introduction and logistics

Introduction and Logistics

Housekeeping

• Washrooms

• WiFi Password: qcc201603

• Handouts on each table

Objectives of the Day

2016-17 Q4 Report out and Celebrating Success

Facilitated learning and networking opportunities

Provide information and tools to help manage change

Recognize RQHR’s newest Lean leaders

Welcome and Opening Remarks

Dick Carter

Board Chairman

Welcome from the Board Chair

Welcome

– Patient Representatives, Dr. Pappas, Board of

Directors, Senior Leadership Team,

Department Head Council, Executive Directors,

Directors, Managers, Affiliates, and Provincial

Colleagues

CEO Update

Keith Dewar

President and CEO

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

Reflection on 2016/17

• Are making progress

• 0 Harm – hand hygiene/appropriateness/staff

injuries/computerized provider order entry (CPOE)

• 0 Waits – accountable community and hospital care

• 0 Deficit – reduced to $3.5 million

• This in spite of the impact of a growing and aging

population

RQHR Population Growth

Reflection on 2016-17

• Transition to a single provincial health authority

• 4 months into the transition

– Significant effort required by transition team and RHAs

– Announcement of the location, name and CEO search

• Recognition of RQHR leadership and innovation

– Accountable community care/Primary Health Care

Networks

• Much work to be done

– Transition not transformation

2017-18 RQHR Focus Areas

2017-18 Focus Areas

• Quality and Safety – 0 Harm

• Access/Patient Flow – 0 Waits

• System Sustainability – 0 Deficit

SLT

informs and

owns focused

areas

All staff

and physicians

execute plans

Board approves

plans and monitors

progress

Portfolio and service line leaders develop plans

to identify the work needed to advance priority areas

• Amalgamation of RHAs to the Saskatchewan

Health Authority will affect work planned for

next year

– May lead to redefined priorities and a reallocation of

resources to support the new structure

• Provincial financial situation will affect how

initiatives are funded and supported

• Potential for essential services

• Infrastructure deficiencies

Risks to Business Plan Implementation

• Support implementation of business

plan initiatives and monitor progress

• Continue to provide the safest,

highest quality care we can to the

people of this province

• Business as usual unless otherwise

directed

• Engage in the work of the Transition

Team and support a successful

transition

– What can your area do to help with

transition

• Prepare for Essential Services

in case required

Direction to Management and Staff

Working Through Change

Communication/Change Management

• Transition Team Weekly Updates

• CEO Weekly Updates

• CEO meetings/presentations

• VP communication – portfolio meetings

• Executive Director/Director/Manager

communication to staff

• Tools - MoH Website, Elink, The Physician

• Daily huddles/visibility walls

• Sharon and her team

Reminder of Today’s Objectives

• Q4 celebration of organizational successes

from the past year

• By doing the right thing, we can achieve

outstanding results

• Provide meaningful learning opportunities

and share information

Q4 Report out and Celebrating Success

Senior Leadership Team (SLT)

Carol Klassen, VP

Knowledge and Technology Services

Portfolio Overview

Knowledge & Technology Services

– Academic Health Sciences

– Research & Health Information Services

– Patient Point of Care IT Services

– Corporate and Clinical Support IT Services

– Clinical Engineering and IT Infrastructure

Services

Celebrating Successes

Quality & Safety - Launched CPOE using Sunrise Clinical Manager

(SCM) Order Management – now a joint

Regina-Saskatoon tertiary hospitals project

Access/Patient Flow - Expanded use of SCM and electronic clinical

documentation to support safer delivery of care: - Mental Health & Addictions

- Endoscopy, Approach database, Pharmacy

- SWADD, Therapies, speech language pathologist, Facility Boards,

18 rural site access to Clinician Viewer

- MDMobile licensing, IMO coding of diagnosis

- Training to support more users


System Sustainability - Replaced Enovation registration with Sunrise

Enterprise Registration;

- Supported significant growth and improvement in

I.T. infrastructure and availability of devices: e.g.

new desktops, upgraded phone infrastructure, more Apple mobile

devices

- Managed health record information for 184,368

visits (inpatient, day surgery outpatient and

emergency visits) - More coding, more transcription, more records filed

- No duplication of electronic information in paper record (01/01/2017)


