Annual Performance Report Eastern Regional Health Authority 2005 - 2006
Table of Contents
1. 2.
Message from the Chair, Board of Trustees, and President/CEO .......................................... 3 Overview..................................................................................................................................................... 4 2.1. Finances .......................................................................................................................................................5 2.2. Statistics .......................................................................................................................................................7 2.3. Vision.............................................................................................................................................................8 2.4. Mission .........................................................................................................................................................8 2.5. Values............................................................................................................................................................8 2.6. Lines of Business.......................................................................................................................................9 2.5.1. Promote Health and Wellbeing .............................................................................................. 9 2.5.2. Provide Supportive Care............................................................................................................ 9 2.5.3. Treat Illness and Injury..............................................................................................................10 2.5.4. Advance Knowledge .................................................................................................................10 3. Shared Commitments..........................................................................................................................11 4. Outcomes of Objectives .....................................................................................................................13 5. Government Directions ......................................................................................................................17 5.1. Strategic Direction #1: Improve Population Health ................................................................17 5.2. Strategic Direction #2: Strengthened Public Health Capacity ............................................18 5.3. Strategic Direction #3: Improved Accessibility to Priority Services...................................18 5.4. Strategic Direction #4: Improved Accountability and Stability in the Health and Community Services System Within Available Resources.....................................................21 6. Opportunities and Challenges .........................................................................................................23 7. Audited Financial Statements ..........................................................................................................25 8. Appendix I – Eastern Health’s Health Service Facilities and Bed Numbers.....................26 9. Appendix II: Statistics By Facility .....................................................................................................27
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1.
Message from the Chair, Board of Trustees, and President/CEO
This performance report signifies a major milestone in the life of Eastern Health. It provides a summary of the activities that have occurred in our first full fiscal year of operation. On the one hand, the year has been about change, learning and growth. The complexities of integration are enormous and much effort has gone into the creation of this new organization. Activities such as the development of the Board of Trustees’ strategic plan, the completion of the management recruitment process and the work in the areas of administrative and clinic integration clearly indicate that the organization is headed in the right direction. All of these efforts are being made to achieve our mission of providing health and community services along an integrated continuum within its regional and provincial mandates and available resources to improve the health of people and communities. On the other hand, while integration proceeds, our clients, patients and residents still require the quality care that they are accustomed to receiving. Across our region, from Port Blandford to St. John’s, including the Bonavista, Burin and Avalon Peninsulas, and across the province, we continue to offer high quality public health, long-term care, community services, hospital care and unique provincial programs and services. We must offer these services in an environment that is collaborative, safe and respectful for our staff, physicians and volunteers. We acknowledge the dedicated staff, physicians, volunteers and community partners who are committed to the well-being of the people we serve. We recognize that times of transition can be difficult but we are very proud of the people who contribute so significantly to the success of our organization. In addition we want to acknowledge and thank our retirees who helped build the solid foundation that Eastern Health is built upon. We are proud of our past, we acknowledge the work ahead and we look forward to a future of Healthy People, Healthy Communities. We are accountable for the preparation of this annual performance report and the results achieved by Eastern Health in the 2005/06 fiscal year.
_________________________ Joan Dawe Chair, Board of Trustees
Eastern Health – Annual Report 2005 – 2006
__________________________ George Tilley President and Chief Executive Officer 3
2.
Overview
Eastern Health is the largest integrated health authority in Newfoundland and Labrador and offers the full continuum of health and community services, including public health, long-term care, community services, hospital care and unique provincial programs and services. The geographic catchment area for Eastern Health is the area east of (and including) Port Blandford and includes the Avalon, Burin and Bonavista Peninsulas as well as Bell Island - a population of over 290,000. With a geographic territory of approximately 21,000 square kilometres, the boundaries of Eastern Health include 111 incorporated municipalities, 69 local service districts and 66 unincorporated municipal units. Eastern Health has the provincial responsibility for providing tertiary level health services which are offered through its academic healthcare facilities and also the provision of provincial programs such as the Provincial Genetics Program and Provincial Perinatal Program.
Eastern Health has: • A workforce of over 12,000 people. • 27 health service facilities: seven acute care facilities, six community health centres, twelve long-term care facilities and provincial cancer care and rehabilitation centres. A listing of these facilities and their bed numbers is in Appendix I. • Community-based offices in 30 communities: Bay Roberts, Bell Island, Bonavista, Burin, Carbonear, Clarenville, Come by Chance, Ferryland, Grand Bank, Harbour Grace, Heart’s Delight, Holyrood, Lethbridge, Mount Carmel, Mount Pearl, Norman’s Cove, Old Perlican, Placentia, Portugal Cove, St. Lawrence, St. Bernard’s, St. Bride’s, St. John’s, St. Joseph’s, St. Mary’s, Trepassey, Torbay, Trinity, Whitbourne, and Witless Bay.
The organization has a significant role with its many partners in the education of the next generation of health providers and in the creation of new knowledge.
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Eastern Health has a physical presence in the communities noted on the map below. Figure 1: Eastern Health’s Region
2.1.
Finances
The audited financial statements are attached to this report. As outlined in Figure 2, 87% of Eastern Health’s revenue comes from the provincial plan. Figure 3 indicates the distribution of expenditures with 58% spent on patient/resident, client, medical and ambulatory services.
