergency Room Director100,00
0 102,000104,04
0 106,121108,24
3 110,408112,61
6 114,869117,16
6 119,509 121,899
Emergency Physician400,00
0 408,000416,16
0 424,483432,97
3 441,632450,46
5 459,474468,66
4 478,037 487,598
Radiologist500,00
0 510,000520,20
0 530,604541,21
6 552,040563,08
1 574,343585,83
0 597,546 609,497
Emergency Nurse103,24
3 105,308107,41
4 109,562111,75
3 113,988116,26
8 118,594120,96
5 123,385 125,852
Triage Nurse 96,360 98,287100,25
3 102,258104,30
3 106,389108,51
7 110,687112,90
1 115,159 117,462Social Worker 30,000 30,600 31,212 31,836 32,473 33,122 33,785 34,461 35,150 35,853 36,570
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Medical Radiation Technician 80,128 81,731 83,365 85,032 86,733 88,468 90,237 92,042 93,883 95,760 97,676MRT P.T. 39,936 40,735 41,549 42,380 43,228 44,093 44,974 45,874 46,791 47,727 48,682Medical Laboratory Technician 75,120 76,622 78,155 79,718 81,312 82,939 84,597 86,289 88,015 89,775 91,571MLT P.T. 37,440 38,189 38,953 39,732 40,526 41,337 42,164 43,007 43,867 44,744 45,639Medical Administrator 52,143 53,186 54,249 55,334 56,441 57,570 58,721 59,896 61,094 62,316 63,562Business Administrator 52,143 53,186 54,249 55,334 56,441 57,570 58,721 59,896 61,094 62,316 63,562Registration Clerk 55,088 56,190 57,314 58,460 59,629 60,822 62,038 63,279 64,544 65,835 67,152Registration Clerk P.T. 27,456 28,005 28,565 29,137 29,719 30,314 30,920 31,538 32,169 32,812 33,469Unit Assistant 50,080 51,082 52,103 53,145 54,208 55,292 56,398 57,526 58,677 59,850 61,047Unit Assistant P.T. 24,960 25,459 25,968 26,488 27,018 27,558 28,109 28,671 29,245 29,830 30,426Security Guard 41,817 42,653 43,506 44,376 45,264 46,169 47,093 48,034 48,995 49,975 50,974Security Guard P.T. 20,842 21,258 21,684 22,117 22,560 23,011 23,471 23,940 24,419 24,908 25,406Janitor 41,817 42,653 43,506 44,376 45,264 46,169 47,093 48,034 48,995 49,975 50,974
Janitor P.T. 20,842 21,258 21,684 22,117 22,560 23,011 23,471 23,940 24,419 24,908 25,406
7.5.10 Pro Forma Salary and Wage by Position
Table 58 Pro Forma Salary and Wage by Position
Salary and Wage by Position 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Emergency Room Director 100,000 102,000 104,040 106,121
108,243 110,408 112,616 114,869
117,166 119,509 121,899
Emergency Physician 400,000 408,000 416,160 424,483432,97
3 441,632 450,465 459,474468,66
4 478,037 487,598
Radiologist 500,000 510,000 520,200 530,604541,21
6 552,040 563,081 574,343585,83
0 597,546 609,497Emergency Nurse 45.00 45.90 46.82 47.75 48.71 49.68 50.68 51.69 52.72 53.78 54.85Triage Nurse 42.00 42.84 43.70 44.57 45.46 46.37 47.30 48.24 49.21 50.19 51.20Social Worker 30000 30,600 31,212 31,836 32,473 33,122 33,785 34,461 35,150 35,853 36,570
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Medical Radiation Technician 32.00 32.64 33.29 33.96 34.64 35.33 36.04 36.76 37.49 38.24 39.01Medical Laboratory Technician 30.00 30.60 31.21 31.84 32.47 33.12 33.78 34.46 35.15 35.85 36.57Medical Administrator 25.00 25.50 26.01 26.53 27.06 27.60 28.15 28.72 29.29 29.88 30.47Business Administrator 25.00 25.50 26.01 26.53 27.06 27.60 28.15 28.72 29.29 29.88 30.47Registration Clerk 22.00 22.44 22.89 23.35 23.81 24.29 24.78 25.27 25.78 26.29 26.82Unit Assistant 20.00 20.40 20.81 21.22 21.65 22.08 22.52 22.97 23.43 23.90 24.38Security Guard 17.00 17.34 17.69 18.04 18.40 18.77 19.14 19.53 19.92 20.32 20.72Janitor 17.00 17.34 17.69 18.04 18.40 18.77 19.14 19.53 19.92 20.32 20.72
7.5.11 Pro Forma Employee Benefits
Table 59 Pro Forma Employee Benefits
Employee Benefits 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Employment Insurance 61,276 61,565 61,806 62,035 62,268 62,507 62,750 62,998 63,250 63,508 63,771
Canadian Pension Plan 130,586 132,067 132,771 133,485 134,108 134,743 135,391 136,052 136,726 137,413 138,114
