2015/16 q2 report on strategic plan november 3, 2015 final slide… · •q1 report on strategic...

2015/16 Q2 Report on Strategic Plan

November 3, 2015

Strategic Reporting

• Q1 Report on Strategic Plan

• Current year course correct

Q1

•Q2 Report on Strategic Plan

• Review inputs into next year plan

Q2 • Q3 Report on

Strategic Plan

• Finalize next year plan

Q3

• Year end report (annual report)

• Celebrate successes

Q4

Provincial Outcomes & Targets

Clinical Best

Practice

Budget

Risks/Gaps/Challenges

Other E-Scan Data

Accred. Standards

CIHI Data

Patient, Staff, and Physician Feedback

Strategic Planning Inputs

We are Here

RQHR Strategic Planning And Reporting

ClinicalBest

Practice

• Initiatives and projects cascaded down from the strategic

plan and one-year business plan• Other important work identified to mitigate risks, fill gaps,

and improve performances

Budge


Other E-Scan Data

Accred. Standards

CIHI Data



Q1



Q2



Q3



Q4

Feedback/

challenges/gapsbrought back to

the MOH and PLT tables.

Initiatives and

projectscascading down

to service lines and departments

where they are able to contribute

to achievement of strategic

outcomes and targets.

• Includes high priority, cross functional initiatives, measures, and targets that require regular monitoring by the Senior Leadership Team

• Identifies the annual priority areas of focus for the region

Portfolio, Service Line,

Department Multi-Year Plans

Key Support: SPBIU/KPO/KOTs

Use Lean tools to support implementation of operational plans wherever applicable: RPIW, 5S, Kanban, Standard Work, Replication, etc. Ongoing review of operationalization of Lean tools and training on the use of Lean tools will take place throughout the year rather than

Provincial

Outcomes & Targets



Strategic PlanningOutput 1:

Strategic Planning Output 2:

Cascading

Plans

RQHR Multi-Year Strategic Plan

Key Supportt: SPBIU

RQHR One-YearBusiness Plan

Key Support: SPBIU

• Daily work of service delivery

• Current year initiatives and projects cascaded down from service line/department multi-year plans

Service Line, Department, Unit

One-Year Operational Plans

Key Support: KPO/KOTs

DRAFT RQHR Planning and Reporting Input/Output

Kaizen Plans/Integrated

TimelinesKey Support: KPO/KOTs

Hard copies are on your

table to see the details

Objectives of Q2 Reporting Day

• Review Q2 outcome measures and corrective

action plans for RQHR strategic multi-year plans

• Understand current state and challenges and

opportunities facing RQHR

• Q2 report as an input to inform 2016-17 planning

• Understand the cross functional nature of plans

• Deep dive on one 2015-16 Focused Area –

Financial Sustainability

Housekeeping

• Washrooms

• WiFi connectivity is limited

• Flu Clinic at 2:00-4:00pm today ONLY

How to Access Today’s Information

1. From the

intranet

homepage,

click Strategic

Framework.

2. Then click

Sharepoint Site.

3. Click Reporting

then click the

RQHR Q3 Report

on Strategies

folder.


• RQHR Lean Website:

http://www.rqhrlean.com/rqhr-quarterly-

report-on-strategic-plan.html

(Or, from the Lean website home page Click on

Strategic Direction Click on RQHR Quarterly

Report on Strategic Plan)

CEO Introduction

November 3, 2015

Keith Dewar

Welcome and Introductions

• Welcome

– Patients, Board of Directors, Senior Leadership

Team, Department Head Council, Executive

Directors, Directors, Managers, Affiliates,

Provincial Colleagues

Our Purpose

Why we are here

Strategic Hierarchy

Government of Saskatchewan

Ministry of Health

Regina Qu’Appelle Health Region

Provincial Health System

Patient, Staff and Physician

Input

RQHR Planning & Reporting

ClinicalBest

Practice




Budge


Other E-Scan Data

Accred. Standards

CIHI Data



Q1



Q2



Q3



Q4

Feedback/



Initiatives and












Provincial

Outcomes & Targets





Cascading

Plans


Key Supportt: SPBIU


Key Support: SPBIU









Step-by-Step Key Activities

We are here

• RQHR Multi-year Strategic Plan includes:

• Provincial Strategies • ED Waits and Patient Flow (prov. Hoshin)

• Mental Health and Addictions (prov. Hoshin)

• Seniors

• Primary Health Care

• Wait 1/ Access to Specialist and Diagnostics

• Appropriateness

• Infrastructure

• Financial Sustainability

• Culture of Safety

• RQHR Internally Identified Strategies • Patient Family Centred Care

• Engagement

• Academics and Research

Q2 Report on Strategic Priorities

RQHR Strategic Plan posted at SharePoint Site:

http://rqhshrpntwebprd:4604/sites/DocShare/Final%20Plans/Forms/AllItems.aspx

VP Quarterly Report on Strategies

Q2 – 2015/16

Vision:

Healthy people, families and communities.

Acting VP: Dawn Calder

Integrated Health Services – Clinical Support

Multi-year Plan:

ED Waits and Patient Flow

Patient Flow Multi-year Plan

2015/16 Provincial Outcome & Improvement Targets for Patient Flow

• By March 31, 2017, no patient will wait for care in the emergency department.

- By March 31, 2016, the length of stay (LOS) in the ER for 90% of admitted patients will be <= 22.3 hours

- By March 31, 2016, 90% of patients waiting for an inpatient bed will wait <= 17.5 hours.