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Figure 1: Revenue by Source, Fiscal Year 2005-06 Resident 3%
Other 3%
Non-Insured 2%
Provincial plan
MCP- Physician Compensation 5%
MCP- Physician Compensation
Non-Insured
Resident
Other Provincial plan 87%
Figure 2: Expenditure By Source, Fiscal Year 2005-06 Interest on long term debt and other 2% Research and education 2%
Administration 10%
Diagnostic and therapeutic 14%
Administration Support 14%
Support Patient, resident, client, medical and ambulatory services Diagnostic and therapeutic Research and education Interest on long term debt and other
Patient, resident, client, medical and ambulatory services 58%
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2.2.
Statistics
Statistics in selected areas are provided below. A further breakdown of acute care statistics by facility is in Appendix II. Hospitals and Primary Health Care Centres Patient Days Emergency Room Visits Surgical Daycare Births Clinic Visits Ambulatory Encounters Community Health Service Events 2 Mental Health3 Continuing Care/ Community Support Addictions3 Rehabilitation Community Youth Corrections Child Youth and Family Health Promotion and Protection Long-Term Care Admissions St. John’s Area Rural Eastern
2003-04
2004-051
2005-06
313,516 228,978 41,334 2,877 337,189 1,382,687
295,714 220,124 38,737 2,765 293,095 1,306,543
294,637 228,127 42,558 2,872 416,643 1,416,087
40,030 191,685
36,374 252,234
43,354 288,716
7,052 2,385 8,710
10,899 2,900 8,935
11,843 3,529 9,077
128,914 49,532
163,646 55,965
195,490 74.653
222
432 210
467 193
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During 2004 – 2005 there was a month long labour strike which significantly disrupted service delivery. 2 A service event is a surrogate for a patient or client visit. It is calculated by entries into the Client Referral Management System (CRMS). 3 Mental Health and Addictions numbers for the St. John’s area are estimates.
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2.3.
Vision
The Vision of Eastern Health is Healthy People, Healthy Communities. Our vision is rooted in the recognition that as an organization we must focus upon both individual and community approaches to health. Healthy communities enhance our prospect for individual health, and when individuals are healthy, communities are healthy. Eastern Health is committed to working with our partners towards our vision of Healthy People, Healthy Communities.
2.4.
Mission
By March 31, 2011, Eastern Health will provide health and community services along an integrated continuum within both its regional and provincial mandates and available resources to improve the health of people and communities.
2.5.
Values
The core values of Eastern Health offer principles and a guiding framework for all employees as they work in their various capacities to provide quality programs and services. The Board of Trustees of Eastern Health has identified the following values for the organization: Collaboration
Each person consults, cooperates, works and advocates with partners to improve services and the health of people and communities.
Confidentiality
Each person ensures individual privacy within policy and legal frameworks.
Excellence
Each person strives for leadership through sound judgment, decision making and competency, adhering to the principle of life-long learning.
Growth
Each person helps individuals and communities achieve their potential.
Integrity
Each person conducts himself or herself in an honest, just, fair and accountable manner.
Respect
Each person treats others with compassion and understanding manifested in their attitudes and actions.
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2.6.
Lines of Business
Eastern Health has four (4) primary lines of business: to promote health and well-being; to provide supportive care; to treat illness and injury and to advance knowledge. 2.5.1. Promote Health and Wellbeing Eastern Health implements measures that promote and protect population health and help prevent disease or injury. The main categories of programs in this line of business include: Health Protection – Disease Prevention, Health Promotion and Child Protection. Health Protection – Disease Prevention - This program is directed towards decreasing the probability of individuals, families, and communities experiencing health problems, assisting with the changes in physical and social environments needed to improve health, and implementing legislation/regulations to support improvements. Health Promotion - This program is responsible for the development, implementation and evaluation of a comprehensive range of population health and community development programs. These services are aimed at enabling and fostering individuals, families and communities to take control of and improve their health. This is accomplished through information sharing, community mobilization and capacity building, group facilitation, advocacy, and the provision of resource materials and the improvement of health status in our communities. These services can be conducted in partnership with other providers or provided to supplement services offered by other agencies. Child Protection - This program focuses on promoting the safety, well-being and protection of children. 2.5.2. Provide Supportive Care Eastern Health provides community-based support and continuing care, residential care options, home support and nursing home care for individuals with assessed needs. These services are provided in select locations and are means-tested and criteriabased. In many cases, there is a relationship with other Government departments such as Human Resources, Labour and Employment for subsidized funding to supplement program funding. The main categories of programs in this line of business are Individual, Family and Community Supportive Services, Short-term Residential Care and Long-Term Adult Residential Care. Individual, Family and Community Supportive Services - These programs provide financial and supportive services and case management for individuals of all ages with assessed need. The program focuses on supporting individuals/families/caregivers and promoting independence, community inclusion, safety and well-being. Services are Eastern Health – Annual Report 2005 – 2006
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limited and provision is based upon financial assessment and the individual’s ability to pay. Short-term Adult Residential Care - These programs provide short respite and/or transitional stays for individuals. The services are offered in selected locations. Long-term Adult Residential Care - These programs are responsible for residential nursing home care that is provided to individuals who require on-going support due to their frailty, disability or chronic illness. Access to services is through the single entry system where an individual’s needs are assessed and matched with appropriate available placements. 2.5.3. Treat Illness and Injury Eastern Health investigates, treats, rehabilitates and cares for individuals with illness or injury. The clinical intent of these services is to treat illness and injuries, relieve symptoms, reduce the severity of an illness or injury, and educate patients. In addition, we provide care at the beginning of life (newborn care) and at the end of life (palliative care). These services are offered in a variety of locations throughout the region. The location of specific services is dependent upon multiple factors including the level of care (primary, secondary and tertiary), access to health professionals and access to appropriate facilities. For certain services people can self-refer, while other services require a referral from a specific health professional. Eastern Health offers services through a variety of mechanisms. 2.5.4. Advance Knowledge Eastern Health is committed to advancing research, education and knowledge dissemination. The organization has a vital role in ensuring that the next generation of health professionals has an appropriate educational experience. We encourage staff and physicians to seek the best information and knowledge from multiple sources and to incorporate the evidence into their practice and standards. We are committed to ensuring that the challenges and issues we face in our day-to-day practice drives new research and education that leads to innovation. Education and research are collaborative endeavours, and our overall success is dependent upon our partnerships with affiliated organizations, particularly Memorial University of Newfoundland. Eastern Health also has permanent representation on the Board of Directors of the Newfoundland and Labrador Centre for Applied Health Research and the Newfoundland and Labrador Centre for Health Information. As new knowledge is created we will seek opportunities to promote knowledge transfer throughout the organization.
