Post on 26-May-2020
Excellence – every moment, every day
Strategic, Quality Improvement and
Performance Improvement Plan
Lakeridge Health
Excellence – every moment, every day
Who is Lakeridge Health?
• 3 acute sites with Emergency Departments
• 1 specialty hospital for complex continuing care and rehabilitation
• Specialty addiction and mental health services
• 4,000 staff and physicians • 1,200 volunteers
• Serve 1,600 patients/day • 559 inpatient beds
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Excellence – every moment, every day
Leading in partnerships
Lakeridge Health
Thoracic (LHIN-wide)
Cancer Services
(LHIN-wide)
Code STEMI, Cardiac rehab
(RVHS – Cardiology)
HR, payroll, ALF, data centre, purchasing
(RVHS – Admin)
Train paramedics in
five regions Nephrology
(DRDN)
Vascular
(Peterborough)
Mental Health
(Five Counties)
Home first & GAIN
(LHIN-wide)
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Excellence – every moment, every day
Our journey to quality
PCOP + Buildings
PIP
2008/09 2009/10 2010/11 2011/12
QIP
Financial recovery
MAC Quality Priorities
Regeneration
Oldest MRI in province
TP4
No LHW
Rising debt
Interim Balanced Scorecard
Balanced Scorecard
Slide 4
Strategic Plan
Excellence – every moment, every day
Our road to excelling in performance
Strategic plan
Quality Improvement Plan
Performance Improvement Plan
2008
Strategic Plan 2011-16
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Excellence – every moment, every day
Listening to our stakeholders
Comprehensive consultation:
+500 colleagues
41 partner organizations
1,500 community members
• 587 internal surveys • Focus groups in five locations • Online community survey
• 1,300 telephone polls • 41 HSP interviews • 5 internal task forces
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Excellence – every moment, every day
Listening to our stakeholders
• Independent analysis of programs (SWOT)
• Consultation with CCO + CE LHIN hospitals (RVHS, TSH)
• Strategic task forces:
1. Academics
2. Health Human Resources
3. Information Management
& Information Technology
4. Revenue Generation
5. Rural Health
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Excellence – every moment, every day
What we learned
Lakeridge Health is:
• Well-regarded by our communities
• Well-regarded provincially:
One of the top five cancer programs
One of the top three nephrology programs
One of the top integrated addiction services
A large acute tertiary critical care referral centre
4th largest community teaching program
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Excellence – every moment, every day
What we learned
Over 90% of Lakeridge Health patients live in
Durham Region. In ten years…
• Total population will increase from 591,309 to 707,346
• Proportion of population age 65+ will increase from 11.7% to 15.9%
• Trend continues for 20+ years
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Excellence – every moment, every day
Our Mission, Vision & Values
VISION
VALUES
MISSION
Excellence – every moment, every day
Creating and delivering a seamless system of care embracing every patient
Compassion Innovation
Courage Trust
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Excellence – every moment, every day
Our Strategic Directions
• Enhance the patient and family experience
• Become the safest hospital in Ontario
• Develop provincially leading, integrated systems of care, along the continuum
OUR PATIENTS
Strategic Direction 1:
Strategic Direction 2:
Strategic Direction 3:
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Excellence – every moment, every day
Our Strategic Directions
• Become the healthiest hospital workplace in Ontario
OUR COLLEAGUES
Strategic Direction 4:
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Excellence – every moment, every day
Our Strategic Directions
• Develop a satellite interprofessional health sciences centre
• Invest in leading facilities, equipment, technology and IT
• Enhance our financial capability to deliver
OUR ENABLERS
Strategic Direction 5:
Strategic Direction 6:
Strategic Direction 7:
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Excellence – every moment, every day
Our Strategy
• Establishing performance improvement targets and initiatives
• CE LHIN engagement: beds and buildings
• Regional engagement: buildings
• 2011/12 priorities and QIP designed to drive strategy
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Excellence – every moment, every day
Strategic plan
Quality Improvement Plan
Performance Improvement Plan
2008
Quality Improvement Plan
Our road to excelling in performance
Slide 15
Excellence – every moment, every day
Quality Improvement Plan
• Lakeridge Health drives many successful, quality initiatives
• QIP must:
Advance our safety agenda
Drive our strategic plan
Meet provincial and CE LHIN priorities
Be manageable
Build our capacity for learning and improvement
• Supports Board/Mgmt. philosophy
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Excellence – every moment, every day
Quality Targets & Initiatives
Slide 17
• Reduce incidence of VAP (from 0.68 to zero)
• Improve hand hygiene compliance (from 72.2% to 86.1%)
• Hold central line infections (to 0.09% or less)
S A F E T Y • Become the safest hospital in Ontario • Become the healthiest hospital workplace
in Ontario
S T R A T E G I C D I R E C T I O N S
Excellence – every moment, every day
Quality Targets & Initiatives
Slide 18
• Unnecessary deaths in hospitals - HSMR (hold to 92 or better)
• Reduce hospital readmissions (from 16.7% to 14.7%)
• Reduce % ALC (from 21.7 % to 20 %)
• Total margin to be zero or better
EFFECTIVENESS • Become the safest hospital in Ontario • Enhance our financial capability to deliver • Enhance the patient & family experience
S T R A T E G I C D I R E C T I O N S
Excellence – every moment, every day
Quality Targets & Initiatives
Slide 19
ACCESS & PATIENT-CENTRED
• Enhance the patient and family experience
• Develop provincially leading, integrated systems of care, along the continuum
S T R A T E G I C D I R E C T I O N S
• Reduce 90% wait times in ED:
• Admitted (from 70.4 to 63.4 hrs.)
• Non admitted (hold at 6.3 hrs.)
• Mental Health (from 62.5 to 50 hrs.)
