Community Report October 2013 - January 2014

January 23, 2014

Index Report of the President and Chief Executive Officer. . . . . . . . 4 Board Members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Patient and Family Centred Care Overview. . . . . . . . . . . . . . . . . 8 Reports from: • Finance, Audit and Resource Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 •

Governance, Nominating and Planning Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

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Patient Safety and Quality Improvement Committee. . . . . . . . . . . . . . . . . . . . . . . . . 14

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Regional Medical Advisory Committee (RMAC) . . . . . . . . . . . . . . . . . . . . . 15

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Regional Professional Advisory Committee (RPAC). . . . . . . . . . . . . . . . . . . . . . 17

Report of the President and Chief Executive Officer Since the last board meeting in October, the organization’s attention has been focused on three major activities: 1. Preparing for the year ahead with a Regional Health and Business Plan. 2. Taking our first steps in engaging patients as part of Patient and Family Centred Care. 3. Planning robust consultations to create a new Horizon Strategic Plan. Regional Health and Business Plan Our executive leadership team has been in contact with Department officials to get an early indication of probable resources for the next (and succeeding) years, and has been preparing plans to match our needs as a health provider with such funding. It is clear there will be no significant funding increase in the new year. Therefore, continued attention to finding efficiencies will be necessary for the foreseeable future. The good news is that, more and more, our staff and leadership team, including physicians, appreciate that changes are needed. We can all contribute to successfully achieving our fiscal goals. Who would have believed five years ago that health care could be sustained with virtually no growth in funding? I think it is important to recognize that the good fiscal stewardship by Horizon did not just start with this management team and board. It was a good base of stewardship and accountability initiated four years ago that we are working to take to a next level. As noted above, that will be a continuous theme for us in the years ahead. Patient and Family Centred Care This concept of ‘Patient and Family Centred Care’ as a strategic theme for our organization was endorsed by our board in October. Since then, we have begun the process of engaging our patients to hear their thoughts on how well we meet their overall needs. We have had three in-depth group meetings with patients, and in some cases family members, who have been very articulate in describing their experiences. Some of these stories have been very hard to hear – we have not always served our patients well. If I had to summarize the major areas for improvement, based on feedback received to date, I would say they include: •

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Patients need to be treated with more respect and courtesy; they need to be treated as persons and not just as medical problems.

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Patients do not need to see, hear, or feel the issues staff have in their professional or personal lives; patients expect all attention will be on them during work hours.

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Cleaning and sanitization practices need to be improved.

We will continue this consultation and determine a manner to engage patients on a more continuous basis in the months ahead. New Strategy for Horizon Health Network Horizon is working on developing a new strategic plan. The process is assisted by a board consultant, and an initial meeting with board members and senior management has taken place. This first session forms a basis for discussion with our stakeholders, both internal to the organization and those with whom we work on an ongoing basis. Our board has articulated some key results that they see as important for Horizon to fully realize its role of New Brunswick’s major health delivery organization. Over the next two months, we will hold several consultations with focus groups to hear their perspectives, leading to a new plan by the start of this summer. Other Activities Fredericton hosted a major meeting of the Centre for the Advancement of Health Innovation (Conference Board of Canada) where most leaders in health care for this province had the opportunity to consider innovative successes and potential opportunities we may have before us. We also held our semi-annual meeting of the Leadership Advisory Committee in December. More than 125 of our executives, directors and physician leadership spent the day discussing major issues within Horizon. This is the single best opportunity for our leadership to debate priorities and direction. In addition to the traditional communication by our senior management on a variety of topics, this session tends to be an open and meaningful forum for those who might have unique perspectives to make their ideas known. In December, our executive leadership team met with representatives of almost all foundations associated with our organization. We made a commitment to be more proactive in letting them know the direction for Horizon and the potential impact this may have on how foundations engage their communities in supporting us. We clearly communicated that their support is critical to our success. Finally and unfortunately, we are now seeing the flu season impact our population – and our staff. A noticeable increase in visits to our facilities has begun. We encourage everyone to take advantage of available flu vaccines, and to practice prevention by using proper hand hygiene procedures.

