Sunrise Health Region looking back and forward

If there was a theme for 2014 in the Sunrise Health Region, it was to utilize teamwork to continue to make the system better.

“In 2014, the Sunrise Health Region team enhanced continuous improvement and made great gains in strategy deployment,” detailed CEO Suann Laurent. “The team also experienced several unplanned emergent events that required quick, decisive and well executed response to protect the safety of our clients and communities. Examples are the Ituna water crisis, OR sterile field restoration, and 2014 flood response and Melville facility evacuation. At all times and especially when crisis strikes, communities and people in our region can count on the Sunrise Health Region team. To follow is a summary of the major activities of 2014.”

In many ways the efforts of the past year are a continuation of past efforts.

“In 2014 Sunrise Health Region was in the fourth year of the Saskatchewan Healthcare Management System adopted by the Province of Saskatchewan,” said Laurent. “We continued the use of daily visual management walls which are located in public areas of every facility and department.  At daily huddles, the team of health care providers and managers gather around the “Connecting Teams for Excellence” wall in their department and information relevant to their team to discuss how to better meet the needs of their clients and to track progress related to safety, quality, cost, delivery and engagement targets. A shared understanding of our “must do can’t fail” initiatives in the health system help us continuously improve towards common goals of improving our patient’s experience.”

To keep progress moving forward the Health Region works at it on a continuous basis.

“Each week “Strategic Visibility Wall Walks” are held in the Mental Health Auditorium and during these presentations members of the Executive Leadership Team explain how progress is being made on a regional level and any plans for course correction,” offered Laurent. “These “Wall Walks” are open to all staff and the public and are held in the Mental Health Auditorium. The schedule and videos of past “Wall Walks” can be found on our website under “Strategy and Innovation”.

“In 2014, the strategic triangle developed by Sunrise Health Region was adopted by all health regions in Saskatchewan. The strategy triangle is a means to visually communicate strategy and explain our patient/client first focus and how the Saskatchewan Healthcare Management System is being used to drive projects linked to the four betters and to our region’s vision, mission, and values.”

Much of the effort dovetails with provincials initiatives. As example the local Health region is working on its Lean Certification.

In 2014, the following individuals achieved Lean Leader Certification – Roberta Wiwcharuk, Suann Laurent, Perry Froehlich, Lenore Pinder. There are currently 40 employees who are part way through their Lean Leader Certification. Each are required to read three textbooks, complete 10 learning modules, participate in a value stream mapping workshop, complete a mistake proofing project, tour facilities to learn how others have used Lean to improve their operations, and must take part in three separate Rapid Process Improvement Workshops as team lead, sub-team lead and participant, detailed a year-end report. Selected individuals also complete KanBan inventory management training. The process to be certified takes 73-80 days of dedicated effort and those who achieve this certification have the information, training and experience to successfully lead our improvement efforts into the future. Our Lean Leaders help groups of staff and patient representatives to seek solutions that will improve the healthcare system. The process of Lean Leader certification is building capacity to accelerate and sustain improvements in the health care system.

There is also ongoing work in terms of Rapid Process Improvement Workshops (RPIWs), which are five day events targeted to study and improve processes to reduce wait time for patients and eliminate waste in how the work is done. Each five day workshop is preceded by several weeks of preparatory work, data collection and analysis. The RPIW week is led by a Team Lead who works with the RPIW team of patient and family representative(s), Lean Leaders, and frontline staff.

Streamlining efforts are also part of the process.

KanBan is a process of inventory analysis and streamlining to ensure the right inventory, is in the right place, at the right time and in the right quantity. KanBan improves patient care by having the resources where they are needed which; reduces chance of errors, increases the time health care workers have for patients, and reduces waste and inventory costs.  From October 20-24, 2014 the health region hosted a KanBan training seminar attended by 40 persons our region and from throughout the province.  Four teams of 10 worked to improve inventory control and flow of materials in the following areas:

• Yorkton Home Care Treatment Centre Supplies Area

• Yorkton Regional Health Centre – 2nd South Medicine/Peds Supplies Area

• Yorkton Regional Health Centre – 3rd South Surgery Supplies Area

• Yorkton Regional Health Centre – Operating Room Supplies Area

Of course better health care for Region residents remains a first priority, said Laurent. Her report touched on several initiatives in that regard.

In June of 2014, Sunrise Health Region joined the rest of the province to celebrate our surgical teams having achieved the provincial target of reducing wait times for all surgeries in the region to less than three months.

