13/14 Year End Report on Strategies

Transcription

1 Healthy People, Families & Communities 13/14 Year End Report on Strategies May 28, 2014

2 Why we are here Our Purpose

3 Year End Report on Strategies What to Expect - Year End (Q 4) report on strategies: - Review status of strategies and highlight successes and challenges of the past year. - Evaluate the effectiveness of the RQHR strategic plan and measure progress of multi-year outcomes - Identify next steps and link to 14/15 plans

4 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies & Operations VP: Karen Earnshaw Strategy: Primary Health Care

5 Goal/Outcome: Primary Health Care Strategy Strategy Improve population health through health promotion, protection and disease prevention, and collaborating with communities and different government organizations to close the health disparity gap. 5 Year Outcome: By 2017, people living with chronic conditions will experience better health as indicated by a 30% decrease in hospital utilization related to six common chronic conditions (Diabetes, CAD, COPD, Depression, Congestive Heart Failure, Asthma)

6 2013/14 Outcome Measure Quarter 2/3/4 Data Unavailable

7 Goal/Outcome: Primary Health Care Strategy Improvement Target: By 2017, 80% of patients are receiving care consistent with clinical practice guidelines for 6 common chronic conditions (Diabetes, CAD, COPD, Depression, Congestive Heart Failure, and Asthma).

8 Results - CDM- QIP roll-out CDM-QIP Training is being led by ehealth Saskatchewan Training for PHC providers: 8 out of 11 PHC sites completed 39 out of 44 physicians 13 out of 17 NP s Target: Training complete for all PHC physicians/nps by May 30, 2014 Training for Fee For Service Physicians: Roughly 65 Fee-for-Service Family Physicians have received training Target: 25% of all family physicians (PHC and FFS) actively participating in CDM-QIP by March 31, 2015

9 Goal/Outcome: Primary Health Care Strategy Improvement Target: By 2017, there will be a 50% improvement in the number of people who say I can access my PHC Team for care on my day of choice either in person, on the phone, or via other technology.

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11 Hoshin Hoshin: By March 2014, improve access and connectivity in Primary Health Care innovation sites and use early learnings to build foundational components for spread across the province. (Provincial System Hoshin).

12 Innovation sites - areas of focus Meadow Primary Health Care Centre Attaching patients, piloting new positions (PHC RN, Clinic Assistants), integration of Mental Health & Addictions, reinforcing Lean principles including space design, the 7 Flows of Medicine and reducing waste Touchwood Qu Appelle Primary Health Care Collaborative Creation of multi-community services in partnership with All Nations Healing Hospital, procuring resources, piloting new positions, team development, renovating facilities, implementation of the PHC EMR, applying Lean principles, development of a comprehensive communications strategy

13 Year End Summary Successes/What is working - PHC networks being established - Interim leadership in place to help build networks and teams - Innovation sites moving ahead and becoming operational - Work on current state assessment and development of final PHC organizational structure nearly complete - Templates and processes for regular data collection and reporting being put into place

14 Status of Strategy Implementation Challenges & Risks Challenges Lack of resourcing (financial and HR) to meet goals of 2012 provincial framework for Primary Health Care Technology big opportunity but infrastructure lagging Data restrictions to support decisions Communication New roles and new staff in leadership and PHC corporate service areas Geographically dispersed population and large, diverse portfolio of services. Need to focus on patient flow through the system and move more people to think of primary health care with a new level of priority.

15 Dollars (000's) PHC Financial Performance Variance from Budget 1,800 1,600 1,400 1,200 1, Variance from Budget Oct Nov Dec Jan Feb March

16 Next Steps / Link to 2014/15 Finalize PHC Organization Structure Establish Urban/Rural PHC Network Design & Service Delivery Model Enhance relationships with Family Physicians Establish standard work for Chronic Disease Prevention and Management Develop a staffing resource plan for PHC Networks Continue with team development (Lean, scope of practice, leadership development, etc.) Build the infrastructure (budget, facilities, technology, Lean processes, EMR, data plan, CDM-QIP roll-out, refine measurements and reporting. Work to influence policies/ legislation Develop/ implement a Communications/Marketing Strategy Link with 2014/15 Hoshins - ED Pt Flow, Seniors, Access to Specialty Care/Diagnostics, etc.