- By March 31, 2016, the LOS in the ER for 90% non-admitted patients will be <= 5.9 hours

Hoshin Measure – ED LOS Admitted

Hoshin Measure – ED LOS Non-Admitted

Hoshin Measure – Time Waiting for an

Inpatient Bed

Root Cause Analysis

• Patient Flow is a complex whole of system issue

• Foundational work underway by all areas

– Patient Flow Visibility Wall

• Opportunity to improve use of data to identify root cause and track performance

• Opportunity to focus and “get right” our core work

Root Cause - Demand and Capacity

* FY2015 to FY2016 Projection

Source SCM

RGH ED Volume

% Change FY 2013 to 2014 2014 to 2015 2015 to 2016*

Total 0.61% 6.27% 3.08%

Admissions -0.43% 3.13% 0.69%

PH ED Volume

% Change FY 2013 to 2014 2014 to 2015 2015 to 2016*

Total -2.79% 2.89% 4.42%

Admissions -4.33% 1.65% -2.64%

Root Cause - Demand and Capacity

LOS RGH

% Change FY 2013 to 2014 2014 to 2015 2015 to 2016*

Medicine -3.82% 0.84% -2.74%

Surgery -6.01% -5.64% -2.99%

LOS PH

% Change FY 2013 to 2014 2014 to 2015 2015 to 2016*

Medicine -3.09% -4.79% 0.00%

Surgery -12.32% -1.43% 5.58%

* Complete FY2015 to 2016 April, May, June only

Source HIMS

Key Actions

• Patient Flow Visibility Wall

• Patient Flow Analytics – Flo Cast

– Dash Boards

• Accountable Care Unit

• Coaching of Unit Staff on Patient Flow Standard Work

Key Actions

• ED LOS Visioning Session June 2015

– All Service Line/Areas

1. Identified or in process of finalizing multi-year targets to achieve ED LOS target

2. Development of Driver Diagrams

3. Identified or in process of finalizing multi-year plans to achieve ED LOS target

• Outcome

– Linking Service Line/Area work plans with Patient Flow Program Goals and Targets

Review of Inputs for Next Fiscal

What We Know:

• Sustainable improvements require a change in how we do our daily work

• Complex challenges – will take time

• We are making progress

• Our approach based on best practice

– Patient Flow Framework/Multi-Year Work Plan

Review of Inputs for Next Fiscal

• Validation of ED LOS target

– 90%P ED LOS by 2019

• Service Line/Area Targets and Actions

• Bed Needs Analysis

• Provincial Targets & Priorities

• Our Data and Outcomes


Q2 – 2015/16

Vision:


VP: Karen Earnshaw – Integrated Health Services

Multi-year Plans: - Primary Health Care Multi-year Plan

Primary Health Care Multi-year Plan

Provincial Health System Outcome

By March 31, 2017, people living with chronic conditions will experience better health as indicated by a 30% decrease

in hospital utilization related to 6 common chronic conditions.

Age and sex-adjusted hospitalization rates

for 6 ACSCs per 100,000 population aged <75

Item Key Work/Initiative/Project Monitored Status (Red/Green)

1 COPD / Chronic Disease Management Quarterly Green

2 Strengthen Home Care / Navigation Quarterly Yellow

3 Chronic Disease Prevention Quarterly Green

4 Build Interdisciplinary Primary Health Care Teams Quarterly Green

5 Hand Hygiene/ Flu Shots Quarterly Green

6 Eliminate Unfunded Positions Quarterly Yellow

7 Physician (and other Provider) Resources Quarterly Red

8 Community Engagement Quarterly Yellow

Key Pieces of Work: Green / Red

2015-16 Q2: Corrective Action Plans

• Navigation:

– From Q1-Q2: Green to Yellow

– CAP:

• SWADD Deep Dive

• Refine process for having providers pull their own

patients.

• Eliminate Unfunded Positions

– From Q1-Q2: Moved from Red to Yellow

– CAP: Work with WOTT to continue to improve

Master Roster

2015-16 Q2: Corrective Action Plans

• Provider Resources

– From Q1-Q2: Still Red

– CAP:

• Participate in Practitioner Affairs Visioning

Session

• Physicians: Funding Model / Recruitment /

Standard Billing for Contract Physicians

• Nurse Practitioner Recruitment

• Community Engagement

– From Q1-Q2: Still Yellow

– CAP: Engage Eagle Moon in kaizen events.

Looking Towards 2016-17

• Patient Flow:

- Chronic Disease Prevention and Management –

Maintain and Move beyond COPD

- Navigation – Known and unknown demand

• Financial Sustainability:

- Maintain adherence to weekly paid hours.

- Explore PHC Modelling - HQC

• Accreditation and Safety:

- Introduce PHC Accreditation Standards


Q2 – 2015/16

VP: Michael Redenbach – Integrated Health Services

Mental Health &Addictions Multi-year Plan

Vision:



Q2 – 2015/16

Vision:


VP: Marlene Smadu - Quality and Transformation

Multi-year Plans:

- Patient Safety/ Stop the Line Multi-year Plan

Mental Health and Addictions

Multi-year Plan

2015-16 Provincial Health System Outcome

• By March 2019, there will be increased

access to quality mental health and

addictions services and reduced wait time

for outpatient and psychiatry services

2015-16 Provincial Improvement Targets

• By March 31, 2016, waits for contract and

salaried psychiatrists will meet benchmark

targets to a threshold of 50%

• By March 2016, 85% of Mental Health and

Addictions clients will meet the wait time

benchmarks based on their triage level.

• By March 31, 2017 wait time benchmarks for

mental health and addictions will be met 100%

of the time.

