“Competing priorities” is a constant concern for staff in Saskatoon Health Region. Work on safety, patient flow and the ever present budget pressures seem to be at odds with one another.

But do these priorities really compete with one another, or are they all linked together?

Looking at it in its basic form, the linkages are clear.

The Cycle

When there is a large influx of people seeking healthcare services at one time, the flow of patients through the system is affected. Emergency departments back up as hospital beds up in the units remain full. The unit hospital beds remain full when patients who no longer require hospital care but still need another form of care, have no alternative but to remain in hospital. Meanwhile, more patients are walking through hospital doors looking for help.

As these “system blockages” start to appear, staff and physicians work under increasingly difficult environments. Due to higher numbers of patients, staff care for a larger number of people at one time, which can lead to higher stress levels and increased sick time. Overtime costs then go up as managers work to fill shifts left empty by those who are sick. And some staff members decide to move to other positions, which means new people have to be trained to fill the positions left empty, and orientation costs rise.

“As all these costs add up, we see our expenses outpacing our revenues monthly,” says Nilesh Kavia, Saskatoon Health Region’s Vice-President of Finance. “The result is a deficit each month. This put us into a position where we were continually asking managers to decrease overtime and sick time costs and reduce safety incidents. Then, in the same breath, we were asking them to do the work needed to improve the system and provide better patient care and improve flow. That wasn’t working.”

Changing the direction of the cycle

Saskatoon Health Region took a different approach this year to change the direction of this cycle. Starting with the concept that by focusing on patient flow, we can build and improve safety and care, the work environment, and see expenses start to go down.

But it’s not a simple or fast journey.

First, teams did significant and focused work to improve patient flow. This included better handling of demand for hospital care by making system improvements to get patients where they need to be, at the right time.

“Services have been expanded to provide healthcare for people in their home community, instead of having them seek help in the emergency department. And we have our forecast model so we know when the surges in demand are coming, and we can prepare for them,” Kavia noted.

Improving patient flow also means better equipping managers to prepare their work environment for increases in demand for healthcare services, and eliminate safety risks.

“We have started to surround nursing managers with the supports directly on their units in areas like human resources, so they can in turn spend less time on administrative tasks and put more time toward supporting their patients and staff,” he added. “This support frees them up to work with staff on improving care and the work environment while eliminating safety risks. Rather than managers struggling to be experts in all things, such as scheduling and recruiting, we are pooling that work and asking the right administrative expert to take on this work for a group of nursing managers. They can often do it faster and more efficiently, allowing nursing managers to do what they do best, be experts in nursing.”

The units where these supports have been put in place are already showing a decrease in overtime hours.

“The results are encouraging and we are heading in the right direction. As we improve the work environment and safety for our staff, our ability to deliver improved care increases, even during peak times. And all this will add up long-term to a decrease in expenses, including overtime and sick time,” says Kavia.

Safety builds and links to patient flow

The Safer Every Day initiative is building on some of this important work, including things like creating a safety resource for units, tracking safety incidents, and to better respond to and learn from these incidents. Combine that with work to improve team communication, which will help patients, families and healthcare professionals anticipate and catch mistakes before they occur, and better identify risks for infections such as sepsis, and we create safer work and care environments.

“As we build systems to better protect each other and our patients, we can deliver care that will heal patients faster and get them to where they need to be,” says Kavia. “That means patients aren’t staying longer in hospital because of something we did incorrectly. It means staff and physicians aren’t living with the mental and physical effects of errors, adding to sick time. And all this adds up to decreased expenses.”

Continuing forward

System improvements so far have resulted in costs not increasing as fast as they should have given population growth.

But it won’t result in a balanced budget overnight. The journey is far from over, even though challenging times are ahead, both in terms of patient flow, and the Region’s financial situation.

The organization is presently trying to find approximately $4 million per month to close the gap between expenses and revenue, which means program and staff cuts are likely ahead in the coming weeks.

“It’s not what we wanted, or what we hoped, when we began this journey,” Kavia notes. “We believed the improvements we made to the system would result in an easing of financial pressures. That is happening, but not quickly enough to make a sufficient difference for this year.”

Despite the financial pressure, the Region remains committed to its goal.

“I believe we will reach it,” says Kavia. “We will become the best place for care, the best place to work, and the most innovative place in creating optimal health for the people of Saskatchewan. Why? Because we have the staff and physicians who have the will and the determination to make this happen.”