Up until a few months ago, the Health Services Authority, which runs the George Town Hospital in Grand Cayman, the Faith Hospital on The Brac and the District Clinics, appears to have been a constant headache for government and patients alike; a loss making entity that desperately needed a new direction for its hard working staff to provide the high quality healthcare deserving of the Caymanian people.
Now the HSA has unveiled a brand new five year strategic plan which paves the way for change, with a dynamic and ambitious action plan that will see changes for the better in the coming months and years. Business Editor Lindsey Turnbull sits down with Canover Watson, the HSA’s chairman of the board of directors to appreciate more and reports.
Back in March a three day session was held with all stakeholders in the HSA, including management, staff, vendors, patients, Ministry of Health officials and board directors.
“We all had one thing in common and that was a passion to get the HSA heading in the right direction,” Watson confirms.
The HSA Board is comprised of a number of highly professional individuals who each bring to the table their own individual expertise to achieve the common goal: provide the best quality healthcare. Watson, managing director of Admiral Administration, is chairman of the board and previous head of the finance subcommittee for the HSA.
The deputy chairman is Peter Young, a past managing partner of an international accounting firm who chairs the newly formed internal audit sub committee; Tommy Ebanks, another qualified accountant heads the finance sub committee; Wanda Ebanks is a partner at law firm Maples and Calder; Ryan Waldron heads IT at PricewaterhouseCoopers; Raquel Solomon is an HR manager with the Fosters Group and Nina Banks is the board’s Brac representative.
Focusing on goals…
The group hired a professional facilitator to bring together all discussions in a well-defined and coherent manner. They focused on creating a mission statement, setting down core beliefs that they all felt were intrinsic as to the values of the HSA, and drew up an action plan, which would have the group meet again in late June, after setting each individual goals which they needed to meet before the next session.
“After setting out our parameters at a high level we were grouped into action teams that were each assigned particular areas for further research,” Watson explains. “We were required to produce objectives for the HSA and an implementation plan as to how we could achieve those objectives.”
These findings were then discussed at length in the second meeting, with all participants focusing closely on the feasibility of the game plan, as well as the practicality of the action points, while always keeping in mind the financial viability of each idea.
In July, after approval by all board members, the HSA was able to unveil its five year strategic plan, to show Cayman its vision for improving health care for the people of these Islands.
“We have come up with a road map for the Authority,” Watson states. “It’s the compass by which all board meetings will be steered.”
…and how to get there
Having set four main objectives of the strategic plan (to reduce the incidence of diseases such as obesity, diabetes and cancer among HSA patients, to implement evidence-based practice in all areas of clinical care, to have collections match operating expenses and to have 90 per cent or better rate the HSA excellent for healthcare) the group drilled down to a series of seven strategies to help them achieve these goals.
Each strategy was then broken down further into specific results. For example, the first strategy decided was to work collaboratively with community partners to engage the public in healthy lifestyle changes. Out of this strategy seven further results include the establishment of a chronic disease information kiosk to help the public understand the risks, management and treatment of such diseases as well as their prevention.
A further result includes the establishment of a network of volunteers to educate the community to promote healthy lifestyle awareness. Another important result was the need to establish surveillance mechanisms to collect and analyse data on the prevalence of risk factors for developing chronic diseases and their mortality rates.
The second strategy decided upon was for the implementation of patient-friendly processes to improve customer service and external communications in order to enhance the public perception of the HSA. The game plan for this strategy was split into seven further specific results, including establishing a customer service desk and creating a hospitable hospital environment that decreases clients’ waiting time and therefore complaints.
Better financial management
The third strategy deals with the importance of financial controls to improve operational efficiencies and enhance revenue collection. This strategy is broken into 11 specific results, including the provision of a comprehensive and accurate costing of all services provided.
“This is a project that has already begun,” Watson confirms.
“We are looking at those services that cost the most (such as caesarian sections), as well as high volume procedures. This is important because there is currently a mismatch between what we are charging and what the insurance companies will cover. We are finding that our prices don’t always even cover our costs and that insurance companies would actually allow the insured to claim a much higher maximum amount per procedure. Of course, we are not about to put all our prices up, but we must ensure that at least our costs are met.”
Watson says that a government overhaul of the Standard Health Insurance Coverage is under way, stating that this goes hand-in-hand with what they are trying to achieve at the HSA.
“We are finding that in many cases people are under insured and that the SHIC is inadequate for individuals. All too often a procedure is carried out only for the insurance companies to revert a month or so later to say that the individual has exceeded their cover. Trying to claw that money back from the patient months after the event is usually very difficult,” he says.
Watson says a White Paper on the issue has been drafted and should appear before the House this month.
Better financial management has of course already resulted in the HSA making a small profit this year, which now gives the board a small budget from which to gradually implement their plans.
The game plan
An implementation schedule has been drawn up for the year 2010/2011 as well as the year 2011/2012. For now a number of initiatives are being focused upon, such as the establishment of the customer service desk, establishing and enforcing policies to ensure that the HSA’s equipment is standardised, efficient and operational and the redefinition of recruitment strategies to attract the highest quality staff. A new payment policy is also due to be implemented and collection will be improved to reduce bad debt.
As with many other healthcare providers the world over, the HSA is also working hard to partner with a not-for-profit trust, which will be completely separate from government so that it will have a pool of funds that they can direct into the Authority.
“Bruce John from Scotiabank is heading up the development of this trust which we feel will be a vital aspect of our future financial success,” Watson explains.
“Like every hospital, we are partly donor based so it is critical that we implement the requisite machinery to get this into place. We are looking forward to the launch of the trust in the near future.”