Mental Health and Addictions

Multi-year Plan

Mental Health & Addictions

Multi-year Plan Outcome Measure

Percentage of Clients Meeting the Triage Benchmarks in Psychiatry Programs

Triage Benchmarks

Very Severe - 24 hrs Severe - 5 working days

Moderate - 20 working days Mild - 30 working days

Goal - 85%



Percentage of Clients Meeting the Triage Benchmarks in

Addictions Outpatient

Triage Benchmarks



Goal - 85%



Percentage of Clients Meeting the Triage Benchmarks in Outpatient

Mental Health

Triage Benchmarks



Goal - 85%


Volumes & Budgeted FTEs

Next Steps

Next Steps

• Continue work on referral management, psychiatry

redesign, crisis and outreach services, and the

program for people with severe mental illness

• Collaboration with IT on Clin docs project

• Continued implementation/refinement of daily

work boards (daily visual management) and

cascade metrics that facilitate problem solving

• Prepare for major changes to Mental Health

Services Act (proclamation expected Fall 2015

sitting)

• Work on smaller point improvements using Lean

tools – med error reduction on inpatient

Patient Safety/ Stop the Line

Multi-year Plan

2015-16 Provincial Outcome & Improvement Targets

• To achieve a culture of safety, by March 31, 2020

there will be no harm to patients or staff.

o By March 2018, fully implement a provincial Safety Alert /

Stop the Line (SA/STL) process throughout Saskatchewan.

o By March 31, 2018, all regions and the Cancer Agency will

implement the six elements of the Safety Management System.

(SMS)

o By March 31, 2019, all regions and the Cancer Agency receive

a 75% evaluation score on the implementation of the elements

of the Safety Management System

o By March 2019 there will be zero shoulder and back injuries.

Next Steps

• Work towards implementation of the regional roll

out plan

• Heighten awareness of STL as a priority within

RQHR & continue to work on culture change

• Continue to provide leadership on multiyear plans

for the two highest COR concerns—medication

errors and falls

Patient Safety/ Stop the Line

Multi-year Plan


Q2 – 2015/16

Vision:


VP: JP Cullen (Mike Higgins)

Human Resources & Communications

Multi-year Plans:

- Workplace Safety Multi-year Plan

Workplace Safety

2015-16 Provincial Health System Outcome To achieve a culture of safety, by March 31, 2020, there

will be no harm to patients or staff.

• By March 2018, fully implement a provincial Safety

Alert/Stop the Line (SA/STL) process throughout

Saskatchewan

• By March 31, 2018, all regions and the Cancer Agency will

implement the six elements of the Safety Management

System. (SMS)

• By March 31, 2019, all regions and the Cancer Agency

receive a 75% evaluation score on the implementation of

the elements of the Safety Management System

• By March 2019 there will be zero shoulder and back

injuries.

Workforce Safety Outcome Measure

Workplace Safety Outcome Measure

Shoulder / Back Injuries

Investigated to Root Cause

50

1/3 of Injuries Not Investigated

to Root Cause

Workplace Safety Outcome Measure

• Why are we red?

51

Why Are We Red?

Root Causes: • 1/3 of Shoulder / Back Injuries Not Investigated to Root Cause

• Audits of Injury Reporting Protocol:

• ~45% reported follow up on Time Loss Claims / Equipment

Malfunctions

• Large Number of EDs did not reply to Audit Request

Corrective Actions / What’s Next?

• Stick to the Strategy

• TLR Audits (Unit Level Support)

• Violence Prevention Policy / Programme

• Stop the Line (Collaboration w Patient Safety)

• SMS / Hazard Assessment (Unit 2-5; Environmental Services)

• Consider Mandatory Training for All New Leaders:

• SMS Basics

• Root Cause Analysis

• Safety & Supervision

• Portfolio Presentations to Build Accountability


Q2 – 2015/16

VP: Robbie Peters– Financial Services &

Chief Financial Officer

Multi-year Plans:

- Financial Sustainability

Vision:


Financial Sustainability –

RQHR Results as of Sept. 30, 2015

-4448 -5666

-10480

-5619

-2917 -3861

-16500

-11500

-6500

-1500

3500

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

$'0

00

's

Financial Sustainability Strategy Surplus / Deficit as of September 30, 2015

Actual (Year to Date) 2014-15 Actual (Year to Date) 2015-16 2015-16 Target

• VP Accountability – monthly budget report outs

• Communication Strategy – shared responsibility and accountability

• Strategic priorities – Efficiency Target Initiatives (ETI) steering

committee

• Long-term sustainability – 11 budget reduction initiatives

• Workforce Optimization Task Team (WOTT)


Getting to Green

11 Initiatives Recap

Priority focuses and preliminary targets to achieve a balanced budget in 2015-16

Regina Qu'Appelle Health Region

2015-16 Operating Budget

In $000's

2014-15P 2015-16B $ Change % Change

Preliminary Deficit ($13,921) ($38,269) ($24,348) 174.90%

Regional focus to a 2015-16 balanced budget and reducing

long-term cost structure VP Responsible

3sHealth and Other Contracts 2,500 Peters

Cost Savings from Reduced Surgical Volumes 8,000 Garratt

Reduction of VAC Beds if No Funding for Alternative use 1,300 Redenbach

Clinical Appropriateness 1,000 McCutcheon

Quality & Safety Initiatives 1,000 Smadu

Patient Flow / 95% Occupancy 1,000 Neville

Improve on Ambulatory Care

Sensitive Condition Indicators 3,000 Earnshaw

Reduce Orientation Costs by 20% * 1,300 Higgins

Reduce Sick Costs by 15% * 2,500 Higgins

Reduce Overtime Premiums by 33% * 3,929 Peters

Workforce Optimization - 152 FTEs at avg, salary $85,000 ** 12,740 All

Revised Surplus (Deficit) $0

* Expected payback from daily management initiatives

** Done through attrition, does not contemplate layoffs

Workforce Optimization Task Team

2015-16 Q2 Report on Strategic Plan Nov 3, 2015

What is the problem we are trying to fix? How do we know it’s a problem? – Data Required What is the size of the problem? – Data Required Where is the problem occurring? – Data Required What is causing the problem? – Go to the Gemba Develop countermeasures - KAIZEN

Problem Solving

What is the Problem?