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3.
Shared Commitments
Eastern Health’s four lines of business—promote health and well-being, provide supportive care, treat illness and injury and advance acknowledge—have a wide variety of influences. Eastern Health recognizes the importance of working collaboratively with all of its partners. The provincial Department of Health and Community Services provides policy development and funding for all health authorities and we work co-operatively with officials from that department. As the provider of tertiary services for Newfoundland and Labrador, Eastern Health has a strong and ongoing relationship with the other three Regional Health Authorities; Central Health, Western Health and Labrador-Grenfell Health. Eastern Health communicates regularly with people at all levels of these organizations, from Board of Trustees to front-line staff. There are formal mechanisms for regular communication at the CEO and COO/ VP level. Eastern Health has a special relationship with the hospital in Saint-Pierre et Miquelon and has a tripartite agreement with Caisse de Prévoyance Sociale (CPS) and Centre Hospitalier F. Dunan (CHFD) to provide services to that population. Eastern Health is mindful of its role within its communities and liaises often with various groups and organizations that play an important role in influencing the determinants of health in our region. The organization has developed a protocol for linking with community groups and citizens which reflects Eastern Health’s commitment to community consultation, partnership and capacity building. Eastern Health has a responsibility to engage our community partners in order to achieve our vision of Healthy People, Healthy Communities. For example, while developing the strategic plan, the Board of Trustees sent questionnaires to a large number of community organizations, requesting their input into the perceived strengths and weaknesses of Eastern Health, as well as service and program gaps. While working on the Burin Peninsula Community Health Needs Assessment, an initial meeting with external stakeholders provided the opportunity to dialogue about the process to be used for the assessment. Additional meetings with municipal leaders and the establishment of an advisory committee provided a further indication of Eastern Health’s commitment to working with the community. A number of organizations have been devolved to Eastern Health, including family resource centres, open custody homes, and Grace Sparkes House, and we are working on developing our relationship with these organizations. Education and research are collaborative endeavours. Eastern Health has partnerships with over 40 education institutions and organizations to help educate the next generation of health providers. The organization has a particularly strong affiliation with Memorial University of Newfoundland for both its education and research initiatives. Eastern Health – Annual Report 2005 – 2006
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Our organization has permanent representation on the Board of Directors of the Newfoundland and Labrador Centre for Applied Health Research and the Newfoundland and Labrador Centre for Health Information. Our volunteers play a critical role in supporting our organization. Auxiliaries, volunteers and volunteens add tremendous value to the health sector and greatly enhance the quality of life for our patients, residents, clients and their families. From providing pastoral care to operating a gift shop, our volunteers selflessly contribute their time and talents to help others. Similarly, our foundations play a tremendous role in the health care sector by fundraising for health care equipment. We acknowledge the role of the board of directors and staff of our foundations: Burin Peninsula Health Care Foundation, Discovery Health Care Foundation, Trinity Conception Placentia Health Foundation, Health Care Foundation, Waterford Foundation, Dr. H. Bliss Murphy Cancer Care Foundation and the Janeway Children’s Hospital Foundation. During this past year our foundations have held special events, created corporate initiatives and organized telethons so that our patients, residents and clients can have access to appropriate health care technology. Eastern Health has a unique relationship with faith- and fraternity-based private not for profit organizations for the delivery of long-term care services in St. John’s. We work closely with these organizations to ensure the appropriate delivery of long term care to our residents. We recognize the importance of working with many stakeholders in order to achieve our strategic and operational goals and to ultimately achieve our vision of Healthy People, Healthy Communities.
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4.
