2015/16 Q1 Report on Strategic Plan June 23, 2015 · { Q1 Report on Strategic Plan { Current year...

2015/16 Q1 Report on Strategic Plan

June 23, 2015

Session Notes Worksheet

• Instructions:

1. Throughout the session please make notes when you

listen to the VP report out:

– What encourages/excites you?

– What makes you nervous?

– What needs to be done differently (for this multi-year plan)?

– What you can do differently?

2. Table discussions & report outs at end of the day.

3. Worksheets will be collected and collated for VP to

consider for course correction.

4. Take personal action items/ideas back to incorporate

into your work plans.

Housekeeping

• Parking:

– Please register your plate # if you drove

• Washrooms

• Connect to WiFi:

– Select “attwifi_meeting” network

– Open Internet Explorer

– Go to google.ca

– Log in using the instructions on your table

– Connect to RQHR network using Cisco

AnyConnect/VPN

If you have issues connecting, please let the registration table know

How to Access Today’s Information

• RQHR Intranet Site:

http://rqhshrpntwebprd:4604/sites/DocShare/Reporting/For

ms/AllItems.aspx

Or, from the RQHR intranet home page Click on Strategic

Framework Click on Sharepoint Site Click on Reporting Select

2015-16 Q1 Report on Strategies - June 23 2015 folder

Other information posted at: RQHR intranet home page Click on

Strategic Framework Click on Sharepoint Site Click on Data to

Support Planning folder

• Public RQHR Lean Website:

http://www.rqhrlean.com/quarter-1-review---june-23-

2015.html

Or, from the Lean website home page Click on Strategic Direction

Click on Quarter 1 Review – June 23, 2015

CEO INTRODUCTION

Keith Dewar, President & CEO

Our Purpose

Why we are here

Strategic Hierarchy

Government of Saskatchewan

Ministry of Health

Regina Qu’Appelle Health Region

Provincial Health System

Patient, Staff and Physician

Input

Planning And Reporting Flow Chart

ClinicalBest

Practice

• Initiatives and projects cascaded down from the strategic

plan and one-year business plan• Other important work identified to mitigate risks, fill gaps,

and improve performances

Budge

Risks/Gaps/Challenges

Other E-Scan Data

Accred. Standards

CIHI Data

• Q1 Report on Strategic Plan

• Current year course correct

Q1


• Review inputs into next year plan

Q2


• Finalize next year plan

Q3

• Year end report (annual report)

• Celebrate successes

Q4

Feedback/

challenges/gapsbrought back to

the MOH and PLT tables.

Initiatives and

projectscascading down

to service lines and departments

where they are able to contribute

to achievement of strategic

outcomes and targets.

• Includes high priority, cross functional initiatives, measures, and targets that require regular monitoring by the Senior Leadership Team

• Identifies the annual priority areas of focus for the region

Portfolio, Service Line,

Department Multi-Year Plans

Key Support: SPBIU/KPO/KOTs

Use Lean tools to support implementation of operational plans wherever applicable: RPIW, 5S, Kanban, Standard Work, Replication, etc. Ongoing review of operationalization of Lean tools and training on the use of Lean tools will take place throughout the year rather than

Provincial

Outcomes & Targets

Patient, Staff, and Physician Feedback

Strategic Planning Inputs

Strategic PlanningOutput 1:

Strategic Planning Output 2:

Cascading

Plans

RQHR Multi-Year Strategic Plan

Key Supportt: SPBIU

RQHR One-YearBusiness Plan

Key Support: SPBIU

• Daily work of service delivery

• Current year initiatives and projects cascaded down from service line/department multi-year plans

Service Line, Department, Unit

One-Year Operational Plans

Key Support: KPO/KOTs

DRAFT RQHR Planning and Reporting Input/Output

Kaizen Plans/Integrated

TimelinesKey Support: KPO/KOTs

Hard copies are on your

table to see the details

• Quarterly Report on Strategic Plan:

– VP Lead of multi-year plans report on outcome

measures and progress towards targets

RQHR Strategic Plan Reporting Mechanism

STRATEGIC MULTI-YEAR PLANNING &

REPORTING

RQHR Strategic Plan

• RQHR Multi-year Strategic Plan includes:

• Provincial Strategies • ED Waits and Patient Flow (prov. Hoshin)

• Mental Health and Addictions (prov. Hoshin)

• Seniors

• Infrastructure

• Primary Health Care

• Wait 1/GP to Specialist

• Appropriateness

• Financial Sustainability

• Culture of Safety

• RQHR Internally Identified Strategies • Patient Family Centred Care

• Engagement

• Academics and Research

RQHR Strategic Plan – Cont’d

• We are confident in the strategic direction we are taking as

a province and organization

• Each strategy is led by a Vice President (VP) who is

accountable for achieving the outcome

• Each strategy is supported by a multi-year plan

• Each strategy is being monitored and reported out

quarterly

• Funding restraint will slow the progress of multi-year plans

and delay achievements and could potentially result in a

deterioration in our gains to date

• We have significant capital and infrastructure deficiencies

(facilities, equipment and information technology systems)

that could impede our ability to meet strategic, business

plan and operating budget targets

2015/16

THE CURRENT YEAR

BUSINESS PLAN

2015-16 RQHR Business Plan

• 2015/16 RQHR Business Plan (One-year Regional

priorities):

– Continues to focus on:

oQuality and Safety

oPatient Flow (also a 15/16 provincial Hoshin)

oPrimary Health Care

– Added one more focused area:

oMental Health & Addictions (also a 15/16 provincial

Hoshin)

Link RQHR Strategic & Business Plan

• RQHR Multi-year Strategic

Plan includes: • Provincial Outcomes

• ED Waits and Patient Flow (prov.

Hoshin)

• Mental Health and Addictions

(prov. Hoshin)

• Seniors

• Infrastructure

• Primary Health Care

• Wait 1/GP to Specialist

• Appropriateness

• Financial Sustainability

• Culture of Safety

• RQHR Internally Identified Strategies

• Patient Family Centred Care

• Engagement

• Academics and Research

• RQHR 2015-16 Business

Plan has 4 Focused Areas:

o Quality and Safety

o Patient Flow (also a 15-16

provincial Hoshin)

o Primary Health Care

o Mental Health & Addictions

(also a 15-16 provincial

Hoshin)

• Focuses on the work of the Senior Leadership

Team (SLT)

– It includes regional work that SLT has to lead, monitor,

and report

• Supports alignment across the RQHR

– It is supported by work plans at the portfolio, service

line and unit level

• Focuses SLT support for daily management

– Quality care, safe care, and financial sustainability

• Business plan can and will change during the year

– When targets are met, initiatives can be replaced by

other work appropriate for SLT

2015-16 RQHR Business Plan – Cont’d

2015/16

WHAT HAS CHANGED SINCE OUR BUSINESS

PLAN WAS APPROVED

2015/16 Preliminary Operating Budget

18

Regina Qu'Appelle Health Region

2015-16 Operating Budget

In $000's

2014-15 2015-16 Budget $ Change % Change

Revenue

Ministry of Health Funding - Base 863,515 901,502 37,987 4.40%

Ministry of Health Funding - Other 67,382 31,044 (36,338) -53.93%

Other Gov't & Agency Revenue 25,830 25,513 (317) -1.23%

Patient & Service Fees 24,745 24,108 (637) -2.57%

Other Revenue 32,485 30,527 (1,958) -6.03%

Total Revenue $1,013,957 $1,012,694 (1,263) -0.12%

Expenses

Salaries & Benefits 664,424 684,107 19,683 2.96%

Medical Remuneration 86,930 86,763 (167) -0.19%

Operating Grants 68,175 69,111 936 1.37%

Medical Supplies 94,529 97,173 2,644 2.80%

Infrastructure 48,768 48,504 (264) -0.54%

Clinical & Operational Supports 52,588 50,561 (2,027) -3.85%

Admin & Other 14,689 14,744 55 0.37%

Total Expenses $1,030,103 $1,050,963 $20,860 2.03%

Preliminary Deficit ($16,146) ($38,269) ($22,123) 137.02%

Service Volume Changes Has

an Impact on Costs

19

Hospital Care Utilization

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015P % Change

Admissions

34,123

34,549

35,281

36,595

38,282 12.19%

Average Daily Census

642.40

655.60

645.70

650.67

650.01 1.18%

Average Lenth of Stay (Days)