September Financial Update:

(Oct 30, 2015 - Robbie Peters)

• Year to date deficit to $3.86M

• projecting a deficit ~ $1.4M higher than last year =

~ $16M

• Most of the deficit is in the area of Salaries and

Benefits.

• “We do not have enough money in the bank to

withstand running a deficit again this year”.

End of September Financial Results (Rounded to the nearest ‘000)

Budget Actual Variance

Revenues $ 506,669,000 $ 511,393,000 $ 4,724,000 **

Salaries and Benefits $ 325,850,000 $ 338,430,000 $ (12,580,000)

Medical Remuneration $ 42,848,000 $ 43,741,000 $ (893,000)

Operating Grants $ 34,660,000 $ 34,319,000 $ 341,000

Medical Supplies $ 46,963,000 $ 44,028,000 $ 2,935,000

Infrastructure $ 23,801,000 $ 23,425,000 $ 376,000

Clinical & Operational Supports

$ 25,020,000 $ 24,992,000 $ 27,000

Admin & Other $ 7,545,000 $ 6,319,000 $ 1,226,000

“Compensation makes up more than 70% of our expenditures”

What is the size of the problem?

Types of Pay/Salaries

Paid Hours

The scale/size of the problem

Where is the Problem Occurring?

Where to start?

• The problem is: Expenses > Budget

• Cause?: Salaries are the largest contributor to

expenses

• Cause?: Unbudgeted paid hours and unbudgeted

rate of pay/cost of the hours

• Gemba?: Units with the largest negative salary

variances.

Where is the Problem Occurring?

0

200000

400000

600000

800000

1000000

1200000

David McCutcheon Karen Earnshaw Michael Redenbach Sharon Garratt Dawn Calder

Do

llars

($

)

Salary Variance by VP

Salary Variance (in…

WOTT

WOTT Mission

• To work with units to reduce paid hours as well as salary

variance and offer assistance in overall efficiency and daily

management practices.

WOTT Mandate

• To facilitate improvement work and change management

on units by analyzing current operations, providing

recommendations and implementation plans, and brokering

connections with subject matter experts. WOTT will

oversee progress and be the accountability partner by

doing regular follow ups, status updates and removing

barriers as necessary and feasible.

WOTT

1. Help Teams Identify Opportunities for Immediate and

Longer Term Improvement:

• Perform assessment through analysis of financial and HR data

• Meet with the operational team of the unit (VP, ED, D,

Manager(s), Finance Manager)

• Structured interview (WOTT Initial Meeting Checklist)

• Individual interviews with corporate supports.

• Identify opportunities – (WOTT Assessment & Newspaper)

• Meet with operational team to finalize the assessment and

project plan

2. Trial Ideas for Improvement - PDSA

3. Spread Successful Methods

WOTT Steps:

WOTT Findings

Initial Findings - Contributing to Paid Hours:

Rosters are not healthy and not within budget

– Models of care based on historical vs. knowing the

demand.

– More guarantees of hours than required for baseline

staffing.

– Costly use of relief dollars (i.e. casuals vs. relief lines).

WOTT Findings

Initial Findings - Contributing to Paid Hours:

- Costly use of relief dollars (i.e. casuals vs. relief staff)

- Casual availability

- Replacing staff at premium pay

- Replacing staff at a higher cost (i.e. RNs replacing Unit

Clerks)

Both: - Variation in administrative role of managers

(i.e. financial management, scheduling) and

supports provided.

- Various decision tools for relief/ OT in place.

Not certain they are being used.

Key Recommendations So Far:

1. Ensure your roster aligns with your baseline

needs and budget. Know the cost of your roster.

2. Implement recommendations from the Master

Roster Review (where applicable).

3. Ensure rigorous daily management around

staffing (confirm hours and cost of the hours are

required to meet demand).

Key Recommendations So Far:

Daily Management

• Develop Daily huddles

• “How do we get todays work done today and be ready for

tomorrow’s work – what is appropriate staffing today?

• Make the work visual

• Talk to KOTs/KPO.

WOTT

• Amy Strudwick – KPO Infrastructure Lead &

Human Resources Support

• Richelle Hahn – Daily Visual Management

Specialist – KPO

• Brent Kitchen – Director, Surgical KOT

• Tanya Lestage – Manager, Financial Support

• Mark Brochu – Labour Relations

WOTT Team:


Questions?

Break

PLEASE RETURN AT

2:45PM


Q2 – 2015/16

VP: Michael Redenbach – Integrated Health Services

Seniors Multi-year Plan

Vision:



2015-16 Provincial Outcome & Improvement Targets

• By March 31, 2020, seniors who require community

support can remain at home as long as possible, enabling

them to safely progress into other care options as needs

change

– By March 31, 2017, the number of clients with a Method of

Assigning Priority Levels (MAPLe) score of three to five

living in the community supported by home care will increase

by 2%


Outcome Measure

Next Steps

Next Steps • RHAs agreed to review the current state of implementation of

the Program Guidelines for Special-care Homes in their

regions. Currently 7 working groups that are reviewing: – Regional policies and procedures to operationalize the standards of care in the

Program Guidelines for Special-care Homes.

