HOSPITALS BOARD .1 IIEFBRT 2001 Bermuda Hospitals Board 'ix C A R I N G FOR OUR COMMUNITY VISION To be a Centre of Excellence MISSION STATEMENT We are a committed team of professionals working in partnership with patients, their families, clients and the community to provide high quality health care services that meet their needs and expectations. VALUES AND BELIEFS The patient is the reason we are here. We treat each other and our patients with dignity and respect at all times. We accomplish our mission through collaboration and teamwork. We provide continuous high quality compassionate care that satisfies the expectations of our patients and their families. We take individual responsibility for the success of our team. We grow and improve by personally accepting and implementing change. We conduct our business in a cost-effective manner. ,,<:i REPORTS The Chief Executive Officer of the Bermuda Hospitals Board 3 Chief of Staff 5 1 The Director of Clinical Programmes 7 e e The Chief Operating Officer of St. Brendan's Hospital 11 The Director of Human Resources 14 The Chief Operating Officer of Support Services 19 The Administrative Quality & Risk Manager 22 The Chief Information Officer 25 N e K FINANCIAL STATEMENTS a Auditor's Report 27 Statement of Financial Position 28 Statement of Operations 29 Statement of Changes in Net Assets 30 Statement of Cash Flow 31 Notes to Financial Statements 32 DIRECTORS AND STAFF The Bermuda Hospitals Board Members and Joint Membership Committee 45 Care and Support Teams 47 CHIEF EXECUTIVE OFFICER The Bermuda Hospitals Board continues to be the hub of health care services for the Island despite the pressures created by inadequate finance, the aging physical facilities, competition with other countries for skilled staff and the changing health care needs, coupled with the new demands that have been thrust upon the BHB by a more sophisticated population. Fiscal year 2000-2001 embraced the changes that had already started and took on new changes that were urgent and essential to the growth and development of the hospitals. Mrs. Stephanie Reid The BHB identified the need to refine and strengthen its management philosophy and embarked upon an in depth evaluation of its Programme Management structure to ascertain our progress associated with the change. The evaluation process included staff surveys, formal structured questionnaires, interviews, formal and informal meetings and one on one talks with staff members. It is instructive to note that the major concern relating to the physicians alignment to the clinical programmes became a focal point at the BHB corporate planning workshop during the year in review. This very important factor later became a corporate objective of the BHB's three-year corporate plan. 63 a Sa E9 There was also the thrust towards the continued education of staff members at all levels of Programme Management, its concept, and philosophy and how this management strategy fits with the vision, mission and philosophy of the Bermuda Hospitals Board. There were two critical factors we took on board; the feelings of the staff including understanding their personal objectives; and the fact that Programme Management is an evolving process that subjects itself to change when it is required. The Hospital Management had to understand these factors and work diligently to ensure that a fair balance was realised in the process. Another major influence in the direction of change for the Bermuda Hospitals Board was the availability of adequate resources to accomplish the task of providing high quality health care services to the Bermudian community. The Human Resource Department had its equal share of challenges of decreasing the vacancy rate of over 30% and improving the position of skilled professional staff for both hospitals. This was an uphill battle as the BHB competed with other hospitals worldwide for the scarce technical skills for our health services. On the resignation of the Human Resource Director at the end of the first quarter of the year the BHB appointed a new Human Resource Director who had to go through a learning curve simultaneously with meeting the manpower challenges of the two hospitals. There was the major thrust towards the strengthening of the Financial Services Department. The BHB employed its Chief Financial Officer on June 1st and worked on the streamlining of the systems and processes guided by the recommendations set out in the Auditor General's Report. Other significant vacancies were filled later in the year and the process of rebuilding the BHB Financial Management systems took on a new meaning and a new shape. Areas such e: G3 as Accounts Receivables and Accounts Payable, the management of fixed assets and the reconciliation of accounts were given priority attention throughout the year. These areas are viewed as the backbone of effective financial management. Succession planning became one of the major focuses for the BHB during this year. The following strategic executive positions were filled: The Chief Operating Officer- Clinical Services, St. Brendan's Hospital The Chief Operating Officer - Support Services, Bermuda Hospitals Board Director of Facilities Management Chief Information Officer Director of Human Resources Chief Financial Officer rsi SB An extensive training programme was developed and implemented for the succession of the Chief Executive Officer's position. The succession planning initiatives will, in time, encompass all the various levels of management, providing the opportunity for the growth and development of staff members and the availability of skilled staff prepared for leadership. Facilities management was also an area that was a major challenge during the fiscal year. There was intense concentration on building the department with skilled personnel; rebuilding the morale of the workers in the department and clean up a number of contractual arrangements that were simply not in the interest of the Bermuda Hospitals Board. There was the urgent need to get our arms around all the outstanding issues such as the unfinished capital projects, the written and implied contractual arrangements on capital works in progress and those that were put on hold. For a new management team this was indeed a challenge and the BHB recognised that the clean up process would continue throughout the current fiscal year into the next year. The fiscal year was also a year for the building of relationships between the BHB and both Trade Unions. The changes around Programme Management created misunderstandings, mistrust and suspicion among the workers and the management team. There was the urgent need to build and foster good relations that would engender trust and encourage cooperation to advance the efforts of the Bermuda Hospitals Board. It became important as well as urgent for the BHB and the Unions to experience a shared vision that will allow both sides to focus on outcomes that are positive for the individual worker and the organization as a whole. ea The year has been one of renewed commitment for staff members, the management team as well as the members of the Board. At all levels individuals worked tirelessly to purge, rebuild and renew our systems and processes to prepare our hospitals to continue to meet the challenging needs of our health care services and exceed the expectations of our patients, clients and our community. 'Where there is no vision, the people perish' - Proverbs 29:18 CHIEF OF STAFF ANNUAL REPORT No hospital can function without excellent staff. A considerable proportion of any Chief of Staff's time is spent in recruitment and retention. The search for qualified staff these days is truly global. During this period the Bermuda Hospitals Board welcomed a new oncologist recruited from the Caribbean, two nephrologists from the United States and two new psychiatrists from the United Kingdom. King Edward and St. Brendan's were reorganized along the lines of Dr. June Hill Programme Management a few years ago. In an effort to foster greater physician involvement in Programme Management and closer physician alignment with the various programmes, a decision was made by the Board in 2000 to create the new position of Physician Leader to replace the old position of Chief, i.e., Chief of Surgery would be in the future Physician Leader - Surgery. These physicians are either full or part-time members of the hospitals' staff and are therefore much more accountable to the Bermuda Hospitals Board. The idea is to have the Physician Leader and the Programme Manager work hand-in-hand, side-byside, to run the programmes. Another part of recruiting excellent staff is vetting credentials. The Chief of Staff and the Privileges Review Committee spend a considerable amount of time and energy in vetting credentials of new physicians and in ensuring that long time members of staff remain current and involved. Two of the most important criteria in this process are having adequate departmental meeting attendance and Continuing Medical Education. The hospital places great emphasis on continuing medical education. No physician in the 21st Century can remain excellent without continuing education. Several new medical initiatives were embarked upon in 2001. One of the most crucial was the institution of an Administrative Patient Safety Committee in November 2001. As stated in our mission statement "The patient is the reason we are here". The Bermuda Hospitals Board is committed to excellent, safe outcomes for its' patients. However, there has been recognition over the past year or so in North America and the United Kingdom that some patients are harmed as a direct result of contact with hospitals and this realization has triggered a re-commitment, a rededication, to Patient Safety emanating from the highest levels of health care administration. The Bermuda Hospitals Board is proud to join this movement and the Administrative Patient Safety Committee is tangible evidence that the Bermuda Hospitals Board has a strong and enduring commitment to patient safety. The goals of the Patient Safety Committee are to examine issues of patient safety in a systemic fashion and to make recommendations that will improve care. Another important patient care initiative undertaken by the Bermuda Hospitals Board was the embodiment of a committee to review the Department of Anaesthesia. The Committee began meeting in September 2001. Excellent clinical care emanates from excellent research and "evidence based care" is one of the q if a e i: aj a u i a a w 121 i 3 ? 