John McGarry President and Chief Executive Officer

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Board Members

W. David Ferguson

Linda Aitken

François M. Beaulieu

Mike Coster

Board Chair

Upper Kingsclear

Saint John

Miramichi

Jo-Ann Fellows

Linda G. Forestell

Dr. Erik Klein

Michael McCoombs

Fredericton

Saint John

Hampton

Miramichi

John B. McKay

Kathleen McMullen

Jane Mitton-MacLean

Chief Candice Paul

Miramichi

Sackville

Moncton

Saint Mary’s First Nation

Luigi Rocca

Mary Louise Schryer

Moncton

Kay Simonds

Quispamsis

Woodstock

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Patient and Family Centred Care Overview Margaret Melanson, Vice President Quality and Patient Centred Care

Ms. Melanson was recently appointed to the Vice President, Quality and Patient Centred Care for Horizon. She is responsible for Horizonwide implementation of the patient centred care initiative, as well as Patient Advocacy, Patient Safety, Infection Control and Prevention, Privacy, Quality, Risk Management and Official Languages. Horizon recognizes that delivery of care must be aligned with the needs, desires, beliefs and cultural sensitivities held by our patients and their family members. To do this, Horizon is shifting its focus from meeting the needs of a system or financial constraints, to meeting the needs of patients, their families and the community. This is done through a community engagement process. Compassion, dignity, respect, communication and coordination of care to meet the unique needs of each patient will be a key driver of Horizon’s success. Consideration of the values, perspectives and choices of patients through collaborative partnership will be embraced fully within our health-care model. This endeavour will introduce a change in culture within our organization – it is a journey as opposed to an objective. The end result will be greater integration of patients and their family members as true partners within the provision of care. Horizon is also committed to providing patients, their family and all members of the public with quality health care in the official language of their choice. As a basic principle in accordance with the New Brunswick Official Languages Act, Horizon will use increased vigilance to ensure access to services for both linguistic communities. A greater focus on patient centred care will encompass an increased level of commitment toward improved patient safety, quality improvement and performance measurement practices. Key steps to attaining Patient and Family Centred Care include:

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Engage executive leadership to ensure participation and accountability for system redesign.

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Develop priorities and action plans using patient, family and community engagement processes and models.

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Create a Patient and Family Advisory Council, with a broad-based focus to improve patient care experiences at all levels across Horizon.

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Involve staff and physicians at the front-line level, in addition to managers and directors, to design and implement changes in care delivery policies, processes and practices.

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Integrate Patient / Family Advisors across the health network in key committees and program groups.

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Commit to ongoing measurement and improvement of patient satisfaction with the care experience across the continuum, with initial focus on the acute care system.

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Embrace an enhanced culture of safety, with focus on improved outcomes in measures of infection, incidents with harm, and hand hygiene.

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Reaffirm the organization’s vigilance toward full implementation of all Required Organization Practices as delineated by Accreditation Canada.

The following is a brief overview of actions undertaken to date. Patient and Family Centred Care: 1. Focus Groups: ‘Ideas and Solutions’ focus groups were held in Fredericton, Saint John and Miramichi with members of the public who had indicated interest. Inclement weather required the Moncton focus group to be rescheduled. In addition, further focus groups will be scheduled in some smaller communities. Targeted focus groups with specific patient populations are also planned to involve, for example, young adults, parents and mental health patients. 2. Steering Committee and Patient / Family Advisory Committees: Terms of Reference for these committees have been drafted, and it is expected that these committees will begin meeting soon. 3. Directors Council / Leadership Advisory Committee Presentations: Meetings have been held with Horizon’s management, including its senior leadership, to introduce the patient and family centred care initiative and seek support as projects are undertaken. 4. Identification Cards: Focus groups have also been undertaken within each geographic area to seek input toward new staff identification cards. Improvements to I.D. cards will ensure staff members’ first name and title/ position will be more visible to patients and the public. 5. Official Languages: A detailed action plan to improve the Active Offer (offering patients and the public the opportunity for service in their language of choice), and to audit the response to the offer, will be developed in collaboration with the Université de Moncton. This will begin in January 2014. Next Steps: 1. Operational Plan: An operational plan with specific objectives and actions for the Patient and Family Centred Care initiative to be completed. 2. Indicator Dashboard for Patient and Family Centred Care: A dashboard with metrics designed to monitor improvement in patient centred care will be prepared. 3. Patient Satisfaction Surveys: A plan for conducting bi-annual patient satisfaction surveys will be prepared.

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Committees of the Board Reports Report of Finance, Audit and Resource Committee Michael McCoombs, Chair

The Finance, Audit and Resource Committee met on December 12, 2013. The following is a summary of the discussions from the meeting.

