We recommended that Five Hills routinely provide its managers with opportunities to learn about outcome-oriented management (i.e., about selecting useful targets, analyzing results in the short, medium, and long term and using performance information).
Five Hills has fully addressed our recommendation.
In 2010, Five Hills routinely provided new staff with a two-week
orientation. In addition, new managers completed an orientation checklist.
This checklist required discussion with other managers about strategic
priorities and monitoring outcomes.4For example, new managers learned about monitoring results in terms of financial reports and quality
improvement projects.
Five Hills also developed a leadership project team. This team promoted leadership training and served as role models for other managers. In 2009 and 2010, the leadership project team improved the managers’
orientation, made presentations about management skills, and began long-term planning for training managers.
Five Hills also provided routine quality-improvement training to those carrying out quality-improvement projects. This training included setting targets for improvements and learning to monitor progress toward these targets. Forty-one staff, including many of its managers, received this training. In addition, several members of the Board and senior leadership team attended six training workshops with the Health Quality Council of Saskatchewan. These workshops explained how to measure outcomes in the short and long term.
Status of other outstanding recommendations of the Standing Committee on Public Accounts
The following table provides an update on recommendations previously made by PAC that are not yet implemented and are not discussed earlier in this chapter.5
PAC REPORT
YEAR6
OUTSTANDING RECOMMENDATION STATUS
Ministry of Health (Regional Health Authorities)
2002 PAC concurs:
6D-1 that all RHAs should prepare capital equipment plans that contain the key elements for capital equipment plans in the public sector.
Partially implemented(as at March 31, 2010).
Capital equipment plans are improving but still do not contain all key elements of good plans.
4Strategic priorities are set out in Five Hills’ Strategic Plan.
5For the definitions of the key terms used in the table, see Chapter 24 – Standing Committee on Public Accounts.
6PAC Report Year refers to the year that PAC first made the recommendation in its report to the Legislative Assembly.
PAC REPORT
YEAR6
OUTSTANDING RECOMMENDATION STATUS
Ministry of Health (Injury reduction)
2005 PAC concurs:
2-1 that the Boards of Governors of the Regina Qu'Appelle and Saskatoon Health Regions should commit to workplace safety as a priority and that the boards should:
- set specific targets to reduce work-related injuries to care staff in the short term
- allocate resources to achieve the targets (e.g. staff or mechanical aids) - receive frequent reports about injury rates and actions to reduce injuries - hold senior managers accountable to reduce injuries
Partially implemented(as at September 30, 2008).
We plan to do a follow-up in 2011.
2005 PAC concurs:
2-2 that the Regina Qu'Appelle and Saskatoon Health Regions should analyze the unit staffing patterns that are associated with high and low injury rates, and implement the lessons learned.
Partially implemented(as at September 30, 2008).
We plan to do a follow-up in 2011.
2005 PAC concurs:
2-3 that the occupational health
committees of the Regina Qu'Appelle and Saskatoon Health Regions should:
- monitor injury trends at least quarterly - analyze the causes of injuries in areas with high injury rates at every meeting - make written recommendations to senior management and their board to fix unresolved causes of injuries
Partially implemented(as at September 30, 2008).
We plan to do a follow-up in 2011.
Ministry of Health (Immunization coverage)
2009 PAC concurs:
2D-1 that the Prince Albert Parkland Regional Health Authority work with First Nations and federal health agencies to maximize access to immunization for children in the region.
Partially implemented(as at September 24, 2008).
We plan to do a follow-up in 2011.
PAC REPORT
YEAR6
OUTSTANDING RECOMMENDATION STATUS
2009 PAC concurs:
2D-2 that the Prince Albert Parkland Regional Health Authority set target immunization coverage rates for children in the region and develop plans to achieve those targets.
Partially implemented(as at September 24, 2008).
We plan to do a follow-up in 2011.
2009 PAC concurs:
2D-3 that the Prince Albert Parkland Regional Health Authority regularly report to its board an analysis of the causes of its low immunization coverage rate.
Partially implemented(as at September 24, 2008).
We plan to do a follow-up in 2011.
