Recommendations for SAH recovery plan

The following is the continuation of SooToday's coverage of the 73 recommendations contained in Sault Area Hospital's proposed improvement plan.

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************************ - The CEO, vice president of medical affairs and chief of staff should engage legal counsel to assist in the development of new medical staff bylaws and associated rules and regulations.

- Within the context of clarification of program management (to be discussed later), the roles and responsibilities of program medical directors should be reviewed, clarified and documented in revised position descriptions.

- The chief of staff, in collaboration with the board, CEO and vice president of medical affairs should lead the development of a vision of the role of physicians as partners (not customers) within SAH.

- The vice president of medical affairs, in collaboration with the chief operating officer, should develop a plan for physician accountability in day-to-day utilization of hospital resources.

- Program medical directors should develop a medical quality plan which includes regular morbidity and mortality rounds, case review process, critical incident review and interdisciplinary rounds.

- The chief of staff and vice president of medical affairs should identify and engage an experienced medical leader to provide counsel as they work together to advance physician management and accountability.

- Expand hospitalist model.

Recommendations to enhance management effectiveness

- Chief operating officer should lead the redevelopment of the program management model for SAH with reference to the literature and best practices of peer hospitals (Royal Victoria, Southlake) and present to senior management a model for SAH.

- Continue to use "Hardwiring Excellence" as a framework for building accountability into every role in the organization.

- SAH recruit a vice president, human resources.

- Revisit the current arrangement of sharing the complete human resource function with the Group Health Centre and consider restricting this shared service to payroll, or to not sharing services at all.

- Focus on enhancing "core" HR activities.

- Engage qualified experts to assist in rapidly moving forward on enhanced HR effectiveness, and in the implementation of the recommendations aimed at improved HR services.

- HR should transfer responsibilities with respect to nursing scheduling back to the front-line nurse managers within six months.

- Consider transferring the payroll function to the finance department.

- The vice president, human resources should pay particular and immediate attention to the redevelopment of the labour relations function and resources and practices. Of specific importance are consistent and appropriate: union executive engagement, membership communication and grievance handling, including efforts to to actively mediate and resolve issues before reaching the grievance level. In addition, it should be a strategic role of HR to improve management maturity in dealing effectively, on a day-to-day basis, with union members and overall union relationships.

- SAH should consider replacing the current external legal counsel.

- Identify a new attendance improvement program from among the many highly functioning programs that currently exist.

- Develop a disability management protocol and increase occupational health nurse positions and secure physician support for one day per week.

- SAH shuld, by September 2009, establish and invest in a multidisciplinary decision support function with the following skills, data compentencies and initial prriorities to include: 1) financial, statistical, operations research/ process engineering, case management skills and 2) MIS discharge abstract, NACCRS, Statistics Canada census and geographical systems and Medwoexx data competencies.

- The initial priorities for the decision support team should include: 1) clinical utilization reporting and analysis including avoidable days as well as the identification iof internal sources of delay (turnaround times for lab, imaging, physician consult, discharge delays, etc.) and 2) optimal staffing levels (fixed and flexible) accounting for systematic (day of weej, shift, seasonal) and random variation in demand.

- The chief nursing officer assumes a leadership role in establishing a task force to develop a comprehensive nursing care model for SAH. This should include a review of the current literature and best practices in other similar hospitals.

Operational recommendations

- Clinical lab staff reductions of three full-time equivalent positions for annual savings of $315,472.

- Clinical lab reduce overtime by 50 percent for savings of $110,000.

- Diagnostic imaging - reduce one full-time equivalent clerical support to save $47,000.

- Diagnostic imaging - reduce one-half full-time equivalent RN to save $45,000.

- Diagnostic imaging - save $43,807 by using newly graduated ultrasound technicians on an evening shift, thus generating revenue for elective procedures performed while providing backup support to the ED.

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