Outstanding Recommendations – Auditor General Report, April 2010

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Health and Wellness and Agriculture and Rural Development

The following recommendations are outstanding and not yet ready for follow-up audits:

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Food Safety: Integrated food safety planning and activities—October 2009, no. 11, p. 107

(repeated once since October 2006)

We again recommend that the Departments of Health and Wellness and Agriculture and Rural Development, in

cooperation with Alberta Health Services and federal regulators, improve planning and coordination of food safety

activities and initiatives. This includes:

• each provincial ministry de

fining its own food safety policies, objectives and measures (satisfactory progress)

• coordinating provincial food safety policies and planning so initiatives are integrated (satisfactory progress)

• ensuring provincial approaches align with initiatives being developed through federal/provincial/territorial

committees (satisfactory progress)

• improving day-to-day coordination of provincial food safety activities

• encouraging the joint application of HACCP and HACCP related programs in Alberta, and (satisfactory

progress)

• improving cooperation and working relationships among provincial and federal partners such as the First

Nations and Inuit Health Branch and the Canadian Food Inspection Agency

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Food safety: Accountability—October 2009, no. 13, p. 114

(repeated once since October 2006)

We again recommend that the Departments of Health and Wellness and Agriculture and Rural Development

improve reporting on food safety in Alberta.

Health and Wellness, Agriculture and Rural Development and Alberta Health Services

Management has identi

fi ed this recommendation as implemented—to be confi

rmed with a follow-up audit:

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Food safety: Eliminating gaps in food safety inspection coverage—October 2009, no. 12, p. 111

(repeated once since October 2006)

We again recommend that Alberta Health Services and the Departments of Health and Wellness and Agriculture

and Rural Development, working with federal regulators, eliminate the existing gaps in food safety coverage in

Alberta. Gaps include:

• mobile butchers

• consistently administering the

Meat Facility Standard

• coordinating inspections in the “non-federally registered” sector

Implementing the Provincial Mental Health Plan—The accountability framework—April 2008, no. 4, p. 77

We recommend that the Department of Health and Wellness ensure there is a complete accountability framework

for the

Provincial Mental Health Plan

and mental health services in Alberta.

Compliance monitoring activities—October 2008, no. 35, p. 300

We recommend that the Department of Health and Wellness complete a comprehensive risk assessment and

develop a risk based plan to improve the effectiveness of its compliance-monitoring activities.

Electronic health records: Project management—October 2009, no. 7, p. 75

We recommend the Department of Health and Wellness execute publicly funded electronic health record proje cts

and initiatives in accordance with established project management standards.

Electronic health records: Monitoring the electronic health records—October 2009, no. 8, p. 78

We recommend the Department of Health and Wellness proactively monitor access to the portal (Netcare),

thr ough which the electronic health records can be viewed, reviewing it for potential attacks, breaches and system

anomalies.

Electronic health records: User access management—October 2009, p. 80

We recommend that the Department of Health and Wellness ensure that its user access management policies are

followed and that user access to health information is removed when access privileges are no longer required.

Accountability for conditional grants—October 2009, p. 252

(repeated twice since October 2002)

We again recommend that the Department of Health and Wellness improve its control processes to ensure

account ability for conditional grants.

Management has identi

fi ed this recommendation as implemented—to be confi

rmed with a follow-up audit:

Monitoring infection prevention and control processes (compliance monitoring activities)—

October 2009, p. 248

We recommend that the Department of Health and Wellness examine and clarify the role of its Compliance

Assur ance Branch in the implementation and execution of infection prevention and control compliance monitoring

in Alberta.

Health and Wellness and Agriculture and Rural Development

The following recommendations are outstanding and not yet ready for follow-up audits:

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Food Safety: Integrated food safety planning and activities—October 2009, no. 11, p. 107

(repeated once since October 2006)

We again recommend that the Departments of Health and Wellness and Agriculture and Rural Development, in

cooperation with Alberta Health Services and federal regulators, improve planning and coordination of food safety

activities and initiatives. This includes:

• each provincial ministry de

fi

ning its own food safety policies, objectives and measures (satisfactory progress)

• coordinating provincial food safety policies and planning so initiatives are integrated (satisfactory progress)

• ensuring provincial approaches align with initiatives being developed through federal/provincial/territorial

committees (satisfactory progress)

• improving day-to-day coordination of provincial food safety activities

• encouraging the joint application of HACCP and HACCP related programs in Alberta, and (satisfactory

progress)

• improving cooperation and working relationships among provincial and federal partners such as the First

Nations and Inuit Health Branch and the Canadian Food Inspection Agency

3+

Food safety: Accountability—October 2009, no. 13, p. 114

(repeated once since October 2006)

We again recommend that the Departments of Health and Wellness and Agriculture and Rural Development

improve reporting on food safety in Alberta.

