Vision:
Healthy people, families and communities.
VP Quarterly Report on Strategies
Q3 – 2015/16
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
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Emergency Department / EMS
Critical Care & Cardiosciences Units
Medicine Inpatient Units
Medicine KOT
• Physician Services
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Senior Medical Office
Department Heads
Practitioner Staff Affairs
Practitioner Advisory Committee
Wait 1 Multi-year Plan
Wait 1/ Access to Specialist & Diagnostics
Multi-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 Multi-year Plan
Wait 1 Multi-year Plan
Status of Strategy Implementation
Successes
Successes/What is working
• Program is on target for eight of the ten parameters
• Saskatchewan began posting current and historical
wait times for Computed Tomography (CT) and
Magnetic Resonance Imaging (MRI) wait times on
Saskatchewan.ca on October 22, 2015.
• The Hip and Knee Treatment and Research Centre
has begun surveying patient satisfaction in Q1 and
will begin using an online survey tool later this
fall. This tool was developed so that it can easily
be adapted to measure patient satisfaction in other
service lines.
Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• 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.
Appropriateness Of Care
“Better Care, Made Easier”
Multi-year Plan
Appropriateness Of Care
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 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.
Appropriateness Of Care
“Better Care, Made Easier”
Multi-year RQHR Plan
• The 2015/16 completion of design phase by end of
June
• RQHR A3 completed and approved by SLT October
2015
• Research generation phase by end of September
• Driver Diagram exercise completed with Department
head Council Dec 2015
• Administrative Dyad supports have been identified
• Prioritization of Actions/projects by end of February
2016
• Implement first project set by end of March 2016
• Monitoring and evaluation by end of March 2016
Appropriateness of Care
DHC Driver Diagram
Appropriateness of Care
RQHR Strategies
Researched best practices and organizational
initiatives lead to these 6 strategies
1Replication of Intermountain Health strategies
2Choosing Wisely
3Review of RQHR PPO strategy
4Review of current RQHR Clinical
Guidelines/Pathways
5Appropriate resource use
6Other : Surgery – indication; extent;
procedure
: Records Management
Appropriateness of Care
RQHR Projects
• Appropriate use of Laboratory resources
– Laboratory Medicine
• Avoid inappropriate bladder
catheterization – Medicine, GIM, FM
• Surgical Site Infection – best practice for
caesareans and hysterectomy – Obstetrics
&Gynecology
• Reduce the number of unnecessary
investigations for critically ill patients –
Critical Care
• Appropriate pre-operative testing for all
patients – Anesthesia/Surgery (Provincial
initiative – RQHR actively participating)
Appropriateness of Care
RQHR Projects (cont.)
• Use of admission to Medical Inpatient
Unit PPO – FM, Hospitalist, GIM
• Compliance with obtaining consent for
Transfusion of blood products –
Laboratory Medicine
• Development of Delirium Care Pathway –
Emergency Medicine (possibility of a
Provincial Plan rollout)
• Complete Travel, Immunization and
Communicable Disease manuals;
immunization coverage; HIV perinatal
transmission – PPHS
• Appropriate use of urine drug triage tests for
patients presenting to ER with psychiatric
presentations - Psychiatry
Appropriateness of Care
RQHR Projects (cont.)
• Appropriate screening for Pulmonary
Embolism – Emergency Medicine,
Radiology
• Compliance for appropriate use of Stroke
and Prostate Pathways – Surgery and
Radiology
• Standardization of sets and trays – Ortho and
Neuro surgery
• Appropriate timing of discharge summaries
completed by physicians; admission history
and physical documented in patient chart;
plan of care identified within 24hrs and
charted in patient chart – all departments
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 (Monthly)
– Involvement in decision making
– Listening
– Resolving important issues affecting medical staff
– Early Pregnancy Program
• Collaboration Plan
– Oversight Group Strategy: GIM
– Development of Compacts: RAHD and in Orthopaedics; pending
for Family Medicine
• Accountability plan
– Performance development
– Complaints management
– Bylaw and rules enforcement – final draft completed
– Leadership development
Status of Strategy Implementation
Successes
Successes/What is working
- The development of a GIM oversight committee has
promoted better communication between PH & RGH and
provided a forum to implement and drive positive change
- Department/Section retreats have been instrumental in
discussing and creating solutions to current issues and
strategizing for the future (20 Appropriateness of Care
projects have been identified)
- Physicians being empowered in their dyad and physician
leadership roles (ACU)
- Physician participation in the development of new service
models that focuses on the patient (MSU, ACU and
Psychiatry Hospitalist program)
- The 2nd Quarterly Physician Newsletter has been well
received
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; Section of Family
Medicine Obstetrics being created.
