Keewatin Yatthé Regional Health Authority

2015- 16 Annual Report Cover photo “Bear Approaching” Green Lake

This report is available in electronic format (PDF) online at www.kyrha.ca

Keewatin Yatthé Regional Health Authority Box 40, Buffalo Narrows, Saskatchewan S0M 0J0 Toll Free 1-866-274-8506 • Local (306) 235-2220 • Fax (306) 235-4604 www.kyrha.ca

2 Keewatin Yatthé Regional Health Authority

2015 - 16 Annual Report

Wholistic Health of Keewatin Yatthé Health Region Residents

3 TABLE OF CONTENTS

Letter of Transmittal ...... 5 Healthy People, Healthy Communities...... 8 Introduction ...... 6 Provincial Health Regions Map...... 9 Population by Age Group...... 11 Alignment with Strategic Direction Population Pyramid...... 11 Alignment...... 8 Occupied Private Dwelling Characteristics...... 11 Strategic Direction and Goals...... 9 Patient Safety Occurrences...... 15 Factors...... 11 KYRHA Facilities Map...... 17 KYRHA Home-Care Coverage Map...... 19 KYRHA Overview Service Utilization...... 30 Organizational Changes...... 14 Patient Safety...... 15 Accreditation...... 16 Programs and Core Services ...... 17 Key Partnerships Population Health Unit...... 20 Prairie North IT...... 22 Northern Medical Services...... 22 Health-Care Organizations...... 22 Governance...... 23

Progress in 2015 - 16 High-Level View...... 26 Falls...... 28 Inappropriate Behaviour...... 28 Primary Health Care...... 29

Financial Information Report of Management ...... 32 2015-16 Financial Overview ...... 33 Financial Statements ...... 35

Appendices KYRHA Organizational Chart...... 66 Payee Disclosure List...... 67

Charts, Graphs and Maps Strategic Deployment...... 8

4 LETTER OF TRANSMITTAL

To: Honourable Dustin Duncan Minister of Health

Dear Minister Duncan,

The Keewatin Yatthé Regional Health Authority (KYRHA) is pleased to provide you and the residents of our northwest Saskatchewan health region with the 2015-16 Annual Report. In addition to outlining activities and accomplishments of the Region for the year ended March 31, 2016, this report provides the audited financial statements for the same period.

Included in KYRHA’s progress during the last fiscal year were the effects of adding Radiology Information System - Picture Archiving and Communications System (RIS-PACS). The addition of RIS- PACS reduced the wait time of receiving diagnostic imaging results from 15 to 21 days to 24 to 48 hours. This has greatly reformed the timely diagnostic decisions and management of patients without delay.

Our Region continues to use Lean tools to make incremental improvement in care delivery by improving efficiencies and facilitating patient flow. Additionally, the organization certified one Lean leader and adopted the hoshin of decreasing inappropriate behaviour midway through the year.

As well, KYRHA met the follow-up requirements set out in Accreditation Canada’s June 2015 Supplementary Survey, recording unblemished results in four separate areas. While more details regarding KYRHA’s Accreditation successes are outlined in the “Accreditation” section of this annual report, the latest results demonstrate our organization’s commitment to meeting national standards in health care. We are positioned well for the full-site visit in May 2017.

In terms of challenges, KYRHA faced evacuation due to forest fires, a major shooting incident, multiple outbreaks toward year-end, staffing shortages in Acute Care, a loss of out-of-scope managers and a decrease in staff immunization. While we continue to address the impact of the aforementioned events, both in terms of personnel and finances, we appreciate all the help and support extended to our organization and the communities that we serve. Likewise, we acknowledge the impact that said events had on the communities in our Region and remained steadfast in our delivery of safe, quality care during those difficult times.

Respectfully submitted,

Tina Rasmussen Chairperson

5 INTRODUCTION

HIS ANNUAL REPORT presents the Keewatin Yatthé Regional Health TAuthority’s activities and results for the fiscal year ending March 31, 2016. The 2015-16 Annual Report provides an opportunity to assess accomplishments, results, lessons learned and a chance to identify how to build on past successes for the benefit of the people of the Keewatin Yatthé Health Region. The health authority is solely responsible for preparation of the report, from the gathering and analysis of information through to the design and layout of pages. As a result, we are confident in the reliability of the information included within the report. Regional breakthrough initiatives in support of provincial hoshins, along with the reduction of sick time and wage-driven premiums, are core performance areas in which the RHA seeks improvement and make up the selection rationale for the critical aspects of performance on which to focus. Data is available from regionally designed measurements and metrics.

6 ALIGNMENT WITH STRATEGIC DIRECTION

7 ALIGNMENT

The Keewatin Yatthé Regional Health Authority’s mandate, mission and principles are aligned to support the regional and provincial directions of better health, better care, better value, better teams.

8 STRATEGIC DIRECTION AND GOALS

ROVIDING FOR REGIONAL residents living in communities Acting as One Pscattered across northwest Saskatchewan, the Keewatin for Yatthé Regional Health Authority (KYRHA) administers a patient- Better Health, oriented health-care delivery system focused on wholistic health Better Care, and well-being. Better Teams Mandate and Better Value Within a context of accountability to the Creator,

KYRHA’s mandate is drawn from: Athabasca • Legislation: Relevant federal and provincial acts and statutes; • Ministry of Health: Policies and procedures; • Community: Priority issues defined by community; • Partnerships: Developed and maintained by the Mamawetan regional health authority. Churchill River Mission Wholistic Health of Keewatin Yatthé Health Region Residents

Wholistic health is: Prairie Prince North Albert : Individual, family, community, region Parkland Kelsey • Inclusive Trail and the world at large; • Balanced: Physical, mental, emotional and spiritual wellness; Saskatoon • Shared: Personal health is tied to family / community health Heartland Sunrise – as community / family health is tied to personal health; : Individuals make better health decisions for Regina • Responsible Qu’Appelle Five themselves and their families, and participate more Cypress Hills fully in community; Sun Country • Focused: Improvement of health and wellness for all; • Unified: Only one option – Working together. Saskatchewan Health Regions

