Finance

This year, COVID-19 has had its impact on the hospital’s performance as with many other businesses across South Australia. In January and February 2022, we experienced further elective surgery restrictions in the state, and faced uncertainties about our planned activity and performance for 2021-22. Product supply lines continued to be disrupted by shipping issues and international logistics and, along with raw material shortages, threatened the supply of medical and surgical consumables needed to run the hospital, particularly personal protective equipment like masks and gloves. Prices of essential items became increasingly costly. Inability to recruit overseas nurses put pressure on our recruitment efforts, resulting in increased costs.

The year ahead was to be challenging and we planned accordingly. However, throughout this difficult time, we maintained a solid financial performance, allowing us to keep our long-term commitments to programs such as our Engineering Services Masterplan and our regular capital spending program.

Our finance team continues to work closely with other staff around the hospital, providing key support services such as billing, payroll, accounts payable, accounting and financial reporting. The team takes on the responsibility for collecting and distributing our money and ensuring that our financial commitments to employees, contractors and suppliers are met on time. In a national economy that is becoming increasingly precarious, we have a reliable team looking after our finances.

Clinical Costing Analyst

Our Clinical Costing Analyst continues to work with management and staff throughout the hospital to strengthen our understanding and management of clinical costs. The Revenue and Clinical Costing Working Group has been established to discuss and address areas of interest, specialist activity, and issues that impact revenue and clinical costs at St Andrew’s.

Quarterly costing and revenue reports are routinely provided to the Finance & Audit Committee. The Clinical Costing Analyst now provides ad-hoc theatre utilisation and hospital activity reports to clinical staff, and has assessed the funding impact of changes to MBS item numbers and prosthetic item listings. The Clinical Costing Analyst is currently engaged with key staff in Finance, Supply and Theatre to enhance the capture of medical and surgical supply usage enabling the hospital to better understand and manage these significant costs. The Power Performance Management (PPM) costing system was used to identify the impact of COVID-19 in the 2019-20 financial year when hospital surgical activity was restricted for the first time, and again in January/February of 2021-22.

Our participation in the annual Private Hospital National Hospital Cost Data Collection continues.

Supply Department

2021 saw the arrival of Jules Jardine as Supply Manager to the team. The first six months of this financial year was centred around strengthening the team, building consistency in processes through training and creation of standard operating procedures (SOPs) for core supply department tasks. In the latter half of the financial year, the focus switched to inventory optimisation strategies for consumable inventory throughout the hospital.

Personal Protective Equipment (PPE) stock levels continued to be managed to ensure the minimal impact on SAH operations. With the sourcing of N95 masks and rapid antigen tests requiring a high level of attention, the professionalism and commitment of the supply team ensured a smooth transition to the increased PPE requirements.

The global market conditions have continued to present the supply department with challenges. The global pandemic, raw material shortages, supply chain disruption, and the war in Ukraine have led to escalating costs and shortages. The supply team has had to manage an exorbitant number of lines where product is not available, working closely with clinical teams across the hospital and suppliers to identify potential alternate products. Many challenges presented themselves when predicting problems that may occur if products could not be sourced.

To combat the rising costs, the team has identified key areas/functions that will lead to improved supply chain operations and inventory optimisation. Some initiatives include:

• Strengthening relationships between supply department and key suppliers and their representatives to create a more collaborative supply chain • Creation of KPIs to focus on reduction of excess, surplus and expired stocks to reduce costs and optimise inventory being purchased and held

Pre-COVID-19 (2019) saw a change in the way inventory was managed throughout the hospital, moving from an imprest type system to multiple warehouses throughout the hospital managed by the supply department. Refining this change since implementation, however, was hampered by the pressures of the pandemic. A renewed focus on these 8,000+ stock locations is now being rolled out, with the supply chain principles of right item, right time, right place being key to planning.

Although this has been a challenging time globally for supply chains, the supply team is motivated to be part of the solution and continue to provide a high level of service to St Andrew’s. Initiatives that will be rolled out over the next 12 months will bring with them opportunities for cost savings through inventory optimisation, process improvement, and team growth and skills development.

Health Information Management

The Health Information Service continued to streamline and enhance services and performance despite the ongoing challenges of COVID-19 through agile and creative solutions.

The Clinical Coding unit has farewelled four staff with minimal impact on service provision as the result of an ongoing proactive recruitment and training development program which has been in place for several years. The unit currently employs two trainee coders who have completed their formal qualifications in clinical classification and are now being mentored through an internal development program. In early 2022, we were pleased to be able to provide a professional placement for a first year La Trobe University graduate-entry Master of Health Information Management student. The student has subsequently been offered a trainee position at the hospital while completing her studies.

A successful upgrade to the new National ICD-10-AM/ ACHI/ACS Clinical Classification 12th Edition was achieved, effective for all data from 1 July 2022. This upgrade was required to meet legislative reporting and patient billing processes at both the state and national level. All Clinical Coding staff have successfully completed online training to demonstrate competency requirements to support this change.

The Health Information Service is also overseeing the delivery of new legislated reporting requirements as a result of changes to the SA Private Hospital Health Care Regulations which came into effect on 1 July 2022. This includes new reporting of non-admitted emergency care service events and sentinel events. Support to the hospital’s participation in My Health Record is also being provided.

The first step of the St Andrew’s clinical documentation improvement program has been achieved in partnering with the nationally recognised leader in this field (CDIA). An audit was conducted that assessed the quality of our medical record documentation to substantiate the care and treatment provided to patients admitted to the hospital. This audit was able to identify key areas for improvement to ensure our hospital funding better reflects our patient complexity. The findings have provided a successful proof of concept to underpin the rollout of the program.

The Health Information Service continues to be represented on a number of state and national committees in the health information and coding fields.

Payroll Services

Payroll Services has continued to experience a growth of workload due to the increase in headcount within St Andrew’s.

St Andrew’s worked with other private hospitals as part for the SA Health Viability Agreement, resulting in Payroll Services working closely with our managers to roster staff at their average hours worked 12 months prior to entering the agreement. Each fortnight, Payroll Services was required to compare the staff’s actual earnings for the fortnight to their 12-month average earnings, and pay a top-up if required.

Payroll Services was one of the major stakeholders in the delivery of the online recruitment system, StandTalent, an onboarding system, and has worked closely with HR to ensure the implementation of the system.

The payroll team continued to collaborate with HR during the St Andrew’s Hospital Nursing Enterprise Agreement 2021-2023 bargaining period, providing financial modelling for changes in terms and conditions.

The finalisation of the St Andrew’s Hospital Nursing Enterprise Agreement 2021-2023 resulted in 481 back payments, reflecting the growth in clinical staff over the three years. St Andrew’s approached automations solutions company, Simplyai, to assist with these back payments. Simplyai delivers on automation technology, executing high volume repetitive tasks reducing personnel’s risk of errors, labour costs and fatigue. Simplyai assisted Payroll Services to deliver 481 back payments in 10 hours, and within the fortnight pay period after the enterprise agreement was accepted by the clinical staff.