REPORT CRITICAL OF RQHR
Auditor criticizes surgical process
The provincial auditor blasted the Regina Qu’Appelle Health Region (RQHR) for inefficient scheduling of surgeries and use of operating rooms — which are contributing to the region’s surgical wait-time woes.
The first volume of Bonnie Lysyk’s 2013 report notes the region has 19 operating rooms in its two hospitals and seven operating rooms in two third-party clinics. Typically, the ORs run eight hours per day, five days a week.
Lysyk said the efficient use of operating rooms is vital to providing timely surgeries. However, the region could not tell auditors how many hours and minutes each operating room was used daily or how many surgeries were performed.
Currently, the RQHR has no computerized scheduling system capable of tracking information to use in decision making. For example, cancelled surgeries are one reason the operating rooms aren’t being used to their full potential.
Analyzing the reasons behind cancellations would help improve efficiency, Lysyk said.
“As well, Regina Qu’ Appelle does not have clear policies to guide the allocation of surgical facility time to surgeons, standards for the use of surgical facilities are not in place, and it does not currently track what and when surgical equipment is available,” Lysyk said.
Nor does the RQHR have standard surgical request forms, which could improve efficiency.
The region knows, in a general sense, how many operating theatres it has and how they are used, said Keith Dewar, CEO of the RQHR.
“What we don’t have is a very robust system to really tell us down to the minutes of time available, how that time is being used and being able to find out what time is not being used and why it’s not being used,” he said.
A surgical information system is being installed in Saskatoon and Regina is next in line.
Even with the current system, Dewar acknowledged the region could have done a better job, “so that’s one reason we agreed with the auditor’s recommendations.”
“We worked hard at getting more access to surgical beds, but more critically to get more OR nurses to support the opening of more OR theatres,” Dewar said. “If an OR theatre can’t be open right now because of staffing reasons, it is zero per cent efficient.”
Additionally, the region has focused on recruiting another orthopedic surgeon and is working out a better scheduling system with the surgeons.
Dewar noted the RQHR did 3,200 more surgeries this year than last.
The auditor also took issue with the region’s budgeting, financial reporting and financial oversight.
In January, at the request of the Ministry of Health, the auditor’s office examined the process the RQHR used to prepare its 2013 budget and for its 2012-2013 financial reporting.
The report noted that during 2012, the Regina Qu’Appelle Regional Health Authority (RQRHA) board “received and reviewed incomplete, incorrect and untimely monthly projected year-end results.”
In January the board received reports that accurately showed the deficit for the year would be about $24 million, despite an initial projection of a $2-million surplus. But because management provided the financial information to the board late in the year, the board could not take timely actions to potentially recover the deficit, the auditor said.
Since Dewar took charge as CEO in November, Lysyk noted that he and the board have made operational changes, including remedies to address the financial issues identified in her report.
The auditor’s recommendations include that the RQRHA request the Ministry of Health to appoint individuals with financial expertise to the board to assess financial reports.
Dewar agreed that someone with an accounting designation would be beneficial and said the board made the request prior to the auditor’s report.
Health Minister Dustin Duncan confirmed that position will be added to the board of directors.
“We agree with the provincial auditor’s recommendations and I’m glad to see that the region agrees as well and they are working to implement and address them,” he said.
He said the ministry has been working closely with the RQHR because of the very issues Lysyk set her sights on.