Health and Wellness for All

2017 - 2018

Annual Report

Letter of Transmittal and Accountability

W e are pleased to present the annual report for Prairie Mountain Health (PMH) for the fiscal year ended March 31, 2018 as approved by the Board of Directors. The annual report was prepared under the Board's

direction in accordance with the Regional Health Authorities Act and directions provided by the Minister of Health, Seniors and Active Living (MHSAL). All material, economic and fiscal implications known as of March 31, 2018 have been considered in preparing this annual report. This report reviews the actions and initiatives of PMH for the fiscal year April 1, 2017 to March 31, 2018.

As with all health care organizations, the period ahead will continue to present many opportunities as well as challenges. With the assistance of our staff, our community partners, MHSAL, and now our new partner—Shared Health—we will continue to work towards our Vision and Mission.

Health care, as we have known it in Manitoba, is changing. This health system transformation will ensure consistent, quality health care is available to all Manitobans within a system that is safe, reliable and sustainable in the long term. Although these changes will take time, this is a tremendous opportunity to refocus our system and better meet the needs of all Manitobans.

The changes underway are very important, but change can make things stressful for community members and patients as the transformation moves ahead. Manitobans can be assured that our staff will continue to provide excellent patient care throughout the transformation process.

PMH, along with MHSAL, and Shared Health, are committed to continued dialogue with our community, our patients and our staff as this journey unfolds.

To the Board of Directors and Executive Management Team – thank you for your leadership over the past year. To our staff – thank you for your contribution each and every day ensuring the best possible care and service is provided within PMH. To our community partners – thank you for working with us, challenging us and supporting us as we work towards our Vision of “Health and Wellness for All”.

Respectfully submitted,

Table of Contents

Letter of Transmittal/Accountability Page 1

Board Governance Page 2

PMH Board of Directors Page 2

Annual Report Overview Page 3

PMH Communications Page 3

Organizational Structure Page 4

Prairie Mountain Health at a Glance Page 5

Executive Team Message Page 6

Our Results: -Capacity Building-Health System Sustainability-Capital Projects Feature-Improved Access to Care

Page 7 Page 8 Page 9 Page 10

-Grad Nurse Recruitment Feature-Improved Service Delivery-Physician Recruitment Feature-Health System Innovation-Improved Health Status-Emergency Preparedness Feature

Page 11 Page 12 Page 13 Page 14 Page 15 Page 16

2017/2018 Year in Pictures Page 17/18

Financial Position and Operations Page 19/20

Expenditures by Program/Service Page 21

Administrative Costs Page 22

Accountability Provisions Page 22

Compensation Disclosure Page 22

French Language Services Page 23

Public Interest Disclosure (Whistleblower) Page 23

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Catheryn Pedersen Chair Board of Directors

Penny Gilson Chief Executive Officer Prairie Mountain Health

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Prairie Mountain Health (PMH) operates under the direction of a 10 member Board, appointed by the Minister of Health, Seniors and Active Living. The Board’s mandate and responsibilities arise from the Regional Health Authorities Act. The Act provides the legislated responsibility and authority to plan, manage, deliver, monitor and evaluate health services within the region. The Board does this in a variety of ways, including providing sufficient oversight measures, ensuring the organization’s accountability by monitoring and evaluating its performance, and interacting and communicating with its stakeholders and partners, which includes the general public. Although Board members reside in various communities throughout the health region, they represent the entire region at the Board table.

The PMH Board meets monthly (except for July and December) and meetings vary from in-person, through the Telehealth Network and by teleconference. The Board is responsible for establishing the Regional Strategic Priorities, contained within the Strategic Plan. Strategic priorities are constant over a five-year period, however, associated indicators, performance measures and major initiatives are monitored and revised annually by the Board.

In 2017/2018 the PMH Board of Directors made a decision to move from regular Standing Committees to Committees of the Whole where all Board members now participate in the discussions of the Executive, Finance, Audit and Quality and Patient Safety Committees. Committees of the Whole allow for the entire board to work towards common understanding of issues by receiving presentations and reviewing reports together.

Advisory Structure Local Health Involvement Groups (LHIGs) are made up of citizens who have an interest in health, health programs and health related services. The LHIGs explore and provide advice to the PMH Board of Directors on issues that impact the delivery of local health services. PMH has four geographical LHIGs in the region. For more information on the work of the LHIGs please see page 12. If you are interested in becoming a member of a LHIG please visit the PMH website at www.prairiemountainhealth.ca.

Ethics Committee The mandate of the Regional Ethics Committee is to foster an ethical climate within PMH and promote the integration of ethics. The membership of the committee is comprised of employees representing various disciplines, community members with specific expertise (i.e. law, religion, education, medicine), the PMH Board of Directors, the Executive Management Team and patients or family members. The members of this committee are appointed by the PMH Board of Directors and serve in an advisory capacity to the Board and organization in regards to key ethical topics, scenarios and issues.

Stakeholder/Health Partner Consultation PMH continued its focus on partnerships, visibility, linkage and communication within and across the region. Executive Management Team members, along with PMH Board members, participated in the region’s annual stakeholder tour undertaken in May/June 2017. There were 11 key community stakeholder meetings, visits in nine First Nation communities, nine physician group meetings and general staff meetings held across the region.

2017/2018 Board of Directors

Back left: Lorne Henkelman, Vice-Chair, (Swan River), Wanda Sandy (Canupawakpa), Gwen Drul (Oakburn), Cheryl Bjornson (Ste. Rose) and Duane Whyte (Swan River).

Front left: Murray Parrott (Franklin), Catheryn Pedersen, Board Chair, (Holland) and Jonathan Murray (Brandon).

The 2017/2018 year marked the second year of the Strategic Plan for PMH, which is in effect from April 1, 2016 until March 31, 2021. Every five years health authorities review and revise their Strategic Plan in response to trends in demographics, health status, and health service use as well as provincial government priorities. The 2015 PMH Community Health Assessment (CHA) was a valuable resource that influenced the plan’s contents.

This report describes actions and operations from the Strategic Plan priorities for 2017/2018. The four operational priorities were to:

Facilitate communication and transfer of clinical information;

Implement strategies to improve client flow;

Recruit and retain staff proud to work for PMH; and

Standardize policies, procedures, models and tools where appropriate.

For the 2018/19 fiscal year, PMH will focus efforts on two priorities; client flow and fiscal sustainability. These priorities, which are aligned with those of MHSAL, are part of the PMH 2016-2021 Strategic Plan under the priorities of Improved Access to Care and Health System Sustainability.

The 2017/2018 strategic priorities align with those of the province of Manitoba:

Capacity Building

Health System Innovation

Health System Sustainability

Improved Access

Improved Service Delivery

Improved Health Status and Reducing Health Disparities

The Vision, Mission and Values for the organization are:

VISION: Health and Wellness for All MISSION: Together , we promote and improve the health of people in our region through the delivery of innovative and client-centered health care. VALUES: Integr ity, Accountability, Equity, Respect, Responsiveness, Engagement.

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The region continued to improve internal and external communication processes in 2017/2018. These included:

Health Plus—a free subscription-based electronic newsletter which has greatly reducedthe need for printed copies saving both the environment and cost. Those wishing tosubscribe to the Health Plus monthly newsletter can visit the PMH website to register.

PMH website—provides easy access to current news, events, public alerts, program andservice information as well as career opportunities.

Social media— PMH has active Facebook , Twitter and Instagram accounts, whichare used to share information in real time.

Staff Intranet—ensures staff can easily find policies, health program and serviceinformation, directory assistance, education updates and career information.

