VP Lead: Marlene Smadu, Quality and Transformation

•Patient and Family Centered Care A3, Driver Diagram and Multi-year Plan

•Patient Safety/ Stop the Line A3 and 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

Multi Year Strategic PlanVP 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 staffingPFCC 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

Patient and Family Centered Care 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

Patient and Family Centered Care Multi-year Plan

Patient Safety/ Stop the LineMulti-year Plan

2015-16 Provincial Outcome & Improvement Targetso To achieve a culture of safety by March 31, 2020 where there

will be no harm to patients or staffo 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

Patient Safety/ Stop the LineMulti-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

Patient Safety/ Stop the LineMulti-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

Patient Safety/ Stop the LineMulti-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