17 Summary New team doing business differently Much of time needs to be spent on engagement and development of relationships with service providers and physicians. Change management needs to be imbedded.

18 Question and Answers

19 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies VP: Michael Redenbach Integrated Health Services Seniors Strategy

20 2013/14 Provincial Outcome & Improvement Targets By 2017, at risk populations (all age groups) will achieve better health through access to evidence based interventions, services and/or supports. 50% reduction in occupation of acute care beds by seniors waiting for community service supports (2017)

21 2013/14 Outcome Measure

22 Year End Summary - Successes/What is working - Continued good processes associated with long-term care placement - Several alternatives to long-term care placement available to seniors Transition Unit; Quick Response Unit; Home Care, etc. - Variety of specialized programming available in LTC facilities including dementia units, acquired braininjury unit, mental health assessment and stabilization, convalescent care, respite - Good quality reporting from all facilities, leading to corrective action plans where necessary

23 Year End Summary - Challenges/Gaps/Risks/ - Growing number of convalescent patients utilizing Alternate Level of Care unit and acute care beds - Growing number of people requiring specialized longterm care, including those with multiple disabilities, mental health concerns, and other complex needs; many of whom are significantly younger than our standard long-term care population - Desire/willingness to improve processes but limited support capacity available - Public concerns about staffing levels and quality of care

24 Next Steps/Links to 2014/2015 Multi-year Summary will include, for 2014/2015, reference to: Implementation of Purposeful Hourly Rounding, and Enhanced Dining Experience Convalescent Care, and Alternate Level of Care options Development of quality improvement plan for LTC Home First/Quick Response

25 Next Steps (cont d) Multi-year Summary: Seniors Friendly Hospital initiatives Planning for replacement LTC facilities Linkages to provincial initiatives, including Zero Waits in Emerg, and Mental Health

26 Questions or Comments Questions or Comments??

27 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies VP: Michael Redenbach Integrated Health Services Mental Health & Addictions Strategy

28 2013/14 Provincial Outcome & Improvement Targets By 2017, at risk populations (all age groups) will achieve better health through access to evidence based interventions, services and/or supports. 50% reduction of individual readmissions within 30 days (mental health inpatient and acute care units) (2017)

29 2013/14 Outcome Measure

30 2013/14 Outcome Measure

31 Year End Summary - Successes/What is working - The KOT commenced as a unit in June In those 10 months, there have been 9 RPIWs completed, 15 programs have had value stream maps completed, 2 5S events, - Over 30 front line staff, 2 psychiatrists, and 14 different patients have participated in Lean improvement events - A large proportion of our staff have taken Kaizen Basics (90% of MHC, 93 % of CYS, 92 % of Addictions office based staff, (50% of shift based), 60% of inpatient) - We have at last count 30 visibility walls in our line, with some trying out production boards.

32 Year End Summary - Successes/What is working - The system generated cancellation rate of appointments with Psychiatrists at MHC went from 31% to 0.8%. - The daily capacity for psychiatry appointments at the MHC increased by 52% - The wait time for a first appointment with a psychiatrist at the MHC was reduced from over 6 months to 6 weeks - The number of people waiting to see a psychologist or social worker for treatment at MHC was reduced from 40 to 0 by creating an open access model - The pharmacist at MHC has her license to prescribe

33 Year End Summary - Successes/What is working - Psychiatrists reliably round in emergency twice per day (compliance rate 86% in the am and 92% in pm) - Pilot of hotspotting clients who repeatedly go to ED at RGH demonstrated intensity of service required one client reduced repeat visits to ER from 12 visits in one month to 0 visits, another from 15 visits per month to 6 - Increased the follow-up for patients who present to ER by connecting to the Crisis Response team by 88% - 100% of patients discharged from the inpatient unit had a warm hand-off to their community provider prior to leaving the unit

34 Year End Summary - Successes/What is working - At the request of patients, the Day Hospital was renamed the Recovery Support Program - The lead time from referral to first day of Treatment in the RSP was reduced from 24 to 9 days, a reduction of 63% - The capacity of the RSP was doubled, and there are no clients waiting to access it - Addictions clients who decide to access social detox no longer have to see a doctor before being admitted.