Digital signage— electronic messaging exists in Brandon, Dauphin, Swan River andVirden. Plans to expand the service to other community sites are under review.

PMH communication plan— As part of the plan, evaluations continue regarding theeffectiveness of the region’s communication methods— both internally and externally.

Both the Strategic Plan and Community Health Assessment are available on the PMH website.

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Changes at the Executive Level 2017/2018 With the retirement of the VP-Planning in June 2017, a decision was made to reduce the overall executive team by one Vice-President position as a cost saving measure. The responsibilities of the VP Planning portfolio were assigned to the other members of the Executive Team.

In December 2017, with the retirement of the VP – Community & Long Term Care, the Executive leadership structure was once again reviewed. A decision was made to implement the following changes:

The VP Acute Care & EMS took on responsibility for Long Term Care services;

The VP Corporate assumed responsibility for, in addition to the existing ICT portfolio, Primary Health Care, Home Care, Mental Healthand Public Health;

A VP Human Resources portfolio was created to be responsible for all Human Resources functions (ie. Payroll, Recruitment,Organizational Development and Labour Relations).

PMH spans an area from the 53rd parallel in the north to the United States border in the south and reaches from the Saskatchewan border across to the lakes and central Manitoba. This land is also defined as the traditional territories of the Cree, Dakota, Ojibway, Oji-Cree and homelands of the Métis. Acknowledging traditional territories and treaties confirms recognition and respect for the Indigenous populations – past and present.

There are 14 First Nation communities situated in the geographical area of PMH. The First Nation communities of Ebb & Flow, Keeseekoowenin, O-Chi-Chak-Ko-Sipi and Skownan are signatory to Treaty # 2 that was signed in 1871. Gambler First Nation, Pine Creek, Rolling River, Sapotaweyak Cree Nation, Tootinaowaziibeeng, Waywayseecappo and Wuskwi Sipihk are signatory to Treaty # 4 that was signed in 1874.

The Dakota First Nation communities of Birdtail Sioux, Sioux Valley and Canupawakpa were not a part of the Numbered Treaties. However, they are recognized as having occupation of territories within Manitoba and have secured alliances and arrangements with the Crown.

Prairie Mountain Health region (approx. shaded white) is one of five Regional Health Authorities in Manitoba. For more information on RHA programs & services, or to review the official PMH map, visit: www.prairiemountainhealth.ca

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2017/2018

Population within PMH: *169,760

Percentage of MB Population: 12.9 %

Geographic area: 67,000 sq. kms

Number of municipalities: 55

Number of Cities: (2) Brandon / Dauphin

First Nation communities: 14

PMH Aboriginal population: 16%

MB Aboriginal population: 16.7 %

Northern Affairs communities: 15

Hutterite communities: 32

Acute care sites: 20

Acute care beds: *795

Long term care sites: 43

Long term care beds: *2,003

Transitional care sites: 9

Transitional care beds: *91

Community Health Service offices: 33

Mental Health Centres: 2

Primary Health Care Centres: 6

Primary Care Centre: 1

Community Cancer Programs: 7

EMS (ambulance) facilities: 38

Telehealth communities: 27

Non-devolved (Affiliates): 9

Dialysis Units: 4

Orthopedic Rehab Unit: 1

MRI machines: 1

CT Scan machines: 2

Number of employees: *8,550

Number of family physicians: *154

Number of specialists: *70

Nurse Practitioners: *17

* numbers subject to change

The Executive Management Team (EMT) of PMH is pleased to report back on the fiscal year of 2017/2018. As we look back on our sixth year of operations we continue to move forward with advancing the organization. Important items of note which transpired throughout the year include:

Health System Transformation Changes to the health care system are underway to ensure access to consistent, reliable care across Manitoba and a sustainable system for the long-term. In June 2017, the Province announced the creation of a new provincial organization —Shared Health. Shared Health, led by Dr. Brock Wright, will support a better connected provincial planning process. This will result in consistent standards of care across the province and more reliable access to services for patients. In addition, it is proposed Shared Health will provide some coordinated clinical and business support to Manitoba regional health authorities (RHAs).

RHAs will continue to be responsible for the delivery of health care services. More about the health transformation journey can be found online: www.gov.mb.ca/health/hst/faq.html

Annual General Meeting (AGM) PMH held its AGM in October 2017. Dr. Brock Wright, CEO, Shared Health, discussed the health transformation strategy underway within Manitoba.

2017/2018 Year-end Financial Position The region’s audited financial statements showed a surplus of just over $2.2 million. More information on the region’s financial position can be found on Pages 19/20.

Capital Projects Several key capital projects remain in varying stages across the region. During 2017/2018, the $13.75 million Brandon Regional Health Centre (BRHC) redevelopment project featured a significant milestone—the opening of a new pediatric ward. The ward, which now features seven single rooms in addition to a new playroom, opened for patients and families in May 2017.

The $23 million construction project to redevelop the Emergency Department and Special Care Unit at Dauphin Regional Health Centre (DRHC) was well underway during the fiscal year. As part of the first of four phases of the project, a temporary entrance and temporary Emergency Department were constructed and opened in November 2017. Work on the new Emergency Department area commenced in mid-November 2017 and is anticipated to continue until the Spring of 2019.

Local residents, physicians and municipal representatives gathered at the Tiger Hills Health Centre in Treherne in mid-October 2017 to celebrate and recognize the new extended clinic space that opened. The six new exam rooms, consultation room and washrooms resulted from community fundraising and support from PMH. (More on capital projects on Page 9).

Medical Transportation Coordination Centre PMH welcomed the Medical Transportation Coordination Centre (MTCC) under its fold April 1, 2017. Located at BRHC, MTCC is responsible for the call processing and dispatch of ground and air Emergency Medical Services resources across the province—outside the city of Winnipeg. We congratulate MTCC for being formally recognized as an International Medical Dispatch Accredited Centre of Excellence.

Community Health Assessment (CHA) Planning is underway for the 2019 Community Health Assessment (CHA). A CHA is an ongoing process to gather information about the health of the population and to provide evidence to inform health service planning. Using a population health approach, it provides information about the health status of community residents, tracks health outcomes over time, and examines health system characteristics and system performance. The last CHA for PMH was released in 2015.

Volunteer contributions PMH is supported by over 1,200 volunteers throughout the region. On average, these volunteers contribute as much as 2-3 hours a week. This includes areas like activities/recreation, one- on-one visitation, wayfinding, transportation support and Palliative Care support. Some 200 volunteers alone offer their time in a Palliative Care support role.

Our volunteer/non-profit organizations which include health centre foundations, hospital auxiliaries, community foundations and health support agencies, greatly contributed towards projects and programs within our region during the past year. We sincerely appreciate all that these volunteers do to assist us on an ongoing basis.

Our thanks In closing, on behalf of EMT and our Regional Leadership Team, we thank all of our staff, physicians, volunteers and board members for the dedication and commitment you bring to your work. We remain as committed as ever to working towards our region’s Vision of “Health and Wellness for All.

Penny Gilson Chief Executive Officer (CEO) Prairie Mountain Health

PMH Executive Management Team 2018 Back left to right: Dr. Shaun Gauthier, Gerry Gattinger and Brian Schoonbaert. Front left to right: Janet Wilcox-McKay, Debbie Poole, Penny Gilson and Lara Bossert. (For portfolio/roles, refer to Page 4.)

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2017 AGM– From left are Brian Schoonbaert, Petr Kresta (DSM), Penny Gilson and Dr. Brock Wright (Shared Health).

