Corrective Action Plan - Move towards including ALL falls - We have all of the necessary preventative measures, and response measures in place, but we need to focus on consistent use and embedding proper practice - Move from a steering committee to an operational group - Planning an improvement event for May, with focus on key principles, and standardization of practice - Ensure audit and monitoring plan is in place
RQHR Q3 Strategic Indicators: Access/Patient Flow
Seniors Current State Analysis Michael Redenbach, VP Integrated Health Services
Access/Patient Flow Indicator – Seniors Current State Analysis Current State Analysis is now complete, but had been significantly delayed. To be presented to RQHR Board and then available for wider circulation. Mostly statistical overview, with some inter-jurisdictional comparisons where possible
Next Steps - RQHR unlikely to have a ‘seniors strategy’ for 2017/2018 - Current State Analysis is intended to assist each service line and program area to assess their own work in seniors care - More ambitious seniors strategy will need to wait for provincial commitment, health region reorganization, and – to some extent – financial commitment - Upcoming year will be devoted to further collaboration with Ministry and RHA partners on seniors-specific initiatives
# of Surgical Cases Waiting Greater than Three Months Sandy Euteneier on behalf of Sharon Garratt, VP Integrated Health Services
Access/Patient Flow Indicator – Su Surgica gical Cases l Cases Waiting >3 aiting >3mon months ths
Corrective Action Plan • Finalize 2016-17 volume and funding with MoH • We will perform our funded volume of surgeries • Allocate available operating room time to meet funded volume; adjusting inpatient and outpatient mix to equalize wait times • Bi-weekly meetings to address long waiters • Planning sessions for 2017-18 are under way
ED LOS at 90th Percentile (all patients) John Ash, Executive Director Quality and Strategy Management Office
Access/Patient Flow Indicator – ED LOS at 90 Percentile
Corrective Action Plan • Improving access and coordination of primary health care, and community mental health and addictions services. • Reducing patient care delays in the emergency department and inpatient units 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.
RQHR Q3 Strategic Indicators: System Sustainability
Define Characteristics of a Culture of Accountability and Develop an Action Plan for Staff Brent Kitchen on behalf of Michele Vogt, VP People & Safety
System Sustainability Indicator - Culture of Accountability (staff) In January the Human Resource Committee of the Board: • Requested more information on the application of the Region’s Corrective Discipline Policy • Confirmed support for the existing Corrective Discipline Policy • Directed the People and Safety portfolio to prioritize the foundational work of the ‘Culture of Accountability’ Framework Next Steps: • Consult with stakeholders. • Develop a framework for a culture of accountability. • The elements within that framework will include: - Clear expectations aligned with organizational values - Effective onboarding/ orientation processes - Engaged and empowered employees - Strengthened performance/leadership development processes - Effective real-time performance feedback and application of corrective discipline processes
People & Safety - Small Wins Patient Safety: • Increasing use of Stop the Line • Advancement of Falls Reduction Strategy • eCOR roll out Employee Injuries: • Dramatic improvement in the rate of TLR Lost time Claims • Monthly monitoring and targets for LTCs for Depts. available. • Monthly audits (just 2) tracking/reporting application ready for “Go Live”. Culture of Accountability: • Improved ‘New OOS Manager’ onboarding experience • Measuring employee engagement- pulse survey developed • Clarity on the work required to develop the framework. *Patient & Employee Safety Integration
Define Characteristics of Culture of Accountability and Develop an Action Plan for Physicians (Merging into Clinical Quality Plan) Dr. David McCutcheon, VP Physician Services & Integrated Health Services
System Sustainability Indicator - Culture of Accountability (physicians) MQP
Small Wins • Physician Engagement – Communication Plan • Department Head Recruitment 4 New/12 • Leadership Development PLI, SLP, CQIP, SACI • DHC Retreat • GIM Reform • ACU – Physician Relationship Building • Making things Visual and Meaningful • Driver Diagram – Physician Report Card • Lumbar Spine MRI Checklist • Transfusion Safety – Drs Ledingham and Lett
Operating Surplus/Deficit Darlene Rorbeck on behalf of Robbie Peters, VP Financial Services
System Sustainability Indicator - Operating Surplus/Deficit Financial Sustainability Strategy Surplus / Deficit as of December 31, 2016 Actual (Year to Date) 2015-16 Actual (Year to Date) 2016-17 2016-17 Target 3500 -1500 $'000's -3291 -3517 -3011 -4678 -4667 -4755 -5128 ($9,369) -6500 -6629 -8165 Projection -11500 -16500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Date Prepared: January 12, 2016 Report Contact: Darlene Rorbeck Source: Finance Refresh Cycle: Monthly Operational Definition: Total operating revenues less total operating expenditures at the end of a specified time period.
