Middlesex Hospital Alliance (MHA) Welcome’s Auditor’s Report
Strathroy, ON- On Wednesday, October 20, in the Ontario Legislature, Health Minister, Deb Matthews released a report by the Auditor General on the use, procurement and management of consultants by Hospitals and Local Health Integration Networks (LHINS). While the MHA was not one of the 16 hospitals that was selected to be audited, the Alliance used the report as a comparator for its internal process. The Hospitals selected were based on size, location, and other operational characteristics so that the Auditor General could examine a diverse range of institutions. The report can be viewed on the Ministry of Health and Long Term Care website. The period being reviewed refers to April 1, 2007 to March 31, 2010.
“A rewrite of all our purchasing policies and procedures and our code of ethics based on the Ministry of Finance Broader Public Sector Supply Chain Guidelines, was just completed last November,” says Paul Long, CFO of the MHA, who led the review and rewrite of policies, “This process improved competitive bidding, where appropriate, and created overall a more transparent process, ensuring greater oversight and increasing documentation.”
In particular, the MHA needed to strengthen its processes with regard to sole sourcing (awarding of contracts without a competitive bidding process) and follow-on agreements (extending existing contracts without a full review beforehand).
Recently MHA implemented a new, well documented, process for how it buys things, including consulting services. Among other things the MHA has strengthened processes that require Directors to document and justify their needs prior to obtaining Senior Management approval. In addition, processes requiring that all consulting engagements have contracts with clear deliverables, ceiling prices, payment schedules, and performance management processes were strengthened.
“The Auditor General report doesn’t question the need to use consultants, it does raise questions about how well they are managed,” said Mike Mazza, CEO of the MHA. “Healthcare is very complex and consultants provide an important service to hospitals as hospitals are not always able to have the required expertise on staff.”
For example, some of the recent ways MHA has invested in the knowledge and experience of consultants include:
- Securing a Lean Consultant to assist with the realigning of processes in the Emergency Department (ED) SMGH site
- Securing a Consultant to develop the Terms of Reference for the Clinical Review of Laboratory Services
- Securing a Consultant to review the efficiency of the SMGH site operating room in comparison to provincial and national benchmarks
- Securing a Consultant from Canadian Health Management Group to Review Clinical documentation in Medical Record Charts in comparison to provincial and national standards
The report condemns the use by publically funded institutions/ hospitals of paid lobbyists. The MHA has never purchased the service of lobbyists but relies instead on negotiations with Ministry of Health and Long Term Care representatives and our local Provincial Member of Parliament carried out by board members and staff.
Board Chair Cheryl Waters said, “This latest report from the Auditor General serves to help make our Alliance more effective in managing our scarce resources while continuing to live our Mission of providing the kind of healthcare we would expect for our own families.”
“Our use of consultants is less than one half a percentage of our annual budget, a very minor portion of our budget and certainly not used for lobbying,” Cheryl Waters, chair of the MHA board of directors said. “We are very aware of our budget constraints and our need to use our resources to the best of our abilities to achieve our ultimate goal – excellent patient care.”
Waters points to the fact that processes around consultant use at the MHA was reported to the board of directors in fall, 2009 and that the next annual review is scheduled for the board’s finance committee in November, 2010. Additionally, she points out that significant work was recently done on the MHA’s purchasing policies. “The appropriate use of healthcare dollars is certainly a serious issue and that the MHA supports the Ontario legislation that outlaws public sector consultants lobbying Queen’s Park,” chair Waters says.