Financial Results at October 31, 2013: Information provided on year-to-date financial results for the seven month period ending October 31, 2013 continues to show a surplus of less than one percent of operating expenditures. Based on the October 2013 results the organization is projecting a small surplus of less than $1 million for the fiscal year 2013-2014. Financial Dashboard: A draft financial dashboard was reviewed by the committee and minor revisions were suggested. This is a work in progress, with a finalized dashboard expected in the spring of 2014. 2014-15 Budget: Dan Keenan, Corporate Director of Financial Services, provided preliminary information on the budget estimates for 2014-15, noting that although we have not received formal written direction, we are basing the revenue estimates on a one per cent increase in funding. A one per cent increase would result in a net revenue budget increase of $7 million. Budgeted salary increases of $15 million and supply inflation estimate of $4 million will leave Horizon with a challenge of $12 million for fiscal year 2014-2015. Andrea Seymour, Chief Operating Officer, reviewed specific initiatives underway. Further discussion will take place on the budget as contained in the Regional Health and Business Plan 2014-2017. Key Quality of Worklife Indicators: Organizational Development’s Key Quality of Worklife Indicators report, updated to November 27, 2013, was provided for information. There has been progress in the WorkSafeNB lost time indicator with the return to work programs in Horizon, but it is still below base. Paid sick leave and unpaid sick leave remain a challenge, as does the job satisfaction rate. Bilingual Staff Recruitment: Kerry Kennedy, Regional Manager Recruitment, provided a presentation on the recruitment of bilingual staff for Horizon. She spoke to Horizon’s efforts in making high school students aware of the careers in health care by attending school fairs and making classroom presentations, as well as connecting with clinical and non-clinical post-secondary students. She also spoke to the challenges of retaining staff including the sensitivities around recruiting families to communities.

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Despite best effort to recruit, there is an inadequate supply of bilingual candidates with the competency requirements per classification, resulting in a challenge of managing Human Resources to ensure bilingual competency on all shifts. These challenges are coupled with a difficulty in sustaining individual language capability if it is not used on a regular basis. Given this, new strategies for language competency are currently in development. Refurbishment of Nursing Units at the Saint John Regional Hospital: A briefing was provided to the committee which explained that in 2011-12 the refurbishment plan for nursing units at the Saint John Regional Hospital was supported by board members with an approved budget of $7 million (using Board funds) over five years. Insurance Costs: Members were provided with an inventory of insurance for fiscal 2013-14. Horizon pays a total of $162,277 annually in premiums to various suppliers for various types of insurance coverage. Most are still managed at the local area and have not been consolidated within the new organization. Risk Management deals with the self-insurance and claims associated with patients while Finance maintains responsibility for corporate insurance policies. Changes have been made and the entire process will now be managed by the Regional Director of Risk Management. It is thought there is opportunity for consolidating the coverage and lowering costs. Discussions with Horizon’s health-care partners will be part of the review process. Succession Planning: Mr. McGarry reviewed a number of potential candidates who might be considered for various senior management positions in the event they were to become vacant. Most of the information, excluding the CEO succession plan, was based upon input from the incumbent executives.

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Horizon Health Network

STATEMENT OF OPERATIONS Seven months ended October 31 Comparison to Budget Unaudited - Provided For Internal Purposes Only

Unaudited - Provided For Internal Purposes Only October 31 Budget 2013 $

October 31 Actual 2013 $

October 31 Actual 2012 $

Budget Variance

Revenues Department of Health Medicare Federal

518,655,334

511,482,638

517,788,085

(7,172,696)

96,622,941

95,463,306

92,879,937

(1,159,635)

9,703,845

9,259,465

9,271,046

(444,380)

Patient recoveries

22,275,875

22,337,211

20,403,657

61,336

Recoveries & sales

13,575,603

13,015,067

12,219,782

(560,536)

(940,970)

(569,832)

(1,345,258)

371,138

659,892,628

650,987,855

651,217,249

(8,904,773)

FacilicorpNB savings - revenue offset

Expenses President / CEO

3,264,935

2,578,826

2,899,410

686,109

Chief Operating Officer / Corporate Resources

96,202,786

90,810,066

91,782,928

5,392,720

VP Clinical

273,717,105

270,667,161

265,997,485

3,049,944

VP Medical / Academic / Research Affairs VP Professional Services VP Community Chief of Staff

13,298,316

11,385,668

11,715,972

1,912,648

103,356,747

101,065,988

100,302,278

2,290,759

79,086,661

75,266,976

75,091,277

3,819,685

626,492

686,583

589,547

(60,091)

