Sunrise Regional Health Authority
- Sunrise Regional Health Authority (RHA)
Audit Scope and Objectives
- To assess if Sunrise Regional Health Authority had adequate processes as of March 15, 2010 for scheduling required nursing staff for patient care in its healthcare facilities including managing labour costs relating to overtime.
- The audit expected that the RHA would:
- clarify working expectations for nursing staff.
- communicate expectations to scheduling office staff, nursing staff, and managers.
- train managers to monitor labour costs.
- schedule nursing staff to meet anticipated staffing needs.
- establish processes to handle contingencies (e.g., absenteeism, increased patient load, and/or acuity).
- balance nurses’ work schedules equitably (e.g., fair, timely, use banked time in lieu).
- keep accurate information on nursing staff labour costs.
- compare actual to expected labour costs and identify patterns and causes of excessive labour costs.
- consult with its stakeholders (e.g., staff, unions, professional associations) to minimize excessive labour costs.
- use prevention strategies to address causes of excessive labour cost.
- take action on excessive labour cost.
Main Audit Findings
- The RHA had adequate processes to schedule required nursing staff for patient care in its healthcare facilities including managing labour costs relating to overtime except for its processes to review and approve nursing staff timesheets, identify causes of overtime costs, and implement strategies to address overtime costs.
- The RHA uses daily timesheets to verify attendance and process payroll. However, 30% of the timesheets examined did not have evidence of appropriate approval. Lack of such approval increases the risk of errors in payroll and unauthorized overtime.
- The RHA tracks overtime and sick time by facility. Departments within facilities analyze the department’s labour costs through monthly financial reports. However, the monthly financial reports did not always explain differences between the actual and budgeted labour costs.
- The payroll system has the capacity to identify and record overtime costs by cause (e.g., sick leave replacement, workload, etc.). A report indicated that the highest cause of overtime was workload pressures, then sick relief, and so on. However, senior management does not receive such information. Reviewing such information could provide management an opportunity to help address how best to control overtime costs.
- The Sunrise Regional Health Authority should:
- ensure its nursing managers or other authorized staff follow established policies to review and approve nursing staff timesheets.
- identify and regularly report to the Board the causes of nursing staff overtime costs.
- implement established strategies for addressing causes of nursing staff overtime costs and provide regular progress reports to the Board.