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MANAGING HEALTH RESOURCES:

A FOUNDATION

WORKSHOP

GETTING STARTED

• Acknowledgement of Country and Elders

• Acknowledgement of Carers

• Housekeeping

• NSW Health CORE values:

- Collaboration

- Openness

- Respect

- Empowerment

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SESSION OUTLINE

TOPIC DURATION

Introduction and goal setting 15 minutes

Finance basics

Activity 1 – Finance terminology

Activity 2 – Principles of resource management

1 hour and 15 minutes

Optional Topics 40 minutes

Morning/afternoon tea 15 minutes

Learning activities 1 hour 20 minutes

Wrap up 15 minutes

Close Total 4 hours

OBJECTIVES

What do you want to achieve from this workshop?

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HEALTH FUNDING

• The cost of providing health care has been steadily rising over the

past few decades

• A focus on efficiency and accountability is essential and will remain

central to service provision in the future

• The Commonwealth will continue to contribute to ABF funded

services until June 2020

• Priorities for NSW Health services:

- Improving patient access

- Ensuring sustainability of funding

- Improving the transparency of public hospital funding

THE FLOW OF FUNDS

ABF: Activity Based Funding

Non-Admitted: eg Outpatient; Community

Clinic

Sub & Non-Acute Admitted: eg Rehab;

Palliative

Block Funding: ie. Not Activity Based

Funding

Interim Funding Model: eg Commonwealth

contribution to the cost of Chemotherapy

TTR: Teaching, Training and Research

RACS: Refugee Advice and Casework

Pillars: eg HETI; NSW Cancer Institute;

NSW Bureau of Health Information

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FINANCIAL TERMINOLOGY

Are you confident?

YTD, variance, favourable, ABF…

ACTIVITY 1: FINANCIAL TERMINOLOGY

Read Sally’s case study. We will then look at her cost centre’s financial

report together.

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SOME REPORTED CATEGORIES

Categories are high level totals of individual “line-

items.” For example, the expense category called

Goods & Services might comprise the line items:

• Drugs

• Medical and Surgical Supplies

• Food

• Admin expenses

• Travel

• etc.

THE MONTH JUST ENDED

The first figures we look at

are the figures for the

month just ended – in this

example, the month just

ended is September. If we

do this while our memory

of what actually happened

in the month is still fresh, it

is easier to recall and

explain the unexpected

events that caused the

variances.

The actual expenses and

revenues for the same

month of the previous year

are often listed. This allows

a useful comparison with

the month just ended.

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THE YEAR TO DATE (YTD)

We were overspent on

Goods and Services

(G&S) in the month of

September by $3,077,

which is roughly 11% of

the budgeted figure of

$23,073.

However, this 87%

unfavourable variance on

G&S for the three months

to date shows that the

overspend in September

is not just a on-off, but is

part of a significant trend.

To help us to

understand whether a

variance in the month

is just a one-off or

part of a trend, the

Year To Date (YTD)

figures are useful.

ACTIVITY 1: PARTS 2 TO 3

Part 2:

Review the budget then, working in your group, answer the questions

in the table

Part 3:

Working in your groups, match the line items to the categories

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PRINCIPLES OF RESOURCE MANAGEMENT

• Ownership

• Communication

• Proactivity

• Balance

What are some practical ways to implement these principles?

ACTIVITY 2: PRINCIPLES OF RESOURCE MANAGEMENT

• We also need to consider NSW Health’s CORE values:

- Collaboration

- Openness

- Respect

- Empowerment

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A – PART 1: THE STAFFING SOLUTION

Question 1:

What are some of the causes of overspend in employee related expenses in your cost centre?

