VP Quarterly Report on Strategies

Q1 – 2015/16

Vision: Healthy people, families and communities.

VP: David McCutcheon – Physician Services & Integrated Health Services

Multi-year Plans:-Wait 1/Access to Specialists and Diagnostics Multi-year Plan

-Appropriateness Multi-year Plan-Physician Engagement Multi-year Plan-Medicine Service Line Multi-year Plan

Portfolio Overview

• Medicine Service Line– Emergency Department / EMS

– Critical Care & Cardiosciences Units

– Medicine Inpatient Units

– Medicine KOT

• Physician Services– Senior Medical Office

– Department Heads

– Practitioner Staff Affairs

– Practitioner Advisory Committee

Wait 1 Multi-year Plan

Wait 1/ Access to Specialist & DiagnosticsMulti-year Plan

2015-16 Provincial Outcome

• By March 31 2019, there will be a 50% decrease in wait time for appropriate referral from primary care provider to all specialists or diagnostics.

–By March 31, 2016, the provincial framework for an appropriate referral to specialists or diagnostics will be implemented in at least four new clinical areas within two service lines.

Wait 1 Outcome Measure

Wait 1 Multi-year Plan

Status of Strategy ImplementationSuccesses

Successes/What is working

Program is on target for eight of the ten parameters

Status of Strategy Implementation – Challenges & Risks

Challenges/Gaps/Risks1.Data issue with access to diagnostics wait time information (awaiting resolution corrective action plan suggests a September resolution)

2.Ministry Staffing issue with regard to the patient and provider satisfaction survey conducted within the Hip and Knee Treatment and Research Centre

3.Issue with referral data set as percentile needed to be re-calculated. (Date seen may not be accurate for date that patient could have been seen).

Appropriateness Multi-year Plan

(Better Care, Made Easier)

Appropriateness Multi-year Plan

2015/16 Provincial Outcome & Improvement Targets(Note: New language still under review)

• By March 31, 2018, 80% of clinicians in 3 selected clinical areas within one or more service lines will be utilizing agree upon best practices.

–By March 31, 2016, at least one clinical area within a service line will have deployed care standards and will be actively using measurement and feedback to inform improvement.

Appropriateness of Care

Progress to Date:

Wall Walk Charts: “Green”

Framework Development

MRI Prototype underway

Awareness Campaign continues: SMA, SHR, MoH, PLT, SMOC, RQHR RHQR DHC meeting on June 30th, 2015

Appropriateness of Care

Better Care, Made Easier

VISION STATEMENT –permission sought from the CMA

“The right care, provided by the right providers, to the right patient, in the right place, at the right time, resulting in optimal

quality care.“OUTCOME TARGET

By March 31, 2018, 80% of clinicians in 3 selected clinical areas within one or more service lines will be

using agreed upon best practices (Subject to Revision)

The Framework Purpose is to create:•A shared understanding of what Appropriateness of Care means, •A common approach to improving Appropriateness of Care across the system, •A roadmap for the health system to adopt this common approach within a broad range of patient-centered clinical areas.

Key Guiding Principles •Clinician-led•Evidence-based Care•Effective Care•Patient- and Family-Centered Care •Information Sharing•Equitable Care •Standardized Care •Continuous Learning and Improvement •Interdisciplinary team (care team)

Value to Patients and Clinicians •Eliminate unnecessary referrals, testing and treatments, thereby reducing wasted time for both clinicians and patients •Improve transparency in clinical decision making•Greater involvement and collaboration of clinicians in developing new knowledge •Standardized care does not mean “exactly the same care”, rather consistent care that makes it easier for clinicians to provide and for patients to understand.•Reduced wait times by ensuring only the right (best) tests or treatments are provided to patients. •Reduce potential risks to patient harms associated with unnecessary testing and treatments

.

Purpose, Guiding Principles & Value

Appropriateness of Care Program Roles

Provincial Program Roles

• Leadership• Integration• Provide support structure• Consultation• Replication• Monitoring• Benefit realization

Healthcare organization roles

• Develop own facility plan• Adopt provincial

methodology • Collaborate with the

provincial program• Monitor and report own

progress• Measure the impact

Provincial Program Strategies

– Data and measurement– Stakeholder engagement– Toolkit development– Model line project (MRI)– Communication and consultation– Customize support

MRI Lumbar Spine

• The main proposed Service Line for 2015-16 includes Medical Imaging: MRI of the lumbar spine

• In 2011-12 there were 1.7 million MRIs performed in Canada (volume doubled in less than a decade) (CIHI data).

• Approximately 5000 MRs performed on lumbar spine in SK annually• A recent JAMA study found:

29% of the MRI requests for lumbar spine were considered “inappropriate” (Emery et al January, 2013) If applicable to Saskatchewan, this represents an unnecessary

expenditure of $833,00.

Appropriateness Multi-year RQHR Plan

(Better Care, Made Easier)

•The 2015/16 completion of design phase by end of June •Research generation phase by end of September •Implement first project set by end of March•Monitoring and evaluation by end of March

Projects

1)Drawing from evidence and with the awareness of the Choosing Wisely initiative, Department Heads and Section Heads are developing and renewing their Pre Printed Orders (PPOs)

2)Standardization of practices • Sets and trays in the OR• Equipment and supplies

3)Evidence based practice

4)Pathways implementation• Spine• Stroke• Pelvic floor

RQHR examples

•New PPO admission orders for medical inpatient units (elimination in unnecessary blood work and radiology exams, codification of VTE prophylaxis)•Appropriate use of the Emergency Department•Review of laboratory, echocardiography, stress testing, and radiology in Cardiosciences•Plan to standardize trays in Orthopaedic procedures starting with knee replacements

Physician Engagement Multi-year Plan

Physician Engagement Multi-year Plan

RQHR OUTCOME

• Biennially, the physician engagement survey will be completed with an engagement score of 55% in 2016

• By 2017, RQHR will reach an average employee and physician engagement score of 80%.