-Departments of Surgery and Medicine need further support to
be able to affectively deliver on the expectations of the
organization. As a result, communication and/or dissemination
of information is sometimes stalled.
-The Department of Surgery is using an Executive Meeting
Strategy to endeavor to improve communication. This strategy
is also being proposed for the Department of Family Medicine
Physician Engagment
Next Steps
Next Steps
- Implement a new structure for the Department of Family
Medicine
- Development of a business plan to remunerate DHs in
accordance with the ACFP model
- Coordinate with HR for the 2016 Bi-annual staff and
physician engagement survey
- Continue to engage physicians in those Lean initiatives
with clinical relevance
- Continue the implementation of the Appropriateness of
Care Agenda
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 (funding dependent) updated target
• 20% reduction in 90th%ile ED Length of Stay
(LOS) for admitted and Non-admitted patients.
• 20% reduction in 90th%ile Time Waiting for and
Inpatient Bed (TWIB).
• Decrease or no Increase in 30/60 day readmission rates to acute care.
• Decrease or no increase in 7 day ED Revisit
rates.
Hoshin Measure - RQHR
Hoshin Measure - RQHR
Medicine Service Line Multi-year Plan
Medicine 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)
Medicine Service Line Multi-year Plan
Medicine Inpatient Units (MIU)
Medicine Service Line Multi-year Plan
Medicine Inpatient Units (MIU)
Principle Strategies
1)Implement Accountable Care Unit
- Model Line is unit 4A at Pasqua Hospital (6-12 month pilot). Replication to follow
to all MIUs
- Structured Interdisciplinary Bedside Rounds (SIBR) with unit based physicians
- The rounds follow a standard process to advance the plan of each patient’s care
- Appropriateness and patient safety issues are addressed within the process
- Concurrent planning for discharge is incorporated
- Patient and identified 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. Trainers were certified in mid-November and training for staff will be
starting on March 1, 2016.
Medicine Service Line Multi-year Plan
Critical Care and Cardio Sciences
• Occupancy goal – 85%
• Cardiac diagnostic scheduling in the process of being
updated by Physician Partners
• Medical Surveillance Unit transition to closed Hospitalist
unit began Jan 15, 2016 ( mimic many components of
ACU – SIBR and bedside rounding)
• RFP posted for Electronic ECG system which will
streamline information flow and access to cath lab
• Evaluation of new in house orientation program to
maximize training an minimize lag time in onboarding
staff
• ICU will trial roll out of IV pumps Feb 16/16. Regional
roll out weeks of March 8 – and March 14/16
EP Lab Wait Times
(Referral to Procedure)
Hand Hygiene
Critical Care/Cardiosciences
Medicine Service Line Multi-year Plan
Critical Care and Cardio Sciences
Medicine Service Line Multi-year Plan
Emergency 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)
Next step – spread nursing e-Primary to PTA and Streaming both sites
(May, 2016)
• Urban EMS Offload (in minutes):
•
September 2015:
Average:
90th P
Pasqua ER
20:19
29:51
RGH ER
23:04
35:41
Leading practice in Western Canada (urban)
Medicine Service Line Multi-year Plan
Emergency and EMS
Emergency Departments:
• Major occupancy pressures
• Increased volume of visits (Pasqua 3%. RGH  7%). We will break
100,000 patients seen this year
• Restricted space
• “To Meets” (approx. 8,000 annually) waiting to be seen by Consultant.
• RPIW #74 has demonstrated shorter stays for rural “to meet” patients
coming in via ambulance
• 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
Medicine Service Line Multi-year Plan
Emergency and EMS
Emergency Departments:
• Innovation
• Use of community paramedics as part of PHC teams supporting
complex patients at home, thus avoiding ED admission
• Continued work and refinement on Patient Triage & Assessment
process at RGH
• Implementation of emergency physician e-charting (targeted for
Pasqua go-live: spring, 2016)
• Developing new Vacation management process (recommendation
from RPIW #87)
• “Unit Council” pilot at RGH (6 peer-elected staff to support
leadership in the department and ensure front-line voice in
decision-making)
• Commenced work on core preceptor group for new orientees
• Introduction of EARS (Early Assessment & Response Vital Signs
Record) – March, 2016.