Towards Quality and Accountability in the BC Mental Health System

Presented by:

June 3, 2003

Lynda BondManager

Policy & ResearchFPSC

Port Coquitlam, BC

Paul AndersonDirector

Education Services

RVHPort Coquitlam,

BC

Derek WilsonConsultant

Policy & ResearchFPSC

Port Coquitlam, BC

Presentation OverviewOrganizational profiles and the “Journey”

to Quality & Accountability

Riverview Hospital

Forensic Psychiatric Services

Joint efforts in Quality & Accountability

Challenges & lessons learned

A look to the future

Our Mission

To improve the quality of life of adults affected by

persistent or severe mental illness by providing

excellent, specialized care for individuals with unique treatment challenges; and

by increasing service capability within BC

through clinical service, education and research

partnerships.

Our VisionTransforming Mental Illness

Into Mental Wellness

Profile: Riverview Hospital BC’s largest tertiary psychiatric facility Located in Port Coquitlam; serving all of BC 600 beds as at May 2003 3 major clinical programs

Adult Tertiary Psychiatry Geriatric Psychiatry Neuropsychiatry

Full range of clinical & logistical support services

582 admissions, 683 discharges in 2002/03

Riverview - The Quality Journey First accredited in 1979 by Canadian Council

on Health Services Accreditation (CCHSA)

Traditional quality assurance focus up to

1980s

Functional/departmental quality standards

Largely a paper-based audit system

Evaluative, problem-oriented approach

Dilemma: How to “assure” quality ???

Riverview - The Quality Journey Shift to CQI/TQM approach in early 1990s

Board, CEO & senior management endorsement

CQI Council, Department QI Plans, ad hoc QI projects

CQI Facilitator Training

Orientation to CQI methods for all staff

Shift to program management structure in 1998 Designed to reinforce high quality, inter-disciplinary,

patient-focused care

Current approach:

CQI focus across all aspects of care & service

QI activities integrated with organizational structures and strategic & operational planning

Modified balanced scorecards aligned with accreditation teams

Committee structure provides additional QI support: Medical Advisory Committee & sub committees

Discipline & Inter-disciplinary Professional Practice Councils

Program Planning/QI Teams

Partnership committees – stakeholders, union/management, etc.

Riverview - The Quality Journey

HR Team Balanced Scorecard

Human Resources Balanced Scorecard Strategy Map Mission: Improve the quality of life of adults affected by persistent or severe mental illness by providing excellent, specialized care for individuals with unique

treatment challenges; and by increasing service capability within BC through clinical service, education and research partnerships

Strategic Goals

CCHSA Quality Dimensions

Client/Community Focus Communication Confidentiality Participation/Partnership Respect & Caring Organization Responsibility & Community

Involvement

Responsiveness Availability Accessibility Timeliness Continuity Equity

System Competency Appropriateness Competence Effectiveness Safety Legitimacy Efficiency System Alignment

Work Life Open Communication Role Clarity Participation in Decision Making Learning Environment Well-Being

PA/May 5, 2003

Recruit, Select & Retain The Best

Manage Change Effectively

Develop A Highly Skilled Workforce

Promote staff currency in core courses to enhance skills & minimize risks

Individual letters to staff mailed 09/01 % of staff current in core courses

Review funding for contracted education

programming/subsidies

Benchmark ed. $ as a % of payroll Funding increased to benchmark levels

Provide continuing/ specialty education

opportunities for HR staff

Training needs documented on appraisal % staff taking training & avg. hrs/employee

Opportunities for continuous learning & professional growth

% of staff current in core courses Avg. hours/employee of learning activity

Implement a structured Management

Development Program

PHSA L&D planning initiated % of managers completing program

Positive employee relations

climate

Regular meetings with joint committees % grievances resolved, withdrawn, to hearing

