When you put the patient first, finances will fall in place. Saskatoon Health Region’s President and CEO Dan Florizone explains the logic.

When our model of care delivery is not effective, bottlenecks emerge in the system. Patients don’t receive care in a timely way. Parts of the system are put under pressure. The result is care units heading into overcapacity and services getting backed up. Over time, the stress takes its toll on staff and it starts to affect their health. They get injured or have to take sick days to deal with their own health matters. This puts more pressure on other staff members who have to work overtime to cover shifts. Those staff are paid a premium for their extra service, and therefore costs go up. 

Dan Florizone, President and CEO of Saskatoon Health Region.

Dan Florizone, President and CEO of Saskatoon Health Region.

By ensuring every person who seeks help from the Region gets the right care at the right place at the right time, staff will have a better place to work and be happier at work. This will result in lower costs for sick time and overtime.

This is how the initiatives of 90 Days of Innovation: Ready Every Day connect to the Region’s financials.

“Our plan is to remove the deficit through improved patient care,” Florizone stated. “What we’re doing, through some of the initiatives of 90 Days of Innovation, is designing care so that our staff are more relaxed, safe, calm, and able to deliver care to the right number of patients in one area. This not only ensures that patients receive the care they need, but staff will be happier to come to work.”

The Evolution of 90 Days of Innovation

In the past year, the demand for health services has risen. Last winter, in January and February, what was first thought to be a short spike in overcapacity at hospitals in Saskatoon did not abate as expected. It lasted, and that prompted Florizone to call the entire Region into action to solve patient flow issues through the Better Every Day 14 Day Challenge in February 2015.

“When we look at our workplace environment, it’s a stressful place,” he said. “Going into the 14 Day Challenge, we were asking our staff to perform heroics, to go above and beyond, day after day. It’s one thing to do it when we get a surge, but when that surge becomes the new norm, that’s not fair. It’s not fair to our staff, and definitely not fair to our patients. And we want to fix it.”

The 90 Days of Innovation: Ready Every Day initiative was born out of the successes of the 14 Day Challenge, and progress is starting to be made.

For example, one of the goals of Ready Every Day was to have 85 per cent of patients requiring admission to an inpatient unit from the emergency department into the unit within five hours.  The monthly average at the 60-day mark was 60 per cent across all facilities.

“But daily, we’ve exceeded that target. We’ve hit 90 per cent on certain days,” Florizone said. “Why can’t we do that every day? Those days prove the art of the possible. We just need to be able to do it every day, and that’s where the innovations that are part of our 90 Days come in.”

What makes a specialized bed so special?

Among those patients waiting more than five hours for a bed are those waiting for a very specialized bed – an observation bed or an isolation bed, or a telemetry bed.

“In order for us to be able to meet our goal of 85 per cent of admitted emergency patients arriving on their unit within five hours every day, we need to make sure we have rooms with the flexibility to become a specialized service,” Florizone explained.  “So when a physician orders observation, we can put that patient in any room and ensure they are observed the way the physician orders it.  That’s been my challenge to the clinical experts – why can’t every room be an observation room? What’s the care needed to make a room an observation room?”

Another focus during the 90 Days of Innovation has been on ensuring that today’s work is being done today.

“In terms of flow, when you experience a wait in the emergency department, it’s because there’s a lack of flow for inpatient services. We need to progress care on the inpatient side by doing today’s work today,” Florizone said.  “For instance, if an MRI is ordered, we do it today. It doesn’t matter what day of the week it is, or if it’s the weekend, the tests get done that day.”

Managers being present to support workers and patients

Part of supporting “today’s work today” is an initiative that sets out more supports for staff by freeing up managers to be more present on the floor to assist in solving daily challenges.  Three trial units have been set up testing decentralization of administrative supports. For instance, someone from Human Resources is physically present on the unit and looks after hiring for it.

“This is working on the test units,” Florizone reported. “The time managers are spending with their staff, on the floor, with the patients, went from three per cent to 13 per cent.”

They’re onto something with these units, Florizone feels. “We need to spread it everywhere, but we need to pace that thoughtful change. Over the next several months in follow-on, we will be watching to make sure we’ve got it right with these units, and deploying the structure to other units,” he said.

All of these changes will help them eliminate that deficit from the 2014-15 year, which was $19.3 million.

“We predicted a $40 million deficit last year and ended the year at $19.3 million,” said Florizone. “But I’m never happy with a deficit. I’ve never run a deficit before, and I don’t want to make a habit of running perpetual deficits. But you don’t get a balanced budget along with improved care and results by focusing on money alone.”

Patient-centred care in a provider-centred workplace

The vision, Florizone said, is to provide patient-centred care in a provider-supported workplace, resulting in meeting budget targets.

“With this thinking, we end up with less overtime, less sick time, fewer injuries in the workplace. We end up with a more caring environment, a better-paced environment. People are more relaxed, less stressed. We end up in a situation that’s really about providing more comfortable care in a more appropriate setting. We are really looking for a triple whammy here – better results, better care and lower cost, all at the same time. We’re going for all three. And we’ve proven through small changes, and small tests of change, that we can do it.”

“It’s not money first,” he said. “And the answer isn’t simply to cut costs. We need to make investments in the right places.”

See more stories about Region improvements at www.saskatoonhealthregion.ca/ReadyEveryDay.