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Cayman Islands Government

HSA CEO Appointed

HSA Chief Executive Officer Mrs Lizzette Yearwood

HSA Chairman, Pastor Al Ebanks, Announcement of appointment of CEO

March 4, 2009

The purpose of this news conference is primarily to announce the appointment of a new Chief Executive Officer of the Health Services Authority, however before making the official announcement I want to first take the opportunity to update you on the progress we have made over the last four years, since my initial appointment as Board Chairman.

Many of you will recall in 2005 and 2006 almost daily newspaper headlines and media report about the untenable state of affairs of the H.S.A. which had caused a loss of public trust and confidence in the hospital; low staff morale; exodus of employees and lack of stable leadership was the unfortunate norm.

A sampling of the headlines and editorials at the time read:

  • HSA finances in a 'terrible mess'
  • Hospital staff in crisis
  • H.SA. in disarray

To further illustrate the magnitude of the problems at the time, consider the sobering comments made in a report of the Auditor General before our taking office: "Had this been a business, we would have filed for bankruptcy long ago."

I've raised all these matters not to point fingers or cast blame at anyone but to set in context where the H.S.A was a few short years ago and to make some comparison to where we are today.

I am mindful of the challenges faced by previous Boards; including the lack of adequate funding for the start-up of the Authority; difficult and probably unrealistic timeframes which were established in transitioning from a government department to a statutory body and ongoing shortfalls in budgetary support which is also a challenge for this current Board as we struggle to maintain the H.S.A as a viable entity and fulfill our legal obligations as prescribed in the H.S.A. Law.

When I took over as Chairman in 2005, I was confident we could make a positive difference in spite of the enormity of the challenges that we faced. We had great confidence in the staff and high hopes for the organization and remained undaunted and committed in our belief that the magnitude of the problems was not beyond our collective ability to deal with and restore the public trust and confidence in the organization.

What was noteworthy was the dedicated team of employees at every level who were committed to the H.S.A, despite its challenges. Many were hopeful and unwavering in their confidence that the organization had the ingredients for success.

The Board recognized that if we were to realize the turn-around which was necessary three fundamental things had to be done, that is to restore the trust, morale and loyalty of the staff and the public in the organization. Secondly, we needed to rebuild the Senior Management Team as there was no permanent CFO, CNO, HR Director, Revolving Medical Directors and of course the ever present challenge of a CEO. In six years an equal number of persons have filled this role.

Thirdly, equal priority had to be given to putting in place proper financial controls to stop the hemorrhaging that was taking place and to be able to both define and defend the budgets and management of the organization as would reasonably be required for any other company functioning or doing business in the Cayman Islands.

We immediately began a series of consultations with employees at every level, including an employee satisfaction survey, to get their feedback about the organization and how we can, as a Board, management and staff jointly effect the turn-around which was necessary. There was much skepticism among many but equally almost immediately a sense of belonging and restoration of pride by employees in being part of an organization in which their views and suggestions were being heard and considered.

While there have been resignations from the Authority since our initial appointment as a Board, employee retention levels at the H.S.A appear to be consistent with the normal ebb and flow of other organizations in the Cayman Islands.

Importantly, in spite of a global shortage of healthcare professionals the Health Services Authority has been able to attract and retain some of the best qualified, competent and skilled professionals to work in the Cayman Islands.

Restoring fiscal prudence in the authority's financial management was a significant priority for the Board, and I must here acknowledge the significant contributions of fellow Board Members, Mr. Peter Gough, Mrs. Anne Owens, Mr. Charlie Watler, Mr. Canover Watson and of course the dedicated H.S.A. finance staff.

The state of the H.S.A's finances up to 2005 has already been well reported so I won't spend much time going back over the history except to again set in context the achievements made over the past four years by highlighting the fact that when the Board took office in 2005 there were no substantial financial reports for the Authority, despite its legal requirement in the HSA Law, and no consistent financial records maintained on which to conduct a proper financial audit.

In the years since, through effective Board management and oversight, we have been able to turn-around the finances of organization and are now providing timely financial reports to the Auditor General and maintain compliance with the reporting regulations of the Public Management Finance Law.

It is also important to note that during this period the H.S.A has made considerable progress in addressing its financial viability as evidenced by the reduction in our operating losses by more than $6m since 2005.

For the first time since the transition to an Authority accurate budget forecasts which have the confidence of the Board, have been prepared which provide credible data on which proper forward planning informed and firm decisions can be arrived at and reasonable projections made.

Our initiatives at prudent financial management have been deliberate in ensuring the sustainability of the organization in accordance with the legal requirements of the H.S.A Law whilst guaranteeing the delivery of quality patient care is not affected.

Some of these included:

  • increased efficiency to ensure that all expenditure is within budget.
  • adjustments in the fees for some services in line to better reflect the cost of providing the services
  • implementation of a new and comprehensive chargemaster system in keeping with international best practices.
  • Referral of delinquent patient accounts to collection agency after 90 days of non-payment to improve collections and reduce liability on the H.S.A's books

Whilst we have made significant strides in many of these areas, we recognize our efforts are continuous and the Board, management and staff are engaged in periodic reviews to ensure that our mission of a financially viable and patient focused organization is being maintained.

Whilst we have been prudent in our financial management, like most other business entities we are increasingly challenged by the current global economic recession and resulting workforce reductions in the Cayman Islands which is already evident in declining revenues; increases the number of persons being unable to pay for healthcare services; tightening of credit arrangements by suppliers which depletes our cash reserve and requires upfront payment for goods and services.

