Presentation to the County of Peterborough. Ken Tremblay, President & CEO April 6, 2011

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1 Presentation to the County of Peterborough Ken Tremblay, President & CEO April 6, 2011

2 PRHC... Is a regional centre serving more than 300,000 people in four counties Is the region's largest employer with 2,200 staff, approximately 350 physicians with privileges, and 600 volunteers Has an annual budget of $250 million Offers specialized services including cancer care, dialysis, cardiac catheterization lab, and interventional radiology, as part of one of the province s most technologically advanced Diagnostic Imaging departments

3 PRHC... Has one of the busiest Emergency Departments in Ontario, with more than 70,000 visits last year Outpatient visits: Oncology 14,376 Renal/Dialysis 20,056 Day/Night Clinic Visits 17,532 Other Clinic Visits 33,803 Admissions: 14,420, including 1500 deliveries Diagnostic Imaging exams: 120,445 Lab Tests: 1,306,424

4 PRHC s current priorities Sustain the fiscal recovery Shape a performance-based culture Build the regional platform

5 Sustain the recovery In its April 14, 2010 report, the Peer Review made 60 recommendations for improvements to the hospital 57 of those recommendations are now complete or in progress as part of the Hospital improvement Plan (HIP) These remaining HIP recommendations are expected to come on-line by the end of 2011 The CE LHIN and the Ministry of Health and Long-Term Care have both indicated approval of progress made Funding announcement April 1: MOHLTC and CE LHIN to provide one-time funding of $7.7M to help cover restructuring costs

6 Sustain the recovery

7 Sustain the recovery PRHC HIP Initiatives Committed vs Target Hip Initiative HIP Savings Feb 28 Commit 1 Absenteeism Overtime Lost time incidents Preferred accommodations Parking Fees Medical Fee remuneration Environmental Services (Housekeeping) Nutrition Services Non-union Management reductions Supply Chain costs Site Consolidations Critical care Medicine (includes Telemetry) Sub Acute Rehabilitation services Surgical Women's & Children Mental Health Reduce use of diagnostic tests Emergency Dialysis Diagnostic Imaging Pharmacy Laboratory Medicine Ambulatory Other Support Areas /11 Estimated Funding Increase Other Benchmarking Opportunities Total $ in Millions As of February 28, Source: PRHC Board Approved HIP, Project Charter, Project Plan activities and budget reviews to date (Feb/11) HIP Strategy Number Orange=HIP Goal; Green=Committed Savings Total savings committed to date $23 M

8 Sustain the recovery Monthly (Deficit)/Surplus 2010/2011 (Excludes Restructuring) $1,500 $1,000 $500 Deficit/Surplus ( $ thousands) Balanced Run Rate $0 Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 ($500) ($1,000) ($1,500) Source: Internal Monthly Financial

9 Sustain the recovery Year To Date Cumulative Deficit 20010/2011 $2,000 Balanced $- Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar $(2,000) Deficit ( $ thousands) $(4,000) $(6,000) $(8,000) $(10,000) $8 M Restructuring $(12,000) $(14,000) $(16,000) 2010/11 YTD Actual excluding restructuring 2010/11 YTD Actual including restructuring 2009/10 YTD Actual 2011/12 Forecast Source: Internal Monthly Financial

10 Sustain the recovery PRHC Cashflow Forecast Bank Balance Mar 10 Apr 10 Jun 10 Sept 10 Dec 10 Mar 11 June Sept 11 Dec 11 Mar 12 Mar Actual BMO line of credit Forecast with LHIN advance

11 Sustain the recovery HR Update 219 layoff notices issued since July 2010 Early retirements, voluntary exits, transfers to vacancies, natural attrition, re-assignments and layoff acceptances have reduced the number of layoffs to layoff notices still in progress 20 staff members will leave involuntarily. These people are placed on a recall list for future opportunities at PRHC

12 Sustain the recovery Layoffs accepted, 20 Attrition Layoffs in process, 32 Layoffs in process Layoffs accepted Attrition, 167

13 Sustain the recovery HR Update Overtime costs have been reduced 62% from last year, for a total reduction of $2M by March 2011 Absenteeism costs have been reduced by $538,453 Benefits savings of $1.2M Forecast for 2010/2011 is a $4.9M deficit, versus the $27M projected prior to the HIP

14 Shape a performance-based culture PRHC Transformation Office PRHC S Transformation Office opened January 10, 2011 Jennifer McLauchlan is the new Director, Transformation This office will provide staff members with support and assistance during their transition to new roles and processes The transformation office will lead LEAN and Kaizen initiatives over the next 12 months