To help you consider this question it is worth first having a look at the

table summarising the suggested solutions to staffing challenges and

workforce issues developed for Emergency Departments…

SUMMARY OF ACTION AREA/STRATEGY OPTIONS

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COMMON CAUSES OF OVERSPEND IN EMPLOYEE RELATED EXPENSES

• Increased need for services in winter

• More staff sick leave in winter

• Recruiting above salary allocation for a position

• A person’s wages being incorrectly charged to a cost centre (e.g. if

they have transferred to another department, but their wages

continue to be allocated against their original cost centre)

• Staff who have excess leave and must take a significant amount of

time off; leading to the need to cover their shifts with agency or

casual staff

THE STAFFING SOLUTION

Question 2:

When there are staffing shortages is it better to use agency and casual staff; or ask permanent staff to work overtime?

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AGENCY, CASUAL OR PERMANENT STAFF?

To calculate these costs:

• Assume an average annual salary of $100,000 (i.e. an RN8)

• To calculate part time, do not change the base figure

• To calculate overtime, add 100% to the base figure

• To calculate casual staff, add 15% to the base figure

• To calculate agency staff, add 25% to the base figure (for agent’s fees)

Remember cost is only one of the factors we need to consider. Other factors

must include:

• What is the best for the patients, and

• What is the best for the staff?

THE STAFFING SOLUTION

Question 3:

What can you do if you are consistently exceeding your budget for employee related costs?

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EXCEEDING EMPLOYEE RELATED COSTS

• Review the rosters and staff mix

• Create a casual pool or relief pool

• Review your training and recruitment strategies

• Consider when annual leave occurs

• Temporarily redeploy staff to meet patient needs

• Fully utilise employees on workers compensation

• Obtain additional staff – build a business case

• Ask for professional advice from finance manager

A – PART 2: REFLECTING ON STAFFING CHALLENGES

If you were taken ill tomorrow…

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Question 1

If a member of your team suddenly needed leave for a week, how

would you cover their workload?

What if they needed indefinite leave – how might that change your

approach?

What if you were the one who needed leave?

Question 2

What challenges (if any) have you had with maintaining adequate

staffing numbers in the last year?

Are there any trends?

Question 3

How could you delegate responsibilities and give junior staff

opportunities to learn new skills without compromising patient safety?

A – PART 3: THE BENEFITS OF TRAINING

Could we do things better if we up-skill?

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“A local podiatrist visits our hospital monthly to attend to

the foot care of our patients. This costs $1,100 per month.

Often we have a list of 20 or more patients waiting for this

service, but the podiatrist can only see 15 or so. We then

escort individual patients to the podiatrist’s premises, at a

cost of $85 per appointment.

A local training company offers a ‘Basic Foot Care for

Nurses’ course at a cost of $210. This would allow a

nurse to complete basic foot care services for patients.

Then only the complex or high risk patients would need to

be seen by a podiatrist.”

“In our maternity ward the usual antenatal care process

involves blood testing at regular specific times during the

40 weeks of pregnancy for healthy well women.

Early last year we identified the pathology costs for

outpatients were steadily increasing. On further

investigation we realised the pathology forms were not

being filled out correctly: a small tick box was not checked

and a patient signature not included. Pathology tests were

being charged to the antenatal clinic rather than to

Medicare.

Educating our staff on how to complete these forms

correctly could potentially save us $15,026 each year.”

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A – PART 3: THE BENEFITS OF TRAINING

Do you have an example of how engaging in training

contributed to positive outcomes in your workplace?

ACTIVITY B: STRATEGIC SUPPLIES AND CONSUMABLES

This activity will share NSW Health examples of cost saving through

changing the way stock and supplies are managed.

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B: STRATEGIC SUPPLIES AND CONSUMABLES

SWOT analysis:

• Strengths

• Weaknesses

• Threats

• Opportunities

B: STRATEGIC SUPPLIES AND CONSUMABLES

Strengths:

• Will there be a cost saving?

• Will there be a benefit to patient care?

• Will there be increase in staff well-being?

• Will it develop a more effective process?

• Will it reduce waste?

• Will it save time?

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B: STRATEGIC SUPPLIES AND CONSUMABLES

Weaknesses:

• Will there be an expense?

• What is the time required to research, plan and implement?

• Does it require staff retraining and engagement?

• Will it lead to negotiating supplier agreements?