Outcomes of Objectives
Since its formation on April 1, 2005, the Board of Trustees and management of Eastern Health have worked diligently integrating seven formerly individual health organizations into one organization with both a regional and provincial mandate. Many of this past year’s highlights are associated with administrative and clinical integration. Board Governance – As the people responsible for governing a new organization, the Board of Trustees has undertaken an ongoing series of orientation sessions to acquaint themselves with the region and the mandate of the organization. The Board also undertook education sessions on policy governance and will be developing a policy governance model. Governance and by-laws were developed and approved by the Board in September 2005. These by-laws were developed in accordance with all legislation requirements and were adopted to regulate the affairs of Eastern Health. The four health authorities in the province have been working with the Newfoundland and Labrador Health Boards Association (NLHBA) to develop a standardized set of medical staff by-laws. This template will then be used to help finalize the by-laws for Eastern Health. Strategic Plan – One of the first duties undertaken by the Board of Trustees was the development of their Strategic Plan 2006–08. This plan was developed by using administrative sources and secondary research and by receiving input from internal and external stakeholders. The strategic plan is in accordance with the legislative requirements as defined in the Government of Newfoundland and Labrador’s Accountability and Transparency Act and will be reported on in subsequent annual performance reports. In addition to the mission, vision and values, the plan outlines four goals that the Board will focus on for the next two years. The Strategic Plan was submitted to the provincial government in Winter 2006 for their approval. Operational Plans – With the completion of the Board’s strategic plan came the opportunity to develop operational plans at the Executive Team and Director levels. Using the Board of Trustees’ Strategic Plan 2006-08 and the strategic directions as outlined in the Department of Health and Community Services’ Strategic Plan 20052008, the Executive Team of Eastern Health developed an operational plan that identified priority issues and associated goals. Late in the 2005/06 fiscal year, the Directors began to develop their operational plans. Budget - Through substantial effort and vigilance, the organization balanced its first budget. Staff vigilance and financial monitoring will play an important role to ensure that Eastern Health continues to operate within its budgetary allotment.
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Administrative Integration – The process of integrating seven organizations and a workforce of 12,000 is very complex. Throughout the integration process the organization sought opportunities to standardize processes and identify economies of scale associated with the reduction in duplicate systems. In addition to the leadership provided by the Executive Team of Eastern Health, an Administrative Transition Steering Committee was established to facilitate the transitional process for administrative departments such as Human Resources, Finance and Information and Management Technology. Integrating the administrative areas will help to move other parts of the organization through the transition phase. During 2005/06, budgeting and accounting staff developed a scripting process to centralize financial reporting to one system. Even though our systems continued to operate on a decentralized basis, our accounting and budget monitoring occurred as though we had a single system. This was critical to ensure proper budgeting and accounting controls were in place as we reorganized our administrative structure. It was also critical in meeting year end financial statement audit deadlines. In addition to the financial side of the organization, integration efforts have also been made in the area of environmental services to provide opportunities for staff to share their knowledge and expertise. We have reorganized our Materials Management and Infrastructure Support departments into region-wide services, attempting to strike a balance between a centralized approach to service management and responsiveness to local concerns of our health services providers. Through expansion of our city facilities’ dietary services management contract and the expansion of our rural facilities’ support services contract, our focus is on meal quality and cost-effectiveness, being particularly mindful of the special concerns of those who call our facilities home. Clinical Integration – Many complexities exist within the clinical side of the organization and time is being taken to finalize structures on the health-delivery side of our organization. The organization wants to ensure that it is people centered and evidence based as we seek mechanisms to strengthen the continuum of care. We have sought out opportunities to develop clinical networks where groups of providers with similar roles throughout our large geographic area can work collaboratively to optimize service delivery. A number of our clinical areas have already made progress in this area. Within the Mental Health and Addictions area, a Joint Mental Health and Addictions Service Planning Group was formed to integrate two separate plans from the founding organizations into one regional implementation plan for Eastern Health. This plan has now been developed and will form the basis of ongoing planning for Mental Health and Addictions services in the region.
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A regional Public Health Network was established by the organization to provide leadership and expertise for the planning and coordination of public health programs and services. A sub-committee of this network is reviewing all public health programs in an attempt to deliver more evidence-based and standardized programming throughout the region. A Long-Term Care and Community Supportive Services Network is in place to develop strategies across the region for consistent and evidenced-based service delivery within allocated resources. Within many program areas, managers meet regularly for regional planning to ensure consistency across the region while remaining flexible to community needs. Community Partnerships – As an organization with a vision of Healthy People, Healthy Communities, the importance of partnerships cannot be overstated. Eastern Health takes many opportunities to dialogue with community stakeholders and to engage with its partners. Developing the Board of Trustees’ strategic plan involved a comprehensive assessment process involving a number of internal stakeholders as well as community partners. The Board of Trustees holds its meetings throughout the region. During these visits, the Board takes the opportunity to hold public information sessions and to hold informal discussions with community representatives. Sessions have been held in the Burin, Placentia, Bonavista and St. Mary’s areas. A preliminary meeting with the Rural Secretariat Regional Planners in the Eastern