Corporate Development and Innovation Corporate Development and Innovation

UpdateUpdate

Executive Director’s Annual Update to Health PEI Board Update to Health PEI Board

November 5, 2013

Overview

• Profile of CDI Services• Strategic Initiatives/Committees

8Collaborative Model of Care8Wait Times8Advisory Committee on Organizational 8Advisory Committee on Organizational Development

• Pursuing Quality and Excellence Program8OALoS Project

• Key Performance Indicators – 2012/2013 Results

CDI Profile of Services

• Human Resources

• Strategic and Business Planning

• Communications

• Legal Services

• Utilization Management

• Evaluation

• Leadership and Org Development

• Board Development & • Legal Services

• Quality and Patient Safety

• Risk Management

• Policy Development

• Website Management

• Board Development & Support

• Project Management

• Clinical and Research Ethics

• Performance Monitoring

Strategic Initiatives/Committees

• Collaborative Model of Care Steering Committee

• Wait Times Steering Committee

• Advisory Committee on Organizational • Advisory Committee on Organizational Development

Collaborative Model of Care

• Currently in phase four of the Implementation • Some planning underway for phase five• To date 106, 000 care hours added• To ensure continued quality and safety at our facilities CMoC Steering

Committee monitors the following key performance indicators at CMoC sites:8 Patient and staff satisfaction, Unplanned readmits (<7 & 8-28 days), Patient Falls &

Medication Incidents, Length of Stay, HPPD, Over time & Sick Time, Proportion of Medication Incidents, Length of Stay, HPPD, Over time & Sick Time, Proportion of Beds Staffed vs. Budgeted and Annual budget

8 High degree of variance in KPI results across the sites

8 Areas of note: Over-time days per FTE down overall in LTC, Re-admits within 28 days down at all Acute Care Hospitals, All acute care sites continue to have LOS over the ELOS but more have been able to decrease or maintain lower and more appropriate LOS (7/11), PCH HPPD impacted by CPOE training, Patient Safety metrics (Falls & Med) seen increased reporting, and Home Care to expand and refine key performance indicators

CMOC Spread Plan

Phase I

Showcase

2010-2011

QEH-3, PCH-SR, HC-Ss, Wedgewood, KCMH

Phase II

2011-2012

QEH-7, PCH-MP, CHO, Maplewood, Colville, HC-Q

Phase III

2012-2013Primary Care Networks, HC-K & W, Souris, SMH , QEH-8, MSEH, Summerset, Riverview Manor , Western Hospital2012-2013 MSEH, Summerset, Riverview Manor , Western Hospital

Phase IV

2013-2014PE Home, BGH, MH & A, QEH-9, PCH Psych, HH, QEH-1&2

Phase V

2014-2015PCH/QEH Amb Care, CTC, QEH 4 & 5 (Mat Peds), PCH Mat/Peds, Sherwood Home, Critical Care, ER, OR, Public Health Nursing, Dental Public Health, Speech Language Pathology & Audiology, Community Dietician Services

11/1/2013

Wait Times Steering Committee

• National Priority Areas8 MRI, CT, Radiation Therapy

meeting/exceeding benchmark8 Redevelopment of day surgery area

at QEH expected to increase capacity for more cataract surgeries & reduce WTs

8 Hip and Knee surgery continue to be a challenge

• General Practitioners8 ACA – 2 pilot sites completed8 9 ACA projects underway8 Focus on increasing access

• Specialists – Planning underway to determine next steps

a challenge8 One time investments to Increase

hip and knee surgery 2012/2013

• Steering Committee Priorities- Access to General Practitioners- Access to Specialists: Internal

Medicine, Gynecology, Orthopaedics, Psychiatry

• Continue work� Hip fractures� Website� Expanding wait time information

Wait Times Status/Results

• RT wait times and access to Radiation Oncologist wait times remain excellent

• CT has seen a sl. decrease at U levels 1; MRI has seen a decrease at all urgency levels; and Ultrasounds are not meeting benchmark but are seeing an improvement at U level 2 & 3.

• Cataracts and orthopedics are not meeting benchmark but latest quarters are up.are up.

• Current priority areas: Access to GPs, Access to Physician Specialists, continue work in Ortho (including hip fractures), website expansion and maintenance

• Ongoing CIHI work

8Cancer surgery wait times and chemo wait times indicators defined.

