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
Draw patients to
hospitals
Historical cost plus
inflation financing
Managed through
central government
Homogenous, all trying
to offer all services
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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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)
4
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)
5
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)
6
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)
7
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)
8
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
on price and quality, while remaining under the singlepayer 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
$43,425,011
Reform (HSFR) Allocation
HSFR Funding Impact
-$5,996,285
Component of Overall
Funding Impact (%)
Post-Mitigation
-4.3%
Health System Funding
$48,432,870
Reform (HSFR) Allocation
HSFR Funding Impact
Component of Overall
Funding Impact (%)
-$968,426
-0.7%
12
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
$120,832,902
$120,633,882
$105,902,111
Total
*Note: This excludes $7.5M in PCOP growth funding.
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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
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BWH
78,948,371
13,182
5,989
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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.
15
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
our 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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Employee Engagement: 4 Quadrants
High
2
Focus on Results
“Driving Metrics”
….bottom line
but is it
sustainable?
1
SUSTAINABLE
SUCCESS
Results and
inspiration
3
…going out of
business…
Low
4
…good for
morale but at
what cost?
Focus on Purposeful Culture
“Inspiring Commitment & Reinforcing
What We Stand For”
High
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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
outcomes
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)
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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
orders.
Current Status
• Currently there are some orders sets in use, particularly ICU, but in most of
the hospital the ones that exist are poor
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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
outcomes
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
27
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, MOREOB, 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
our 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
34
What's truly unsustainable is doing business the same old way.
“We cannot continue to:
consume expensive new drugs when less expensive, older
ones 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
35
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
of 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
36
Inventory of Possibilities
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
37
Decisions
NO DECISIONS or JUDGEMENTS have been made
on 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).
38
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
open 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
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Ideas
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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