Promote employee wellness & work/life

balance

Wellness programs listed in ESOD calendar STIIP/WCB attendance rates

Develop & implement effective employee retention strategies

FPSC retention study completed Turnover rates at FPSC/key RVH positions

Implement performance management process in tandem with HS move

Ward leadership issue addressed # and % of overdue appraisals by work area

Prompt, effective HR services & benefits

administration

Develop HR client survey % of managers/staff satisfied per survey

Timely, fair labour relations services &

investigations

% investigations within time limits % grievances resolved, w/d, to hearing

Develop/promote illness/injury prevention &

rehab. strategies

% of safety inspections completed STIIP/WCB time loss rates

Maintain a healthy, safe, discrimination &

harassment-free workplace

% of staff current in core courses WCB/STIIP & harassment complaint rates

Promote a balanced, healthy work culture within the

HR portfolio

Review of HR staff assignments completed % of HR staff satisfied on survey

Install ceiling lifts on selected RVH wards &

train all users

Ceiling lifts installed on selected wards % of users trained by 03/04

Develop transition services for employees

impacted by downsizing

Transition services in place % of impacted staff utilizing services

Offer ERIP/VDP programs to staff

impacted by downsizing

ERIP/VDP approval from P.S. Agency # of vacancies created

Train users in new HRIS technology as it

comes on-line

Training needs identified % of staff trained by go-live date

Ready HR processes & systems for move

to the Health Sector

Health Sector transition plan completed % of objectives completed by target date

Design, test and install Peoplesoft

system for RVH/FPSC

# of milestones achieved per plan System implemented by go-live date

Prepare RVH/FPSC for move to the Health Sector

# of milestones achieved per plan Move to HS completed by target date

Support HR staff & Managers to deal

effectively with changes

Timely communication & info resources % of objectives achieved by target date

Upgrade RVH ROSS/Empath

system

# of milestones achieved per plan System implemented by go-live date

Review implementation of ESP/TCT Staffing

System

Review completed by 12/03 Business case developed by 03/04

Riverview - The Environment Many changes in leadership/governance since 1996

On-again, off-again downsizing/redevelopment plans

On-going financial constraints

Increasing consumer/family expectations for care

New medications & evidence-based care

Significant information technology enhancements

External CCHSA Accreditation visits every 3 years

Profile: Forensic Services

FPSC Mandate

Responsible for the provision of psychiatric assessment, treatment and community case management to mentally disordered adults who are in conflict with the law.

Profile: Forensic Services (cont.)

Inpatient Services Forensic Psychiatric Hospital 211 bed secure psychiatric

hospital in Port Coquitlam

460 Admissions for 2002/03

Outpatient ServicesRegional Clinics Vancouver, Surrey/FV,

Kamloops, Prince George, Victoria, & Nanaimo

2279 Admissions for 2002/03

FPSC - The Quality Journey 1970s-1990s – Strong strong tradition of providing

high quality forensic psychiatric assessment and treatment services to patients and to the courts

1990s – quality improvement & accountability not a key strategic thrust of the organization – lack of formal QI program and organization not accredited

1997 – new Forensic Psychiatric Hospital opened

1998 (late) – decision to pursue accreditation – for FPH

1999-2000 – heavy organizational focus on preparing for accreditation

FPSC - The Quality Journey 2000 (early) – new CEO for FPSC 2000 (fall) – accreditation survey visit by CCHSA 2001 (early) – FPSC granted “Accreditation with

Focused Visit” Develop Quality Improvement program Develop a formal Information Management plan Clarify committee structure for the organization Develop a Communications plan

2001 – Regional clinics joined accreditation process 2002 – focused visit by CCHSA – all areas

addressed 2002 – new governing body for FPSC – PHSA

FPSC - The Environment

Dramatic shift in the environment at FPSC – in terms

of the organization’s focus and emphasis on quality

and accountability.

This shift has been driven by a number of factors or

forces, both internal and external to the organization.

FPSC - The Environment

External Forces Accreditation

Change in Governing Body

Fiscal Constraints

Internal Forces New Leadership

Infrastructure Development

Committee Structure

Environment InformationManagement

HumanResources

Regional ProgramsIntegration Council

Directors(Leadership & Partnerships)

Hospital Council

RiskManagement

Regional ProgramsQuality Council

Regional ProgramsInter-ProfessionalPractice Council

Article 29

J oint Standing

Hospital CareTeam

Clinical Risk(Program &Privilege)

Patient Advisory

OccupationalHealth & Safety

Case ManagementSystem

ClinicalServices

CorporateServices

FPSC

Infection Control

Pharmacy

Credentialling

ResearchAdvisory

MedicalAdvisory

FPSC - The Environment

Ongoing Challenges Resource commitments Meaningful QI/Accountability indicators

Positive Aspects of Current Environment QI/Accountability framework QI/Accountability infrastructure Leadership by management Staff understanding and involvement

Joint Efforts in QI/Accountability

Health System Restructuring

Accreditation

PHSA Reporting Requirements

Challenges & Lessons Learned

A Look to the Future

BC Health System Restructuring Healthcare system restructured in December ‘01

Objective: To reduce system costs & improve quality/accountability 52 regional boards, councils & societies reduced to:

5 regional health authorities 1 Provincial Health Services Authority (PHSA)

PHSA unique in Canada

Unites all health services with province-wide scope

RVH & FPSC included with other key health agencies

RVH and FPSC Integration

RVH and FPSC began integrating in May 2002

Common President/CEO assumed responsibility for all mental health services under the PHSA

Integration of senior management team 1st step

Efficiencies & resource sharing options identified

Looming accreditation surveys for both organizations “galvanized” integration process

QI/Accountability Framework

0

20

40

60

80

100

1st

Qtr

2nd

Qtr

3rd

Qtr

4th

Qtr

East

West

North

ACCREDITATIONACCREDITATION

FPSCFPSC

RIVERVIEWRIVERVIEW

TQM Q

I

TQM Q

I

PHSAPHSA

Joint Accreditation Process Integration of Accreditation Teams:

Leadership & Partnerships (joint) Human Resources (joint) Information Management (joint) Environment (joint)

Clinical Service Teams: Forensic Psychiatric Hospital (FPSC) Forensic Psychiatric Community Services (FPSC) Adult Tertiary Psychiatry (RVH) Geriatric Psychiatry (RVH) Neuropsychiatry (RVH)

