ALBERTA HEALTH SERVICES Action Plan 2013-14 Supplement to Health Plan and Business Plan 2013-2016 Amended February 2014
AHS Action Plan 2013-14 (This document was amended in February 2014, to include the 16 new performance measures now being used by Alberta Health Services) Alberta Health Services Strategic Directions and Work Streams 2013-2016 BRINGING APPROPRIATE CARE TO COMMUNITY PARTNERING FOR BETTER HEALTH OUTCOMES ACHIEVING HEALTH SYSTEM SUSTAINABILITY 1. Delivering innovative service models for complex high needs populations. a a a 2. Strengthening community and primary health care to deliver care in most appropriate setting. a a a 3. Advancing the adoption of evidence-informed practices and clinical appropriateness. a a a 4. Implementing new funding models and revenue initiatives. a a a 5. Optimizing service delivery. a a a 6. Driving productivity improvements. a a a 7. Containing costs. a Bringing Appropriate Care to Community Partnering for Better Health Outcomes Achieving Health System Sustainability To support the 2013-2016 Health Plan and Business Plan, Alberta Health Services has developed the following Action Plan. It outlines the key actions that will be undertaken by Alberta Health Services, beginning in 2013-14, to work toward achieving the goals outlined in the Health Plan. Actions included in this list reflect significant examples of the work underway in each of the work streams outlined. This includes initiatives that are provincial in nature, represent innovation and/or will significantly impact how services are delivered. The plan also identifies key strategic measures that will assist us in monitoring progress. A full list of measures is included in Appendix 1. 1 AHS Action Plan 2013-2014
STRATEGIC DIRECTION: BRINGING APPROPRIATE CARE TO COMMUNITY Work Stream #1: Delivering innovative service models for complex high needs populations AHS will work with partners, stakeholders and communities to develop innovative care models to support individuals and populations with high-needs or risk factors such as multiple chronic conditions. Examples of populations that require focused attention are the frail elderly, the vulnerable, complex high-needs children and youth, and those at the end of life. Complex, high needs populations Develop innovative community-based service model(s) to address complex, high needs individuals/ populations. SVP Priorities and Performance, EVP and Chief Medical Officer (CMO) Clinical Operations Develop and begin implementation of new service delivery models, that include complex, high needs groups, for existing AHS Family Care Clinics (FCCs) in Edmonton and Calgary Work Stream #2: Strengthening community and primary health care to deliver services in the most appropriate setting AHS will support all Albertans to be attached to a primary health care team no matter where they enter the system. AHS will work with Alberta Health (AH) to increase the number of Family Care Clinics in the province and to enhance access to primary care networks and the services they provide. AHS will continue its work to support the Continuing Care Plan and the Addiction and Mental Health Strategy. We will take significant steps toward a more coordinated and seamless approach to service delivery at the local level and across the system. We will work to promote wellness and support prevention of illness and to provide greater follow-up after hospital stays. Strengthening community and primary care Family Care Clinics (FCC) Further develop AHS FCCs and work with AH to increase the number of FCCs within the province., SVP Priorities and Performance Five new FCCs will successfully complete business plans and have a grant agreements in place to begin their work Primary Care Networks (PCN) Work with AH to enhance the work of PCNs through further development of common standards and expansion of the range of services where needed. Develop PCN Accountability Framework (with Alberta Health, Primary Care Committee, and Primary Care Alliance) Develop common quality and outcome measures in primary care (for 13 PCNs) Continuing care and support to seniors Home care standardization Streamline and standardize homecare services. Continuing care options and capacity Further development of continuing care spaces, options and capacity. Addiction and Mental Health Strategy Implementation Support the implementation of the provincial Addiction and Mental Health Strategy through: - Further development of coordinated and consistent access for children and adolescents to addiction and mental health services - Work with Alberta Health and other Ministries in support of the Alberta Alcohol Strategy. EVP and Chief Operating Officer (COO), EVP and CMO Clinical Operations EVP and COO,, EVP and COO Serve an additional 3000 unique Home Care clients Reduce Emergency Department visits (two per cent) and acute care inpatient days (five per cent) for home care clients Additional 1000 spaces available in 2013/14 Percentage placed within 30 days increase to 80 per cent for clients placed from acute/sub-acute care Percentage placed within 30 days increase to 60 per cent for clients placed from community Completion of the Children s Mental Health Plan summative evaluation and use the results to inform recommendations for enhancing access to mental health services. Support 25 community coalitions to identify, develop and implement local actions to reduce alcohol related harms AHS Action Plan 2013-2014 2