• Continue roll-out and embedding of Purposeful Hourly

Interactions and Enhanced Dining Experience

• LTC Service Visioning Session (November 23-24)

• Consider the development of an ‘official’ Seniors Strategy

that incorporates Long-term Care, community-based care and

acute care

Next Steps

• New Ministry LTC Initiatives

– Geriatric Program

• Recruiting for a Geriatrician

• Steering committee in the process of developing a framework

• Conducting an inventory of all services and programs in all regions.

– Specialized Dementia units/behaviour Unit

• Completed 3 day design event of the layout of the unit

• Resource Team kaizen event scheduled November 30- December 4

– Spread LEAN in remaining 50% - DVM

• LTC KOT along with the RQHR KPO will be rolling out a plan to implement

in areas without a DVM and/or working with the units to improve their current

DVMs.


Q2 – 2015/16

Vision:


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

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

Next Steps

Next Steps

Appropriateness 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, 2016, at least one clinical area within a

service line will have deployed care standards and

will be actively using measurement and feedback to

inform improvement.

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

• Implement first project set by end of March

2016

• Monitoring and evaluation by end of March

2016

Next Steps

Next Steps


Q2 – 2015/16

Vision:


VP: Marlene Smadu - Quality and Transformation

Multi-year Plans:

- Patient and Family Centered Care Multi-year Plan

Multi Year Strategic Plan

VP leading on: Patient and Family Centred Care

RQHR Outcome

By March 31, 2017 RQHR will have

created a culture of Patient and Family

Centered Care that leads to zero defects, no

waits and waste from the perspective of

patients and families, and that incorporates

the core concepts of Patient and Family

Centred Care (dignity and respect,

information sharing, participation and

collaboration).

• Next Steps

– Emphasis on hand hygiene continues—aim 100%

– Region-wide spread and replication of best practices in

patient and family centred care

– Continue to focus on zero defects, no waste/waits

– Increased communication/education of staff,

physicians, public, patients, residents, clients, families

– Patient Experience Survey analysis to direct

improvements

– Family presence policy

– Professional Image policy

Patient and Family Centered Care

Multi-year Plan


Q2 – 2015/16

VP: Carol Klassen – Knowledge & Technology Services

Multi-year Plans:

- IT/IM/Equipment

Vision:


IM/IT/Equipment Multi-year Plan

2015-16 Provincial Outcome

By March 31, 2017, all infrastructures (information

technology, equipment & facilities) will integrate with

provincial strategic priorities, be delivered within a

provincial plan and adhere to provincial strategic work.

2015-16 Improvement Target

• By March 31, 2016, have delivered results on 3 high

impact capital areas that address high risk for critical

failure using alternative funding/delivery options.

• By March 31, 2016, common criteria and options for

investing are used to vet all capital investments.

2015/16 RQHR Outcome Measures

1. Key projects on schedule – Milestone Chart

2. Responsive support services • # of Users of SunRise Clinical Manager

• Turnaround time for discharge summary

• # of unplanned repair/replacement of critical equipment

3. Multi-year Plan for Equipment Replacement

IM/IT/Equip Multi-year Plan

Provincial Outcome Measure

Next Steps – Information

Technology & Clinical Engineering

• Identify 2016-17 technology and equipment

priorities

• Complete multi-year replacement timeline for

high-cost equipment

• Continue implementing approved IT projects

• Continue to eliminate high-risk equipment

preventative maintenance backlog and

implementation of beds, lift maintenance program

• Begin set-up work to enable rollout of new Hospira

pumps in 2016

Next Steps – Information

Management

• Continue to work with physicians to eliminate

backlog of chart completion to reduce wait for

discharge summary information

• Expand capacity to reduce backlog of non-priority

dictation waiting more than 7 days for transcription

• Begin moving files for deceased patients from main

health record storage areas at RGH to 4A

• Consult and finalize plan to eliminate duplication of

electronic information in paper health record chart


Q2 – 2015/16

VP: Carol Klassen – Knowledge & Technology Services

Multi-year Plans:

- Research and Academics

Vision:


RQHR Outcomes & Improvement Targets

By March 31, 2017 RQHR will:

- Have the necessary infrastructure in place to grow

patient oriented research

- Enhance its role as an academic health science

centre

• By March 31, 2016, RQHR will have confirmed

strategies and multi-year plan to enhance patient

oriented research and grow as an academic health

science centre.

Research/Academic Multi-year Plan

Next Steps

Continue dialogue/planning to refine the

Research vision and multi-year plan

Work with College of Medicine to provide

RQHR input into the affiliation agreement

Work with SCPOR to launch the Regina hub

and approved projects

Continue planning for expansion of

geographically based residents


Q2 – 2015/16

VP: Robbie Peters– Financial Services &

Chief Financial Officer

Multi-year Plans:

- Facilities

Vision:


• Significant facility infrastructure deficiencies identified across the

province requiring significant sustained investment

• RQHR Facility condition assessment

– Average FCI 31.5% on assessed asset value of $1.6 billion

– FCI > 15% is considered deficient for health care

• Minimal annual funding to address deficiencies and no multi year

funding commitments

• Maintenance and Repair

– Estimated Required funding $50.2/ year

– Actual funding $5.2m/ year

• Capital Renewal

– Estimated required funding $23.8/year

– Actual funding received $0 but ad hoc

Facilities Strategy

RQHR Challenges

– Infrastructure is our Board of Directors # 1 advocacy priority

– Electrical renewal – RGH and PH

– Energy projects – PH and WRC

– Pioneer Village and Grenfell planning

– Parking project

– Real estate initiatives

– Space management – space advisory committee

– Infrastructure committee expanding – capital planning

– Maintenance standardization in all facilities

Facilities Management Updates

Facilities Strategy

Questions?


