Presenter judith henderson hospital john hunter hospital greater newcastle acute hospital network
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The Health Roundtable. New Zealand. Allied Health Making a Difference: Allied Health contributing to organisational goals & outcomes.

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Presenter judith henderson hospital john hunter hospital greater newcastle acute hospital network

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: [email protected]: (02) 4922 3060

Presenter: Judith HendersonHospital: John Hunter Hospital/ Greater Newcastle Acute Hospital Network


Key problem

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.


Key strategies ideas implemented

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


Key strategies ideas implemented1

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.


Key strategies ideas implemented2

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.


Key strategies ideas implemented3

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


Timelines resources

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.


Results

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.


Results cont

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.


Lessons learnt

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


  • Acknowledgements

    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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