9 9 catch phrases in medicine these days. In the past, the Bermuda Hospitals Board has done very little in the area of research; however, I am pleased to report that all this has changed. In 2001, King Edward VII Memorial Hospital became part of the DREAM Trial, the smallest centre in a multicentre international clinical trial to examine the efficacy of certain medications in actually preventing Type II Diabetes, one of our major health problems. Our Director of Cardiology, Dr. Shane Marshall, is the principal investigator, ably assisted by Debbie Jones of the KEMH Diabetes Centre. As previously stated in this report, the Bermuda Hospitals Board is global in its composition and orientation. The words of the popular song "Bermuda is Another World" no longer apply. I refer, of course, to the events of 9/11. There is no need to recap the tragic events of that Tuesday, but those events highlighted our connection and dependence as an institution and an island on the United States for supplies--food, drugs, IV solutions, equipment, etc. e (C) For a few days in that awful September, airline traffic and shipping from the United States were extremely curtailed. We were therefore forced to look very closely at our inventories in all departments. We were also forced to learn more than any of us has ever cared to know about "Bioterrorism". The hospital "weathered the storm" in excellent condition and the staff responded magnificently to the crisis. mm 95 Healthcare is dynamic and we must equip ourselves to confront new challenges as they arise. (C) as 'The Woods are lovely, dark and deep, but I have promises to keep, and miles to go before I sleep' -Robert Frost g (C) CLINICAL PROGRAMMES DIRECTORATE The second operational year of Programme Management at KEMH could certainly be described as challenging. It was challenging because the hospital remained in the throes of a global shortage of nurses, physiotherapists, and occupational therapists in addition to other health care professionals. It was challenging because of the forced relocation of some patient care areas in order to expand others. Another challenge was the necessary restoration of some badly needed replacement items because of insufficient capital funds. Improvement in communication at all levels Lucille Parker remains a continuous challenge and another challenge this year was adjusting to the changing faces and management styles of the leadership team. A new Board Chairperson and six new departmental chiefs and operating officers were appointed during the year. One outcome of these aforementioned challenges was the somewhat unfair negative image of Programme Management that seemed to evolve and flourish throughout the hospital community. For example, if a physician was unable to immediately locate a nurse on a busy unit, it was because of Programme Management; if a work permit was delayed, it was because of Programme Management; if a staff member was denied a last minute request for a month's vacation, it was because of Programme Management. A slowdown in the Dietaiy department was once attributed to Programme Management and high acuity, malfunctioning equipment, stained ceiling tiles, floods, low salaries, as well as numerous other operational issues of concern were not infrequently partnered with Programme Management which even received unfavourable mention in the House of Parliament on one occasion. It is my pleasure to report that there were fewer patient complaints, fewer patient and staff injuries, and more staff compliments this year in comparison to last year and this report will briefly highlight the achievements and activities of the Programmes during this year of challenge and controversy. Patient Care Care maps were developed for clients diagnosed with deep vein thrombosis, pneumonia, laporoscopic cholecystectomy, asthma, and total abdomina hysterectomy. Protocols and guidelines were also introduced for paediatric patients who require sedation for various diagnostic tests, for sickle cell disease, and for children who require hospitalisation for fever of unknown origin. The Intensive Care Unit was relocated from the second floor to the ground floor adjacent to the Emergency Department. This move was necessary so that construction of the new Cardiac Diagnostic Centre could commence. The new temporaiy ECU. site is much smaller and more restrictive, however the staff must be commended for excellence in their coping skills particularly when they 01 << ;-o; t:i : I q vn experienced a significant staffing shortage for several months. After months of staff recruitment and training, hyperbaric wound care treatments commenced with very successful outcomes. The Asthma Education Centre was established at the beginning of the year and under the leadership of Mrs. Debbie Barboza R.N., 182 clients were assessed and given individualized plans of care to promote improvement in their health status. The Pre-admission Clinic, which underwent a name change to The Pre-operative Assessment Clinic, was relocated from the fourth floor to an attractively reconstructed, spacious, and private area on the second floor. Also relocated nearby is the amalgamated Surgical Ambulatory Unit, previously known as the Surgical Outpatient and Same Day Admission Units. The quality of haemodialysis delivery was improved by the purchase and use of a Transonic Doppler that more accurately assesses the status of clients' fistulae. Approval was granted for the expansion of Home Care services, which has contributed to a decrease in the length of hospital stays for many patients. Amputee clients were transferred from the care of the Limb and Brace staff to the care of the physiotherapists. Patient Education Educational booklets were produced on many topics including wound care, pressure ulcer prevention, stoma care, hysterectomy, and pre-operative instructions. Childbirth classes led by Mrs. Roxanne Kipps-Jackson and Mrs. Catherine Roberts commenced in July and were held on Thursday evenings at the Montrose Conference Centre. Topics included relaxation techniques, labour and delivery, and infant feeding. Five sessions were held during the year with an average attendance of six couples. Staff Education The Clinical Educators organized twenty-four Learning Lunches during the year. Topics were varied and attendance overflowed at each session. Seventy-six staff members attended the Disaster Preparedness workshop and Mass Casualty Management course held in May. A one-week course for Hyperbaric Technicians was held in June. The National Association of Activities presented a three-day conference. In addition to Continuing Care staff, many staff from the community Rest Homes were also in attendance. Two Bermudian nurses successfully completed a twelve-month Operating Room Nurse course. A trauma nurse core course was presented in October at the Sonesta Beach Resort and attended by twenty-two Critical Care nurses. Twelve staff from the Medical Programme were the recipients of $1000.00 educational grants through the generosity of Merck, Sharpe, and Dohme. Biweekly surgical education sessions for multidisciplinary team members commenced in January with topical patient care presentations. A surgical conference sponsored by the New Jersey/Bermuda chapter of the Perianaesthesia Nurses Association was held at the Hamilton Princess Hotel in February and well attended by local nurses. Booklets detailing Practice Standards for the Sterile Processing Department and for Perioperative Care were developed. Community Outreach o o o o Organ donor information is now available on driver's licenses in Bermuda thanks to the persistence and assistance of the Intensive Care Unit staff. Multidisciplinary team members participated in career days at seven schools. Health screenings for members of the public along with educational exhibits were held in the hospital lobby in celebration of Critical Care week. Staff from the Medical Programme took advantage of the opportunity to provide education in churches and in schools throughout the island during Heart Month (February). Continuing Care Programme staff preceptored six Geriatric Aide students from the Bermuda College. Age Concern welcomed the Continuing Care Programme as a new member of their proactive group. Infant Car Seat Safety was successfully promoted in the hospital lobby and in the media during National Safety Week. Communication o o o o o Informative, eye-catching Programme newsletters were published monthly and/or quarterly. Town Hall style open staff meetings were held on a regular basis. Multidisciplinary patient care team meetings in most Programmes were held monthly and were well attended. A Surgical Advisory Committee was established to advise on problems and deal with issues confronting the Programme. The Surgical Programme staff produced artistic nurse recruitment brochures. The Chief Executive Officer met with several different groups of staff throughout the year to listen and to respond to their concerns. Each Programme Manager presented progress reports toward the achievement of the Bermuda Hospitals Board corporate goals to the Leadership Team and presentations on quality issues were also made at Quality Council meetings. The Professional Practice Leaders and Programme Managers met formally on several occasions to resolve various staff and administrative issues. Programme activities, achievements, and challenges were regularly shared at Joint Management Team meetings. l"\ 4 Staff Congratulations Ms. Mia Daniels, Physiotherapist, and Ms. Jenal Swan, MSW were appointed Professional Practice Leaders of Rehabilitation Services and Medical Social Work respectively. Mrs. Karen Raynor RN was promoted from staff nurse to Clinical Coordinator, Curtis Ward. Mrs. Deborah Jones was elected Vice President of the International Diabetes Federation Ms Antoinette Paynter and Mr. Manual Alves, members of the Medical Programme were named Nurse Aide and Orderly of the Year. The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. - Martin Luther King Jr. ui 10 ST. BRENDAN'S HOSPITAL CHIEF OPERATING OFFICER - ANNUA Our focus at St. Brendan's Hospital has been the delivery of mental health care services to the community of Bermuda. Our primary objective is to ensure that the clients gain positive outcomes from our services. "How do we do this?," one may ask. For the staff at St. Brendan's Hospital, this means being prepared to meet all our challenges and any changes head on, but always ensuring that the quality of our care provision is never compromised. Patrice Dill in this new millennium, St. Brendan's Hospital has remained committed to its vision of being a Mental Health Centre striving for excellence. There have been many initiatives introduced this year to ensure that the delivery of mental health care services were either maintained at a high quality or improved upon. With change being inevitable, our hospital has met the challenges, and ensured that our organization remains on the cutting edge of health care delivery. 1* What were the initiatives? The Bermuda Hospitals Board implemented a new management structure at St. Brendan's Hospital, in order that succession planning could be realized. Succession planning initiatives involved all the managerial positions at SBH. One such position was that of Chief Operating Officer, which was created to replace the position of Director of Programmes and Administration for SBH. The COO of SBH position is one of several which have been designed as training positions for the position of Chief Executive Officer for BHB. All Bermudians who demonstrated progressive management skills and had the academic qualifications for upward mobility within the organization were selected for these positions. With the succession planning initiative, a bridge has been forged to ensure continuity of strategic planning for the BHB, and that meeting the specific health needs of the Bermudian community remain paramount. There have been numerous other improvements in mental health care services during the year 2001, upon which we are proud to report. Each of the three clinical programmes at SBH, i.e. Mental Health, Learning Disability and Substance Abuse, have increased and improved in their service delivery efforts. Within the Mental Health Programme, its five services have each instituted quality initiatives this year. The Child and Adolescent Service formulated a care map for Attention Deficit Disorder clients. What are care maps, one may ask? A care map provides a clear outline of services one can expect to effectively manage a specific illness. In addition, at the Child and Adolescent Services, their facilities were revamped to be more age appropriate for their clients. This was a welcomed improvement. The Acute Community Services' quality initiative involved converting to a one-file system. Now, all of a client's medical data, whether they have been an inpatient or an outpatient, have been merged into one file. This has eradicated duplication of information and has fostered a continuum of service delivery. The Community Rehabilitation Services, in partnership with the Bermuda Mental Health Foundation, secured 01 C c another client group home. This two-unit house with a studio apartment will accommodate seven clients. Only three clients were moved initially into the lower apartment, while renovations to the back studio and upper apartment were being completed. Our outpatient clients were introduced to computer training, and now produce a clients' quarterly newsletter containing interesting articles