Quarter three report and what it means for physicians

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Quarter three report and what it means for physicians

29-Feb-2016

February 2 and 3, senior leaders reported on the progress made over the last three months. Each quarter of the region's planning and reporting cycle serve a unique purpose. Quarter three is an opportunity to:

 

  • Review Q3 outcome measures and corrective action plans for RQHR strategic multi-year plans
  • Understand current state and challenges and opportunities facing RQHR
  • Q3 report as an input to inform 2016-17 planning
  • Understand the cross functional nature of plans
  • VPs reported on the Region's multi-year strategic plan, which includes:

    Provincial Strategies

  • ED Waits and Patient Flow (prov. Hoshin)
  • Mental Health and Addictions (prov. Hoshin)
  • Seniors
  • Primary Health Care
  • Wait 1/ Access to Specialist and Diagnostics
  • Appropriateness
  • Infrastructure
  • Financial Sustainability
  • Culture of Safety
  • RQHR Internally Identified Strategies
  • Patient Family Centred Care
  • Engagement
  • Academics and Research
  • RQHR identified strategies

  • Patient Family Centred Care
  • Engagement
  • Academics and Research
  • The following provincial outcome and improvement targets have an impact on practitioner staff within the region:

    1. 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, 90% of patients waiting for an inpatient bed will wait <= 17.5 hours.
    • By March 31, 2016, the LOS in the ER for 90% non-admitted patients will be <= 5.9 hours

    Q3 report outcome:

    • ED LOS ( All Patients) decrease of 20 min 2014/15 vs 2015/16 ( YTD)
    • Decrease Time Waiting for an Inpatient Bed of 13 min 2014/15 vs 2015/16 ( YTD)
    • Change in admission volume is -0.70% 2014/15 vs 2015/16 ( YTD)

    Barriers:

    The capacity of some services is not able to meet demand i.e. primary health care physicians, Community resourses; or Service delivery is not as efficient as it could be i.e. higher LOS than national benchmarks

    2. By March 31, 2017, people living with chronic conditions will experience better health as indicated by a 30% decrease in hospital utilization related to 6 common chronic conditions.

    Outcome: initiative around HIV testing and childhood immunization and hand hygiene/flu shots need more work

    What's being done:

    HIV Testing: Establish standard work for every client to be offered an HIV test.

    Childhood Immunization: Realign caseloads, home visits and work with Health Canada on data sharing
    Hand Hygiene: Hand Hygiene Campaign and daily management
    Flu Shots : Continue to encourage staff
    Physician Recruitment and Retention: 10 point physician recruitment plan established

     

    3. By March 2019, there will be increased access to quality mental health and addictions services and reduced wait time for outpatient and psychiatry services

    • By March 31, 2016, waits for contract and salaried psychiatrists will meet benchmark targets to a threshold of 50%
    • By March 2016, 85% of Mental Health and Addictions clients will meet the wait time benchmarks based on their triage level.
    • By March 31, 2017 wait time benchmarks for mental health and addictions will be met 100% of the time.

    Challenges:

    • Communication – we don’t do enough
    • Change Management – we don’t always get it right
    • Demand from other areas, both internal and external to the region

    Risks:

    • Change fatigue
    • Loss of momentum in projects
    • Temporary dip in capacity at some points of program change
    • Meeting wait time target must not compromise quality

    Next Steps

    • Continue work on referral management, psychiatry redesign, crisis and outreach services, and the program for people with severe mental illness
    • Collaboration with IT on clinical docs project
    • Continued implementation/refinement of daily work boards (daily visual management) and cascade metrics that facilitate problem solving
    • Prepare for major changes to Mental Health Services Act (proclamation expected Fall 2015 sitting)
    • Work on smaller point improvements using Lean tools – med error reduction on inpatient

    4. To achieve a culture of safety, by March 31, 2020 there will be no harm to patients or staff.

    • By March 2018, fully implement a provincial Safety Alert / Stop the Line (SA/STL) process throughout Saskatchewan.
    • By March 31, 2018, all regions and the Cancer Agency will implement the six elements of the Safety Management System. (SMS)
    • By March 31, 2019, all regions and the Cancer Agency receive a 75% evaluation score on the implementation of the elements of the Safety Management System
    • By March 2019 there will be zero shoulder and back injuries.

    Next steps for the Patient Safety/ Stop the line multi-year plan:

    • Work towards implementation of the regional roll out plan
    • Heighten awareness of STL as a priority within RQHR & continue to work on culture change
    • Continue to provide leadership on multiyear plans for the two highest COR concerns—medication errors and falls

    5. 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.

    Challenges/Gaps/Risks of strategy implementation:

    Orthopedic Pooled referrals

    Challenge to the process by Saskatchewan Family Doctors at the SMA regional assembly.

    Challenge reiterated by RQHR Department of Family Medicine.

    Decision by the Orthopedic Section to withdraw from the process was made.

    Therefore Wait 1 times will be much more difficult to assess.

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

    • By March 31, 2017, there will be at least 2 clinical areas that have deployed care standards at the provincial level.

    7. By March 31, 2017 RQHR will have created a culture of Patient and Family Centered Care that leads to zero defects, no waits and waste from the perspective of patients and families, and that incorporates the core concepts of Patient and Family Centred Care (dignity and respect, information sharing, participation and collaboration).

     

    Challenges/Gaps/Risks/

    • Much work to spread and replicate practices redesigned by patients and frontline staff and physicians.
    • Lack of EHR and difficulty getting RQHR forms on physicians’ EMR, e.g. Accuro
    • Have not yet implemented many best practices, e.g. family presence policy, signage
    • Huge requirement for education/training in all areas and don’t have a region-wide integrated learning system, including monitoring

    What isn’t working/What can be improved

    • Timely disclosure to patients/families and resolution of client concerns in real time
    • Patient information needs to travel with the patient—advanced directives, blood consent, etc.
    • “Concern handling is not a department – it is everyone’s responsibility” – processes need to continue to evolve

    Next Steps:

    • Region-wide spread and replication of best practices in patient and family centred care
    • Emphasis on hand hygiene continues—aim 100%
    • Increased communication/education of staff, physicians, public, patients, residents, clients, families—Planning for integrated learning system
    • Patient Experience Survey analysis to direct improvements
    • Family presence policy implementation
    • Professional Image policy implementation