35 Year End Summary - Successes/What is working - MHC will be a pilot site for the Mental Health Commission of Canada s Psychological Safety in the Workplace strategy - Hospitals of Regina support for Friends an evidence based depression and anxiety prevention program to be delivered by CYS in partnership with Regina Public Schools to elementary school children

36 Year End Summary - Challenges/Gaps/Risks/ Uncertainty associated with upcoming provincial Action Plan recommendations, and expectation that Mental Health and Addictions will have significant demands put upon it Need to integrate with Primary Health Care networks Finding the time and energy to do more and different, while still doing the current KOT staff churn (2 promoted in last 5 months)

37 Vacancy management financial targets meant that all operational programs worked short handed. This meant that we were unable to make as much progress on our wait times & list targets. There are additional provincial priorities phrased as targets that are outside of the provincial Hoshins. Psychiatrists & psychologists are still difficult to recruit. Increase in incidence of aggression on our adolescent inpatient unit resulting in staff injury & resulting in an increase lost time costs. SGI announced funding change resulting in loss of FTEs (4.5)

38 Next Steps / Link into 2014/15 Finalize strategic plan and multi-year summary with focus on: Improving outpatient wait times Embedding and replicating lean improvements Preparing for Mental Health Action Plan report Support provincial initiatives, e.g.. Hot-spotting Link with primary health care networks.

39 Questions and Comments Questions and Comments?

40 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies Vice President: Val Hunko Integrated Health Services Strategy: Surgical Access Strategy

41 2013/14 Provincial Outcome & Improvement Targets By March 2017, all people have access to appropriate, safe and timely surgical and specialty care (cancer, specialist, and diagnostics) as defined by the improvement targets. 100% of cancer surgeries/treatments done within consensus timeframe from the time of suspicion or diagnosis of cancer (2015) 3 month surgical wait time (2014) 50% decrease in wait time for appropriate referral from primary care provider to specialist or diagnostics (2017)

42 2013/14 Outcome Measure Surgical Waiters

43 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14* % Performed Within 3 Weeks 2013/14 Outcome Measure % of Invasive Cancer Surgeries Performed within 3 Weeks 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Invasive Cancer Performed Within 3 weeks in 2013/14 Fiscal Year Concern Date Prepared: April 30th, 2014 Report Contact: Dmytro Rukas Source: Surgical Registry Refresh Cycle: Monthly Operational Def: % Performed Within 3 Weeks Actual Goal

44 Cancer Targets by Specialty

45 Corrective Action Plan Maximize OR theatre capacity & efficiency OR scheduling Maximize inpatient bed capacity Load level waitlists with targeted sections Stabilize work force Surgical Pathway targets

46 Summary Our Goal: 26,500 cases Operating Room Capacity: Actual Surgeries to March 31, ,613 Last Year s Performance 23,249 Base Capacity to March 31, ,425 Target Volumes to March 31, ,500 Cases Above Target 113

47 Year-end Summary How d it get done? Our patients guide our planning Daily/weekly Management Leadership- direct/indirect

48 Next Steps / Link into 2014/15 More of the same Communication never ends Connect the team to the work to be done.

49 Questions?

50 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies VP: Sue Neville Integrated Health Services VP: Dr. David McCutcheon Physician & Integrated Health Services Strategy: Access & Patient Flow Strategy

51 2013/14 Provincial Outcome & Improvement Target By March 31, 2017, no patient will wait for care in the Emergency Department (ED). 50% decrease in ED wait times (2015) By March 31 st 2015, 85% of patients will be admitted within 5 hours of decision to admit made in the ED Interim Goals: 95% occupancy in Medicine 90% occupancy in Critical Care/Cardiosciences ANBs 0 an 0 at each site