RECRUITMENT AND RETENTION Recruitment and retention of primary care/health care- providers has been consistently identified as a priority by PMH and our stakeholders. At an event in Neepawa in September 2017, PMH highlighted that 22 new primary care physicians had been recruited to work within the health region. The event was attended by MHSAL Minister Kelvin Goertzen who recognized the region’s recruitment work and accomplishments. (See Physician Recruitment Page 13).

Two new Nurse Practitioners were hired within PMH in 2017/2018, both in Swan River. In the areas of nursing and health care aides, numerous student graduates were hired throughout the year (see Grad Nurse Recruitment on Page 11).

The Indigenous human resources staff continue to support recruitment of Indigenous people by working with PMH departments in an effort to address vacancies, recruitment and retention.

MOBILE CLINIC PMH was first in the Province to establish a Mobile Clinic in early 2014. Since then, two First Nation communities that were part of initial service routes remain on the regular visitation schedule —Birdtail Sioux FN and Keeseekoowenin FN. In late 2016, two new First Nation communities joined the schedule—O-Chi-Chak-Ko-Sipi FN and Ebb and Flow FN.

Mobile Clinics are staffed with a Nurse Practitioner, Community Health Nurse and a Driver. A wide scope of services are available that help provide care closer to home.

Total number of client visits to the Mobile Clinic during 2017/2018 was 3,615. During this period, the total number of Mobile Clinic visits to communities was 204.

REGIONAL SKILLS BLITZ PMH once again held a very successful Skills Blitz in May 2017. Nursing staff and other health care providers attended sessions that were held in Brandon and Dauphin. The events provided an excellent opportunity for those wishing to update their nursing skills and/or complete their professional continu-ing competency requirements.

Some of the education stations included wound prevention and management, infection control, hand hygiene, ostomy care, chest tubes, pain management, dialysis and mental health awareness. E-learning, including the SPOT program, was also a major component of the informational stations for the two- day event.

The SPOT Program allows for online access to valuable clinical education both on and off site at times convenient to staff.

EMPLOYEE WELLNESS In 2017, the PMH employee wellness committee was the recipient of a national merit award for outstanding initiatives that help create safe and healthy work environments from Excellence Canada. Some of the wellness initiatives included:

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PMH Quits- PMH Quits provides interested employeeswith support and counselling to reduce employee tobacco use.

New Respectful Workplace- was promoted and incentiveswere provided for completing the SPOT module. About 10%of PMH employees and 25% of managers completed the edu-cation in four weeks.

21–Day Mindfulness Challenge- taught employees abouthow small changes in your day can improve your mentalhealth and well-being.

WORKPLACE SAFETY & HEALTH COMMITTEES PMH has 52 Workplace Safety and Health committees across the region made up of both management and worker representation. Each committee meets and completes inspections quarterly. Each inspection provides opportunities for deficiencies to be reported for corrective action. Through a review of the Incident Reporting System, there were 3,387 workplace-related incidents reviewed by various committees and 35 serious incident investigations conducted during the fiscal year.

DISASTER CODES/RESPONSES The Disaster and Emergency Preparedness Program oversees the emergency plan to be activated within any of the PMH facilities in the case of any disaster, emergency or incident that has the poten-tial for a significant impact to operations. Different codes are identified for different scenarios that may occur such as a cardiac arrest (Code Blue) or a fire (Code Red). Specific instructions are available for staff to follow should a code of any type be called within a facility.

After a code has been called and the situation has been managed, event documentation is prepared and submitted to the program’s

Manager for quality assurance purposes. (See Disaster and Emergency Preparedness on Page 16)

The Regional Skills Blitz was once again held in Brandon and Dauphin for health care-providers within the region.

-Create a positive and safe work environment-Establish workforce planning processes that meetfuture needs of PMH

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TELEHEALTH Telehealth continued to be well-utilized within PMH. Access to MBTelehealth (MBT) continued to mean less travel for patients, more access to medical specialists and overall, better health care services closer to home.

In 2017/2018, four new sites within PMH came on board, bringing the total number of PMH communities with Telehealth to 27. They included the communities of Erickson, Glenboro, Melita and Ste. Rose (Primary Health Care Centre). Local committees in Erickson, Glenboro and Melita raised money for the purchase of the equipment, and five years of operating costs. Recognition events for the community efforts were held. In November 2017, open houses were held for Telehealth demonstration events in the region as part of Digital Health Week.

Consistent with the past fiscal year, DRHC was the most

utilized rural site for all of MBT.

AGENCY NURSING/OVERTIME UTILIZATION The Region focused upon resolving the issue of the increased use of agency nursing and nursing overtime due to insufficient supply of human resources. Overtime is considered a staff safety issue since excessive hours can lead to fatigue, injuries, absenteeism and turnover. It can also impact patient safety by increasing the risk of errors.

The Overtime and Agency Oversight Committee achieved success in addressing this issue during the fiscal year, resulting

in the reduction of the total hours attributable to either agency nurses or overtime from 8.1% in 2016/17 to 7.0% in 2017/18.

This reduction resulted in an organizational fiscal year savings of approximately $880,000.

Source: MB Telehealth Utilization Report: April 1,2017-March 31, 2018

A Telehealth recognition event with community partners and the local Palliative Care Committee was held in Erickson in June 2017.

SAFETY AND SECURITY PROJECTS PMH works with the Province to ensure health-care facilities are properly maintained. A list of potential projects is submitted to MHSAL each year. Safety and security projects (over $150,000) that were approved were:

Mafeking EMS Station- New EMS (ambulance) quarters

Brandon Child and Adolescent Treatment Centre –shingle replacement and fan vent upgrades

Brandon - Rideau Park Personal Care Home – shinglereplacement

Minnedosa Health Centre – boiler replacement

Rossburn Personal Care Home – phase two of the domesticwater system replacement

Souris Health Centre – roof replacement

Virden- Sherwood Home – shingle replacement

Safety and Security projects (less than $150,000) that were approved included:

Birtle Health Centre and Personal Care Home- boilerreplacement

Glenboro Health Centre – fire alarm system replacement

Killarney Health Centre – fire alarm panel replacement

Rivers Health Centre – flooring replacement

Shoal Lake EMS Station – vehicle exhaust captureinstallation

Shoal Lake Health Centre – replace headend controller

Wawanesa Health Centre and Personal Care Home –replace headend controllers

-Develop regional infrastructure and processes

Brandon’s Child and Adolescent Treatment Centre was one of 14 sites that received provincial funding for building upgrades in 2017/2018.

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BRANDON REGIONAL HEALTH CENTRE (BRHC) The first phase of the $13.75 million BRHC Redevelopment saw the Pediatric Ward relocated to the second floor annex of the hospital. The new ward, which opened for patients and their families at the end of May 2017, features seven spacious single rooms, examination and clinic rooms, and a new play-room. A grand opening of the Westman Dreams for Kids Pediatric Unit was held in June 2017.

Through the rest of the 2017/2018 fiscal year, the majority of work on the second project phase took place on the fifth floor of the General Centre. Fifth floor work finished at the end of March 2018. The third project phase commences in early 2018/2019 with renovations to the fourth floor.

Overall, the project calls for over 53,000 square feet of redevelopment which includes the pediatric and acute medical areas. When all phases are completed, 12 new medical in-patient rooms will be created as well as expanded and im-proved areas for patients, staff and family support.

The project, which commenced in May 2016, is expected to be completed in mid-2019.

