Quality Qualit y & & Saf Safety ety Indica Indicator tors s – WCB CB Claims Claims INJURY RATE RQHR 7.0 5.8 5.7 6.0 5.2 5.1 4.8 4.4 5.0 4.1 4.1 4.0 3.0 2.0 0.5 0.4 1.0 0.4 1.0 1.0 1.0 1.4 1.4 1.4 2.0 1.9 1.8 2.4 2.4 2.2 3.0 2.9 2.5 3.4 3.2 4.1 3.7 4.5 4.1 4.9 4.6 5.5 5.1 6.0 5.4 0.0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2014-15 2015-16 2016-17 2016-17 2016-17 Year-end Projection Year-end Target
Act Actions ions • Continue with main elements of region injury reduction strategy. • Continue roll out of Stop the Line • Complete Workplace Violence Risk / Hazard Assessments • Initial meeting of Regional Violence Prevention Steering Committee • Finalize electronic TLR Skills Audit tool and reporting process
Vision: Healthy people, families and communities. Hand Hygiene Audit Regional Compliance Rate SLT: Dr. David McCutcheon Physician Services & Integrated Health Services
Qualit Quality y & & Saf Safety ety Indica Indicator tors s – Hand Hygiene Hand Hygiene Regional Compliance rate: 78.8% Hand Hygiene Audit Regional Compliance Rate June 2016 data
Act Actions ions High Level Regional Actions: 1) Strict Hand Hygiene policy in place 2) Discipline is being implemented 3) Continual support to staff 4) Corporate Services will be participating in Regional Hand Hygiene audits 5) Regional Hand Hygiene audit schedule will be adjusted to provide real time data for Quarterly reporting cycles 6) Any units/areas reporting less than 100% compliance will be reported as red 7) More frequent auditing is being considered
RQHR Strategic Plan Focus Area – Access / Patient Flow Introduction by David McCutcheon for SLT
Why Access/ Patient Flow • Access to the right care, in the right place, at the right time, by the right provider is a cornerstone of high quality care. Effective patient flow supports this by identifying and resolving delays within the system in order to improve capacity.
Key Message • Enabling the patient to get access to the right care, in the right place, at the right time, by the right provider is a cornerstone of high quality care.
Multi-year Outcome • Access/Patient Flow Multi-year Outcome : – To improve access for patients and reduce Emergency Department waits by 60%, necessary improvements in key areas (primary healthcare, specialist consults, diagnostics, mental health & addictions, long term care, home care and acute care) will be achieved by 2019. Waits
2016-17 Board Measures and Targets • ED LOS at 90th Percentile – All Patients • # of Surgical cases waited greater than three months • Seniors Plan current state, future state and gap analysis
Vision: Healthy people, families and communities. ED LOS at 90th Percentile – All Patients John Ash Executive Director, Strategy
Access/ Patient Flow Indicator – ED LOS at 90 Percentile
Actions Improving access and coordination of primary health care, and community mental health and addictions services, aimed at improving preventative care in the community and reducing dependency on emergency departments and acute care service. Reducing patient care delays in the emergency department and inpatient units aimed at enhancing the quality of patient care while improving bed capacity through supporting team based care and bedside rounds. Improving the sharing of information between the emergency department, inpatient units and community services to reduce delays in waiting for non-acute services.
Vision: Healthy people, families and communities. # of Surgical Cases Waited Greater than Three Months SLT: Sharon Garratt Integrated Health Services
# Sur # Surgical Cas gical Cases es Waiti aiting >3months ng >3months
Projected Waitlist Growth
Actions • Work with MoH to finalize 16-17 target volume and funding. Continue monthly meetings to keep MoH informed of increasing demand. • Allocate available Operating Room (OR) time to meet funded volume, adjusting In Patient (IP)/ Out Patient (OP) mix to equalize wait times. • Meet bi-weekly to address long-waiters. • Review emergency cases to ensure they are appropriate. • Review IP cases to identify opportunities to shift to OP. • Explore strategies to optimize use of Hip and Knee Clinic
Vision: Healthy people, families and communities. Seniors Current State Analysis SLT: Michael Redenbach Integrated Health Services
Seniors Current State Analysis • Target was completion by August 31, 2016 • Off-target – likely completion by mid-November • Next Steps: SLT to review draft and offer amendments/additions • Finalize and circulate internally and to stakeholders • Use to inform future state planning and gap analysis
Important Business Plan Initiative Update Enhance Medicine Bed Capacity SLT: Michael Redenbach Integrated Health Services
The Importance of Capacity • Access to the right care, in the right place, at the right time, by the right provider is a cornerstone of high quality care. Effective patient flow supports this by identifying and resolving delays within the system in order to improve capacity. • Overcapacity contributes to poor patient care, off- service care, care in non-care areas, waits for care; patient and family dissatisfaction; staff and physician dissatisfaction; overtime costs; staff churn; and in general, much greater expense.