System Sustainability - Signed new Affiliation Agreement with the

College of Medicine; Memorandum of

Understanding to support further development of

Regina campus agreed to in principle

- Supported 330 research studies - 11th Annual Research Showcase

- New policies and procedures

- Supported 40 new research related collaborations with

institutions or industry (100% increase)

- Improved and expanded library services - 5% increase in literature searches 683 requests

- New integrated library system with 4 other RHAs

Michael Redenbach, VP

Integrated Health Services

Falls Resulting in Harm

(Code 3 and 4)

Executive Sponsors:

Michael Redenbach and Karen Earnshaw

VPs of Integrated Health Services

Quality & Safety Indicators - Falls

Target = Reduce Falls Resulting in Harm by 50%

Code 3 & 4 Falls by Quarter

April, 2014-March 31, 2017

0

5

10

15

20

25

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Nu

mb

er o

f F

alls

Target

Seniors Current State Analysis

Michael Redenbach, VP


Access/Patient Flow Indicator –

Seniors Current State Analysis (LTC)

- Current state analysis complete

- Shared with the Regional Health Authority Board

Portfolio Overview

Mental Health & Addiction Services • Outpatient Adult Mental Health Services

• Outpatient Child & Youth Mental Health & Addictions

Services

• Inpatient Mental Health Services

• Outpatient & Inpatient Addiction Services

• Quality, Strategy, Business Unit

Long Term Care • Regina Pioneer Village

• Extended Care / Veterans Program, WRC

• Continuing Care, Programing & Utilization

• Health Services Organizations

Celebrating Successes:

Long Term Care

• Established South Sask Dementia Assessment

Unit

• Established Geriatric Services Resource Team

• Improved Resident Dining Experience

• Improved MDS QI Scores

• Established Falls Rollout Program

• Reviewed Special Care Home Guidelines

• Increased Subsidized Assisted Living &

Convalescent Care Beds


Long Term Care

• Created Family Orientation Program

• New Spaces & More Room thru 5S Projects

• Reduced O2 Errors

• Affiliate & Contracted Facilities Accredited

• Staffing Mix Changes

• Improved Care Staff Shift Handover

• Improved Physician to Physician Handover

• Completed Provincial Resident & Family

Satisfaction Survey


Mental Health and Addictions

• Increased access to child & youth outpatient

services

• Increased access to adult outpatient services

• Increased access to child psychiatry services

• Centralized Referral Management and

Electronic Health Record

• Consult Liaison Team


Mental Health and Addictions

• Police & Crisis Team

• Internet Cognitive Behaviour Therapy

Outcomes

• Take Home Naloxone Program

• Psych support available for Brief and Social

Detox

• Dedicated Substance Abuse Treatment Unit

Jan Besse & Terri Carlson, Acting VP’s

Clinical Support Services

Portfolio Overview

Clinical Support Service Line 5 Portfolios – 30 distinct services

– Medical Imaging

– Lab Services

– Pharmacy Services

– Rehabilitation, Spiritual Care, Native Health

Services, Respiratory Services

– Support Services


Medical Imaging

• Reduction in MRI wait times from 239 days

to 114 – a 52% reduction from September

2017 to January 2017

Laboratory Services

• College of American Pathologists

Accreditation Award in April 2017


Rehab, Spiritual Care, Native Health Services,

Respiratory Services

• Rehab: Major focus on supporting flow (acute

therapy & rehab), quality & safety (employee injury

reduction, TLR audits) and system sustainability

(March 31, 2017 paid hours result 2,200 hours

favorable)

• Native Health Services support to facilitate provision

of pediatrician care to 1st Nations Communities

• Respiratory working in partnership with Primary

Health Care to support community clients with

COPD


Pharmacy

• Celebration of 50 Years of Hospital

Pharmacy Residency May 30, 2017

Support Services

• Environmental Services quality improvement

work to support the Emergency Department

and align services

• Nutrition & Food Services – More to Eat

Study on Unit 4A

Karen Earnshaw, VP


Coverage Rate for DPT for

Two-year Olds Residing in RQHR

Karen Earnshaw, VP


Quality & Safety Indicators –

Diphtheria-Pertussis-Tetanus (DPT)