BRHC MRI REPLACEMENT PROJECT A replacement magnetic resonance imager (MRI) was installed at BRHC in August 2017. The new scanner provides the latest technology which includes improved image quality along with reduced scan times. The former scanner was over 10 years old and in need of frequent repairs. The project also included replacing the protective shielding in the room. The total project cost was $3.5 million.

DAUPHIN REGIONAL HEALTH CENTRE (DRHC) The first phase of the $23 million DRHC Emergency Department/Special Care Unit project was completed within the 2017/2018 fiscal year. The initial phase saw the demolition of former administration/office area space and the construc-tion of a temporary Emergency Department. As part of the project, the main entrances for the general public were closed for the remainder of the construc-tion period. A temporary entrance was created for the general public and opened in early November 2017. The temporary Emergency Department opened to the general public in mid-November 2017.

Overall, the project calls for 16,000 square feet of new and renovated area for the Emergency Department and Special Care Unit. The plan also calls for an enhanced, enclosed ambulance garage for patient drop off.

The entire redevelopment project is anticipated to be completed in the summer of 2019.

DAUPHIN MRI PROJECT The addition to the DRHC for the MRI Suite was completed in the fall of 2017. The project was still subject to review as part of the Manitoba Wait List Task Force report. In December 2017, MHSAL confirmed the project would proceed with the ordering of the MRI unit and approval of an operational plan.

It’s anticipated the MRI Suite will be operational in late fall of 2018.

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PERSONAL CARE HOME BED TURNAROUND TIME Every day counts when patients remain in hospital beds awaiting placement into a Personal Care Home (PCH). On January 1, 2018, the region went live with a new electronic method to collect bed turnaround time data from its 43 PCHs. The target is to admit a new resident within four days of a room becoming vacant (inclusive of weekends and statutory holidays).

Often reasons for delay are room maintenance (e.g. painting or repair), followed by inability to admit due to outbreak. Other factors that may cause delay include decline of offers, no client on waitlist, multiple deaths or discharges, internal room moves of existing residents, availability of the new resident or their family, cleaning/disinfecting/preparing the room or being short-staffed.

SWAN VALLEY PRIMARY CARE CENTRE Prior to the opening of the Swan Valley Primary Care Centre (SVPCC) in July 2015, a large portion of the population within the community of Swan River and surrounding area were without a consistent Primary Care Provider. The SVPCC now has 13 physicians, two nurse practitioners, and a Primary Care Outreach clinician practicing within it.

Previously, there was a long list of patients on the Family Doctor Finder list without an assigned Primary Care provider. The expansion of clinic staff allowed for the waiting list to be eliminated this fiscal year. Office hours for the Advanced Care Clinic have been expanded to two evenings per week, thus reducing the number of people seeking medical services at the emergency department. Services were also expanded to Sapotaweyak Cree Nation with three primary care clinics being held per month at Sapotaweyak Cree Nation.

PRIMARY CARE OUTREACH CLINICS

Using a harm reduction approach, Primary Care Outreach clinics in Swan River and Dauphin focus on providing primary care to a priority population including those clients living with HIV, Hepatitis C, addictions and vulnerable populations not connected to primary care. Examples of vulnerable situations for clients include housing insecurity, street involvement, sex trade work, injecting drugs, socioeconomic disadvantage, etc.

The Swan River clinics have been in operation for four years through the Swan Valley Primary Care Centre. Planning for the Dauphin clinic occurred during 2017/2018, and they are slated to begin at the Dauphin Community Health Services Office in mid-2018/2019.

Primary care is supported by Community Health Nurses (CHNs), physicians with training in addictions medicine, Infectious Disease Specialists in Winnipeg, Addictions Foundation of Manitoba Counsellor, Public Health Nurse, and Mental Health Worker.

OUTPATIENT MEDICAL ALCOHOL DETOXIFICATION PROGRAM

In February 2018, under the leadership of Dr. R. Tatineni, PMH implemented a new Outpatient Medical Alcohol Detoxification program to assist with mild to moderate alcohol detoxification.

This one day program is based on a model from the United Kingdom that has shown success with alcohol dependency. It is a voluntary program for individuals age 18-60 years who meet specific criteria including a referral by a Physician or Nurse Practitioner.

WAIT TIME MEASURES Public opinion surveys identify long waits as a serious problem and reducing wait times continue to be a priority for health care systems. Several factors influence the ability to deliver timely care, such as an increased need due to an aging population, available human resources and other supports such as bed capacity for some services.

Overall, wait times in PMH took a step back in 2017/2018, but the region remains optimistic that several improvements implemented throughout the year should lessen waits going forward:

In August 2017, a new replacement MRI was installed atBRHC. This unit is more efficient as it reduces scan times incomparison with the previous unit (see Page 9 for moreinformation).

In October 2017, PMH performed its first outpatient partialknee replacement. The ability to perform this surgery on anoutpatient basis will help to reduce wait times.

In March 2018, PMH booked its first bilateral hip surgery.Select patients can take advantage of this option to eliminatethe need to wait twice. This should also improve bedutilization.

The complete 2017/2018 Annual Wait Time Report is available on the PMH website. Go to “About Us” and select “Regional Reports”.

INTERPRETER SERVICES In 2017/2018, PMH introduced a regional policy for Interpreter Services – Language Access. Interpreters are trained individuals who facilitate communication between individuals who do not share a common language.

These services benefit the relationship between PMH health care providers and their clients by enhancing patient safety, and improving quality of care, access to care and patient satisfaction. Westman Immigrant Services –one of PMH’s partners– provided Interpreter Services in over 570 client interactions in 2017/2018.

Swan Valley Primary Care Centre- The Swan Valley Primary Care Centre continued to expand its programs and services during 2017/2018.

-Facilitate client-centered flow through the entirehealth care system-Reduce barriers to access for remote and/orvulnerable populations

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C ontinuous engagement with nursing and health care aide graduates is fundamental to recruit and establish a regional workforce that sustains current and future health care needs. PMH connects with

applicable classes at Brandon University, University College of the North, University of Manitoba, Red River College, Assiniboine Community College and Robertson College through class presentations and career fair exhibits to inform students of rewarding employment opportunities offered in the region.

The region recruited the following graduates this year:

23 Registered Nurses

14 Psychiatric Nurses

17 Licensed Practical Nurses

20 Internationally Educated Nurses

numerous Health Care Aides

Rural Graduate Nurse Mentorship Program The Rural Graduate Nurse Mentorship Program offers

students a three-month term within a rural facility that allows easier transition from student to graduate nurse to fully registered nurse. Seven students took advantage of the Grad

Nurse Mentorship positions, one of which was Morgan Stewart. (See related story at right).

International Educated Nurses Bridging Program In partnership with Red River College (RRC), College of Registered Nurses of Manitoba (CRNM) and MHSAL, Internationally Educated Nurses complete gap training through a bridging program offered at RRC. Students complete the theory component of the program from January to June of each year, and the practical component in various health care facilities. Upon completion of the program and successfully obtaining their license with CRNM, 20 nurses began employment in various locations throughout our region in the past year.

Practicums Student practicum placements continue to increase as educational institutions deliver programing throughout PMH. In 2017/2018 over 800 student placement requests were accepted and confirmed in PMH programs and services.

Senior clinical practicum is an important recruitment

opportunity. Fourth year nursing students typically request a specific placement based on personal and/or professional interests.

The Manitoba Centre for Nursing and Health Research at the

University of Manitoba conducts a six-month post-graduate survey with each graduate from nursing programs in the

province who provide consent for follow-up. Students are asked a series of questions including the impact of their senior

clinical practicum on securing employment. The majority of survey respondents reported a positive relationship between

their senior clinical practicum and securing their first nursing position. More than half of the respondents reported that their first nursing position was in the same facility where they

completed their senior clinical practicum and almost half secured their first nursing position on the same unit where

they completed their practicum.