6.90

7.0

6.70

6.30

6.30 -8.70%

Births/Newborn Admissions

3,771

3,954

4,087

4,234

4,253 12.78%

Emergency Visits

106,755

108,900

110,000

107,033

113,805 6.60%

Surgeries

21,683

22,774

23,232

26,615

26,216 20.91%

Diagnostic Imaging Procedures

274,490

272,759

305,956

312,977

257,129 -6.32%

Laboratory Tests Performed

3,555,074

3,662,535

3,783,155

3,952,096

3,952,096 11.17%

Home Care Service Workload Units

168,106

334,791

361,498

357,718

360,000 114.15%

Emergency Medical Services Calls

23,598

23,764

24,870

24,811

25,028 6.06%

# of Influenza Immunizations provided by

Public Health

34,487

33,076

35,447

52,346 n/a 51.78%

Ambulatory Care & Medical Outpatient

Procedures

86,056

99,906

108,445

112,025

118,899 38.16%

# of Long Term Care Beds n/a

1,989

1,961

1,963

1,963 -1.31%

Primary Driver – Paid Hours

20

Regional Focus to a Balanced Budget



In $000's

2014-15 2015-16 Budget $ Change % Change

Total Revenue $1,013,957 $1,012,694 (1,263) -0.12%

Total Expenses $1,030,103 $1,050,963 $20,860 2.03%


Regional Focus to Reducing Long-Term Cost Structure VP Responsible

3sHealth and Other Contracts 2,500 Peters

Cost Savings from Reduced Surgical Volumes 8,000 Garratt

Reduction of VAC Beds if No Funding for Alternative use 1,300 Redenbach

Clinical Appropriateness 1,000 McCutcheon

Quality & Safety Initiatives 1,000 Smadu

Patient Flow / 95% Occupancy 1,000 Neville

Improve on Ambulatory Care

Sensitive Condition Indicators 3,000 Earnshaw

Reduce Orientation Costs by 20% * 1,300 Higgins

Reduce Sick Costs by 15% * 2,500 Higgins

Reduce Overtime Premiums by 33% * 3,929 Peters

Workforce Optimization - 152 FTEs at average salary of $85,000 ** 12,740 All

Revised Surplus (Deficit) $0

* Expected payback from daily management initiatives

** Done through attrition, does not contemplate layoffs

ACCREDITATION

Accreditation Items before Sept. 17, 2015

Standard Set Due Date

June 15-19

June 22-26

June 29-July

3 July 6-

10 July 13-

17 July 20-

24 July 27-

31 Aug 3- 7 Aug 10

- 14 Aug

17-21 Aug

24-28 Aug 31- Sept 4

Sept 7-11

Dr. McCutcheon

Emergency Department Sep-15

Emergency Medical Services Sep-15

Medicine Services Sep-15

Cancer Care and Oncology Sep-15

Critical Care Sep-15

Michael Redenbach

Mental Health Sep-15

Population Health and Wellness

Sep-15

Long-Term Care Sep-15

Sharron Garratt

Ambulatory Sep-15

Obstetrics Sep-15

Perioperative Sep-15


Cont’d

Karen Earnshaw

Hospice, Palliative, and End-of-Life

Sep-15

Home care Sep-15

Public Health Sep-15

Rural (Imbedded in other CQI Teams)

Emergency Department

Ambulatory

IPAC

Reprocessing

Medication Management

Perioperative

Long -Term Care

Keith Dewar

Leadership: Medication Reconciliation

Sep-15

Leadership: Workplace Violence Prevention

Sep-15


Cont’d

Dawn Calder

Reprocessing Sep-15

Rehabilitation Sep-15

Medication Management Sep-15

Medication Reconciliation

Antimicrobial Stewardship Program

Concentrated Electrolytes

High- Alert Medications

Heparin

Narcotics

Infusion Pump Training

Marlene Smadu

IPAC Sep-15

PATIENT FLOW VISIONING SESSION

Current Year Course Correction

• Listen and take notes throughout the day

• Note changes to things that will influence your

area and your plan, e.g. budget restriction.

• Dedicate time after the session to work in your

teams and look at your plans to see what needs

to be adjusted for this year and the following

years

• Who will you need to talk to/link in with to

connect your work?

Portfolio Planning & Deployment

ClinicalBest

Practice

• Initiatives and projects cascaded down from the strategic

plan and one-year business plan• Other important work identified to mitigate risks, fill gaps,

and improve performances

Budge

Risks/Gaps/Challenges

Other E-Scan Data

Accred. Standards

CIHI Data


• Current year course correct

Q1


• Review inputs into next year plan

Q2


• Finalize next year plan

Q3

• Year end report (annual report)

• Celebrate successes

Q4

Feedback/

challenges/gapsbrought back to

the MOH and PLT tables.

Initiatives and

projectscascading down

to service lines and departments

where they are able to contribute

to achievement of strategic

outcomes and targets.

• Includes high priority, cross functional initiatives, measures, and targets that require regular monitoring by the Senior Leadership Team

• Identifies the annual priority areas of focus for the region

Portfolio, Service Line,

Department Multi-Year Plans

Key Support: SPBIU/KPO/KOTs

Use Lean tools to support implementation of operational plans wherever applicable: RPIW, 5S, Kanban, Standard Work, Replication, etc. Ongoing review of operationalization of Lean tools and training on the use of Lean tools will take place throughout the year rather than

Provincial

Outcomes & Targets

Patient, Staff, and Physician Feedback

Strategic Planning Inputs

Strategic PlanningOutput 1:

Strategic Planning Output 2:

Cascading

Plans

RQHR Multi-Year Strategic Plan

Key Supportt: SPBIU

RQHR One-YearBusiness Plan

Key Support: SPBIU

• Daily work of service delivery

• Current year initiatives and projects cascaded down from service line/department multi-year plans

Service Line, Department, Unit

One-Year Operational Plans

Key Support: KPO/KOTs

DRAFT RQHR Planning and Reporting Input/Output

Kaizen Plans/Integrated

TimelinesKey Support: KPO/KOTs

VP Quarterly Report on Strategies

Q1 – 2015/16

Vision:

Healthy people, families and communities.

Acting VP: Dawn Calder

Integrated Health Services – Clinical Support

Multi-year Plan:

ED Waits and Patient Flow

Portfolio Overview

• Patient Flow

• Pharmacy & Respiratory Services

• Medical Imaging

• Lab Services

• Rehabilitation, Spiritual Care & Native Health

Services

• HealthLine

• Support Services, Central Scheduling & Sterile

Processing

Multi Year Strategic Plan

VP leading on:

• Corporate Patient Flow Multi-year Plan:

Provincial Hoshin ED Waits & Patient Flow

Implementation Strategy

RQHR Multi Year Strategic Plan & Business

Plan

RQHR Patient Flow Program / Framework

Patient Flow Multi-year Plan

2015/16 Provincial Outcome & Improvement Targets for

Patient Flow

• By March 31, 2017, no patient will wait for care

in the emergency department.

- (Hoshin) By March 31, 2016, 90% of patients

waiting for an inpatient bed will wait <= 17.5 hours.

- By March 31, 2016, the length of stay (LOS) in the

ER for 90% of admitted patients will be <= 22.3

hours

- By March 31, 2016, the LOS in the ER for 90% non-

admitted patients will be <= 5.9 hours

Hoshin Measure – Combined

Hoshin Measure - RQHR

10

20

30

40

M A M J J A S O N D J2015

F M

Regina

Date Prepared: 02Jun2015

Report Contact: Sheena McRae, MoH

Source: 06May2015 cut of NACRS/DAD

Operational Defini tion: The time from the decis ion to admit to the time the patient leaves the ED for an inpatient bed.

Time waited in the ED for an inpatient bed: 90th percentile in hours

Patient Flow Multi-year Plan

Status of Strategy Implementation

Successes

Successes/What is working

- Recognized Provincially and Nationally for our Success - Improved occupancy and ANB #

- Continued Shift in Culture and Ownership: Flow is “our” issue

- Patient Flow Visibility Wall - Corrective Action Plans

- Improves understanding of system view and connection

- Patient Flow Analytics - Improving access to data

- Excellent engagement from operational areas

- FloCast

- Accountable Care Unit- early results - Improved patient care, participation and awareness of care plan

- Staff and physician engagement

RQHR FloCast

http://rqhanalwks/RQHROF

RQHR FloCast

Accuracy

39

Medicine

Program Occupancy

104%

Target: 95% Occupancy

14 day trend

80%

100%

120%

Unit Occupancy

Unit 3E 106%

Unit 5E 100% ▲

Unit 6F 108%

Patient Flow Dashboard > RQHR > RGH >

Last Updated: Today at 11:50am

6 month average

Past 24 hours

Avg. ED Pull Time

7.0 hours

Target: < 4.0 hours

Transfers from ICU

2 patients

Typical: 4 Patients 0

10

20

Admitting Pressures

6 month average

Medicine Avg. LOS

7.5 days

Target: < 6.0 Days

Off-Service Beds

29 patients

Target: < 6 Patients

Inpatient Performance

28 patients admitted over 31 days Target: < 30 Patients

Past 24 hours

20

30

40

50

Past Week Net Flow

+18 patients


D -1 Accuracy

61%

Target: > 70%

Discharging Performance

1 discharge before 11:00 Target: > 5 Discharges

Past 24 hours

6 month average -50

-25

0

25

50

Infl

ow

O

utf

low

M

an

ag

em

en

t

Admitting Pressures

10 ANB patients Target: < 5 Patients

40

Unit 3E

Program Occupancy

106%

Target: 95% Occupancy

14 day trend

80%

100%

120%

Last Updated: Today at 11:50am

6 month average

Past 24 hours

Avg. ED Pull Time

6.3 hours

Target: < 4.0 hours

Transfers from ICU

1 patient

Typical: 4 Patients 0

10

20

Admitting Pressures

6 month average

Medicine Avg. LOS

7.2 days

Target: < 6.0 Days

Inpatient Performance

16 patients admitted over 31 days Target: < 30 Patients

Past 24 hours

20

30

40

50

Past Week Net Flow

+1 patient


D -1 Accuracy

67%

Target: > 70%

Discharging Performance

0 discharges before 11:00 Target: > 3 Discharges

Past 24 hours

6 month average -50

-25

0

25

50

Infl

ow

O

utf

low

M

an

ag

em

en

t

Admitting Pressures

3 ANB patients Target: < 3 Patients

Patient Flow Dashboard > RQHR > RGH > Medicine >

41

Status of Strategy Implementation –

Challenges & Risks

Challenges/Gaps/Risks

• Significant Work Required to Achieve Targets

• Consistent Use of Patient Flow Standard Work and Tools

• Shifting from Reactive to Proactive

Next Steps

Next Steps

- Visioning Session - Validation of targets and activities

- Incorporation of actions into each areas multi-year plan

- Continued coordination of activities

- Patient Flow Analytics - Initial unit/system level dashboard functionality ( next 3-4

months)