Principles Adults ― supported by extended family and local community ― are responsible for their own health. To assist individuals, families and communities develop the knowledge, skills, abilities and resources to carry out this responsibility, KYRHA will act in accordance with the following principles: • Show respect as a foundation for working together; • Focus on healthy communities by emphasizing factors that build healthy individuals and families; • Focus on healing in our own lives and in the lives of individuals, families and communities; • Recognize in our programs, services and activities that spiritual healing is a significant compo- nent of wholistic healing, and support individual and family approaches to spiritual healing; • Strive to create an attitude of responsibility and self-reliance in our people, our families and our communities; 9 • Support, strengthen and build upon skills, • Accountability: Take ownership in achieving knowledge and energy of board, staff and desired results; the people of the Region so that we can work • Empathy and compassion: Practise non- together towards our full health potential; judgmental listening and support that reflects • Build on strengths, transform weaknesses caring and sensitivity in interactions with and not violate our potential; colleagues, patients, stakeholders and resi- • Strive to meet the needs of people in our dents; decisions, programs and activities; • Honesty and trust: Be straightforward, open • Encourage and support healing initiatives of and truthful. Take responsibility for one’s ac- our people, families and local communities; tions. • Support community caring and traditional strengths in programs and activities; Community Priorities • Utilize the skills, talents and abilities of local Within the scope of our mandate, mission and people as much as possible in all initiatives, principles, issues-driven, community-identified programs and activities; priorities shape the health authority’s strategic • Build on existing community-based services; direction. These priorities fall into four areas: • Strive for excellence in quality of care, in the • Community healing – including denial, un- quality of workplace and in the qualifications, willingness or reluctance to face problems or skills and attitudes of staff, no less than can take action, to identify issues, to develop and be found in any jurisdiction, anywhere; implement solutions or volunteer; as well as • Remain committed to developing and en- lack of trust and issues of violence, poverty, couraging a spirit of co-operation with north- housing and teen pregnancy; ern health partners to enhance health out- • Individual and family healing – including comes at the regional and local levels. parents unable to care for and nurture children, high levels of family breakdown and Values the decline of the family unit; lack of respect KYRHA maintains and promotes respect as a between generations; reliance on health primary organizational value and building block workers to provide what should be consid- for the successful achievement of our wholistic ered self-care; health goals and objectives. By reflecting organi- • Program planning and implementation – zational values in daily actions, Keewatin Yatthé’s including diabetes and complications from 350-plus employees create a healthy work envi- the disease; sexually transmitted infections; ronment – the starting point for delivery of best mental health and addictions; retention of care and services to residents of the Region. medical health professional services; support • Mutual respect: Reflect high regard for for the elderly; information and emphasis on unique abilities, talents, feelings and opin- spiritual wellness; ions of others; • Existing activities and service outcomes • Personal integrity: Undertake one’s duties – including empowering people to take re- and responsibilities openly, respectfully and sponsibility for their own health as opposed honestly; to creating dependence; greater teamwork • Self-belief and courage: Meet challenges between service providers; jurisdictional is- with confident ability and take responsibility sues between treaty and non-treaty people, with courage and conviction; and among health services across the north; • Collaborative work: Build productive rela- lack of understanding of the role of the Board tionships with co-workers and stakeholders; of Directors. 10 FACTORS

TH DIFFERING NEEDS to its older Wcounterparts, the Region’s pre- Population by Age Group, KY and Saskatchewan, 2015 dominately younger population factors into management decisions about strategy. Beyond the direct mandate that the RHA addresses, social determinants can simi- larly shape strategic direction and require external partnerships to begin to effect better health outcomes.

Population KYRHA’s population remains young compared to the province, with 28 per cent of the population less than 15 years of age and only seven per cent older than 65 years. More than 90 per cent (93.5%) of the population self-identify as aboriginal. Population Pyramid by Age and Sex, Keewatin Yatthé 2015 In 2014, the Keewatin Yatthé and Ma- mawetan Churchill River Regional Health Authorities, as well as the Athabasca Health Authority, had some of the highest “dependency ratios” of all health regions in Canada. The dependency ratio compares the number of youth younger than 20 and elders older than 65 years of age with the “working” population of 20-64 years. Re- gions with high dependency ratios indicate economically stressed areas. Social Determinants of Health KYRHA has almost three times the pro- Occupied Private Dwellings Chararistics and Crowding in Homes Keewatin Yatthé and Saskatchewan portion of dwellings requiring major repair, and almost five times the rate of crowding, having more than one person per room, compared to the province. The median after-tax income of people living in the Keewatin Yatthé Health Region is $17,320, which is almost $12,000 less than the provincial median. Approximately half (51.5%) of the Kee- watin Yatthé Health Region population aged 25-29 years graduated high school compared to the province’s 84.5 per cent. 11 12 KYRHA OVERVIEW

13 ORGANIZATIONAL CHANGES

Management Staff Engagement The 2015-16 fiscal year saw many organiza- Building on a regional commitment to quality and tional and personnel changes, from key positions saftety, the level of staff engagement was mea- being filled to more familiar faces taking up new sured with the Engagement-Driver Survey in 2014. roles. The results from that survey were revealed in the Among the most noteworthy additions was the last fiscal year, yielding 65 responses in total. recruitment of a Mental Health and Addictions Engagement-Driver Surveys measure com- Director. The addition branches off from the previ- mitment by asking questions relating to whether ous year’s breakthrough that saw mental health employees consistently say positive things about and addictions (MH&A) become integrated into the Region, are intending to stay with the Region primary care. and strive to exceed the expectations of their cur- Health Services was also able to secure two rent role. Director positions for the Acute Care and Clni- Eighteen areas, known in the survey as “driv- cal Services departments in both La Loche and ers,” influence employee engagement. Examples Ile a la Crosse. As well, the Executive Director of drivers are “People,” “Total Rewards,” “Proce- of Health Services became responsible for the dures,” “Quality of Life / Values,” “Opportunities” Director of Population Health on an interim basis. and “Work / Motivation.” The recruitment of a Director for La Loche and In terms of overall engagement, 40 per cent of appointment of a Director of Acute Care and Clin- the responses within our Region are considered to ical Services with a be engaged. nursing background However, our Region recorded much more in Ile a la Crosse positive results when it came to striving to exceed were moves toward expectations. Forty-six percent of our employees quality improvement. are inspired to do their best work every day, and 43 Additionally, the per cent are motivated to contribute more than is organization hired normally required to complete work. a Director of Com- Opportunities for improvement were revealed in munity Development areas including Corporate Social Responsibility, and Health Promo- Senior Leadership and Recognition, among others, tion, as well as a which spurred the action to develop a routine visi- Communications Di- tation schedule for Senior Leadership to regularly rector toward year- See full KYRHA organi- meet with staff across the Region. There was also end. Meanwhile, a zational chart in report a renewed commitment to staff appreciation. new Patient Care appendices on page 66. The well-being of patients relies heavily on the Co-ordinator was commitment of their caregivers. Results of the appointed to manage and co-ordinate the day-to- Engagement-Driver Survey have provided founda- day operations related to patient-care services in tional data for Senior Leadership and managers to Acute Care and Emergency, as well as for long- make informed decisions about the necessities to term care residents. keep staff engaged and committed to ensure safe- Several other positions were filled, including in ty in offering the best care possible. That feedback IT, springing a software and hardware upgrade will strengthen our understanding of what areas across the Region. need to be addressed and prioritize accordingly. 14 PATIENT SAFETY April 1, 2015 - March 31, 2016 Definition of an Occurrence • An event inconsistent with routine, client, • Damage / loss, or potential damage / loss, of patient or resident care. equipment or property. • An injury or potential injury to a client, patient, • Equipment malfunction or failure that did, or resident, visitor, physician or contractor. had the potential to, result in harm to a person. Patient Safety Occurrences Q1 Q2 Q3 Q4 Year Falls 7 14 25 9 55 Medication 6 11 12 21 50 Other 29 30 21 29 109 Total 42 55 58 59 214

