2016-17 Q2 Report on Strategic Plan November 1, 2016 RQHR Strategic - - PowerPoint PPT Presentation

2016-17 Q2 Report on Strategic Plan November 1, 2016

RQHR Strategic Planning & Reporting Process

https://www.youtube.com/watch?v=L2zqTYgcpfg

Quarterly Reports on Strategic Plan

• Q1 Report on

Strategic Plan

• Current year

course correct

Q1

• Q2 Report on

Strategic Plan

• Review inputs

into next year plan

Q2

• Q3 Report on

Strategic Plan

• Finalize next year

plan

Q3

• Year end report

(annual report)

• Celebrate

successes

Q4

Provincial Outcomes & Targets Clinical Best Practice Budget

Risks/Gaps/Challenges

Other E-Scan Data

Accred. Standards

CIHI Data

Patient, Staff, and Physician Feedback

Strategic Planning Inputs 

We are here

Objectiv Objectives es of the Day

• f the Day
• Q2 Report on Strategic Plan Progress and Key

Business Plan Initiatives

• Review Strategic Planning Inputs and Communicate

Strategic Direction

• Initiate Region-wide Planning for 2017-18

How to Access Today’s Information

• 1. From the

intranet homepage, click Strategic Framework.

• 2. Then click

Sharepoint Site.

• 3. Click Strategic

Reporting then click the Regional Reporting to get to the quarterly report.

Housekeeping

• Washrooms
• WiFi Password: qcc201603
• Handouts

CEO Introduction

Keith Dewar President and CEO

RQHR Planning & Reporting Framework

• RQHR planning and

reporting framework ensures a coordinated and comprehensive planning effort that aligns the region’s strategic plan, business plan, cascading

• perational plans, budget

and capital plans to ensure achievement of outcomes and targets.

• Initiatives and projects cascaded down from the strategic

• Other important work identified to mitigate risks, fill gaps,

• Q1 Report on

• Current year

• Q2 Report on

• Review inputs

• Q3 Report on

• Finalize next

• Year end report

• Celebrate

• f strategic
• utcomes and

• Includes high priority, cross functional initiatives, measures,

• Identifies the annual priority areas of focus for the region

• Daily work of service delivery
• Current year initiatives and projects cascaded down from



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

Patients, Clients, Residents and Families Patients, Clients, Residents and Families

Checklist for Ethical Decision Making

• Consideration of 7 Tests and Confidence

Score:

Handout on table: Checklist for Ethical Decision Making Electronic location: Q2 Report on Strategies - November 1, 2016 - All Documents

Elephant in the Room

RQHR Strategic Plan Focus Area

• Quality and Safety

Introduction by Mike Higgins for SLT

Why Quality and Safety

• Everyone has a right to expect safe, high

quality health care provided in a safe environment.

Key Message

• Quality and Safety is everyone’s
• responsibility. Our goal is to ensure the

safety of all those who use our services and provide care within it.

Multi-year Outcome

• Quality and Safety Multi-year Outcome:

– To achieve a culture of safety, by 2020, there will be no harm to patient, clients, residents, staff and professional practitioners.

harm

2016-17 Board Measures and Targets

• Surgical Site Infection Rate of 6 Procedures
• Coverage rate for diphtheria-pertussis-tetanus

(DPT) for two-year olds residing in RQHR, Regina, and Rural

• Coverage rate for measles-mumps-rubella

(MMR) for two-year olds residing in RQHR, Regina, and Rural

• # of Falls resulting in harm (code 3 and 4)
• Hand Hygiene Audit Regional Compliance

Rate

• # of Workers' Compensation Board Claims

(WCB) per 100 FTE

No audit in Q2

Surgical Site Infection Rate of 6 Procedures

SLT: Sharon Garratt Integrated Health Services

Vision: Healthy people, families and communities.

0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% Q1 Q2 Q3 Q4

Surgical Site Infection (SSI) Rate, targeted procedures, RQHR, 2015-16

SSI Rate (%) Target

Quality & Safety Indicator – SSI Rate

Actions

• SSI Prevention Working Group meets bi-monthly
• Standing item on Surgical Executive Committee
• Determining if there would be a benefit to

rescheduling diabetic patients based on their HBA1C results

• New OR Case report implemented October 1,

2016 to help track compliance with surgical site infection bundle. Will improve timeliness of reporting and enable us to investigate spikes and implement corrective action plans.

