Behavioural Supports Ontario (BSO)/media/sites/sw... · Kaizen events produce an array of tools and...

Behavioural Supports Ontario (BSO)

Presented to: Southwest LHIN – Quality Symposium

Presented by: Bernie Blais, BSO Project Sponsor & CEO North Simcoe Muskoka LHIN Dr. Lisa VanBussel, St. Joseph’s Health Care, London

Thursday, May 31, 2012

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a changing reality (video presentation)

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reflectionis this what we’ve come to accept... to expect

what if this was your mother… your father… someone close to you… someone you love… someone who loved and cared for you in return…

or someone you don’t even know

what if we don’t change reality?

nice to meet you

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objective

Provide provincial and local overviews of strategies deployed - by the Ministry ofHealth and Long Term Care (MOHLTC), Alzheimer Society of Ontario (ASO), HealthQuality Ontario (HQO) and LHINs - to improve the lives of older adults withresponsive behaviours - verbal, physical, or sexual aggression, wandering, agitationet.al. - associated with dementia, mental health and addictions issues and otherneurological disorders, their families and caregivers.

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agenda changing reality

the local perspective

the provincial picture

better health, better care, better value

continuing our discussion

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the local perspectivequality improvement in the south west LHIN

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background Demographic change

• By 2021 18% of Canadians will be > 65yrs of age; 45% of this group may be > 85 yrs

Significant impact of mental illness on seniors and their families• Mental health problems in late life usually occurs in context of medical illness, disability

and > range of psychosocial issues.


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aging at home

In the Fall of 2009, 31 partners from across the LHIN, were challenged to submit a business case to describe what a “coordinated system of care for seniors with behavioural challenges” would look like.

They needed to meet 3 objectives…

Improve the health of the defined population Enhance the care experience (including quality, access and reliability) Reduce or at least control the per capita cost of care.

they succeeded… and so… the journey began!


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emerging themes | aging at home

Greater system integration Local accountability and engagement across care partners Meaningful for the person, families and caregivers Practice to action LHIN wide collaboration Capacity Building and Education was needed (health promotion).


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the problem… finding solutions

It is time for a new paradigm, one that views older adults as active participants in an ageintegrated society and as active contributors as well as beneficiaries of development.

- Kalache, 2006

"The Situation is distorted when the Population is defined as the Problem… Rather theProblem is best defined as those factors which have created the gulf between the needsof the population and the approaches to address these needs.”

- Cohen


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behavioural support system of care | leveraging new and existing resources… 2010/11

BSS – 2010/11 ~ $3 M AAH funding allocated to create a LHIN wide system of care SJHC (LHIN wide coordination – project lead, evaluation) Schedule 1 Hospitals (GBHS, HPHA, LHSC (STEGH), WGH) to create or expand

existing mobile Seniors Mental Health and Addictions Response teams for older adults experiencing responsive behaviours in LTCHs and/or community

Enhanced Psychogeriatric Resource Consultants OTN in LTCHs.


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top down… bottom up

Establishment of LHIN-wide Steering Committee Memorandum of Agreement - SJHC and Schedule 1s Geriatric Cooperatives - mandate is to build local capacity to address responsive

behavior's where people reside to enable them to be connected to the current community support system. To coordinate, leverage and improve accountability of the existing geriatric mental health and addiction services, crisis services, day programs, hospitals and community partners within each community.


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learning from within and… learning from outside

Evidence informed practice Person centered team based service learning Not an expert model but is a shared learning model Common language and consistency when appropriate Inter-professional and inter-organizational.


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behavioural support system of care | leveraging new and existing resources… 2011/122011/12 ~$3 M Provincial BSO funding combined with AAH $3M LHIN-wide Project Lead Dedicated LHIN-wide Evaluation and QI resources for monthly reporting from HSPs

to Steering Committee/LHIN/CRO 5 Mobile Teams – BSO LTCH resources attached to the teams through a purchase

of service agreement with “host” LTCH 4 EPRCs for skill building (North, Central, South, LHIN-wide LHIN-wide dedicated Specialists – Geriatric Psychiatrist, Psychologist Enhanced Social Work Services OTN – 38/78 LTCHs, clinical and protocol training beginning 78 Long Term Care Homes Overnight Respite in Adult Day Programs.