Workers' Compensation 19,009 19,389 19,777 20,172 20,576 20,987 21,407 21,835 22,272 22,717 23,172
Holiday Pay 167,581 170,932 174,351 177,838 181,395 185,023 188,723 192,498 196,348 200,274 204,280
Health and Dental Benefits 826,473 843,003 859,863 877,060 894,601 912,493 930,743 949,358 968,345 987,712 1,007,466
Total Employee Benefits 1,204,925 1,226,956 1,248,567 1,270,590 1,292,948
1,315,753 1,339,014 1,362,740 1,386,941 1,411,625 1,436,804
7.5.12 Pro Forma Marketing Expenses
Table 60 Pro Forma Marketing Expenses
Marketing Expenses 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Information Brochures
923 941 960 979 999 1,019 1,039
1,060 1,081 1,103 1,125
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Website 2200 204 208 212 216 221 225 230 234 239 244Total 3,123 1,145 1,168 1,192 1,215 1,240 1,26
51,290 1,316 1,342 1,369
7.5.13 Pro Forma Debt Amortization
Table 61 Pro Forma Debt Amortization Schedule
Debt Amortization 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Beg Balance - 872,812 785,842 696,524 604,794 510,588 413,838 314,47
5 212,430 107,630 -
Addition 957,495 - - - - - - - - - - Payment 110,536 110,536 110,536 110,536 110,536 110,536 110,536 110,53
6 110,536 110,536 -
Interest 25,852 23,566 21,218 18,806 16,329 13,786 11,174 8,491 5,736 2,906 - Principal Reduction
84,684 86,970 89,318 91,730 94,206 96,750 99,362 102,045
104,800 107,630 -
End Balance 872,812 785,842 696,524 604,794 510,588 413,838 314,475 212,430
107,630 - -
7.5.14 Capital Cost Allowance Schedule
Table 62 Capital Cost Allowance Schedule
CCA
CCA Rate
2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Class: Leasehold Interest (Class 13)
Beg Balance 4% - 882,000
846,720
812,851
780,337 749,124 719,159
690,392
662,777 636,266 610,815
Addition 900,000 - - - - - - - - - -
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CCA Expense 18,000 35,280 33,869 32,514 31,213 29,965 28,766 27,616 26,511 25,451 24,433
End Balance
882,000
846,720
812,851
780,337
749,124 719,159 690,392
662,777
636,266 610,815 586,382
Class: Business Electronic Equipment (Class 50) Beg Balance 55
% -
22,163 9,973 4,488 2,020 909 (21,341
) (9,603) (4,322) (1,945)
(22,625)
Addition 30,569
- - - - (30,000)
- - - (30,000)
-
CCA Expense 8,406 12,189 5,485 2,468 1,111 (7,750) (11,738) (5,282) (2,377) (9,320) (12,444)
End Balance
22,163 9,973 4,488 2,020 909
(21,341) (9,603) (4,322) (1,945)
(22,625)
(10,181)
Class: Furniture and Fixtures (Class 8)
Beg Balance 20%
- 1,749 1,399 1,119 895 716 2,373 1,898 1,519 1,215 972
Addition 1,943 - - - - 2,000 - - - - 2,000
CCA Expense 194 350 280 224 179 343 475 380 304 243 394
End Balance 1,749 1,399 1,119 895 716 2,373 1,898 1,519 1,215 972 2,578
Class: Medical Equipment (Class 8)
Beg Balance 20%
- 974,282
779,425
623,540
498,832 399,066 364,253
291,402
233,122 186,497
149,198
Addition 1,082,53
5
- - - - 50,000 - - - - 50,000
CCA Expense
108,254
194,856
155,885
124,708 99,766 84,813 72,851 58,280 46,624 37,299 34,840
End Balance
974,282
779,425
623,540
498,832
399,066 364,253 291,402
233,122
186,497 149,198 164,358
Total CCA Expense 134,854
242,675
195,519
159,914
132,270 107,371 90,354 80,994 71,062 53,673 47,223
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8.0 Business Plan Summary
Health MattERs provides the Government of Saskatchewan with the opportunity to reduce
emergency room wait times for outpatient emergency patients, increase emergency room
capacity in Saskatoon, and to implement and manage this in a cost-effective way. Health
MattERs’ business plan was developed to meet three main objectives, as outlined below:
1. Financial: Provide emergency medical care in a cost-effective way, as measured by cost
per patient indicators. This objective aims to provide emergency medical care, on a cost
per patient basis, that is lower than the current industry standard in Saskatoon.
