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Better care, more efficiently

A letter from the Winnipeg Health Region

BY ARLENE WILGOSH
Winnipeg Health Region President & CEO
Wave, November / December 2012

Arlene Wilgosh

The global economic recovery is uncertain, and the provincial government's budget is tight.

But even though we are facing some economic and fiscal challenges, the public's expectations of their health system, and those who run it, remain very high. And rightfully so.

Our job here at the Winnipeg Health Region is to deliver high-quality care as efficiently as possible. But before I explain how we are going to continue doing just that, let me provide a bit of background.

As I noted at our annual general meeting last month, the Winnipeg Health Region spent just under $2.5 billion to provide health care in 2011/12.

Of course, much of that money, about 75 per cent, went to wages and benefits for the nurses, doctors, health-care aides, allied health staff, cleaning staff, security guards, and others who keep the system operating. About seven per cent went to medical supplies, and about six per cent was spent on direct patient support items, such as linens, laundry and food. Other costs include pharmaceuticals, amortization, and other assorted costs.

The Region's administrative costs, which are among the lowest in the country, according to the Canadian Institute for Health Information, amounted to 4.22 per cent in 2011/12. That includes corporate costs of about 2.24 per cent, which are well below the 2.99 per cent corporate cost ceiling legislated by the province.

What does $2.5 billion buy in terms of health care? Here are some examples:

  • About 287,000 Emergency room visits.
  • About 109,000 visits to urgent care centres.
  • Home care services for more than 14,000 people.
  • The delivery of more than 11,000 babies.
  • More than 623,000 diagnostic imaging procedures, including procedures such as CT scans, MRIs, X-rays, ultrasounds and mammograms.

In planning our budget for the coming year, we will continue to be guided by the things that matter most to our patients. This means working to:

  • Improve access to our services.
  • Ensure services are safe and of high quality.
  • Reduce wait times for services.
  • Improve transition among services.
  • Strengthen patient choice.

Safety, access, wait time, transition, and choice. All of these things are key to a well-functioning, high-performing healthcare system, and it's not unreasonable for the public to expect the most from us in this regard. Equally important, however, is the need to demonstrate value in the services we provide. We need to ensure that patients and taxpayers are getting good, or better, value for their dollar.

Essentially, that means finding ways to deliver safer, higher-quality or additional services at the same or lower cost.

To achieve this goal, we must first look for ways to improve the operation of the system while reducing waste, through business process re-engineering and the application of LEAN management practices. In other words, we must make our services better and cheaper, but not at the expense of patient care or staff.

Second, we must be innovative in looking for ways to do things better at lower cost, taking advantage of opportunities to maximize the talents and skills of our workforce. A good example of this is our effort to use nurse practitioners to deliver primary care in certain situations. As our story on page eight of this issue of Wave points out, there is no point in paying a doctor to do something that a nurse practitioner can do at lower cost.

Third, we must further improve overall patient flow across our hospitals to ensure patients are not using hospital-based resources unnecessarily.

And last, we need to strengthen health services in the community, which are less costly to provide, to reduce reliance on more costly hospital care. Let me explain why this last point is an important one.

Here at the Region, spending is allocated along the following lines:

  • About 69 per cent is for acute care.
  • About 16 per cent is for long-term care.
  • About 15 per cent is for community care.

Hospital-based care will never, ever vanish. A health system needs hospitals. However, I believe some services traditionally provided in hospitals can be moved into community settings where they can be delivered more inexpensively.

A recent pilot project illustrates the point. It involved redirecting patients in need of intravenous antibiotic therapy from Emergency rooms to a community facility for the service. As a result, the average number of scheduled IV visits in Emergency rooms decreased 88 per cent. That freed up time, space, and staff for Emergency departments to deal with emergency cases.

The Bell Hotel on Main Street is another example of where we've been able to provide care in the community that reduced pressure on hospitals and Emergency rooms. With our partners at CentreVenture, the Main Street Project and Manitoba Family Services and Housing, we helped turn the Bell into a home for a dozen or so of our most at-risk clients. Since moving into the Bell, there's been a 70 to 80 per cent drop in their use of ambulances, Emergency services and encounters with police under the Intoxicated Persons Detention Act.

Of course, there are other ways to control costs. A healthy community also means fewer people using the health-care system. We all can take steps to lead healthier lives, a point underscored by the articles and columns in this magazine.

By taking steps to improve our health and build additional capacity within the community, we can address some of the larger systemic challenges that we face. In doing so, we can also help create a healthcare system that delivers better value to our patients and to taxpayers.

Wave: November / December 2012

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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