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 2

• • • •

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 3

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)

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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) 9

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 single payer model. (5-97) 10

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 11

Pre and Post Mitigation – 11/12

Pre Mitigation Health System Funding Reform (HSFR) Allocation

HSFR Funding Impact Component of Overall Funding Impact (%)

$43,425,011

-$5,996,285 -4.3%

Post-Mitigation Health System Funding Reform (HSFR) Allocation

HSFR Funding Impact Component of Overall Funding Impact (%)

$48,432,870

-$968,426 -0.7% 12

BWH Actual Expenses vs. Expected Funding

Acute CCC ER MH Rehab Total

2010-11 Actuals 2011-12 Actuals

$78,948,371 $13,961,673 $17,919,465 $4,910,894 $5,092,499 $120,832,902 *$78,671,939 $13,537,174 $17,941,934 $4,968,039 $5,514,796 $120,633,882

2012-13 Expected Expenses

$65,958,049 $13,114,780 $16,735,006 $4,485,281 $5,608,995 $105,902,111 *Note: This excludes $7.5M in PCOP growth funding. 13

Cost / Weighted Case Comparator for Large Community Hospitals

Rank Facility Name

1 2 3 4 5 35 Brantford Markham Oakville Burlington Ottawa BWH

Acute & Day Surgery with adj Direct & Overhead Cost 2010-11

68,108,919 77,412,929 130,093,246 82,291,400 88,695,149 78,948,371

Acute & Day Surgery Weighted Cases 2010-11

14,629 16,129 27,004 17,074 18,287 13,182

Cost/Weighted Case 2010-11

4,656 4,800 4,818 4,820 4,850 5,989 14

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.

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Other Variables

• LHIN Accountability Agreements • • • • ALC Reductions ED Wait Times MH Readmits Lowering Overall Readmission Rates 16

Our Journey

For the last 6 years we have used three principles to establish our directions

1.

2.

3.

High quality, safe, and reliable care A trusted working environment founded on respect A strong financial base to sustain our journey

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Employee Engagement: 4 Quadrants

High Focus on Results

“Driving Metrics”

2 ….bottom line but is it sustainable?

4 SUSTAINABLE SUCCESS Results and inspiration 1 …going out of business… 3 …good for morale but at what cost?

Low Focus on Purposeful Culture

“Inspiring Commitment & Reinforcing What We Stand For”

High 18

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 20

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 21

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) 23

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 24

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 25

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 26

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 28

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, MORE OB, 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 29

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 30

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 32

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

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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).

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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 39

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. 40

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