Current Capacity Need • RQHR is consistently at or over-capacity • Winter surge expected January 1-March 31 • Code Burgundy has been operational at Pasqua since late January 2016 • Demand will continue to increase with the growing and aging population Bed analysis confirms the 2016/2017 shortfall is 20 medicine beds
Capacity Solutions • Reducing actual Length of Stay (LOS) to the expected LOS for all patients • Providing alternative locations for care for those who should not be admitted or who can be discharged if the appropriate community supports were in place • Better access to comprehensive primary care to reduce presentations to the ER and admissions • Reallocating underutilized beds within service areas to areas of greater need • Opening additional permanent medicine beds.
Daily Improvements • Daily bed management and commitment to patient flow • Relatively low number of LTC and Convalescent patients in acute beds (subject to occasional spikes) • Enhanced home care and primary health care services • Diverting LTC residents from emerg visits • Diverting Mental Health and Addictions clients • Reduce number of admissions for Ambulatory Care Sensitive Conditions • Reduce bed-days for all Alternate Levels of Care patients • Improve repatriation of rural hospital patients and better utilization of rural hospitals in general
Adding Medicine Bed Capacity Project • Renovations on 5D • Infusions Clinic moving out of 5D into Therapies. • Therapies partly occupying Auditorium. • Temporary movement of Alternate Level of Care Unit to 5D. (Planning underway to locate a permanent home for ALC Unit). • New Medicine Unit on 4B with renovations to be complete by early January. • New unit to open on January 9, 2017. • Code Burgundy to close.
RQHR Strategic Plan Focus Area - System Sustainability Introduction by Robbie Peters for SLT
Why System Sustainability • System Sustainability is about using our people, infrastructure and financial resources responsibly to build a strong health care foundation now, and into the future.
Key Message • We will achieve sustainability through accountability, stewardship and commitment, and ensuring that key foundational structures are in place in order to support the people we serve.
Multi-year Outcomes • System Sustainability Multi-year Outcome : – Ongoing, RQHR will achieve a balanced or surplus budget. Deficit
2016-17 Board Measures and Targets • Define characteristics of culture of accountability and develop an action plan for staff and physicians • RQHR Operating Surplus / Deficit
Vision: Healthy people, families and communities. Define Characteristics of Culture of Accountability and Develop an Action Plan for Staff & Physicians SLT: Mike Higgins, People & Safety & Dr. David McCutcheon, Physician Services & Integrated Health Services
Staff Accountability - Actions Define Characteristics of Culture of Accountability and Develop an Action Plan for Staff Key informant consultations to define accountability, accountability culture Identify elements of accountability culture based on consultation and review of literature, best practice Create Accountability Framework
Physician Accountability – Actions Define Characteristics of Culture of Accountability and Develop an Action Plan for Physician • Leadership Development – New Department Heads Appointed – New Job Descriptions created • Rules & Discipline – RQHR Rules and Regulations to be completed by Dec 31/16 – Education regarding discipline is in process • Medical Quality Plan – Appropriateness of Care – Section Specific Report Cards • Trust and Engagement – Diagnostic Imaging – Communication via Physician newsletter
Vision: Healthy people, families and communities. RQHR Operating Surplus / Deficit SLT: Robbie Peters Financial Services
RQHR Operating Surplus/ Deficit Status
RQHR Operating Surplus / Deficit Actions and Leads • Diligent daily management (All leaders) • Optimizing People Resources initiatives (Garratt/Higgins) • Continuing focus on sick time, overtime and avoidable orientation costs (All leaders) • Maximizing real estate revenue opportunities (Peters) • Participating in shared service opportunities with 3sHealth and other RHAs/SCA (Peters) • Improving inventory and procurement management and product standardization (Peters/Garratt) • Preparing and reporting on monthly corrective actions plans for each service line/portfolio not meeting its budget target (All leaders) • Monthly reporting on progress toward balancing strategies to the Ministry of Health (Peters/Rorbeck)