- Patient Flow Standard Work Coaching Support for IP

Units.

- Continued Implementation of ACU


Q1 – 2015/16

VP: Carol Klassen – Knowledge & Technology Services

Multi-year Plans:

- IT/IM/Equipment Multi-year Plan

- Academic & Research Multi-year Plan

Vision:


Portfolio Overview

• Information Technology

• Research & Health Information Services

• Clinical Engineering

• Academic Health Sciences

Multi-year Strategic Plans

VP is Leading on:

• IM*/IT*/Equipment Multi-year Plan

• Research/Academic Multi-year Plan

*IM - Information Management

*IT - Information Technology

IM/IT/Equipment Multi-year Plan

2015-16 Provincial Outcome

By March 31, 2017, all infrastructures (information

technology, equipment & facilities) will integrate

with provincial strategic priorities, be delivered

within a provincial plan and adhere to provincial

strategic work.

IM/IT/Equipment Multi-year Plan

Provincial Improvement Targets

2015-16 Improvement Target

• By March 31, 2016, have delivered results on 3 high impact

capital areas that address high risk for critical failure using

alternative funding/delivery options.

• By March 31, 2016, common criteria and options for

investing are used to vet all capital investments.

2015/16 RQHR Outcome Measures

1. Key projects on schedule – Milestone Chart

2. Responsive support services • # of Users of SunRise Clinical Manager

• Turnaround time for discharge summary

• # of unplanned repair/replacement of critical equipment

3. Multi-year Plan for Equipment Replacement

IM/IT/Equip Multi-year Plan

Background: IT/IM Vision

Vision IT/IM

Better health by empowering patients and

enabling providers with the right information

at the right time through a provincially

standardized system that is sustainable and

secure

Background: IT/IM Key Strategies

Key Strategies

– Supporting Patient and Family centred care

– Connecting care across the Region and

integrating with the provincial E.H.R.

– Advancing clinical decision supports for safer

care

– Turning data into actionable information

– Ensuring system integrity and usability

RQHR IT Project Status

as of June 15, 2015

Connect Care Across the Region and the Electronic Patient Record

Patient Care Through Automation and Innovation

Ensuring System Integrity and Usability

Turn Data into Actionable Information

Provincial/Mandatory Projects

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

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QA

Health Record Chart Assembly Backlog

BaselineDate Prepared: Mar 30, 2015

Report Contact: Kim Fichter, CHIM

Source: HIMS QA Backlog

Refresh Cycle: Weekly Plan Baseline

Dec 6, 2013 started to send 2 buckets to Pasqua (ER Coding and

Assembly/QA). Jan 20, 2014 started sending 4 buckets to Pasqua (2 for

Front Office, 2 for IP Coders) [Janelle off for surgery month of February]

OT done May 3, 2014 No QA going to Pasqua on a regular basis. August

25, 2014 started with 1 ER coder in Conference Room.(Sep 30 started

Number of Open Work Orders –

Clinical Equipment [2013 to current]

Status of Strategy Implementation -

Successes

• Key Project - Replacement of Enovation on

schedule

• Growing use of electronic clinical information

• 6,400+ staff and physicians with access to SCM

• Availability of discharge information

• Achieving turnaround times for Priority (24

hours) and Non-priority (14 days) dictation

• Improved chart availability in physician dictation

room to 7 days after patient discharge.

• Improving reliability of Clinical Equipment

• The backlog of preventive maintenance is

ALMOST eliminated

• As anticipated, seeing a direct correlation

between preventive and decreasing corrective

maintenance needs

• Successful 5S projects at PH and RGH

• All positions filled – our 2 NAIT Coop students

from last year are now employees of CES


Success Continued


Challenges & Risks


High need and demand for services

High workload with limited resources

Lack of processes to prioritize work

Lack of work standards

Impact of Provincial Projects on resources

Key Deadlines and Regulatory Requirements in

HIMS need organizational (including physician)

support to achieve

Next Steps / Link to 2014/15

• Continue implementing approved IT projects

• Begin process to update IT disaster recovery

plan

• Continue to work with 3S and eHealth

• Complete planning and begin roll-out of

new Hospira pumps

Next Steps / Link to 2014/15 -

continued

• Identify a partner and develop a model for

embedded data analysis support

• Value Stream Map processes in Health

Records to identify areas for improvement

• Continue to reduce wait for discharge

summary information for the community

physician (#days)

• Develop plan for eliminating duplication of

electronic information in paper health record

chart


continued

• Continue work on a region wide equipment

evergreen process/work standards

• Successful launch and completion of the bed

lift maintenance program

• Create a baseline and targets for critical

downtime – upgrade in AIMS will allow us

to track

• Staff morale – significant gains and will

continue with work and annual staff survey

• Monitor and track unused vacation

RESEARCH and ACADEMIC

Research/Academic Multi-year Plan

RQHR Outcomes & Improvement Targets

By March 31, 2017 RQHR will:

- Have the necessary infrastructure in place to grow

patient oriented research

- Enhance its role as an academic health science

centre

• By March 31, 2016, RQHR will have confirmed

strategies and multi-year plan to enhance patient

oriented research and grow as an academic health

science centre.


• Vision/Strategy and multi-year Plan • Research and Academic Health Science Centre

Milestone chart(s)

• Increase research and academic

contribution and visibility • Impact measure showing value add to patient

outcomes/experience of research

• 15% increase in use of Simulation Centre

Research/Academic Outcome Measures


Outcome Measure

• Under Development


Successes

• Research Showcase 2015 on June 22nd

• RQHR participating in the provincial application to

CIHR for funding Saskatchewan Centre for

Patient-Oriented Research (SCPOR)

• Initial discussions underway with College of

Medicine regarding a new Affiliation Agreement

with RQHR to support Regina as 2nd campus

• Renovation of space (5B) underway to improve

capacity for residents’ participation in call


Challenges & Risks


• Lack academic-RQHR agreements specific to

research and academic partnerships

Next Steps / Link to 2014/15

Launch new research impact measurement tool

and profile value of Research

Continue dialogue/planning to refine the

Research vision and multi-year plan

Continue development of partnerships and

affiliation agreement(s)

Finalize RQHR’s commitment for SCPOR


continued

Monitor renovations to meet timelines for fall

students

Launch ATLS program in the Simulation

Centre

Continue planning for expansion of

geographically based residents and transition

to 2+2 curriculum

Continue development of Family Medicine

Unit partnership with Primary Health Care on

‘Connect to Care’ project –targets in progress

QUESTIONS


Q1 – 2015/16

Vision:


Acting VP: JP Cullen

Human Resources & Communications

Multi-year Plans:

- Workplace Safety Multi-year Plan

- Employee Engagement Multi-year Plan

Portfolio Overview

• Workforce Strategy, Safety & Wellness • Employment Services

• Workplace Health & Safety

• Attendance Support

• Volunteer Services

• Workforce Planning

• Employee Relations & Development • Labour Relations

• Employee Relations

• Learning and Mentorship

Portfolio Overview

• Security & Parking Services • Security

• Parking

• Communications • Corporate Communications

• Medical Media

Multi-year Strategic Plan

VP is Leading on:

• Workplace Safety Multi-Year Plan

• Employee Engagement Multi-Year Plan

Workplace Safety Multi-year Plan

2015-16 Provincial Health System Outcome To achieve a culture of safety, by March 31, 2020, there

will be no harm to patients or staff.

• By March 2018, fully implement a provincial Safety

Alert/Stop the Line (SA/STL) process throughout

Saskatchewan

• By March 31, 2018, all regions and the Cancer Agency will

implement the six elements of the Safety Management

System. (SMS)

• By March 31, 2019, all regions and the Cancer Agency

receive a 75% evaluation score on the implementation of

the elements of the Safety Management System

• By March 2019 there will be zero shoulder and back

injuries.