The University College of the North (UCN) celebrated graduating students from the Diploma of Practical Nursing Program in Swan River in 2017/2018. (Photo courtesy of Jakki Lumax, Swan Valley Star and Times).

The Rural Graduate Nurse Mentorship Program: A seamless transition for new Registered Nurses

Morgan Stewart began dating a young farmer from the Hamiota area while she was in the nursing program at Brandon University. When she had the opportunity to request a clinical placement for her senior practicum in 4th year, she knew the Hamiota District Health Centre was where she wanted to be. During the 450 hours of senior clinical practice, Morgan found that she loved the facility and rural nursing. She described the staff and management as incredibly welcoming and supportive, and she enjoyed the wide range of patients that she had the privilege to care for.

Morgan took a Grad Nurse position for two months until she successfully passed her licensing examination and became a Registered Nurse.

According to Morgan: “It’s a great program. I was still mentored but less protected than I was in a student role. It really helped with the transition to being an RN”.

Morgan has since secured a permanent RN position in the facility.

As Morgan states, “I couldn’t be happier. They’ve been wonderful to me here. I’ve settled on a farm in the area and I’m committed for the long-term”.

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VOICE OF THE CUSTOMER PMH is committed to putting patients first by providing quality, patient and family centered care. The Declaration of Patient Values document finalized in 2017 strives to ensure patients are put first in the provision of care. Patients have identified five areas that are most important to them:

• Dignity;

• Respect and trust;

• Accessibility and responsiveness;

• Quality;

• Information sharing; and

• Participation.

Work was completed to ensure that common questions regarding the different values are included in all the regional client experience surveys.

PMH continued to participate in a 49 question provincial acute care survey, which is distributed by MHSAL via mail, to eligible patients in the month following their discharge.

During the 2017/18 fiscal year, there were 518 complaints and 153 compliments reported. Common complaints related to reduction/loss of pharmaceutical services, lack of an anesthesiolo-gist in BRHC, ER wait times and negative experiences with health care personnel. Complaints related to dignity and respect issues were the most common at 40.2% followed by access to care at 20.8%. The Patient Relations staff also monitor formal compliments and when specific employee(s) are named in the compliments and thank yous, the information is passed onto the employee(s).

ACCESSIBILITY FOR MANITOBANS ACT This act was passed on December 5, 2013 and provides a clear, proactive process to identify, prevent and remove barriers to accessibility. The mandatory accessibility standards address barriers to accessibility in the following five areas:

Customer service;

Employment;

Transportation information;

Communication; and

Built environment.

The PMH Accessibility Plan was approved by the Board of Directors on April 27, 2017 and it can be found on the PMH website.

PATIENT SAFETY LEARNING ADVISORIES Critical incidents and other patient safety incidents are reviewed to identify ways in which the health care system can make improvements so that health care delivery can be made safer.

All Manitoba health regions are required to share lessons learned from these events in a Patient Safety Learning Advisory (PSLA) and distribute them to relative regional teams.

MHSAL publishes PSLAs on the patient safety website, to share learning with the public (www.gov.mb.ca/health/patientsafety/

psla.html). These are also linked to the Canadian Patient Safety Institute database to further share learning.

PATIENT SAFETY WEEK PMH participated in Canadian Patient Safety Week (Oct. 30– Nov. 2, 2017). The National campaign helps raise awareness of patient safety and related programs and initiatives. The theme in 2017 was Medication Safety. In conjunction with the Manitoba Institute for Patient Safety, resources were made available and communicated across the health region to help empower patients and families to be engaged and informed in their care and decision-making.

LOCAL HEALTH INVOLVEMENT GROUPS LHIGs are made up of citizens who care about health and health services. The LHIGs function as a key component of PMH’s public engagement process and provide one mechanism for ongoing community input to assist PMH in its planning and decision making processes respecting population health, health needs and priorities, and health services in the region.

An annual joint meeting with PMH Board and LHIG members was held in the fall of 2017. PMH Planning & Innovation staff shared key findings from the 2015 CHA report and facilitated discussions with participants. LHIG members provided valuable input regarding existing communication networks in their communities, key resources (individuals, committees and organizations) that reflect the local perspective, and additional information that is needed by community residents. PMH welcomes applications from any resident within the region who may have an interest in serving on a LHIG. (Further LHIG information is found on the PMH website).

SOURCE: Provincial acute care survey- April 1 to September 30, 2017.

-Improve client safety throughout the region-Develop client-centered optimal models of servicedelivery

Percent of PMH Acute Care clients responding to the question, “Were you involved as much as you wanted to be in decisions about your care and treatment?”

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R ecruitment and retention of primary care/health care providers has been consistently identified as a priority by PMH and our stake- holders. At an event in Neepawa in September 2017, PMH high-lighted that 22 new primary care physicians had been recruited to

work within the health region. The event was attended by MHSAL Minister Kelvin Goertzen who recognized the region’s recruitment efforts and accomplishments.

The following specialists were recruited to PMH within the last year:

General surgery (Brandon/Dauphin);

Nephrology (Brandon);

Itinerant ENT (ears, nose, throat) specialist (Brandon).

PMH continues to work with Winnipeg Regional Health Authority and Shared Health on anesthesia recruitment for BRHC. Other BRHC Medical staff recruitment include the addition of two ER physicians, one family physician and two midwifery providers.

Additional family physicians were recruited to the following communities: Swan River (6), Dauphin (3) —two family physicians and one with anesthesia specialty, Deloraine (2), Grandview, Neepawa, Roblin, Shoal Lake, Souris, Minnedosa, Glenboro, Virden, and Winnipegosis.

Despite ongoing recruitment efforts, some communities remain short of adequate primary care resources and have experienced temporary suspensions of acute/ER services over the course of the last 12 months. The region continues to work closely with the Manitoba Locum Tenens Program to secure locum physicians throughout PMH where possible.

PMH continues to work with the U of M Medical School and Manitoba Health Care Providers Network on a variety of recruitment initiatives geared at Manitoba graduates. In January 2018, the U of M Medical Student Rural Interest Group visited two communities (Brandon and Neepawa) for their annual weekend workshop. In May 2017, 34 first-year medical students were assigned to 13 PMH communities as part of ‘Rural Week.’

In September 2017, PMH hosted the Family Medicine Resident Retreat in Brandon. There were 116 family medicine residents from all of the family medicine residency programs in Manitoba. At this event, PMH met with many prospective physicians and discussed practice opportunities with residents and their spouses.

The region continues to participate in the provincial International Medical Graduate (IMG) program. Six additional family physicians will be ready to practice in locations within the region in the fall of 2018.

There were some milestones to recognize during the past fiscal year as well. During the summer of 2017, the Parkland Family Medicine Residency Unit celebrated 25 years of training medical students. The Residency Unit, based out of Dauphin and Ste. Rose, commenced its training program in affiliation with the U of M back in 1991.

The Brandon Satellite Campus of the Max Rady College of Medicine, U of M, continued making strides in physician training. In 2017, the family medicine training program marked five years of training and apprenticeship.

During 2017, a five-year Royal College Psychiatry training program commenced in Brandon (shared with Winnipeg) and the Campus also expanded to provide a third year option of medical school in Brandon.

PMH recruitment– Dr. Kristen Wareham, recently recruited to Neepawa, speaks about practicing medicine within a rural setting. Also pictured are MHSAL Minister Kelvin Goertzen and PMH CEO Penny Gilson.