on mental health issues. On our inpatient acute units, the furnishings were upgraded and new types of group therapy were provided. Outcome measurement tools have been implemented to provide evidence that positive results are being achieved from the care provided. This year, a care map for electroplexy was launched with positive results. A post discharge follow-up telephone service was established, which provided immediate follow- up for clients being discharged. This service was well received. On our rehab and continuing care inpatient units, which are considered home for most of these clients, the facilities and environments were upgraded. These enhancements improved the therapeutic milieu and created a more home-like atmosphere. Likewise, the Learning Disability Programme was able to improve the quality of life for their clients both in hospital and in the community. All inpatient units were upgraded with new furnishings aimed at increasing the comfort and quality of life for their clients. The Sandpiper Unit, a previously locked unit that provided intensive care interventions, has now been converted to an open unit. Another major accomplishment was the philosophical shift from using a medical model in providing care to the learning disabled population to a social model. St. Brendan's has joined the rest of the world in ensuring that the learning disabled clients receive appropriate services to meet their needs. Establishing new group homes for the learning disabled clients continues to be a goal of the programme. To that end, another group home was secured in partnership with Project 100, bringing the total complement to six group homes. In our Substance Abuse Programme, services have increased. The Methadone Clinic is now located at SBH instead of Victoria Street Clinic. Now clients also have access on site, on a weekly basis, of two nurses from the Sexually Transmitted Disease Clinic. As a result of this inclusion of these services, our clients now can receive a continuum of care, i.e., medical, educational, counselling and follow-up, all on one site. Their final initiative was the confirmation of the construction of an 8-bedded inpatient detox unit. It is anticipated that the unit will be operational in 2002. Overall, the Bermuda community can be assured that St. Brendan's Hospital's services are comparable to those of major overseas mental health facilities. St. Brendan's Hospital has had a number of visits from mental health professionals from Canada, USA, the Caribbean and the UK - all of whom have commented positively on the quality and quantity of services that SBH provides. St. Brendan's Hospital hosted the American Black Psychiatrists delegates for one day during their annual conference held in Bermuda for the first time this year. It was an exciting addition to their agenda, and they were very appreciative of the opportunity this afforded them to network with health professionals from SBH. The Healthcare Quality Network of the Conference Board of Canada held their meeting at SBH, toured our facility, and were very impressed with the services being offered. The Bedford Trust in the United Kingdom has agreed, after surveying our services, to send a resident doctor yearly to join our training programme to become psychiatrists. Their first resident doctor is due to arrive in Bermuda April 12 2002. This initiative will enhance our recruitment efforts in securing competent medical personnel. All our allied services continue to foster new partnerships to improve the services being offered to our clients, i.e. the Aquarium and Windreach to name a few. Our SBH Bermuda Day Parade continues to grow - the attendance and community involvement has increased considerably. Acknowledging that our greatest asset is our staff, St. Brendan's Hospital has been committed to ensuring continuing education, support and recognition for excellent performance. Aldwin Savery was named Manager of the Year, Susan Clarke SBH Nurse of the Year, Berlyn Rogers SBH People's Choice Award, Anita Minors SBH Support Worker of the Year, and Dr. Donald MacKenzie, a psychiatrist, BHB Employee of the Year. oT A significant highlight of the year was the successful Mock Drill carried out at SBH to test our preparedness for a Mass Casualty disaster. SBH is designated as the facility to care for the walking wounded. This event was held in February, with the assistance of over 40 students and teachers from CedarBridge Academy posing as victims. The entire exercise was an overwhelming success. The official observers from the Red Cross and KEMH were thoroughly impressed with our efforts. In conclusion, St. Brendan's Hospital remains committed in ensuring that it stays on the cutting edge in terms of its services and facilities. This year's accomplishments have provided the evidence of our commitment to achieving our vision. St. Brendan's Hospital continues to position itself to be one of the best mental health facilities in the world - better able to serve our Bermudian community, and ready to face the mental health service challenges of this new millennium. "Difficulties are meant to rouse not discourage' -William Ellery Channing 1 a HUMAN RESOURCES DIRECTORATE )R OF HUMAN RESOURCES - ANNUAL REPORT The 2000 -2001 fiscal year continued to see the Human Resources Directorate expand its role and take on greater responsibility in the organizational development of the Bermuda Hospitals Board. The restructuring of the Human Resources Directorate, which had taken place during the previous year, began to bear fruit. Working within the new Programme Management organizational structure, Clinical Programmes, St. Brendan's Hospital and the Support Services were each assigned a dedicated Human Resources Manager to focus on the needs of their Scott Pearman business unit. The business units where further fused to their respective manager by redesigning communication and reporting protocols to ensure that the newly instated teams were functioning as a cohesive unit. The successes of the first year has seen faster response times by Human Resources to posting vacated positions, a substantial decrease in the number of actual vacancies, a 50% decrease in the time required to process a new employees through the Department of Immigration, and greatly improved communications with prospective employees. In conjunction with their area managers, the Human Resources Managers have also identified recruitment pools for future talent needs, that has enabled us reduced our advertising expenditures. Bermuda is not another world, as we so frequently prefer to tease ourselves; we are part of the real world. Consequently, Bermuda is not exempt from the realities of a worldwide shortage of nurses, physicians, technicians, therapist, pharmacist and most other healthcare professionals. Pink sand and beaches are no longer the ultimate draw for international talent. Although competitive, the Bermuda Hospitals Board's remuneration package is not geared to be an international wage leader. We are no longer afforded the luxury of screening self-directed applicants, and are reconfiguring our talent search strategies by developing candidate pools and actively recruiting potential prospects. Understanding that worthy healthcare professionals are never without standing job offers and often in multiple jurisdictions, we have developed professional recruitment packages and head hunting skills. During the summer of 2000, the Bennuda Hospitals Board lost a substantial portion of our Bennuda resident rehabilitation therapists to another local employer that had enacted a new pay scale that was substantially in excess of the Board's. The Board took the opportunity to conduct a comprehensive review of the salaries of our nursing and other categories of qualified staff against the remuneration packages offered in the major overseas jurisdictions from which we recruit. We concluded that recent aggressive wage increments, that were designed to combat talent shortages in the onshore jurisdictions, had acted to disadvantage the attractiveness of the Bennuda Hospitals Board as a possible employer. In response, although the collective agreement was closed, the Board proposed a corrective salary adjustment to the Bermuda Public Services Association. Initially the package was generally accepted and the parties were working to iron out abnormalities, when dissatisfied factions of the BPSA drove the matter into an industrial dispute over working conditions for 14 nurses. The Department of Labour & Training mediated the dispute and by in far the original package proposed by the Board prevailed. The implementation of the Board's new salary structure for qualified line staff was critical in recognizing competitive threats and acting to retain the front line professionals that drive the core services of the organization for the benefit of the community. The year saw the signing of three major agreements between the Board and our labour partners. In May of 2000, the Board completed negotiations with the Bermuda Public Services Association and signed off on a new two-year collective bargaining agreement. Agreement was reached without the involvement of third parties. In September 2000, The Bermuda Hospitals Board signed a new Collective Bargaining Agreement with the Bermuda Industrial Union. We did find cause to invite the Government Mediator to assist us near the conclusion of negotiations, however both parties succeeded in reaching an amicable agreement. In March of 2001, the Drug, Alcohol & Substance Abuse Policy was signed, which was the conclusion of a momentous tripartite agreement that took three year to formulate. The Bermuda Hospitals Board along with its labour partners were concerned about the impact of drug, alcohol and substance abuse on our employees and their families. Although the Bermuda Hospitals Board had a drug and alcohol policy in place for many years, it was decided to write a new policy in conjunction with our labour partners. The policy embraced the Board's philosophy of encouraging self-referral, in addition to managerial referral and rehabilitative treatment. Achieving a safe and healthy working environment is desired by all parties, however drafting a working document was a challenge in merging differing philosophies. The understanding of roles and protocols was essential since the Board is unique amongst employers in that we carry out our sample collection, lab tests, and even provide clinical services in-house through our Employee Health Services, Employee Assistance Programme, and Turning Point Substance Abuse Program. The quality of the finished document and the and concept of drafting and signing the policy in concert with our labour partners has been endorsed by the National Drug Commission, and overseas agencies. Thirty students participated in our Summer Internship Program. The Summer Internship Programme is specifically designed to place students studying for a healthcare related career in a job that gives them practical experience within their field of expertise. Internship placements are made to BHB scholarship recipients, and then to qualified applicants based on their field of study, academic and year standing. The Bermuda Hospitals Board total financial commitment to Bermudian students pursuing healthcare related careers exceed $200,000. EMPLOYEE HEALTH SERVICES (EHS) An important part of the Employee Health Services activities for this year has involved working with other BHB teams and committees to protect our patients and staff. Infection Control A number of problems have been addressed as Employee Health Services continue work closely with Infection Control. Of particular concern is the increase in the number of MRSA exposures, which has led to the revision of the policy to prevent the spread of infection to patients and co-workers. Presently in draft form, amendments to the policy will include doing culture swabs on all new employees prior to patient contact. The challenge of monitoring locum physicians and surgeons is also being addressed. M