Wellness, health promotion and injury and disease prevention Children and youth nutrition, activity and mental health Partner with schools, school jurisdictions and community organizations to plan and carry out initiatives that increase availability of healthy foods and beverages, expand opportunities to be physically active, and improve mental health for children and youth. Early childhood development Work with the Ministries of Health, Education, Justice and Solicitor General, and Human Services to implement the Regional Collaborative Service Delivery Model (RCSDM) in support of early childhood development. SVP Priorities and Performance, SVP Health Professions Strategy and Practice and CHNPO 70 per cent of school jurisdictions receive a presentation regarding a comprehensive school health approach to child and youth health External AHS Comprehensive School Health Resource Website is launched Identification of needs completed and supports required described. Work with communities, including school staff, service providers and families to enhance capacity to support healthy development in early childhood. Begin implementation of improved integration and coordination of supports and services provided for early childhood development Personal Health Portal Work with Alberta Health to support the development of a personal health record for Albertans that can contain both self-entered and clinical reports from the provincial electronic health record, Alberta Netcare. Workplace Mental Health AHS Mental Health Promotion team has engaged eight sites from different sectors and across the province; four internal to AHS and four external. This initiative endeavours to identify, implement and evaluate various best and promising practices to address workplace mental health and addiction in Alberta. This pilot project work is funded through a grant from Alberta Health. Tobacco Reduction Strategy Work with Alberta Health and other Ministries to implement the Alberta Tobacco Reduction Strategy. Infant and pre-school screening and follow-up Work with Alberta Health to support implementation of the Infant and Preschool Screening and Follow-Up Services Framework and the Early Childhood Development Priority Initiative. EHR Delivery Services (AH), EVP and Chief Financial Officer (CFO) EVP and COO, EVP People and Partners Communication Strategy Public launch of MyHealthAlberta.ca Implement and evaluate mental health promotion programming to address areas of concern identified by worksites participating in the pilot project Use the evaluation results to inform the development of a broader employee mental health strategy to reduce stigma and discrimination associated with mental health issues and to promote good mental health Establish and implement a process to assess compliance with the AHS Tobacco and Smoke free policy (site-based) Complete the implementation of the requirements of the Newborn Metabolic Screening (NMS) policy document which includes (Alberta Health) standards, sub-standards and AHS responsibilities Maintain 99.5 per cent participation rate in NMS screening Complete joint plan with Alberta Health to develop a Universal Newborn Hearing Screening program 3 AHS Action Plan 2013-2014
Suicide prevention Work in partnership across the AHS Provincial Steering Committee on suicide prevention to increase the availability of prevention programs. Child injury prevention Develop guidelines and training resources and implement A Million Messages for child injury prevention (aimed at parents of infants and children to prevent abuse and injury for that age group). Healthy parents and children Disseminate and begin evaluation of Healthy Parents, Healthy Children: Pregnancy and Birth (promotes healthy parenting, pregnancy and birth) and Healthy Parents, Healthy Children: The Early Years (promotes healthy parenting, growth and development in children 0 5 years of age). Complete the development of a provincial suicide prevention action plan. Develop and evaluate suicide risk assessment and intervention training strategy focusing on skill-building and competency development for AHS staff An Online A Million Messages module will be added to the AHS My Learning Link and the access and usage will be tracked to ensure staff are appropriately trained to deliver this program Complete plans for the implementation of a social marketing campaign to promote Healthy Parents, Healthy Children resources Develop an evaluation plan for the Healthy Parents, Healthy Children initiative AHS Action Plan 2013-2014 4
