Over the last year, I know there has been much concern over how we would meet our budget targets while continuing to deliver the same level of outstanding care to our global community. The TSH team has not only met but exceeded this challenge. Thanks to the rigorous work of all departments, for the current fiscal year ending March 31, 2014, TSH implemented initiatives totalling more than $19 million to control or reduce our costs, while simultaneously maintaining or improving quality patient care.
One excellent example, among many, is in our Emergency Departments (EDs). Despite a four per cent increase in demand at our EDs over the last two years and five stretchers being closed at the General campus last June, both campuses have the lowest ED wait times in the Greater Toronto Area (GTA). There have also been improvements in total length of stay for patients admitted through the EDs and the length of time it takes for patients to be seen by a physician in the ED.
This performance improvement was made possible by a collective team effort across the hospital, and through our commitment to process improvement using LEAN methods. Consistent with this LEAN management approach, the ED leadership team invited those who do the work and know it best to identify strategies to improve our quality of care and operating performance. Some notable initiatives that contributed to their success include:
- ED physicians added hours during peak times and developed their own IT tracker to direct them to the area of greatest need;
- The General campus nursing team committed to a standard work flow and collaborative model in the Rapid Assessment Zone that enabled them to manage the additional 3,000 ED visits this year;
- The Birchmount ED, in collaboration with registration and our external EMS partners, worked to improve the flow of patients through triage and registration.
In addition, a number of broader strategies were implemented, such as:
- Responding to demands for inpatient care by opening beds and adapting them to specific needs, like patient isolation; and
- Developing new processes for expedited flu testing through our Shared Hospital Laboratory partnership with North York General Hospital and Toronto East General Hospital.
These incredible results demonstrate that it is possible for TSH to be a highly efficient hospital providing excellent quality care. They also highlight the need for operating budgets to be created with the strategic, long-term priorities of the hospital in mind. It’s not just about paring down our operating costs. Instead, it’s an opportunity to make investments in priority areas: new or expanded programs; innovations in patient care; staff development to further build internal expertise and capacity; and, “right sizing” departmental budgets to reflect patient activity, where appropriate.
There’s always more we can do to improve patient care, quality performance and be more efficient with our resources. These are ongoing commitments. For 2014-2015, we are projecting an increase in expenses of $8.4 million compared to 2013-2014. At the same time, we have identified revenue increases of $1.6 million, leaving us with a shortfall of $6.8 million, which represents two per cent of total revenues.
I anticipate the following investments will be included in the 2014-2015 operating budget when it is reviewed and approved by the Board of Directors:
- Expanding staff training, expertise and capacity in LEAN continuous quality improvement methods and project management to help support our hospital in its transformation journey; and,
- Adjusting budgets and staffing levels for certain departments to match patient activity.
We also have plans to increase hospital revenues, such as:
- Implementing a new retail food services strategy;
- Automating patient/visitor parking payments; and,
- Improving patient billing collection practices.
And we will continue to pursue operating efficiencies across the organization by applying peer benchmarking results, pursuing process improvements to reduce waste, and reducing administrative and management costs.
This year’s operating plan and budget will be submitted to our Board of Directors on March 25.
Providing value for taxpayer’s dollars and implementing the Ontario government’s health reform agenda are ongoing responsibilities of this hospital. The objectives we set out in our operating plans and budgets are not only meant to deliver on these responsibilities, but also ensure the long-term viability of the organization.
Having said that, I also acknowledge that many of these budget balancing initiatives present difficult changes and I extend my gratitude and appreciation for your commitment and dedication to TSH and our patients. Your support is crucial as we move ahead into equally challenging and exciting times.