Health catchment area occurred in 2005/06 and regular meetings with the Rural Secretariat will be ongoing to discuss common issues. A provincial forum has been established with the Department of Human Resources, Labour and Employment to ensure appropriate dialogue and identification of similar priorities. Research and Education – One of Eastern Health’s lines of business is to advance knowledge. Many strides were made in this area in 2005/06. Research activities ranged from four research projects completed by the Early Psychosis Program to research in many areas of Children’s and Women’s Health including juvenile diabetes and childhood obesity, and Seamless Care Outcome Research Project which involved comprehensive pharmaceutical care for study intervention patients. Within the Centre for Nursing Studies, the Practical Nursing Program, the Nurse Practitioner Program and the Bachelor of Nursing (Collaborative) Program anticipate 126 new graduates during the 2006/07 fiscal year. This past year, Memorial University’s Senate Committee on Undergraduate Studies approved a revised curriculum for an amended Bachelor of Nursing (Collaborative) Program. Eastern Health – Annual Report 2005 – 2006
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Eastern Health has an important role to play in the education of future health providers. Within Allied Health, for example, 186 students were provided with clinical placements. Learning within the health sector is continuous. As new knowledge is learned, it is important to transfer that knowledge to colleagues and co-workers. Eastern Health offers many education opportunities. Sessions such as a Clinical Leadership Program for Patient Care Co-ordinators, LPN Medication Administration Courses, and mock disasters provided excellent learning opportunities. Infrastructure and Capital Equipment – During the fiscal year 2005/06, there were a number of announcements related to capital equipment and infrastructure improvements. On April 11, 2005, a new hemodialysis unit in Carbonear accepted its first patient. This satellite dialysis unit can provide hemodialysis for 12 patients. In March 2006, government announced funding for a satellite dialysis unit on the Burin Peninsula. Work will now begin on preparing for this new service. A number of improvements in the area of Diagnostic Imaging were made in the 2005/06 fiscal year, including funding approval for a second Magnetic Resonance Imaging (MRI) machine to be located at the Janeway Children’s Health and Rehabilitation Centre. This MRI will enhance the health care services offered regionally and provincially. New 64slice CT scanners were installed at St. Clare’s Mercy Hospital and the General Hospital and government also announced funding for a CT scanner for the Burin Peninsula which will be operational by Fall 2006. Improved infrastructure also occurred within the Laboratory Program, including replacing chemistry and/or haematology equipment at Eastern Health sites in Bonavista, Grand Bank, St. Lawrence, Old Perlican, Placentia and Whitbourne. This new equipment has resulted in increased automated processing and testing capabilities. Concept design for a new primary health care clinic in Grand Bank was completed as was a preliminary analysis of renovations for Blue Crest Nursing Home, Grand Bank. Concept and detail design work was completed for a new long-term care facility in Clarenville. Planning commenced for a 14-bed extension to the Caribou Memorial Veterns Pavilion at the Leonard A. Miller Centre. The new unit will provide care for residents with dementia and allow for three semi-private rooms. In St. John’s, construction was completed for a methadone clinic and an adolescent day program for adolescents with addictions. Pandemic Planning – In 2005 the organization seconded staff to work on the development of an Eastern Health Pandemic Plan which will be aligned with the Provincial and National initiatives in this area. Significant work continues in this area and the organization is planning to be prepared to release its initiative following the release of the Provincial plan in the forthcoming year. Eastern Health – Annual Report 2005 – 2006
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5.
Government Directions
In its Strategic Plan 2005-08, the Government of Newfoundland and Labrador outlined four strategic directions. Eastern Health has contributed significantly to the Department of Health and Community Services’ four strategic goals as outlined below. The lists below are not exhaustive but rather serve to indicate the progress that Eastern Health has made in these areas.
5.1.
Strategic Direction #1: Improve Population Health
The province has high rates of several chronic diseases, high rates of negative outcome behaviours and low rates of preventative self-care practices. A number of Eastern Health’s activities during this past fiscal year were aimed at improving the health of our population. Some of these activities included but are not limited to: • • •
• •
• • • • •
Launched Our Health magazine, which provides practical and locally relevant health information and showcases the services and the people of the region. Participated in the healthy aging consultations of the Department of Health and Community Services which will lead to the development of a healthy aging framework. Participated in the development of a provincial cancer control strategy, including the co-ordination of a provincial stakeholder forum. Working groups were established to determine priorities and make recommendations in a number of areas. Began work on the Provincial Cervical Screening Initiatives Program in rural Eastern to educate the public and health professionals on the importance of screening and the risks related to cervical cancer. Began implementation of the Chronic Disease Management Diabetes Collaborative in the three primary health care teams in the region--Bonavista, Placentia and St. John’s to improve the care of individuals living with diabetes and to prevent people from developing the disease. Began development of a newborn hearing screening program in the region. Implemented a Lymphedema Prevention and Pilot Project, funded by a grant from the Canadian Breast Cancer Foundation. Offered a tobacco control workshop for 43 downtown St. John’s primary health care providers. Initiated the Nurses’ Care Program – Fax Referral Program whereby nurses are actively referring patients to the Smoker’s Helpline. Implemented a Building A Better Tomorrow Initiative, designed to support staff in working in an enhanced primary health care model, with over 400 staff attending these sessions.
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5.2.
Strategic Direction #2: Strengthened Public Health Capacity
The core functions of the public health system include population health assessment, health surveillance, prevention, health promotion and health protection as well as responsiveness to public health issues and planning for disaster and emergency planning. A number of Eastern Health’s activities during this past fiscal year were aimed at strengthening public health capacity. Some of these activities included but are not limited to: • • • •
• • • • • •
5.3.