Incidents are rated according to severity and risk to the consumer or Region • Code 1: No known injury. tential for adverse outcome. Serious incident No clinical significance where the potential for litigation is through to • Code 2: Minor injury requiring basic first aid or be prevalent. short time monitoring. Action to rectify must be • Code 4: Tragic Incident. Unanticpated death or noted. potential of major loss of function or major injury. • Code 3: Adverse outcome or significant po- • Unknown: Code not documented.

Codes by quarter Q1 Q2 Q3 Q4 Year Code 1 19 25 22 20 86 Code 2 8 15 24 23 70 Code 3 7 15 12 16 50 Code 4 - - - - - Unknown 8 0 0 0 8 Total 49 56 63 78 214

Patient Safety Occurrences - Four-year comparison by quarter

Rising occurrence numbers parallels a growing awareness of the importance of reporting, driven by increased staff training and a streamlining of the reporting process. 15 ACCREDITATION

MPLEMENTATION OF PROGRAMS AND linens, supplies, devices and equipment in a way Ientering evidence on the online portal helped that avoids contamination, meeting Infection and KYRHA to meet Accreditation Canada’s follow-up Prevention Control criteria. requirements detailed in the June 2015 Supple- In the Emergency Department, our team quick- mentary Survey. ly recognizes overcrowding and follows protocols Maintaining “Accredited” status is a testament to move clients elsewhere within the organiza- to the progress that has been – and is continuing tion. The team is also trained to identify and man- to be – made by Accreditation team leads and age physically threatening or violent clients. members in our Region. Our Emergency Medical Services team follows Defined criteria prepared by Accreditation Can- standard process when responding to hazard- ada are used to rate our Region’s performance ous materials incidents, and in the area of Public in a well-rounded Health, our orga- way. Our organiza- nization has pro- tion received a rat- cesses in place to ing of “Met” in 10 promptly detect, of the 13 criteria respond to and tested for the June contain any dis- 2015 Supplemen- ease or outbreak. tary Survey. To not only In fact, KYRHA maintain but hand- recorded unblem- ily achieve “Ac- ished results in credited” status four areas, includ- demonstrates ing Governance, our commitment Infection Preven- to meeting na- tion and Con- tional standards trol, Emergency in health care. Department and Furthermore, it Emergency Medical Services. signals our organi- For Governance, KYRHA ensures the govern- zation’s dedication to improving health outcomes ing body receives required information in ad- and health-system performance. vance of making decisions. The governing body Integral to our success is precisely that focus also reviews the organization’s fiancial perfor- on aspects like patient and staff safety, and creat- mance in relation to the strategic plan. Lastly, the ing community partnerships. governing body routinely assesses its own func- However, a necessity in maintaining success tioning. is having the will to improve – and continuous In terms of Leadership, our organization’s lead- improvement is exactly what we strive for as an ers require, monitor and support service, unit or organization. We must appreciate where we are program areas to monitor their process and out- but move onwards as well. come measures that align with the strategic goals We will continue to set goals, gather data and and objectives. observe metrics in our pursuit of ensuring quality Staff store, prepare and handle food appropri- and safety in our deliverance of care and servic- ately, while the organization stores and handles es ahead of the full-site visit in May 2017. 16 PROGRAMS AND SERVICES

UALITY HEALTH-CARE PROGRAMS and Qservices are provided across the Region through: • Two integrated health centres: Ile a la Crosse and La Loche; • Three Primary-Care centres: Beauval, Buffalo Narrows and Green Lake; • Six outreach and education sites: Cole Bay, Jans Bay, Michel Village, La Loche Patuanak, St. George’s Hill and Turnor Lake.

Integrated Health Centres Buffalo Narrows Integrated facilities offer a variety of health- care programs and services, including: • Emergency care; Ile a la Crosse • Acute Care; • X-ray and lab; • Physician / medical health clinic; Beauval • Public health clinic; • Home Care; • Long-Term Care; • Inpatient social detox; Green Lake • Mental health and addictions; • Community Outreach and Education Worker; • Dental therapy; • Buffalo Narrows • Physical therapy; Physicians services (four days a week); • Community health development programs. Nurse Practitioner; Home-Care Licensed Practical Nurse; Primary-Care Clinics Special care / home health aids; Primary-Care clinics offer 24/7 on-call RN cov- Public Health Nurse; erage and emergency medical services. Emergency Medical Services; • Beauval Community Outreach & Education Worker; Physicians services (two days a week); Dental Therapist; Nurse Practitioner; Addictions counsellor; Public Health Nurse; Mental Health Therapist; Home-Care Licensed Practical Nurse; Medical transportation; Special care / home health aids; Community health development programs. Community Mental Health RN; Dental Therapist; • Green Lake Addictions Counsellor; Registered Nurse / Public Health and Emergency Medical Services; Home-Care Nurse; Community Outreach & Education Worker; Community Outreach & Education Worker; Community health development programs. Home-Care Co-ordinator. 17 teeth extraction, cavities and fillings; open to Outreach and Education Sites children up to the age of 17; Community Outreach and Education Workers • Dietitian (COEWs) provide service to Cole Bay, Jans Bay, One-on-one diet counselling and prevention Michel Village, Patuanak, St. George’s Hill and of diseases through education; Turnor Lake, promoting individual, family and • EMS - 24-hour emergency services; community health through a variety of programs • Home-Care Services and workshops. Community members are helped Services ensuring quality of life for people to understand and make use of health services with varying degrees of short- and long-term and clinics, as well as advised of available health illness or disability and support needs; in- resources and benefits. cluding palliative, supportive and acute care; • Mental health therapy Programs Services and interventions for individuals, Available to Region residents: families, groups and communities experienc- • Addictions counselling education ing significant distress or dysfunction related Client eduction on the effects of alcohol and to cumulative stress, situational difficulties or drug abuse, including one-on-one counsel- difficulties related to biochemical disorders; ling, follow-up support and home visits; • Nutritionist • Community diabetic education One-on-one nutrition counselling; prevention Counselling for diabetics and those at risk of of diseases through education; developing diabetes, as well as prevention • Public health nursing through education; Prenatal / postnatal care, immunizations, • Community outreach and education school programs and health teaching; Help to understand and make use of commu- • Public health inspection nity health services and clinics; information Health regulations assessment / monitoring; on health resources and benefits; • Travel co-ordination • Dental clinic Travel arrangements for patients seeing spe- Provides and promotes dental care; primary cialists who have no other means of access.

