Lack of boundaries good news for sustainability, health

Balancing a Budget

"The boundaries are down,” said Nova Scotia Health Authority’s Vice-president, Stewardship and Accountability, and Chief Financial Officer, Allan Horsburgh. He’s referring to the benefits of being one system as compared to nine separate health authorities, a change that allowed the organization to achieve a balanced budget in fiscal 2015-16, a result not experienced in the Nova Scotia health system in the past several decades. The achievement is more than financial, supporting the organization’s focus on delivering sustainable, quality care and health services.

Reaching balance for the first time in recent memory was not an easy feat, and meant mitigating a $70-million deficit. The organization carried $29-million in structural deficits from the former district health authorities (DHA), and faced $41-million in new pressures and inflation. 

“We’ve been focused on financial accountability since day one of Nova Scotia Health Authority,” said Horsburgh. “Now that we’re one system, it’s far easier for us to co-ordinate our efforts, make real time decisions,  take advantage of economies of scale, and build a single culture of financial accountability.”

The efforts to address the $70M pressure included a variety of new province-wide organization initiatives, including:  

  • Identifying many pockets of best practices, and rolling them out province-wide
  • Looking at activities that enable NSHA to better plan and deliver services across old borders
  • Enhancing purchasing  practices that span the full organization and are more consistent, allowing NSHA to take advantage of bulk purchasing and better pricing
  • Planning services and activities as a system (e.g. co-ordinating slowdowns; ensuring greater consistency of tests, drugs and staffing patterns; taking a co-ordinated approach to overtime, sick time and management of job vacancies) 
  • Standardizing rates for uninsured services (e.g. semi-private and private rooms, inpatient rates for out-of-country patients)
  • Streamlining administration

With a balanced budget in year one, what does the financial future look like for NSHA? 

“We’ve just received approval for our 2016-17 business plan, which is good news,” said Horsburgh. The organization will soon look, however, to a five-year business planning cycle.

“We’re a $2-billion dollar organization. No business of that size does business planning one year at a time. We need to be looking out five years and determining where we need to invest today for future return on our investment – a return that goes directly back into our patient care and community health initiatives.”

Ultimately, Horsburgh said the organization’s success – both financially and in improving health outcomes – comes down to culture and leadership. “We need to remain focused as individuals and as an organization on making the best possible use of our resources for the sake of improving the health of Nova Scotians, and having it sustainable for generations to come.  Every tough financial decision we make today is a financial decision that will benefit our patients and communities now as well as in the future.”