in the Current Healthcare Environment We have to shift spending to - - PowerPoint PPT Presentation

Strengthening our Capacity in the Current Healthcare Environment

“We have to shift spending to where we get the highest value. Our funding models need to be updated, to accelerate the transition from a provider-centred funding model towards a patient-centred funding model, where funding is based on the services provided.”

• The Honourable Deb Matthews

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Current System Reformed System

• Keep patients out of hospitals
• Blend of base funding and

pay-by-activity

• Regional management
• Differentiation and

specialization along with specialized clinics

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• Draw patients to

hospitals

• Historical cost plus

inflation financing

• Managed through

central government

• Homogenous, all trying

to offer all services

Key Drummond Recommendations Impacting BWH

• Divert all patients not requiring acute care from

hospitals and into a more appropriate form of care. (Recommendation 5-3)

• Support a gradual shift that ensure a continuum of

care and care that is community-based. (5-7)

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Key Drummond Recommendations Impacting BWH

• Use information from funding models such as the

Health-Based Allocation Model (HBAM) to examine where services may not be provided equally across health regions and conduct ongoing evaluations of each Local Health Integration Network’s progress in managing high-use populations. (5-17)

• Increase the use of personal support workers and

integrate them into Teams with nurse practitioners, registered nurses and other staff members where appropriate to optimize patient care. (5-22)

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Key Drummond Recommendations Impacting BWH

• Local Health Integration Networks need to use funding

as a lever to encourage hospitals and other health care providers to use the full scope of practice of their staff. (5-23)

• Empower primary caregivers and physicians in the

Family Health Teams (FHTs) or specialized clinics to play the role of “quarterback,” tracking patients as they move through the integrated health system. (5-32)

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Key Drummond Recommendations Impacting BWH

• Use data from the Health-Based Allocation Model

(HBAM) system to set appropriate compensation for procedures and cease the use of average costs to set Hospital payments. (5-50)

• Create a blend of activity-based funding (i.e., funding

related to interventions or outcomes) and base funding managed through accountability agreements. (5-51)

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Key Drummond Recommendations Impacting BWH

• Create policies to move people away from inpatient

acute care settings by shifting access to the health care system away from emergency rooms and towards community care (i.e., walk-in clinics and Family Health Teams), home care and, in some cases, long-term care. (5-52)

• Encourage hospitals to specialize so all are not trying to

provide all services regardless of their comparative

• advantages. (5-53)

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Key Drummond Recommendations Impacting BWH

• Given the burden of alternate level of care (ALC)

patients on hospital capacity, hospitals must become more effective in optimizing this capacity while applying best practices in planning patient discharges. (5-54)

• Use hospitalist physicians to co-ordinate inpatient care

from admission to discharge. Hospitalists should work with Family Health Teams to better co-ordinate a patient’s moves through the health care continuum (acute care, rehabilitation, long-term care, community care and home care). (5-55)

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Key Drummond Recommendations Impacting BWH

• Centralize all back-office functions such as information

technology, human resources, finance and procurement across the health system. (5-95)

• Put a wider array of specialist services to tender based
• n price and quality, while remaining under the single-

payer model. (5-97)

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Funding Model - HBAM

* A similar concept will be applied to Community Care Access Centres and Long-Term Care Homes, but with different grouping methodology and proportions of quality based funding. ** Year 2 and 3 quality-based procedures to be finalized

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Pre and Post Mitigation – 11/12

Pre Mitigation Health System Funding Reform (HSFR) Allocation $43,425,011 HSFR Funding Impact

• $5,996,285

Component of Overall Funding Impact (%)

• 4.3%

Post-Mitigation Health System Funding Reform (HSFR) Allocation $48,432,870 HSFR Funding Impact

• $968,426

Component of Overall Funding Impact (%)

• 0.7%

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BWH Actual Expenses vs. Expected Funding

2010-11 Actuals 2011-12 Actuals 2012-13 Expected Expenses Acute $78,948,371 *$78,671,939 $65,958,049 CCC $13,961,673 $13,537,174 $13,114,780 ER $17,919,465 $17,941,934 $16,735,006 MH $4,910,894 $4,968,039 $4,485,281 Rehab $5,092,499 $5,514,796 $5,608,995 Total $120,832,902 $120,633,882 $105,902,111

*Note: This excludes $7.5M in PCOP growth funding. 13

Cost / Weighted Case Comparator for Large Community Hospitals

Rank Facility Name Acute & Day Surgery with adj Direct & Overhead Cost 2010-11 Acute & Day Surgery Weighted Cases 2010-11 Cost/Weighted Case 2010-11 1 Brantford 68,108,919 14,629 4,656 2 Markham 77,412,929 16,129 4,800 3 Oakville 130,093,246 27,004 4,818 4 Burlington 82,291,400 17,074 4,820 5 Ottawa 88,695,149 18,287 4,850 35 BWH 78,948,371 13,182 5,989 14

Balancing the Budget

To achieve a balanced budget by 2013/14, we must make an estimated $5 M in adjustments to our operations. We are not alone. All hospitals in Ontario must change the way they are doing things.