Advisory Committee on Organizational Accomplishments 2012-13

• Day to Day Management Series

• Launched 2012-13. Peer to peer courses. Delivered across PEI. 140 participants. 31 courses. Topics included communications, finance, Human Resources, etc. Positive feedback. 2013-14 Calendar launched.

• Leading Workplace Communities (Acadia, CHD, AVH, IWK)

• 1 cohort (8)completed in 2012. 1 cohort (7) 2013. 2 surveys completed. 1 survey for 2014. • Leadership in Diverse Work Environments (PEI Health Sector Council)

• 2012: 1 cohort (12). 2013: 1 cohort (17)• Leadership Cadre: Three new or renewed development forums

• Leadership Forum (Executive and Directors Group). Quarterly.• Leadership Forum (Executive and Directors Group). Quarterly.• Leadership Summit (Full Cadre meetings). Four Conversations – September 2013.• Managers Community (FLM topics). Launched in 2012. 6 meetings to date. 3-4 times / year

• UPEI: 2013 - New Managers Series (4); Facilitation Skills Certificate (6)

• Staff Resource Center - http://www.healthpei.ca/mrc/ . Launched in 2012. Rebranded 2013.• Leadership Pathways - Project definition phase. To develop leadership framework for HPEI.• Strengthening Workplace Resilience - Code of Conduct – Engagement underway.

• Projects Completed 2013:

• Nursing Leadership / Allied and Support Leadership

• Nursing Mentorship Project

• Ceridian: 4 cohorts launched 2012-13, however, contract cancelled in early 2013.

Advisory Committee on Organizational Development 2013/14 Priorities

• Leadership Pathways. Objectives for 2013-14:

8 Define the Leadership Framework for Health PEI8 Define and more consistently implement evaluation, feedback and development

planning processes8 Align learning and development priorities with strategic direction

• Resilient Workplaces Framework. Objectives for 2013-14:

8 Engage organization on “Living our Values” and implement a “Code of Conduct”8 Engage organization on “Living our Values” and implement a “Code of Conduct”8 Engage organization on “psychological health and safety in the workplace”8 Define Health PEI approach to improving “psychological health and safety in the

workplace”

• Staff Resource Center Objectives for 2013-14:

8 Former “Manager Resource Center” rebranded as a resource for all staff8 Streamlined and refreshed8 Will seek feedback from staff

Public Health- Increased access for targeted

populations- All program areas

PURSUING QUALITY & EXCELLENCE PROGRAMOverall Average LoS (OALoS)

Targeted Minimum 50% ReductionCalculated as: (OALoS – ELoS)/2 = 50% reduction

Western and KCMH

Home Care- Increased access for clients- All program areas

Long Term Care- Decrease preventable

admissions

Phase I

Acute LoS

Phase II

Goal for OALoS is 7.3

Days

Western and KCMH- Reduce OALoS

Primary Care- Reduce wait time to see a care

provider- Sites being selected

admissions- Beach Grove Home- Summerset Manor- Colville and Riverview Manor

Extended Care- Reduction of ALC stays- Reduction of ALOS for CHO

and O’Leary

Inpatient

Mental Health and Addictions Services

Community Mental Health and Addictions

QEHPCH

The goal is to reduce OALoS by 50%

OALoS is 8.99 Days

ELOS is 5.68 Days

8.99 – 5.68 = 3.318.99 – 5.68 = 3.31

3.31 x 50% = 1.65

Days

New OALoS is 7.3

Days

Quality Improvement - Covers Prince Edward Island Like the Dew

25 Rapid Improvement Projects in Phase 1.

Key Performance IndicatorsProvincial 2012/2013 Results

• 21 Key Performance Indicators in total 84 Financial and 17 non-financial

• 2 of the non-financial indicators do not have results for 2012/2013 – staff satisfaction (not measured) and Ambulatory care sensitive measured) and Ambulatory care sensitive conditions (not available until Spring 2013).

• KPI document for Health PEI has been evaluated as part of the strategic planning process and performance indicators have been changed in Health PEI’s 2013-2016 Strategic Plan.