STRATEGIC DIRECTION: PARTNERING FOR BETTER HEALTH OUTCOMES Work Stream #3: Advancing the adoption of evidence-informed practices AHS will focus on building consistent processes to improve how clinical teams work together and the quality of care provided and to support prevention and early intervention, and streamline transitions between services. Strategic and Operational Clinical Networks will support acceleration of the implementation of evidence-informed processes and standards across the continuum of care and throughout the province. This will include reassessing current practices, technologies and how patients access the system. Model of care transformation Implement and spread the Model of Care Innovation by integrating multiple projects into one initiative: workforce model transformation, care transformation, Path to Home and transition projects and expedite roll-out plans for two additional sites. Ensure that all staff are working collaboratively and to the full scope of their roles, while bringing the patient and family into the care planning process and increasing time spent on care. SCN Cardiovascular Health and Stroke Rural Stroke Action Plan - Develop and implement best practice recommendations for stroke unit equivalent care (SUEC) which is applicable to the small urban and rural setting - Develop and Implement a community-based stroke rehabilitation service that includes Early Supported Discharge (ESD) and Community Rehabilitation (CR) for mild-moderate stroke patients phased at five selected sites. SCN Cardiovascular Health and Stroke Vascular Risk Reduction Project - Phased in beginning with vascular risk factor screening and early management project in primary care setting, identified pharmacies and at least one identified worksite partner - Develop and implement a model for an integrated approach to vascular risk factor reduction in at least one integrated clinic. SVP Health Professions Strategy and Practice and CHNPO, EVP and CMO Quality and Medical Affairs Implement the Collaborative Practice Model of Care and supporting improved care processes including the standard discharge process on several units at a minimum of seven sites Stroke Unit Equivalent Care (SUEC) best practice recommendations developed and applied to two rural settings Patient reported outcome measures survey developed and issued to patients/families Clinical teams recruited in conjunction with the phased schedule of five selected sites Initiate increased access to SUEC, ESD and CR at the five selected sites using a phased approach Identification of Primary Care Networks and providers to participate in the project Confirmation of pharmacy and worksite partnerships Completion of staff training and education for pharmacies and worksites Development of integration model to be applied to selected clinic(s) Begin implementation of integration model at selected site(s) 5 AHS Action Plan 2013-2014
SCN Obesity, Diabetes and Nutrition Enhancing Recovery After Surgery - Develop surgical care pathway (integrating best practices in nutrition and physical functioning) starting with colorectal and pancreatic surgeries. SCN Obesity Diabetes and Nutrition Diabetes Clinical Standards and Pathways Development: Insulin Pump Therapy (IPT) - Development of IPT clinical eligibility/ ineligibility criteria for children, youth and adults with Type 1 Diabetes (TD1) and identification of required AHS infrastructure across the province. SCN Cancer Care Access for Referral and Triage (ART) ereferral Project - One component of a larger provincial ereferral project, which will focus on the development of a web portal to support referrals provincially for breast and lung cancer. - Will be developed for other tumour groups following the lung cancer proof of concept project. OCN Surgery Adult Coding Access Target for Surgery (acats) Sustain and Spread - Develop and implement a standardized diagnosisbased surgical benchmark for all surgeries in Alberta (diagnosis and urgency access management, surgical wait list clean up and maintenance, standardized provincial reporting of wait times and business processes and data to support equitable access to surgery). OCN Surgery Safe Surgery Checklist - Implementation and standardized measurement of compliance in AHS facilities and contacted nonhospital surgical facilities throughout the province. Colorectal protocol implemented in two sites (Peter Lougheed and Grey Nuns) Recruitment of two new sites, training and baseline data collection completed IPT eligibility criteria document completed AHS Guidelines developed Education Resources and toolkit developed Wait time standards developed Begin reporting on referral, wait time, compliance and satisfaction measures Develop and implement a provincial web portal to support referrals for lung cancer Provincial diagnosis and urgency access targets for surgical services, based on best available evidence, will be updated and signed off prior to provincial spread Quantify the number of patients having their surgery within their acceptable wait time or waiting beyond acceptable time Complete the pilot phase evaluation to inform the spread of acats to further sites Implement acats and captures Decision-to-Treat and Ready-to-Treat status across 11 subspecialties 95 per cent of surgical procedures completed in an operating room in Alberta will use the Safe Surgery Checklist (SSC) 95 per cent compliance using the SSC in all five Zones on time-out, briefing and debriefing AHS Action Plan 2013-2014 6