Talks are in progress to revise the Infection Control Outbreak Policy and to form an Outbreak Management Team, which would include Employee Health Services internally and health services in the community as well. With concerns about latex allergies increasing world wide, we have begun to compile a registry of staff that are sensitive or allergic to latex, and to monitor the use of non-latex gloves. A decision to retain occurrence reports related to blood and body fluid exposures longer than five years was made as a result of documentation being required relating to an employee that had contracted Hepatitis C approximately 20 years after exposure. We continue to closely monitor varicella exposures, and this year we have also screened some departments for salmonella. Employee Health Services joined the Infection Control Department in presenting a "Learning Lunch" addressing Sharps Injuries and Blood Bourne pathogens. Wellness Program The BHB Wellness Programme activities have included a successful 'Wellness Week' in January, which involved wellness walks, motivational speakers, additional healthy meal choices in the staff cafeteria, and the revival of the 'Go for the Gold' programme, re-named the "Wellness Express". The staff was also encouraged to participate in the International Race Weekend activities. Renewed commitment of the committee members, and a revision of our plans for the future have produced some new ideas for wellness activities, which include a wellness fair, a charity fun run/walk and staff participation in recreational and sporting activities. Workmen's Compensation A review of the system used to follow-up claims, resulting costs and reimbursements is in progress, as we work in partnership with Information Services and our insurers. The workmen's 1K compensation policy is still in draft form as new challenges emerge and are addressed. Health and Safety In an effort to revive the Health and Safety Committee and renew our commitment to promote a safe environment for our patients and staff, the structure of the committee is being reorganized. A proposal for the introduction of sub-committees that will address patient, employee, environmental and hazardous waste safety issues is being discussed. These committees will include non-managerial employees and will report through the chairpersons who form the Administrative Committee, to the Risk Management Team. The format of each sub-committee will include participation in safety activities, addressing concerns, forming action plans and making recommendations. 9 H The Manual Handling Project Team that is addressing lifting and handling concerns is preparing for a visit from a health and safety consultant, with a view to making improvements in our methods for lifting, and preventing further injuries through the use of lifting devices. Overall, the major challenges for the year continue to include containing infections, particularly MRSA, improving the workmen's compensation process, improving the wellness facility, reducing injuries and resulting costs and acquiring resources that will assist in improving our service, such as a specific Employee Health information system and an increase in staff. EMPLOYEE ASSISTANCE PROGRAMME The EAP experienced a good year. Some of the accomplishments for the department included the EAP involvement in assisting the organization deal with the crisis that occurred in the United States and the impact those activities had on the hospital. The EAP played a pivotal role in this area with assisting staff to deal with the crisis by having informational talks that resulted in the creating of administrative learning lunches and other programs for staff to handle themselves as well as assisting the senior staff in making decisions regarding the organization. The CISM team also reached a milestone this year. A request has been made to the team to assist in the recovery efforts at Ground Zero. Being a registered team under ICISF, this will give us international recognition and exposure. The team was able to secure funding from two exempt companies and will be preparing to assist in the recovery effort in the next few months. There will be a lot of lessons to learn from this experience that could be bought back and used to assist with coordinating services of this nature on the island. The EAP continues to be involved in the Joint Union Management Committee. The focus has been on implementing the training program for the Drug, Alcohol and Substance Abuse Policy. Of concern is the delay with implementing the training, the readiness of the managers and supervisors with driving the policy and the role this committee will have after the training is complete. These concerns will be addressed in committee. The department continued to see a steady stream of clients who continue to come in with multiple problems. Job related stress problems as well as marital/relationship difficulties continue to be the most assessed problems presented at the EAP. Managers and supervisors \" have also made good use of the program as referrals increased from managers and supervisors. The use of the clinical consultant has been useful in terms of case planning but this will need to be reviewed due to conflicts in scheduling. The EAP also continued to receive requests for unit specific workshops covering a range of different topics. Attempts have been made at looking at expansion of the EAP service. Meetings have been held with the Human Resources Consultant. Thus far we have been able to look at trends in the department and discuss what my experiences have been like since the programs inception. Recommendations will be made later on this year regarding this issue. . B The EAP also assisted the Human Resources Department in putting on a retirement program for retiring employees. This appeared to be appreciated by staff that participated. Since there is a large number of staff over the age of 50, a pre-retirement program will be held to assist staff in looking at what their needs are in preparation for retirement. The staff was very receptive to this program in the past. V Overall the Bermuda Hospitals Board continues to be a dynamic organization to work in with many exciting changes being driven by the employees at all levels of the organization. The Human Resources Department will continue to facilitate the development and deployment of capable staff that will ensure that the Bermuda Hospitals Board remain the leader in healthcare management in Bermuda. "Education is a progressive discovery of our own ignorance" -Will Durrant in SUPPORT SERVICES CHIEF OPERATING OFFICER - ANNEAL REPORT "We Grow and Improve by Personally Accepting Change" is the Bermuda Hospitals Board value statement that best reflects the spirit of the Support Services Team this fiscal year. The departments of Diagnostic Imaging, Laboratory Services, Pharmacy, Materials Management and Infection Control came together as a team August 2000, under the direction of the newly appointed Chief Operating Officer, Support Services. The responsibility for these areas was gradually Venetta Symonds divested from the Director, Clinical Programs, the Quality Administrative Manager and the Information Services Consultant who assisted with their direction from January 2000. :a: These dynamic areas provide the required diagnostic results, pharmaceuticals, supplies and infection control initiatives to support our Clinical Programmes, as a part of an integral partnership in the deliveiy of Healthcare to our inpatients. A large outpatient population is also served by our departments, both those insured, and those clients subsidized by Government facilitating the early detection and management of disease. Consultations are often provided for the community, since we occupy the distinctive position as specialists in many of our positions. Quality of service became a focus this year as we further embraced the concept of performance improvement. Our Laboratory Services underwent an external review to identify opportunities for enhancement, which resulted in a renewed interest by this department to pursue departmental accreditation. Infection Control continued its efforts to combat the permanent establishment of Methicillin Resistant Staphylococcus Aureus (MRSA) in our hospital, through increased surveillance, isolation techniques and the education of patients and employees. MRSA has become established in many healthcare organizations internationally who have not found the interventional methods to be cost effective, but it is our belief that aggressive interventional methods will prevent the spread of this bacterium throughout our population. Hand washing was once again driven as the most effective way to manage the control of infectious disease. Process improvement efforts continued to Pharmacy and Diagnostic Imaging services to investigate the use of automation and technology to improve efficiency. Staffing of the numerous vacant positions across the Support Services presented the greatest challenge to the Bermuda Hospitals Board management team. Materials Management, Diagnostic Imaging, Pharmacy and Infection Control each lost a leader this year, compounded by severe staffing shortage. Efforts were made to overcome this knowledge and skills drain by participating in intense recruitment efforts, along with Human Resources. Succession planning within the Directorate was initiated for key positions, and teamwork and restructuring activities sparked creative approaches to work processes. I * This year presented challenges but our Support Services Team, along with our BHB family forged ahead towards the corporate vision of Excellence. Listed below are a few of this year's departmental accomplishments: Infection o Control Manager appointment - internal Refined MRSA management program Improved surveillance for hospital acquired pathogens. Materials Management Materials Manager (Designate) appointment - internal Teambuilding activities Decrease in inventory 2000/2001 of $32,790.60 (2.82%) Pharmacy Manager appointed - internal Staffed unfilled Pharmacist positions Initiated credentialed Pharmacy technician strategy. Improved medication error surveillance Expanded service to Specialty Clinics Outpatient prescriptions filled increased by 32% over the previous year. Laboratory External review of Laboratoiy Three out of five senior positions filled by "acting seniors" internal appointments. Stores Inventory Technician position filled. Aggressive recruitment and hiring drive for Medical Technologists Blood bank policies regarding the screening of blood for international diseases. Increased MRSA testing. Second Histopathologist position approved Purchased Microtome and Tissue Embedding Centre. Testing volumes increased by 9.5%. 