B: STRATEGIC SUPPLIES AND CONSUMABLES

Opportunities:

• Skill development?

• Cost re-distribution?

• Try or use potentially superior resources?

• Improve standards?

• Inter-departmental collaboration?

• Staff empowerment?

• Is the recommended solution based on contemporary evidence and

agreed best practice?

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B: STRATEGIC SUPPLIES AND CONSUMABLES

Threats:

• What’s the threat of inaction?

• What’s the threat of implementation charge?

• Could it be more expensive?

• May there be insufficient demand/reason to warrant investigation

and implementation of change?

B – PART 1: STRATEGIC SUPPLIES AND CONSUMABLES

Read the case study and apply the SWOT analysis tool

“I have recently started a new role as a Nurse Unit Manager (NUM) in the Emergency Department (ED) at my hospital. Within our ED we have 15 cardiac monitors: 12 fixed and 3 mobile. All are Philips brand monitors.

We have been ordering consumables for these cardiac monitors from the NSW Health stores warehouse (e.g. blood pressure cuffs). For each order they will send items that fit within our advised description, but may be from different companies.

These differences in consumables can lead to challenges when they are connected to the equipment. For example, there are three types of blood pressure cuff connections depending on which company supplies them. The rubber tubing attached to the cuffs varies in diameter and sometimes has to be cut and reattached so that the cuffs will fit.

This mismatching of consumables to monitors can compromise patient safety because the readings produced may be inaccurate. The treatments and medications given to the patient may therefore be inaccurate.”

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B – PART 1: STRATEGIC SUPPLIES AND CONSUMABLES

Outcome:

To address this problem I called Philips and asked the local representative for our area to visit the hospital. He identified mismatches for blood pressure cuffs, oxygen saturation probes and tubing for both adults and paediatrics.

I received the following information on the unit costs if we purchased consumables directly from Philips:

• $27 for small/medium sizes

• $30 for large and extra-large sizes

By comparison the costs from the NSW Health warehouse were:

• $82 for small/medium sizes

• $101 for large sizes

We have 15 monitors and wear and tear means we purchase new cuffs for each monitor every 4 months.”

Are we using supplies in the most efficient way possible?

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C. CONSIDERING PROCESS IMPROVEMENTS

“We realised that if we moved the printer closer to the

reception desk, we didn’t have to spend so much time

walking to and fro and could answer calls easier.”

“Every time a new Junior Medical Officer came on

board we needed to send a pager off-site to the supplier

to be reset. By learning how to do this process in-house

we made a huge cost saving.”

C – PART 1: CONSIDERING PROCESS IMPROVEMENTS

Why do we do things this way?

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WHY DO WE DO THINGS THIS WAY?1. What are we doing that involves a lot of time? What processes

take the longest for the least benefit?

2. What are we doing that involves a lot of people?

3. What are we doing that involves a lot of equipment or supplies; or

very expensive equipment or supplies?

4. What are we doing that involves the most time from senior staff?

C – PART 2: REFLECT ON HOW YOU WOULD APPLY THESE

1. If you could make one process improvement to help your team

work more efficiently, what would it be?

2. Who would you need to talk to before starting this process? Who

would you need to consult during the process?

3. What factors might prevent you from implementing the change in

your team?

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REFLECTION AND EVALUATION

And lastly…

• Be responsive

• Be proactive

• Question the status quo

• We are all responsible for initiating improvement

• Remember, there is only limited funding and we are best placed to

ensure we get the best value from it

STRATEGIES

1. What are the top 3 takeaway strategies or ideas that you can put into action in your workplace?

2. How are you going to keep learning after this workshop?

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FURTHER INFORMATION AND SUPPORT

• Locally – each other, your manager, mentor, workforce, peers

• Health Education and Training Institute

Management Development Team:

Phone: 02 9844 6136

Email: HETI-Management@health.nsw.gov.au

Website: www.heti.nsw.gov.au

Thank you for attendingManaging Health Resources:A Foundation

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