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					 28 Years
1983-2011



     Hospice Greater Saint John owns and operates both
       “Bobby’s Hospice” and “The Hospice Shoppe”
        In the fall of 2005,
   facing her own end-of-life
    illness, Bobby Lawson,
 a 20-year Hospice volunteer,
     and her family made a
 significant donation to enable
Hospice to purchase a home in
 the community suitable for a
      Residential Hospice.
                        The Business Case
                        Community Needs
•   800 people die annually of a palliative illness in the Greater Saint John area.

•   Over half of the annual palliative deaths take place in the SJRH
      - 200 in the Palliative Care Unit
      - 200 in Acute Care Beds

•   In the last month of life, 50% of palliative patients are hospitalized because
    they need 24-hour care that families are unable to provide.

•   SJRH has some of the longest wait times for elective surgery & admissions
    from the ER

•   Seniors account for 75% of palliative deaths. By the year 2025, the
    proportion of seniors in NB is projected to be 21% higher than the national
    average.

•   Palliative deaths are set to rise significantly, particularly in Saint John, which
    has NB’s oldest population
                       The Business Case
                     The Community Benefits
    Dying Patients – 130 dying patients who will otherwise face hospitalization
        annually in the last month of life receive individualized quality end-of-life
        comprehensive care in a home-like setting.

•    Hospital Wait Times –Residential Hospice frees up over 2,500 acute
     care bed days at the SJRH annually and increases access for 500+ patients on
     surgical wait lists, etc.

•    Families –Hospice palliative care positively influences the quality of dying
     and the recovery of survivors. With the death of one person affecting an
     average of 5 other people, 650 families are positively affected by Residential
     Hospice care.

•    Tax Dollars – Government is spending $200/day to care for palliative
     patients in the Residential Hospice compared to $1,000/day in an acute care
     hospital. Over $2 million dollars/year is being reallocated to acute care
     services.
       Twinning & Sharing for Success



Carpenter Place, Burlington, ON – www.thecarpenterhospice.com
Hospice May Court, Ottawa, ON – www.hospicemaycourt.com
Vernon & District Hospice, Vernon, BC – www.vernonhospice.ca       Thank
Rosedale Hospice, Calgary, AB – www.hospice.calgary.com
Red Deer Hospice, Red Deer, AB – www.reddeerhospice.com             You!
Hospice Niagara, St. Catherines, ON – www.hospiceniagara.ca
Dr. Bob Kemp Hospice, Hamilton, ON – www.kemphospice.org
Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association
Janet Dunbrack, Healthcare Consultant and Former Executive Director, CHPCA
Carolyn Tayler, RN, BN, MSA, Director, Hospice Palliative Care, Fraser Health, BC

    Ontario & Fraser Health Standards for Residential Hospices
      Our Greatest Challenges

• Challenging the status quo

• Selling the unwanted

• Developing a critical mass

• Staying the course
Our Attitude
         Secrets of Success
Fearless Leaders & Dedicated Teams
More important than technical brilliance or
political smarts is the need for leaders to be
courageous, persistent and resilient.
It requires tremendous commitment and many sacrifices by
   a lot of people to get the job done.
• Dedicated Board of Directors willing to take smart, calculated
  risks
• Strong Staff Team to lead the way and manage the current
  business units
• Medical Experts to add credibility and rally a community
• Political Champions to open doors and lobby internally
• Community Champions to believe, invest and support
Secrets of Success
          Master the art of “The Spin”
People buy want they want, not what they need.
 Selling death services is not what people want.
  Package it differently - how your Residential Hospice
  will reduce hospital wait times, improve acute care
  services and support economic development.
 Tell compelling stories to back up your facts.
 Communicate, communicate, communicate. If you’re
  not sick of saying it, you haven’t communicated
  enough! On average, it takes hearing or reading a
  message 8 times for someone to grasp it.
   Secrets of Success
Engage the media and be media savvy
Meet with your newspaper’s editorial board to sell your
    plan. If you have a solid business case that will
  benefit the community, they will give you thousands
 of dollars worth of free publicity that will help inform
        the public and encourage political action.
Remember that the media do not exist to support you –
   give them newsworthy items to report on, both the
 good and the bad. Be honest, fair and smart with your
                        comments.
      Everything you say is ON THE RECORD.
 Secrets of Success
Develop political champions
Secure experienced politicians in all parties, at all
   levels of government to take up your cause.
 They will open doors to government, give you
    wise advice and lobby internally for your
                     project.
Invite them to your public functions.
Give them an opportunity to speak.
Give them recognition.
Praise them publically and in the media.
  Secrets of Success
Lean on and learn from others
Take smart, calculated risks
 Build relationships with others who have travelled this
  path. Let them be your coach and champion. Lean on
  them for support, hope, guidance and strength. Learn
    from their experiences – don’t reinvent the wheel.