Residents’ Retreat– PMH hosted the Family Medicine Residents’ Retreat in Brandon in September 2017. Some 116 family medicine residents were in attendance.

Celebrating 25 years- The Parkland Family Medicine Residency Unit, based out of Dauphin and Ste. Rose, celebrated 25 years of training medical residents at an event in June 2017.

Brandon Satellite Medical Residency– Another group of physicians successfully com-pleted their training via the Brandon Satellite Medical Residency Program.

INFORMATION SERVICES Many initiatives were undertaken by the Information Services portfolio this year. Over 30 different projects were completed and work continued on more than 20 additional ones. In the north portion of the region, the provincial Admissions-Discharge-Transfer System, the Emergency Department Infor-mation System (EDIS) and the Scheduling Module for Diagnostic Imaging were implemented at the DRHC and Swan Valley Health Centre as well as Respiratory Therapy in Swan River. At the same time new Chart tracking and Dictation and Transcription systems were implemented for all the North sites and the Surgical Information System was expanded to Dauphin and Swan River. A Centralized Registration process was also implemented for the North Acute and PCH sites. Expansion of the Electronic Medical Record and the Community Electronic Health Record continued with implementation for Midwifery and Palliative Care. The Community Paramedicine Program was also added —this relatively new and evolving service expands the role of Emergency Medical Services personnel to reach out to underserviced and aging community members. Having access to pertinent medical information greatly improves the level of care provided. The upgrade of information technology hardware and equipment continued across the region and several databases were developed to support regional operations (e.g. Vacancy Reporting, Capital Requests, Privacy Incidents). Cell Phone boosters were installed at the Brandon Regional Health Centre to improve reception. Skype for Business is a messaging program that was rolled out across PMH. It allows staff across the region to connect via instant messaging, voice and video calls. Meetings with multiple participants can be held and documents can be presented. It has greatly improved communication and significantly reduced staff travel. REGIONAL PROJECTS 5S INVENTORY MANAGEMENT As part of the region’s commitment to delivering efficient health services, Planning and Innovation staff worked with PMH facilities and community programs to complete 5S projects and enhance inventory management processes. 5S is a simple but effective set of Lean techniques that remove clutter and waste

while creating an organized work space. Inventory Manage-ment specifies the quantity and placement of stocked items and implements efficient re-order processes. With this project work in 2017/2018, the region realized nearly $724,000 in savings in medical, surgical and inconti-nent supplies over the previous year. LEAN SIX SIGMA YELLOW BELT COURSE Lean Six Sigma is a quality improvement methodology implemented within businesses and organizations to reduce waste, create efficiencies and measure defects using standard-ized tools and processes. Yellow Belt training provides students with the skill sets needed to be involved in small improvement projects within their department. Twenty staff completed Wave II & III of the provincially developed Yellow Belt Lean Six Sigma in-class training and completed project work over the last year. One of the projects examined improving the way Mobile Clinic clients were processed and seen by providers. The aim of the project was to increase the collaborative visits utilizing both the Nurse Practitioner and the Community Health Nurse to help improve patient care by using a team approach. The project saw an increase in joint visits from 17% to 43.2%. Once Yellow Belt certification has been received, at least one project must be completed within a two year time frame to maintain certification. One co-led recertification project looked at creating an improved recruitment process within the EMS Department. This project helped to fill EMS positions that previously took weeks to months to fill and created a centralized orientation based on an annual schedule that helped reduce the time it took to complete the required EMS provider orientation process.

A regional 5S/Inventory Management project streamlined the medical, surgical and incontinent stocking processes throughout the region.

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The Dauphin Regional Health Centre went live with the Emergency Department

Information System (EDIS) in November 2017.

-Develop a culture of quality improvement -Plan based on experience, evidence and best practice

Before After

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BETTER ACCESS TO GROCERIES (B.A.G.) PROJECT (PMH North Zone) In the summer of 2016, Health Promotion and Community Development staff implemented a food security project with residents in Camperville and Duck Bay to address challenges with access to fresh vegetables and fruit. The project ran successfully in Camperville until January 2018 when it closed for the best possible reason, a local couple in the community opened a new grocery store that offers ongoing access to fresh vegetables and fruit. As a result of enhanced community capacity, participation in the monthly B.A.G. program decreased. The community of Duck Bay is currently undergoing a trial period to determine local interest in continuing with the B.A.G. program. Although vegetables and fruit are now available in Camperville, Duck Bay is 50 kms away (round trip) and potential geographical challenges are being examined.

BIRTLE HEALTH CARE PROVIDER ENGAGEMENT PROJECT

In April 2017, a group of health care providers who deliver services in Birtle met to identify opportunities to improve the health of the community. Key issues included access to care, collaboration among health care team providers and the need to address service delivery challenges within existing resources. Client input was gathered through a survey that was administered at a community flu clinic, the Birdtail Sioux Health Centre and the Birtle Clinic. Based on the survey findings, several activities were implemented including the development of the Birtle and Area Health Services document and articles in the local newspaper, enhanced coordination among service providers and increased awareness of client referral processes.

CRYSTAL METHAMPHETAMINE CRISIS IN PMH REGION

In February 2018, PMH hosted a forum to explore urgent gaps and needs related to the increased prevalence of crystal methamphetamine use in Brandon and PMH region. A total of 28 participants attended representing a wide range of agencies and organizations with a vested interest in the issue. Each participant provided an overview of their organizational experience with the challenges associated with crystal meth use and a summary of existing services and resources. A working group was established to develop an action plan addressing priority areas for action including:

1. Inform the public through prevention and education efforts

2. Reduce harm to individuals 3. Increase skills of service providers 4. Ensure effective treatment options including care of

intoxicated people, acute withdrawal management, short- term treatment and transitional/long-term treatment.

Several interventions have been initiated and will be rolled out over the next year.

WEST END COMMUNITY GARDEN IN DAUPHIN The power of partnerships is certainly evident in Dauphin, as 17 organizations, groups, government departments and businesses have joined together with PMH Health Promotion staff to create and oversee various initiatives including a community garden, play structure revitalization and a “Little Free Library”. Having multiple people working outside together facilitates access to fresh air & exercise, companionship and fresh vegetables. A video has been made highlighting this work:https:/vimeo.com/264200312 TEEN HEALTH CLINICS PMH offers Teen Health Clinics within some of the high schools within the region. Teen Health Clinics are a safe, confidential and non-judgmental place for youth to deal with health care concerns and needs. They are staffed by Public Health Nurses, Nurse Practitioners, Community Mental Health Workers, Addictions Foundation workers and in some cases physicians. In 2017/2018, Teen Health Clinics were available in Birtle, Brandon, Dauphin, Forrest, Hamiota, Minnedosa, Roblin, Rossburn, Russell, Strathclair and Swan River. GET BETTER TOGETHER Get Better Together (GBT) is a free, six-week program for individuals who have an ongoing health condition(s) and want to live better. Participants can learn to manage pain, deal with fatigue and frustration, increase energy levels and start an exercise program. There were 14 GBT sessions held in communities across PMH including Birdtail Sioux First Nation, BRHC, Boissevain, Dauphin, Killarney, Rivers, Russell, Samaritan House (Brandon), Shilo Military base, Ste. Rose du Lac and Virden. A total of 133 individuals participated in the program and 95 participants completed all of the sessions. MENTAL HEALTH EDUCATION SESSIONS In 2017/2018, the mental health program offered public education opportunities involving three key areas:

1. Mental Health First Aid workshops were provided at various communities to help those experiencing a mental health problem.