OCN Seniors Appropriate Use of Antipsychotics in Long Term Care - Development of best practice guidelines re: long-term use in long term care - Development of strategies for managing challenging behaviours - Phased in small number of sites followed by provincial implementation. SCN Bone and Joint Bone and Joint Fragility and Stability - Plan and Design a Subsequent Fracture Prevention Program for Albertans - Develop inventory of Osteoporosis resources and services for Alberta through a central repository - Implement full continuum of care for fragility fractures - Begins with acute care, post-acute care and post surgery support testing and evaluation in 12 sites. Cancer Plan implementation Begin actions in support of the phased implementation of Alberta s Cancer Plan to 2030., EVP and COO 11 sites have implemented the draft clinical guidelines for appropriate use of antipsychotic drugs in the absence of psychotic and related conditions Unintended consequences of reducing the use of antipsychotic medications, such as increased benzodiazepine and physical restraint use are monitored in EAS 90 per cent of EAS staff are educated on the toolkit for alternative strategies for the management of responsive behaviors Representatives of residents and/or families receive information and have opportunities to provide feedback Monitoring system for tracking expenditures on antipsychotics is established Strategy for provincial spread is developed Post-acute care service delivery, programs and services design complete Secondary fracture prevention program design complete Acute hip fracture pathway completed and phased implementation initiated across the province Development of a provincial accountability framework that addresses alignment and integration to support provincial operational standards and equity of care across the cancer continuum (includes coordinated system of screening, care, research, application of knowledge and appropriate sharing of patient health information) Development of an AHS provincial cancer care plan aligned with Alberta s Cancer Plan 2030 Development and implementation of comprehensive health information cancer-specific management unit, C-MORE. Development of three provincial councils (Radiation Medicine, Systemic Therapy, Supportive Care) and 12 tumour group teams to support quality improvement and integration of services across the province Opening of the associate cancer center in Red Deer 7 AHS Action Plan 2013-2014
Research and Innovation funding criteria and processes The Alberta Partnership for Research and Innovation in the Health System (AHS and AIHS) will establish a funding framework, cycle and process, select projects and announce funding in support of research and innovation projects that target high impact activities associated with any part of the continuum of care. Research and Innovation ethics Contribute to streamlining ethics for health research and clinical trials towards provincial harmonization of research ethics boards. Alberta health data repository Joint initiative with Alberta Health to develop an integrated analytics network. Health technologies assessment (HTA) and reassessment Joint initiative with Alberta Health to optimize the use of HTA and expand the use of HT reassessment to support the adoption, use and discontinuation of health technologies and services based on scientific evidence regarding their safety, effectiveness and costeffectiveness. Provincial CIS Planning and development of a provincial Clinical Information System (CIS). Measurement and reporting Work with Alberta Health to develop and implement an outcomes based framework to standardize measurement and reporting. SVP Research, EVP and CMO Quality and Medical Affairs Clinical Advisory and Research (AH), SVP Research ADM Strategic Services (AH), SVP Research Clinical Advisory and Research (AH), SVP Research EVP and COO,, SVP and CMO Quality and Medical Affairs ADM Strategic Services (AH), SVP Priorities and Performance Funding Framework established Application process announced by AIHS Review and selection of applications to move from Letter of Interest to full application. Funding announcements by AIHS Funding agreements between AIHS and selected investigators. In collaboration with Alberta Health, academic partners and AIHS, develop a plan for provincial harmonization of research ethics boards. Final plan to be submitted to minister. Development of an integrated health data repository strategy Review and assessment of new technologies and services Re-assessment of existing technologies and services Provincial CIS Vision, Strategy and Target State with five year roadmap developed CIS implementation plan, budget, cash flow and schedule Design/Build (18-21 months) System outcome measures development completed in collaboration with Alberta Health AHS strategic measures developed AHS Action Plan 2013-2014 8
