A3 TEMPLATE Primary Health Care Strategy

Transcription

1 A3 TEMPLATE Primary Health Care Strategy Title: Primary Health Care Strategy Which prvincial hshin/utcme des this strategy supprt: By 2017, 30% decrease in hspital utilizatin related t 6 cmmn chrnic cnditins Primary Owner (SLT Lead): Karen Earnshaw Team Lead(s) (Leaders f key initiatives): Marci Sctt, Sheila Andersn, Fran Neuls, Expert Advisr (if applicable): Nancy Buchan 1. Prblem Statement (Current state and the reasn fr actin.) [Explain what and hw big the prblem is and why strategic actin is required t address it.] Date f Original Draft: April 1, 2014 Estimated Budget Requirements: Estimated Resurce Requirements: 4. Implementatin Plan (What are the high-level actins that will be taken t address the prblem within the given timeframe? What actins need t be taken t achieve the future state?) [Mre detail can be included in a separate implementatin plan.] Nt everyne in the RQHR has a PHC prvider Unstable/fragile services acrss the RQHR There are underserved ppulatins particularly in RQHR s rural, First Natins and inner city cmmunities PHC t data has nt had sufficient spread althugh there are pckets f prgress in sme areas. There is a lack f cnsistent cmmunicatin N netwrk is established t cnnect r integrate pckets f successful wrk Wrk is still being dne in sils Nt all clients with chrnic disease receive care based n best practice standards as evidenced by high hspitalizatin rates related t chrnic illness. Clients are nt sufficiently empwered t self-manage their care N standard EMR and difficulty in accessing utcme data There is lw physician engagement in RQHR PHC In many areas there is lw cmmunity and team engagement Significant differences exist between urban and rural services There is a need t strengthen relatinships between the RQHR and the First Natins health system. Key Areas t Wrk On (fill ut supprting multi-year summary as well attached) 1. Accuntability Framewrk Begin t establish Urban / Rural PHC Netwrk Design &Service Delivery Mdel Launch Tuchwd Qu Appelle PHC Netwrk Begin t replicate Tuchwd Qu Appelle t enhance Twin Valleys as a Netwrk Refine Meadw/Initiate Central Regina Mdel Line (Meadw, Fur Directins, Family Medicine Unit, etc.) Begin t realign RQHR primary healthcare resurces int inter-disciplinary teams in Regina, fcusing n team building, thrugh the develpment and implementatin f a rerganizatin transitin plan. (E.g.Nrth Netwrk beginning with Nrthgate Medical Centre, Staplefrd Medical Clinics) Wh PHC/K. Earnshaw F. Neuls/D Drummnd F. Neuls/M. Petrychyn/N.Buchan/ M Sctt S. Andersn/ L Tratch/M. Sctt/ N. Buchan S. Andersn/L. Tratch/M Ingjaldsn/N. Buchan/ M. Sctt/ T Kuhtz Date Initiate May 8/14 fr Urban Cmplete Sept 30/14 Initiate May 8/14 Establish Standard Physician Cmpact /legal agreements PSA/PHC Establish Dyad Accuntability Framewrk PSA/PHC/Karen E./ Dr. McCutchen Establish standard wrk fr Chrnic Disease Preventin and Management using the Expanded Chrnic Care mdel as a framewrk. M. Sctt/N. Buchan/ F. Neuls/M Petrychyn/ S Andersn/ L. Tratch/ M. Ingjaldsn/ C Benz-Tramer/T Initiate Apr 10/14

2 Diener/ D. Drummnd/ U. Parris 2. Human Resurces Physician Resurce Plan Mre fully understand demand fr FP services. MOH/Practitiner Staff Affairs/PHC Finalize PHC Organizatin Structure (Cnry Rss) K. Earnshaw / PHC Executive team T SLT May 13/14 Initiate Transitin Plan Phase 1 Initiate Transitin Plan Phase 2 Initiate July/14 Initiate Nv/14 PHC netwrks staffing resurce plan Cmplete PHC human resurces Inventry Undertake needs assessments Rerganize int interdisciplinary teams Cntinue t study the demand Pl resurces and level lad T. Kuhtz/ PHC Executive team May 15/14 Onging Physician Engagement Plan Establish and implement a plan that cntinues relatinship building with physicians that supprts including principles f equality and transparency and supprts implementatin f EMR, CDM-QIP, and knwledge building f the Urban and Rural Netwrks. Thrugh participatin in knw yur practice.knw the interdisciplinary teams.knw the netwrk Wrk with RQHR physician partners and PSA t request strengthened supprt frm SMA and CPSS, including cmpetencies and expectatins fr team wrk and pling resurces. PHC Executive team/ PSA/ Physician Dyads Initiate Apr 10/14/ Onging Urban and Rural Kaizen Plans using Ministry f Health Mdel Line Plan as the fundatin fr develpment. Team Develpment (Lean, scpe f practice, leadership develpment, ther) PHC Leadership team PHC Leadership team Onging Onging 3. Facilities (and/r ther majr infrastructure requirements) Facility rerganizatin (5S, Kanban, 7 Flws f Medicine, etc.) Frt Q BICC SJICC WMICC N.Buchan/E.D s/d s F. Neuls/ D. Drummnd/ Facilities F.Neuls/M.Petrychyn/ Cmplete March 2015