20 Diagnostic Imaging Manager appointed - internal appointment 4th Radiologist position filled Aggressive radiographer recruitment drive o Plans developed for the implementation of Diagnostic Imaging service expansion projects - MRI, Radiology Information System, Centralized Film Library and the Radioisotope Hot Lab. o Succession plan established for DI Manager position. n Testing volumes increased by 1.6% The Support Service Team grew and adapted with each change over the year as their services continued to meet the needs of our clients. The core values of our hospital provided the perfect foundation on which to build, grow and deliver the desired outcomes during stormy uncertain conditions. i" "A successful team is a group of many hands, but of one mind" -Author Unknown << q 3! ;i a q 35 I* :c n t: :s N es QUALITY REPORT LITY & RISK MANAGER - ANNUAL REPORT One of the greatest challenges that hospitals face is measuring the quality of care and service delivered. However, before we can improve quality we must first understand how well these services are functioning. o 3R o The hospital utilizes a number of systems to help evaluate its performance. Prominent among these evaluative processes are listening to the voice of the patient. This is accomplished by recording and dealing promptly and objectively to patient complaints; reviewing patient comment cards; Aldwin Savery telephone call back to discharged patients; ongoing rounds and observations; clinical and environmental audits; and an external mail out survey which is done every two years. Additionally, there are a number of functions that are carried out organizationally which contribute to the monitoring and improvement of quality. These are: Infection Control Risk Management Utilization Management with its review component Health and Safety Monitoring Care Mapping Monitoring, trending and analysing performance indicators Impact Analysis The Accreditation Programme And Programme Management These functions are implemented through numerous vehicles such as unit based Quality Improvement Teams; Accreditation Care and Support Teams; Medical Teams; Education Services; Clinical Educators; and Quality Management Staff among others. E5 Within this dynamic hospital milieu there is a never-ending pursuit of excellence in patient care service, driven by the notion that "nothing is good enough" and "everything can be made better". These beliefs crystallise the true intent of the Bermuda Hospitals Board's Vision Statement "To be a centre of excellence", and provides the synergy for staff to strive to do better. This year the Quality and Risk Management Department spent considerable time evaluating the success of Programme Management with the assistance of the Hospital Auxiliary and St. Brendan's Hospital Volunteer Service. Three surveys were implemented randomly throughout both hospitals: the first amongst the staff, the second amongst the managers and department chiefs, and the third amongst a combination of all three groups. Not surprising, managers had a much more positive outlook about Programme Management than the staff and physicians. This is probably due to the fact that in Programme Management, managers have a greater responsibility and autonomy to control the budget and other resources of the Programme. This is not to say that all the staff and physicians' comments were negative. Some of their comments are as follows: 22 Improved quality of care. Lack of physician involvement in Programmes. More patient / family involvement in care. Increase in number and variety of in-service education programmes for staff. More education on Programme Management needed. Easier to transfer patients across Programmes. Increase in healthcare information for patients / families. No staff empowerment. "Turf battles continue. Improvement in continuity of care. Improved budgetary controls (not exhaustive). As a direct result of these surveys a number of programmes were implemented to help staff gain a better understanding of the philosophy and structure of Programme Management with good result. Senior Management staff and external healthcare professionals led these sessions. They were well attended and well received. 15 :i a There were two significant undertakings by the Bermuda Hospitals Board that were very successful. In March, a one-day seminar was held at the Sonesta Beach Hotel for the Hospitals and their Community Partners. The seminar, "Depression in the Workplace", was designed to help healthcare and other managers recognize early signs of depression in staff and to direct them to the appropriate professionals for treatment. The seminar was well supported by the community. The second programme was the hosting of the 24th Meeting of the Healthcare Quality Network of the Conference Board of Canada here in Bermuda. The Board received generous support from the Government of the day and the meeting was held over two days. The meeting included a number of local speakers and tours of both hospitals. It was a tremendous success from the standpoint of content and delivery. Individual ratings of the attendees showed that they regarded the meeting content as relevant, informative and exciting. The presenters included the Honourable Nelson Bascome, Minister of Health and Housing; Dr. John Cann, Chief Medical Officer; Dr Shane Marshall, Chief of Medicine; Mrs. Norma Smith, Medical Programme Manager; Ms Patrice Dill, Programme Manager, Mental Health Programme; Ms Joanne Dill, Programme Manager, Turning Point; Dr. Donald MacKenzie, Consultant Psychiatrist; Ms Debbie Jones, Diabetic Clinic Coordinator and Dr. Malik Joshie from the United States who addressed "Building and Use of a Balanced Scorecard for Healthcare". We congratulate the presenters and also the Quality Improvement staff for organizing the event. I am pleased to announce the promotion of Ms. Judy Richardson, Quality Improvement Coordinator, to the new position of Chief Nursing Administrator of the Bermuda Hospitals Board. Please join us in wishing her every success in her new job. The laundry continues to function in a less than satisfactory environment with outdated equipment. There is the occasional complaint from staff about the environmental conditions, but overall the quality and quantity of work remains at a good standard. Renovation of the u i" s e laundry is a high priority for the Board during the next financial term. A team of multidisciplinary staff will be established to deal with this process. Working in the Environmental Services is one of the most frustrating areas in the hospital. The staff strive hard to keep the floors not merely clean, but beautiful. Housekeepers spend countless hours stripping and re-waxing floors on the inpatient and outpatient units. In no time after completing these audacious tasks, it is not unusual for them to observe some careless person walking on the floor without cleaning the sole of their shoes and leaving mud or shoe prints in their way, or pulling a chair or table instead of lifting, or even pushing a poorly maintained food trolley and leaving track marks on the once beautifully finished floor. The next time you walk into the hospital and notice the shiny floors, think of the hardworking housekeeper, and the thankless task she/he has of cleaning and sanitizing floors for the benefit of all of us. Food Service staff continues to do a good job in providing nourishing meals for the patients, staff and visitors. Our challenges in this service are keeping labour and food cost within reasonable limits, and changing room and storage space. The Food Service Managers' position has been vacant for some time pending a full review of the department. When this is completed and the right structure is in place we will look to the staff to provide new and innovative ways to improve the service. I believe that the future of health care lies in providing better quality care in a cost efficient manner and being more productive. The Bermuda Hospitals Board is well placed to pursue these initiatives with vigour in the ensuing years. The Quality and Risk Management Department is proud to be part of this movement. I end this report with this quote: 'The health of our people is really the foundation upon which all their happiness and all their powers of state depend." -Benjamin Disraeli 24 INFORMATION SERVICES CHIEF INFORMATION OFFICER - ANNUAL REPORT 1FT1 1 1 ? f The Information Services Directorate consists of the following departments, Admitting Services, Clinical Record Services, Information Services, Health Sciences Library, and Telecommunications Services. Admitting Services i ?.. - mi*.-"*!* Katyna Rabain o Along with improving the cosmetics of the department with painting and general cleaning, the Admitting Department continued with process improvement. The following processes were improved: "Point of service" in the Rehabilitation Department. Patients are now admitted in the Rehab Department and no longer wait in the Admitting Department. The process for transporting patients between Dialysis and the main hospital was clearly defined. Security and patient confidentiality. The Inpatient Admitting section now has a security lock, which is providing security for admitting staff and increasing patient confidentially. Clinical Records Services This year the Clinical Records Department addressed the following challenges: o The difficulty in finding qualified Health Records Technicians. The Clinical Records department developed a program where candidates are trained in-house and then encouraged to further their education overseas and become certified. o The lack of space. Developed a purging process, which reduces the active files, by developing closed volumes. This has resulted in a more organized and manageable filing system, a reduction in retrieval time of records, and an increase the space in the active filing area. Health Sciences Library After being without a head librarian for over a year we now have a Librarian and a fulltime Library Assistant. The new librarian brings a wealth of experience to the Bennuda Hospitals Board. Since October 2000, the KEMH Health Sciences library has been redesigned to better utilize the space. The Journal collections at both KEMH and SBH have been weeded and updated. Work is underway to weed and update the reference collections at both hospitals. An efficient and cost-effective new electronic document delivery system is in place. Planning has been started to address the library security systems at both hospitals. The Librarian has begun to design a website to provide accurate online health reference material to both medical staff and health consumers. J>> Information Services The Information Services Department has continued to improve the Information Technology infrastructure in order to prepare for future needs of the organization. We began the process of upgrading the cabling, the data transmission speed and our Internet capabilities throughout the hospitals. On the software side, there has been continued upgrading of all applications, ensuring the BHB remains current. Steady progress has been made with the OR scheduling application and selection of a Radiology Information System. (R) A Bermuda Hospitals Board web site was developed with the initial focus on improving the Human Resource recmitment process. This web site provides vital information about Bermuda, the hospital and the recruitment process. All job postings can be found on the web site along fonns that are required for recruitment. Telecommunication Services The Telecommunications Department have changed many of the Bermuda Hospitals Board private lines to Direct Inward Dialling (D.I.D.), which has resulted in substantial savings. ''Knowledge is of two kinds- that which is absorbed and that which is heard. The one which is heard does not give benefit unless it is absorbed" -Author Unknown 26 Office of the Auditor General Hemisphere House 9 Church Street Hamilton HM 11, Bermuda Tel: (441)296-3148 Fax: (441) 295-3849 Email: auditbda@bdagov.bm o AUDITOR'S REPORT o ; To the Minister of Health and Family Services it'-' I have audited the statement of financial position of the Bennuda Hospitals Board as at March 31, 2001 and the statements of operations, changes in net assets and of cash flows for the year then ended. These financial statements are the responsibility of the Board's management. M y responsibility is to express an opinion on these financial statements based on my audit. o ii- Except as explained in the following paragraph, I conducted my audit in accordance with auditing standards generally accepted in Bermuda and Canada. Those standards require that I plan and perform an audit to obtain reasonable assurance whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. In common with many not-for-profit organizations, the Bemiuda Hospitals Board derives a portion of its revenue from the general public in the form of donations, the completeness of which is not susceptible of satisfactory audit verification. Accordingly, verification of these revenues was limited to the amounts recorded in the records of the Board and I was not able to determine whether any adjustments might be necessary to donation revenues, excess of revenues over expenses, assets and net asset balances. SB- r" i M C In my opinion, except for the effect of