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The Health Roundtable

The Health Roundtable. New Zealand. Allied Health Making a Difference: Allied Health contributing to organisational goals & outcomes.

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The Health Roundtable

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  1. The Health Roundtable New Zealand Allied Health Making a Difference: Allied Health contributing to organisational goals & outcomes Greater Newcastle Acute Hospital Network Allied Health Budget Savings Strategies 2008-2010October 2009Key contacts for this project:Todd McEwan - General Manager, Greater Newcastle Acute Hospital Network, (GNAHN) Judith Henderson - A Service Manager & Operations Manager Allied Health, GNAHN; Director Physiotherapy GNAHN & HNEAHSEmail: Judith.henderson@hnehealth.nsw.gov.auTelephone: (02) 4922 3060 Presenter: Judith HendersonHospital: John Hunter Hospital/ Greater Newcastle Acute Hospital Network

  2. Key Problem On June 17 2009 an interim Allied Health Management structure was implemented whilst the Allied Health management model was reviewed and evaluated. A directive was received from GNAHN Executive to address budget issues for 08-09 and realise savings against the Allied Health budget results for 07-08 at June 30 09: Total expenses unfavourable -$511,439. GNAHN Allied Health 07-08 budget result U $511,439. Analysis of the apparent Allied Health 07-08 budget Unfavourability indicated that the additional costs related to: • Approved but unfunded leave relief • Unfunded staff pay increments (bracket creep) resulting from “rollover” budgets • Approved unfunded activity to support service Divisions eg Winter bed strategies/ SAP, Hand surgery, overtime for increased activity eg in Division Surgery. • Services provided for other sites- eg leave accrual of secondments (provided in the interests of area service access, continuum of care, transfer of care after acute episodes, support of clients in their local communities) etc • Ambitious salary packaging targets unrelated to Dept staff percentages eligible, or benefited by it. HNEAHS required all units to make a 2.9% saving on 07-08 actual expenditure in 08-09. A secondary target was to make budget. A rebuild of the budget for 09-10 indicated a $480,081 projected deficit.

  3. Key Strategies / Ideas Implemented Process Outline: • Definition & agreement re Allied Health service required • Clarification of the historic available budget • Clarification of current affordable budget • Agreement re affordable FTE & staff profiles • Next steps- Opportunistic reinvestment

  4. Key Strategies / Ideas Implemented Key changes that were implemented: 1. Definition & agreement re Allied Health service required - Allied Health activity data and FTE collated per Clinical Division & presented to executive. - Allied Health staff profile documentation developed: Allied Health staff rosters and profiles documented in standardised format. 2. Clarification of the historic available budget - A review of profiles back to 03-04 was conducted to determine if FTE have historical consistency/ where or why variance had arisen.

  5. Key Strategies / Ideas Implemented 3. Clarification of current affordable budget Total 08-09 Allied Health profiles balanced to amended 07-08 budget FTE profiles. 07-08 salaries and wages budget balanced to 06-07 salaries and wages budget (with ML and LSL removed from both budgets). - Renegotiation of the agreements between Universities and Allied Health regarding reimbursement of costs of student placements renegotiated to ensure full cost recovery- particularly for Speech Pathology. - Costs of outreach relievers and secondments (up to 26 FTE Physiotherapy) be costed to the receiving services- particularly for Physiotherapy - Processes developed to capture chargeable outpatients. Data for 08-09 submitted. Numerous Dept specific strategies to make organisation wide target savings: Each Discipline was to save 2.9% from a selection of the following strategies: • Leave and other on costs of Physiotherapy HNEAHS secondment and relief pool staff to be costed to services utilising relief and secondments (up to approx 26 FTE). • Rostering to minimise increased costs eg overtime • Potential savings on goods and services eg bulk orders • Increase Salary Packaging and Meal Entertainment take up across the Division • Backfill not to be provided for administrative roles of staff on Long Service Leave, and other types of leave as possible • Recoup student educator costs from University of Newcastle (mainly applies to Speech Therapy). • Cost Speech Services correctly to wards. • Research funding to be recouped and managed appropriately.