Joint Accreditation: Positive Outcomes

Joint preparation has helped to:

build relationships & foster teamwork across both sites

acquaint RVH/FPSC partners to relative strengths

spur integration activities

accelerate identification of improvement opportunities

identify common CQI processes

PHSA Accountability Requirements

Availability and Access:

Access: Patient/client easily obtains required services in the most appropriate setting

PI: Average Number of Days on FPH Waitlist

5.1

6.6

5.2

4.5

5.4

4.6

8.6

5.3

8.5

6.25.7

6.1

0

1

2

3

4

5

6

7

8

9N

um

be

r o

f D

ay

s

Q1 02/03 Q2 02/03 Q3 02/03 Q4 02/03

Remand Temporary Absence Total

PI: Average Wait Times by Program (RVH)

8.7

1

7.3

1

15.2

1

9.6

3.5

18.4

1 2.6

75.5

16.7

13.3

64.3

0

10

20

30

40

50

60

70

80

Adult Tertiary ICU Geriatric Psychiatry Neuropsychiatry

Programs

No

. of

Da

ys

Wa

it

2001/02 Period 11 2001/02 Period 122002/03 Period 11 2002/03 Period 12

PHSA Accountability Requirements

Availability and Access:

Access: Patient/client easily obtains required services in the most appropriate setting

Availability: Services and resources are available to meet the needs of populations

PI: Average Number of Days to Complete PSR Assessments (FPSC)

24.1

38.6

30.4

41.2

22.7

43.4

28

36.7

0

5

10

15

20

25

30

35

40

45

Nu

mb

er

of

Da

ys

Q1 02/03 Q2 02/03 Q3 02/03 Q4 02/03

In custody Out of custody

PHSA Accountability Requirements

Availability and Access:

Access: Patient/client easily obtains required services in the most appropriate setting

Availability: Services and resources are available to meet the needs of populations

Diversion out of Province: Number of patients sent out of province for services normally available in BC

PI: Number of Patients Admitted vs. Diverted (RVH)

6064 66

43

11 92 4

0

10

20

30

40

50

60

70

2001/02 Period 11 2001/02 Period 12 2002/03 Period 11 2002/03 Period 12

Fiscal Periods

No

. of P

atie

nts

Patients Accepted Patients Diverted

PHSA Accountability Requirements

Service Quality and Appropriateness:

Effectiveness: Services, interventions or actions achieve optimal results

Safety/Harm: Potential risks and or unintended results are avoided or minimized

Utilization: Resources are brought together to achieve optimal results with minimal waste, re-work or effort

PI: Utilization as % of Available Beds (RVH)

93.2%91.9%

82.5%81.7%

75.0%

80.0%

85.0%

90.0%

95.0%

2001/02 Period 11

2001/02 Period 12

2002/03 Period 11

2002/03 Period 12

Fiscal Periods

% Utilization

PHSA Accountability RequirementsService Quality and Appropriateness: Effectiveness: Services, interventions or actions achieve

optimal results

Safety/Harm: Potential risks and or unintended results are avoided or minimized

Utilization: Resources are brought together to achieve optimal results with minimal waste, re-work or effort

Critical Incidents

Clinical Audits, Departmental or Program Reviews

Complaints Received

Legitimacy: Services conform to ethical principles, values, conventions, laws and regulations

PHSA Accountability RequirementsResources:

Providers, Equipment, Space Planning

Satisfaction:

Patient, Providers, Community

Value:

Services: Cost per case

Innovation:

Not Defined

QI/Accountability FrameworkOther Common Accountability Areas:

Partnerships with key stakeholders

Legislative/regulatory compliance/professional standards

Evidence-based practices & policy development

Prudent fiscal management (budgets & resources)

Research capability (academic & program/policy)

Thorough evaluation of organizational initiatives

Periodic external reviews & QI recommendations

Some Challenges...

Different approaches to QI/accountability

Differing organizational mandates/circumstances

Building working relationships

Quality & accountability continues to evolve at PHSA

Statistical reporting requirements

Lessons Learned

Clearly articulated vision & strategic priorities are key

Demonstrated commitment by senior management is essential

Adequate data collection/information management systems are required for effective decision making

Education and training on quality management principles provide staff with “tools of the trade”

A Look To The Future... Continued efforts to merge Riverview/FPSC

CCHSA Accreditation survey & recommendations

Continuing to review/improve/streamline processes

Development of common leadership & philosophy

Integration & development of common policies

Ongoing integration of Riverview/FPSC within

PHSA Integration with 6 other diverse health care agencies

Use of Riverview/FPSC experience to inform corporate integration, accountability and quality improvement efforts

Towards Quality and Accountability in the BC Mental Health System

Presented by:

June 3, 2003

Lynda BondManager

Policy & ResearchFPSC

Port Coquitlam, BC

Paul AndersonDirector

Education Services

RVHPort Coquitlam,

BC

Derek WilsonConsultant

Policy & ResearchFPSC

Port Coquitlam, BC

Questions ?