 Do your research and have a solid business plan.
 Have the courage to move forward.
 People and resources will follow.
   Secrets of Success
                     Don’t give up
    This will be an amazing, frustrating, exhausting and
                     exhilarating journey.
 Learn to live on the brink of disaster – it’s the norm.
  Keep moving forward.
 Hard times bring strength, solidarity, clarity, unity and
  success.
 Things outside of your control will come along to propel
  you forward when you need it the most.
 In retrospect, you wouldn’t have missed any of it – you
  cannot appreciate the highs without suffering the lows.
$2M Renovation Project
     2008 - 2010
Sprinkler System
•Elevator
•Fire System
•New Plumbing System
•Furnace Upgrade
•Window & Lighting Upgrades
•Automatic Generator
•Parking Expansion
•New Flooring
•Architectural Design
•Nurse Call System
•Security Upgrade
•Patient Bedrooms & Bathrooms
                  Renovation Costs
REVENUE
Capital Campaign Revenue             $1,992,049
Hospice Fundraising Surplus           $151,815
TOTAL COMMITTED REVENUE              $2,143,864


EXPENSES (Inc. 6.5% HST)
Architect                             $130,000
Bird Construction                    $1,784,757
Paving + Lines                         $19,170
Garden of Hope & Healing               $12,206
Window Etching                          $1,095
Energy Audit                            $1,500
Security System                        $16,060
Furnace System                         $73,125
Flooring                               $94,785
Nurse Call System                       $9,568
Additional Cupboards                    $1,598
TOTAL EXPENSES                       $2,143,864


SURPLUS (DEFICIT)                           $0
           Power of the Dream
  A Capital Campaign Strategy for Residential Hospice

1. Build the Dream – 2006 - 2007
 $300,000 raised to purchase our first Hospice
  House.

2. Realize the Dream – 2007 – 2010
 $2M raised to renovate and ready for operations

3. Live the Dream Legacy Fund – 2012…
 Endowment fund for bequests, etc. with annual
  interest earnings supporting operations
 Realize the Dream Capital Campaign
                               Amount       Goal         Variance     % of Goal


Total Individual Donations      $378,590     $200,000      $178,590        189%


Total Physician Donations        $56,297      $50,000        $6,297        113%


Total Lawyer Donations             $6,725     $40,000      -$33,275         17%


Total Foundation Revenue        $401,503     $400,000        $1,503        100%


Total Corporate Donations       $276,787     $300,000      -$23,213         92%


Total Service Club Donations     $114,589    $100,000       $14,589        115%


Total Government Donations      $657,558     $650,000        $7,558        101%


Total Hospice Shoppe Revenue     $110,000     $60,000       $50,000        183%


TOTAL REVENUE                  $2,002,049   $1,800,000     $202,049        111%
Government & Hospice Contract

 Annual budget of $1.6M
    Hospice – 55%
 NB Government – 45%
  No fee to patients !!
                Partnership Principles
$730,000/year                                   $870,000/year

 •   Patient’s first
 •   Hospice governance & administration model
 •   Partnership evidenced by a contract
 •   End-of-life care
 •   Industry best practices –evidenced-based model-
     Canadian Residential Hospice standards.
 •   Quality control
 •   Stability & predictability
 •   Integrated with volunteer support
 •   No duplication – seamless care
 •   Full accountability and public reporting
     Over-Arching Principles
          Palliative Care Partners


• Patient and Family first (not about us)
• Seamless care through Triage process.
• Good communication and collaboration
  amongst partners
• Right Person, Right Place (Home, PCU, RH),
  Right Time
• Patient Preference is respected if possible
• All attempts should be made to avoid ER
10-Bed Residential Hospice
  Opened November 2010
          Residential Hospice Overview
•   22,000 sq. foot palliative care facility with 24-hour care delivered by
    certified and licensed professionals and trained volunteers.

• 10 private home-like bedrooms and bathrooms for end-of-life palliative
  care

•    24-hour physician coverage and nursing care with expert pain and
    symptom management

• 4 family bedrooms, living rooms, TV room, dining room, kitchen, warm
  fireplaces, communication room, etc.

• A playroom for children, a chapel for spiritual reflection and outdoor
  garden to connect with nature.