3 Msmin (Kanban Prvincial Mdel Line) Facilities F.Neuls/Urica Parris/3sHealth Technlgy ( IT/IM/Heath Technlgies/Equipment)/ Measurement Implement EMR Tuchwd Qu Appelle Nrth Netwrk practices Twin Valleys All sites identified fr participatin in Central Netwrk. Rural enhanced telehealth Data plan Identify gaps eg: data fr cnsistent reprting Identify existing pls f data available fr access IT/eHealth / PHC /Ministry f Health I.T./F Neuls/Rural EDs ehealth/i.t./ PHC Managers, teams Apr/14 CDM-QIP rll-ut t PHC physicians/ NPs ehealth/i.t./phc Training cmplete May/14 Hme Care I.T. Review S. Andersn/M. Ingjaldsn/I.T. Cmplete June/14 4. Plicy/Legislatin E.g. Pint f care testing Physician payment fr alternative types f visits Legislatin fr dcumentatin f health recrds Funding mdel Unin relatins Prvincial/federal jurisdictin Interprfessinal Practice Issues 5. Budget Identify budget implicatins f new PHC rganizatin structure Determine budget implicatins f varius Actin Items Realign budgets accrding t new PHC rganizatin structure 6. Develp and Implement Marketing & Cmmunicatins Strategy Cmmunity Engagement Intersectral Engagement Relatinship develpment First Natin & Metis Engagement Etc. MOH/ K. Earnshaw/ M. Sctt PHC/Finance M Jhnsn/RQ Cmmunicatins/KPO Cmmunicatins Cnsultants Onging