Immunize or Mask – Chief Medical Health Officer for Saskatchewan, Dr. Shahab, declared December 1, 2014 as the start of influenza season. Influenza season is the time of year when the influenza rates are expected to be highest and the season typically lasts until April. As of December 29, 2014, in Saskatchewan there are 416 confirmed cases of influenza, eight admissions to ICU due to influenza and three confirmed deaths. These numbers are known to be an underestimate. Not all people seek medical care and are tested for influenza, and not all those who died with influenza-like illness were tested. Information about influenza, the link to the provincial surveillance page and how to access immunizations can be found on the Sunrise Health Region website.

Beginning in the fall of 2014, as recommended by the Medical Health Officers for the Province of Saskatchewan, all health care workers in Saskatchewan must choose to be immunized for influenza or will be required to wear a mask in patient care areas throughout influenza season. This change in practice will reduce the exposure of clients and patients to influenza viruses. Visitors to health care facilities are asked to voluntarily mask, if they have not had the influenza immunization. Patients and long-term care residents are not required to mask while in care.

Infection from exposure to influenza can be devastating to anyone with a compromised immune system. No one wants to be responsible for harm to a patient, co-worker, family member or friend that could have been prevented.

Measles - Measles is another contagious illness for which immunization is available.  In 2014 Sunrise Health Region engaged in a campaign to increase awareness of measles activity in Saskatchewan, Alberta, British Columbia and Ontario.  The Ministry of Health recommends measles vaccines for all child care providers, children and parents to ensure they are protected against measles.

Ebola – Ebola, a rare and serious viral infection, became a major concern in 2014 when the illness appeared and was wide-spread in several countries in West Africa. The risk of Ebola in Canada is very low; however, it is not zero, and we are taking it seriously. Supplies and staff training have taken place and are being coordinated by a regional emergency preparedness team. We continue to work with the Ministry of Health, regional, provincial and national partners; learning from the experiences of others and refining our plans and approach. We are working cooperatively to make sure we all prepare appropriately, even for this low risk.

Still all work within the Region must also work within a very tight financial budget.

“After three consecutive years of balanced budgets, the 2013-14 year broke the trend and ended with a deficit in the general operating fund of $1,843,071. The majority of the deficit was in compensation expenditures, due to higher than budgeted sick time replacement and wage driven premiums. The deficit was also due, in part, to higher levels of complex care requiring one-on-one care for some residents, and reciprocal billing revenue that were less than expected. In March 2014 the health region learned that it would receive a .7 per cent increase in base funding. In May the health region approved a budget consisting of revenues totaling $214,850,836 balanced by total budgeted operating expenditures of $212,839,986 and with $2,010,850 held for replacement. The health region is currently forecasting a small deficit by year end; however,  efforts continue with the goal of balancing the budget and managers whose departments are over budget are required to post course correction plans and speak to them at the “Indicators of Excellence” visibility wall which is located in the Mental Health Auditorium.

In 2014-15 the health region reduced non-salary expenditures, adjusted revenue, utilizing deferred funding and did not allocate inflationary funding. Compensation expenditures are being closely managed to reduce straight-time worked hours, and aggressive attendance targets were set, call backs and in-charge procedures are continuously reviewed, and the region is managing vacant positions. There were no facility closures; however some services were realigned. Fourteen beds were taken out of circulation at the Yorkton & District Nursing Home – Skinner Unit with eleven residents transitioned into other beds in the same facility where their needs could be better met (3 beds had been vacant).  The Skinner Unit remains with 35 long-term bed unit for care of residents with health conditions requiring behavioral management; this includes persons in the progressive stages of dementia or Alzheimer’s disease. An eight bed long-term care wing at Canora Hospital was returned to acute care use (five of the beds were vacant).  All long-term care residents in Canora are now cared for at the Canora Gateway Lodge.  The Canora Hospital remains a 16 bed acute care facility with mostly private rooms.

A small number of strategic investments were made to support mental health and addictions and hemodialysis services, recruitment, retention and employee training, patient safety and improvement, and information technology.  Other priorities included decreasing emergency room waits, appropriate long-term care placement, implementation of clinical practice guidelines for the six most common chronic conditions, supporting the health of employees and clients by increasing influenza immunization and hand hygiene rates, and continuing the work to reduce workplace injuries.  

The health region employs 2,975 people, operates 23 health care facilities and serves a population of 59,007 people within the region proper and has a trading service area of 120,000 people.

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