STRATEGIC DIRECTION: ACHIEVING HEALTH SYSTEM SUSTAINABILITY Work Stream #4: Implementing new funding models and revenue generation initiatives We will shift our funding models to allocate funds to programs and providers based on the needs of the patients and populations served. We will also improve our processes for and standardization of interprovincial and other billing rates. Results based budgeting - AMH Work with AH to complete the results based budgeting review process for Addiction and Mental Health. Results based budgeting acute and continuing care Work with Alberta Health to continue the results based budgeting review process for Acute Care and Continuing Care. Patient-based funding - LTC Continue the new patientbased funding for long term care and develop for designated supportive living. Patient-based funding acute services Implement patient care based funding for acute services (i.e. arthroplasty, computed tomography CT). Revenue generation Identify revenue generation initiatives. Complete review of addiction and mental health services Acute Care Complete detailed review and data collection Complete recommendations, impact analysis and interim report Continuing Care: In collaboration with Alberta Health, develop plan for review Complete detailed review Continued implementation of patient-based funding for long term care implementation plan for designated supportive living Initial implementation of patient-based funding and quality incentive funding for three per cent of hips and knees Initial implementation of patient-based funding for three per cent of CT exams Revenue opportunities identified and plans developed and reviewed/approved by appropriate stakeholders Monitoring and reporting mechanisms developed Work Stream #5: Optimizing service delivery We will address the health needs of Albertans in a proactive manner, including providing supports in the community from appropriate primary health care providers. We will work with communities to align service models and facilities to provide appropriate care in the appropriate setting. Community service delivery alignment Develop transformation plans to support the implementation of integrated community and primary care services, enhancing primary care, chronic disease management and other community based options. Alternative service delivery Develop alternative service models for various functions as appropriate., SVP Priorities and Performance (AHS will lead FCC design in cooperation with AH) EVP and COO, Completion of Shift to the Community strategic plan Development of appropriate metrics Contracting, Procurement and Supply Management Complete implementation plan developed Phased implementation beginning with one department Capital Management Complete implementation plan developed for one department 9 AHS Action Plan 2013-2014
Third party contracts Conduct a review of third party contracts to reduce costs, increase accountability and consolidate as appropriate. Laboratory services New laboratory services model development and implementation. The model will support better health outcomes, appropriate care (diagnostic services) to the community, and health system sustainability. President and CEO Review plan developed Phased implementation beginning with home care services Procurement process Northern Alberta vendor award completed Laboratory service model design and final model transition detail completed Service levels defined to provide consistent access, improved quality and expert consultation for all Albertans Model to support AHS strategic measures by investing in innovation and advance technologies Model developed to build and implement targets aimed at long term appropriate utilization of laboratory service Work Stream #6: Driving Productivity We will adopt care models that make the best use of the skills of our physicians and staff, improve our processes, procedures and flow of patients through our facilities. Scheduling and rotations Implement and spread the standardized scheduling and rotation management initiative to approximately 16,000 staff in 2013-14 to increase the number of full time staff, streamline staffing processes and reduce costs. Support services - value Harvest the value from systems recently installed, including i-procurement, e-people, e-facilities, etc. Zone planning Identify productivity and sustainability initiatives by working with the Zones and using a consistent approach to health and business planning at the Zone and subzone levels. SVP Health Professions Strategy and Practice and CHNPO SVP Priorities and Performance, EVP and COO