2. Non-financial: Reduce emergency room wait times for outpatient emergency patients.
3. Non-financial: Provide quality, patient-centered emergency medical care to all patients
seeking treatment at the Health MattERs facility
As this business plan has outlined, these objectives will be met if Health MattERs is
operationalized by the Government of Saskatchewan. This freestanding emergency room
provides the government with a unique opportunity to implement an innovative solution to
emergency room problems. This business plan was developed for both the single paying
customer of Health MattERs, namely the Government of Saskatchewan, as well as the patient
population in Saskatchewan. The value that Health MattERs will provide to the Government of
Saskatchewan will be derived from the investment opportunity it provides that will enable a
reduction in emergency room wait times for outpatient emergency patients. The value that Health
MattERs will provide to the Saskatchewan patient population stems from the facility’s ability to
provide them with quality outpatient emergency medical care, in a timely manner, by qualified
and trusted healthcare professionals.
As the population of Saskatoon will continue to grow over the coming years, the need for
increased emergency room capacity is of ever increasing importance. Since these emergency
medical services will be needed by Saskatoon’s growing population, it is anticipated that Health
MattERs can sustainably operate into the future at near-to or at full capacity.
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Health MattERs is composed of a highly qualified and trained team of healthcare professionals
and support staff. Emergency physicians and radiologists are available to provide emergency
medical treatment and are supported by a team of emergency nurses, triage nurses, medical
radiation technicians, medical laboratory technicians, social workers, and several support staff
positions. With the Emergency Room Director organizing and leading the operations of the
facility, this group of individuals is positioned to provide compassionate, quality, and timely
medical care to the patient population.
Health MattERs depends on patient flow through the facility to efficiency and effectively run this
service. Patients are the critical variable to Health MattERs success in Saskatoon. Their
experiences, feedback, and use of the facility are essential to its operations. To utilize the
government’s investment and resources effectively, patients must present at the freestanding
emergency room seeking treatment.
Health MattERs provides the Government of Saskatchewan, and the people of Saskatoon and
Saskatchewan, with a solution to the current emergency room wait times. The overall risk of the
facility is quite low, leaving the government with a viable opportunity to invest in the health of
the province. Health MattERs fills a gap in Saskatchewan’s medical market. As the population of
Saskatoon continues to grow and age, it is necessary to increase the supply of emergency
medical services. The Government of Saskatchewan has three choices in addressing emergency
room overcrowding and increasing demand: a) do nothing and face the backlash of emerging
patient activists, b) open a new hospital that has an emergency department, or c) open a
freestanding emergency room. Based on cost considerations, patient requirements and demand,
the Government of Saskatchewan is best positioned to invest in a new freestanding emergency
room.
Health MattERs will be the first freestanding emergency room in Saskatchewan. This will
require efforts to educate the public, patient population, and healthcare professionals regarding
the purpose of the facility and the services that it provides. Health MattERs will be located in the
growing Eastern suburban area of Saskatoon, to meet the service needs of the growing suburban
population in the city.
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Health MattERs will not generate excess net income. Rather, it will act as a break-even
government-owned entity in which revenues are equal to the facility’s total operating expenses.
Based on current financial and patient quantity projections, the cost per patient visit is $321.02.
Mike Stensrud, Saskatoon Health Region’s President, noted that each time a person visits an
emergency room currently it costs approximately $800 (CKOM, 2016). Thus, Health MattERs
offers an affordable and cost effective approach to addressing the issue of emergency room wait
times.
Opening Health MattERs will position the Government of Saskatchewan as an innovative and
responsive government, with regard to operationalizing a solution to current emergency room
overcrowding and long wait times. Health MattERs aligns with the current goals of the
Government to reduce emergency room wait times and will positively benefit the patient
population of Saskatchewan. The successful introduction of a freestanding emergency room in
Saskatoon can serve as a medical model for other cities and provinces in Canada looking to
reduce emergency room wait times, overcrowding, and to improve patient care.