Beauval Clinic 18 19 KEY PARTNERSHIPS

The Population Health Unit takes a leadership Population Health Unit role in the Northern Healthy Communities Part- The Northern Saskatchewan Population Health nership (NHCP), a network of organizations work- Unit is unique in the province. It is a major collab- ing to improve the health of people in the region orative initiative of the Athabasca Health Authority by influencing the conditions in which they live, (AHA), Keewatin Yatthé Regional Health Author- learn, work and play. In 2015-16 the Healthy Eat- ity (KYRHA) and Mamawetan Churchill River ing Team of NHCP expanded its School Nutrition Regional Health Authority (MCRRHA), formalized Mentorship Project to now support 15 schools through a Co-Management Partnership Commit- on and off reserve to provide nutritious foods to tee memorandum of understanding. The popula- students. This project was showcased at the fall tion is approximately 40,000 within a geographi- first National School Food Conference. NHCP’s cal area of 307,180 square kilometres, almost Babies, Books and Bonding program distributed half the province. approximately 2,500 children’s books at immu- The Population Health Unit (PHU) is respon- nization clinics to promote language and literacy sible for health surveillance and health status development among young children. Ongoing reporting; health protection and disease control, NHCP projects include efforts to promote physi- including enforcement, as mandated by The Pub- cal activity, to support maternal tobacco cessation lic Health Act, 1994 and related regulations. In and youth tobacco reduction, and to reduce risk- addition, the Unit has a role in population health taking behaviour among young people through consultation and advice; population and public positive youth development. The NHCP Building health program planning and evaluation; and Vibrant Youth team began a video production population health promotion, including: healthy project in followup to last year’s Northern Youth public policy, community development and health Role Model Campaign. The Northern Tobacco education. Strategy team engaged a social-marketing firm The team includes: to build capacity in social marketing targeted at • A Medical Health Officer and Deputy youth tobacco reduction. Medical Health Officer; PHU staff supported the Northern Health • An Environmental Health Manager, Public Conference in September 2015 through sev- Health Inspectors and Environmental eral presentations on Healthy Living in Northern Health Protection Co-ordinator; Saskatchewan, the Northern Healthy Commu- • A Nurse Epidemiologist; nity Partnership role in Health Promotion, and • A Communicable Disease / Immunization on a panel on tuberculosis and HIV in northern Co-ordinator, TB Outreach Nurse, HIV Saskatchewan. At the Northern Health Confer- Nurse Specialist and Community Case ence, there was the public release of the northern Workers; Saskatchewan HIV Awareness initiative including • Infection Prevention and Control the mobile app on “Health Is Vital,” and various Practitioners (one northern and one promotional materials. provincial position); In 2015-16, the Population Health Unit par- • A Dental Health Educator / Technical ticipated in the provincial and northern STI, HIV Consultant, Public Health Nutritionist and and high incidence TB strategies, in collaboration Population Health Promotion Co-ordinator; with the three northern health authorities and the • A Unit Director and Administrative Support Northern Inter-Tribal Health Authority. Scattered Staff. Sites, a community-based organization, was 20 funded for harm reduction programming in one were evacuated. PHU staff assisted at evacua- community. Several outreach events in northern tion centres during this time; provided essential communities were successful in providing edu- public health services related to infection control cation, social support, flu shots, TB testing, and and communicable disease control; participated building relationships with people living at risk. in debriefs and reviews of the summer forest fire The Environmental Health program improved evacuations across the north; updated the forest both scheduled inspection completion rates and fire evacuation and smoke assessment guide- demand service response in 2015-16. More than lines for health-care workers; prepared commu- 93 per cent (331/355) of Category I facilities in nity fact sheets on health impacts of forest fire the three smoke and northern reducing your health au- risk, being thorities were prepared for inspected at the forest least once. fire season, Public Health and consid- Inspectors did erations for not inspect returning 100 per cent home after an of these fa- evacuation; cilities in part and provided due to forest guidance to fires and trav- facilities and el logistics. communities Several other preparing for facilities were the return of moved to a bi- evacuated ennial inspec- citizens. tion schedule The Popu- based on risk lation Health assessment. Unit was We expanded involved in our program PSA: The Population Health Unit issues advisories alerting environmen- to include northern residents to situations that may affect their health and tal assess- tobacco offers actions to take under those circumstances. ment projects retailing and at various tanning facility monitoring. We made progress stages. These reviews are part of our work with in developing our emergency management and the Saskatchewan Environmental Assessment preparedness role and developed our website to Review Panel (SEARP). As of March 2016, there improve client access to service and information. are four active environmental assessments oc- During the La Ronge evacuation due to forest curring in the three northern health authorities. fires in July 2015, the Population Health Unit set The PHU continues to support and assist with up a virtual office for needed public health work various environmental monitoring initiatives re- for residents still in the north and for those who lated to various types of developments. 21 The Northern Saskatchewan Prenatal Bio- Prairie North IT monitoring Project for environmental chemicals Prairie North Regional Health Authority, is continuing through a partnership with the through contractual agreement, provides infor- Saskatchewan and Alberta Ministries of Health, mation technology (IT) services to KYRHA that and Northern Inter-Tribal Health Authority. During include: 2015-16 year, analysis was completed and report • Technical support services writing occurred with final completion and dis- • Application hosting services semination planned for 2016-17. • Data centre services The PHU Medical Health Officer, as a member • Projects of the Northern Mines Monitoring Secretariat, • Networks supported the work of the Northern Saskatche- With all service requests initially logged wan Environmental Quality Committees (NSEQC) through the eHealth service desk (Tier 1), as and assisted with a Uranium 101educational required these requests are escalated to Prai- workshop for the NSEQC members. rie North IT (Tier 2) for resolution in a prioritized The Population Health Unit assesses health manner. The Prairie North Tier 2 support team research proposals for Northern Saskatchewan consists of specialists in network and systems to ensure that they follow quality, safety and ethi- management, Windows servers, desktop support, cal guidelines. In 2015-16, the northern health IT security, database administration and applica- authorities approved 11 research projects and tion maintenance and support. These specialists provided letters of support for three others. Two focus on using proactive tools and processes other research projects were started in the pro- designed to reduce the number of infrastructure cess this fiscal year. trouble calls while minimizing the downtime as- In 2015-16, we began developing a new ap- sociated with trouble events when they do occur. proach to provide Internet-based Health Indicator reports as new data becomes available. The first Health-Care Organizations sections will be released early in 2016-17. Health-care organizations, for-profit and non- Northern Medical Services profit, receive funding from the RHA to provide health services. Two such organizations provide Northern Medical Services (NMS) serves services within KYRHA: KYRHA with two models of care. La Loche is • Meadow Lake Tribal Council (MLTC) pro- served by six full-time equivalent physician posi- vides after-hours nursing coverage for adja- tions each contributing 26 weeks of service per cent communities; funding to MLTC for provi- annum. These are itinerant services, with travel sion of these services has been increased: to outlying clinics. KYRHA provides a duty ve- Community Health Development works hicle for weekly clinics serving Birch Narrows in partnership with MLTC on a health and Turnor Lake. The health region also provides services integration, focusing on the co- clinic space, support and accommodations, while ordination of mental services and addic- Northern Medical Services is responsible for tions between the two health systems; recruitment, continuity of service, reimbursement Also working in partnership with MLTC and travel. Ile a la Crosse is served by six full- to develop and deliver a health-informa- time equivalent salaried positions and an NMS tion / self-management guide. clinic with six administrative staff. Itinerant ser- • Ile a la Crosse Friendship Centre runs the vices are provided to Beauval, Buffalo Narrows, Successful Mothers Program that helps give Dillon and Patuanak. children the best possible start in life. 22 GOVERNANCE