Important Business Plan Initiative Update Implement Procurement/ Supplies Efficiency Strategies SLT: Robbie Peters Financial Services
Break 20 minutes
Senior Leadership Team Questions & Answers
Planning for 2017-18 Keith Dewar President and CEO
RQHR Strategic Directions Validate RQHR Strategic Direction: Quality and Safety: harm Access and Flow: waits System Sustainability: deficit Note: See exact outcome language in the RQHR strategic plan
Develop 2017-18 Priorities • How to plan for next year: – Selection of work – Pace of work • Between Q2 and Q3: – Consider current year progress and root causes of not meeting targets – Consider Board direction, provincial plan and other planning inputs – Prioritize and select – Develop portfolio/service line plan
Review Strategic Planning Inputs
External Environment E- Scan • Our Environment: Data – Provincial economic situation – Provincial health system transformation – Budget/expenditure reductions are expected to be significant – Growing population places pressure on demand for services • Increased volume • Services to ageing population still an issue • Aboriginal population needs • SK population overall health
External Environment RQHR Covered Population
Governance of Organization: Environmental Considerations $5380 $7279 $9437 $12658 $24539 $15987
External Environment Aboriginal Population • SK Aboriginal Population (source: 2011 National Household Survey) : o 15.6% of the total population - second highest proportion among provinces o Over half (53.2%) live on reserves o 34% of Aboriginal population under the age of 15 compared to 17% of the general population • RHQR Aboriginal population o 12.3% of RQHR respondents identified as aboriginal o 17 First Nation communities within the borders of RQHR
External Environment Overall Population Health Source: You Health System , Canadian Institute for Health Information
Internal Considerations Increased Volume SERVICE UTILIZATION VOLUMES Data Source: RQHR Annual Report 2007-08 2015-16 % Change Hospital Admissions 30,314 34,105 12.51% Births/newborn admissions 3,313 4,353 31.39% Average Daily Census 569.00 637.55 12.05% Emergency Visits 92,793 113,322 22.12% EMS Calls 21,741 25,543 17.49% Home Care Total Units 296,963 373,729 25.85% Surgeries (IP) 9,224 10,975 18.98% Surgeries (OP) 11,528 14,366 24.62% Laboratory Tests Performed 3,061,187 4,267,135 39.39% General Radiology Procedures 105,564 101,949 -3.42% Ultrasound Procedures 22,412 23,916 6.71% CT Services 67,609 46,558 -31.14% MRI Services 7,541 17,470 131.67%
Estimated Costs Absorbed 2008 - 2017 Total Absorbed in 2017 Population Change 46,616 Health Care Cost Increase (Total) $ 196,547,875 RQHR Cost Increase (69% of total) $ 135,618,034 Increase for Out of Region Inpatient Volumes 41,259,102 Increase for Out of Region Outpatient Volumes 8,385,365 $ 185,262,501 Related funding information Inflation Funding $ 104,047,109 Funding Specific to Demographics 25,971,500 Funding Decrease for Efficiency Targets (70,983,851) $ 59,034,758 Estimated excess costs over funding available $ (126,227,743) Operating surplus/(deficit) (13,500,000) Estimated costs absorbed by RQHR $ 112,727,743 Accumulated costs absorbed $ 466,113,183
Internal Considerations Bed Needs Current Med Projection Year 2016/17 2017/18 2018/19 2019/20 2020/21 2025/26 2030/31 Occ. Capacity 226 231 235 240 244 276 318 95% 206 20 beds
Internal Considerations LTC Admissions and Bed Needs Utilization of the LTC Beds: Year # Admissions RQHR will require an 1994 – 1995 390 additional 768 LTC 1998 – 1999 529 beds over the next 10 2002 – 2003 561 years to maintain the 2008 – 2009 current bed to 581 population (75+) ration 2011 – 2012 617 2013 – 2014 826 2014 – 2015 778 2015 – 2016 745
Internal Considerations Critical Deficiencies • Facility Condition Issues – Current deferred maintenance backlog per VFA is now $787 million (source: Ministry of Health). – Up from $515 million from the 2013 VFA assessments – Facility Condition Index (FCI) for a functional portfolio should be below 0.10. FCI of 0.05 is a commercial target. For health care, FCI over 0.15 is generally recognized as a deficiency and poor value in the asset portfolio . FCI of over 0.30 is considered necessary to work towards replacement and over 0.45 should be decanted and disposed of. – RQHR’s average FCI for all facilities is 31.5% based on the 2013 assessments