Established a regional Public Health Network to provide leadership and expertise for the planning and coordination of public health programs and services. Offered three new vaccines for infants within the routine immunization schedule. Expanded the immunization program to include meningococcal vaccine for school-aged children. Recruited additional public health nurses. These professionals will help to reduce child health clinic waitlists, increase annual influenza coverage, provide greater support to high-risk families under the Healthy Beginnings program and increase surge capacity in the event of a pandemic. Registered 30 health promotion initiatives in rural Eastern Health. These initiatives ranged from Moving for Health to increasing breastfeeding initiation rates. Developed a pandemic influenza plan for long-term care homes in Eastern Health in line with provincial and national initiatives. Provided a provincial education and networking initiative with the Centre for Pain and Disability Management. Developed a proposal for the Community Crisis Service in response to community emergencies in the seniors’ population in the St. John’s area. Implemented community integration programs within the rehabilitation/continuing care area, including Cook Smart and a brain injury group. Initiated a collaborative forum with the Rural Secretariat to work towards common priorities.
Strategic Direction #3: Improved Accessibility to Priority Services
There are many challenges associated with providing health and community services in a province with a vast geography and a declining and aging population. Ensuring access to services requires extensive planning. A number of Eastern Health’s activities during this past fiscal year were aimed at improving accessibility to priority services. Some of these activities include but are not limited to:
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• • •
•
• • • • • • • • •
• • • • •
Integrated two mental health and addictions implementation plans from founding organizations to form a new regional plan for mental health and addictions services. Developed and implemented a tele-oncology project funded by the Dr. H. Bliss Murphy Cancer Care Foundation to provide specialist services and education via telemedicine. Provided opioid treatment service with over 200 individuals accessing the program in the first six months of operation and we also organized a methadone training workshop for physicians, pharmacists and addictions counsellors from across the province. Increased the age of clients served at the Janeway Children’s Health and Rehabilitation Centre to age 18. Implemented a home Infusion chemotherapy project in the St. John’s area. Developed an electronic wait time measurement system in radiation therapy. Piloted the InterRAI Community Mental Health Assessment Tool which helps to evaluate the strengths, preferences and needs of adults with mental illness living in community settings. Began work with community partners to identify a range of supportive housing options for youth. Continued to work on the expansion of cancer clinics in Grand Falls and Gander with the clinics scheduled to be open in 2006. Standardized the referral process for all patients requiring rehabilitation which has reduced the wait time for people who live outside the region. Reviewed the application for nursing homes, personal care homes and community living and supportive services with a goal to have one integrated form for the region. Established a committee to look at shared intake processes for mental health services in youth in the St. John’s area with a goal to enhance service coordination for children and youth with mental health and addictions issues. Initiated a community corrections pre-employment program, Planning for the Gateway, for youth with multiple barriers to employment and training with a goal of introducing them to a positive learning environment and increasing their motivation to continue their learning/training. Established a Community Advisory Committee to assist in the planning for an adolescent day treatment program. Developed a position paper, provided education and purchased specialized equipment for bariatric medicine/surgery. Completed a discussion paper and consultation around cultural diversity. Implemented a 24/7 on-call French translation service for the St. John’s hospitals. Established a committee with the Department of Human Resources, Labour and Employment and the youth services residential program to review the process of transferring clients from youth services to income support.
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• • • • • • • • •
• • • • • • • • • • • •
Worked with seven child care centres in the region on Enhancing Quality in child care centres Universally Inclusive Programs (EQUIP) to provide high quality care and good outcomes for children in licensed child care centres. Implemented new services/procedures such as endovascular surgery. Expanded minimally invasive surgery to nephrectomies and colorectal surgery. Developed a multi-disciplinary adult cystic fibrosis clinic. Piloted an early intervention social work discharge project for joint replacement. Implemented an adult geriatric clinic to support the frail elderly. Implemented new Visudyne clinic for sight restoration. Developed and operationalized a sexual assault nurse examiner service in St. John’s. Expanded nurse practitioner services in a number of areas across the region, including the Grand Bank Community Health Centre, U.S. Memorial Health Centre, Dr. Walter Templeman Health Centre, St. Clare’s Mercy Hospital and the General Hospital. Implemented a nurse managed follow-up clinic for cardiac devices (ICD, pacemakers). Began endovascular (abdominal and aortic) grafting program. Added Tropmin testing at the U.S. Memorial Health Centre and the Dr. William Newhook Community Health Centre. Implemented enhanced clinical information support tools in partnership with the Canadian Institute for Health Information. Improved wait-times in a number of areas across the region, including echocardiology, cardiac surgery and speech language pathology. Increased the number of surgeries and procedures in a variety of areas, including general surgery and urology surgeries. Implemented telehealth clinics for assessment and follow-up of heart and lung transplants through the Toronto Health Network. Implemented a pilot project in long-term care in St. John’s to more effectively respond to the care needs of individuals with challenging behaviours and to enhance the knowledge of clinical staff in challenging behaviours. Worked with new regulations permitting the licensing of adoption agencies to be able to deliver orientation and training for agency applicants. Worked with provincial Pictorial Archiving Communications System (PACS) group to implement a provincial model for PACs. The Eastern Health data centre will host the provincial database. Implemented Meditech’s Meditime Lab Order/Results System among various sites around the province. Hired a regional director of Primary Health Care with regional responsibilities for supporting the current primary health care initiatives in Bonavista, Burin and St. John's and for developing a regional primary health care plan.
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5.4.