Medicare

96,903,634

95,570,531

92,967,560

1,333,103

Corporate challenges

(6,139,947)

0

0

(6,139,947)

660,316,729

648,031,799

641,346,457

12,284,930

(424,101)

2,956,056

9,870,792

(19,474,383)

(19,142,658)

(19,690,663)

7,649,515

113,546

8,003,137

0

0

0

Surplus (deficit) from Hospital operations before amortization, capital grants, retirement allowances and sick pay Other operating expenses Amortization of tangible capital assets Capital grant funding Retirement allowances - net of recoveries Sick pay obligation Net surplus (deficit) for the period

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(1,050,872)

(1,029,543)

(817,865)

(13,299,841)

(17,102,599)

(2,634,599)

Report of Governance, Nominating and Planning Committee Jane Mitton-MacLean, Chair

The Governance, Nominating and Planning Committee met on December 11, 2013. The following is a summary of the discussions from the meeting.

Recommendations: At the last meeting of the Committee, recommendations were made to the Board for Regional Medical Advisory Committee appointments; medical staff reappointment form; policies on board director continuing education; roles and responsibilities of board directors; gift acceptance; and the refurbishment plan for the 5AN unit of the Saint John Regional Hospital. Strategic Planning: The Committee was updated on plans for the upcoming strategic planning process that has now formally begun. The first meeting was held with both the Board and Horizon’s senior management team in January. The process is expected to be completed in June 2014. CEO Role: A policy document that better defines the role of the Chief Executive Officer was discussed. The Committee hopes to have it for the Board’s approval in April 2014.

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Report of Patient Safety and Quality Improvement Committee Linda Forestell, Chair

The Patient Safety and Quality Improvement Committee met on December 11, 2013. The meeting was chaired by Horizon Board Chair Mr. David Ferguson, in the Committee Chair’s absence. The following is a summary of the discussions from the meeting. Committee Work Plan: The Committee approved its work plan for 2013-14 and affirmed its intent to review it at each meeting. Public Engagement Sessions / Patient and Family Centred Care: A summary of the Community Engagement Strategy was provided to the members for information. The purpose of the strategy is to help promote positive attitudes and beliefs and a facilitate a change in behaviours that will lead to improved patient care. The strategy also provides guidance to Horizon on how to motivate staff and encourage trust and confidence in the organization. Dashboards: The Committee was presented with the Patient Safety Dashboard (first quarter year to date) and the Risk Management Dashboard. Services to Francophone population/Official Languages: Ms. Melanson highlighted the Official Languages Report. Since the last meeting, two Horizonwide initiatives have been adopted – the first being an awareness-building campaign and the second relating to the Active Offer of health-care services in both official languages. Further planning is scheduled for early January 2014 to prepare initiatives that will be undertaken in the 2014-15 fiscal year. This planning will involve other Horizon departments as key stakeholders in Official Languages strategic initiatives. The creation of an Official Languages Dashboard will monitor improvements in service delivery to patients. Quality and Safety Committee: A summary of reports were reviewed with suggested improvements for future reports by the Quality and Safety Committee, including a progress summary. Alternate Level of Care (ALC) Patients: Geri Geldart, Vice President of Clinical Services, reported that as of October 31, 2013 there were 332 ALC patients in acute care facilities. Although there is variation, the trend is relatively unchanged. Staff has worked with the provincial Department of Social Development on a new model to help patients. It is felt that the problems will not be solved without additional nursing home beds being created. Patient Care Initiatives at Dr. Everett Chalmers Regional Hospital: President and Chief Executive Officer John McGarry said that improvements are taking place at the hospital. Guidelines are being developed for the use of whiteboards in patient rooms and the privacy issues surrounding the boards are being discussed with the Chief Privacy Officer. Survey Results: Accreditation Canada’s survey results, as well as New Brunswick Health Council’s 2013 Acute Care survey results, were provided to the Committee.

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Report of Regional Medical Advisory Committee Tom Barry, MD FCFP C, Chief of Staff

The Regional Medical Advisory Committee (RMAC) met on November 19, 2013 and on January 7, 2014. The following is a summary of the discussions from the meeting.