adjustments, if any, which I might have determined to be necessary had I been able to satisfy myself concerning the completeness of donations referred to in the preceding paragraph, these financial statements present fairly, in all material respects, the financial position of the Bennuda Hospitals Board as at March 31, 2001 and the results of its operations, the changes in its net assets and its cash flows for the year then ended in accordance with accounting principles generally accepted in Bemiuda and Canada. Hamilton, Bermuda August 31, 2001 Lany T. Dennis, C.A. Auditor General >SITION $ 2000 $ 6,451,444 3,740,628 9,739,696 2,185,713 4,253,109 11,042,331 41,122 587,655 677,072 2,193,572 560,222 1,148,060 2,588,896 516,441 23,403,756 22,322,205 83,437,130 84,603,941 250,000 2,827,561 896,028 1,807,994 1,716,028 87,160,719 88,377,963 110,564,475 110,700,168 2001 ASSETS Current assets Cash and time deposits Restricted cash and time deposits (note 3) Accounts receivable (net of allowance for doubtful accounts 2001 - $1,048,831; 2000 - $649,878) (note 7) Due from the Consolidated Fund of the Government of Bermuda (note 7) Other receivables Inventories Prepaid expenses Long term assets Capital assets (note 5) Due from the Consolidated Fund of the Government of Bermuda (note 7) Bond sinking fund (note 8) Pledges receivable (note 4) LIABLLITLES, DEFERRED CAPITAL CONTRTBUTIONS AND NET ASSETS Current liabilities Accounts payable and accrued liabilities (note 7) Accrued salary and payroll expenses (note 7 and 12) Current portion of long term debt & bonds (note 8) 7,713,526 8,050,289 908,518 9,567,622 5,849,283 986,814 16,672,333 16,403,719 5,307,524 21,250,000 4,772,274 22,158,518 26,557,524 26,930,792 Deferred capital contributions (note 9) 24,278,334 24,656,448 Net assets Invested in capital assets (note 10) Restricted for pensions (note 11) Unrestricted 39,413,449 458,344 3,184,491 40,370,741 43,056,284 42,709,209 110,564,475 110,700,168 Long term liabilities Pension accrual (note 12) Long term debt (note 8) Total net assets The accompanying notes are an integral part of these financial statements 458,344 1,880,124 EMENT OF OPERATIONS KEMH 2001 2000 $ OPERATING REVENUES Outpatient (note 7) Inpatient (note 7) Extended care unit (note 7) Amortisation of deferred revenue (note 9) Non-medical (note 7) Investment Income Surcharge to non-residents Donations Government grants (note 7) SBH $ $ $ 44,271,911 104,137 44,376,048 40,311,653 40,101,324 825,601 40,926,925 39,128,308 8,958,207 - 8,958,207 8,958,207 1,040,204 424,545 1,464,749 1,507,938 1,232,914 186,566 1,419,480 1,097,413 441,490 - 441,490 260,606 382,431 - 382,431 600,099 327,646 - 327,646 347,858 - 20,365,121 20,365,121 1 9,553,106 96,756,127 21,905,970 118,662,097 111,587,903 SALARIES AND EMPLOYEE BENEFITS Direct medical staff 22,441,334 Supporting medical services 11,119,074 Ancillary services 10,948,942 Employee benefits (note 7) 8,025,170 Administrative services 6,296,979 9,007,072 2,983,449 1,621,120 1,902,383 208,453 31,448,406 14,102,523 12,570,062 9,927,553 6,505,432 29,518,262 13,571,600 11,405,460 8,655,276 6,245,068 58,831,499 15,722,477 74,553,976 69,395,666 8,735,593 1,650,967 10,386,560 9,959,251 a 9,756,960 290,079 10,047,039 8,564,738 x 4,469,520 479,301 4,948,821 5,123,909 3,647,175 652,065 4,299,240 3,971,474 3,674,986 425,021 4,100,007 4,171,598 2,440,443 365,835 2,806,278 2,986,566 1,295,320 551,318 1,846,638 1,718,999 e 1,765,996 - 1,765,996 738,184 a 1,623,442 - 1,623,442 1,317,275 1,614,223 - 1,614,223 1,625,825 226,455 - 226,455 - 82,904 - 82,904 136,071 13,443 - 13,443 86,318 1,183,895 - - 38,162,565 5,598,481 43,761,046 40,400,208 96,994,064 21,320,958 118,315,022 109,795,874 585,012 347,075 1,792,029 Total operating revenues OPERATING EXPENSES General supplies and services (note 7) Medical supplies Amortisation of capital assets Utilities (note 7) Consulting and business expenses Repairs and maintenance Food Bad debt expenses Miscellaneous (note 7) Interest expense Loss on write-down of capital assets Scholarships issued Loss on disposal of capital assets Management charge Total expenses Excess of revenues over expenses (1,183,895) (237,937) The accompanying notes are an integral part of these financial statements >> << 1 r>> a & O a OF CHANGES NET ASS1ETS Invested in capital assets NET ASSETS $ $ 40,370,741 458,344 1,880,124 42,709,209 40,917,180 Excess (deficiency) of revenue over expenses (note 10) (3,723,970) 4,071,045 347,075 1,792,029 Net change in investment in capital assets (note 10) I E $ Balance, beginning of year o ess Restricted for Pensions (2,766,678) 43,056,284 42,709,209 Balance, end of year 2,766,678 39,413,449 458,344 Unrestricted 3,184,491 K us. I , SK o C3 o (C) i The accompanying notes are an integral part of these financial statements ZQ 2001 Total $ 2000 Total $ ITATEMENT OF CASH FLOWS 2001 $ 2000 $ CASH FROM OPERATING ACTIVITIES Excess of revenues over expenses Amortisation of capital assets Loss on disposal of capital assets Loss on write-down of capital assets Amortisation of deferred contributions related to capital assets Net change in non-cash working capital Pension benefit expense Net cash generated through operating activities 347,075 4,948,821 13,443 226,455 1,792,029 5,123,909 86,318 - (1,464,749) 2,472,076 535,250 (1,507,938) 1,538,450 553,942 7,078,371 7,586,710 k e a FINANCING AND INVESTING ACTIVITIES Deferred contributions related to capital assets Repayment of long term debt Purchase of capital assets Payment on government grant Pledges for capital assets Grant receivable from government Bond sinking fund payment Net cash used in financing and investing activities 1,086,635 (986,814) (4,021,908) 250,000 820,000 546,533 (1,019,567) 2,130,488 (1,091,837) (7,732,759) 250,000 408,872 131,971 (935,309) (3,325,121) (6,838,574) m 89 a 8" 33 O >> zr I 1 Net increase in cash and cash equivalents 3,753,250 748,136 Cash and cash equivalents, beginning of year 6,438,822 5,690,686 10,192,072 6,438,822 i 6,451,444 3,740,628 2,185,713 4,253,109 o 10,192,072 6,438,822 30 Cash and cash equivalents, end of year Cash and cash equivalents consist of the following: Cash and time deposits Restricted cash and time deposits > M 9 a* The accompanying notes are an integral part of these financial statements I NOTES TO THE FINANCIAL STATEMENTS 31ST MARCH 2001 1. AUTHORITY AND ORGANISATION (A) AUTHORITY Bermuda Hospitals Board "the Board" was established under the provisions of The Bermuda Hospitals Board Act, 1970 as amended. (B) ORGANISATION The Board is responsible for operating the King Edward VII Memorial Hospital "KEMH" and St. Brendan's Hospital "SBH" and receives contributions, which are held in the Donations and Education Funds. These operations are included in the financial statements. KEMH is an inpatient acute care and extended care hospital with two hundred and twenty-six (226) acute care beds and an extended care unit of one hundred and four (104) beds. SBH is a psychiatric facility with twenty-five (25) inpatient acute care beds and ninety-five (95) long-term rehabilitation beds. (C) DONATIONS AND EDUCATION FUNDS The Donations Fund and Education Fund receive funds or gifts given for the purpose of the hospitals or for a specific purpose. 2. SIGNIFICANT ACCOUNTING POLICIES The financial statements are prepared in accordance with accounting principles generally accepted in Bermuda and Canada. The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the period. Actual results could differ from these estimates. (A) REVENUE RECOGNITION The Board follows the deferral method of accounting for contributions, which include donations and government grants. Operating grants are recorded as revenue in the period to which they relate. Grants approved but not received at the end of the accounting period are accrued. Where a portion of the grant relates to a future period, it is deferred and recognised in that subsequent period. 32 Unrestricted contributions and pledges are recognised as revenue when received or receivable if the amount to be received can be reasonably estimated and collection is reasonably assured. Externally restricted contributions are recognised as revenue in the year in which the related expenses are recognised. Contributions restricted for the purchase of capital assets are deferred and amortised into revenue at a rate corresponding with the amortisa tion rate for the related capital assets. Restricted investment income is recognised as revenue in the year in which the related expenses are incurred. Unrestricted investment income is recognised as revenue when earned. (B) CAPITAL ASSETS OB Purchased capital assets are recorded at cost. Contributed capital assets are recorded at fair value at the date of contribution. Interest costs associated with capital expenditure are capitalised. Repairs and maintenance costs are charged to expense. Betterments, which extend the estimated life of an asset, are capitalised. When a capital asset no longer contributes to the Board's ability to provide services, its carrying amount is written down to its residual value. Capital assets are amortised on a straight-line basis using the following annual rates: (C) Buildings Major Equipment Software Computer Equipment 2.5% 10.0% 20.0% 20.0% i 39 (C) I rr (C) CASH AND CASH EQUIVALENTS 1 The Board considers all cash on hand, deposits with financial institutions that can be withdrawn without prior notice or penalty, and short-term deposits with an original maturity of ninety days or less, as equivalent to cash. (D) INVENTORIES i Kg Inventories consisting of general stores, medical stores, orthopedic supplies, pharmacy, stationery, and film, are valued at the lower of cost and net realizable value. 3. RESTRICTED CASH AND TIME DEPOSITS These deposits are externally restricted for specific purposes including the constmction projects as described in note 5, patient comfort funds and staff pension plan. Included in restricted cash and time deposits is an investment of $300,000 of the Board's long-term bonds. These funds are to be used for specific educational purposes. 4. PLEDGES RECEIVABLE These amounts are due from the Bermuda Health Alliance and other donors. The Bermuda Health Alliance is considered a related party as the Board can elect two out of ten members on the Alliance's Board of Directors. 5. CAPITAL A S S E T S COST 2001 NET 2000 NET $ Land and Buildings Equipment Computer Equipment Software Construction in Progress ACCUMULATED AMORTISATION $ $ $ 90,611,463 25,890,866 1,239,566 2,370,908 1,090,861 20,564,400 14,357,557 671,782 2,172,795 - 70,047,063 11,533,309 567,784 198,113 1,090,861 69,871,274 12,471,453 633,532 552,706 1,074,976 121,203,664 37,766,534 83,437,130 84,603,941 Interest and financing costs of $69,297 (2000 - $ 160,998) were capitalised relating to ongoing construction projects. The insured value of all capital assets under the Board's control is approximately $240 million (2000 - $238 million). On March 27, 1997 the land on which the Hospitals stand was vested to the Board by the Government of Bermuda. As part of this transfer, Government has right of first refusal on any sales of the land and buildings. The land and buildings are security for the bonds payable, as described in Note 8. 6. COMMITMENTS As of March 31, 2001 the Board has operating commitments of $2.9 million relating to a fuel contract extending over seven (7) years and an additional $2.4 million relating to an air care agreement extending over eight (8) years. The Board also has capital commitments of $1.3 million extending over a five (5) year period relating to the purchase of new beds and $2.9 million extending over the next year for other capital acquisitions. 