• Improve patient satisfaction:
• “Recommending (IP from 67.5 to 70%)
Lakeridge Health” (ER from 56.6 to 60%)
Excellence – every moment, every day
Current Results & Accountabilities
• Cancer: many targets > provincial
• Nephrology: one of 3 > provincial
• Wait times: overall positive
• H-SAA: overall positive
• Diagnostic wait times
• ER
• ALC
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SUCCESSES:
CONCERNS:
Excellence – every moment, every day
Quality in Patient Safety
2009-10 Q2 50.00%
2009-10 Q3 77.20%
2009-10 Q4 73.90%
2010-11 Q1 71.80%
2010-11 Q2 67.70%
2010-11 Q3 71.60%
2010-11 Q4 85.00%
2011-12 Q1 87.70%
2011-12 Q2 70.0%
Hand hygiene
2008-09 110
2009-10 92
2010-11 87
HSMR
2009-10 Q2 4.42
2009-10 Q3 4.4
2009-10 Q4 1.18
2010-11 Q1 0
2010-11 Q2 1.63
2010-11 Q3 0
2010-11 Q4 1.03
2011-12 Q1 1
2011-12 Q2 0
VAP (LHO) Before Patient Initial Patient/Patient Environment Contact
+20.0%
-23
- 4.42
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Excellence – every moment, every day
Wait times (monthly)
Cancer Surgery
Hip replacement
Knee replacement
MRI CT
Cataract Surgery
105 days
29 days
42 days
163 days
134 days
101 days
Note: Days are based on 2011-12 Q1 (provincial) and Q2 (Lakeridge Health)
61 days 127 days 189 days 210 days
92 days 36 days
PROVINCIAL WAIT TIMES (AVERAGE)
LAKERIDGE HEALTH WAIT TIMES
LAKERIDGE HEALTH
PROVINCIAL
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Excellence – every moment, every day
FINANCIAL
Accountability indicators (H-SAA)
Slide 23
VOLUMES
ALC
REPEAT MH AND SA VISITS
READMISSIONS FOR CHF/COPD
ER LOS
WAIT TIME SERVICES
--
--
2
--
3
1
2
7
--
6
3
6
--
2
--
--
--
2
2 4 --
28
4
8
TOTAL
Excellence – every moment, every day
Quality Cancer Care • Unique features:
Management/services in other hospitals
A radiation machine in another hospital
• RCC/RCP targets: 41% exceed provincial targets
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RADIATION SYSTEMIC SURGERY
July-June (2010-11)
WT Ref-Con (% w/in 14 days)
WT RTT-Tr (% w/in target)
WT Ref-Con (% w/in 14 days)
WT Con-Tr (% w/in 28 days)
WT (% w/in target)
Meeting or within 2% of
target, improved
Meeting or within 2% of target,
decreased
Meeting or within 2% of
target, improved
Not meeting target, improved
Meeting or within 2% of
target, improved
Excellence – every moment, every day
Strategic plan
Quality Improvement Plan
Performance Improvement Plan
2008
Performance Improvement Plan
Our road to excelling in performance
Slide 25
Excellence – every moment, every day
Performance improvement plan
Slide 26
CE LHIN & LAKERIDGE HEALTH CONCERNS:
• Emergency and ALC wait times
• Long-term care capacity
• Home First implementation (Oshawa)
• Administration and physician engagement
• ED PIP a challenge with consultants
Long-s tand ing p ressures o f g rowth and sys tem capac i t y con t r i bu te
to the p rob lem
Excellence – every moment, every day
ED & ALC Targeted Improvements
Fo
cu
s
Performance Indicator Baseline (2010
Calendar)
Target Q1 Actual Q1 2011-12
Em
erg
ency D
epart
ment
90th percentile ER LOS (LHO)
Admitted patients 77.1 61.5 75.10
Non-admitted high acuity patients
6.6 Maintain or improve
7.10
Non-admitted low acuity patients
4.3 4.0 5.17
ER LOS of admitted patients 80.10 61.45 75.10
ER LOS of non-admitted high acuity patients 6.82 6.60 7.10
ER LOS of non-admitted low acuity patients 4.48 4.0 5.17
Time to physician assessment 3.0 2.7 3.4
ALC
ALC-LTC volume (Corporate)* 60 60 100
New ALC designations 432
Total ALC designations 165
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*ALC-LTC volume (Corporate) target reduction is based on the current ALC-LTC volume and does not include new ALC designations that occur after Q1 (That is we aim to reduce the Q1 ALC-LTC patients by 2 per month. This will not reflect if new ALC designations are present).
Excellence – every moment, every day
Performance improvement plan
Slide 28
OUR STRATEGIES:
• Operate within a quality framework
• Investment in Quality, Safety & Patient Experience Departments
• Improve physician engagement
• Rebuild patient flow as transition management team
• Implement meetings in addition to daily bed/flow meetings
• Reinforce principles of Regeneration the organizational transformation journey
• Delegate to program-specific leadership
• Open the right type of BEDS
Excellence – every moment, every day
Our targets (PIP)
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ALTERATE LEVEL OF CARE:
• Working aggressively with CCAC to reduce # waiting
• Establish approval forum for each new LTC case
• Improvement target for ALC-LTC
• LTC: 100 in August; 91 in October; target is 80
EMERGENCY ROOM:
• Learning from ED PIP
• Increasing physician hours
• Speeding up transitions via seven-day model of care
• Target 10% improvement over 90 days (~ 68 hours)
Excellence – every moment, every day
Conclusion
• Lakeridge Health succeeding/leading in regional systems
• Continuing to partner to improve the system
• Building and capital challenges continue
• Emergency wait times proving to be challenging
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Excellence – every moment, every day
Excellence – every moment, every day
Excellence – every moment, every day
Lakeridge Health