52 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Avg # Beds 2013/14 Outcome Measure 16 Average # of Patients Admitted With No Bed Available RGH RTDC 10 8 SSU Open EBM Go Date Prepared: April 1, 2014 Date Report Prepared: Contact: : December Savanna 2, 2013 Giannini Report Source: Contact: Patient Flow Desiree Brisebois Source: Refresh Cycle: Patient Monthly Flow Refresh Operational Cycle: Def: Monthly Number of patients who have an MRP assigned, but no inpatient Operational bed available. Def: Number of patients who have an MRP assigned, but no inpatient bed available. Target line Baseline Actual

53 2013/14 Outcome Measure

54 2013/14 Outcome Measure

55 2013/14 Outcome Measure

56 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Avg # Beds 2013/14 Outcome Measure 16 Average # Admitted Patients With No Bed Available PH SSU Open RTDC Implemented EBM Go-Live 0 Date Prepared: April 1, 2014 Report Contact: Savanna Giannini Source: Patient Flow Refresh Cycle: Monthly Operational Def: Number of patients who have an MRP assigned, but no inpatient bed available. Target line Baseline Actual

57 2013/14 Outcome Measure

58 2013/14 Outcome Measure

59 2013/14 Outcome Measure

60 Year End Summary - Successes/What is working - Hospital occupancies have improved - Number of ANB patients in ER have improved - All 9 inpatient hallway beds are closed - Infrequent use of ED overflow space and significant reduction in Code Burgundy Use - Better Bed Management - Greater cooperation from Medical Staff - Active Bed Management by Unit Managers - RPIW activity in MSL focus on patient flow - Implementation of Electronic Bed Management System - Implementation of Real Time Demand Capacity Management

61 Year End Summary: Challenges Current allocation and geographic distribution of medicine beds - Drs are frustrated: 6 patients could be admitted to 6 different wards Family Drs are leaving inpatient care management Poor patient preparation for arthroplasty surgery with inconsistent messaging in regard to patient stay ED (ab)use: direct admits; to meets; access to Primary care Require constant vigilance in ensuring the work standards for Real Time Demand Capacity Management are followed by leaders More rigor around adhering to the bed management policies

62 Gaps and Risks 10% over capacity in medicine Too many admits for Ambulatory Sensitive Conditions; Timely access to Primary, Home and Convalescent Care Discharge planning: 50-60% known on day of discharge Too many patient moves: costly and risky Further diminution of the number of family Drs attending inpatients Review of Daily Bed Meeting Plans in the future

63 Next Steps / Link into 2014/15 Integrate the regional patient flow 14/15 workplan with the initiatives under the provincial Emergency Department Waits and Patient Flow Implementation Strategy Hoshin Specifically: Strategic Use of the RPIW Process to focus on Medical Patients flow opportunities including: Convalescent Care and Primary Care Options Review the Model of Inpatient Care including a Seniors Care Strategy across the MSL Minimize Admission Times to all Inpatient Areas, including: - Implementing strategies identified in each of the AnalysisWorks projects Tools - Electronic Bed Management Phase 2 (portering) - Standard work for admissions

64 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies VP: Marlene Smadu Quality & Transformation Strategy: Patient Safety Strategy

65 2013/14 Provincial Outcome & Improvement Targets By 2017, establish a culture of safety with a shared ownership for the elimination of defects (uncorrected errors). Provincial Safety Alert/Stop the Line System Implemented (2017) Zero patients experiencing a medication defect (2017) Zero patients experience a preventable surgical site infection from clean surgeries (NHSN class I,II) (2017)

66 2013/14 Outcome Measure Hospital Standardized Mortality Rate

67 2013/14 Outcome Measure 30 Day Readmission Rate ( Rate per 100)