General Bylaws KYRHA BOARD MEMBERS Based on a review of general bylaws used in other jurisdictions, board-approved general bylaws include concepts from best practice in corporate governance and are developed and enacted to: a. Provide an administrative structure for the governance of the affairs of the board; b. Promote the provision of quality health-care services; Tina Rasmussen Bruce Ruelling c. Improve the health standards of the resi- (Chair) Green Lake (Vice-Chair) La Loche dents of the health region through the provision of quality health services. Board Education Board members participated in the Health Director Education & Certification Program, designed to ensure Saskatchewan directors have the skills, knowledge, attitude and capabilities to fully contribute to the pursuit of excellence in Elmer Campbell Barb Flett corporate governance in the health sector. Dillon Ile a la Crosse The director certification program is comprised of separate two-day long modules plus a com- prehensive exam, and it has been designed to ensure that each director has the ability to take all components of the governance training program over a period of approximately two years. At the completion of this program, directors will possess: • Skills and competence required to fulfill their roles as board members in the health sector; Patty Gauthier Kenneth (Tom) Iron • Excellent knowledge of the function of corpo- Beauval Canoe Lake rate governance and how it operates within their organizational structure; • Good knowledge of finance specific to the Saskatchewan health sector and the tools and know-how to use financial information appropriately; • Good understanding of their own personal strengths and weaknesses, and be able to continually develop themselves to meet their Myra Malboeuf Peter Laprise future needs. Ile a la Crosse Buffalo Narrows 23 24 PROGRESS 2015 - 2016

25 2015-16 HOSHINS

Using Saskatchewan Health-Care Management System Lean principles and tools, KYRHA 2015-16 continuous quality improvement focused on Better Health, Better Care, Better Teams and Better Value — on delivering safe, patient and family centred programs and services, aligned with provincial strategic priorities and reflective of regional needs. KYRHA undertook two breakthrough projects (hoshins) in 2015-16: • Achieving a culture of safety, with a goal of no harm to patients (falls) or staff (inappropriate behaviours); • Developing a northern definition of primary health care and an understanding — from a resident’s perspective — of the programs and services required to meet unique northern needs. High-Level View During annual Catchball midway through the 2015-16 hoshin cycle, a cross-functional KYRHA improvement team made up of board members, the CEO, executive directors, directors, in- and out-of-scope managers, the deputy medical health officer, physicians and population health representatives was asked to reflect on the state / status of RHA efforts to achieve provincial targets — measuring progress along a timeline from not started to implemented. While subjective, the results (Table 1: Improvement Target Timeline) reveal a broad range of opinion, both to position along the timeline as well as agreement on that position. Commu- nication — lack of information about provincial targets and / or regional plans or actions to achieve those targets — was cited most often by respondents for difficulty placing the region along the timeline and agreeing on that placement. 26 Barriers to Progress Training Using Lean continuous improvement principles Building on the previous year’s achievement for the purpose of guiding quality-improvement of putting 17 leaders and managers through work, KYRHA worked to move from the once the Lean Leader Training certification process, familiar “firefighting” approach, reactively ad- KYRHA certified its first Lean Leader in the sum- dressing issues, to a managed and measured mer of 2015. Certification is the culmination of approach of planned proactive actions — based studying and applying Lean principles and tools on and aligned to strategic direction. 2015-16, like mistake proofing and rapid improvement however, proved to be fire-fighting year, literally, process workshops (RPIWs), aligning with the with mass evacuation of northern residents due provincial goal of delivering better health, better to forest fire — the first of several issues forcing care, better teams and better value. the region to operate in emergency-management mode. Critical staffing shortages that threatened Organization or forced service and facility closures, a tragic Rather than wait to receive 5S training, the school shooting incident in the Northern Village incoming Public Health Nurse in Green Lake of La Loche, as well as a virulent flu season identified an opportunity to improve care by re- that incapacitated residents and staff alike, kept organizing his workspace, sifting through boxes, Emergency Operations Centres open for days at discarding superfluous material and designating a time, with new EOCs opening barely before old shelf space for each item. were closed. Another serious barrier to progress involved the Kaizen Promotion Office. The regional driver of quality improvement planning and delivery, was short-staffed throughout the period, operated single-handedly by a director tasked with additional non-KPO critical responsibilities. Before After

Value-Stream Mapping the Hiring Process (March 2016)

Current State: 23 steps Ideal Future State: Five steps 27 Better Care Five-year outcome: Achieve a culture of safety by March 31, 2020

Hoshin: Falls (No Harm to Patients)

Problem • Lack of safety / practice changes implemented Clients and residents hurt as a result of falls — at after fall occurs. home and in KYRHA care. Plan of action

Root cause • Create and implement new clinical tools for fall • Consistent use of a tool to assess risk for falls risk assessment, prevention techniques (inter- between departments; ventions) and post-fall management; • Lack of fall-prevention strategies consistently • Develop a process for standardized referral to identified and used; physiotherapy on resident admission, and / or • Limited understanding of staff roles and re- when identified at high risk for falls (Physio- sponsibilities for fall prevention; therapy assessment will lead to a personalized • Inconsistent referral of patients identified as exercise program for the resident); high risk for falls to medical and / or specialist • Develop and create standard work for a clear staff; procedure for post-fall clinical management, reporting, investigation and followup. Hoshin: Inappropriate Behaviour (No Harm to Staff)