4 7. Other Begin t think and act as ne within RQHR arund Chrnic Disease Preventin and Management Link t 2014/15Hshin arund ED Pt flw, Link t Senirs, Link t access t Specialty Care and Diagnstics Establish tl with system f patient flw that allws t measure physician accuntability and apprpriateness Varius assigned Task Teams Initiate March/14; Cmplete March /15 (Fr strategies f large scale this sectin can be supplemented by prject plans r ther plan template. See example f Multi-Year Plan template the MOH is using.) 2. Rt Cause Analysis (What is causing the prblem and what evidence can be prvided t supprt the analysis?) [Highlight baseline data and analysis that helps clarify the magnitude f the prblem statement and narrws the fcus fr the future state sectin. What are the barriers impeding change r success?] 5. Metrics (Hw will yu knw whether the prject is successfully mving twards the future state? Hw will yu knw a change has been an imprvement?) [Identify bth utcme and prcess metrics that will help indicate the prject success and include balancing measures t ensure the prject desn t negatively affect ther metrics. These shuld relate t the actins nted abve in the implementatin plan sectin] In certain areas f the RQHR There is a perceived lack f trust and cnfidence with the health care system a perceptin that the RQHR is wrking t reduce services Cmmunities tend t be fcused n their wn needs versus a cperative apprach; There are deep and histrical divisins between cmmunities The new apprach t PHC develpment will require a significant cmmitment n the part f RQHR leaders and staff particularly arund engagement, cmmunicatin, innvatin and leading and supprting transfrmative change. An pprtunity exists fr RQHR t cntinue t cllabrate with All Natins Healing Hspital/File Hills Tribal Cuncil, ther tribal cuncils within RQHR and members f First Natins and Metis cmmunities. Several barriers t interprfessinal team cllabratin exist. Many physicians functin independent f /are nt integrated with the RQHR health care delivery system, which limits access and team-based care. Many RQHR Family Physicians are nt aware f pprtunities t becme engaged in PHC initiatives under the new prvincial PHC framewrk. Physician services cntinue t be unstable and fragile There is an verall shrtage f health care prfessinals in rural Saskatchewan. The traditinal care delivery system inhibits access t care as des expectatins in hw care shuld be received and delivered. N frmal linkage exists between RQHR CDM prgrams and PHC teams. Peple are nt always getting care in a timely manner, in the right settings, r by the mst Shrt Term Gal: By March 31, 2015, 100% f PHC teams will be using the patient experience survey. Lng Term Gal: By March 31, 2017, there will be a 50% imprvement in the number f peple wh say, I can access my Primary health Care Team fr care n my day f chice either in persn, n the phne r via ther technlgy. Shrt Term Gal: By March 31, 2015, 25% f family physicians are using an EMR and the CDM-QIP. By March 31, 2020, 80% f patients with six cmmn chrnic cnditins (diabetes, crnary artery disease, chrnic bstructive pulmnary disease, heart failure, depressin and asthma) are receiving best practice care as evidenced by the cmpletin f prvincial flw sheets available thrugh apprved electrnic medical recrds EMR and the EMR viewer Shrt Term Gal: By March 31, 2015, there will be a decrease in the number f admissins t hspital fr the targeted ht sptting patients selected frm the tp 1% list fr RQHR (t be further defined by the RQHR ht sptting team). Lng Term Gal: By March 31, 2017, peple living with chrnic cnditins will experience better health as indicated by a 30% decrease in hspital utilizatin related t six cmmn chrnic cnditins (diabetes, crnary artery disease, chrnic bstructive disease, depressin, heart failure and asthma. Shrt Term Gal: By March 31, 2015, there will be an increase in the number patients attached t a PHC team in the Central Netwrk and a decrease in the number f patients living in the Central Netwrk visiting the ER (targets t be defined n May 8 th, 2014). Lng Term Gal: By March 31, 2017, n patient will wait fr care in the emergency department. / At least 85% f patients requiring admissin frm emergency department are admitted t an apprpriate bed within 5 hurs. Shrt Term Gal: By March 31, 2015, there is a 5% increase in capacity f hme care, including prviding supprt t senirs living in the cmmunity. Lng Term Gal: By March 31, 2017, the number f clients with a Methd f Assigning Pririty Levels (MAPLe) scre f three t five living in the cmmunity supprted by hme care will increase by 2 %. By March 31, 2015, increase hme care utilizatin and clients in the three pilt RHAs by 5%. Shrt Term Gal: By March 31, 2015, participate in the develpment f a prvincial mdel fr apprpriate referral t

5 apprpriate prvider. Many PHC prviders dn t always knw the best practices fr dealing with Mental Health and Addictins issues. There is a strng crrelatin between chrnic disease and depressin/anxiety. Supprting Data: Hspitalizatin fr 6 Chrnic Cnditins as f June 2013: 70 per 100,000 COPD 40 per 100,000 Depressin 30 per 100,000 CHF 15 per 100,000 Diabetes <10 per 100,000 Asthma / CAD CTAS 4s and 5s as f February 2014: CTAS 4 CTAS 5 Ttal # f Visits RGH Pasqua All Natins Healing Hspital Msmin n/a n/a n/a diagnstics and specialists in ne r tw clinical areas. N lng term gals have been set by the Ministry at this time. Shrt Term Gal: By March 31, 2015, participate in the develpment f a prvincial apprpriateness framewrk strategy, implementatin plan and accuntability mechanisms. / By March 31, 2015, participate in the develpment f methds fr data analysis and reprting mechanisms t capture and analyze baseline data. Lng Term Gal: By March 31, 2018, there will be a 50% reductin in inapprpriate services. Shrt Term Gal: By March 31, 2015, PHC Service Line will meet the reductin in straight time and premium csts, straight time and premium hurs, sick time csts and sick time hurs as defined by RQHR Human Resurces. Lng Term Gal: By March 31, 2017, as part f a multi-year budget strategy, the health system will bend the cst curve by lwering status qu grwth rate by 1.5% per year. Shrt Term Gals: By March 31, 2015, all RQHR facilities within the Central Urban Netwrk and the Tuchwd Qu Appelle will have cmpleted 5s and Kanban and using EMR; Frt Qu Appelle, Balcarres and Lestck Primary Health Care Facilities will have been aligned with the 7 flws f medicine. By March 31, 2015, Msmin Integrated Health Care Facility will becme a Kanban Prvincial Mdel Line. Lng Term Gal: By March 31, 2015, equipment and facility renewal planning prcesses will be develped t ensure a crdinated and integrated prvincial apprach. Shrt Term Gal: By March 31, 2015, PHC Service Line will meet the target fr reductin in lst time claims as defined by RQHR Human Resurces. By March 31, 2015, there will be a reductin in cnfidential ccurrences reprted t the Ministry f Health (further defined n May 8 th, 2014). Lng Term Gal: T achieve a culture f safety, by March 31, 2020, there will be n harm t patients r staff. Additinal Measures Include: -# f hme care patients shwing a MAPLe Scre three t five. -# f hme care clients. -# f hme care units f service. -Incidence f ver-capacity in hme care. -Hme care service cancellatins; by prvider and client -TNAA fr PHC teams in Central and Tuchwd Qu Appelle -# f visits t Tuchwd Qu Appelle -% f staff trained in Kaizen Basics -% f staff trained in Hand Hygiene. -Flu vaccinatins (during seasn) -Falls, Med Rec, Med Errrs -Rural LTC (Urban is mnitred in anther prtfli) Newly ccurring pressure ulcers Wrsening pressure ulcers Wrsening cntinence Daily Physical Restraints Use f antipsychtics withut a diagnsis f psychsis. Wrsening Pain