68 2013/14 Outcome Measure Health Care Associated C. Dif Infection Rate

69 Year End Summary - Successes/What is working - SAS-STL - Provincial Guiding Coalition, SHR prototyping, RQHR internal working group - Change in culture, implementing stop the line - Medication Errors - Focus now is on Medication Reconciliation at Corporate wall - Units have medication error safety crosses and are dealing with errors in real-time - Surgical Site Infections - RQHR working group--number of interventions including SSIP Bundles, surveillance and reporting - Part of provincial working groups (SSIP and SSI)

70 Year End Summary - Challenges/Gaps/Risks - SAS-STL need database; have to stop the line even we don t have all of the processes and pieces lined up - Medication Errors, SSI need to line up the interventions provincially and year over year to ensure we get to zero defects - Many different kinds and types of defects/harm need to keep them visible, have an overarching plan, deal with them in real-time - Always need to integrate patient safety with staff safety = NO HARM - Focus on measures that can be audited quarterly or monthly (most CIHI results are lagging)

71 Next Steps / Link into 2014/15 - Focus on Patient and Family Centred Care (A3) identifying key strategies in each year of the multiyear summaries for the various areas of patient safety/no harm - Support management of patient safety at the unit/service level daily visual management, safety huddles, stop the line - Ensure we review information from CIHI and focus attention on broad system areas for improvement such as readmission rates - Continue with rigourous hand hygiene campaign and auditing

72 Questions? Comments? Questions or Comments

73 Vision: Healthy people, families and communities. VP Quarterly Report on Strategies VP: Mike Higgins Human Resources & Communications Strategy: Culture of Safety Injury Reduction Strategy

74 2013/14 Provincial Outcome & Improvement Targets By 2017, establish a culture of safety with a shared ownership for the elimination of defects (uncorrected errors). Zero workplace injuries (2017) Provincial Safety Alert/Stop the Line System Implemented (2017)

75 Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar 2013/14 Outcome Measure 1.00 RQHR Injury Rate (WCB Lost Time Claims per 100 FTE) April 2012 to March Date Prepared: April , Report Contact: Kristal Zwarych Source: MedGate / Workforce Planning Refresh Cycle: Monthly Operational Def: Claims : Monthly lost time WCB Claims per 100 FTE Monthly Target Target: Zero lost time claims WCB claims by March NOTES: Year End Lost Time Claims per FTE: 2013/14: 5.87; Target = /13: 7.34; Target = 6.64 Claims/100 FTE

76 WCB LOST TIME CLAIMS PER 100 FTE Click dropdown arrow to 2013/14 Outcome select department Measure RQHR RQHR HELP Click here for Cognos HR Reports RQHR Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year-end Projection Year-end Target Date Prepared: April 15, 2014 NOTE: March represents year end total Data Source: MedGate Developed by: Workforce Planning Report Contact: Kristal Zwarych Refresh Cycle: Monthly Operational Definitions: Year-end Target: Calculated as a 25% reduction of target or total

77 Year End Summary Successes: Our region has made consistent progress in reducing injuries and costs in our region 14% reduction in % reduction in % reduction over last 2 fiscal years

78 Year End Summary Challenges: - Management Capacity - Safety Resource Capacity - Information Technology tracking, especially for training - Ambitious Goal but it is the right thing to do - Initiatives are working but change is not on pace to achieve the results being sought - Need more direct, front line management of injury (a la Unit 3-2 Strategy) - Extremely resource intensive

79 Next Steps / Link into 2014/ Injury Reduction Continues to be a Priority Culture of Safety IR Strategy will focus on: Incident Reporting Procedure Leadership Accountability Hazard Risk Assessment (SMS) Training Resources (Partnership with SASWH)

80 Next Steps / Link into 2014/ Culture of Safety IR Strategy will focus on: Violence Prevention Policy and Program Bariatric Equipment Safety Policy & Standard Work Stop the Line Replication of Unit 3-2 Strategy

81 Questions or Comments THANK YOU FOR YOUR CONTINUED EFFORTS IN MAKING OUR WORKPLACE SAFE