Q2 – 2015/16

Vision:


VP: JP Cullen (Mike Higgins)

Human Resources & Communications

Multi-year Plans:

- Employee Engagement Multi-year Plan

Employee Engagement

RQHR Outcome

By 2017, RQHR will reach an average employee

and physician engagement score of 80%

• Leading measure: 90% of leaders receive

training around engagement

Employee Engagement Outcome

Measures

Engagement Score: ~35 Region-Wide

Leader Training: 0

Why Are We Red?

Why Are We Red?

Root Causes:

• Have not assessed engagement since 2014

• Leader Training has not started

• Low initial response to session invitation

Significant Challenges

• This is an organization-wide issue – requires

and organization-wide response

• Manager Capacity

• Structural issues that are hard to fix

• Resources

• Span of Control

Corrective Actions / What’s Next?

• Director of Workforce Planning & Development in place

• Completed Survey & Leader Interviews to identify

Barriers & Opportunities

• Training Sessions Begin November 5th

• Working with External Experts

• Continue to work on Span of Control

• Recommendations

• Costing

• Business Case


Q2 – 2015/16

Vision:


VP: David McCutcheon – Physician Services & Integrated Health Services

Multi-year Plans: - 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 Results

Next Steps

Next Steps

CEO Recap of Day 1

November 3, 2015

Keith Dewar

CEO Recap

• Summary of challenges and opportunities

• Understand how the Q2 report is an input to

inform 2016/17 planning

• What to expect for tomorrow’s planning

2015/16 Q2 Report on Strategic Plan

November 4, 2015

Objectives of the 2016/17 Planning Day

• Review strategic planning input data

• Present 2016/17 strategic priorities

• Obtain feedback on draft Provincial Matrix

(Catchball).

• Understand how data can be used to inform

portfolio, service line and unit plans (Driver

Diagram Workshops)

• Understand next steps and expectations in

2016/17 planning process


1. From the

intranet

homepage,

click Strategic

Framework.

2. Then click

Sharepoint Site.

3. Click Reporting

then click the

RQHR Q2 Report

on Strategies

folder.


• RQHR Lean Website:

http://www.rqhrlean.com/rqhr-quarterly-

report-on-strategic-plan.html

(Or, from the Lean website home page Click on

Strategic Direction Click on RQHR Quarterly

Report on Strategic Plan)

CEO Introduction

November 4, 2015

Keith Dewar

Welcome and Introductions

• Welcome

– Patients, Board of Directors, Senior Leadership

Team, Department Head Council, Executive

Directors, Directors, Managers, Affiliates,

Provincial Colleagues

Our Purpose

Why we are here

Strategic Hierarchy

Government of Saskatchewan

Ministry of Health

Regina Qu’Appelle Health Region

Provincial Health System

Patient, Staff and Physician Input

Patients, Clients, Residents and Families

Patients, Clients, Residents and Families

RQHR Planning & Reporting Vision

ClinicalBest

Practice




Budge


Other E-Scan Data

Accred. Standards

CIHI Data



Q1



Q2



Q3



Q4

Feedback/



Initiatives and












Provincial

Outcomes & Targets





Cascading

Plans


Key Supportt: SPBIU


Key Support: SPBIU









Step-by-Step Key Activates

We are here

Next Steps

Next-Step Planning

• Multi-year planning

• Portfolio planning

• Q3

Gemba Video – Connecting to Care

Sheila Anderson, ED, Primary Health Care

Manager Standard Work

Sharon Garratt, VP, Integrated Health Services

Objectives

• Define core management functions/

accountabilities.

• Develop framework that supports managers

to translate these to daily work.

• Trial in acute care.

Core Function Categories by Position

Planning

Admin

Operational Flow

Vice

President

Director/

Executive

Director

Manager

Admin

Operational flow

Planning

Admin

Planning

Operational Flow

Source: McNair Business Development Inc., RQHR Management Functionality Assessment, 2014

Operational Flow/Daily Management

• Consists of the daily flow of the Manager’s scope

of operations – managing the demand and logistics

of patient requirements.

• It is important to balance regional and portfolio

initiatives with operational visibility and follow

through with staff and patients.

• This focus ensures that staff are supported to be

successful in their roles.

• The Manager should be available to provide

support to their staff, and ultimately the patients.

Operational Flow

• Enhanced operational flow also means focusing on

quality improvement and project management

strategies within the unit.

• Identify root causes of flow disruptions or other

issues, implementing standard work and

developing strong policy and procedures.

• This focus will cross over into planning as the

Manager is an important partner and subject

matter expert to inform regional, portfolio and unit

level decisions.

Administration

• Between the operational flow and planning.

• Bridges between the two functional themes,

as it is imperative for the Manager to own

the duties that allow their staff and unit to

conform with organization requirements, as

well as have the tools they need to perform

optimally in their role.

Administration

• Administrative functions include, but are

not limited to:

– staffing responsibilities such as scheduling,

attendance support and turn over;

– negotiating staff issues,

– staff engagement; and

– professional development and education.

Planning

• Planning involves both standard work

development, role clarity for staff and

strengthening relationships.

• Relationships are both with staff, to build

growth and visibility of their successes, as

well as with other units and health care

providers to ensure seamless flow

throughout regional operations.

• The least amount of a manager’s functional

time but not the least important.