6 -% f Saskatchewan residents wh are cnnected t a family physician r primary health care team as their usual prvider f care. (This needs t be defined and balanced with available f prviders and attendance by clients). -% f emergency department visits that are scred as Level 4 r 5 n the Canadian Triage Acuity Scale (CTAS). Nte: CTAS scres are used in RQHR as a methd fr ding a rapid priritizatin f patients visiting the ER within a perid f time. It is nt intended t be a measure f whether r nt the patient requires ER services r a measure f perfrmance fr primary healthcare services. -Shrt Term Gal: By March 31, 2015, there will be a decrease in rural physician turnver t 8% frm 18.1%. Lng Term Gal: By March 31, 2017 increase rural physician supply by 33%. (These targets will need t be discussed further) 3. Target Statement (Describe the future state by March 31, 2015.) 6. Engagement (Hw is this plan infrmed by the principles f Patient and Family Centred Care and hw are patients and families being engaged in the wrk? Please als explain hw physicians are being engaged as well as any ther necessary stakehlder.) See Sectin 5. Metrics Physician Engagement: Physician/PHC Exec Directr Dyads Physician engagement in the develpment f netwrks Cmmunicatins Strategy- with specific strategies fr engagement f physicians Dept f Family Practice bth urban and rural Offer t get t knw yur practice Patient/ Cmmunity Engagement: Patient Experience Surveys Lcal advisry cmmittees where applicable Annual Twn Hall meetings where applicable RQHR PHC Cmmunicatins Strategy RIC cmmittees

7 Multi-year Summary Which prvincial hshin/utcme des this strategy supprt: Reduce acute care admissins fr Chrnic Disease. Imprvement Targets: Reduce acute care admissins fr Chrnic Disease by 30% by Hshin r Shrt Term Target: ED Wait / Pt. Flw Key Areas Key stakehlders and partners Key Areas Key Areas Key Areas Accuntability Framewrk Establish Urban / Rural PHC Netwrk Design &Service Delivery Mdel Establish Standard Physician Cmpact /legal agreement Establish Dyad Accuntability Framewrk Develp chrnic disease service mdel based n the Framewrk and Accreditatin Canada Standards. PHC/Karen E. MOH/PSA PSA PHC/Karen E./Dr. McCutchen Accuntability Framewrk Phase tw Netwrk implementatin (frntline staff wrking n different teams alignment t Netwrk Directrs) Cntinue t wrk tward establishing a standard physician cmpact (including cmpensatin issues, regulatins, perfrmance) All physicians understand the Dyad Accuntability Framewrk. Develping cmmunity based service delivery mdel. Key stakehlde rs and partners Accuntability Framewrk Phase three Netwrk implementatin (wrking differently crss-functinal) Dyad physicians wrk alng side Administratin in the cmmunity by making decisins and influence their clleagues. Supprt and influence the success f alternate payment cntracts. Supprt and mnitr fee fr service remuneratin mdels. Implementing the chrnic disease service mdel and beginning t evaluate urselves against accreditatin Key stakehlde rs and partners Accuntability Framewrk Phase three implementatin (wrking differently crss-functinal) Dyad physicians leading change. Evaluate alternate payment cntracts and fee fr service remuneratin mdels fr effectiveness. Evaluating urselves against accreditatin standards fr Chrnic Disease Preventin and Management and Primary Healthcare. Key stakehlders and partners