Problem Standard work and training Inappropriate behaviours between staff resulting Timeliness; in physical and psychological injuries lead to lost • Staff Issues: time and reduced client satisfaction with services Commitment, motivation and accountability offered. Roles, responsibilities and expectations Personality conflicts, cultural differences Root cause Staffing levels, fatigue. • Environmental issues: Plan of action Confidentiality Respect and trust • Create a huddle tool for supervisors to use to Stressful environment gauge staff morale; Working in silos; • Develop an organizational (ORG) chart that • Policy issues: clearly defines roles, connections and expecta- Access tions; Awareness • Introduce personality conflict training for man- Clarity agers and staff; Consistency in application; • Redesign staff recognition awards; begin to • Process issues: reward for productivity and performance excel- Communication lence in care and service delivery in addition to Documentation recognizing longevity of service; 28 • Restructure the staff workplace incident report- and stop harassment. KYRHA committed to: ing process to facilitate more timely flow; roll • Providing employees with harassment-preven- out with an introduction and staff training. tion training; • Acting promptly to end harassment and prevent Results: recurrence; Respectful Workplace - Inappropriate Be- • Providing diversity and conflict resolution train- haviour Policy (effective April 2016) ing, as well as effective management practices to clearly define tasks, roles and workload and A new policy, outlining both employer and em- to promote fairness in the workplace; ployee responsibilities for ensuring a workplace • Protecting workers from reprisal or retaliation free of harassment, was implemented to prevent for making a harassment complaint.

Better Care In partnership with patients and families, improve the individual’s experience, achieve timely access and continuously improve health-care safety.

Hoshin: Primary Health Care (Planning Hoshin)

Problem organizational assistance rather than self-reli- • Lack of shared vision: What is primary health ance; care (PHC)? What programs and services does • Federal / provincial jurisdictional issues lead- it include? Regional staff and providers, physi- ing to gaps in service — creating “cracks” with cians, communities and patients / families view regional residents at risk of falling through; PHC differently; • Not involving patient and family in care design • Lack of understanding: What services are — “Nothing about me, without me”; available across the region and in each com- • Difficulty engaging patients / community mem- munity? What services are needed?; bers to learn about programs, services. • Limited understanding of population needs, with limited data and / or access to data to as- Plan of action sess needs; • Paper surveys for clients, patients and family • Limited integration of services and lack of con- (completed); sistent referral processes; • Focused group sessions (not done); • Limited transition support for patients travelling • Spreadsheet development and data compila- “south,” as well as for repatriation support back tion (completed); to local provider team; • Literature review of primary health care defini- • No PHC-integrated electronic medical record tions (completed); — poor information sharing across patient-care • Data review and literature discussion (com- teams. pleted); • Development of primary health-care definition Root cause and shared vision (completed). • Limited empowerment — over-reliance on

29 Results care in partnership with individuals, families Utilization of Services and communities, focusing on health promotion, prevention, chronic disease management, By surveying clients, patients and family mem- early diagnosis and treatment, referral and bers, a better understanding of service utilization rehabilitation. was realized. The system enables the people to access required services via telephone services / helpline to empower self-reliance.

Areas for improvement

Planning work pointed to three areas for improvement: 1. Access to appointments: Diagnostics Specialists; 2. Co-ordinated chronic disease management; 3. In-region ophthalmology and expanded dental services.

Service Utilization Graph Additional areas for improvement • Co-ordination and liaison with Northern Medical Definition Services. Through literature research and surveying users, • Computer / technology disparity between loca- a northern perspective of primary health care was tions (Ile a la Crosse has Wi-Fi, while La Loche developed: does not; Ile a la Crosse has 100 Mb fibre optic • Primary Health Care (PHC) encompasses first- bandwidth, while some outreach offices barely contact care necessary to meet clients’ need by have speeds above dial-up). Physicians, Nurse Practitioners, Public Health Barriers to success identified Nurses and other frontline, health-care providers, including emergency medical services • Electronic data tracking abilities; (EMS), community services, mental health and • Baseline data and knowledge — How many addictions services, therapies, early childhood specialist visits? How long are patients waiting services, Community Outreach and Education to be referred? How many patients miss ap- Workers, a Dietitian, dental programs for ser- pointments; vices and home-care services. • Strong feeling success would be greater if • The Keewatin Yatthé “wholistic model of care” EMR was in place. ensures seamless client flow through a collaborative, interdisciplinary care process, with expedited referral to appropriate agencies and While value of work done was acknowledged for professionals to receive required services, re- the planning hoshin in 2015-16, Primary Health ducing exclusion and social disparities. Care received no votes during Catchball to be • The model provides patient family centered given full hoshin status as for 2016-17.

30 FINANCIAL INFORMATION

31 REPORT OF MANAGEMENT

May 27, 2016

Keewatin Yatthé Regional Health Authority

Report of Management

The accompanying financial statements are the responsibility of management and are approved by the Keewatin Yatthé Regional Health Authority. The financial statements have been prepared in accordance with Canadian Generally Accepted Accounting Principles and the Financial Reporting Guide issued by Saskatchewan Health, and of necessity include amounts based on estimates and judgments. The financial information presented in the annual report is consistent with the financial statements. Management maintains appropriate systems of internal control, including policies and procedures, which provide reasonable assurance that the Region’s assets are safeguarded and the financial records are relevant and reliable. The Authority is responsible for reviewing the financial statements and overseeing Management’s performance in financial reporting. The Authority meets with Management and the external auditors to discuss and review financial matters. The Authority approves the financial statements and the annual report. • The appointed auditor conducts an independent audit of the financial statements and has full and open access to the Finance/Audit Committee. The auditor’s report expresses an opinion on the fairness of the financial statements prepared by Management.