Responsibility

Responsibility – “a duty or task that you are

required or expected to do”

1. Sole Responsibility

2. Responsible and delegate to achieve (Charge

Nurse, CNE, CRN)

3. Responsible with supports (scheduler, dyad

physician, financial manager,

HR/LR/Attendance Support consultant)

4. Participates under direction of D/ED

Operational Flow

Category Core Functions Responsibility

Operational

Flow

-Daily

management

• Understand your service and the

supply/demand of needs 1

• Patient Rounding 1

• Overall Staff and Patient/Family Centered 1

• Staffing

• Teamwork/Engaged 1,2

• Medical support and teamwork

• Outside relationships that impact the team

(physicians)

1

• Right Equipment to do the work/Supply

management 1,2

• Standards of Care/Best Practice 1,2

Operational Flow

Category Core Functions Responsibi

lity

Operational

Flow

-Daily

management

• Quality improvement/change management

champion 1,2

• Culture around safety and communication

• COR Incident reporting/Risk

Management/root cause analysis

• Environmental Responsibilities/ Safety of

Area

• OH&S management and training

1,2

• Understand daily Financial Management 1

• Advocate/Ambassador for the area, staff

and pt/family (daily and in planning) 1

Administration


Administration

• Patient Scheduling/Staff Scheduling

• Vacation Management 3

• Supports in place so staff are able to provide their

functions i.e. Clinical Education and Training,

• Professional Development for ongoing or new

education/training

3

• Performance Management/CBA understanding 1

• HR/LR/Attendance Support

• HR management – hiring, external, paperwork, etc. 3

• Equipment and supply management 3

• IT and other requests for coordination of technology 3

• Financial management 3

• Statistic management and data collection 3

• Committee work and structures 1,2

• Coordination with Universities, Colleges & Students 1

• Research projects – engagement 1,2

Planning


Planning • Program planning for growth or new

program 4

• HR planning - Staff Mix/Providers

• Succession planning 1,4

• Financial stewardship and budget 4

• Clinical Equipment (future needs) 4

• Regional Interdepartmental

relationships, improved

communication regionally

1

• Creating connections with other

jurisdictions/networking 1,4

• Provincial work and direction 1,4

Core Function Categories by Position

Planning

Admin

Operational Flow

Vice

President

Director/

Executive

Director

Manager

Admin

Operational flow

Planning

Admin

Planning

Operational Flow

So what?

• Spread patient rounding/hand hygiene audits

• Imbed daily visual and financial management

• Focus on delegated functions

– CNE, CRN, Unit Coordinator roles and

functions

• Focus on supported functions

– HR

– LR

– Finance

Review Strategic Planning Inputs



Q1


•Review inputs into next year plan

Q2 • Q3 Report on

Strategic Plan


Q3



Q4

Provincial Outcomes & Targets

Clinical Best

Practice

Budget


Other E-Scan Data

Accred. Standards

CIHI Data


Strategic Planning Inputs We are Here

Strategic Planning Input Data

Being considered:

• Provincial Plan

• Board Direction

• Staff and Physician

Feedback

• CIHI

• Accreditation

• Environmental Scan Data

(from presentation to

Board and Treasure

Board)

• Budget Projection

What’s missing:

• Auditor’s Report

• Ombudsmen's Report

• HR

• Clinical data

• Clinical Best Practice

• Other?



Provincial Outcomes &

Targets


Draft Provincial Matrix

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

To improve access for patients and reduce ED waits by 50%,

necessary improvements in key areas (primary health care,

specialist consults, diagnostics, mental health & addictions,

long term care, home care, and acute care) will be achieved

by 2019.** 0

Appropriateness / Best

PracticeBudget

Referral to Specialists

and Diagnostics (Wait 1)

Outcomes/Results1. To achieve a culture of safety, by March 31, 2020, there will be no harm

to patients or staff. 2 2 2 2 1 1 0 1 1 1 2 1 2 2 2 2 1 25

* 2. ED Waits Outcome: Currently under review 1 1 1 1 2 2 2 1 2 2 1 2 2 1 1 2 1 25

3. By March 2019, there will be increased access to quality mental health &

addiction services and reduced wait time for outpatient and psychiatry

services.0 1 2 1 1 1 0 2 2 1 1 1 1 0 1 2 2 19

4. By March 2017, people living with chronic conditions will experience

better health as indicated by a 10% decrease in hospital utilization related

to 6 common chronic conditions (Diabetes, CAD, COPD, Congestive Heart

Failure, Depression, and Asthma).

1 2 1 2 2 2 1 1 1 2 2 2 2 1 2 2 1 27

5. By March 31, 2020, seniors can access supports, to remain at home,

allowing them to progress into other care options as needs change. 1 1 1 2 2 2 1 2 1 1 2 1 2 2 1 2 1 25

6. By March 31, 2018, 80% of clinicians in at least 3 selected clinical areas

within two or more service lines will be utilizing agreed upon best

practices. 1 1 1 1 1 1 1 1 1 0 2 1 1 1 2 1 2 19

7. Ongoing, as part of a multi-year budget strategy, the health system will

bend the cost curve by achieving a balanced or surplus budget. 1 1 1 2 1 1 1 1 1 1 1 1 2 1 2 2 2 22

8. Saskatchewan will reduce the wait time for an appropriate first consult

appointment with a specialist by 50% in eight to ten specialty groups by

March 31, 2019.1 1 1 1 1 1 0 2 1 1 1 1 1 1 2 2 2 20

8 10 10 12 11 11 6 11 10 9 12 10 13 9 13 15 12

Better Health Strategy - Improve population health through health promotion, protection and disease prevention, and co llaborating with communities and different government organizations to close the health disparity gap.

Better Care Strategy - In partnership with patients and families, improve the individual's experience, achieve timely access and continuously improve healthcare safety.