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Other Variables

• LHIN Accountability Agreements
• ALC Reductions
• ED Wait Times
• MH Readmits
• Lowering Overall Readmission Rates

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Our Journey

For the last 6 years we have used three principles to establish

• ur directions
• 1. High quality, safe, and reliable care
• 2. A trusted working environment founded on

respect

• 3. A strong financial base to sustain our journey

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….bottom line but is it sustainable?

SUSTAINABLE SUCCESS Results and inspiration

…going out of business… …good for morale but at what cost?

4 2 1 3 High Low High

Focus on Results “Driving Metrics”

Focus on Purposeful Culture “Inspiring Commitment & Reinforcing What We Stand For”

Employee Engagement: 4 Quadrants

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Our Mission Vision Values

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Actively Advancing Our Mission

1. Patient and Family Centred Care, Patient Advocate 2. Best Practice Spotlight, Best Practice Guidelines 3. Order sets 4. Hospitalist Expansion 5. Talent/Leadership Development 6. RTC, ED PIP, Patient Flow 7. ThedaCare 8. Performance and Transformation

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Actively Advancing Our Mission

9. Integration

 Chronic Disease Management  Merger of CHIS and PROcure (TransForm)  Mental Health Redesign  Psychogeriatrics

• 10. More OB - Managing Obstetrical Risk Efficiently
• 11. Advance Practice Model
• 12. QIP and improving quality and patient safety

 Re-invigorating Medication Reconciliation  Re-invigorating Medworxx to improve patient flow

Many other initiatives that you may be involved in

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Patient Advocate: Patient and Family Centred Care

What?

• Called Patient Ombudsman in some organizations

Why?

• Responsible for helping patients/families with concerns
• Work with staff to see the issue “through the patient’s eyes”
• Identify the “real” problem and mediate the solution
• Responsible lead for Patient and Family Centred Care (PFCC)

Benefits

• Improved satisfaction and outcomes for patients/families/staff
• Further integration of PFCC philosophy

Current Status

• Denise Dodman in role. Recruiting Patient Experience Advisors &

establishing PFCC Steering Committee 22

Best Practice Spotlight (BPSO), Best Practice Guidelines (BPGs) What?

• RNAO key strategy in influencing practice excellence and positive patient
• utcomes

Why?

• Ensure quality by using the most up-to-date evidence, clinical guidelines and

best practices

Benefits

• Improved patient outcomes through consistency, efficiency and

standardization of care (i.e. reducing falls; pain management; reducing pressure ulcers)

Current Status

• Year One of three-year partnership between BWH and RNAO
• One fellowship has begun
• Two corporate Best Practice Guidelines (BPG) under-way (Client Centred Care

and Therapeutic Relationships) 23

Order Sets

What?

• Standardized patient order sets are being implemented throughout

Bluewater Health for each clinical condition

Why?

• This project will reduce variation in care, ensure best evidence-informed

practices are followed and eliminate legibility concerns

Benefits

• Patients benefit by getting best care and fewer medication errors. Nurses

benefit by receiving standard format clear orders. Pharmacists benefit from clarity of medication and reduction in dosing errors. Physicians benefit by not having to rely on memory for each order and fewer calls to clarify

• rders.

Current Status

• Currently there are some orders sets in use, particularly ICU, but in most of

the hospital the ones that exist are poor 24

Hospitalist Program Redesign Discussion

• The possibility of creating a robust hospitalist program is

under active consideration

• There are benefits to having patients cared for primarily by

physicians based in the hospital

• Improvement in patient flow
• Better compliance with hospital procedures and processes
• Reduced length of stay
• Lower overall cost
• Currently we have two hospitalists who provide excellent

service, but cannot meet all of our needs. Most patients are cared for by physicians who see their patients at variable times and discharges and transfers are frequently delayed

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Releasing Time To Care - RTC

What ?

• Suite of proven, trademarked, improvement programs for health

care delivery

• Developed in the UK by the NHS Institute for Innovation &

Improvement

• Based on Lean & Six Sigma methodology

Why?

• To improve standards of safety and quality of care by helping you put

your time towards patient care in the most efficient way possible. Empowers frontline staff to drive out wasteful activities in their workplace to free up time for bedside care and thereby help improve patient outcomes

• Unit led, driven by care providers and guided by facilitators

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Releasing Time To Care - RTC (Cont’d)

Benefits

• Staff engagement
• Improved patient care
• Reduction of errors and patient harm and improved patient
• utcomes

Current Status

• Spread to all In-Patient units
• All units through all modules
• Biggest challenge - the uptake, spread, and sustainability of change

and improvement once support of facilitation ends March 2013

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ED PIP & Patient Flow

What?

• A Facilitator-led (coaching model) program to identify and

implement improvements in patient flow and to reduce ED wait time.

Why?