• Creating action plan to address non-compliant

results of the OR Infection Control Audit

Coverage Rate for DPT & MMR for Two- year Olds Residing in RQHR, Regina, and Rural

SLT: Karen Earnshaw Integrated Health Services

Vision: Healthy people, families and communities.

Qualit Quality y & & Saf Safety ety Indica Indicator tors s - DPT DPT

Coverage rate for DPT for two-year olds residing in RQHR (Regina & Rural)

Actions

Measure: Coverage rate for Diphtheria-Pertussis-Tetanus (DPT) for two year olds residing in RQHR, Regina and Rural HOW ARE WE DOING?

• We have never met the target of 80% in RQHR. Q2 resulted in a 76.6

coverage rate for DPT. WHAT ACTIONS ARE WE TAKING?

• Child health clinics have as of October 31, 2016 enhanced access by two

evenings a week and all Saturdays in each network. Low SES families receive in home support for immunization. Evening access to child immunization appointments have been enhanced in some rural neighborhoods.

• Reminder phone calls are being made to clients who already have an

appointment booked. Focused interventions for neighbourhoods with lowest rates and imbedding immunization into other services where possible.

Qualit Quality y & & Saf Safety ety Indica Indicator tors s - MM MMR R

Coverage rate for MMR for two-year olds residing in RQHR (Regina & Rural)

Measure: Coverage rate for Measles-Mumps-Rubella (MMR) for two year

• lds residing in RQHR, Regina and Rural

HOW ARE WE DOING?

• We have never met the target of 80% in RQHR. Q2 resulted in a 75.9%

coverage rate for MMR. WHAT ACTIONS ARE WE TAKING?

• Child health clinics have as of October 31, 2016 enhanced access by two

evenings a week and all Saturdays in each network. Low SES families receive in home support for immunization. Evening access to child immunization appointments have been enhanced in some rural neighborhoods.

• Reminder phone calls are being made to clients who already have an

appointment booked. Focused interventions for neighbourhoods with lowest rates and imbedding immunization into other services where possible.

Act Actions ions

# of Falls Resulting in Harm (Code 3 and 4)

SLT: Mike Higgins People & Safety

Vision: Healthy people, families and communities.

Qualit Quality y & & Saf Safety ety Indica Indicator tors s - Falls Falls

Q1 & Q2 2015 (April - September) Q1 & Q2 2016 (April - September) 67 64 7 7

Falls - Code 3 & 4 Q1 & Q2 2015 & 2016

Code 3 Code 4

Actions

• The Falls Working Group is developing a Regional Falls

Reduction Plan.

• A Falls Survey has been completed and data analysis is

underway to identify key focus areas.

• RQHR continues to work on implementing Purposeful

Hourly Rounding/Interactions throughout the region.

• The Patient Safety Office is working to support service

lines in efforts to meet Board target through provision of base line data for their work areas.

• Work continues to imbed falls safety as part of daily work

and awareness of falls tools.

• Awareness of existing falls resources are being promoted

throughout the region.

# of Workers' Compensation Board Claims (WCB) per 100 FTE

SLT: Mike Higgins People & Safety

Vision: Healthy people, families and communities.

2014-15 2015-16 2016-17 2016-17 2016-17 Year-end Projection Year-end Target 0.4 1.0 1.4 2.0 2.4 3.0 3.4 4.1 4.5 4.9 5.5 6.0 0.5 1.0 1.4 1.9 2.4 2.9 3.2 3.7 4.1 4.6 5.1 5.4 0.4 1.0 1.4 1.8 2.2 2.5

4.4 5.7 5.8 5.1 5.2 4.8

4.1 4.1 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

RQHR INJURY RATE

Qualit Quality y & & Saf Safety ety Indica Indicator tors s – WCB CB Claims Claims

• 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

Act Actions ions

Hand Hygiene Audit Regional Compliance Rate

SLT: Dr. David McCutcheon Physician Services & Integrated Health Services

Vision: Healthy people, families and communities.

