The Scarborough Hospital (TSH) will implement an additional 61 expense- reduction initiatives as part of its Phase 2 Operating Plan to deal with a projected $17 million budget shortfall in 2013-2014. The shortfall is a result of changes to the provincial funding formula for hospitals and inflationary costs. As the hospital incurs about $300,000 per week in unfunded costs due to delay of implementing initiatives, the shortfall is now approximately $19.6 million.
On April 10, 2013, TSH announced Phase 1 initiatives, which included 111 strategies to reduce expenses by approximately $9.2 million. At the same time, department and program leaders, including physicians, worked to identify further strategies to address the remaining $8.5 million shortfall. All Ontario hospitals are required to develop an annual Operating Plan, which outlines the activities undertaken during the fiscal year (April 1 – March 30) and achieve balanced budgets.
Over the last few weeks, 65 additional strategies were identified by TSH leaders. These initiatives were reviewed by the CELHIN, with 61 approved as part of the hospital’s Accountability Agreement. Implementation will result in estimated savings of $7.6 million. While there is approximately $900,000 difference, the hospital will not develop additional strategies, as there are initiatives from Phase 1 that are still being finalized with the CELHIN, as they requested more detail. All the approved 172 initiatives from Phase 1 and 2 are in line with the
Provincial Government’s Action Plan for Health Care.
As a result of the Phase 2 initiatives, hospital administration met with union leaders to provide notice that an additional 100 positions will be eliminated. The actual impact is 69 due to voluntary exit packages and elimination of vacant positions.
Some of the approved initiatives include delivering care in a more efficient manner, while maintaining access to care. Hospitals will begin to specialize, focusing on services that can only be done in acute care hospital settings. These programs must also be delivered in an efficient manner, while maintaining high-quality and safe care. Some services that are currently offered in hospital sites will move into community clinics, providing they can be offered at the same high quality and at less cost. For patients, it will mean receiving the right care, at the right time, in the right place.
The changes at TSH include:
- Summer slowdown in medicine during a four-week period, which ensures staff get their vacation time and operating expenses can be reduced through this concentrated time period.
- Improving efficiencies in paediatric day surgery by having similar procedures booked over a concentrated 3 day per week period.
- Staffing surgical inpatient beds to meet utilization rates by reducing 20 beds in program, 15 of which have not been used during the last fiscal year. By consolidating the beds into appropriate size wards, cost efficiencies will be achieved by maximizing staffing levels. This will require all beds in 4 East, General campus to be eliminated.
- Operating rooms will be utilized for those procedures that must be completed in a hospital setting. Procedures that can be done safely in other settings will be redirected to appropriate locations, including internal and external clinics.
“As we continued to develop initiatives to deal with our budget shortfall, access to care had to be maintained. Changing delivery of that care will occur; however, as was recently recognized by Accreditation Canada, our staff, physicians and volunteers consistently provide high-quality and safe care for our patients,” said Dr. John Wright, President/CEO, The Scarborough Hospital.
The Operating Plan initiatives are not connected with the proposed changes to Maternal Newborn and Surgery programs developed through the Strategic Plan Refresh. Through CELHIN Board motions on March 27, there is a process underway to review those two proposed changes.
The Scarborough Hospital continues to consult with its internal and external partners to obtain input and feedback on initiatives to balance its budget. This includes consultation with the Community Advisory Council, Fiscal Advisory Committee, union leadership, program leaders, including physicians, hospital staff, and community healthcare organizations and partners.
The human resources team continues to work with the unions to respect the collective agreements. The receipt of a lay-off notice starts a several months-long process that may, or may not, result in the person who receives the notice being laid off. The hospital currently has 60 unfilled positions. The hospital will support staff with ongoing training and development, and encourage those affected by lay-offs to consider skills upgrading and skill changes so that they may continue at TSH, if possible.