Physician Engagement Multi-year Plan

The elements of the Multi-year Plan are:

•Communication Plan

– Providing timely information

– Involvement in decision making

– Listening

– Resolving important issues affecting medical staff

•Collaboration Plan

– Oversight Group Strategy

– Development of Compacts (RAHD and in Orthopaedics)

•Accountability plan

– Performance development

– Complaints management

– Bylaw and rules enforcement

– Leadership development

Status of Strategy ImplementationSuccesses

Successes/What is working - The Senior Medical Office (comprised of Drs. Gill

White, David McCutcheon and George Carson) is committed to improving physician engagement which is evident by the work that has been completed to date.

- Department/Section retreats have been instrumental in discussing and creating solutions to current issues and trending

- Physicians are being empowered in their dyad and physician leadership roles

- New service models have been implemented in Cardiology and Psychiatry

Status of Strategy Implementation – Challenges & Risks

Challenges/Gaps/Risks

- The Department of Family Medicine structure needs to be redesigned to provide better support and communication to community based family physicians

- Departments of Surgery and Medicine need further support to be able to affectively deliver on the expectations of the organization.

- The Department Heads have very limited administrative time to fulfill their duties and accountabilities. Not enough time provided to engage their members on a daily/weekly basis. As a result, communication and/or dissemination of information is sometimes stalled

Next Steps

Next Steps

- Publish a quarterly newsletter, commencing in September 2015

- Second DHC retreat (scheduled for the fall 2015)- DH performance assessment completed by Senior

Medical Office during summer of 2015- Development of a business plan to remunerate DHs in

accordance with the ACFP model

Medicine Service Line Multi-year Plan

RQHR Multi-year plans that Contributes to 15/16 Patient Flow Hoshin

2015/16 Provincial Hoshin

• By March 31, 2016, 90% of patients waiting for an inpatient bed will wait <= 17.5 hours.

• RQHR Supporting Multi-year Plans: Patient Flow

Primary Health Care Seniors

Mental Health & Addictions

Medicine Service Line

Medicine Service Line Multi-year Plan

2015/16 Provincial Outcome & Improvement Targets for Patient Flow

• By March 31, 2017, no patient will wait for care in the emergency department.- By March 31, 2016, the length of stay (LOS) in the

ER for 90% of admitted patients will be <= 22.3 hours

- By March 31, 2016, the LOS in the ER for 90% non-admitted patients will be <= 5.9 hours

Hoshin Measure - RQHR

Hoshin Measure - RQHR

RQHR Multi-year plansMedicine Inpatient Units (MIU)

Medicine Inpatient Units Goal of 95%-0-0:

The work will focus on:

1) advancing a high quality daily plan of care for each patient.

2) Identifying and removing barriers to advancing the care plan

3) Preventing iatrogenic effects of hospitalization for seniors 4)Preventing harm to all hospitalized patients (i.e. falls, med errors, infection transmission)

5)Driving to goal of admitting patients to the unit from the ER within 30 minutes of decision to admit (assuming bed ready and available)

RQHR Multi-year plansMedicine Inpatient Units (MIU)

RQHR Multi-year plansMedicine Inpatient Units (MIU)

Principle Strategies

1)Implement Accountable Care Units

- Model Line is unit 4A at Pasqua Hospital (6-12 month pilot). Replication to follow to all MIUs

-Interdisciplinary in-room patient rounding with unit based physicians

-The rounds follow a standard process to advance the plan of each patient’s care

- Patient safety issues are addressed within the process

- Concurrent planning for discharge is incorporated

- Patient and family members are participants in the rounds

2)Seniors Friendly Hospital

-33% of seniors over the age of 85 admitted to RQHR die.

-Care issues include:

- functional decline - medication toxicity

- altered consciousness(delirium) - care transition

- malnutrition/dehydration - polypharmacy

-Gentle Persuasive Approach has been demonstrated to be the most effective strategy

Medicine Service Line Multi-year PlanCritical Care and Cardio Sciences

• Ongoing assessment of Cardiology service model and diagnostic scheduling management

• Understanding ED flow and pull times with establishment of production boards starting on one nursing unit and one diagnostic area

• Occupancy and surge is manageable – now tracking wait times for transfers out.

• Ongoing development of Medical Surveillance Unit model.

• New database established to manage volumes within the EP Program

• Work ongoing for development of Electronic ECG system which will streamline information flow and access to cath lab.

• Agency nursing to support vacancy management in both areas.

• Team is involved in Hospira IV Pump implementation.

Medicine Service Line Multi-year PlanCritical Care and Cardio Sciences

Medicine Service Line Multi-year PlanEmergency and EMS

Emergency and EMS:•e-Primary Assessment

• RPIW #69 – decreased time to complete and document primary assessment in SCM from 25 minutes (average) to 10 minutes (average)

•Urban EMS Offload:• May 2015:

Leading practice in Western Canada (urban)

  Average: 90th P

Pasqua ER 12:19 30:29

RGH ER 12:24 39:41

Emergency Departments:

•Major occupancy pressures• Increase volume of visits• Restricted space• “To Meets” waiting to be seen by Consultant (RPIW #74)• Admit no bed patients

•Results in:• Increased patient complaints• Lack of space for clinical assessment• Privacy and dignity concerns• Risk of delirium in seniors• Increased patients leaving without being seen• Delays for ED patients

•Innovation • Use of community paramedic to do at home assessments thus

avoiding ED admission

Medicine Service Line Multi-year PlanEmergency and EMS