VP Quarterly Report on Strategies

Q1 – 2015/16VP: Michael Redenbach – Integrated Health Services

Multi-year Plans:

- Seniors Multi-year Plan

- Mental Health &Addictions Multi-year Plan

Vision: Healthy people, families and communities.

Portfolio Overview

• Facility Based Continuing Care Service Line– Pioneer Village– Extended Care/ Veterans Program– Continuing Care, Programing & Utilization– Health Services Organizations

• Mental Health & Addiction Service Line– Outpatient Adult Mental Health Services– Outpatient Child & Youth Mental Health Services– Inpatient Mental Health Services– Outpatient & Inpatient Addiction Services – KOT

Multi-year Strategic Plans VP is Leading on:

• Seniors Multi-year Plan will focus on:– Community-based services – Home First/Quick

Response, Home Care opportunity analysis, standard work

– Long-term care – Purposeful Hourly Interactions (Rounding), Gentle Persuasive Approach, Enhanced Dining

– Acute care – Seniors Friendly Hospital approach– Proposal for multiple facility replacements

Seniors Multi-year Plan

2015-16 Provincial Outcome & Improvement Targets

• By March 31, 2020, seniors who require community support can remain at home as long as possible, enabling them to safely progress into other care options as needs change

–By March 31, 2017, the number of clients with a Method of Assigning Priority Levels (MAPLe) score of three to five living in the community supported by home care will increase by 2%

Seniors Multi-year Plan Outcome Measure

Status of Strategy ImplementationSuccesses

Successes/What is working RPIW #76 Post Fall Huddles Implemented on 3West, Regina Pioneer Village

– Improved communication to the family when they are able to participate in a huddle

– Improved resident safety by getting to the root cause of a fall

– Improved quality of care results when all care staff contribute to a residents falls prevention plan

RPIW #79 reduce the variation of resident information and eliminate defects in shift handovers on Unit 2-6 WRC

– Shift handover reports decreased from 6 to 5.

– Patients now feel they have a voice in their care with the implementation of weekly patient rounds. Changes in shift handover, so that every patient is discussed at each report, are expected to result in safer patient care.

Status of Strategy ImplementationSuccesses

Successes/What is working •Antipsychotic without a diagnosis project on the 2nd floor of Santa Maria Senior Citizen’s home.

– Initial Project Co-hort (n=38)

• 74 % discontinued (28)

• 13% decreased dosage (5)

• 13% residents deceased or transferred (5)

– Project team held a kaizen session to prepare for spread to the 3rd and 4th floor of Santa Maria. Staff and resident’s family were involved in creating a driver diagram.

– Comments from family:• “Reduction has been great for my husband”,

• “ noticed a good change in my mother – brighter, more alert and healthier”

Status of Strategy ImplementationSuccesses

Status of Strategy ImplementationSuccesses

Successes/What is working

•Regional Pilot at RPV to determine impact of Nurse Practitioner on the delivery of appropriate care to residents in LTC Facilities.

– April 20, 2015: Nurse Practitioner hired.– Education and SBAR completed– Developing standardized clinical tools for staff

to complete comprehensive assessment

Status of Strategy ImplementationSuccesses

Status of Strategy ImplementationSuccesses

Status of Strategy Implementation – Challenges & Risks

Challenges/Gaps/Risks • Immense financial pressure the Region is currently experiencing. Service Line understanding that there will be many excellent things we are not able to accomplish due to limited funding, people and time.  •Accreditation – Required evidence submitted September 17, 2015 for 4 ROPs for compliance•Severe physical infrastructure needs in several long-term care facilities•Importance of “Quality of Life” measures in LTC – No process or oversight for Quality of Care in LTC

Next Steps

Next Steps•Ombudsman’s Report on Long-Term Care, RHAs agreed to review the current state of implementation of the Program Guidelines for Special-care Homes in their regions. This is a starting point for further discussions with the ministry to look at:

– Develop and implement policies and procedures to operationalize the standards of care in the Program Guidelines for Special-care Homes.

– Identify, track and report on specific and measurable outcomes that ensure the standards of care in the Program Guidelines for Special-care Homes are met consistently for each long-term care resident.

– Include those specific and measurable outcomes as performance requirements in their agreements with long-term care facilities.

• Continue roll-out and embedding of Purposeful Hourly Interactions and Enhanced Dining Experience

• LTC Service Line Planning Session to develop work plan

Next Steps

• New Ministry LTC Initiatives– Geriatric Program

• Recruiting for a Geriatrician

• Steering committee in the process of developing a framework

• Conducting an inventory of all services and programs in all regions.

– Specialized Dementia units/behaviour Unit • Pulling environmental scan and lit search data together and collate.

• Complete gap analysis

• Identify suggested program models based on leading practice

• Set up steering committee meeting to pull team together and present foundational work, and plan next steps

• Work with the KOT to help create plan and steps, including use of lean tools

– Spread LEAN in remaining 50% - DVM• LTC KOT along with the RQHR KPO will be rolling out a plan to implement

in areas without a DVM and/or working with the units to improve their current DVMs.

Portfolio Overview

• Mental Health & Addiction Service Line– Outpatient Adult Mental Health Services– Outpatient Child & Youth Mental Health Services– Inpatient Mental Health Services– Out patient & Inpatient Addiction Services – KOT

Multi Year Strategic PlanVP leading on:

Mental Health and Addictions Multi-year Plan

2015-16 Provincial Health System Outcome

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

2015-16 Provincial Improvement Targets• 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.

Mental Health and Addictions Multi-year Plan

Mental Health & Addictions Multi-year Plan Outcome Measure

50%

0%

20%

40%

60%

80%

100%

A M J J A S O N D J F M A

Child and Youth Psychiatry

50%

0%

20%

40%

60%

80%

100%

A M J J A S O N D J F M A

Adult Psychiatry

Percentage of Clients Meeting the Triage Benchmarks in Psychiatry Programs

Triage BenchmarksVery Severe - 24 hrs Severe - 5 working daysModerate - 20 working days Mild - 30 working daysGoal - 85%

Mental Health & Addictions Multi-year Plan Outcome Measure

Percentage of Clients Meeting the Triage Benchmarks in Addictions Outpatient

Triage BenchmarksVery Severe - 24 hrs Severe - 5 working daysModerate - 20 working days Mild - 30 working daysGoal - 85%

Mental Health & Addictions Multi-year Plan Outcome Measure

Percentage of Clients Meeting the Triage Benchmarks in Outpatient Mental Health

Triage BenchmarksVery Severe - 24 hrs Severe - 5 working daysModerate - 20 working days Mild - 30 working daysGoal - 85%

Status of Strategy ImplementationSuccesses

Successes/What is working •Value stream mapping, daily visual management, using PQA and other data to better understand the service line issues•Distributed Leadership in projects – tap into the expertise of many, leadership characterizes the team•Implementation Science – set up projects to sustain outcomes•Cross-functional work and support especially with ED and IT •Collaborative work with Ministry of Health•Patient partnership with Canadian Mental Health Association

Status of Strategy Implementation – Challenges & Risks

Challenges/Gaps/Risks•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•Gaps: • Resource realities – demand exceeds capacity

•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 / Link to 16-17

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 Clin 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