Corrective Action Plan • Diligent daily management • Optimizing People Resources - matching capacity with demand (correct staffing models, benchmarking and staffing standards, reduce variations in service), effective management of work units and consistent standards for leaders • Reduce sick time, overtime and avoidable orientation costs • Participating in 3sHealth initiatives to reduce costs • Internal procurement and inventory management strategies • Preparing and reporting on monthly corrective actions plans for each service line/portfolio not meeting its budget target. • Reduce salary costs by reviewing all job postings to ensure only essential positions are filled, as per Ministry hiring freeze directive • Deferring infrastructure upgrades and projects to the extent possible without creating safety risks or impeding service delivery
Lunch Break Please return at 1:00pm sharp
Setting the Context: Planning Inputs and Considerations John Ash, Executive Director Quality and Strategy Management Office
Recap From Last Quarter: Strategic Planning Inputs
Major Data Drivers: Quality and Safety
Major Data Drivers: Quality and Safety
Major Data Drivers: Access/Patient Flow
Major Data Drivers: Access/Patient Flow
Major Data Drivers: System Sustainability
Major Data Drivers: System Sustainability
2017-2018 Planning The Strategic Plan summarizes the direction from the Regina Qu’Appelle Regional Health Authority (the Board). The Business Plan is the Region’s one ‐ year operational work plan that guides us towards achieving the goals and targets that have been outlined in the Strategic Plan. Cascading Plans are worked on by the teams who can contribute to the success of the initiative.
2017-2018 Business Plan
RQHR 2017-18 Business Plan: Initiatives by VP
2017-18 Draft Business Plan Carol Klassen, VP Knowledge and Technology Services
Portfolio Overview Knowledge & Technology Services – Academic Health Sciences – Research & Health Information Services – Patient Point of Care IT Services – Corporate and Clinical Support IT Services – Clinical Engineering and IT Infrastructure Services
Planning for 2017-18 Regina General & Pasqua Hospitals - 140,000 patients hospitalized and Emerg Dept visits annually (75% inpatients RQHR) Orders (2015/16): - 210,000 medical images (575/day) - 1,197,151 Laboratory orders (3,279 orders per day with 11,690 test results) - Plus drugs, nutrition & food services, therapy, ….
2017-18 Initiatives • Quality and Safety – Deploy SunRise Clinical Manager (SCM) – Order Management (by June 2018) Support Other Business Plan Initiatives Support Health System IT consolidation plans Support Portfolio Specific Plans
Steps for Implementation KTS Business Initiative: • Work with Saskatoon/eHealth/others to finalize governance, project charter & milestone chart for SCM Order Management Project and begin work/engagement (RQHR -IM/IT Steering Committee) KTS Support for other Business Initiatives: • Support Quality Care Transitions with expanded SCM electronic clinical documents (Emerg, PHC, MH&A) • Clinical Quality Plan: Analysis, tools, reports, & clinical e-document support services
Steps for Implementation Other Key Work • Work with eHealth/stakeholders to coordinate IT services for transition to single provincial health authority • Identify & develop plan for portfolio specific needs
2017-18 Draft Business Plan David McCutcheon, VP Medicine Service Line and Physician Services
Portfolio Overview Medicine Service Line – Emergency Department/EMS – Critical Care & Cardioscience Units – Medicine Inpatient Units – Regional Infection Prevention & Control – Transfusion Safety – Antimicrobial Stewardship Program Physician Services – Practitioner Staff Affairs – Department Heads
Planning for 2017-18 • Review ITL • Review Driver Diagram • ACU Pilot Outcomes • Provincial Catchball Document • Integrated Risk Assessment • Pt Flow Data ALOS/ELOS • Financial Data • RQHR Business Plan 2016-2017 – Appropriateness of Care – Comprehensive Medical Quality Plan – Physician Culture of Accountability
2017-18 Initiatives • Antimicrobial Stewardship Program • Horizontal Infection Prevention & Control Strategy • Improving Appropriateness of Care, Physician Culture of Accountability, and Comprehensive Medical Quality Plan – 3 merged into Clinical Quality Plan – more info later • ELOS=ALOS • ED - Human, Space and IT Infrastructure • Accountable Care Unit Replication
Steps for Implementation • Antimicrobial Stewardship Program – Recruitment of ID Specialist: Closing- Start Time, Contract • Horizontal Infection Prevention & Control Strategy – Update hand hygiene policy and rollout/reintroduce policy to the Region. – Implement monthly auditing to all RQHR units. • Improving Appropriateness of Care, Physician Culture of Accountability, and Comprehensive Medical Quality Plan – 3 merged into Clinical Quality Plan
Steps for Implementation • Clinical Quality Plan – Data analyst recruitment – Physician Report Card Pilot – Physician leadership development – Physician onboarding – Engagement of Program VPs, EDs, Directors • ED - Human, Space and IT Infrastructure – IT support for data gathering – Synergy Tool – HQC partnership - Modeling – Identified as Portfolio’s area of highest risk
Steps for Implementation • Accountable Care Unit Replication – Ministry submission – 3D identified as the next unit – 1Unit partnership – MSU and 4B – Standardize to Alpha Unit (4A) – Physician Model and compensation • High Quality Care Transition (HQCT) - partnering with PHC, HQC and MSL • ELOS=ALOS – RCA – Interportfolio Teams – Oversight and Operations – A3; Milestone Charts
2017-18 Draft Business Plan Jan Besse and Terri Carlson, Acting VP’s Clinical Support Service Line
Portfolio Overview Clinical Support Service Line – Medical Imaging – Lab Services – Pharmacy Services – Rehabilitation – Spiritual Care – Native Health Services – Respiratory Services – Support Services
Planning for 2017-18 • Inputs: – 2016-2017 ITL, regulations/legislation, other service line business plans, accountability document, operational pressures, patient flow data, CAP, accreditation, IRM, advisory panel recommendations, and budget information. • Activities/Outcomes: – Employee/Physician engagement, Med Rec, seniors outcomes, SMS, Horizontal IPAC, 3 rd party contracts, antimicrobial stewardship, capacity plan, 3S Health transcription project, recruitment and retention strategies, and patient and family centered care.