7. RELATED PARTY TRANSACTIONS AND BALANCES The following related party transactions are in the normal course of operations and are measured at the exchange amount, which is the amount of consideration established and agreed to by the related parties. (A) GOVERNMENT PROGRAMMES Included within operating revenues are subsidies and grants from the Consolidated Fund of the Government of Bennuda as discussed in paragraphs (I) and (II), as follows: 34 (I) Government Subsidy During the year the Hospital Insurance Commission approved claims totaling $45,167,122 (2000 - $43,606,493) in respect of services rendered by the Hospital to patients covered under the Government's subsidy programmes as follows: 2001 $ Aged Subsidy Indigent Subsidy Geriatric Subsidy Youth Subsidy Other Subsidy Clinical Drugs 2000 $ 24,395,173 4,099,864 7,920,689 6,145,895 1,855,501 750,000 22,387,193 4,954,461 7,914,583 6,049,782 1,593,274 707,200 45,167,122 43,606,493 As at March 31, 2001, $1,294,417 (2000 - $2,161,746) was outstanding from Government for subsidy programmes. This amount is included in the accounts receivable balance. a OS i e (II) Government Grants a SBH receives operating and capital grants. The operating grant received during the year was $20,365,121 (2000 - $19,553,106) and the capital grant received was $397,859 (2000 - $555,586). As at March 31, 2001, the amount due from the consolidated fund of the Government of Bermuda was $41,122 (2000 - $587,655) in current assets which consists wan of the following capital grants: o $30,293 (2000 - $326,826) for SBH o $10,829 (2000 - $10,829) for KEMH o $0 (2000 - $250,000) for Hospice Capital Grant . Oi (B) MUTUAL REINSURANCE FUND a e Included within the accounts receivable balance as at March 31, 2001 is $361,686 (2000 - $784,740) receivable from the Mutual Reinsurance Fund. During the year, the Hospital Insurance Commission approved the following claims: 2000 2001 $ Hemodialysis Treatments Long stay Patients Home Health Care Anti-rejection Drugs $ 3,242,250 1,110,975 204,214 80,018 3,596,660 946,925 4,637,457 4,598,886 55,301 OC (C) HOSPITAL INSURANCE FUND As at March 31, 2001, $408,580 (2000 - $1,251,406) is receivable from the Hospital Insurance Fund. During the year, the Hospital Insurance Commission approved claims totaling $3,912,691 (2000 - $3,530,251). (D) GOVERNMENT EMPLOYEES HEALTH INSURANCE FUND Included within the accounts receivable balance as at March 31, 2001 is $1,004,903 (2000 - $1,026,388) due from the Government Employees Health Insurance Fund (GEHI). During the year, $5.4 million (2000 - $5.9 million) in claims was billed to the GEHI. (E) NATIONAL DRUG COMMISSION As at March 31, 2001, all amounts have been settled with the National Drug Commission. A receivable of $470,246 was outstanding as at March 31, 2000. (F) OTHER AMOUNTS During the year, the BHB expensed the following: $1,920,876 (2000 - $1,771,702) for payroll tax $1,379,999 (2000 - $1,653,393) for social insurance $268,416 (2000 - $182,844) for nurses' annual pensions $134,125 (2000 - $120,644) for audit fees $924,386 (2000 - $919,229) for services provided by the Ministry of Works and Engineering $11,268 (2000 - $10,473) for superannuation $5,014 (2000 - $5,193) for land tax $49,339 (2000 - $28,604) for miscellaneous charges. The following amounts were remitted to the government on behalf of the Board's employees: o $2,723,481 (2000 - $2,363,309) for payroll tax o $1,334,843 (2000 - $1,271,606) for social insurance. Non-refundable duty of $779,111 (2000 - $658,151) was paid during the year. War Veteran Association Claims in the amount of $233,070 (2000 - $197,611) were billed during the year. The following balances remain outstanding: (a) Accrued salary and payroll expenses balance includes $1,175,228 (2000 $1,051,932) for payroll tax and $283,561 (2000 - $229,271) for social insurance. (b) Accounts payable balance includes $369,187 (2000 - $ 142,820) payable to the Ministry of Works and Engineering and $146,191 (2000 - $160,000) of audit fees payable to the Auditor General. (c) The nurses' annual pensions is included in the accounts payable balance and 3fi (d) (e) (f) totals $893,555 (2000 - $625,138). Refundable deposits paid for duty in the amount of $152,851 (2000 -$149,314) were included in the other receivables balance. The accounts receivable includes $58,940 (2000 - $38,047), which represents mis cellaneous departmental charges. The accounts receivable balance includes $128,096 (2000 - $63,830) payable by the government on behalf of the War Veterans Association. 8. LONG TERM DEBT Long-term debt as at March 31, 2001 and 2000, is as follows: C 2001 $ Bonds payable of $14,000,000, interest at 8% per annum due 2009. Annual sinking fund payments of $850,000 are required for redemption of funds and these funds will be held by the bond trustee. The bonds are secured by a mortgage on land and buildings. Bonds payable of $10,400,000, interest at 7.5% per annum, (6.5% in US Dollars), due 2010. Semiannual principal payments are $450,000. The bonds are secured by a second mortgage on land and buildings. 2000 $ o X 9 9 x14,000,000 14,000,000 x 51 8,150,000 9,050,000 s Obligation on Capital Leases bearing interest at 9% per annum payable in various installments to 2002. Note payable of $400,000 bearing interest of 9% per annum, payable in monthly installments of principal and interest of $5,860 to June 1, 2000. 8,518 83,748 s - 11,584 22,158,518 CURRENT PORTION HO 23,145,332 908,518 986,814 21,250,000 22,158,518 e Principal repayments and sinking fund payments required in each of the next five years are as follows: YEAR AMOUNT $ 2002 2003 2004 2005 2006 1,758,518 1,750,000 1,750,000 1,750,000 1,750,000 8,758,518 9. D E F E R R E D CAPITAL CONTRIBUTIONS Deferred capital contributions represent the unamortised amount and unspent amount of donations and grants received for the acquisition of capital assets. The amortisation of capital contributions is recorded as revenue in the statement of operations. The balance of the deferred capital contributions is as follows: 2001 2000 $ $ Balance, beginning of year Add: contributions received Less: amounts amortised to revenue 24,656,448 1,086,635 (1,464,749) 24,033,898 2,130,488 (1,507,938) BALANCE, END OF YEAR 24,278,334 24,656,448 The balance of deferred capital contributions is comprised of the following: 2001 $ Unamortised capital contributions used to purchase assets Unspent contributions 2000 $ 23,249,216 1,029,118 22,573,039 2,083,409 24,278,334 24,656,448 10. I J N W S T M E N T I N CAPITAL A S S E T S (a) Investment in capital assets is calculated as follows: 2001 $ Capital Assets Amounts financed by: Deferred contributions Loan and bonds payable 2000 $ 83,437,130 84,603,941 (23,249,216) (20,774,465) (22,573,039) (21,660,161) 39,413,449 40,370,741 H (b) Change in net assets invested in capital assets is calculated as follows: > 2001 $ Excess of revenues over expenses: Amortisation of deferred contributions related to capital assets Amortisation of capital assets Loss on disposal of capital assets 2000 SB $ f ci e so 1,507,938 (5,123,909) (86,318) (3,723,970) (3,702,289) 4,021,908 7,732,759 (2,140,926) (101,117) 986,813 (1,530,486) (683,162) 1,091,837 2,766,678 Net changes in investment in capital assets: Purchase of capital assets Amounts funded by: Deferred contributions Bond issues Repayment of long term debt 1,464,749 (4,948,821) (239,898) 6,610,948 o 2,908,659 O a > 1 of- 1 N 9 a O-. (957,292) a 11. RESTRICTION ON NET ASSETS The Pension Fund was established in 1987/88 for the purpose of providing funds to supplement pensions at the discretion of the Board. tit 12. EMPLOYEE BENEFITS The Board has a number of defined benefit and defined contribution plans providing pension, other retirement and post-employment benefits to most of its employees. The Canadian Institute of Chartered Accountants (CICA) issued new requirements for accounting for employee future benefits. The Board has applied these requirements on a prospective basis. The Board now accrues its obligations under employee benefit plans and the related costs, net of plan assets. The Board has adopted the following policies: The cost of pensions and other retirement benefits earned by employees is actuarially determined using the projected benefit method pro rated on service and management's best estimate of expected plan investment performance, salary escalation, retirement ages of employees and expected health care costs. For the purpose of calculating the expected return on plan assets, those assets are valued at fair value. The excess of the net actuarial gain (loss) over 10% of the greater of the benefit obligation and the fair value of plan assets is amortized over the average remaining service period of active employees. The average remaining service period of the active employees covered by the pension plan is 3.5 years (2000 - 4.3 years). The average remaining service life of the active employees covered by the other retirement benefit plans is 7.9 years. (A) PENSION PLANS There is a Defined Contribution Pension Plan for all employees, whereby the Board contributes 6% of gross salary and the employee contributes 4% of gross salary. Prior to January 1, 2000, vesting rights began to accrue after five (5) years with respect to the Board's contributions. Beginning January 1, 2000, 100% of the Board's contributions will be vested after two (2) years. When an employee leaves the Board's employ, other than through retirement, the Board's contributions, which are not vested, are refunded to the Board. These are reflected as a reduction in employee benefits expense. The expense for the period April 1, 2000 to March 31, 2001 totaled $2.0 million (2000 $2.2 million). The Hospital Nurses Superannuation Act 1948 established a non-contributory defined benefit final average pension plan, which covered certain nurses employed prior to January 1, 1971. The cost of these pensions is shared with Government, with Bennuda Hospitals Board being liable for pension benefits earned by these nurses since January 1, 1977. The pension expense of $535,250 (2000 - $553,942) includes the amortisation of past service costs over periods ranging from eleven (11) to four (4) years. 40 2001 2000 $ $ Balance beginning of year Pension expense Current cost Amortization of past service costs Interest Experience (loss) gain 4,772,274 Balance end of year 5,307,524 43,334 163,900 349,473 (21,457) 535,250 4,218,332 44,244 163,900 310,482 35,316 553,942 4,772,274 Bermuda Hospitals Board and Government have obtained an actuarial valuation of the accrued pension benefits at March 31, 2001, which estimates that Bermuda Hospitals Board's portion of the liability under the Act is approximately $4.6 million at that date (2000 - $5.0 million). The significant actuarial assumptions adopted in measuring the Board's accrued benefit obligations include a discount rate of 7% and a salary escalation rate of 5%. e 03 To date, no contributions have been made by the Board and the plan remains unfunded. Benefits are paid by the Government and at March 31, 2001, the Board's payable to the Government totals $894k (2000 - $625k). (B) OTHER BENEFIT PLANS 39 Other employment benefits include maternity leave, sick leave, vacation days and health insurance. All of these plans are unfunded. Maternity leave does not accumulate or vest and therefore an expense and liability is only recognized when leave has been applied for and approved or when a settlement amount can be reasonably determined. The approved maternity leave as at March 31, 2001 is $62k and is included in accrued salary and payroll expenses. The maternity leave taken during the year totals $62k. Sick leave accumulates but does not vest, and like maternity leave, a liability is recorded only when extended leave is applied for and approved. As at March 31, 2001, the liability is $95k and is included in accrued salary and payroll expenses. The sick leave expense for the year totals $2.1 million. o e Vacation days accumulate and vest and therefore a liability is accrued each year. The expense for the year is $4.7 million (2000 - $4.2 million) and the benefits paid out total $4.3 million (2000 - $4.1 million) resulting hi a liability as at March 31, 2001 of $4.0 million (2000 - $3.6 million). An actuarial study has not been performed for the vacation days benefit obligation as there are no factors used in the calculation that are materially different from the figures that would be estimated by an actuary. A I The Board pays for a portion of the health insurance premiums for employees who retire with the Board. A transitional obligation as at March 31, 2000 of $7.3 million and an accrued benefit obligation as at March 31, 2001 of $8.4 million were determined by an actuarial valuation. The expense recognized for the period totals $1.9 million and the benefits paid during the period total $284k. The significant actuarial assumptions adopted in measuring the Board's accrued benefit obligations include a discount rate of 7% and a medical trend rate of 8% per annum. 