The Board is already actively reviewing all aspects of our operations to ensure that the quality of patient care is not impacted and we have been in discussions with the Ministry regarding the evidence and research that has shown funding for healthcare cannot be sacrificed in times of economic crisis. It is only natural to expect that in these difficult times that more people will seek healthcare services due to mental stress or stress related problems which further complicate their medical condition.

With no immediate indicators forecasting any positive change in the economic environment we can only expect further job losses in both the public and private sector and declining revenue. However, we believe that healthcare is too important a national issue and the implications are far reaching if adequate funding is not provided by reprioritizing expenditure, even more so in the prevailing economic climate.

We are confident that the government will take the necessary action, and even amidst the prevailing difficult economic situation provide the required funding to ensure safe and quality patient care to the people of these islands.

Ladies and Gentlemen, whilst the Board has provided the strategic leadership necessary for the organization's turn-around over the last four years, we cannot take sole credit for the achievements which have been made and here I want to commend the management and staff of the organization for their commitment, professionalism and unwavering faith in the success of the H.S.A and without whose support many of the things we have been able to accomplish would not have been possible.

As Chairman and with the full support of the Board I would like to make special mention of the outstanding leadership of Mrs. Lizzette Yearwood as Acting Chief Executive Officer over the last two and a half years, under her stewardship much of the record of success which I alluded to earlier was achieved.

She has been a unifying force, a positive role model and a calm, knowledgeable professional in providing the Board with sound advice in its decision making as well as at the senior management level and in her interactions with staff and patients.

During her tenure there has been a welcomed rebirth and fundamental transformation in the trust, confidence and working relationship between the Board and the executive leadership of the H.S.A. as well as with our business partners and the public.

By any barometer including your own reporting of matters pertaining to the H.S.A I am sure you will agree that the past two and a half years of the H.S.A have been the most stable period for the Authority, under her leadership and direction.

Mrs. Yearwood has been instrumental in guiding the H.S.A during some of the most dynamically changing and challenging times and has shown a remarkable ability to provide steady leadership in meeting the many challenges and opportunities which we have dealt with during her tenure as Acting CEO.

She took the helm of the organization for an initial period of six months and at a time when many would have easily shied away from such responsibility given the frequent changes and instability in the leadership of the organization. This was made even more challenging by the fact that she was also pursuing full time graduate studies. Nonetheless she demonstrated a capacity to balance both these demanding responsibilities, performing admirable under extreme pressures and deadlines whilst carrying out her responsibilities.

With her performance over the years, her extensive experience in healthcare as a practitioner and an administrator, leadership abilities, passion for patient care, as well as her astute awareness of the global healthcare environment and especially the Caymanian context. Along with her track record of accomplishments, in the circumstances the Board believed it was the right and reasonable thing to do and agreed to confirm her to the post as Chief Executive Officer of the Health Services Authority; an appointment which has also been endorsed by the Minister of Health.

I am therefore pleased to announce this morning the appointment of Mrs. Lizzette Yearwood as Chief Executive Officer of H.S.A. effective February 1, 2009.

Her appointment demonstrates our commitment to succession planning and the professional development of Caymanians within the health services.

The Board is confident that her dedication and commitment will serve the organization well and we remain confident that with her strong, capable, compassionate and stable leadership and the continued commitment of the staff the H.S.A we will continue to build on the successes thus far achieved and will have a bright future.

Chief Executive Officer of the Health Services Authority Mrs. Lizzette Yearwood Remarks

Thank you Pastor Al for your kind comments and for your leadership as Board Chairman over these years; and acknowledge as well as the support of the other members of the Board who have dedicated considerably voluntary time and effort in continuing our mission of making the H.S.A a fiscally responsible and high quality healthcare provider in the Cayman Islands.

As Pastor Al mentioned, in October 2006 when I was asked to temporarily fill the vacant post of Chief Executive Officer I did so reluctantly because of the untenable state of affairs which had resulted in the loss of public confidence, low staff morale, and a high turn over of staff including senior leadership.

Inspite of these challenges and my initial apprehension about taking on the role I knew that we needed someone inside the organization to step up and bring much needed stability to the H.S.A.

After 13 years working with the organization, at various levels, and knowing the capability and commitment of the staff as well as the goodwill and support of the community and the genuine desire of the Board to see the organization progress I was convinced that the H.S.A could once again become a place where the staff and the community could all be proud of.

Even with that I had to be sure that my decisions were in full alignment with God's plans and after much prayer and the support of my husband, daughter, family as well as the wider community, Board and as a young Caymanian who remains passionate about service to country I agreed to accept the interim post.

And now as we reflect on those 2 years and compare the progress of organization I am quickly reminded that it is only by the grace of God and some very resilient and devoted staff, who were empowered to do what they do best, that we have regained the trust and support of the community and are ready to do great things.

I emphasize the community because it is only through continued partnership with both the political, business, civic, social and all other important stakeholders in the community that we will continue to raise the standard of health care in these islands and make H.S.A. a centre of excellence.

As Pastor Al mentioned, the H.S.A. is not devoid of its challenges but I am confident that with a very engaged work force, the continued support of the Board, government and community we are able to withstand the challenges on the horizon.

We have a competent and dedicated leadership team and staff at every level who are passionate about healthcare and the H.S.A which were the key to realizing many of the achievements which Pastor Al mentioned earlier and I am confident that together we will make the H.S.A a medical centre of excellence and the place where all residents of these islands turn to first for their healthcare.