15 Shape a performance-based culture LEAN & Kaizen Events LEAN is not about job loss. It s about preserving value with less work, fewer steps and streamlined processes Two VSAs and two Kaizen events have been held since December Rapid change based on findings is implemented after each event. Additional VSAs and Kaizen events are scheduled for 2011 Read more about these events on Ken s blog

16 Shape a performance-based culture Quality Improvement Plan (QIP) PRHC is working on a new Quality Improvement Plan (QIP) as mandated by the Excellent Care for All Act. Corporate strategy addresses three quality themes in this framework: Patient Flow & Access / Patient Safety / Patient Satisfaction The Board Quality of Care Committee s annual workplan focuses on one of these quality themes every month PRHC s legislated QIP is now posted on the public website at

17 Shape a performance-based culture ED Quality of Care Improvements reported in ED Initial Physician Assessment times, with December results reported at 3.2 hours, exceeding the provincial target time of 4.1 hours Offload time from ambulance into hospital care has also improved, with recent results of minutes exceeding the 30-minute target Admitting times are improving but require further work to achieve target levels

18 Shape a performance-based culture % positive response to overall quality of care received Apr 08- Jun 08 (n=64) Jul 08- Sep 08 (n=64) Patient Satisfaction - ED Jan2008-Sept2010 Oct 08- Dec08 (n=60) Jan 09- Mar 09 (n=103) Apr 09- Jun 09 (n=114) Jul 09- Sep 09 (n=93) Oct 09- Dec09 (n=98) Jan 10- Mar 10 ( n=110 ) Apr 10- Jun 10 (n=103) Jul 10- Sep 10 (n=90) PRHC-ED Ont Average Highest Performing Hospital Target

19 Shape a performance-based culture 4.4 Time To Physician Initial Assessment (2010/11) 4.2 Target 4.1 hrs Hours Source: CCO ERNI April May June July Aug Sept Oct Nov Dec Jan Feb Mar

20 Shape a performance-based culture th Percentile EMS Offload Time November January Minutes Target = 30 min 20 0 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Source: CCO ERNI

21 Build the regional platform Strategic Planning is a new, Board-driven governance process Part of Strategic Planning is attracting new investments (GAIN, radiation bunker, etc.), serving a broader catchment area and expanding our regional role Stakeholder input, community consultation & engagement currently underway. The results will help to shape the planning process. Planning retreat to take place May 6-7 at Trent University Final Strategic Plan to be completed and approved by June 2011

22 Build the regional platform Results from recent community input sessions were released on March people attended sessions at the hospital in early March 337 people responded to the online survey before the March 14 deadline Number-one issue is timely access to care Other priority issues with the public are: having a local walk-in clinic, cancer care services, and caring doctors and nurses who listen

23 Build the regional platform PRHC Strategic Planning video available online

24 Build the regional platform Why Organizations Plan* Identify/address challenges or issues Identify/exploit emerging opportunities Address priorities amidst rapid environmental and system change PRHC Planning Drivers Maintain post-hip momentum for change, accountability & performance Ensure PRHC is positioning itself as other hospitals in the CE LHIN plan Develop consensus on growth areas Engage community and stakeholders in shaping the future of the organization Develop understanding/educate stakeholders and public on direction Engage & reinvigorate staff to share in strategy development Setting priorities and allocating resources Establish mechanisms to monitor and report on progress Align with other organizations, sector Build on community engagement begun through HIP process Team building and alignment process for new board & senior team members, and programmatic model. Provide detailed direction to, and articulation of, the earlier iteration of the plan given the context of PRHC today, (post-hip, post IHSP, new programmatic structure). Allocate resources to priorities prior to next round of budget negotiations * Adapted from Strategic Planning for Associations and Not-for-profit Organization, Knowles & Hayward, CSAE, 2010.

25 Build the regional platform Environmental scan External input STRATEGIC ANALYSIS Internal input STRATEGIC STRATEGIC PLANNING PLANNING WORKSHOP WORKSHOP Draft Draft strategies strategies CONSULTATION FINE-TUNE/ VALIDATE APPROVED STRATEGIC PLAN Final Strategies OPERATIONAL PLAN/BUDGET Actions PERFORMANCE MANAGEMENT Success Measures * Adapted from Strategic Planning for Associations and Not-for-profit Organization, Knowles & Hayward, CSAE, 2010.

26 Build the regional platform

27 Read more about PRHC

28 Questions?

Balanced Scorecard Highlights

Balanced Scorecard Highlights Highlights from 2011-12 fourth quarter (January to March) Sick Time The average sick hours per employee remains above target this quarter at 58. Human Resources has formed