                      The care at our facility exceeds the
               Canadian Standards for Residential Hospice care.
           Hospice Care Philosophy
       Compassionate Care that Celebrates Life
• Individualized, dignified, respectful and compassionate whole person quality
  care that includes physical, emotional, spiritual and social care for both
  patients and family members.

                        This is their journey – their way.
 We focus on what is important to patients and families and let them guide the way.
                 We help people to live fully until the end of life.
     We provide non-judgmental, respectful, dignified and compassionate care
                                   and support.

• A home-like, peaceful environment that respects patient and family wishes.

         This is their home away from home for the remainder of their life.
           We work hard to make people feel comfortable and at home.
 We are committed to keeping things as home-like and non-institutional as possible.
                 We create an environment of peace and tranquility.
                     We care for this home as if it were our own.
        Hospice Care Philosophy
    Compassionate Care that Celebrates Life
• Experienced and dedicated staff and volunteers who work together in full
  cooperation with each other and with community healthcare partners to
  serve patients and families and deliver excellent healthcare and
  comprehensive support.

                  We are here to serve others, not ourselves.
We are dedicated to excellence in our clinical practice and respectful teamwork.
We go the extra mile to provide superior customer service and exceed people’s
                                   expectations.

• A supportive community that provides the funds needed to cover our
  share of the operational costs.

      We treat our community’s donations as if they were our own funds.
    We are cautious with our use of supplies and spending. We don’t waste.
        We contribute to Hospice fund raisers to the best of our ability.
Customer Service
   “The Pickle”
Hospice is committed to quality customer service and
 “giving the pickle” which is about going the extra
 mile to make customers happy and fully satisfied.

  Our customers include patients, families, donors,
 shoppers, community partners and anyone outside the
  organization who interacts with the organization to
      receive or provide services and/or support.
                Admission Guidelines
                     Terminal care with ongoing
                    pain & symptom management


• Patient and family aware of diagnosis & prognosis
• End stage disease management & terminal care
• Ongoing pain & symptom management
• Limited diagnostics/disease specific treatment
• Expected length of stay 6 weeks or less
• Cannot stay at home and does not require hospital
  care
• No ventilators
• No wandering
                  Residential Hospice
                     Admissions



1. From community through Family
   Physicians, Extra Mural and the HPC
   Outreach Clinic


2. From Hospital via consult to Palliative
   Care Unit or direct consult to Hospice
               Medical Coverage
                         Funded by Hospice



• 2 FTE Medical Director – two ½ days per week
                   Dr. Chris O’Brien
• Two additional ½ days of palliative physician coverage –
  Dr. Julia Wildish and Dr. Jennifer Hannigan
• Family physicians encouraged/supported to admit and
  follow
• 24-hour call team with physicians from the PCU

 Leading the country in RH medical coverage
                         Nursing & Support
                              Services

• Nurse Manager – Monday to Friday – Nicole Hamming

• 24-hour Nursing & Personal Care
      1 Registered Nurse (RN)
      1 Licensed Practical Nurse (LPN)
      1 Personal Support Worker (PSW)

• Volunteers in 4-hour shifts 8:00 am – 8:00 pm

              Exceeding Ontario Standards
          Volunteers
         Adding Value
             Serving Meals
           Doing nails and hair
            Running errands
                 Laundry
    Emotional and spiritual support
              Playing piano
           Baking and cooking
Cleaning, mopping, dishes, changing beds
            Massage therapy
• Oxygen and Respiratory Therapy
• Complex Wound Care and Help with Supplies
• Specialized air flow Mattresses
• Liaison Nurse - EMP Hospice Palliative Care Coordinator
• Continuity of care. Frequent visits to patients from their
  community EMP nurse ( “ they love to visit”)
• Payer of Last Resort (not had to utilize to date)
• OT /PT / SW
               Medications

• Exclusive pharmacy for all patient prescriptions
• Delivery, supply MARS, Flips and holders
  Medication discard and Sharps disposal
• Back up supplier for medical supplies
• Staff promo medication discount card
• Future engagement for team rounds
                  Lives Lived at Hospice
                       November 2010 – October 17, 2011

•   96 admissions
•   60% from hospital and 40% from home
•   82% are age 65 and older
•   85% cancer diagnosis
•   Average PPS on admission – 41%
•   85 deaths; 4 discharges
•   Average length of stay: 22 days (16 days outliers removed)
•   Over 2,200 beds days saved at SJRH
•   Occupancy Rate – 72%
•   Projected to care for 130 patients/year
      Community Feedback
 “How can we even begin to express our
 gratitude for all the excellent love and care
 that you gave to our Mom during our time
                    with you.