Better Value Strategy - Achieve best value for money, improve transparency and accountability, and strategically invest in facilities, equipment and information infrastructure.

Better Teams Strategy - Build safe, supportive and quality workplaces that support patient- and family-centred care and collaborative practices, and develop a highly skilled, professional and diverse workforce that has a sufficient number and mix of service providers

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**Note: Catchball will help to inform specific targets around the necessary

improvements for 2016-17.

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CorrelationsHoshin

Mental Health & Addictions ED Waits & Patient Flow Primary Health Care Seniors




Targets

Board Direction

Patient, Staff, and Physician

Feedback


Frontline Staff Feedback

• Patient Flow

– Infrastructure (technology and facilities)

– Accountability/Culture

– Working Together

– Staffing

– Appropriateness



– Staffing

– Education and Training

– Supply Chain


– Patient/External


• Quality and Safety

– Operational

– Equipment


– Staff/Engagement

– Resources

– Errors

Physician Feedback

• Department Head planning session in

September 2015

• Feedback solicited from section heads and

other physicians

• Each Department Head identified three

priorities (available on the strategic

SharePoint site)


CIHI Data



Targets

Board Direction


Feedback


Canadian Institute of Health Information

(CIHI)


Accred. Standards

CIHI Data



Targets

Board Direction


Feedback


Accreditation Quality Dimensions: ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Population Focus 94% criteria met

Accessibility 95% criteria met

Safety 82% criteria met

Worklife/Workforce 89% criteria met

Client-centred 96% criteria met

Continuity 97% criteria met

Appropriateness 86% criteria met

Efficiency 94% criteria met

Required Organizational Practice

Patient Safety Goals: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

100% Safety Culture met

Accountability for Quality

Adverse Event Disclosure

Adverse Event Reporting

Client Safety Quarterly Reports

Client Retrospective Analysis

67% Communication met

× Informing the patient and family of their

role in safety

× Information transfer

× Medication Reconciliation as Strategic

Priority

× Medication reconciliation at care transitions

× Two client identifiers

Dangerous Abbreviations

× Surgical Checklist

16% Medication Use met

× Antimicrobial Stewardship Program

× Concentrated Electrolytes

× Heparin Safety

× High-Alert Medications

× Infusion Pump Train\ng

× Narcotics Safety

80% Workforce met

Client Flow

Client Safety Plan

Education and training

Preventative maintenance

× Workplace Violence

85% Infection Control met

× Hand Hygiene Compliance

Hand-Hygiene Education and Training

Infection rates

Pneumococcal Vaccine

Reprocessing (EMS)

72% Falls Prevention met

× Falls Prevention Strategy

64% Safety/Risk Assessment met

Home Safety Risk Assessment

Skin and Wound Care

Suicide Prevention

× Pressure Ulcer Prevention

× VTE Prophylaxis

2015 Accreditation Result


Other

E-Scan Data

Accred. Standards

CIHI Data



Targets

Board Direction


Feedback


Environmental Scan

• External:

– Economic slowdown

– Growing and aging population

– Increasing demand for technology

• Internal:

– Shortage of family physicians result in increase in Emergency

usage

– Growing and aging population result in significant volume

increase for the majority of services of the Region.

– The Region is facing risks from the lack of investment in the

IT/IM and facilities areas.

– Falls and medication errors are top two patient safety issues

– The biggest contributor to financial challenges is the growing

and unstable workforce.


Other

E-Scan Data

Accred. Standards

CIHI Data



Targets

Board Direction


Feedback


Budget

Financial Sustainability –

RQHR Results as of Sept. 30, 2015

-4448 -5666

-10480

-5619

-2917 -3861

-16500

-11500

-6500

-1500

3500

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

$'0

00

's

Financial Sustainability Strategy Surplus / Deficit as of September 30, 2015

Actual (Year to Date) 2014-15 Actual (Year to Date) 2015-16 2015-16 Target

Lunch Break

PLEASE RETURN AT

1:00PM

2016/17 Strategic Priorities

Keith Dewar, President and CEO

RQHR Strategic Plan

• RQHR Multi-year Strategic Plan includes:

• Provincial Strategies • ED Waits and Patient Flow (prov. Hoshin)

• Mental Health and Addictions (prov. Hoshin)

• Seniors

• Infrastructure

• Primary Health Care

• Wait 1/GP to Specialist

• Appropriateness


• Culture of Safety

• RQHR Internally Identified Strategies • Patient Family Centred Care

• Engagement

• Academics and Research

2016-17 Focused Areas

• Quality and Safety

• Access (Patient Flow)

• System Sustainability

Drivers Diagram Workshop

What is a driver diagram?

. A visual that identifies:

. aim / direction

. primary / major drivers/influencers

. actionable and measurable ideas

. cross-functional influences

. Drives discussion to action

Aim Statements

The “desired state” on a theme

Clear and simply worded

Resolves a problem

One year focus – 2016-17 fiscal

Aim Statements

Quality and Safety

The RQHR will reduce or eliminate

preventable harm to patients and staff

System Sustainability

Provide services within available resources

Patient Flow

Improve access for patients and reduce waits

Primary Drivers

The main factors believed to have a

direct impact and influence on the aim.

Secondary Drivers

• Action statements

• What we need to address locally to achieve success with the primary drivers

• The main processes we’ll seek to improve

What does it look like? Aim Primary Drivers Secondary Drivers Change ideas

Cause Effect

Break

PLEASE RETURN AT

2:45PM

Drivers Diagram Report-out

Next Steps

Keith Dewar, President and CEO

2015/16 q2 report on strategic plan november 3, 2015 final slide… · •q1 report on strategic...

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