2012/13 Results

• 6 of 15 available indicators (excluding financial indicators) either exceeded or met the target 8 % unplanned readmissions within 8 to 28 days to same acute care facility8 % Unplanned Readmissions within 7 Days to Same Acute Care Facility8 Client, Patient, Family with Services (acute care)8 Radiation Therapy8 CT Scan Provincial Rollup8 HSMR

• 2 of 16 indicators are trending in the right direction• 2 of 16 indicators are trending in the right direction8 Hip Replacement 8 Overtime Days per FTE

Note: Although CIHI numbers are not yet available, internal metrics indicate that ACSC result will likely trend downward for 12/13

Explanation of Variance

2012/2013 Results

Quality Indicator Results

• All available indicators met or exceeded targets

• Ambulatory Care Sensitive Conditions (ACSC) result from Canadian Institute for Health Information (CIHI) not available until Spring 2014, however, internal metrics indicate positive however, internal metrics indicate positive downward trend

Equity Indicator Results

• CT Scan overall wait-time exceeded target• MRI overall wait-time had been trending positively but dipped in 2012/2013. Factors influencing this decline include increased demand for services, an aging population and increased requests from ordering physicians. With limited staff, ordering physicians. With limited staff, appointment times and workflow has been made as efficient as possible and the number of appointment times increased, however, demand is in excess of current capacity. Despite this wait times remain among the best in Canada in particular for urgent cases.

• Wait time for hip surgery improved slightly and the number of surgeries also increased.

Equity Indicator Results

• Wait time for knee surgery continues to increase. Factors impacting wait times in this area include availability of OR time and access to in-patient beds.8 Mitigation Strategy Hips/Knees: Additional one-time funding was

introduced this year to increase the number of orthopedic surgeries. Special focus will be on those who have waited long periods of time for surgery. The number of beds for orthopedic surgery has also been increased.increased.

• Wait time for cataract surgery continues to increase. Factors impacting wait times in this area include increased demand for service resulting from an aging population as well as referral patterns. 8 Mitigation Strategies: Additional one time funding supported increased

cataract surgeries during the summer months. Redevelopment of day surgery area at QEH expected to increase capacity for more cataract surgeries & reduce WTs

• Budgeted spending per capita results indicate that most areas met or exceeded target. Physician services exceeded targeted spending.

Efficiency Indicator Results

• The variance between acute average length of stay and expected length of stay continues to increase. Factors influencing length of stay include aging population, availability of community programs to prevent or reduce length of hospital stays as well as internal processes. internal processes. 8Mitigation Strategy: A major project Overall Average Length of Stay (OALoS) launched in October focuses on reducing the length of stay in hospitals. Phase 1 is focused on building increased capacity in community programs and community hospitals. Phase 2, to be launched in February 2014, will focus on internal processes within QEH and PCH.

Efficiency Indicator Results

• Length of stay in long-term care increased in 2012/2013, not meeting our target. We have approximately 100 LTC residents across the province who are below the age of 65. These residents have a much longer stay than those 65+ which brings up our average. When you only factor in residents who are 65+ and occupying a LTC bed, we did in fact meet our 65+ and occupying a LTC bed, we did in fact meet our target.

• Hours per patient day (HPPD) continues to increase. Factors impacting this increase include increasing patient acuity and lack of availability of allied supports.8Mitigation Strategy: CNO/EDCDI leading initiative to assess patient acuity and associated staffing requirements

Sustainability Indicator Results• Financial indicators have changed over time in an effort to

select those indicators which are most relevant.• Percentage of overall budget continues to increase

8Mitigation Strategy: A new process, Program Based Marginal Analysis (PBMA) was introduced to facilitate improved investment and disinvestment decision making processes.

• A surplus of $13.92 million was recorded in 2012/13 because of changes in the Public Sector Accounting Standards of changes in the Public Sector Accounting Standards effective April 1, 2012 that requires revenues for capital activities to be recognized when it is received. Under previous Canadian accounting standards for public sector entities, monies received for the acquisition of tangible capital assets were amortized over the same period as the related asset. With the change in accounting standards, Health PEI recorded $16.85 million in surplus due to capital activities which, when combined with the $2.93 million deficit in operating activities, resulted in a net overall surplus of $13.92 million.

Sustainability Indicator Results

• The number of sick days per full-time equivalent (FTE) has increased slightly and exceeded the 2012/13 target.

8Mitigation Strategy: Opportunities to reduce the average number of sick days used are currently average number of sick days used are currently being explored.

• The number of overtime days per FTE is trending downward. Although it is challenging to directly link reasons for this downward trend, it is expected that the introduction of replacement nursing positions and CMOC were contributing factors.

• Staff satisfaction was not measured in 2012/13.

Questions??