Meaford council presentation march 13 2017

The Journey Back to Balance Meaford Council March 13, 2017 GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

GBHS – Seven Sites

Meaford

Lion’s Head

Owen Sound Wiarton

Markdale

Southampton

Withdrawal Management Services

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

GBHS by the Numbers 1630 employees 250 physicians credentialed 1,100 volunteers Six hospitals, Withdrawal Management Centre All six hospitals have 24/7 ER, lab, x-ray $190+ million annual budget

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

GBHS at a Cross Roads If GBHS does not change its cost structure the annual deficit from operations is projected to exceed $17 million by the end of 2019/20

(4.5M)

(7.0M)

(12.0M)

(17.0M)

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Back to Balance Board approved action plan to reduce the operating deficit over four years.

Being Inclusive, transparent, respectful of all stakeholders Making evidenced-based decisions with measurable outcomes

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Current Initiatives

Wave 2 Initiatives

Surgical Services Review

Cafeteria Reviews

Internal Efficiencies

Retail Pharmacy/Gift Shop Remodel

Skill Mix Review

Energy Management

Ambulatory Care Review

Review of Uninsured Items (D-listed OHIP Items

OHIP Physician Billing and Recovery

Laundry Services

QBP Funding Maximization

Case Costing

Transportation Costs

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Surgical Services Review A year-long review of the GBHS elective surgery

Working group of staff and physicians from across all GBHS sites

5 options assessed for quality outcomes, patient experience, process efficiency and cost effectiveness

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Options Considered Option

Savings

1

Modifying the staff complement to a mix $186K of both Registered Nurses and Registered Practical Nurses

2

Consolidate all rural elective surgeries in Meaford and continue roaming endoscopy program

$270K

3

Consolidate all rural elective surgeries in Meaford and all rural endoscopies in Southampton

$295K (1/2 block Endoscopy Southampton/day surgery Meaford) $469K (Endoscopy full day block alternate weeks Southampton/Meaford

4

Consolidate all elective surgeries and all endoscopies in Owen Sound

$456K

5

Consolidate all elective day surgeries in Owen Sound and continue with rural roaming endoscopy program at all four rural locations

$550K

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Recommendation Consolidate elective surgery currently offered in Meaford, Markdale and Southampton hospitals into the surgical program at the Owen Sound Regional Hospital

Continue endoscopies in Markdale, Meaford, Southampton, Wiarton And Owen Sound

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Elective Day Surgery Elective surgery is scheduled in advance, and includes procedures such as knee scopes, carpal tunnel and other minor hand procedures, and minor foot surgery Patients are not admitted to hospital after surgery Surgeries that require an overnight stay (inpatient surgery) are not typically done at the rural hospitals

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Elective Surgery Volumes 10,000 elective surgeries at GBHS annually: 88% in Owen Sound (10 ORs, 1 procedure room) 5% in Meaford

(1 operating room)

4% in Markdale

(1 operating room)

2.5% in Southampton (1 operating room)

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Endoscopy A diagnostic procedure; not surgery e.g. colonoscopies

Less stringent requirements to maintain sterility of environment Conscious sedation; not deep anesthesia

Do not need a fully equipped Operating Room

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Endoscopy Traveling endoscopy program – no need to purchase five sets of instruments

Maintains presence at local hospitals of the 5 general surgeons who support the travelling endoscopy program

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Where do Patients Come From?

Local Resident Analysis - Meaford OR

Local Resident Analysis - Markdale OR

28% 33% Endoscopy

Endoscopy

Day Surgery

Day Surgery

Total Cases 710 Endoscopy 289 Day Surgery 421

78%

78%

Total Cases 1076 Endoscopy 597 Day Surgery 479

Local Resident Analysis - Southampton OR 31% Endoscopy Ear Nose and Throat Dental

21%

80%

Total Cases 577 Endoscopy 324 Ear Nose Throat 112 Dental 141

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Surgery – Owen Sound • 28 surgeons • 40 -70 elective surgeries booked per day

• Approx. 12,350 surgical cases/year (elective & emergency) • OR is staffed until 11:00 p.m. daily; back-up team on call as needed for urgent and emergency procedures 24/7

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Surgery – Owen Sound Owen Sound surgery program is at 87% capacity, with 5-6 operating rooms in use daily Consolidation will add 6-8 cases per day at Owen Sound There is capacity in Owen Sound to take on more surgery, without impacting inpatient beds (day surgery patients only)

7 OR rooms per day, hiring up to four additional staff, plus an additional anesthesiologist

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Benefits of Consolidation Standardized patient care pathway Same number of surgeries performed No increase in wait times Annual operating budget savings of $550,000 Eliminates the need to invest $3 million to replace/refresh surgical equipment and sterilization systems, and other needed improvements to rural operating rooms

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Considerations

 Patient first/ quality of care

 Economic impact  Social Impact

 Staff  Financial  Physician livelihood

 Physician recruitment

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Considerations Markdale OR is not adequate Southampton OR in critical need of a new HVAC system to maintain sterile environment All sites require new sterilization equipment and anesthesia machines Lack of infrastructure investment at Owen Sound may hinder recruitment of new surgeons and anesthetists

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Capital Needs Capital Need

Current State (Status Quo)

New State (Proposed)

Current Owen Sound operating room capital needs

$4M

$4M

Complete replacement of anaesthetic gas machines

$2M

$1.4M

Immediate equipment upgrades in Owen Sound Medical Device Reprocessing Department (sterilization)

$1M

$1M

Immediate upgrades to Southampton operating room, Medical Device Reprocessing Department HVAC system

$2M

-

There are a number of operative procedures that require fluoroscopy (x-ray visualization). To bring the operating rooms up to current standards, the walls need to be lead-lined. This is a standard for any operating room

$2.5M ($500K x 4 rooms in Owen Sound + 1 in Meaford)

$2M

Lighting upgrades to all Owen Sound operating rooms

$700K

$700K

Renovations will be needed to the Owen Sound Post Anaesthetic Care Unit, Day Surgery and Endoscopy suite regardless of consolidation

$2M-$4M

$2M-$4M

Meaford Medical Device Reprocessing Department equipment

$210K

-

Replace the entire fleet of travelling endoscopes

$1M-$2M

$1M-$2M

$18.5M

$15.1M

APPROX. TOTAL

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Back to Balance Efforts

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Next Steps Staff will report back to the Board in late April with a summary of stakeholder feedback and final staff position Decision in late April 2017 Implementation would begin October 2017 at earliest

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton

Opportunity for Input Phone: 519.378.1587 Email: Back2Balance@gbhs.on.ca

Website: www.gbhs.on.ca See also the Back to Balance Backgrounder and Transformation ActionPlan

GBHS Lion’s Head | GBHS Markdale | GBHS Meaford | GBHS Owen Sound | GBHS Southampton | GBHS Wiarton