Internal Considerations Critical Deficiencies • Infrastructure Sustainment Model o Hard Maintenance and Repair • Per 2013 VFA, replacement value ( construction only) and related M&R, investments should be $50.2M/year • Our actual funding in 16-17 is $7.9M Block Funding and $6.1M electrical renewal • Prior 5 years average of less than $5M o Deferred Maintenance and Capital Renewal • For Capital Renewal ( note this does not extend the life of the facility – merely keeps it useful) typically $23.8M/year • Our actual funding for annual capital renewal = $0 planned / some ad hoc funding
Internal Considerations Critical Deficiencies • Information Technology: RQHR needs to invest in information technology to provide better care (safer and lower cost). [Current expenditures are approximately 2% of operating budget compared to 4% average for healthcare] CURRENT STATE: EMRAM Levels RQHR, Canadian Hospitals [2014] The Safest Hospitals Embrace Automation (U.S R Leapfrog “A” Grades) Q
Internal Considerations Workforce Challenges Physician Supply per 100,000 pop Source: CIHI 2015 200 RQHR Saskatoon RHA per 100,000 pop 150 156 119 100 107 103 50 0 Family Medicine Physicians Specialists City of Regina National Average City of Regina Population # of Family Physicians ( Per 100,000 pop – (as of July 1, 2015) (PSA data) CMA data - 2014 ) Difference 241,422 168 224 - 56 85
Internal Consideration Workforce Benchmarking Data Per 100,000 Population SK + / - CIHI 2013 RQHR Occupation (Projection) (RQHR vs. SK) Canada SK 2016 Aug 2016 Health Information Management 13.4 33.1 34.9 21.8 - Professionals NG 78.8 81.8 46.7 - Medical Laboratory Technologists 53.6 43.9 45.6 34.2 - Medical Radiation Technologists 40.8 29.4 30.5 23.5 - Occupational Therapists 54.8 59.0 61.2 31.1 - Physiotherapists* 995.4 1153.4 1195.6 1386.5 + Regulated Nurses (2015)** + 275.5 273.1 283.0 313.5 Licensed Practical Nurses 706.5 814.1 843.8 939.7 + Registered Nurses (Including NPs) 13.4 66.3 68.7 106.4 + Registered Psychiatric Nurses 31.3 18.4 19.0 22.5 + Respiratory Therapists
Internal Considerations Workforce Challenges • Increased demand and reduced management capacity to support system change • Challenging management environment o Budget restraint o Voluntary and involuntary staff movement o Union relationships o Provider-centered mindset
2016-2017 Board Direction Board Direction • Quality and Safety o T he Board’s first and foremost priority • Access and Patient Flow o The Board’s focus is on seniors • System Sustainability o Engagement, Accountability and Culture of Quality Improvement o Financial Sustainability Workforce optimization
2016-17 Q2 Board Dashboard Performance 2016-17 Regina Qu'Appelle Regional Health Authority Dashboard Document Creator: Anna Liu Document Owner: Strategic Planning & Business Intelligence Unit Date Prepared: April 21, 2016 Last Revision:October 28, 2016 <100% of target 100% of target Target Performance RQHR SLT Baseline Measures By Year-end Multi-year 2016-17 2016-17 2016-17 2016-17 Focus Area Lead 2015-16 2016-17 Outcome Q1 Q2 Q3 Q4 Notes 1.35% 3.45% 3.36% Data is delayed - most Q1: 1.8% Average Rate of Surgical Site 2.7% (50% reduction recent data is Q4 of Sharon Garratt (Most recent data for (Most recent data for (2014-15) compared to 2014- Q2: 3.1% Infection of 6 Procedures* 2015-16 Q3 2015-16) Q4 2015-16) 15) Coverage rate for diphtheria- pertussis-tetanus (DPT) for Karen Earnshaw 77.1% 80% 77.1% 76.5% 76.40% two-year olds residing in / Tania Diener (2015-16) RQHR, Regina and Rural Coverage rate for measles- mumps-rubella (MMR) for Karen Earnshaw 76.2% By March 31, 2020 80% 76.2% 75.5% 75.50% Quality & (2015-16) two-year olds residing in / Tania Diener there will be no harm Safety to patients or staff RQHR, Regina and Rural 61 Code 3: 88 Code 3: 110 Code 3: 27 Code 3: 37 # of Falls resulting in harm (50% reductions Mike Higgins Code 4: 16 compared to 2015- Code 4: 12 Code 4: 4 Code 4: 3 (code 3 and 4) (2014-15) 16) 79% Hand