Ministry of Health (Hospital acquired infections)
2009 PAC concurs:
11D-2 that the Sunrise Regional Health Authority provide guidance to help staff fully identify, investigate, analyze and report hospital-acquired infections.
Partially implemented(as at August 31, 2009).
We plan to do a follow-up in 2011.
2009 PAC concurs:
11D-3 that the Sunrise Regional Health Authority focus its actions to prevent and manage hospital-acquired infections by reporting and monitoring:
-the rates and causes of hospital-acquired infections
-progress toward targets by type of infection
Partially implemented(as at August 31, 2009).
We plan to do a follow-up in 2011.
Main points ... 180
Introduction ... 181
Background ... 181
Our audit objective, criteria, and summary findings ... 182
Our conclusion and recommendations ... 183
Our detailed findings ... 184
Setting policies and procedures for medical equipment maintenance ... 184
Maintaining medical equipment... 185
Monitoring performance... 186
Selected reference ... 186
Main points
To provide adequate patient care, regional health authorities must adequately maintain medical equipment used to treat and diagnose patients. Preventative maintenance of medical equipment can help reduce overall capital spending over the long term. Poorly maintained equipment could malfunction resulting in incorrect dosage and treatment.
Equipment failure could result in unsafe care and patient harm.
Kelsey Trail Regional Health Authority (Kelsey Trail) did not have
adequate processes to maintain its medical equipment. It needs to clearly define roles and responsibilities for maintaining its medical equipment and establish written policies and procedures. It must also maintain a
complete and current list of all medical equipment, its location, and its maintenance record. About 28% of the equipment that we tested at Kelsey Trail did not conform to the manufacturer’s preventative maintenance standards.
The chapter has seven recommendations for Kelsey Trail to help
strengthen its processes. We encourage other regional health authorities to use the criteria described in this chapter to assess the adequacy of their processes to maintain medical equipment.
Introduction
The Kelsey Trail Regional Health Authority (Kelsey Trail) has
approximately 1,580 staff and 35 physicians. It has three district and three community hospitals. Kelsey Trail has 116 acute care and 482 long-term care beds.
Kelsey Trail is responsible for the overall quality of care of its patients. To provide a high level of patient care, Kelsey Trail uses medical equipment to help diagnose and treat patients. In 2009-10, it spent $1.4 million on capital equipment purchases1and $698 thousand on repairs and maintenance.2
Background
Providing safe, patient-centred care is an objective of the Government.
Fostering a culture of quality improvement and client-centred service, and transforming the care and service experience through a focus on
patient/client safety are two of seven strategic goals set by Kelsey Trail.3 Medical equipment (e.g., intravenous pumps, ventilators, cardiac
monitors, diagnostic equipment, beds, lifts) is essential to diagnose and treat patients. Medical equipment requires preventative maintenance.
Such maintenance helps ensure the equipment works as planned. For example, well maintained equipment pumps help ensure the correct dosage of medication.
Preventative maintenance of medical equipment can reduce overall capital spending over the long term. Properly functioning medical equipment also maintains the capacity of the healthcare system to provide safe, patient-centred care.
Manufacturers set out preventative maintenance requirements in their recommended standards. Legislation also sets out preventative maintenance requirements for medial equipment. For example, the Regulations underThe Occupational Health and Safety Act, 1993require regional health authorities to use competent persons to implement
1Kelsey Trail Regional Health Authority’s 2009-10 Annual Report, p 83.
2Ibid, p 99.
3Ibid, p 7.
preventative maintenance programs that meet manufacturers’
recommendations for medical equipment to mobilize, lift, hold, turn, position, or transfer patients. Also, the Regulations underThe Hospital Standards Actrequire regional health authorities to take precautions to ensure anaesthesia equipment is maintained in a serviceable condition for immediate use.
Management told us it maintains medical equipment in one of three ways:
a service contract with a manufacturer, an agreement with an affiliate of another regional health authority (service provider), or Kelsey Trail
employees. Manufacturers maintain approximately 55% of the equipment, the service provider maintains about 30%, and Kelsey Trail employees maintain the rest.
Poorly maintained equipment could malfunction resulting in incorrect diagnosis and treatment. Furthermore, equipment failure could result in unsafe care that may harm patients.