Jean-Marc Desmeules Edward Harding Chief Executive Officer Executive Director of Finance and Infrastructure

32 2015-16 FINANCIAL OVERVIEW

HE ACCOUNTS OF Based on As noted on Statement 2, TKEEWATIN Yatthé Regional actual operating fund expenses Health Authority (KYRHA) are operating fund for 2015-16 were $29.158 maintained in accordance with expenses million, which equates to the restricted fund method spending $79,884 per day to of accounting for revenues. of $29.158 mil- deliver health-care services Consequently, you will see an lion, KYRHA within our Region. The $29.158 “operating fund” and a “capital million in operating expenses fund” in these statements. spent $79,884 represents a 3.2 per cent The operating fund records per day to deliver increase over 2014-15 actual the revenue received and the operating expenses. When expenses incurred to provide health care compared to the 2015-16 daily health-care services to in 2015-16 budget, actual expenses came the residents of the region. The in under budget by $264,603. capital fund records revenue The delivery of health care is received to purchase equipment/ very labour intensive. Of the infrastructure and the expenses relating to the $29.158 million spent, eighty-two per cent (82 cost of equipment and infrastructure used in the per cent) relates to salaries and benefits paid to delivery of health-care services. employees. With respect to salaries for fiscal 2015-16, Operating Fund sick leave and wage-driven premiums continue KYRHA ended the fiscal year with a surplus to be areas of concern: of $445,468 in its operating fund, as noted on Statement 2 of the financial statements. The 1. KYRHA saw a slight increase of $9,022 entire surplus has been transferred to the in sick-leave costs when compared to internally restricted fund (Schedule 4). This the previous fiscal year. fund is used to purchase new or replace broken 2. KYRHA saw a $271,042 increase in equipment in order to continue providing health- wage-driven premiums when compared care services. to the previous fiscal year. There were a As of March 2016, the operating fund had a couple of events that contributed to this working capital surplus of $802,900. The working increase. We experienced forest fires capital ratio is an indication of an organization’s throughout the entire Region, resulting ability to pay its financial obligations in a timely in patients and long-term residents being manner. This indicator is calculated as “current evacuated to other parts of the province. assets” less “current liabilities” in the operating As a result, our staff accompanied fund, as per the Statement of Financial our clients to provide care. The tragic Position (Statement 1) in the audited financial shooting incident on Jan. 22 in La statements. Currently, the Region is operating Loche translated into additional staffing with a positive 10 days of working capital in the demands to support staff and community operating fund. members in the village. 3. During the fiscal year, KYHRA made Expenditures payments totaling $262,580 to health-care

33 organizations located within our Region to needs. The expenses of $1,190,657 represent provide services to our residents as follows: the allocation of capital assets’ cost over their Meadow Lake Tribal Council....$219,080 estimated useful life. Ile a la Crosse Friendship Centre...... $43,500 The Region spent $182,859 for equipment and infrastructure purchases in the 2015-16 fiscal Revenue year, as noted on Statement 4 of the financial As noted on Statement 2, actual operating statements. The sources for funding these fund revenues totaled $29.603 million, of which purchases can be found on Schedule 3 and Ministry of Health funding accounted for $27.475 Schedule 4 of the financial statements. million or ninety-three per cent (93 per cent) of the Region’s total funding. Other . KYRHA holds special-purpose funds that are Capital Fund classified as “deferred funds.” These funds are KYRHA ended the fiscal year with a deficit of held for specific purposes and can only be drawn $678,922 in its capital fund, as noted on Statement down when those conditions are met. As of March 2 of the financial statements. Actual revenue 31, 2016, deferred funds totaled $322,383. totaled $511,735, of which $480,000 is allocated These deferred funds are listed in Note 5 of the to the La Loche facility to address infrastructure financial statements.

34 2015-16 FINANCIAL STATEMENTS

35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 APPENDICES

65 KEEWATIN YATTHE REGIONAL HEALTH AUTHORITY ORGANIZATIONAL CHART

Board Board Committees of Directors

October 2015

Executive Chief Executive Senior Medical Assistant Officer Officer

Jean-Marc Desmeules

Executive Director Executive Director Executive Director Finance & Health Services Corporate Services Infrastructure

Girija Nair Edward Harding Carol Gillis

Population Health Community Board Development & Finance Services Health Promotion Development

Acute Care & Mental Health and Infrastructure Communications Clinical Services Addictions

Emergency (Contracted Service) Support Human Response & Medical Transport Pharmacist Services Resources

Information KPO / QCC Technology 66 PAYEE DISCLOSURE LIST

Keewatin Yatthé Regional Health Authority Payee Disclosure List For the year ended March 31, 2016

As part of government’s commitment to accountability and transparency, the Ministry of Health and Regional Health Authorities disclose payments of $50,000 or greater made to individuals, affiliates and other organizations during the fiscal year. These payments include salaries, contracts, transfers, supply and service purchases, and other expenditures.

Personal Services Durocher, Dolores...... 107,279 Durocher, Liz...... 81,042 Listed are individuals who received payments for salaries, Durocher, Martin...... 83,421 wages, honorariums, etc. which total $50,000 or more. Durocher, Peter...... 95,141 Durocher, Waylon...... 128,931 Dyrland, Jared...... 112,290 Abele, Brandi Da...... $ 70,440 Elliott, Hilda...... 78,154 Abubakar, Suadh...... 82,815 Ericson, Chelsea...... 75,066 Aguinaldo, Rosalina...... 202,679 Favel Gardiner, Pamela...... 75,573 Ballantyne, Betsy...... 116,928 Favel, Brittany...... 78,203 Basaraba Pedersen, Anne...... 63,382 Favel, Dennis...... 58,866 Brunelle, Elizabeth...... 149,777 Favel, Marlena...... 119,269 Burnouf, Jordyn...... 54,513 Favel, Ryan...... 52,349 Caisse, Loretta...... 80,231 Fontaine, Owen...... 57,787 Caisse, Samantha...... 95,186 Forde, Maudlin...... 106,459 Campbell, Deborah...... 95,417 Francis, Bibin...... 152,952 Chartier, Bertha...... 54,004 Gardiner, Brenda...... 65,506 Chartier, Paul...... 62,231 Gardiner, Christine...... 97,632 Clarke, Cathy M...... 63,689 Gardiner, Leona...... 52,776 Clarke, Crystal...... 106,739 Gardiner, Melanie...... 107,447 Clarke, Dawn...... 69,248 Gardiner, Robert...... 62,226 Clarke, Iris...... 107,172 Gardiner, Sheri...... 127,893 Clarke, Jacqueline...... 99,529 Geetha, Rakesh Mo...... 206,214 Corrigal, Amy...... 75,403 Gibbons, Edith...... 125,379 Corrigal, Anna...... 105,588 Gillis, Carol...... 138,819 Daigneault, Diania...... 60,451 Gordon, Calla...... 94,092 Daigneault, Karen...... 58,435 Gordon, Maureen...... 65,090 Daigneault, Lena...... 56,584 Hansen, Cindy...... 81,369 Daigneault, Robert...... 92,672 Hansen, Kayla...... 50,274 Deegan, Peter...... 113,390 Hansen, Marlene...... 92,485 Dennett, Lindsay...... 86,551 Hansen, Rae-Ann...... 70,610 Desjardin, Bernice...... 59,168 Hanson, Jolene...... 106,601 Desjardins, Raeah...... 85,256 Hanson, Brenda...... 91,514 Desjarlais, Bodean...... 103,311 Hanson, Kimberly...... 59,317 Desjarlais, Erica-Rae...... 116,640 Harbor, Kristi...... 144,657 Desjarlais, Judy...... 50,935 Harding, Edward...... 163,371 Desjarlais, Kylie...... 59,822 Harrison, Cameron...... 63,049 Desjarlais, Marieadele...... 51,552 Hercina, Karen...... 64,574 Desjarlais, Tammy...... 73,635 Herman, Dean...... 96,349 Desmeules, Jean Marc...... 219,304 Herman, Judy...... 68,978 Durocher, Cheyanne...... 62,488 Herman, Kevin...... 65,000

