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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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

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

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 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 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 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 &

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

  • 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

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

  • 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

    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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