Workforce Safety Multi-year Plan

Outcome Measure

Workplace Safety Outcome Measure


Successes

Successes/What is working • Did not meet targets in 2014-15, but did sustain gains

from previous years

• Increased communication at department visibility walls

regarding patient/staff safety issues

• Self Serve Run Charts

• Increased participation in safety training for leaders

• Improvements in incident investigations and remedial

action plans

• Safety interventions at Unit Level aid reduction in lost

time incidents

• Safety Remains a Priority


Challenges & Risks


• Management Capacity

• Safety Resource Capacity

• Information Technology – tracking, especially for

training

• Need more direct, front-line management of injury (a

la Unit 3-2, Unit 2-5 Strategies)

• Extremely resource intensive


Priorities for 2015-16:

• Hazard / Risk Assessment

– SMS

• Shoulder / Back Injury Strategy

– TLR / SMART

• Co-Lead Stop the Line

• Violence Prevention


• Focus on smaller number of initiatives

• Work Standards

82

Next Steps

Next Steps • Finalize A3s

• Continue Work Already Begun:

• Unit Level Work

• Action Plan

• Violence Policy / Programme

• Complete Phase 2

• Begin Phase 3

• Stop the Line

• PDCA Cycles

• TLR Audits

Employee Engagement Multi-year Plan

RQHR Outcome

By 2017, RQHR will reach an average employee

and physician engagement score of 80%


Successes

Successes/What is working - Pockets of Excellence

- High Engagement at Local Levels

- Strong Committed Teams

- Lean Processes


Challenges & Risks


• Manager Capacity

• Structural issues that are hard to fix

• Resources

• Span of Control

Next Steps

Next Steps

• Priorities: Resources, Performance Management

• Focus Areas: Management Capacity; Workforce

Optimization; Performance Management /

Accountability; Lean Tools

• Engagement Training for Leaders

• Information Resources, Tools

• Strategy to Address Span of Control

BREAK

Resume at 2:05pm


Q1 – 2015/16

Vision:


VP: Marlene Smadu,

Quality and Transformation

Multi-year Plans:

- Patient and Family Centered Care Multi-year Plan

- Patient Safety/ Stop the Line Multi-year Plan

Portfolio Overview

• Regional Infection Prevention and Control

• Patient Safety Office—Risk, Privacy and

Access to Info, Emergency Planning

• Transfusion Safety

• Patient Advocate Services

• Kaizen Promotion Office

• Clinical Quality and Professional Practice


VP leading on: Patient and Family

Centred Care

RQHR Outcome

By March 31, 2017 RQHR will have

created a culture of Patient and Family

Centered Care that leads to zero defects, no

waits and waste from the perspective of

patients and families, and that incorporates

the core concepts of Patient and Family

Centred Care (dignity and respect,

information sharing, participation and

collaboration).

A3 TEMPLATE - RQHR STRATEGY

Title: Patient and Family Centred Care Which provincial hoshin/outcome does this strategy support: Primary Owner (SLT Lead): Marlene Smadu Team Lead(s) (Leaders of key initiatives): Shelley Hoffman, Debra Wiszniak, Kateri Singer, Alan Chapple, Paula Van Vliet, Dona Braun Expert Advisor (if applicable): Tamara Quine

Date of Original Draft: February 26, 2014 Date Last Updated: Estimated Budget Requirements: Estimated Resource Requirements:

1. Problem Statement (Current state and the reason for action.) [Explain what and how big the problem is and why strategic action is required to address it.]

4. Implementation Plan (What are the high-level actions that will be taken to address the problem within the given timeframe? What actions need to be taken to achieve the future state?) [More detail can be included in a separate implementation plan.]

Over the years the health care system has evolved to one where the processes, policies, services, scheduling, approaches and other aspects have become increasingly provider-centred The Patient First Review conducted in Saskatchewan provided many examples of how the current health care system is not patient and family centred.

Lean principles are based on viewing the system from the perspective of the patient and family journey, eliminating waste and waits, and aiming for zero defects for the patient and family. .

Key Areas to Work On

(fill out supporting multi-year summary as well – attached)

Who Date

1. Accountability Framework—will include appropriate policies,

services and initiatives that support patient and family centred care

region-wide, and consequences when policies are not adhered to.

Clear process on how to incorporate patient and family feedback for

service delivery improvements

SLT

2. Human Resources—Ensure appropriate mechanisms (per diems,

travel allowances, etc.) to support full patient and family advisor

engagement in development, implementation and evaluation of patient

and family centred care

3. Facilities (and/or other major infrastructure requirements)—Signage,

parking, etc to support patient and family centred care

C. Klassen/R.

Peters, M. Smadu

4. Technology ( IT/IM/Heath Technologies/Equipment)—Public and

patient portals for information

Updated RQHR website for easy placement of information for and

access by the public, patients, residents, clients, families.

C. Klassen

5. Policy/Legislation—policy development including consequences SLT

6. Budget

(For strategies of large scale this section can be supplemented by project plans or other plan template. See example of

Multi-Year Plan template the MOH is using.)

RQHR demonstrates a culture of PFCC that incorporates the core concepts of dignity, respect, information sharing,

participation and collaboration and leads toward zero defects, zero waits, and zero waste from the perspective of patients and families at every level of interaction

PRIMARY DRIVERS SECONDARY DRIVERS ACTIONABLE

Staff educated on PFCC

Educate family and patients

Culture demonstrated by leaders (belief that we serve patients)

Support infrastructure (process pathways)

Accountable for behaviour (HH,TLR)

Adequate and appropriate staffing

PFCC part of performance appraisals

Patient and family engagement

Patient and Family Centred Care (PFCC) – A3Driver Diagram CatchballQuality and Transformation Leadership Team March 17, 2015Cityview OfficesV.April 23, 2015

IT solution to enable to speak to each other

Training staff to listen how to speak

Awareness , expectation of behaviour

Celebrate, recognise when things go right

Replicate model behaviour

More simplified process for patient

Policy to ensure patient involvement

Right Person, Right time, Right Place

Staff communication with multi disciplinary team

Mon – Fri , 8 – 5 Staff for 24/7 service

Human contact expectation – greet people

Patients in committee meetings

AIDET, SBAR Training

Train for leadership

Develop Standard work / Work standard

Welcoming Signage

Parking Access

Patient Experience survey

Engage patient family on selection committee

Patient given handout expectation document

Standards of care document

Incorporate into healthcare education – nursing school, docs, reg. bodies, etc.

5 Votes (Debra) 6 Votes (Debra, Tamara)

Awareness and Education

Family Presence Policy

Rounds at the bedside

5 Votes (Debra, Tamara)

4 Votes (Tamara)

2015-16 Multi-year Plan

• Transforming the system

– Supporting family presence

– MDR and shift to shift at the bedside

– 100% use of whiteboards

– Intentional rounding

– Appropriate patient centred signage

– ID badges

– Patient Experience Survey in RGH / PH / Rural

2015-16 Multi-year Plan

• Transforming the system – Cont’d

– Patient and family advisory groups

– Coordinating with provincial partners

– Staff education on PFCC

– Policy on patients/families on interview panels

– Patients and families engaged in improvement /

lean work

Successes/What is working • Completed driver diagram for this year—will focus on key drivers

• Patient and family advisors educating public on HH, region orientation, board

meetings, flow visioning, patient experience survey/whiteboard presentations

to staff, patients on the quality and safety admin committee, patients leading

gemba walks

• Initiatives such as multidisciplinary rounds at the bedside, white boards,

safety huddles, manager rounding, Accountable Care Unit

• Consent for transfusions great improvement

• Engagement of RQHR leadership in placing patients first through initiatives

such as HH, Immunization, SSI prevention

• Developing family friendly and evidence based PPE protocols for visitors

and families of colonized isolated patients.

• Beginning implementation of “real-time concern handling” with Medicine

Service Line

Patient and Family Centered Care

Multi-year Plan

• Challenges/Gaps/Risks/

- Much work to spread and replicate practices redesigned

by patients and frontline staff and physicians.