Health and Wellness, Agriculture and Rural Development and Alberta Health Services

Management has identi

fi ed this recommendation as implemented—to be confi

rmed with a follow-up audit:

3+

Food safety: Eliminating gaps in food safety inspection coverage—October 2009, no. 12, p. 111

(repeated once since October 2006)

We again recommend that Alberta Health Services and the Departments of Health and Wellness and Agriculture

and Rural Development, working with federal regulators, eliminate the existing gaps in food safety coverage in

Alberta. Gaps include:

• mobile butchers

• consistently administering the

Meat Facility Standard

• coordinating inspections in the “non-federally registered” sector

Departments of Health and Wellness and Alberta Health Services

The following recommendations are outstanding and not yet ready for follow-up audits:

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Seniors care: Effectiveness of services in long-term care facilities—October 2005, no. 7, p. 59

We recommend that the Department of Health and Wellness and Alberta Health Services, working with the

Department of Seniors and Community Supports, assess the effectiveness of services in long-term care facilities.

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Seniors care: Effectiveness of services in long-term care facilities—October 2005, no. 8, p. 59

We recommend that the Department of Health and Wellness, working with the Department of Seniors and

Community Supports, collect suf

fi

cient information about facility costs from Alberta Health Services and long-term

care facilities to make accommodation rate and funding decisions.

Implementing the Provincial Mental Health Plan: Implementation systems—April 2008, no. 3, p. 72

We recommend that the Department of Health and Wellness, working with other mental health participants,

strengthen implementation of the

Provincial Mental Health Plan

by improving:

• implementation planning

• the monitoring and reporting of implementation activities against implementation plans, and

• the system to adjust the

Plan

and implementation initiatives in response to changing circumstances

Mental health: Standards—October 2008, no. 16, p. 162

We recommend that the Department of Health and Wellness and Alberta Health Services create provincial

standards for mental health services in Alberta.

Mental health: Funding, planning, and reporting—October 2008, p. 186

We recommend that the Department of Health and Wellness and Alberta Health Services ensure the funding,

planning, and reporting of mental health services supports the transformation outlined in the

Provincial Mental

Health Plan

as well as system accountability.

Mental health: Aboriginal and suicide priorities—October 2008, p. 190

We recommend that the Department of Health and Wellness and Alberta Health Services consider whether the

implementation priority for aboriginal and suicide issues is appropriate for the next provincial strategic mental

he alth plan.

Electronic health records: Oversight and accountability for electronic health records—

October 2009, no. 6, p. 73

We recommend that the Department of Health and Wellness and Alberta Health Services, working with the

Electronic Health Records Governance Committee, improve the oversight of electronic health record systems by:

• maintaining an integrated delivery plan that aligns with the strategic plan

• improving systems to regularly report costs, timelines, progress and outcomes

Management has identi

fi ed these recommendations as implemented—to be confi

rmed with follow-up audits:

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Seniors care: Compliance with Basic Service Standards—October 2005, no. 6, p. 58

We recommend that the Department of Health and Wellness and Alberta Health Services, working with the

Department of Seniors and Community Supports, improve the systems for monitoring the compliance of long-term

care facilities with the

Basic Service Standards

.

Seniors care: Information to monitor compliance with legislation—October 2005, p. 61

We recommend that the Department of Health and Wellness, working with Alberta Health Services and the

Department of Seniors and Community Supports, identify the information required from long-term care facilities to

enable the Departments and Authorities to monitor their compliance with legislation.

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Seniors care: Determining future needs for services in long-term care facilities—October 2005, no. 9, p. 62

We recommend that the Department of Health and Wellness, working with Alberta Health Services and the

Department of Seniors and Community Supports, develop a long-term plan to meet future needs for services in

long-term care facilities. We also recommend that the Departments publicly report on progress made towards

goals in the plan.