Strategic Direction #4: Improved Accountability and Stability in the Health and Community Services System Within Available Resources
Government and public bodies must be accountable to ensure the wise and prudent use of public resources and demonstrate performance achievements. This requires quality information for both decision-making and reporting in the health and community services system. A number of Eastern Health’s activities during this past fiscal year were aimed at improving accountability and stability in the delivery of health and community services within available resources. Some of these activities included but are not limited to: • • • • • • • • • • • • • • • •
Initiated a community health needs assessment on the Burin Peninsula to assess the health needs of that population based on the full continuum of care. Established a Long-Term Care and Community Supportive Services Network to develop strategies across the region for consistent and evidenced-based service delivery within allocated resources. Developed a workforce plan and initiated plans to expand the Human Resources Information System across the region. Implemented an allied health professional practice self-peer review process. Developed and implemented a priority rating system for elective adult surgery and reviewed adult surgery waitlists. Developed and implemented computerized approaches to support the data collection and reporting to the Department of Health and Community Services of identified wait-times. Implemented a cardiac database within the Cardiac/Critical Care Program. Developed and distributed a secondary service access report for the three other health authorities in the province. Developed an inventory of evidence-based practice protocols within the Clinical Efficiency Unit. Improved patient length of stay variances in the inpatient programs in St. John’s. Implemented the Managed Care Appropriateness Program within acute care in the region to identify appropriateness of admission. Provided Quality Professional Practice Environment Program projects in Carbonear, Clarenville and St. John’s. Participated in accreditation in a number of different areas, including dental services and mammography. Established human resources and clinical processes for the ongoing skill enhancement of RN’s and LPN's, particularly related to health assessment LPN medication administration. Reviewed compliance with provincial long-term care facilities operational standards for Eastern Health’s long-term care facilities and put an action plan in place to ensure ongoing monitoring. Reviewed care policies and practices for long-term care.
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• • • • • • •
Secured permanent funding for introduction of a new service delivery model for Early Intervention Services. Introduced clinical psychology services for adults with mental health issues who are served by the developmental program of Community Behaviour Support Services. Worked collaboratively with partners to establish residential proposals for less restrictive living arrangements for some Community Living and Supportive Services clients. Revised a role delineation document for Allied Health Professional Practice. Implemented the Resident Assessment Instrument within the long-term care setting. Developed Piecing It Together package for promotion of patient safety. Developed principles to guide the delivery of resident-centred care within nursing homes. An action plan is in place to facilitate implementation of the plan.
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6.
Opportunities and Challenges
Clearly the most significant opportunity for Eastern Health is within the organization itself as it integrates seven distinct organizations together. This merger offers the opportunity to provide the full continuum of care to our clients, patients and residents. There is substantial work to be done as an organization as complex and large as Eastern Health proceeds with its integration plan. This includes developing a culture and workplace that is healthy, respective and a collaborative environment. As Eastern Health grows, it is committed to becoming a national leader in its field. In addition to providing outstanding health services, Eastern Health will strive to be a workplace that is sought out by those seeking employment. As the largest health authority in the province, there is tremendous opportunity for partnerships with community organizations and educational institutions. Eastern Health has been involved in many community engagement activities this past year and we look forward to continuing this dialogue. The population of our province continues to decline, particularly in the rural areas. A declining birth rate, increasing out-migration and an aging population are resulting in communities that are getting smaller and have an increasingly aging population. As the population ages, there is increasing pressure on health and community services, particularly when community supports are not available. As the population gets smaller, it becomes increasingly difficult for towns to maintain existing infrastructure and levels of volunteerism, which can have an impact on the health of a community. Towns that become smaller and offer fewer services face challenges with the recruitment and retention of health care workers. The changes in demographics have implications on the accessibility of services and present opportunities for innovative solutions such as through the use of technology. Eastern Health has an aging infrastructure with many of our facilities requiring significant investment. While preventative maintenance is ongoing, it is a constant struggle to keep infrastructure at appropriate levels. Some of Eastern Health’s facilities are many decades old. The natural deterioration of infrastructure over time, the heavy use of the facilities and changes in the delivery of services means that substantial funding is required in order to keep our facilities up to a high standard. In addition, standards and public expectations change with time. In the long term care sector, the Board of Trustees of Eastern Health supported principles associated with improving residents privacy through the encouragement of semi private and private living arrangements. An appropriate allocation of resources is critical to a health and community services organization. New technology, drugs and treatments as well as external environmental factors can drive costs and challenge budgets.
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We work with a population that is becoming increasingly knowledgeable about their health and health issues in general. It will be important for Eastern Health to ensure that it engages individuals and their communities. The stress on budgets means that evidenced-based decision making and accountability are paramount. The links between financial and clinical data, the integrity of data and the formation of benchmarks and indicators emphasize the importance of consolidated information systems to ensure Eastern Health makes appropriate evidenced-based decisions. The recruitment and retention of health care workers, particularly physicians, pharmacists and allied health professionals are ongoing challenges, both provincially and nationally. We continue to implement multiple strategies to recruit and retain the highest trained and skilled workforce for the benefit of the organization. The health care sector is no doubt a challenging but rewarding one. The workforce of Eastern Health is committed to environmental-scanning to be cognizant of the opportunities and challenges that exist and to respond to them as appropriate.
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7.
Audited Financial Statements
Please see the attached audited financial statement.