- Lack of EHR and difficulty getting RQHR forms on

physicians’ EMR, e.g. Accuro

- Have not yet implemented many best practices, e.g.

family presence policy, signage

• What isn’t working/What can be improved

• Timely disclosure to patients/families and resolution of

client concerns in real time

• “Concern handling is not a department – it is everyone’s

responsibility” – processes need to evolve


Multi-year Plan

• Next Steps

– “Full court press” on HH continues—aim 100%

– Region-wide spread and replication of best practices in

patient and family centred care

– Continue to focus on zero defects, no waste/waits

– Increased communication/education of staff,

physicians, public, patients, residents, clients, families

– Patient Experience Survey – medicine, critical care,

surgery, rural facilities

– Family presence policy


Multi-year Plan

Patient Safety/ Stop the Line

Multi-year Plan

2015-16 Provincial Outcome & Improvement Targets

o To achieve a culture of safety by March 31, 2020 where there

will be no harm to patients or staff

o By March 2018, fully implement a provincial Safety Alert

System / Stop the Line (SAS/STL) process throughout

Saskatchewan

o By March 31, 2018, all regions and the Cancer Agency will

implement the six elements of the Safety Management System

(SMS)

o By March 31, 2019, all regions and the Cancer Agency receive

a 75% evaluation score on the implementation of the elements

of the Safety Management System

o By March 2019 there will be zero shoulder and back injuries

Getting to Green:

SAS/STL Model Implementation

• Status: Spread of SAS/STL to Saskatoon City and Royal

University Hospitals - in progress

• Measure: Progress of Implementation and Spread of the Safety

Alert System Model Line

• Corrective Actions: Improvements to data base in process,

increase leadership and staff focus, and investments in

SAS/STL through elevation of work to 90 Day Hoshin in 2015

• PLT Action Required:

Continue to support resource sharing between eHealth and SHR to continue to

PDCA SHR data base

Actively support SAS/STL implementation in all RHAs and Regional participation in

the Safety Network to coordinate and align SAS/STL across the province


Multi-year Plan

• Challenges/Gaps/Risks/

What isn’t working/What can be improved – The region is waiting on a provincial decision regarding

the purchase of an Adverse Event Management System

that will be critical to the success of STL

– Front line engagement has been great in some trials and a

struggle in others in STL PDSA trials. This may relate to

the cultural readiness of individual units in relation to the

change

– Psychological safety for patients/families, staff and

physicians


Multi-year Plan

• Successes/What is working – STL Algorithm, Roles/Responsibilities document and

Tool Kit have been developed and are being used by

other RHAs

– STL PDSA has been completed on 4 units and 1 trial

remains underway at the WRC

– STL working group has patient/family representation

– RQHR STL is moving forward as planned—e.g. have

done design RPIW on STL re equipment and supplies

– Confidential Occurrence Reporting Database is being

kept current—trending occurring in real time and trials of

an electronic COR are underway


Multi-year Plan

Next Steps

• Complete a cultural readiness survey and

replication/roll-out plan prior to implementing

STL throughout region

• Heighten awareness of STL as a priority &

continue culture change

• Provide leadership on multi-year plans for the two

highest COR concerns: medication errors and

falls


Q1 – 2015/16

VP: Michael Redenbach – Integrated Health Services

Multi-year Plans:

- Seniors Multi-year Plan

- Mental Health &Addictions Multi-year Plan

Vision:


Portfolio Overview

• Facility Based Continuing Care Service Line

– Pioneer Village

– Extended Care/ Veterans Program

– Continuing Care, Programing & Utilization

– Health Services Organizations

• Mental Health & Addiction Service Line

– Outpatient Adult Mental Health Services

– Outpatient Child & Youth Mental Health Services

– Inpatient Mental Health Services

– Outpatient & Inpatient Addiction Services

– KOT


VP is Leading on:

• Seniors Multi-year Plan will focus on:

– Community-based services – Home First/Quick

Response, Home Care opportunity analysis,

standard work

– Long-term care – Purposeful Hourly Interactions

(Rounding), Gentle Persuasive Approach,

Enhanced Dining

– Acute care – Seniors Friendly Hospital approach

– Proposal for multiple facility replacements

Seniors Multi-year Plan

2015-16 Provincial Outcome & Improvement Targets

• By March 31, 2020, seniors who require community

support can remain at home as long as possible, enabling

them to safely progress into other care options as needs

change

– By March 31, 2017, the number of clients with a Method of

Assigning Priority Levels (MAPLe) score of three to five

living in the community supported by home care will increase

by 2%

Seniors Multi-year Plan

Outcome Measure


Successes


RPIW #76 Post Fall Huddles Implemented on 3West, Regina

Pioneer Village – Improved communication to the family when they are able to participate in a

huddle

– Improved resident safety by getting to the root cause of a fall

– Improved quality of care results when all care staff contribute to a residents falls

prevention plan

RPIW #79 reduce the variation of resident information and

eliminate defects in shift handovers on Unit 2-6 WRC – Shift handover reports decreased from 6 to 5.

– Patients now feel they have a voice in their care with the implementation of

weekly patient rounds. Changes in shift handover, so that every patient is discussed

at each report, are expected to result in safer patient care.


Successes

Successes/What is working • Antipsychotic without a diagnosis project on the 2nd floor of Santa Maria

Senior Citizen’s home.

– Initial Project Co-hort (n=38)

• 74 % discontinued (28)

• 13% decreased dosage (5)

• 13% residents deceased or transferred (5)

– Project team held a kaizen session to prepare for spread to the 3rd and 4th

floor of Santa Maria. Staff and resident’s family were involved in creating

a driver diagram.

– Comments from family:

• “Reduction has been great for my husband”,

• “ noticed a good change in my mother – brighter, more alert and healthier”


Successes


Successes


• Regional Pilot at RPV to determine impact

of Nurse Practitioner on the delivery of

appropriate care to residents in LTC

Facilities.

– April 20, 2015: Nurse Practitioner hired.

– Education and SBAR completed

– Developing standardized clinical tools for staff

to complete comprehensive assessment


Successes


Challenges & Risks


• Immense financial pressure the Region is currently

experiencing. Service Line understanding that there will be

many excellent things we are not able to accomplish due to

limited funding, people and time.

• Accreditation – Required evidence submitted September 17,

2015 for 4 ROPs for compliance

• Severe physical infrastructure needs in several long-term care

facilities

• Importance of “Quality of Life” measures in LTC – No process

or oversight for Quality of Care in LTC

Next Steps

Next Steps • Ombudsman’s Report on Long-Term Care, RHAs agreed to

review the current state of implementation of the Program

Guidelines for Special-care Homes in their regions. This is a

starting point for further discussions with the ministry to look

at: – Develop and implement policies and procedures to operationalize the standards of care

in the Program Guidelines for Special-care Homes.

– Identify, track and report on specific and measurable outcomes that ensure the

standards of care in the Program Guidelines for Special-care Homes are met

consistently for each long-term care resident.

– Include those specific and measurable outcomes as performance requirements in their

agreements with long-term care facilities.

• Continue roll-out and embedding of Purposeful Hourly

Interactions and Enhanced Dining Experience

• LTC Service Line Planning Session to develop work plan

Next Steps

• New Ministry LTC Initiatives

– Geriatric Program

• Recruiting for a Geriatrician

• Steering committee in the process of developing a framework

• Conducting an inventory of all services and programs in all regions.

– Specialized Dementia units/behaviour Unit

• Pulling environmental scan and lit search data together and collate.

• Complete gap analysis

• Identify suggested program models based on leading practice

• Set up steering committee meeting to pull team together and present

foundational work, and plan next steps

• Work with the KOT to help create plan and steps, including use of lean tools

– Spread LEAN in remaining 50% - DVM

• LTC KOT along with the RQHR KPO will be rolling out a plan to implement

in areas without a DVM and/or working with the units to improve their current

DVMs.

Portfolio Overview

• Mental Health & Addiction Service Line

– Outpatient Adult Mental Health Services

– Outpatient Child & Youth Mental Health Services

– Inpatient Mental Health Services

– Out patient & Inpatient Addiction Services

– KOT


VP leading on:

Mental Health and Addictions

Multi-year Plan

2015-16 Provincial Health System Outcome

• By March 2019, there will be increased

access to quality mental health and

addictions services and reduced wait time

for outpatient and psychiatry services

2015-16 Provincial Improvement Targets

• By March 31, 2016, waits for contract and

salaried psychiatrists will meet benchmark

targets to a threshold of 50%

• By March 2016, 85% of Mental Health and

Addictions clients will meet the wait time

benchmarks based on their triage level.

• By March 31, 2017 wait time benchmarks for

mental health and addictions will be met 100%

of the time.