  6. Key Strategies / Ideas Implemented 4. Agreement re affordable FTE & staff profiles FTE and staff profiles documented and costed in standard format 5. Next steps- Opportunistic reinvestment to reinstate leave relief positions with funding to support them

  7. Timelines & Resources & Process of Review (Timeline of Events): • August 2008: Rosters from all professions in Allied Health developed in a uniform format. The format was developed, information manually collated and reviewed. • 22/9/08- a meeting was scheduled for 20/10/08 between the General Manager and Allied Health Operations Manager/ Acting Service Manager re Staff Profiles/Rosters and 2.9% Saving • To 24/10/08- Departmental profiles developed in uniform format. • 24/10/08- Dept profiles collated for Allied Health. Some inconsistencies in the profiles were identified. In summary, unexplained profile variances: Total 1.91 over 07-08 reconciliation. • To 26/11/08- Acting Service Manager/ Allied Health Operations Manager meets with each individual Departmental Director to revise/ clarify profiles, and budget saving strategies in light of Departmental profile variance between years. • A review of profiles back to 03-04 was conducted to determine if FTE have historical consistency/ where or why variance had arisen. The result indicated a 0.85 affordable variance over 6 professions and 6 years- explainable On the basis of this the 08-09 profiles were again revised and balanced FTE and salaries and wages budgets over successive years demonstrated: • Total 08-09 Allied Health profiles balance to amended 07-08 budget FTE profiles. 07-08 salaries and wages budget balance to 06-07 salaries and wages budget (with ML and LSL removed from both budgets). • Salaries and wages of 08-09 profiles built into a revised 08-09 budget, balance to the salaries and wages of the original 08-09 budget, and (as above) the salaries and wages budget of the amended 07-08 budget and 06-07 budget with ML and LSL removed from each, and 3.9% wage increase for 07-08 included in the 08-09 budget. • 09-10 budget build indicates a $480,081 deficit. Leave relievers could not be funded for 09-10.

  8. Results • The 08-09 affordable GNAHN Allied Health FTE profiles were collated.The affordable FTE were documented • The affordable FTE profiles and associated salaries and wages budget balanced • FTE Funded in non Allied Health cost centres were documented • Approved or explained unfunded FTE were documented • Results reviewed and Nov 08 budget results adjusted for revenue pending, and the 3.9% wage increase for one pay period. Results indicated Allied Health was saving approx 1.9% against actual 07-08 expenditure YTD. Of this, the target 2.9% saving was being realized in Salaries and Wages which are the main line item which Allied Health can influence. • The 08-09 affordable GNAHN Allied Health FTE profiles were approved. • Recruitment proceeded against the approved FTE profiles. • Allied Health performed to budget for 08-09. • A balanced budget was built for 09-10 including all funded and unfunded FTE except the leave relievers. • Recruitment is proceeding against the affordable FTE profiles for Allied Health for 09-10.

  9. Results cont During the period of this project Allied Health has continued to provide services and deliver key outcomes required by the executive eg: • Accreditation was achieved. • Brief re Recommended Allied Health Management Structure, • Data and Presentation to GNAHN Executive: Allied Health Activity and FTE, • Review of Allied Health FTE and Budget, • Brief re Costs of the Outreach Rotation, • Secondment and Relief Program, • Implementation of a process to recoup revenue for chargeable clients, • Implementation of Allied Health service to MACU • Review of an opportunity for private practise, • Implementation of savings strategies, • Ongoing quality and research initiatives • etc.

  10. Lessons Learnt • There needs to be clear definition, agreement and documentation describing: • What service is to be provided • What budget is available to provide the agreed service • What service and FTE is affordable • Standardised documentation of affordable FTE required. • Allied Health performed to budget for 08-09, generated a balanced budget build for 09-10, & is performing to budget 09-10 YTD. • This permitted recruitment to the affordable FTE, and continuation of service. • Next steps involve opportunistic reinvestment in the unaffordable unfunded leave relief positions suspended in 08-09

  11. Acknowledgements Heather Menzies- Finance Officer, GNAHN Fran Hodgson- Director Social Work, GNAHN MaryAnne Barlas- Director Occupational Therapy, GNAHN Anne Vertigan/ Tina Wilkie- Director/ A Director Speech Therapy, GNAHN Cheryl Watterson- Director Nutrition & Dietetics, GNAHN David Rhodes- Area Director Allied Health, HNEAHS

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