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quality improvement & relationship building

Value Stream Mapping ( 2 day event, Nov 2011)• Client value statement “I am a unique individual who wants to live fully with

meaning and dignity through my life journey” Kaizen event (Change for the better ) -May 24, 25, 2012 QI Facilitator (to be hired June, 2012) Collaborative working groups (QI ) - Mobile teams, Intake and access, Standardized

assessment tools and Education Consortium


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Woodingford Lodge - Woodstock (09/14/2011)

Woodingford Lodge - Tillsonburg (09/14/2011)

Woodingford Lodge - Ingersoll (09/14/2011)

The Maples Home for Seniors (11/17/2011)

Rockwood Terrace (11/30/2011)

Ritz Lutheran Villa (11/23/2011)

PeopleCare - Tavistock (11/11/2011)

PeopleCare - Oakcrossing (10/18/2011)

Mitchell Nursing Home (11/23/2011)

Meaford Long Term Care Centre (08/31/2011)

McCormick Home (02/15/2012)

Lee Manor Home for the Aged (08/29/2011)

Dearness Home (02/24/2012)

Caressent Care -Mary Bucke (12/16/2011)

Caressant Care - Woodstock (12/19/2011)

Caressant Care - Bonnie Place (11/11/2011)

Long

Term

Car

e Ho

mes

(wit

h liv

e si

te d

ate)

Long Term Care Homes - UtilizationSeptember 1 2011 - Feb 29 2012

Clinical Direct Clinical Indirect Education Administrative

learning to work differently - OTN


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where are we going?

Change management strategy Improve access to care and transitions of care Solution focused across teams and finding the right balance Engaging and supporting primary care Communication strategy Person-centred team-based service- learning.

BEHAVIOURAL SUPPORTS ONTARIO PROJECT

successful aging

“A state wherein an individual is able to invoke adaptive psychological and social mechanisms to compensate for physiological limitations to achieve a sense of well being, high self-assessed quality of life , and a sense of personal fulfillment even in the context of illness and disability.”

- Bowling and Dieppe , 2005


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the provincial picture cultural change and BSO

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the provincial picture

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current state… a changing reality Local seniors across the province are starting to see changes in how care is provided in long-term care

homes, hospitals and the community. Through the Behavioural Supports Ontario (BSO) Project new services, programs and training are now being introduced to provide appropriate care and support for an increasing number of seniors across Ontario and their families and caregivers, who live and cope with dementia, mental illness and/or other neurological conditions.

First announced by the province last August, BSO represents a comprehensive system redesign that has successfully broken down barriers, encouraged collaborative work, shared knowledge and fostered partnerships among local, regional and provincial agencies. The result is a cultural transformation; a new way of thinking, acting and behaving.

To date, more than 300 new front-line staff have been hired across the province, over 310 long-term care homes have increased their in-house behavioural supports, and upwards of 4,000 new and existing front-line staff have received specialized training in techniques/approaches applicable to behavioural supports.

the provincial picture cont’d…

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principles for cultural and/or systemic change

Move toward a new vision, fundamentally different and better than the status quo Identify / communicate key themes that a) will have big impact and b) people can relate to Multiples of things (‘lots of lots’) Frame issues in ways that engage and mobilize the imagination, energy and will of a large

number of diverse stakeholders; create a shift in the balance of power and distribute leadership

Reinforce change across multiple processes/subsystems Continual refresh of “the story”; attract new, active supporters Emergent planning and design, based on monitoring progress and adapting as you go Many people contribute to the leadership of change, beyond organizational boundaries Transform mindset and lead to inherently sustainable change Maintain and refresh the leaders’ energy over the long haul.


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At the core of the project is creating a system that ensures people are treated with dignity and respect in an environment that supports safety for all and is based on QUALITY, evidence-based, patient-centredcare and practice.


QualityAccessible

Effective

Safe

Patient-Centered

EquitableEfficient

Appropriately Resourced

Integrated

Focused on Population

Health

quality at the core

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a partnership for cultural / systemic change Health care has been traditionally dominated by sector and silo approaches Sustainability requires an integrated system approach to transform system performance,

resource utilization and quality outcomes Improved system effectiveness and quality of care are the goals of an integrated

approach Partnerships, collaboration and coordination at multiple levels are fundamental building

blocks (both provincially and locally) BSO builds on existing program investments (for seniors, care transitions, Emergency

Room/Alternate Level of Care, etc.) to maximize the benefits for older adults and their caregivers

BSO is not a “new service” it has become the catalyst for system-wide transformation.


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the BSO formulaA unique, LHIN rollout approach is proving to be one of the project’s great strengths:

Thorough research and consultation produced a “Framework for Care” to guide system redesign and cultural change - panel of experts acted as reference on specific questions

4 Early Adopter LHINs first to implement, then share experiences with remaining 10 LHINs through “buddy system” approach

Up-front investments in quality improvement training set the stage for change Persons with lived experience were engaged throughout the planning, implementation

and evaluation processes Commitment to knowledge transfer events, organization and e-tool Team building: mobilize and engage across the system Formal evaluation of outcomes.