What started out as a dark and fearful time
  into the unknown became a place of joy
 and laughter and friendship that made her
  final journey a blessed time. She loved
  you all and told me so all the time. You
      are truly God’s Angels on earth.”
Updated Sept. 2011
                                             Board of Directors



                     Chief Executive Officer                            Director of Medical Care




                                        Grief, Spiritual           Finance &       Nurse          Palliative
Shoppe               Marketing
                                       Care & Operations            Website       Manager      Support & Food
Managers              Manager
                                           Manager                  Manager                    Services Manager



                                                     Housekeeping
                                                                                 24-hour       Food
 Shoppe                                               Coordinator
                                 Admin.                                        RH Care Team   Services
 Clerks
                                 Assistant                                      RN’s, LPN’s   Coord(s)
                                                                                  PSW’s
                                                     Maintenance
                                                     Coordinator



             Friends
                                                                                                          PS &
Shoppe         Of                            Grief
                                                                                                         Kitchen
 Vol’s       Hospice                         Vol’s
                                                                                                          Vol’s
              Vol’s
John Carver’s Policy Governance Model
•     Advanced Board Model - not involved in operations

•     Board has two employees – CEO and Director of Medical
      Care - run operations and report to the Board on outcomes

•     Board’s Role –Oversee the affairs of the organization on behalf of the
      community and be accountable that the org works and delivers on
      community needs

1.     Governance and Stewardship
     –    Confirm strategic direction, delegate authority and evaluate results.
     –    Review and authorize plans, policies and commitments.
     –    Ensure compliance with legal and contract requirements.
     –    Monitor performance outcomes and evaluate the organization work against
          quality standards and best practices.
     –    Ensure dedication to, and use of assets for public benefit.
2.     Leadership and Support
     –    Ensure the long-term financial health of the organization.
     –    Act as ambassadors to the community and attend special events
     –    Ensure the Board performs effectively.
Executive Committee            Board of Directors




               Chief Executive Officer        Director of       Community HPC
                       (CEO)                 Medical Care          Network



                Management Team             Medical Advisory
                                              Committee



                                              Community

                  Quality Care             Triage & Care Team
              Operations Committee           (IDT Rounds)



                 Health & Safety
                   Committee
             What Does It Cost To Run A
          Residential Hospice for One Year?
Nursing Costs                                 $800,000
General Operations & Management                150,000
Hospice Shoppe                                 135,000
Medical Supplies & Services                    100,000
Events & Promotion                              70,000
Food Services                                   70,000
Maintenance & Housekeeping                      65,000
Supplies & Equipment                            60,000
Heat, Lights, Water                             40,000
Volunteer Services                              40,000
Worker’s Compensation                           18,000
Laundry & Supplies                              15,000
Professional Fees (audit, legal, payroll)       12,000
Phone and Cable TV                               8,000
Insurance                                        8,000
Grounds                                          6,000
Garbage & Compost                                3,000
Total Costs                                 $1,600,000
   Where Does the Money Come From?
Govt = 45%
Shoppe = 20%
Events = 15%                    3%   $730,000/year
Donations = 15%         15%
United Way = 3%
Grants = 2%

                                     45%
                  15%


                    2%

                          20%
  $48,911/year                        $360,000/year
           Special Events


December 8-17, 2011
     $20,000
                          Saturday
                      February 12, 2012
                          $110,000




   Saturday                  Wednesday
  May 12, 2012              June 13, 2012
    $50,000                   $25,000
77 Catherwood Street
                                       Open Monday – Saturday
  West Saint John
                                       10:00 am – 5:00 pm
                                       Thurs & Fri Evenings until
                                       8:00 pm

   100% of proceeds fund care at the Residential Hospice
   Leading Org. Change
• Tough-Minded Optimist
• Be Somewhat Naïve and Believe it is
  Possible
• Make Tremendous Sacrifices
• Doggedly Persistent & Very Resilient
• Surrounded by a Dedicated Team of
     Leaders & Champions
• Team’s Greatest Cheerleader
• Be Aware of “Founders’ Syndrome”
• Accept Not Everyone will Make the Journey
• No Matter What – The Journey will be Worth It!
The Tipping Point
We Made It!
      “At some time, in some way, we must
          all face the end of life.

And most of us share a common hope—that
 when death comes to us or to a loved one,
    it will be peaceful and free of pain.

We hope to face death and grief surrounded
    by a circle of support, feeling safe,
        comfortable and cared for.

      This is the promise of Hospice
           Greater Saint John.”

				
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