Mental Health and Addictions

Multi-year Plan

Mental Health & Addictions

Multi-year Plan Outcome Measure

50%

0%

20%

40%

60%

80%

100%

A M J J A S O N D J F M A

Child and Youth Psychiatry

50%

0%

20%

40%

60%

80%

100%

A M J J A S O N D J F M A

Adult Psychiatry

Percentage of Clients Meeting the Triage Benchmarks in Psychiatry Programs

Triage Benchmarks

Very Severe - 24 hrs Severe - 5 working days

Moderate - 20 working days Mild - 30 working days

Goal - 85%



Percentage of Clients Meeting the Triage Benchmarks in

Addictions Outpatient

Triage Benchmarks



Goal - 85%



Percentage of Clients Meeting the Triage Benchmarks in Outpatient

Mental Health

Triage Benchmarks



Goal - 85%


Successes


• Value stream mapping, daily visual management,

using PQA and other data to better understand the

service line issues

• Distributed Leadership in projects – tap into the

expertise of many, leadership characterizes the team

• Implementation Science – set up projects to sustain

outcomes

• Cross-functional work and support especially with

ED and IT

• Collaborative work with Ministry of Health

• Patient partnership with Canadian Mental Health

Association


Challenges & Risks


• Challenges: • Communication – we don’t do enough

• Change Management – we don’t always get it right

• Demand from other areas, both internal and external to the

region

• Gaps: • Resource realities – demand exceeds capacity

• Risks: • Change fatigue

• Loss of momentum in projects

• Temporary dip in capacity at some points of program

change

• Meeting wait time target must not compromise quality

Next Steps / Link to 16-17

Next Steps

• Continue work on referral management, psychiatry

redesign, crisis and outreach services, and the

program for people with severe mental illness

• Collaboration with IT on Clin docs project

• Continued implementation/refinement of daily

work boards (daily visual management) and

cascade metrics that facilitate problem solving

• Prepare for major changes to Mental Health

Services Act (proclamation expected Fall 2015

sitting)

• Work on smaller point improvements using Lean

tools – med error reduction on inpatient

VP: Karen Earnshaw – Integrated Health Services

Multi-year Plan:

Primary Health Care Multi-year Plan


Q1 Report – 2015/16

RQHR Primary Health Care Vision

Right Service, Right Provider, Right Place…

All the Time

RQHR Primary Health Care Mission

Primary Health Care is the everyday support for individuals and communities to better

manage their own health. Our commitment is to provide coordinated health services

that are client centred, community designed

and team delivered.

NEW NETWORK VISUALS

Primary Health Care

Portfolio Overview

(Transitional Structure)

Primary Health Care Service Line

• Networks and Services

– Urban Networks

– Rural Networks

– Home Care/ SWADD

– Palliative Care/ Midwifery

– Population & Public Health

– Eagle Moon Health Office

• Quality, Planning and Resource Management

- KOT

- Strategic Engagement and Decision Support

- Program and Resources Management

VP is Leading on:



Provincial Health System Outcome

By March 31, 2017, people living with chronic conditions will experience better health as indicated by a 30% decrease

in hospital utilization related to 6 common chronic conditions.

Age and sex-adjusted hospitalization rates

for 6 ACSCs per 100,000 population aged <75

2015-16 Provincial Improvement Targets

– By March 31, 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"

– By March 31, 2020, 80% of patients with 6 common chronic

conditions (diabetes (DM), coronary artery disease (CAD), chronic

obstructive pulmonary disease (COPD), depression, congestive heart

failure (CHF) and asthma) are receiving best practice care as

evidenced by the completion of provincial templates available

through approved electronic medical records (EMRs) and the eHR

viewer

– By March 31, 2016, TBD% of patients with 4 common chronic

conditions (DM, CAD, COPD, and CHF) are receiving best practice

care as evidenced by the completion of provincial flow sheets

available through approved EMRs and the eHR viewer


Item Key Work/Initiative/Project Monitored Status (Red/Green)

1 Strengthen Home Care Quarterly Green

2 Navigation Platform Quarterly Green

3 Chronic Disease/ COPD Platform Quarterly Green

4 Build Interdisciplinary Primary Health Care Teams Quarterly Green

5 Chronic Disease Prevention Quarterly Green

6 Hand Hygiene/ Flu Shots Quarterly Green

7 Eliminate Unfunded Positions Quarterly Red

8 Physician (and other Provider) Resources Quarterly Red

9 Community Engagement Quarterly Yellow

2015-16 Key Work/Initiative/Project

To Achieve Multi-year Plan Outcome & Targets


Successes

Successes / What’s Working?

A few examples….

• Regular Home Care Huddles – Urban and Rural

• RPIW #81: Med Rec Acute Care to Home Care

• Reassignment of all urban case managed clients complete in June

• COPD A3 and Work plan created

o Inventory of equipment, education and rehab services

nearly complete

o Practices selected for kaizen work

• Health Promotion and Therapies staff transitioning to Rural

• 5 Physicians soon at Meadow PHC Centre

• Reorganizing payroll and budget system for better use and

functionality


Challenges & Risks


• Ongoing recruitment and retention of family physicians and

other providers

• Data/ Information Flow

• Funding Models

• Tight Budget Year

• Rollercoaster of Change

• Continue to Strengthen Home Care

• Complete re-alignment of PHC leadership team and begin asking teams to work differently

• Reduce ER waits and improve pt. flow

PHC Actions

• Improve accessibility to PHC; integrate Mental Health and PHC services

• Improve HIV testing and Immunization rates

• Safety: Hand Hygiene and Flu Shots

• Support seniors at home

• Recruit family physicians

• Strengthen Open Access in Moosomin

• Eliminate unfunded positions; establish a priority list of redeployed positions

Next Steps: 2015-16 Work Plan


• Roster Realignment

• Establish Network Hubs and supply chain

• Mobile Technology

• Inter-disciplinary Case Conferences

• Establish Network Production Boards

• Clinical Standards Review

• Medication Reconciliation on Admission

Strengthening Home Care


Complete re-alignment of PHC leadership team and begin asking

teams to work differently • PHC Center and Open Access Clinic in Moosomin

• Redesign Home First, Connecting to Care and Seniors Home Visiting into single team focused on preventing ER visits and Acute Care Admissions.

• Network Analysis

• Home Care Transition

• Public Health Transition

• PHC Chronic Disease Teams

• Business Admin and Support

2015/2016 Focus

Focus for PHC:

- Complete alignment into Networks and start to build on our foundation

- Support leaders in their new roles - Support staff in working differently

- Continue work towards achieving

improvement targets


Q1 – 2015/16

Vision:


VP: David McCutcheon – Physician Services & Integrated Health Services

Multi-year Plans: - Wait 1/Access to Specialists and Diagnostics Multi-year Plan

- Appropriateness Multi-year Plan

- Physician Engagement Multi-year Plan

- Medicine Service Line Multi-year Plan

Portfolio Overview

• Medicine Service Line

– Emergency Department / EMS

– Critical Care & Cardiosciences Units

– Medicine Inpatient Units

– Medicine KOT

• Physician Services

– Senior Medical Office

– Department Heads

– Practitioner Staff Affairs

– Practitioner Advisory Committee

Wait 1 Multi-year Plan

Wait 1/ Access to Specialist & Diagnostics

Multi-year Plan

2015-16 Provincial Outcome

• By March 31 2019, there will be a 50% decrease

in wait time for appropriate referral from primary

care provider to all specialists or diagnostics.

– By March 31, 2016, the provincial framework for an

appropriate referral to specialists or diagnostics will

be implemented in at least four new clinical areas

within two service lines.

Wait 1 Outcome Measure

Wait 1 Multi-year Plan


Successes


Program is on target for eight of the ten parameters


Challenges & Risks


1. Data issue with access to diagnostics wait time

information (awaiting resolution corrective action

plan suggests a September resolution)

2. Ministry Staffing issue with regard to the patient and

provider satisfaction survey conducted within the Hip

and Knee Treatment and Research Centre

3. Issue with referral data set as percentile needed to be

re-calculated. (Date seen may not be accurate for date

that patient could have been seen).

Appropriateness Multi-year Plan

(Better Care, Made Easier)

Appropriateness Multi-year Plan

2015/16 Provincial Outcome & Improvement Targets

(Note: New language still under review)

• By March 31, 2018, 80% of clinicians in 3

selected clinical areas within one or more service

lines will be utilizing agree upon best practices.

– By March 31, 2016, at least one clinical area within a

service line will have deployed care standards and

will be actively using measurement and feedback to

inform improvement.

Appropriateness of Care

Progress to Date:

Wall Walk Charts: “Green”

Framework Development

MRI Prototype underway

Awareness Campaign continues: SMA, SHR, MoH, PLT, SMOC, RQHR

RHQR DHC meeting on June 30th, 2015

Appropriateness of Care

Better Care, Made Easier

VISION STATEMENT –permission sought from the CMA

“The right care, provided by the right providers, to the right

patient, in the right place, at the right time, resulting in optimal quality care.“

OUTCOME TARGET

By March 31, 2018, 80% of clinicians in 3 selected clinical areas within one or more service lines will be

using agreed upon best practices

(Subject to Revision)

The Framework Purpose is to create:

• A shared understanding of what Appropriateness of Care means,

• A common approach to improving Appropriateness of Care across the system,

• A roadmap for the health system to adopt this common approach within a broad range of patient-centered clinical areas.

Key Guiding Principles

•Clinician-led

•Evidence-based Care

•Effective Care

•Patient- and Family-Centered Care

•Information Sharing

•Equitable Care

•Standardized Care

•Continuous Learning and Improvement

•Interdisciplinary team (care team)

Value to Patients and Clinicians

•Eliminate unnecessary referrals, testing and treatments, thereby reducing wasted

time for both clinicians and patients

•Improve transparency in clinical decision making

•Greater involvement and collaboration of clinicians in developing new knowledge

•Standardized care does not mean “exactly the same care”, rather consistent care

that makes it easier for clinicians to provide and for patients to understand.

•Reduced wait times by ensuring only the right (best) tests or treatments are

provided to patients.

•Reduce potential risks to patient harms associated with unnecessary testing and

treatments

.

