PBMA at Menno Place

PBMA at Menno Place Francois Dionne School of Population and Public Health, UBC Craig Mitton Centre for Clinical Epidemiology and Evaluation, VCHRI Robert Turnbull COO Menno Place

Why this case study? • How PBMA can be used to provide financial stability • Use of PBMA in long term care • Year two implementation issues

Plan • What is Menno Place • Why PBMA at Menno Place • PBMA implementation and results • The second year

Menno Place • Menno Home and Menno Hospital, in Abbotsford, BC. Funded by the Fraser Health Authority • Menno Home: 196 beds, annual budget about $12 million • Menno Hospital:151 beds, annual budget about $12.5 million • Daily operations managed by the Management Team

Why PBMA • Structural cost problem- Summer 2007 • Menno Home projected deficit for 08-09 was $355,000 • Menno Hospital projected deficit for 08-09 was $191,000 • Total projected accumulated debt at the end of 08-09 almost $1 million • Need for a “structural” solution

Role of PBMA • Guide adjustments to the operations so that the organization can do as much as possible for its residents and patients with the resources available

Implementation- Scope • Across both the Home and Hospital • Reallocations from one to the other are possible • No pre-set split of cost reduction between the facilities • First year objective: minimization of deficit

Implementation- Advisory Panel • 25 members • Union and association are represented • Wide but shallow representation

Implementation- Mission statement • To meet the long-term housing and health needs of our frail and elderly residents by providing quality care and support in a compassionate, Christian environment.

Implementation- Criteria Developed by Management Team, approved by Advisory Panel Four categories: • Strategic alignment • Technical efficiency • Quality of services • Management effectiveness

Strategic alignment • Menno Place Mission, Vision and Commitment • FHA plans • Accreditation • Quality improvement

Technical efficiency • Productivity • Worker satisfaction • Worker safety • In-house capacity • Staffing benchmarks • Staff recruitment and retention

Quality of services • Burden • Gain (loss) • Resident safety • Equity • Best practices

Management effectiveness • Availability of data • Decision-making efficiency • Financial risk management • Stakeholder support

Criteria- Weights and scoring tool • Developed by Management Team and approved by Advisory panel • Scoring tool went from -3 to +3

Proposal development • Staff involvement- with incentives • Two step process: short form and business case (long form) • Requirements : resource releases= 5% • No explicit limitations on investment proposals

Proposal requirements Seven departments: • Resident Care Services • Administration • People Services • Food Services • Laundry • Housekeeping • Maintenance and Maintenance

Short form proposals • 111 proposals- 540 staff • 93 resource releases • 18 investments • 80 related to the Home • 20 related to the Hospital • 11 related to both

Short form assessment • All proposals were reviewed within one week of submission • Feedback on all proposals • Proposals were either: - Declined - Returned for rework - Eligible for inclusion in the pool from which the proposals for business case would be selected.

Business case proposals • 12 resource release and 1 resource investment business cases • How did we get there: - Amalgamation of proposals by theme - Limit on the total number of business case proposals - Assessment on the basis of strategic feasibility from the perspective of the Management Team

Rating meeting Investment proposal rating: 94.42 Worst resource release proposal rating: -40.84

Proposals • Examples of proposal: CRN Positions at Menno Home and Hospital and Professional Practice Leader: Eliminate Clinical Resource Nurse (CRN) positions at the Home (1.0 FTE) and at the Hospital (0.5 FTE) and create the position of a Professional Practice Leader to be shared by the Home and Hospital. This position will replace the services provided by the CRNs and provide management leadership to contracted services. Net release $46,703 per year

Funding recommendations • All proposals accepted for implementation • Forecasted results: reduction in total costs of about $409,000 for 08/09 • Split between Home and Hospital: Home $390,000 Hospital $19,000

Recommendations implementation • Proposed by Management Team and approved by Board • Support of union and association • Financial targets were met

The next year Background: • Four year debt elimination plan from the Board with Home and Hospital specific targets • Discussions around the “equitable” distribution of adjustments • New Advisory Panel- about one third new members

Some problems • Key symptom of problems: lack of proposals • Challenges to proposals development: - lack of enthusiasm for the process - lack of ideas - notions of fairness - no proposals means no PBMA reallocations…

The next year- Back on track • Communication: 3 points • Going back to success factors: - shared vision - buy-in - transparency

PBMA at Menno Place