Qualit Quality y & & Saf Safety ety Indica Indicator tors s – Hand Hygiene Hand Hygiene

Hand Hygiene Audit Regional Compliance Rate June 2016 data

Regional Compliance rate: 78.8%

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

ED LOS at 90th Percentile – All Patients

John Ash Executive Director, Strategy

Vision: Healthy people, families and communities.

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.

# of Surgical Cases Waited Greater than Three Months

SLT: Sharon Garratt Integrated Health Services

Vision: Healthy people, families and communities.

# 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

Seniors Current State Analysis

SLT: Michael Redenbach Integrated Health Services

Vision: Healthy people, families and communities.

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

• rder 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

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

Vision: Healthy people, families and communities.

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

RQHR Operating Surplus / Deficit

SLT: Robbie Peters Financial Services

Vision: Healthy people, families and communities.

RQHR Operating Surplus/ Deficit Status

• Diligent daily management (All leaders)
• Optimizing People Resources initiatives (Garratt/Higgins)
• Continuing focus on sick time, overtime and avoidable
• rientation costs (All leaders)
• Maximizing real estate revenue opportunities (Peters)
• Participating in shared service opportunities with 3sHealth and
• ther 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)

RQHR Operating Surplus / Deficit Actions and Leads

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

• Our Environment:

– 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

E- Scan Data

External Environment RQHR Covered Population

Governance of Organization: Environmental Considerations

$5380 $7279 $9437 $12658 $15987 $24539

• SK Aboriginal Population

(source: 2011 National Household Survey):

• 15.6% of the total population - second highest proportion

among provinces

• Over half (53.2%) live on reserves
• 34% of Aboriginal population under the age of 15

compared to 17% of the general population

• RHQR Aboriginal population
• 12.3% of RQHR respondents identified as aboriginal
• 17 First Nation communities within the borders of RQHR

External Environment Aboriginal Population

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 Occ. Capacity

2016/17 2017/18 2018/19 2019/20 2020/21 2025/26 2030/31

95% 206 226 231 235 240 244 276 318

20 beds

Internal Considerations LTC Admissions and Bed Needs

Year # Admissions

1994 – 1995 390 1998 – 1999 529 2002 – 2003 561 2008 – 2009 581 2011 – 2012 617 2013 – 2014 826 2014 – 2015 778 2015 – 2016 745

Utilization of the LTC Beds:

RQHR will require an additional 768 LTC beds over the next 10 years to maintain the current bed to population (75+) ration

• 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

• ver 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

• f.

– RQHR’s average FCI for all facilities is 31.5% based on the 2013 assessments

Internal Considerations Critical Deficiencies

• Infrastructure Sustainment Model
• 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
• 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]

Internal Considerations Critical Deficiencies

R Q CURRENT STATE: EMRAM Levels RQHR, Canadian Hospitals [2014] The Safest Hospitals Embrace Automation (U.S Leapfrog “A” Grades)

85

City of Regina Population (as of July 1, 2015) City of Regina # of Family Physicians (PSA data) National Average (Per 100,000 pop –

CMA data -2014)

Difference 241,422 168 224

• 56

Internal Considerations Workforce Challenges

107 103 119 156

50 100 150 200

Family Medicine Physicians Specialists per 100,000 pop

Physician Supply per 100,000 pop Source: CIHI 2015

RQHR Saskatoon RHA

Internal Consideration Workforce Benchmarking Data

Occupation

Per 100,000 Population

+ / -

(RQHR vs. SK)

CIHI 2013 SK (Projection) RQHR Canada SK 2016 Aug 2016

Health Information Management Professionals

13.4 33.1 34.9 21.8

• Medical Laboratory Technologists

NG 78.8 81.8 46.7

• Medical Radiation Technologists

53.6 43.9 45.6 34.2

• Occupational Therapists

40.8 29.4 30.5 23.5

• Physiotherapists*

54.8 59.0 61.2 31.1

• Regulated Nurses (2015)**

995.4 1153.4 1195.6 1386.5 +

Licensed Practical Nurses

275.5 273.1 283.0 313.5 +

Registered Nurses (Including NPs)