Risk Management: Horizon’s Chief Risk Management Officer, Sandra Rooney, presented the risk management dashboard and indicators, outlining to the members the process in which incidents or sentinel events can be reported. Communication will be held at the Local Medical Advisory Committee level to educate physicians on the importance of reporting events. Process Improvement: Jennifer Kikkert, Regional Lead Business Process Manager for Horizon gave a presentation on Lean Six Sigma and other continuous improvement projects from 2013-14. Recent Appointments: RMAC welcomed Margaret Melanson to her new position as Vice President of Quality Patient Centred Care and Dr. David Bell was announced as the new Local Chief of Staff in the Upper River Valley area replacing Dr. Colin Lockhart. At the November meeting of RMAC, Dr. Clay Marco, Family Physician was welcomed as a new member replacing Dr. Arthur Losier as a rural representative and Dr. Patrick Feltmate, Geriatrician was welcomed in January replacing Dr. Raheel Shahid as a representative from the Fredericton area. Bio-Chemists Group: The Quality Care Efficiencies Committee, led by Dr. Dana Hanson and Dr. Jeff Moore, has been working in conjunction with the biochemists within the province to implement guidelines for laboratory testing. RMAC has approved a list of interval guidelines which were forwarded on to the Bio-Chemists group and Laboratory Leadership Committee. Once the implementation of these guidelines is confirmed, RMAC will be informing physicians as to our support and rationale for this directive. Key Performance Indicators: The Peer Review / Incident Reporting Committee has been working with Steve Savoie, Business Health Analyst for Horizon to develop standard key performance indicators for the Clinical Department Heads across Horizon. Medical Billing Numbers: The Senior Medical Leadership Committee has been meeting to prioritize the Medicare billing numbers for specialists within Horizon. This comprehensive list will be submitted to the Department of Health, with the physician impact forms accompanying the list to show justification for the need. As well, a list of required billing numbers for Family Physicians will be included in the report. On-call Schedule: A trial of the Provincial Neurology weekend on-call schedule is continuing. Meetings and discussion have been held to ensure that all

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members of the group are in agreement with the schedule and the scope of call. A motion was brought forth from RMAC to outline that all neurologists within Horizon are expected to take part in the provincial on-call schedule. H1N1 Virus: RMAC expressed concern on the recent reported cases of H1N1 with the expectation that the number of cases will increase. Horizon’s senior management have agreed to fund nursing staff relative to providing support to clinics, which will be opened to target the affected population. RMAC will also be communicating with family physicians to encourage their patients who are in the target population to be vaccinated. Other Points Discussed:

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Geri Geldart, Vice President of Clinical Services, brought forth a Medical Discharge Policy and also the Ambulatory Care Benchmarking Project for information to RMAC, to ensure physicians are aware of the process.

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The Physician re-application form was approved by RMAC with slight revisions and was forwarded on to the Horizon Governance and Nominating and Planning Committee for approval.

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With the approval of the new By-laws, the physician reappointment process will now be on a biennial basis.

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A short discussion on the topic of discharge summaries was held and the implications that follow if a physician neglects to complete his patient charts.

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Several motions were passed in relation to medical staff appointments.

Report of Regional Professional Advisory Committee (RPAC) Danica Wallace, Chair

The Regional Professional Advisory Committee (RPAC) of Horizon met on December 5, 2013. The following is a summary of the discussions from the meeting.

Privacy Initiatives: Nancy Lindsay, Chief Privacy Officer, provided an update on Horizon’s privacy initiatives. The presentation was well received and the committee has requested annual updates from this department. Accreditation Canada survey: Results from Horizon’s recent survey by Accreditation Canada were presented by Lauza Saulnier, Director of Research and Patient Safety Services. Horizon received ‘Accredited’ status and met 97 per cent of the evaluation criteria. Ms. Saulnier noted that evidence on 11 major Required Organizational Practices (ROPs) will be submitted to Accreditation Canada in February 2014. With this submission, Horizon has the opportunity to improve its status to ‘Accreditation with Commendation’. Further evidence on other minor recommendations will be submitted in February 2015 and again in February 2016. Interdisciplinary Representation: Committee members brought forward the importance of ensuring interdisciplinary representation on Horizon’s Clinical Networks. Geri Geldart, Vice President of Clinical Services, will discuss the matter with Horizon’s management. It was felt that the inconsistent representation makes communication difficult. Sectors are also not well informed regarding the purpose and actions of the clinical networks, and how and where they can access this information. In addition, networks that are trying to implement system-wide changes may benefit from having representation from various sectors to assist with the coordination and implementation of network initiatives across the care continuum. This need must be balanced with the desire to reduce the amount of unnecessary meeting time.

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