Establish a minimum of one centralized Staffing Service Centre Implement optimized regular and relief rotations and new standard staffing processes for approximately 16,000 staff Full transition to e-people complete Phased zone implementation of i-procurement Implementation of e-facilities Zone Health Plans and Business Plans developed for 2014-15 Zone long range plans developed for Edmonton, Central and Calgary Zones Work Stream #7: Containing Costs We are taking steps to ensure we are making the most efficient use of health resources, getting the greatest value for our money and are containing or reducing the costs associated with delivering health care services across the province. All areas are being examined, including supplier contracts, compensation and benefits. Administration costs Reduce administrative costs by 10 per cent. Optimizing support services Optimize the support service areas in relation to Zones and operating units (i.e. Finance, QHI, CPSM, DIMR, etc.) President and CEO Reduce administrative costs by $35 million over three years. Target for 2013-14 is $10 million Capital Management LEAN initiatives implementation roll out in rural sites (major sites already complete) AHS Action Plan 2013-2014 10
Workforce actions Implement the following workforce actions: - Compensation freeze for management and out of scope - Implement vacancy management and head count freeze. Workplace health and safety Create a healthy, safe and supportive work environment to enable staff to provide quality patient care. President and CEO EVP People and Partners Compensation frozen No increase in head count Develop and implement occupational injury reduction plans for all operations Develop plan for a provincial solution to manage health and safety in the workplace Implement a prevention of violence in the workplace initiative in alignment with accreditation requirements 11 AHS Action Plan 2013-2014
Appendix 1 Alberta Health Services Strategic Measures STRATEGIC DIRECTIONS ALBERTA HEALTH SERVICES STRATEGIC PERFORMANCE MEASURES (ACCOUNTABILITY) Continuing Care Placement the percentage of patients placed into continuing care within 30 days of being assessed. Bringing Appropriate Care to Community Satisfaction with Long Term Care the percentage of families of long term care residents who rated the overall care as 8, 9, or 10, where zero is the lowest level of satisfaction possible and 10 is the best. Emergency Department Length of Stay for Discharged Patients the average patient s length of time in the emergency department before being discharged at the 17 busiest emergency departments. Early Detection of Cancer the percentage of patients with breast, cervical and colorectal cancers who are diagnosed at early stages. Satisfaction with Hospital Care the percentage of adult patients who rated their overall care in hospital as 8, 9, or 10, where zero is the lowest level of satisfaction possible and 10 is the best. Emergency Department Wait to see a Physician the average patient s length of time in emergency department before being seen by a physician at the 17 busiest emergency departments. Emergency Department Length of Stay for Admitted Patients the average patient s length of time in the emergency department before being admitted to a hospital bed at the 16 busiest emergency departments. Access to Radiation Therapy the length of time or less that 9 out of 10 patients receive radiation therapy. Partnering for Better Health Outcomes Mental Health Readmissions the percentage of mental health patients with unplanned readmission to hospital within 30 days of leaving hospital. Surgery Readmissions the percentage of surgical patients with unplanned readmission to hospital within 30 days of leaving hospital. Heart Attack Mortality the percentage of patients dying in hospital within 30 days of being admitted for a heart attack. Stroke Mortality the percentage of patients dying in hospital within 30 days of being admitted for a stroke. Hospital acquired Infections the number of Clostridium difficile (C-diff) infections acquired in hospital every 10,000 days of care. A rate of 4.1 means approximately 100 patients per month acquire C diff infections in Alberta. Hand Hygiene the percentage of times health care workers clean their hands during the course of patient care. Hospital Mortality the actual number of deaths compared to the expected number of deaths in hospital. Values less than 100 mean fewer than expected deaths. In Alberta, a rate of 84 means 850 fewer deaths in hospital than expected each year. Achieving Health System Sustainability Actual length of hospital stay compared to expected stay the average number ofactual days patients stay in acute care hospitals compared to the expected length of stay for a typical patient, taking into account differences in patient types. AHS Action Plan 2013-2014 12
ALBERTA HEALTH SERVICES Action Plan 2013-14 Supplement to Health Plan and Business Plan 2013-2016 Better Quality, Better Outcomes, Better Value