Seniors care: Determining future needs for services in long-term care facilities—October 2005, p. 62

We recommend that the Department of Health and Wellness require Alberta Health Services to periodically upd ate

and report on progress implementing their ten year continuing care strategic service plans.

Food safety: Tools to promote and enforce food safety—October 2006, vol. 1, p. 83

We recommend that Alberta Health Services and the Department of Health and Wellness consider a wider range of

tools to promote and enforce food safety.

Alberta Health Services

The following recommendations are outstanding and not yet ready for follow-up audits:

Mental health: Housing and supportive living—October 2008, no. 17, p. 164

We recommend that Alberta Health Services encourage mental health housing development and provide

supportive living programs so mental hea lth clients can recover in the community.

Mental health: Concurrent disorders—October 2008, no. 18, p. 168

We recommend that Alberta Health Services strengthen integrated treatment for clients with severe concurrent

disorders (mental health issues combined with addiction issues).

Mental health: Not-for-pro

fi t organizations—October 2008, p. 169

We recommend that Alberta Health Services improve relationships with not-for-pro

fi

t organizations to provide

better coordinated service delivery.

Mental health: Gaps in service—October 2008, no. 19, p. 171

We recommend that Alberta Health Services reduce gaps in mental health delivery services by enhancing:

• mental health professionals at points of entry to the system

• coordinated intake

• specialized programs in medium-sized cities

• transition management between hospital and community care

Mental health: Provincial coordination—October 2008, p. 176

We recommend that Alberta Health Services coordinate mental health service delivery across the province better

by:

• strengthening inter-regional coordination

• implementing standard information systems and data sets for mental health

• implementing common operating procedures

• collecting and analyzing data for evidence-based evaluation of mental health programs

Mental health: Community-based service delivery—October 2008, p. 181

We recommend that Alberta Health Services strengthen service delivery for mental health clients at regional clinics

by improving:

• wait time management

• treatment plans, agreed with the client

• progress notes

• case conferencing

fi

le closure

• timely data capture on information systems

• client follow up and analysis of recovery

Expense claims and corporate credit cards controls—October 2008, p. 311

We recommend that Alberta Health Services strengthen and follow its policies and processes for employee

exp ense claims and corporate credit cards. We also recommend that Alberta Health Services develop and

implement policies and guidance on appropriate expenses for hosting and working sessions.

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Food safety: Inspection programs—October 2009, no. 9, p. 93

(repeated once since October 2006)

We again recommend that Alberta Health Services improve their food establishment inspection programs.

Speci

fically, Alberta Health Services should:

• inspect food establishments following generally accepted inspection frequency standards

• ensure that inspections are consistently administered and documented

• follow up critical violations promptly to ensure that food establishments have corrected those violations

• use their enforcement powers to protect Albertans from the highest risk food establishments (satisfactory

progress)

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Food safety: Information systems—October 2009, no. 10, p. 99

(repeated once since October 2006)

We again recommend that Alberta Health Services, supported by the Department of Health and Wellness, improve

their automated foo d safety information systems. This includes:

• enhancing system management, security, and access control

• ensuring data consistency

• ensuring that service level agreements are in place

• developing reporting capacity for management and, accountability purposes

Supplementary retirement plans—October 2009, no. 28, p. 260

We recommend that Alberta Health Services review existing supplementary retirement plans and:

• understand the terms and conditions for each plan

• develop clear and consistent policies and processes for administering them

• obtain actuarial valuations, using appropriate and consistent assumptions, for the plans

• understand the impact of funding options

• ensure suf

ficient funds are available to meet plan obligations

Information technology control policies and processes—October 2009, no. 29, p. 2623

We recommend that Alberta Health Services:

• develop an information technology control framework, including appropriate risk management processes and

controls, for the management of its information technology resources

• monitor compliance with security policies, implementing effective change management processes and

improving passwor ds controls

Capital project monitoring systems—October 2009, no. 32, p. 271

We recommend that Alberta Health Services improve the ef

ficiency and effectiveness of its financial capital project

mo nitoring and reporting systems and processes by:

• implementing common systems, policies and procedures to track and monitor key

financial information

• providing relevant, timely and accurate information to Executive Management and the Audit and Finance

Committee

Expenditure policies and approvals—October 2009, p. 277

We recommend that Alberta Health Services improve the ef

fi

ciency and effectiveness of its expense approval

controls by:

• developing and implementing a clear and comprehensive expenditure approval policy

• automating the expenditure controls within the purchasing system

Approval of drug purchases—October 2009, p. 278

We recommend that Alberta Health Services improve controls for drug purchases by ensuring they are properly

approved and duties are appropriately segregated.