67 Herman, Marilyn...... 59,869 Park, Georgina...... 51,035 Herman, Melinda...... 91,367 Paun, Marian...... 107,054 Hodgson, Christina...... 77,731 Pedersen, Phyllis...... 86,371 Hodgson, Roberta...... 83,037 Petit, Melissa...... 97,197 Honrada, Charry...... 203,876 Petit, Richard...... 57,677 Hood, Samantha...... 96,687 Piche, Carol...... 93,352 Howson, Marianne...... 70,099 Probert, Phyllis...... 51,656 Iron, Terrance...... 85,546 Raymond, Carmen...... 82,054 Janvier, Antoinett...... 64,043 Reid, Victoria...... 67,029 Janvier, Gloria...... 51,978 Reigert, Cindy...... 101,425 Janvier, Joanne...... 65,721 Riemer, Ann...... 89,304 Janvier, Kylie...... 91,197 Roesler, Diane...... 63,019 Janvier, Leona...... 51,864 Roy, Jocelyn...... 86,682 Janvier, Ricky...... 58,437 Roy, Lorraine...... 96,793 Janvier, Rita...... 53,407 Seright, Eva...... 73,163 Jones, Kalvin...... 58,040 Seright-Gardiner, Pearl...... 150,584 Kent, Stephanie...... 108,260 Shmyr, Stacey...... 96,039 Kilfoyl Justina...... 99,881 Smith, Brenda...... 94,237 Kimbley, Sharon...... 118,653 Smith, Ryan...... 137,493 Kissick, Margaret...... 89,260 Solway, Loretta...... 121,732 Koskie, Megan...... 86,660 Starks, Faye...... 58,724 Kucharski, Michal...... 113,146 Striker, Bertha...... 54,912 Kyplain, Jane...... 60,799 Sylvestre, Brenda...... 65,173 Lafleur, Leanne...... 73,598 Sylvestre, Flora...... 53,466 Laliberte, Iona...... 54,681 Taylor, Patricia...... 215,745 Laliberte, Katelyn...... 55,598 Taylor, Sharon...... 76,793 Laliberte, Kathy...... 52,097 Thompson, Marlene...... 68,777 Lanteigne, Michelle...... 90,343 Toulejour, Justine...... 54,200 Laprise, Devin...... 73,119 Tsannie, Linda...... 101,434 Laprise, Lawrence...... 65,438 Wallace, Robin...... 126,592 Lariviere, Doreen...... 126,599 Watson, Pamela...... 53,960 Lemaigre, Antoinett...... 98,340 West, Dale...... 113,284 Lemaigre, Carol...... 74,817 Williams, Ronda...... 62,671 Lemaigre, Jessie...... 60,526 Wishlow, Janelle...... 70,578 Lemaigre, Jessie E...... 50,243 Woods, Doris...... 94,646 Lemaigre, Marcella...... 55,714 Yelland, Rochelle...... 101,020 Listoe, Eileen...... 110,879 Yole-Merasty, Sasha...... 79,975 Makar, Nadia...... 64,175 Yuhasz, Juanita...... 106,860 Maurice, Judy...... 75,872 Maurice, Linda...... 52,504 Mazurik, Matt...... 100,849 Mccallum, Jason...... 53,171 Mcgaughey, Calvin...... 90,708 Misponas, Evelyn...... 63,253 Moise, Clara...... 71,570 Montgrand, Brenda...... 50,867 Montgrand, Glenda...... 102,680 Morin, April...... 128,717 Morin, Darryl...... 125,016 Morin, Ida...... 59,324 Morin, Lyndsay...... 116,587 Morin, Lynn...... 61,270 Muench, Lori...... 64,522 Nair, Girija...... 152,192

68 Supplier Payments Listed are payees who received $50,000 or more for the provision of goods and services, including office supplies, communications, contracts and equipment.

HSAS Union Dues...... $ 50,045.16 Wood Wyant...... 51,337.73 OCD Canada Holdings...... 54,114.18 Meyers Norris Penny LLP...... 56,363.75 Philips Healthcare...... 56,376.72 SUN...... 56,815.33 OK Tire...... 60,612.64 Grand & Toy...... 60,814.21 Abbott Diagnostics Division...... 62,017.53 Marsh Canada Limited...... 62,930.00 North Sask Laundry...... 62,933.12 Public Employees Pension Plan...... 64,336.88 Autism Services...... 65,000.00 Hospira Healthecare Corp...... 70,018.02 Ile a la Crosse Friendship Centre...... 73,500.00 La Loche Housing Authority...... 77,849.00 Ile a la Crosse Development Corp...... 80,660.00 Prairie North Regional Health Authority...... 87,768.69 SGEU - Ltd...... 88,905.35 3sHealth-Disability Income Plan...... 103,006.76 Ile a la Crosse School Division...... 104,864.48 Physio-Control Canada Sales Ltd...... 105,109.08 The Great West Life Assurance Co...... 110,216.62 Garda Canada Security Corp...... 111,459.30 MD Ambulance Care Ltd...... 113,923.40 Select Medical Connections Ltd...... 114,906.59 SGEU...... 117,046.81 Andrea, Gaudet ...... 124,976.93 3sHealth...... 125,771.20 The North West Company...... 128,798.03 3sHealth- Core Dental Plan...... 129,401.94 Eckert, Arlene...... 139,626.00 SaskTel...... 142,902.71 Sysco Serca Food Services Inc...... 163,879.52 Federated Co-Operatives Ltd...... 166,639.96 SaskPower...... 166,979.54 McKesson Canada...... 178,161.03 MCR Regional Health Authority...... 180,580.00 Schaan Healthcare Products...... 184,213.09 101134903 Saskatchewan Ltd...... 187,738.32 Campbell, Becky Jo...... 218,527.45 Saskatchewan Worker’s Comp Board...... 240,464.25 The Minister of Finance...... 292,660.66 3sHealth Dental Plan...... 347,803.06 The Minister of Finance...... 438,013.03 Sask Healthcare Employees Pension...... 2,305,906.67 Receiver General for Canada...... 5,982,326.39

69 70