2. ASIST (Applied Suicide Intervention Skills Training) workshops were held for people who want to feel more comfortable, confident and competent in helping prevent immediate risk of suicide.

3. SafeTalk workshops were held to prepare anyone over the age of 15 to identify persons with thoughts of suicide and connect them to suicide first aid resources.

-Partner to address social determinants of health and inequities

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INCIDENT COMMAND SYSTEM IMPLEMENTED DURING SWAN RIVER WATER SUPPLY ISSUE

The severity of a water supply system issue in Swan River at the end of January 2018 had PMH on high alert. As potable water is a necessity in the provision of health care services, the Swan River incident proved that having emergency planning and processes in place allowed— in this case —for minimal disruption to services within our hospital, personal care homes, community health programs and primary care centre. The PMH Disaster and Emergency Preparedness Program (DEPP) received the critical call from Town of Swan River emergency officials on January 27th. They declared a state of local emergency due to a lack of incoming water supply to the town water treatment plant. All community areas were being asked to immediately comply with dedicated water conservation measures. Timeframes on finding the cause of the issue and fixing the problem were not readily apparent. For PMH, this meant automatic activation of its Incident Command System (ICS). Through its ICS, a complete review was undertaken on the impact this would have on all of our health programs and services. The first of many regional teleconferences was held early Sunday morning and our managers and staff came prepared to offer solutions to prioritized challenges. Some of those included potential disruption to key services like the Emergency Room, Operating Room and Dialysis schedules. PMH Community Managers also had to consider those clients in the community. How would the water disruption affect them? Were they coping and what supports did they need? This aspect of the assess-ment and response plans was also part of the ICS activation. DEPP presented an over-view of its priorities and challenges to Town Emergency Operation Centre officials and, in turn, were continually updated regarding the status of the water supply situation. These briefings were extremely important to keep everyone informed about situation status. In addition to the service provision challenges, there are operational needs as well that are dependent on water supply, such as water needed for the site sprinkler and fire protection systems, meal preparations, toileting, and even client bathing to name a few. One of the first areas ICS dealt with was water supply and with assistance from our Materiels Management and Maintenance Departments, PMH ensured delivery of bottled water, bulk water jugs, nutrition supplies, hand sanitizers, hygiene products, juice and other deemed essentials to the Swan Valley Health Centre and PCH. Alternate planning continued for laundry, meals, patient care needs, water reduction strategies, community

health client/staff needs (which included home care) and systems operations at facilities and at the Swan Valley Primary Care Centre. As the scenario unfolded, ICS was able to ensure Emergency Department Services were maintained. Only a few dialysis patients were transported to a nearby PMH site for treatment early on in the week. Once the Town was able to get two of its three water pumps working to supply its reservoir later in the week, ICS was de-activated. ICS takes into account the many aspects of an emergency situation beyond what could affect the hospital. DEPP was able to identify some of the lessons learned and apply them to the draft Code Alert-Water Supply Disruption Plan. (The new plan was formally adopted and included in the PMH Disaster Emergency Preparedness Plan in May of 2018). To learn more about emergency preparedness in PMH, staff have access to the full plan on the PMH Intranet. The public, municipal and non-government organization partners have access to the Community Programs Quick Reference Guide on the PMH website. The lessons learned from this plan, and the communication processes, have since been utilized in other smaller scale events that have impacted PMH since the Swan River incident. We sincerely thank all of the PMH staff that assisted in managing this incident. We also thank the dedicated staff at the Town of Swan River for keeping us informed in the planning process during the week-long situation in January.

Working together, we remain committed to individuals, families and communities within the PMH region.

The PMH Disaster and Emergency Preparedness Program (DEPP) kicked in to high gear during a January 2018 Town of Swan River water supply issue. From left are DEPP representatives Brent Lubiniecki and Steve Geletchuk who were the first two deployed to Swan River to assist PMH staff and connect with Town of Swan River Emergency Operation officials.

Dialysis schedules at Swan Valley Health Centre needed to be revisited with the Town water supply being impacted.

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In pictures information 1) Melita ACC nursing class–The Assiniboine Community College (ACC) rural rotating training site in Melita

continued during 2017/2018. Some 25 students commenced training in Melita and are expected to complete the two-year course in September 2018.

2) BRHC Auxiliary–In 2017, the BRHC Auxiliary celebrated 125 years of making a difference for patients and staff at BRHC.

3) BRHC Redevelopment–Ribbon cutting ceremonies for the new Westman Dreams for Kids Pediatric Unit at Brandon Regional Health Centre were held in June 2017.

4) Operation Walk–Led by Dr. Norman Klippenstein, BRHC was once again well represented in the charitable “Operation Walk” in Nicaragua in November 2017. The surgical crew helped perform a total of 69 joint replacements in three days for those who would otherwise not be able to receive life-changing surgery.

5) National Paramedic Honours–Taralynn Stephen of Swan River was recognized nationally for achieving the highest score on a Primary Care Paramedic Exam in 2017. She also received the Lt. Governor General of Manitoba award for her accomplishments.

6) Caring for Kids Radiothon–Over $84,000 was raised during the Caring for Kids Brandon Radiothon in April 2017. The BRHC benefitted from the event by receiving a portable neonatal cardiac monitor.

4

3

2

5

6

1

In pictures information 7) Ste. Rose Primary Health Care Centre–The grand opening and ribbon cutting for the Ste. Rose Primary Health

Care Centre was held in May 2017. 8) Treherne doctor honoured-Dr. Alewyn Vorster, who practices out of the Tiger Hills Health Centre in Treherne,

was honoured by Doctors Manitoba as Family Physician of the Year in May 2017. 9) Brandon Fire & EMS Milestone- An open house was held in September 2017 to celebrate the 100 year mile-

stone of providing Emergency Medical Services in Brandon. 10) Volunteer Appreciation event–A ceremonial drumming and song session by the “Sweet Medicine Singers” high-

lighted a volunteer appreciation event—for the BRHC Auxiliary—in Brandon in May 2017. 11) Medical Student Rural Week–Once again PMH participated in “Rural Week” in May 2017. Some 34 first-year

medical students were assigned to 13 communities within the region. 12) Brandon Stroke Prevention Clinic– The Brandon Stroke Prevention Clinic, located in the BRHC, recognized

Stroke Prevention Month in June 2017. 13) Patient Safety Champion 2017–PMH Manager of Disaster and Emergency Preparedness, Steve Geletchuk,

received accolades from the Manitoba Institute of Patient Safety (MIPS) in June 2017. Geletchuk combined rural disaster plans with incident command to create one operation for ease of understanding and use.

14) Treherne Medical Clinic– An event was held in October 2017 to celebrate the extended medical clinic space that opened in Treherne at the Tiger Hills Health Centre.

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7 8

12

9 11

13 14

10

19

(In thousands of dollars) For the year ended March 31, 2018

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(In thousands of dollars) For the year ended March 31, 2018

A complete set of financial statements, which includes the accompanying ‘Notes’ listed in the previous two pages, can be found on the Prairie Mountain Health website. (www.prairiemountainhealth.ca) They can be found on the PMH website under the ‘About Us’ section—Regional Reports.

(In thousands of dollars)

To the Board of Directors of Prairie Mountain Health:

We have audited the accompanying consolidated financial statements of Prairie Mountain Health, which comprise the consolidated statement of financial position as at March 31, 2018 and the consolidated statement of operations, changes in net assets, remeasurement gains and losses and cash flows for the year then ended and a summary of significant accounting policies and other explanatory information.