• Ministry of Health sponsored for all large EDs with a goal to improve

patient flow and reduce ED wait time

Benefits

• Coaching
• Highly structured
• Significant change processes

Current Status

• Sustaining changes

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Performance + Transformation System (P+T)

Driving Reliability with Innovation, Values & Evidence (DRIVE) What?

• A framework to manage transformation (training, development, coaching

support, reporting, and knowledge development)

• Provides structure, metrics, consistency of approach, operational discipline &

measurement for change initiatives

• Based on Lean theory
• Built on best practices and existing initiatives; i.e. RTC™, ED-PIP, Flo, MORE-

OB, ThedaCare

Why?

• Desire for more consistent improvement approach
• Lack understanding of performance measures and the link to organizational

strategies

• Coordinate improvement efforts
• Better utilize coaching and training
• Engage and empower front line staff

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Performance + Transformation System (P+T)

Benefits

• Improve the patient & family experience of care and quality by removing

waste from the patient experience

• Enhance performance and staff engagement
• Sustain a culture of daily continuous improvement
• Eliminate waste, Save money & resources

Current Status

• Organizational Preparation
• Develop model, guides, standard work to guide daily continuous

improvement

• Recruitment of a Lean Improvement Specialist & Director of Organizational

Development

• Planning and preparing for organizational spread and support

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Integration

What?

• Integrating services via coordination, partnering, transferring, merging, or

amalgamating services

Why?

• Local Health Integration Systems Act requires(LHISA) LHINs/Health Service

Providers (HSP) to identify integration opportunities

Benefits

• Healthier communities, equitable access, improved quality of care &

services, sustainability, integration of healthcare delivery

Current Status

• Required to identify and submit integration opportunities to the LHIN
• Bluewater Health initiatives include: Chronic Disease Management;

Hospital-based Palliative Care; Hospitalist Program Redesign; Merger of CHIS/PROcure; Psychogeriatric 31

Advance Practice Model

What

• A movement toward post graduate education for all health care

professionals (nursing, pharmacists, social workers etc.)

Why?

• Changing needs and expectations demand a model where all health

professionals expand to their full scope of practice and abilities

• Aligns with Provincial directions

Benefits

• HC professionals need to be formally equipped to support health in its

physical, mental, emotional, spiritual and social dimensions

Current Status

• Phase One:
• Inter-Professional Practice team working toward Master’s level education
• Bridging courses with Ryerson RPN to BScN and RN to BScN

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Establishing our Priorities

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A Call to Lead

• Improving Quality and Safety with Patients at the Centre of
• ur Considerations
• The budget must be balanced
• Becoming efficient
• Ensuring PCOP growth funds remain in Sarnia Lambton
• Effective and realistic HR planning including succession

planning

• Strategic Planning
• System Integration

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What's truly unsustainable is doing business the same old way. “We cannot continue to: consume expensive new drugs when less expensive, older

• nes are just as effective most of the time

 to have specialists do what family doctors ought to do, family doctors do what nurse practitioners ought to do and nurses do what licensed practical nurses ought to do.  persist with a voluntarist, incremental model of quality improvement, where practitioners and institutions are free to embrace or refuse to adopt smarter and cheaper ways of delivering care. to accept the prices of goods and services that have no relationship to what they deliver.”

Steven Lewis, Healthcare Quarterly, 10(2) 2007: 103-104

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HR Impacts on the Budget

• Staffing costs account for approximately 70% of the

hospital’s operating budget

• From March 2010 to March 2012 there was an increase
• f approximately 261 employees = $6M
• Approximately 313 employees are currently eligible for

retirement (based on 55 years)

• The average age of retirement from BWH = 57 years
• The financial impact to BWH for sick time/replacement

costs in the last two years was approximately $3.6M each year

• The current year to date sick time/replacement costs are

approximately $1.1M

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Inventory of Possibilities

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Examples

• Standardization of supplies and products
• Utilization of health professionals to their full scope of

practice and abilities

• Increased engagement with front line staff and physicians
• Improved technology
• Change/reduction/integration/consolidation of services

Decisions

NO DECISIONS or JUDGEMENTS have been made

• n any of the ideas. Criteria for future decision

making will include financial implications, human, technology and facility resources, and alignment with priorities (e.g. Mission, Vision and Values, Strategic Plan; Quality Improvement Plan; government direction).

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Principles

• Patient and family centred care will remain at the core
• We will thoughtfully and thoroughly consider each idea through the lens of

the patient’s eyes

• We will not compromise quality and safety
• We are committed to a transparent collaborative process with timely and
• pen communications
• We value what key stakeholders bring and expect of us
• We will seek alignment with priorities (Mission, Vision, Values, Strategic

priorities, Quality Improvement Plan, government requirements)

• We will be courageous, innovative and leaderful.
• We will generate savings that will address our fiscal imperatives through

innovation and efficient resource utilization 39

Ideas

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The leaders at Bluewater Health value your ideas. Please submit any ideas you have to strengthen Bluewater Health’s capacity in the current healthcare environment to the Bright Idea program found on the Intranet.

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