Purpose, Guiding Principles & Value

Appropriateness of Care Program Roles

Provincial Program Roles

• Leadership

• Integration

• Provide support structure

• Consultation

• Replication

• Monitoring

• Benefit realization

Healthcare organization roles

• Develop own facility plan

• Adopt provincial methodology

• Collaborate with the provincial program

• Monitor and report own progress

• Measure the impact

Provincial Program Strategies

– Data and measurement

– Stakeholder engagement

– Toolkit development

– Model line project (MRI)

– Communication and consultation

– Customize support

MRI Lumbar Spine

• The main proposed Service Line for 2015-16 includes Medical Imaging: MRI of the lumbar spine

• In 2011-12 there were 1.7 million MRIs performed in Canada (volume doubled in less than a decade) (CIHI data).

• Approximately 5000 MRs performed on lumbar spine in SK annually

• A recent JAMA study found:

29% of the MRI requests for lumbar spine

were considered “inappropriate”

(Emery et al January, 2013)

If applicable to Saskatchewan, this represents an unnecessary expenditure of $833,00.

Appropriateness Multi-year RQHR Plan

(Better Care, Made Easier)

• The 2015/16 completion of design phase by

end of June

• Research generation phase by end of

September

• Implement first project set by end of March

• Monitoring and evaluation by end of March

Projects

1) Drawing from evidence and with the

awareness of the Choosing Wisely

initiative, Department Heads and Section

Heads are developing and renewing their

Pre Printed Orders (PPOs)

2) Standardization of practices

• Sets and trays in the OR

• Equipment and supplies

3) Evidence based practice

4) Pathways implementation

• Spine

• Stroke

• Pelvic floor

RQHR examples

• New PPO admission orders for medical

inpatient units (elimination in unnecessary

blood work and radiology exams,

codification of VTE prophylaxis)

• Appropriate use of the Emergency

Department

• Review of laboratory, echocardiography,

stress testing, and radiology in

Cardiosciences

• Plan to standardize trays in Orthopaedic

procedures starting with knee replacements

Physician Engagement Multi-year Plan


RQHR OUTCOME

• Biennially, the physician engagement survey will

be completed with an engagement score of 55%

in 2016

• By 2017, RQHR will reach an average employee

and physician engagement score of 80%.


The elements of the Multi-year Plan are:

• Communication Plan

– Providing timely information

– Involvement in decision making

– Listening

– Resolving important issues affecting medical staff

• Collaboration Plan

– Oversight Group Strategy

– Development of Compacts (RAHD and in Orthopaedics)

• Accountability plan

– Performance development

– Complaints management

– Bylaw and rules enforcement

– Leadership development


Successes

Successes/What is working - The Senior Medical Office (comprised of Drs. Gill White,

David McCutcheon and George Carson) is committed to

improving physician engagement which is evident by the

work that has been completed to date.

- Department/Section retreats have been instrumental in

discussing and creating solutions to current issues and

trending

- Physicians are being empowered in their dyad and

physician leadership roles

- New service models have been implemented in

Cardiology and Psychiatry


Challenges & Risks


- The Department of Family Medicine structure needs to be

redesigned to provide better support and communication to

community based family physicians

-Departments of Surgery and Medicine need further support to

be able to affectively deliver on the expectations of the

organization.

-The Department Heads have very limited administrative time

to fulfill their duties and accountabilities. Not enough time

provided to engage their members on a daily/weekly basis. As

a result, communication and/or dissemination of information is

sometimes stalled

Next Steps

Next Steps

- Publish a quarterly newsletter, commencing in September

2015

- Second DHC retreat (scheduled for the fall 2015)

- DH performance assessment completed by Senior

Medical Office during summer of 2015

- Development of a business plan to remunerate DHs in

accordance with the ACFP model

Medicine Service Line Multi-year Plan

RQHR Multi-year plans that Contributes

to 15/16 Patient Flow Hoshin

2015/16 Provincial Hoshin

• By March 31, 2016, 90%

of patients waiting for an

inpatient bed will wait <=

17.5 hours.

• RQHR Supporting

Multi-year Plans:

Patient Flow

Primary Health Care

Seniors

Mental Health &

Addictions

Medicine Service Line


2015/16 Provincial Outcome & Improvement Targets for

Patient Flow

• By March 31, 2017, no patient will wait for care

in the emergency department.

- By March 31, 2016, the length of stay (LOS) in the

ER for 90% of admitted patients will be <= 22.3

hours

- By March 31, 2016, the LOS in the ER for 90% non-

admitted patients will be <= 5.9 hours

Hoshin Measure - RQHR

RQHR Multi-year plans

Medicine Inpatient Units (MIU)

Medicine Inpatient Units Goal of 95%-0-0:

The work will focus on:

1) advancing a high quality daily plan of care for each patient.

2) Identifying and removing barriers to advancing the care plan

3) Preventing iatrogenic effects of hospitalization for seniors

4)Preventing harm to all hospitalized patients (i.e. falls, med

errors, infection transmission)

5)Driving to goal of admitting patients to the unit from the ER

within 30 minutes of decision to admit (assuming bed ready and

available)



Principle Strategies

1)Implement Accountable Care Units

- Model Line is unit 4A at Pasqua Hospital (6-12 month pilot). Replication to follow

to all MIUs

- Interdisciplinary in-room patient rounding with unit based physicians

- The rounds follow a standard process to advance the plan of each patient’s care

- Patient safety issues are addressed within the process

- Concurrent planning for discharge is incorporated

- Patient and family members are participants in the rounds

2)Seniors Friendly Hospital

- 33% of seniors over the age of 85 admitted to RQHR die.

- Care issues include:

- functional decline - medication toxicity

- altered consciousness(delirium) - care transition

- malnutrition/dehydration - polypharmacy

- Gentle Persuasive Approach has been demonstrated to be the most effective strategy


Critical Care and Cardio Sciences

• Ongoing assessment of Cardiology service model and diagnostic

scheduling management

• Understanding ED flow and pull times with establishment of

production boards starting on one nursing unit and one

diagnostic area

• Occupancy and surge is manageable – now tracking wait times

for transfers out.

• Ongoing development of Medical Surveillance Unit model.

• New database established to manage volumes within the EP

Program

• Work ongoing for development of Electronic ECG system

which will streamline information flow and access to cath lab.

• Agency nursing to support vacancy management in both areas.

• Team is involved in Hospira IV Pump implementation.


Critical Care and Cardio Sciences


Emergency and EMS

Emergency and EMS:

• e-Primary Assessment • RPIW #69 – decreased time to complete and document primary

assessment in SCM from 25 minutes (average) to 10 minutes (average)

• Urban EMS Offload: • May 2015:

Leading practice in Western Canada (urban)

Average: 90th P

Pasqua ER 12:19 30:29

RGH ER 12:24 39:41

Emergency Departments:

• Major occupancy pressures

• Increase volume of visits

• Restricted space

• “To Meets” waiting to be seen by Consultant (RPIW #74)

• Admit no bed patients

• Results in:

• Increased patient complaints

• Lack of space for clinical assessment

• Privacy and dignity concerns

• Risk of delirium in seniors

• Increased patients leaving without being seen

• Delays for ED patients

• Innovation

• Use of community paramedic to do at home assessments thus

avoiding ED admission


Emergency and EMS


Q1 – 2015/16

Vision:


VP: Sharon Garratt – Integrated Health Services

Update on Surgical Initiative

Portfolio Overview

• Surgical Service Line

– Perioperative Services

– Surgical Access & Inpatient Services

• Women’s & Children’s Health

• Specialized Ambulatory Care

– Ambulatory Care & Medical Outpatients

– Kidney Program

• KOT

Saskatchewan Surgical Initiative

Transform the patient experience through

sooner, safer, smarter surgical care

• By March 31, 2014 100% of patients have the

option of receiving surgery within3 months

• By March 31, 2015, 100% of cancer

surgeries/treatments done within consensus

timeframe from the time of suspicion or diagnosis

of cancer

Surgical Initiative Outcome Measure


Successes


• Good tracking systems are in place

• Surgical Team understands the contributors

to volume, what is within control and not

within control

• Weekly and monthly monitoring identifies

need for course correction


Challenges & Risks


• We need to match capacity to demand, however demand is a

projection – which is an educated guess about the future based

on a variable that fluctuates widely throughout the year.

• There is a risk that patients will experience longer wait times as

our budgeted volumes assume demand growth under 1% and as

of June 1st we were at 2.2%.

• It takes time to course correct – OR allocation changes take

months to implement

• It was much easier to achieve cooperation when the program

was adding capacity and resources. Now that those two things

need to be constrained it is more difficult.