8 Human Resurces Physician Resurce Plan / Physician Engagement Plan PHC netwrks staffing resurce plan PHC Organizatin Structure (Cnry Rss) Team Develpment (LEAN, Scpe f practice, leadership develpment, ther) MOH/Practitiner Staff Affairs/PHC Karen E./ PHC Executive team Human Resurces Physician Resurce Plan engage, recruit, retentin, expectatins and cntract management. Explre cmpensatin mdels and invlve Physicians in the develpment f the PHC netwrks. PHC netwrks staffing resurce plan understand ur current human resurces, identify gaps and start addressing the gaps (i.e. lad levelling, regig teams) evlutin strategy. Develp standard prgrams/services acrss teams and netwrks in the space prvided and resurces available. PHC Organizatin Structure well established in new rles. Team develpment facilitatin and team learning standards fr Chrnic Disease Preventin and Management and Primary Healthcare. Human Resurces Cntinue Physician Resurce Plan Start t use ur resurces differently in ther areas f Primary Healthcare (i.e. Rural acute care t primary healthcare) Develp service and prgram standards and principles acrss teams and netwrks in the space prvided and resurces available. Human Resurces Cntinue Physician Resurce Plan Use ur resurces differently in ther areas f Primary Healthcare (i.e. Rural acute care t primary healthcare) Develp service and prgram standards and principles acrss teams and netwrks in the space prvided and resurces available.

9 Marketing & Cmmunicatins Cmmunity Engagement Intersectral Engagement Relatinship develpment First Natin & Metis Engagement PHC/Cmmunicat ins/kpo Cmmunicatins Cnsultant Bard Marketing & Cmmunicatins Develp verall marketing & cmmunicatins strategy Marketing & Cmmunicatins Onging review and cntinue implementatin f cmmunicatin plans. Marketing & Cmmunicatins Onging review and cntinue implementatin f cmmunicatin plans. Infrastructure Data & reprt Facility rerganizatin (5S, Kanban) Budget Identify gaps ($25 millin additinal investment request) Technlgy/Measurement EMR implementatin Rural enhanced telehealth Data plan Infrastructure Understand what we need fr space and use existing RQHR space differently. Start visining fr new space (i.e. Fur Directins) Setting up Urban PHC supply chain management t align with Netwrks. Mve beynd PHC and Tuchwd Qu Appelle in Rural fr 5s and Kanban. Begin planning fr Lng Term Care facility in Grenfell. PHC/Finance Budget Operatinal: Align with the wrk f the RQHR Efficiency Task Team. Strategic: Submit individual business prpsals t the Ministry, link t verarching $25 millin request. IT/eHealth / PHC Technlgy / / Physician Measurement practices EMR implementatin Remte presence Infrastructure Cntinue t use existing RQHR space differently. Submit plan fr new space. Building Lng Term Care facility in Grenfell. Budget As we align space, identifying additinal budget. Technlgy / Measurement EMR implementatin Remte presence Infrastructure Build additinal new space. Budget As we align space, identifying additinal budget. Technlgy / Measurement EMR implementatin Remte presence

10 Internet / Intranet, Share Pint technlgy Onging PQA cllectin Understand and reslve IT issues. Infrmatin flw. Plicy/Legislatin Pint f care testing Legislatin fr dcumentatin f health recrds Unin relatins Prvincial/federal jurisdictin Chrnic Disease Preventin and Management. MOH Plicy/Legislatin All prviders wrk at tp f scpe. Pint f care testing Legislatin fr dcumentatin f health recrds Unin relatins Prvincial/federal jurisdictin Operatinalize the mdel f Chrnic Disease Management and align with Canadian Accreditatin Standards. Enhance training, equipment and generalists clinicians. technlgy Onging PQA cllectin Understand and reslve IT issues. Infrmatin flw. Plicy/Legislatin Expand scpe f practice. Pint f care testing Physician payment fr innvative visits Legislatin fr dcumentatin f health recrds Funding mdel Unin relatins Prvincial/federal jurisdictin Cntinued imprvement in Chrnic Disease Management. technlgy Onging PQA cllectin Understand and reslve IT issues. Infrmatin flw. Plicy/Legislatin Expand scpe f practice. Pint f care testing Physician payment fr innvative visits Legislatin fr dcumentatin f health recrds Funding mdel Unin relatins Prvincial/federal jurisdictin Cntinued imprvement in Chrnic Disease Management. Strengthen Hme Care Increase capacity. Supprt Pt Flw / Ed Waits Imprve Infrmatin flw. Strengthen Hme Care Increase capacity. Supprt Pt Flw / Ed Waits Imprve Infrmatin flw. Strengthen Hme Care Increase capacity. Supprt Pt Flw / Ed Waits Imprve Infrmatin flw. Strengthen Hme Care Increase capacity. Supprt Pt Flw / Ed Waits Imprve Infrmatin flw.