13. COMPARATIVE FIGURES Certain comparative figures have been reclassified to confonn with the current year's presentation. STATISTICAL ANALYSIS - KING EDWARD VH MEMORIAL HOSPITAL April 1998 March 1999 April 1999 March 2000 April 2000 March 2001 Inpatient - Acute Care Beds Patient Days Discharges (incl.deaths) Length of Stay Births Percentage Occupancy 226 56,540 7,303 7.7 827 69% 226 58,133 7,391 7.9 845 70% 226 58,213 7,398 7.9 845 Extended Care Unit Beds Patient Days Discharges Length of Stay Percentage of Occupancy 103 36,934 93 348.9 96% 103 36,194 88 393.4 96% 103 35,087 98 354.4 93% 71% cs o X m Hospice Beds Patient Days Discharges Length of Stay Percentage of Occupancy All Patients Emergency Dept. Visits Operations (Inpatients) Operations (Outpatients) Physiotherapy treatments (Inpatients) (Outpatients) (E.C.U.) X-Ray (Exams) Laboratory (Thousand units) Cardiac Investigations Attendances Ultrasound Scans Nuclear Medicine Chemotherapy Treatments (Outpatients, Cat Scans Neurological Treatments Occupational Therapy Treatments (Inpatients) (Outpatients) (E.C.U.) Speech/Language Pathology (Inpatients) (Outpatients) (E.C.U.) 12 2,190 87 25.2 50% 12 2,556 86 29.7 58% 12 1,938 94 20.6 44% 05 e Of X 3! ? 31,740 2,566 5,002 N/A N/A N/A 31,503 3,003 9,865 6,308 1,491 790 4,540 N/A 32,349 2,594 4,910 N/A N/A N/A 33,379 3,078 10,261 7,664 1,491 745 5,058 N/A 31,918 2,770 5,105 11,558* 16,691* 1,766* 31,687 3,370 10,716 8,499 1,482 780 4,426 3,507* N/A N/A N/A N/A N/A N/A 4,633* 2,283* 220* N/A N/A N/A N/A N/A N/A 862* 341* N/A * Please note - Physiotherapy, Neurological Treatments, Occupational Treatments and Speech/Language Pathology figures are from April 2000 to February 2001. 5 35 o* a 3 e e >> O e STATISTICAL ANALYSIS - ST. BRENDAN'S HOSPITAL April 1998 March 1999 April 1999 March 2000 April 2000 March 2001 Inpatient - Acute Care Beds Discharges (inch deaths) Patient Days Length of Stay Admissions Percentage Occupancy 25 224 7,330 30.4 228 80% 25 251 6,049 18.4 228 80% 25 253 5,084 19.3 253 56% Long - Term & Rehabilitation Beds Discharges (excl. deaths) Patient Days (excl. respite) Length of Stay Deaths Transfer from Acute Percentage of Occupancy 95 100 30,904 687 0 15 93% 95 87 31,681 364 5 8 91% 95 79 29,629 425 2 10 85% Outpatients Visits of Mental Welfare Officers Home Visits New Referrals & Re-referrals Follow-up Visits 1,567 3,063 508 8,352 1,929 3,102 550 8,719 2,076 3,102 554 8,056 KEMH Clinical Records Staff 44 I . .. ., .. TALS BERMUDA HOSPITALS BOARD MEMBERS JOINT MANAGEMENT COMMITTEE Mrs. Ianthia Wade Chairperson Mrs. Stephanie Reid Chief Executive Officer Mr. Edward Saunders Deputy Chair Mrs. Lucille Parker Director of Clinical Programmes Mr. Colin James Board Member Dr. J.M.S Patton ChiefofStaff Dr. Burton Butterfield Board Member Dr. June Hill Chief of Staff Designate Mr. Eugene Blakeney Board Member Mrs. Delia Basden Chief Financial Officer Mrs. Lynne Cann Board Member Mr. Scott Pearman Director of Human Resources Mrs. Jane Spurling Board Member Mr. Aldwin Savery Administrative Quality & Risk Management Mrs. Niranjalie Romeo Board Member Ms. Katyna Rabain Acting Chief Operating Officer Dr. John Cann Chief Medical Officer Ex Officio Member Mrs. Venetta Symonds Chief Operating Officer, Support Services Mrs. Stephanie Reid Chief Executive Officer Ex Officio Member Dr. J.M.S. Patton ChiefofStaff Ex Officio Member Dr. Valerie James President, Active Staff Ex Officio Member Ms. Patrice Dill Chief Operating Officer, St. Brendan's Hospital Mr. Patrick Jones Director of Facilities Management CONSULTANTS Mr. Richard Lau Consultant to CI.O Mrs. Joan Dilias-Wright Consultant to C.E.O. /B.H.B CARE AND SUPPORT TEAMS .- 3'5 too: man: an CRITICAL CARE TEAM M E M B E R S ENVIRONMENTAL TEAM M E M B E R S Mrs. K Burns Clinical Coordinator, Agape House (Team Leader) Kereen Richards Programme Manager Critical Care (Facilitator) Aldwin Savery Administrative Quality and Risk Manager (Facilitator) Kathy-Ann Lewis Programme Manager (Facilitator) Dr. Woolfgang Spangenbergcr Chief of Surgery (Team Leader) Dr. K. Myint Director of Geriatric Care Lucinda Bean Admitting Department Lolita Dumbrique Patient & Cafeteria Services Coordinator Shelley Bascome Pharmicist Lorraine Beasley ORTHO/HBO John Fevriere Dietary, Production & Equipment Kevin Burke CCU Lower Resident Diane Brown RN Emergency Patrick Jones Director of Facilities Management Maxine Sinclair Acting Clinical Coordinator, CCU Lower Ronnie Coburn RNICU Victoria Manning, RN Nursing Glenda Daniels Clinical Coordinator ICU Patricia Miller Security Services Manager Gillian Freelove-Jones Rehabilitation Services Sonya Smith Security Services Officer Colette Simmons Activities Coordinator CCP Karen Gehan CE Critical Care Jill Davidson Occupational Therapist Louise Graves RN Emergency Cindy Pace Manager, Materials Management Dept. John Igbikil Physiotherapist Terry Hart Pharmacy Keva Piper Clinical Dietician Tammy Hendrickson Laboratory Shirlene Scott Supervisor Environment SVS CCP Carol Moore Ward Clerk Emergency C O N T I N U I N G CARE A N D SPECIALIZED GERIATRICS TEAM M E M B E R S Debra Chase Clinical Coordinator, ARDU Sharika Thomas Medical Social Worker CCP Venetia Williams Day Care Nurse Specialist Ms. P. Hayward CCP Administration LynetteFurbert Occupational Therapy Alyce Douglas Team Secretary Blanche Phillips-Wilkinson Manager, Laundry ServicesLinda Rothwell Manager Infection Control Dept. Emergency Raymond Santucci EMT Emergency Edward Schultz, MD Director of Emergency Gwen Smith Patient Rep Critical Care Andrew Spence Anaesthetist Sharika Thomas Medical Social Worker Jessica Wade Clinical Dietician Wayne Watson Biomedical Engineer Carla Cann Diagnostic Imaging 48 Shirlene Scott Supervisor, Environmental Services Rosa Simons Manager Environmental Services Michael Nisbett Quality Improvement Lynnette Raynor Clinical Coordinator Janice DeSilva (Chairperson) Infection Control Practitioner (Team Leader) Derek Smith Biomedical Technician Susan Smith Training Officer, Educational Services George Simons Environmental Health Officer, Dept. of Health Kalix Todd Facility Management Supervisor SBH INFORMATION MANAGEMENT ACCREDITATION TEAM MEMBERS Katyna Rabain (Facilitator) Chief Information Officer Sonya Holder (Team Leader) Information Services Rosemaric Scission Library Beverly Marshall Communications Dean Parris St. Brendan's Hospital Debbie Chase Continuing Care Programme Sheila Dickinson Admitting Supervisor Derek Smith Human Resources Marshalita Tota Housekeeping Tamra Broadley Medical Programme Michael Nisbctt Research Associate Pearl Simons Clinical Records Richard Smith Dialysis Technician LEADERSHIP AND PARTNERSHIPS TEAM MEMBERS Mr Aldwin Savery Administrative Quality & Risk Manager (Facilitator) LEARNING DISABILITY TEAM MEMBERS Michael Murray Programme Manager (Facilitator) Anne Bennette-Smith (Team Leader) Mrs Stephanie Reid CEO (Team Leader) Dr. Anthony Parillon Consultant Psychiatrist Mr. Edward Saunders BHB Chairperson Preston Swan L.D. Clinical Coordinator, Community Homes Dr June Hill Chief of Staff Dr John Cann Chief Medical Officer Mrs Jane Spurling BHB Member Mrs Vcnetta Symonds COO Support Services Ms Patrice Dill COO St Brendan's Hospital Mr Patrick Jones Director of Facilities Management Mr Scott Pearman Director of Human Resources Mrs Delia Basden Chief Financial Officer Ms Katyna Rabain Chief Information Officer Mrs. Joan Dillas-Wright Consultant Rosetta Walwyn L.D. Clinical Coordinator, In-Patient Services SO Sue Astwood Physiotherapist Julie Lawson Occupational Therapist s Juliette Basden Activities Coordinator Karen Lightboume Community Nurse Edward Price Team Leader, Sandpiper Ward LaDonna Tucker Live-In Coordinator Gwcn Lightboume Care Giver Shirley Simmons Social Worker e g N e MENTAL HEALTH CARE TEAM MEMBERS SURGICAL CARE TEAM MEMBERS Glen Caisey Programme Manager, Mental Health (Facilitator) Hollie Mcintosh RN, Pre-Operative Assessment (Facilitator) Dr. R. Vallis Chief of Surgery (Team Kate Williams Clinical Psychologist (Team Leader) Loretta Santucci Surgical Programme Dr. Donald MacKenzie Psychiatrist Leader) Manager Carol Cam Rehabilitation Chris Tuckett Clinical Coordinator Sue Clarke Somers Ward (Team Services (PT) Susan Reeves RN, PACIJ Leader) Programme Carol Dickens Care Giver Lomette Simons Devon Lodge (Team Leader) Aldwin Savery Administrative, Quality & Risk Management Lori Davis O.R. Scheduler Dr. Eugene Outerbridge Paediatrician Mrs. Jill Davidson Occupational Therapist Carmen Moniz Clinical Coordinator, Perry Ward Judith Richardson Chief Nursing Administrator Don Moore Chaplain Control Cindy Webb Clinical Educator Patrice Dill COO-SBH Karen Manderson Wound Care Nurse Vanessa Paynter Secretary to Programme (Recording Secretaty) Manager Sylvia Robinson Community Nurse Dr M. Joseph Surgical Officer Rochelle Christopher Quality Improvement Coordinator Margaret E. Seymour RN, PACU Diannc Lovell Clinical Coordinator, KO Mr. Michael Nisbctt, RN Research Associate Dept. Dr. Bente Lundh Paediatrician Sheila Dickinson Admitting Supervisor Linda Rothwell Manager, Infection Mrs. Harlcne Saunders-Fox Manager, Pharmacy Dr. Elaine Campbell Anaesthetist Nicole James Clinical Dietician Supervisor Mrs. Christine Virgil, RN Clinical Coordinator, Gosling Ward Ms. Samantha Branch Medical Social Worker Christine Skinner O.R., Clinical Coordinator Maureen Rego Mental Welfare Officer Obstetrics Ms. Gwen Hill Nursing Assistant, Gosling Ward Paul Chan Medical Social Worker Dawn Smith Clinical Coordinator Mrs. Kathleen P. Roberts, RN (Team Leader) Clinical Coordinator, Maternity Ms. Glenna Rose-Williams, RN Staff Nurse, Gosling Ward Dr. Cindy Morris Anaesthesiologisl Angela Brangman Clinical Coordinator Mrs Roxannc Kipps-Jackson, RN BSN MA (Facilitator) Dr. T. L. Emery Physician Leader Katrina Mulherin Pharmacist Norbert Seymour Pharmacist Donna Williams Clinical Records Clinic Dr. J. Brockenbrough Vascular Surgeon Jascinth Albouy-Onyia Mental Welfare Officer Dean Parris New Dimensions MATERNAL/CHILD TEAM MEMBERS PACU Jennifer Simons Clinical Coordinator, SAU THE MEDICAL CARE TEAM MEMBERS HUMAN RESOURCES TEAM MEMBERS Norma Smith Medical Programme Manager (Facilitator) Aldwin Savery Administrative Quality & Risk Manager (Facilitator) Myrian Balitian-Dill, RN Cardiac Care (Co-Leader) Doris Da Costa Team Leader Debbie Barboza, RN Asthma Education Clinical Co-Leader Tamra Broadley Clinical Educator Scott Pearman Director Craig Dutton Consultant Jill Caines Dialysis Coordinator Elaine Williams Manager, Diagnostic Imaging Andrew Cooper Physiotherapist Arlenc Andrews Food Setyice Cordinator, S.B.H. Lynn Henry RN Clinical Coordinator Ronnie Tuckett Training Officer Jane Hope RN Staff Nurse Kathy Ann Lewis Programme Manager, CC Suzanne Madeiras Clinical Dietician Janice Swan Executive Assistant to CEO Dr. Shane Marshall Chief of Medicine Angela Brangman Clinical Coordinator, S.B.H. Linda Philpott Nursing Aide Paul Harleye Team Leader, S.B.H. Karen Raynor RN Clinical Coordinator Edna Simmons Employee Heath Sendees Coordinator Jenal Swan Medical Social Worker Debbie Byrd Director of Volunteer Sendees Netta Williams Clinical Pharmacist Laverne Smith Housekeeping Debbie Jones Diabetes Nurse Educator Shawn Scraders Housekeeping Shirly Richardson Nurses Aide, S.B.H. Geraldine Cann Community Psychiatric Nurse I II n > S NOTES . . A J. 3. . .. .3 -. Bermuda Hospitals Board CARING FOR OUR COMMUNITY