706.5 814.1 843.8 939.7 +

Registered Psychiatric Nurses

13.4 66.3 68.7 106.4 +

Respiratory Therapists

31.3 18.4 19.0 22.5 +

Internal Considerations Workforce Challenges

• Increased demand and reduced management

capacity to support system change

• Challenging management environment
• Budget restraint
• Voluntary and involuntary staff movement
• Union relationships
• Provider-centered mindset

2016-2017 Board Direction

• Quality and Safety
• The Board’s first and foremost priority
• Access and Patient Flow
• The Board’s focus is on seniors
• System Sustainability
• Engagement, Accountability and Culture of Quality

Improvement

• Financial Sustainability
• Workforce optimization

Board Direction

2016-17 Q2 Board Dashboard Performance

• f patients waiting

• $15.20

• $4.76 million

• $6.6 million

2017-2018 Board Direction

• Quality and Safety
• The Board’s first and foremost priority
• Access and Patient Flow
• The Board’s focus is on seniors
• System Sustainability
• Engagement, Accountability and Culture of Quality

Improvement

• Financial Sustainability
• Workforce optimization

Board Direction

No change in Board direction

2016-2020 Provincial Plan

Electronic location: 2016-2017 Provincial Plans - All Documents

• Eight long-term outcomes
• Twenty 2016-17 targets
• 2017-18 targets not

available

Provincial Outcomes & Targets

Accreditation

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

Accred. Standar ds

CIHI Indicators

CIHI Data

Areas of ‘Best Performance’

RQHR Canada % Nat. avg. % Previous year Hospitalised heart attacks 190 252 25% 5% In-hospital sepsis 2.5 4.1 39% 36% Total time (hrs) spent in ED for admitted patients 28.1 30.5 8% 3% 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 23rd Avenue, Regina, SK, S4S 0A5 306 766 5361 ali.bell@rqhealth.ca

Areas of ‘Worst Performance’

RQHR Canada % Nat. Avg. % Previous year ACSC 545 331 65% 6% Obstetric Trauma 24.6 18.3 34% 13% Obstetric readmissions 2.5 2.0 25% 19% 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. Avg. Potential cost ($) Potential saving ($) ACSC 545 331 65% 9,812,738 6,344,187 % Readmissions 9.7 9.0 8% 19,796,380 1,539,718

Other Planning Considerations

• Patient, staff and physician feedback
• Collected and resolved through DVM
• 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

• Medical Quality Plan
• Human Resource Plan
• Physician Resource

Plan

• IT/IM Projects
• Capital Plan
• Facility Plan
• Academic & Research

Foundational Work

Next Steps

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?

Portfolios and Service Lines, supported by KPO/KOTs identify and plan for next year priorities. November - January

Collin Hartness Director, Medicine Kaizen Operations Team

The Evolution of Planning A Medicine Service Line Experience

We Will Cover

• Last years process
• Implementation
• Examples that we are unpacking
• Ongoing work
• The new process
• Diagnosis and Review
• What next?

What did your Dad tell you?

• People don’t plan to fail, they fail to plan!

What did your Mother tell you?

• I’m sorry, the lack of planning on your part

does not constitute an emergency on my

• part. I have a life and you are a full grown

adult.

Provincial Plan Direction

• Set goals so big you get uncomfortable

telling small minded people.

RQHR Strategic and Planning & Reporting Process

What did your high school teacher tell you?

• Start using your head, that’s the lump that’s

3 feet above your ass.

MSL Planning 2016-2017

What did your mother tell your father about getting those renovations done?

• There are 7 days in the week and Someday

isn’t one of them.

Late Arrival for the 2016/17 Planning Cycle The Approved RQHR Business Plan

• Minor adjustments to

ensure alignment of activities

Tool Evolution – Appropriateness of Care

More Evolution

Evolution – SUN Regularization - EDs

Satisfied Customer – Driver Diagrams

Unpacking the Data - Accreditation

Medication Reconciliation – Placeholders RPIW 83 RGH 5E

• Acute Care Discharge

RPIW 95

• LTC - Admission and Discharge for Convalescent

Care MUSIC Committee

• Med Rec Implementation Plan
• MSL has placeholders for replication

Unpacking Data - Appropriateness of Care

Unpacking Data - Appropriateness of Care

Lab Results

• Data Mining currently Challenging
• Usage Comparisons

Orthopedic and General Surgeons, Nephrology Physicians Report Cards

• Peer comparisons
• Results comparisons

Several other Initiatives involving Data

Ongoing Work Service Line Wall

What do our wall walks teach us?