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9.0 Acknowledgements
The development of Health MattERs’ business plan could not have been done without the
generous contributions of many professionals who gave their time and knowledge to enhance the
validity and accuracy of this report. I would like to extend my thanks to the following
individuals:
Jocelyn Orb:Manager, Student Health Service at the University of Saskatchewan
Patrick Robertson: Director of Pharmacy, Saskatoon Health Region
Dr. James Stempien: Head, Emergency Department, Saskatoon Health Region and Conference Chair of the Western Emergency Operations Department Operations Conference (April 6-7th, 2017 – Saskatoon)
Dr. Ian Sunderland: Clinical Assistant Professor, Division of Plastic Surgery, College of Medicine, University of Saskatchewan
Dr. Keith Willoughby: Dean of Edwards School of Business and author of “Achieving Wait Time Reduction in the Emergency Department”
Lilah Weinberger: Business Development Manager, Emergency Department, Saskatoon Health Region
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10.0 References
650 CKOM. (2016). “Saskatoon Health Region eyes move to more home-based care.” 650 CKOM, http://ckom.com/article/1122026/saskatoon-health-region-eyes-move-more-home-based-care. Accessed 13 May 2017.
AED Superstore. (2017). “Laerdal The Bag II Disposable Resuscitator, Child Mask.” AED Superstore, http://www.aedsuperstore.com/laerdal-the-bag-ii-disposable-resuscitator-child-mask.html. Accessed 18 April 2017.
Alibaba. (2017). “800 Degree Laboratory Differential Scanning Calorimeter Price.” Alibaba, https://www.alibaba.com/product-detail/800-Degree-Laboratory-Differental-Scanning-Calorimeter_60610559755.html. Accessed 18 April 2017.
Alibaba. (2017). “Dual purpose vaccine transport cooler box with handle.” Alibaba, https://www.alibaba.com/product-detail/dual-purpose-vaccine-transport-cooler-box_60603325506.html?s=p. Accessed 18 April 2017.
AliExpress. (2017). “Medical oxygen regulator pressure flowmeters.” AliExpress, https://www.aliexpress.com/item/Medical-oxygen-regulator-pressure-flowmeters-hot-sales/2031161179.html?spm=2114.40010508.4.23.Ds3Sp7. Accessed 2 May 2017.
American College of Emergency Physicians. (2014). “Freestanding Emergency Departments.” American College of Emergency Physicians, https://www.acep.org/Clinical---Practice-Management/Freestanding-Emergency-Departments/. Accessed 12 March 2017.
Belmont Instrument Corporation. (2013). “Belmont Rapid Infuser Performs Over 350,000 Life-Saving Blood Transfusions.” Belmont Instrument Corporation, http://www.marketwired.com/press-release/belmontr-rapid-infuser-performs-over-350000-life-saving-blood-transfusions-1805494.htm. Accessed 2 May 2017.
Best Buy. (2017). “HP 21.5” All-in-One PC –White (iNtel Pentium J3710/ITB HDD/8GB RAM/Windows 10 Home).” Best Buy, http://www.bestbuy.ca/en-ca/product/hp-hp-21-5-all-in-one-pc-white-intel-pentium-j3710-1tb-hdd-8gb-ram-windows-10-home-22-b009/10440893.aspx?. Accessed 5 April 2017.
Best Buy. (2017). “Insignia 47”-80” Tilting TV Wall Mount.” Best Buy, http://www.bestbuy.ca/en-ca/product/insignia-insignia-47-80-tilting-tv-wallf-mount-ns-htvmt1703-c/10422982.aspx?. Accessed 5 April 2017.
Best Buy. (2017). “Sony 60” Smart 1080p LED TV.” Best Buy, http://www.bestbuy.ca/en-ca/product/sony-sony-60-smart-1080p-led-tv-kdl60w630b-2-kdl60w630b-2/10432317.aspx?. Accessed 5 April 2017.
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Beta Medical Inc. (2017). “Refurbished Hill-Rom Hospital Beds.” Beta Medical Inc, http://www.betamed.com/hospitalbeds/criticalcarebed.html. Accessed 18 April 2017.
Block Imaging. (2017). “GE Logiq Ultrasound Cost Price Guide.” Jason Block at Block
Imaging, https://info.blockimaging.com/ge-logiq-ultrasound-cost-price-guide. Accessed 12 April 2017.
Canadian Association of Emergency Physicians. (2002). “Canadian Emergency Department Information System (CEDIS).” CAEP, http://caep.ca/resources/ctas/cedis/cedis-data-set. Accessed 22 March 2017.
Canadian Association of Emergency Physicians. (2012). “Canadian Emergency Department Information System (CEDIS): Presenting Complaint List (V2.0).” CAEP, http://caep.ca/sites/caep.ca/files/caep/nacrs_presenting_complaint_list_v2_0_en_fr_pdf_pdf.pdf. Accessed 22 March 2017.
Canadian Association of Emergency Physicians. (2017). “Overcrowding.” CAEP, http://caep.ca/advocacy/overcrowding. Accessed 2 May 2017.
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