Management’s Responsibility for the Consolidated Financial Statements

Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with Canadian public sector accounting standards, and for such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

Auditors’ Responsibility

Our responsibility is to express an opinion on the consolidated financial statements based on our audit. We conducted our audit in accordance with Canadian generally accepted auditing standards. Those standards require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the consolidated financial statements. The procedures selected depend on the auditors’ judgment, including the assessment of the risks of material misstatement of the consolidated financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the consolidated financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

Opinion In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of Prairie Mountain Health as at March 31, 2018 and the results of their consolidated operations, (including remeasurement gains and losses) changes in net assets and its cash flows, for the year then ended in accordance with Canadian public sector accounting standards.

MNP, LLP Chartered Professional Accountants Brandon, Manitoba 1401 Princess Avenue, Brandon, Manitoba, R7A 7L7, June 26, 2018 Phone: (204) 727-0661, 1-800-446-0890

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Acute $225,595 37.5%

PCH $141,625 23.6 %

Medical Remun.

$ 43,514 7.2%

Mental Health

$ 24,164 4.0%

Home Care $ 40,732 6.8%

Community Health

$ 25,852 4.3 %

EMS $ 29,225 4.9%

Regional costs

$ 36,518 6.1%

Capital Assets

$ 18,556 3.1%

Employee Benefits

$ 3,535 .6 %

Therapy $ 9,074 1.5%

Anc. Exp. $ 2,882 .5 %

TOTAL $601,272 100%

In thousands of dollars

38%

24%

7%

4%

7%

4%

5%

6%

3%

1%

1%

0%

Expenditure by Program/Service 2017-18

Acute Care

Personal care home service

Medical remuneration

Community-based mental health

services

Community-based home care

services

Community-based health

services

Emergency medical services

Regional undistributed costs

Amortization of capital assets

Future employee benefits

Therapy services

Ancillary expenses

The Regional Health Authorities Act include provisions related to improved accountability and transparency and to improved fiscal responsibility and community involvement.

As per Sections 22 and 51 The establishment by the Minister of terms and conditions of employment (compensation, etc.) to be included in the employment contract of the chief executive officer and designated senior officers of a regional health authority. Employment contracts have been established for the CEO and all Senior Leaders of the organization. These contracts contain all terms and conditions of employment as set out by the Minister. As per Section 23 (2c) The preparation, implementation and posting on the website and updating of the regional health authority’s strategic plan. Prairie Mountain Health’s 2016-2021 Strategic Plan, that took effect the first day of the new fiscal year (April 1, 2016) is posted to the PMH website. As per Sections 23.1 and 54 The establishment by the Minister of requirements relating to accreditation of a regional health authority and the accreditation participation in RHA accreditation of health corporations and certain health care organizations and publishing of the results. Prairie Mountain Health has been continuing efforts related to Accreditation. Results of recent Accreditation Canada surveys can be found on the region’s website. Manitoba Health, Seniors and Active Living requires that health authorities report on steps taken and plans to meet the requirements under this Act.

Prairie Mountain Health adheres to standardized coding guidelines (MIS) as defined by the Canadian Institute of Health Information (CIHI). All primary cost centres include costs related to salaries, benefits, travel, telecommunications, insurance, audit & other fees, office supplies and other supplies and expenses. Administrative costs include corporate operations (including hospitals, non-proprietary personal care homes and community health agencies), as well as patient care-related functions such as infection control and patient relations and recruitment of health professionals. The figures presented are based on data as of 2017/2018. The most current definition of administrative costs determined by CIHI includes:

Administrative Expenses

% of Total 2017/2018Expenses

% of Total

2016/2017Expenses

% of Total 2015/2016 Expenses

Corporate Operations: Includes the primary cost centres of general administration, Executive, Board of Directors, public relations, planning, risk management, Advisory Councils, Community Health Assessment, finance and communications.

2.39 2.47 2.49

Patient-care Related: Includes the primary cost centres of quality assurance and accreditation, infection control, patient relations, bed utilization management, privacy office and visitor information.

.37 .36 .45

Human Resources and Recruitment: Includes the primary cost centres of Human Resources, recruitment & retention, labour relations, employee benefits, health & assistance programs and occupational health & safety prevention.

1.31 1.31 1.41

TOTAL 4.06 4.14 4.35

Public Sector Compensation Disclosure In compliance with the Public Sector Compensation Disclosure Act of Manitoba interested parties may obtain copies of the Prairie Mountain Health public sector compensation disclosure (which has been prepared for this purpose and certified by its auditor to be correct) and contains the amount of compensation it pays or provides in the corresponding fiscal year for each of its officers and employees whose compensation is $50,000 or more. This information, along with the complete set of financial statements, including the auditor’s report, is available in either electronic or hard copy by contacting Prairie Mountain Health at (204) 483-5000, Toll-Free 1-888-682-2253, or by email pmh@pmh-mb.ca.

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59%

9%

32%

Administrative Costs 2017/18Corporate Patient Care Related Human Resources & Recruitment

The Public Interest Disclosure (Whistleblower Protection) Act came into effect April 2007. This law gives employees a clear process for disclosing concerns about significant and serious matters (wrongdoings) in the Manitoba public service, and strengthens protection from reprisal. The Act builds on protections already in place under other statutes, as well as collective bargaining rights, policies, practices and processes in the Manitoba public service. As per reporting requirements regarding Section 18 of the Act, PMH did not receive any disclosures in 2017/2018 under the legislation, therefore, no investigations commenced as a result.

As part of the Government of Manitoba’s French Language Services Policy, the Rural Municipality of Ellice – Archie and the Municipality of Ste. Rose are specifically designated to receive French Language Services. In the spirit of the Francophone Community Enhancement and Support Act, PMH recognizes there are members of Manitoba’s Francophone community that live throughout the health region. The following facilities are designated within PMH to provide French Language Services:

Birtle Health Centre

Ste. Rose Primary Health Care Centre

*Ste. Rose General Hospital

*Dr. Gendreau Personal Care Home * These are affiliate facilities owned and operated by the Catholic Health Corporation and governed by their own Board of Directors. As of March 31, 2018, PMH had three designated positions filled with bilingual individuals and three of the designated positions are filled with non-bilingual individuals. The PMH French Language Services Plan (2018 – 2023) will be presented for approval in 2018 – 2019. The Plan has been developed in consultation and collaboration with PMH designated Affiliates, stakeholders in PMH particularly in the areas of St. Lazare, Ste. Rose du Lac, Laurier and Brandon/Shilo and Santé en Français.

The Regional Health Authorities (RHA) Act (section 38.1) requires that RHAs publish on their website expenses paid to and on behalf of the CEO of the health authority, as well as the senior officers of each health corporation (non-devolved hospitals and personal care homes) located within the health region. This requirement also applies to Diagnostic Services of Manitoba, CancerCare Manitoba, and the Addictions Foundation of Manitoba. The CEO Expense Report for period ending March 31, 2018 can be found by accessing the PMH website –About Us section.

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PMH offers a toll-free number whereby any patient, client (and family) can bring forth concerns or compliments about the care they received. This is a voice messaging system that is checked daily and all phones calls are returned when contact information is provided. All programs and facilities in PMH have posters of information, as well as a supply of Patient Comment Cards for patients and public to take home. PMH commits to following up on all concerns. The toll –free Patient Comment Line number is 1-800-735-6596. It is always best to try to resolve concerns as close to the unit/site/ program where the issue arose. Issues are much more difficult to follow up on when a significant delay has occurred in bringing forth concerns, or if not enough information provided (i.e. name and date of patient issue, and site/unit/program referenced).