• There are only 2 options: Make progress or

Make excuses

Program Wall

Unit Wall

Living The Dream – MC Testimonial

This Year

• Revised planning cycle activities
• We are not starting with a blank page
• Provincial Mandate
• Regional Must Do’s
• Board Strategies
• Accreditation
• Emerging pressures
• Aligning opportunities

Aligning our Opportunities

• If the plan doesn’t work, change the plan

but never the goal.

• Never give up on a dream just because of

the time it will take to accomplish it. The time will pass anyway. (Earl Nightingale)

The Planning Journey

• RQHR Board Retreat
• DHC Retreat
• Provincial Inputs
• Diagnosis and Review
• ITLs – ensure alignment
• WPs
• MCs

Diagnos Diagnosis is and Rev and Review iew

• How are we progressing?
• Did we bite off too much?
• Push back to DD
• Revisit and Mature the DD
• Opportunities for improved traction
• Where do we have data?
• Info from the front lines
• Ensure alignment of 3 Strategies

DVM Id Idea ea bo board ards s - Wha What i t is s within ithin ou

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• ntrol?

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What do we know?

• We live in the era of smart phones and

stupid people

• A plan not implemented is useless
• The most reliable way to predict the future

is to create it.

Opportunities

• Chance to work the plan
• Same objectives

(Provincial/Regional/Board/ Accreditation)

• Tweak our initiatives
• Energy and Momentum
• More mature on our planning journey
• Physician Engagement

Challenges

• Volume of initiatives – Staging, holding places

for crossfunctional work / regional initiatives

• Tracking it all
• Access to data for some initiatives
• Proper scoping of action
• Emerging pressures
• Focus
• Entering a time of uncertainty

What do you need to do?

• Set goals that make you want to jump out of

bed in the morning.

Actions

• Track to ensure sustainment
• More Data mining

– HIMS – CIHI – Financial

• Crossfunctional engagement
• Scoping and pre-work
• Maintain the objectives

What did Dr McCutcheon tell you?

• Set goals, say prayers, work hard

Covered

• Last years process
• Implementation
• Examples that we are unpacking
• Ongoing work
• The new process
• Diagnosis and Review
• What next?

What else did Grandpa say?

• Git ‘Er Dunn!

Parting Thought from Me!

• Go ahead, make a plan… I dare you!

I was once told…

• If you made your point, Stop Talking!

DHC Planning Update

SLT: Dr. David McCutcheon Physician Services & Integrated Health Services

Vision: Healthy people, families and communities.

01/11/2016

• Dept. Heads Retreat 2016

Safety

Effectiveness

Appropriateness Efficiency Continuity Accessibility Acceptability

Provider Competence

Patient satisfaction surveys Utilization Review Monitoring Wait Times Continuing Education

• Perform. Appraisals

Peer Review Credentialing Recruitment Manpower Plan Program Plan RM OH & S Patient Safety *Critical Clinical Incidents Referring Dr.'s LTC Home Hospital Budget Variance Analysis Bed Utilization Review Practice Guidelines Algorithms Tissue Audits Clinical Care Review Antibiotic Use Evaluation Departmental Review Morbidity & Mortality Outcome Screens Clinical Audits Technology Impact Assessment Drug Safety Listening to the Complaints Process Tertiary Facility Day Surgery Rates Staff Morale

A Quality Management Model

DHC Planning Update

DHC Annual Retreat held October 4, 2016

• Department Head members and

administrative dyad partners attended

• Each Department identified one good thing

and two challenges

DHC Planning Update

• Quality and Safety

– Appropriateness of Care – Medical Quality Plan

• Patient Flow and Access

– Consults – Pull times

• System Sustainability

– Accountability – Physician Leadership Development

Next Steps

• Link DHC planning into RQHR Strategic

Plan

• Continue to leverage the engagement of

Department members

• Data mining group will be essential to

support the program

Closing Remarks

Vision: Healthy people, families and communities.