Financial operations transition plan—October 2010, no. 19, p. 164

We recommend that Alberta Health Services prepare and implement a formal transition plan for the organization’s

fi

nance operations. The plan should include and integrate the following:

• assessing the resources, timelines and critical path needed to consolidate the general ledger and sub-ledger

systems

• ensuring rigorous change management controls are applied before implementing application system changes

• harmonizing

financial reporting policies and processes across the organization

• determining the adequate amount of human resources and skill levels required to implement the plan and

then keep the processes operational

Effectiveness of insurance reciprocal—October 2010, no. 21, p. 167

We recommend that Alberta Health Services assess the effectiveness of its arrangement with the

Liability and Property Insurance Plan

as a risk management tool, and assess the resulting accounting implications.

Accounting for restricted contributions—October 2010, no. 22, p. 168

We recommend that Alberta Health Services implement consistent and ef

ficient accounting processes for externally restricted contributions to assure the Alberta Health Services Board that it is complying with the

restrictions attached to those contributions.

Year-end

fi nancial reporting processes—October 2010, no. 23, p. 169

(repeated once since October 2009)

We again recommend that Alberta Health Services improve its year-end

financial reporting processes by improving

Management has identi

fi ed these recommendations as implemented—to be confirmed with follow-up audits:

Performance measures for surgical services—October 2001, p. 135

We recommend that Alberta Health Services establish a comprehensive set of outcome-based performance

measures for surgical facility services and incorporate these standards of performance into ongoing monitoring of

contracted facilities.

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Contracting practices: Internal controls—November 2006, no. 1, p. 14

We recommend that Alberta Health Services management improve controls over contracting by:

• ensuring adequate segregation of duties exists over the contracting process

• monitoring and verifying contractors’ compliance with contract terms and conditions

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Contracting practices: Board governance—November 2006, no. 3, p. 17

We recommend that the Board, at least annually, receive reports from management on the design and

effectiveness of the Alberta Health Services internal controls.

Contract documentation—October 2008, p. 312

We recommend that Alberta Health Services develop and implement a sole-sourcing policy for contracts and

ensure that s ole-sourcing is clearly documented and justi

fied. We also recommend Alberta Health Services—

Peace Country Health ensure contract amendments, including changes to deliverables, are documented and

agreed to by both parties.

Physician recruitment incentives—October 2009, p. 279

We recommend that Alberta Health Services improve controls for physician recruitment incentives by developing

and impleme nting a policy that identi

fies:

• criteria and approvals required for granting loans, income guarantees and relocation allowances

• monitoring and collection procedures for physician loans

Capital project funding and approval—October 2009, no. 31, p. 269

We recommend that Alberta Health Services:

• obtain appropriate approval from the Minister of Health and Wellness and secure adequate capital funding

before start ing capital projects that are internally funded or debt

financed

• ensure budgets include the estimated future operating costs associated with new capital

Funding agreements for capital projects—October 2010, no. 20, p. 166

We recommend that Alberta Health Services ensure that funding agreements are signed prior to commencement

of construction of capital projects, and are formally amended when there are signi

ficant changes in the scope of a

capital project.

Alberta Health Services, Health and Wellness and Agriculture and Rural Development

Management has identi

fi ed these recommendations as implemented—to be confi

rmed with follow-up audits:

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Food safety: Eliminating gaps in food safety inspection coverage—October 2009, no. 12, p. 111

(repeated once since October 2006)

We again recommend that Alberta Health Services and the Departments of Health and Wellness and Agriculture

and Rural Development, working with federal regulators, eliminate the existing gaps in food safety coverage in

Alberta. Gaps include:

• mobile butchers

• consistently administering the

Meat Facility Standard

• coordinating inspections in the “non-federally registered” sector

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