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provincial partnership structure


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collective wisdom and collaboration


Early Adopter LHIN 9LHIN Project Lead

LHIN Steering CommitteeProject Working Group

4 LHIN Early Adopter Steering Committee (SC)







Coordination and Reporting Office (CRO)Project Management

Health Quality Ontario (HQO)

* Quality Improvement Guidance* Coordination between BSS and other related local QI initiatives* System alignment * QI Evaluation/ measurement

Provincial Resource Team (PRT)

* Resource and Advisory

Quality Improvement Teams

LHIN 6

LHIN 7

LHIN 1

LHIN 2

LHIN 3

LHIN 5

LHIN 8

LHIN 11

LHIN 13

LHIN 14

Alzheimer Knowledge Exchange (AKE)

Communication and Knowledge Dissemination

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Primary Care (in Community and in Long Term Care) Collaborative Working Group

Centralized Intake Collaborative Working Group

Mobile Support Teams (Community and Long Term Care) Collaborative Working Group

Behavioural Su pport Units (transitional)


collaborative working groups Collaborative Working Groups initiated early in 2012 (align with key change ideas)

While the intent of the Collaborative Working Groups is to learn collectively, local context is reflected and there is no requirement to produce a single “provincial solution”

Kaizen events produce an array of tools and processes for each change idea (Each element constitutes a “ramp” of Plan-Do-Study-Act (PDSA) cycles i.e., at any given time, up to 79 concurrent pieces of improvement work can be moving BSO toward achieving its aim.)• Primary Care Toolkit - 8 elements• Centralized Intake - 7 elements• Mobile Support Team - 16 elements• Behavioural Support Units - 21 elements• Common Assessment Toolkit - 27 elements

Collaborative Working Group Lead LHIN Participating LHINs ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW

Primary Care HNHB Centralized Intake NSM

Mobile Teams SE Behavioural Support Units MH

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primary care collaborative Primary Care toolkit (created by HNHB)

The Primary Care Toolkit was established to provide guidance to clinicians so that they can provide comprehensive care to patients with Mild, Moderate or Severe Responsive Behaviours. It was tested by HNHB in January 2012, with recommendations for specific circumstances for optimal use.

• Safety Checklist Assessment• Behavioural Assessment Tool• Caregiver Burden Assessment • Potentiating Factors Checklist• Cognitive Assessment Tools• Functional Assessment Tools• Laboratory Investigations• Treatment/Management

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centralized intake and mobile teams collaborative Referral, Intake and Triage Mobile Support Team Care (community) Mobile Support Team Care (LTCH) Transition from Mobile Support Team Primary Care toolkit (created by HNHB)

behavioural supports unit collaborative Determine eligibility to SBSU Admission to SBSU Care in SBSU (transitional) Discharge Planning Admission to LTC (following SBSU discharge) Summary of development and testing by LHIN


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Phase 1:Consultative - develop the Framework for Care

Phase 2:Implement the Framework in 14 LHINs

Pillar 1:System Coordination

Pillar 2:Interdisciplinary Service Delivery

Pillar 3:Knowledgeable Care Team and Capacity Building

the Behavioural Support System

Knowledge Exchange & Training

HQO led Kaizen and VSA improvement events pan-LHIN

7 oversight committees / working groups providing subject matter expertise

4 pan-LHIN collaborative working groups

14 Improvement Facilitators trained

Over 3800 new and existing front-line staff trained

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better health, better care, better valueFunding & Resources

$40M invested to hire and train new resources/staff

$3.6M invested on service redesign

Over $2.6M in LHIN funding from non-BSO sources

Over 13000 volunteer hours from more than 600 HSPs

12 standardized core competencies and job descriptions

Quality

Over 30 intersectoral system redesign and improvement initiatives

14 Action Plans approve and now in the process of being implemented

Over 310 LTCHs with enhanced in-house behavioural supports

14 LHINs with BSO Outreach teams

5 LHINs indicating BSU implementation

Knowledge Exchange & Training

Mutually reinforcing change across multiple processes/subsystems

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better health, better care, better valueFunding & Resources

Capacity Building Roadmap distributed to LTCHs

Over 350 new health care staff hired to date

Quality

Reported reduced length of stay of LTC clients in hospital

Timely access to the right services

Consistent client and family education (e.g. prevent premature placements)

Integrate best practices and learning's for better quality care

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the patient perspective… Mary’s story


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smiling is infectious and so is BSO


“You matter because you are you; and you matter to the last moment of your life. Wewill do all we can to help you, not only to die peacefully but to live until you die.”

- - Saunders, 1976

- let’s continue our conversation…questions?

thank you

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