Eastern Health – Annual Report 2005 – 2006
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As of June 2006
- Janeway Children’s Health and Rehabilitation Centre - General Hospital - Leonard A. Miller Centre - St. Clare’s Mercy Hospital - Waterford Hospital - Dr. Walter Templeman Health Centre - Salvation Army Glenbrook Lodge - St. Patrick’s Mercy Home - Saint Luke’s Homes - The Agnes Pratt Home - Masonic Park Nursing Home - Hoyles-Escasoni Complex - Carbonear General Hospital - Harbour Lodge Nursing Home - Carbonear Interfaith Seniors Citizen Home - Pentecostal Senior Citizen’s Home - Placentia Health Centre/Lions Manor Nursing Home - Dr. G. B. Cross Memorial Hospital - Burin Peninsula Health Care Centre - U.S. Memorial Health Centre - Bonavista Peninsula Health Centre - Golden Heights Manor - Dr. William H. Newhook Community Health Centre - Dr. A.A. Wilkinson Health Centre - Grand Bank Community Health Centre - Blue Crest Nursing Home - Hostel – Agnes Cowan Hostel TOTAL
Critical Care 25 32 0 16 0 0 0 0 0 0 0 0 6 0 0 0 0 4 4 0 0 0 0 0 0 0 87
Acute Care 53 312 58 188 73 8 0 0 0 0 0 0 74 0 0 0 10 43 38 0 10 0 0 4 0 0 871
1684
0 0 74 0 104 12 114 213 127 128 40 377 0 107 54 75 75 15 0 30 13 65 0 0 0 61
9
0
3 0 4
0
0
2
0 0 0
0 0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
Long-Term Holding Care
Appendix I – Eastern Health’s Health Service Facilities and Bed Numbers
Eastern Health
8.
2651
78 344 132 204 177 20 114 213 127 128 40 377 80 107 54 75 85 62 42 32 23 65 3 4 4 61
Beds Total
120 120
Hostel
Appendix II: Statistics by Facility
166 2,857 2,605 18,559 8,655 590 2,435 38,737
263 2,608 2,340 20,473 9,578 686 2,572 41,334 10,494 15,989 11,013 6,894 8,593 18,914 6,883
Clinic Visits Burin Peninsula Health Care Centre Bonavista Peninsula Health Centre Dr. G.B. Cross Memorial Hospital Grand Bank Community Health Centre U.S. Memorial Health Centre Dr. A.A. Wilkinson Health Centre Carbonear General
10,911 13,824 10,027 8,109 8,043 16,861 5,665
2,870
57,736 58,973 44,894 3,711 295,714
64,126 63,949 46,215 4,772 313,516 2,814
10,829 2,860 14,197 577 23,468 2,325 109,857 20,543
2004-05
9,900 2,904 14,729 682 24,615 2,342 114,110 20,344
2003-04
Surgical Day Care Burin Peninsula Health Care Centre (includes MDC) Bonavista Peninsula Health Centre (includes MDC) Dr. G.B. Cross Memorial Hospital (includes MDC) Carbonear General General Hospital St. Clare’s Mercy Hospital Waterford Hospital Janeway Children’s Health and Rehabilitation Centre Total Surgical Day Care
Patient Days Burin Peninsula Health Care Centre Bonavista Peninsula Health Centre Dr. G.B. Cross Memorial Hospital Dr. A.A. Wilkinson Health Centre Carbonear General Placentia Health Centre General Hospital Janeway Children’s Health and Rehabilitation Centre St. Clare’s Mercy Hospital Waterford Hospital Leonard A. Miller Centre Dr. Walter Templeman Health Centre Total Patient Days
STATISTIC
9.
11,208 13,502 10,740 10,152 7,811 16,341 7,568
42,558
2,987 21,280 8,965 658 2,577
3,020
192
2,879
57,947 60,066 44,387 4,326 294,637
11,120 2,771 14,581 712 22,077 2,793 107,795 20,116
2005-06
Births Burin Peninsula Health Care Centre Dr. G.B. Cross Memorial Hospital Bonavista Peninsula Health Centre Carbonear General General Hospital Total Births
ER Visits Burin Peninsula Health Care Centre Bonavista Peninsula Health Centre Dr. G.B. Cross Memorial Hospital Grand Bank Community Health Centre U.S. Memorial Health Centre Dr. A.A. Wilkinson Health Centre Carbonear General Dr. William H. Newhook Community Health Centre Placentia Health Centre General Hospital St. Clare’s Mercy Hospital Janeway Children’s Health and Rehabilitation Centre Total ER Visits
Placentia Health Centre Dr. William H. Newhook Community Health Centre Adults – St. John’s hospitals Children – St. John’s hospitals Total Clinic Visits
220,124
228,978
162 194 0 234 2,175 2,765
4,296 44,406 29,317 38,291
4,388 43,943 39,469 32,580
167 196 2 267 2,245 2,877
21,184 14,258 18,818 14,272 4,128 3,865 20,393 6,896
224,803 68,292 293,095
267,259 69,930 337,189 20,851 15,549 20,610 14,628 4,110 3,478 21,194 8,178
12,938 9,440
12,685 11,155
142 171 2 278 2,279 2,872
228,127
4,795 44,460 38,834 34,934
20,632 14,797 21,220 13,455 4,081 3,986 20,607 6,326
340,511 76,132 416,643
14,100 10,568