2017-18 Initiatives Business plan initiatives we are leading Medication Reconciliation – implementation Business plan initiatives we support • Horizontal IPAC – Hand Hygiene • Building Manager Capacity • Accountable Care Replication • Patient Flow – ELOS=ALOS • Employee Injury Reduction – TLR/SMART Audits – WHMIS • Improving Appropriateness of Care – Lab - Business Intelligence – Medical Imaging
Steps for Implementation • Med Rec – Implementation will begin in February with Units 1D, 3F and 4B. Ongoing roll-out will occur until all units are live. • Accountable Care Replication – Each September and April another Medicine Inpatient Unit is scheduled to transition to an ACU model and that replication will require workflow changes to a number of CSS areas. • ELOS=ALOS – Optimum length of stay while desirable impacts the work of all CSS areas. More throughput of patients requires increased workload and business processes will be adjusted to accommodate
Steps for Implementation • Improving Appropriateness of Care – Lab Business Intelligence software to be selected and installed. Data gathering and action plans related to findings will be critical to the success of this work – Medical Imaging
2017-18 Draft Business Plan Karen Earnshaw, VP Integrated Health Services
Portfolio Overview Primary Health Care Service Line Urban Networks ( North, South, Central, East ) Rural Networks ( Touchwood, Twin Valleys, Prairie East ) Home Care/SWADD Palliative Care Population & Public Health Eagle Moon Health Office Saskatchewan Health Line
Planning for 2017-18 Large provincial expenditures but poor health outcomes High rate of hospitalization for ACSC Increase in demand and complexity of care System complex and difficult to navigate Barriers to shared care with family physicians Little focus on prevention and health promotion
2017-18 Initiatives Accountable Community Care Initiative • Expand Response Team service to support care at the community level • Implement the community COPD pathway • Increase coverage rate for Diphtheria-Pertussis-Tetanus (DPT) & Measles-Mumps- Rubella (MMR) for two year olds residing in Rural & Urban RQHR • Work with stakeholders to improve intake, referral and coordination of PHC services
Steps for Implementation Expand response team service to support care at the community level Imbed response service into PHC networks Improve after hour urgent care and diagnostics in the community Focus on high quality transitions between stakeholders Implement the community COPD pathway Initiative COPD prevention activities Develop a central referral process for COPD services Improve access to COPD diagnostics and rehabilitation services
Steps for Implementation Increase Coverage rate for Diphtheria-Pertussis-Tetanus (DPT) & Measles-Mumps-Rubella (MMR) for two year olds resident in RQHR, Regina and Rural Establish timely access for immunization services that is client centered. Develop an immunization marketing and communication strategy Establish network websites Work with stakeholders to improve intake, referral and coordination of PHC services To be determined
2017-18 Draft Business Plan Michael Redenbach, VP Integrated Health Services
Portfolio Overview Integrated Health Services – Long-term Care – Mental Health & Addiction Services
Planning for 2017-18 Assisted Living/Subsidized Housing Initiative • Using an assessment tool (DASH Algorithm) LTC residents have been identified as possibly no longer needing institutional-based care • In-depth, individual assessments of targetted residents will occur • Aim will be to transfer residents – as appropriate – to an assisted living setting
2017-18 Initiatives Assisted Living/Subsidized Housing Initiative • Significant partnership required from Home Care and/or other community-based services – while not requiring institutional long-term care, clients will still require some care and support • Initiative will free space within long-term care facilities in Regina for alternate uses, and over time reduce need for additional LTC beds • Will be accompanied by a process to minimize any unnecessary admissions to LTC
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