Hygiene Audit David 34.3% Hand Hygiene Audit is 78.8% Not Available 100% (May 2013) (Feb. 2016) done three times a year. Regional Compliance Rate McCutcheon # of Workers' Compensation 8.3 4.1 5.4 1.4 2.5 Board Claims (WCB) per 100 Mike Higgins (2011-12) FTE 12 hours 18 min ED LOS at 90th Percentile 11hrs 54min Keith Dewar 7hrs 45min 12 hrs 11 min 13 hours (2013-14) All Patients (April & May) 1934 Reduce the number # of Surgical cases waited 2046 1934 2859 Sharon Garratt (March 31, of patients waiting ED LOS at 90th greater than three months Access / (as of April 30, 2016) 2016) greater than 3 percentile will achieve Patient Flow months 12 hours by 2018-19 Gap analysis complete, and seniors Not In Progress & Seniors Plan current state, Michael multi-year plan Off Target Not Applicable future state and gap analysis Redenbach Applicable On Track updated, by February 28, 2017 Define characteristics of Not In Progress & In Progress & culture of accountability and Mike Higgins / Not Applicable Action plan develop an action plan for David Applicable On Track On Track developed by System Balanced or surplus staff and physicians McCutcheon March 31, 2017 budget Sustainability -$15.20 -$4.76 million RQHR Operating Surplus / $1.072 million -$6.6 million Robbie Peters $0 (2013-14) million (as of May 31, 2016) Deficit
2017-2018 Board Direction Board Direction • Quality and Safety o T he Board’s first and foremost priority No change in Board direction • Access and Patient Flow o The Board’s focus is on seniors • System Sustainability o Engagement, Accountability and Culture of Quality Improvement o Financial Sustainability Workforce optimization
2016-2020 Provincial Plan Provincial Outcomes & Targets • Eight long-term outcomes • Twenty 2016-17 targets • 2017-18 targets not available Electronic location: 2016-2017 Provincial Plans - All Documents
Accreditation Accred. Standar ds Accreditation • What is Accreditation – best practice? • Why it is important? • What do we need to do? Accreditation Contact: Carley Winter Coordinator, Strategic Planning and Business Intelligence Unit Regina Qu’Appelle Health Region T: (306) 766 - 5727 C: (306) 519 - 8442 carley.winter@rqhealth.ca
CIHI Indicators CIHI Data
Areas of ‘Best Performance’ % % RQHR Canada Nat. Previous avg. year Hospitalised heart attacks 190 252 25% 5% In-hospital sepsis 2.5 4.1 39% 36% Total time (hrs) spent in ED for 28.1 30.5 8% 3% admitted patients Hip fracture surgery wait times 88.2 84.4 5% 0% Report Contact: Ali Bell Research Scientist | Research & Performance Support | Regina Qu’Appelle Health Region 2180 23 rd Avenue, Regina, SK, S4S 0A5 306 766 5361 ali.bell@rqhealth.ca
Areas of ‘Worst Performance’ % Nat. % Previous RQHR Canada Avg. year ACSC 545 331 65% 6% Obstetric Trauma 24.6 18.3 34% 13% 25% 19% Obstetric readmissions 2.5 2.0 Self injury Hospitalisations 74 65 14% 23% % Medical Readmissions 15.0 13.6 10% 0% % All readmissions 9.7 9.0 8% 1%
Potential Cost Drivers RQHR Canada % Nat. Potential Potential Avg. cost ($) saving ($) ACSC 65% 9,812,738 6,344,187 545 331 % Readmissions 9.7 9.0 8% 19,796,380 1,539,718
Other Planning Considerations • Patient, staff and physician feedback o Collected and resolved through DVM o Escalate to higher level if can’t be solved at your level • Critical Incidents /Confidential Occurrence Report • 3sHealth, eHealth plans • Other data that signals major gaps/risks
Self Selected Foundational Important Work Foundational Work • Medical Quality Plan • IT/IM Projects • Human Resource Plan • Capital Plan • Physician Resource • Facility Plan Plan • Academic & Research
Next Steps Portfolios and Service Lines, supported by KPO/KOTs identify and plan for next year priorities. November - January Considerations : • Do you understand your accountabilities (board direction, provincial plan, AC, etc.) and resource/capacity required to achieve them? • Do you have a plan to achieve 2016-2017 targets? • What is your 2016-2017 progress and are you working on the right things? • What are the gaps/risks/challenges identified from Diagnosis and Review and how to prioritize for the next year?
The Evolution of Planning A Medicine Service Line Experience Collin Hartness Director, Medicine Kaizen Operations Team
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