Surgical Demand – Surgical

Bookings by Section

Section 2014 2015 Growth Rate

DENTISTRY 170 240 41.2%

NEUROSURGERY 200 247 23.5%

OTOLARYNGOLOGY 211 252 19.4%

VASCULAR SURGERY 63 72 14.3%

OBSTETRICS GYNAECOLOGY 559 623 11.4%

UROLOGY 252 273 8.3%

PLASTIC SURGERY 164 176 7.3%

ORTHOPAEDIC SURGERY 1391 1473 5.9%

ONCOLOGY 11 11 0.0%

THORACIC SURGERY 39 39 0.0%

OPHTHALMOLOGY 992 879 -11.4%

GENERAL SURGERY 682 595 -12.8%

CARDIOVASCULAR SURGERY 67 57 -14.9%

PAEDIATRIC SURGERY 83 53 -36.1%

TOTAL 4884 4990 2.2%

Surgical Targets

Uncontrollable Controllable

Month Emergencies C-Sections

Electives TOTAL IP OP IP

Apr-15 366 50 73 1612 2101

May-15 432 34 83 1599 2148

Jun-15 423 49 76 1667 2215 Jul-15 429 55 85 1118 1687

Aug-15 455 44 97 1491 2087

Sep-15 416 44 80 1665 2205

Oct-15 391 47 83 1661 2182

Nov-15 384 50 85 1594 2113

Dec-15 395 48 79 1466 1988

Jan-16 415 48 84 1597 2144

Feb-16 368 37 68 1349 1822

Mar-16 443 45 83 1669 2240

Total 4917 551 976 18488 24932

Surgical Waitlist

31.2% 23.2%

68.8% 76.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Waitlist Snapshot: April 1st, 2014 Waitlist Snapshot: April 1st, 2015

Waitlist: IP/OP Mix

IP OP

Next Steps

Next Steps

- Continue to monitor volume to target weekly

- Proceed with summer, Christmas and February

slowdowns as planned

- Review IP/OP mix

- Deep dive on reasons for increase in emergency

surgeries

- Close vacated OR time

BREAK

Resume at 3:40pm


Q1– June 23, 2015

Robbie Peters,

Vice President, Financial Services &

Chief Financial Officer

Vision:


Portfolio Overview

• Finance

– Accounting & Financial Reporting

– Payroll & Benefits

– Decision Support

• Facilities Management

• Materials Management

192


VP is Leading on:

• Financial Sustainability Strategy

Multi-year Plan

• Facilities Strategy Multi-year Plan

193

Financial Sustainability

Provincial Outcome

2015-2016

• By March 31, 2017, Ongoing, as part of a multi-

year budget strategy, the health system will

bend the cost curve by achieving a balanced or

surplus budget.

194


Provincial Targets

2015-2016

• All health system partner organizations will be in

a balanced or surplus year-end financial position

in 2015-16.

• Shared services activities will produce $10M net

new savings in 2015-16

195

Financial Sustainability –

RQHR Results as of May 31, 2015

196

Financial Sustainability –

Shared Services Reported at PLT Wall

197

• Carry forward of financial deficiencies of prior years • Continually exceeding budget by approximately 140 FTEs

• High level of employee movement

• Reduced funding over last 5 years through

efficiency targets in an effort to bend the provincial

costs curve • In the range of $60 - $70 million

• Increasing population and demographic changes

resulting in growing demand for services • Estimated cost of $70 million last 4 years

• Planned investments to respond to growing complex

and changing environment • Physician leadership structure and service expansion

• Sask. Healthcare Management System

• 3sHealth shared service opportunities


RQHR Challenges

198

• Board Approved Priority Areas

- Quality and Safety

- Patient Flow

- Primary Health Care

- Mental Health and Addictions

• Long-term Sustainable Initiatives RQHR continues to focus on developing a strong and

sustainable foundation

• 11 initiatives addressing $38 million deficiency

• 5 initiatives of ETI steering committee (some overlap with 11

initiatives)

• Diligent Daily Management

shared responsibility and accountability for all decision

makers on daily decisions we make


Recap of Strategy Implementation

199

Recap of regional focus to a 2015-16 balanced

budget and reducing long-term cost structure

Priority focuses and preliminary targets to achieve a balanced budget in 2015-16



In $000's

2014-15P 2015-16B $ Change % Change


Regional focus to a 2015-16 balanced budget and reducing

long-term cost structure VP Responsible

3sHealth and Other Contracts 2,500 Peters

Cost Savings from Reduced Surgical Volumes 8,000 Garratt

Reduction of VAC Beds if No Funding for Alternative use 1,300 Redenbach

Clinical Appropriateness 1,000 McCutcheon

Quality & Safety Initiatives 1,000 Smadu

Patient Flow / 95% Occupancy 1,000 Neville

Improve on Ambulatory Care

Sensitive Condition Indicators 3,000 Earnshaw

Reduce Orientation Costs by 20% * 1,300 Higgins

Reduce Sick Costs by 15% * 2,500 Higgins

Reduce Overtime Premiums by 33% * 3,929 Peters

Workforce Optimization - 152 FTEs at avg, salary $85,000 ** 12,740 All

Revised Surplus (Deficit) $0

* Expected payback from daily management initiatives

** Done through attrition, does not contemplate layoffs

1. Management Capacity

2. Accountability Frameworks

3. Master Roster Reviews

4. Overtime Deep Dive

5. Workforce Optimization

Reminder of Efficiencies Targets Initiatives

(ETI) Steering Committee Focuses

201

• Significant budget challenge ahead of us – creating a mechanism to

monitor and report on success of the $38M deficit mitigation strategies

and ETI work

• Monthly SLT and Finance/Business Manager budget meetings

• Wall walk format

• Trialing a virtual wall next week and will be rolled out widely when ready

– want to make this work visible to the organization and other

stakeholders

• Continue to build on the themes of Accountability and Shared

Responsibility throughout the organization

• Monthly meeting and virtual wall will also hold VPs accountable through

monitoring and reporting of portfolio financial results, paid hours, service

volumes, etc.

• Daily management by everyone is key to our success

• Continue to support and lead initiatives such as 3sHealth business cases

• Continued commitment to on-going continuous improvement work (lean,

other)

• Exploring options to develop a temporary dedicated task team to address

immediate financial challenges and operational outliers

Financial Sustainability Going Forward

202


Questions?

203

Facilities Strategy

Provincial Improvement Outcome

• By March 31, 2017, all infrastructures (IT,

equipment & facilities) will integrate with

Provincial strategic priorities, be delivered with a

Provincial plan and adhere to Provincial strategic

work.

204

Facilities Strategy

Provincial Improvement Targets

• By March 31, 2016, have delivered results on 3

high impact capital areas that address high risk

for critical failure using alternative

funding/delivery options.

• By March 31, 2016, common criteria and

options for investing are used to vet all capital

investments.

205

Provincial Model - Infrastructure

206

Provincial Deliverables -

Infrastructure

207

Provincial Timeline - Infrastructure

208

• Lack of Regional involvement in provincial strategy and targets

development and related action plans

• Improvements needed in developing RQHR specific facilities

outcomes and targets which link to provincial and other RQHR

strategies

• Traditionally focusing on upcoming priorities for the

department

• Initiating work with KPO and SPBIU to further develop a

comprehensive strategy plan for Facilities Management

• Significant facility infrastructure deficiencies identified across the

province requiring significant sustained investment

• Minimal annual funding to address deficiencies and no multi year

funding commitments

Facilities Strategy

RQHR Challenges

209

Immediate to Short-Term:

•Working with KPO and SPBIU to enhance overall strategy and

action plans

•Development of comprehensive capital plan to address most critical

areas over the next 3 years and beyond including: • Optimization of annual capital funding to address greatest

operational risks while maximizing ROI ($5.3 million for 2015-16)

• Advancing major capital renewal of critical electrical systems at PH

and RGH and energy upgrades at PH and WRC

• Advancing renewal and building capacity of residential, primary care

and community infrastructure

•Planning workshop in the next quarter with Board/SLT and other

stakeholders to develop an action plan to advance the most critical

areas identified above

Facilities Management Going Forward

210

Immediate to Short-Term (continued):

• Department restructuring to better respond to organizational

operational and capital project requirements, risk mitigation and

maximizing return on investments for limited dollars available to

us, and capitalizing on market opportunities

• Developing / enhancing policies and procedures on space

planning, utilization and alterations

Longer-term:

• Taking a longer term outlook on aligning our facilities, property

and infrastructure management to optimally sustain, critically

enhance and strategically support change and innovation to

increasing demands of better health care for our communities

Facilities Management Going Forward

211

Facilities Strategy

Questions?

212

DEEP DIVE SESSION

Course Correction for Current Year

Table Discussion & Report

• Instructions:

1. Table Discussion (20 minutes): Use your Session

Notes Worksheet and focus table discussions on:

– What needs to be done differently (for particular multi-year

plans)?

– What you can do differently (for your work plan)?

2. Group report out (15 minutes).

3. After Q1 Session:

o Leave your Session Notes Worksheets on the table – we will

collate information for VPs to consider for course correction.

o Take personal action items/ideas back to incorporate into

your work plans.

CLOSING REMARKS

President and CEO, Keith Dewar

2015/16 Q1 Report on Strategic Plan June 23, 2015 · { Q1 Report on Strategic Plan { Current year...

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