Coverage rate for DPT for two-year olds residing in RQHR (Regina & Rural)

Coverage Rate for MMR for

Two-year Olds Residing in RQHR

Karen Earnshaw, VP



Measles-Mumps-Rubella (MMR)

Coverage rate for MMR for two-year olds residing in RQHR (Regina & Rural)

Portfolio Overview

Primary Health Care Service Line

Urban Networks (North, South, Central, East)

Rural Networks (Touchwood, Twin Valleys, Prairie East)

Home Care/SWADD

Palliative Care

Population & Public Health

Eagle Moon Health Office

Saskatchewan Health Line


Immunization Outcomes: Taking Care to the Clients

The Central network took on the challenge of bringing up immunization rates to heart in the past year.

By changing the way they deliver public health in their community, they have seen an increase in

immunization rates across the board and they have also seen an increase in community engagement.

They started taking public health to the places their clients are – schools, community centers, etc. By

doing this, it has improved access to services for that group and the result has been increased

immunization rates.

Seniors House Calls: Taking healthcare to those who can’t access it themselves

In the past year, the Seniors House Calls team has expanded their staff and been a critical link in

improving access to service for Regina seniors who have mobility issues, complex medical issue and

who are frequent visitors to the ER. AS part of a multi-disciplinary team, they liaise with their

colleagues through the region to bring care to those who cannot seek it themselves thereby reducing

the reliance on acute beds in hospital and in ER visits.

Breathe Easy: Respiratory Therapy being done in community

Access to Respiratory Therapy Services in community has improved over the past 12 months. An

interdisciplinary Primary Health Care team has been collaborating with Physicians and Nurse

Practitioner’s in Private and Primary Health Care practices to offer pulmonary services to RQHR

clients. Spirometry is being performed in community clinics as well as in client homes. The team has

been working closely with clients and their care teams to better manage COPD in community. This

team has also been facilitating COPD rehabilitation programs in our PHC Networks.


RN in hospital supporting high quality transitions

Our hospital colleagues care for a high volume of COPD clients. To help improve quality transitions

from hospital to home, a community Registered Nurse is working in hospital to support clients with

suspected and diagnosed COPD.. She connects with colleagues in hospital to collaboratively care for

clients and supportively transition them to our Primary Health Care Networks who provide care to

clients to remain well at home.

Community Support Worker: Improving safety and access one patient at a time

In the urban Primary Health Care portfolio, North, Central and now South, have embraced a new type

of heath care provider that focuses on medical and social needs. The Community Support Worker fills

in the gaps in care for those people who need much more than medical intervention. Their health is

also reliant on accessing safe housing, medical appointments and food. But they are not in it alone,

they often work with other providers to ensure continuity of care and high quality transitions between

providers to ensure their clients continue to stay out of acute and ER facilities.

Medication Room Kanban at Wolseley Memorial Integrated Care Centre.

An improvement event at Wolseley Memorial Integrated Care Centre has reduced the amount of time

staff needs to order medications by 93% (from 2.5 hours to 10 minutes every two weeks). Staff

grouped similar items together, set regular ordering amounts and posted those amounts on the

medication bins to improve ordering practices. Nurses now use a cart to deliver patient medications

which has reduced the amount of unnecessary walking by 100% (from 18 feet per patient to 0). This

success built on the work completed in the last fiscal year by Indian Head and Broadview. It’s a true

example of team work.


Palliative Care Comfort Cart

When people arrive onto the Palliative Care unit, they are in a fragile state of health and often families

are accompanying them for long periods of time. To ensure that both patients and families are

comfortable, a Comfort Cart was implemented. Thanks to volunteers from St Cecilia Parish, Holy

Trinity Parish and a donation by Alfords, a cart stocked with the comforts of home is providing some

much needed comfort. They even have homemade quilts that families and patients can keep after their

stay.

Home Care cuts care supply costs 16 per cent

Home Care is spending 16 per cent less on supplies (a projected $585,051 in 2016-17 compared to

$695,591 in 2013-14) all while providing more units of service* and caring for more clients, in part,

because of the implementation of a new inventory management system. The system includes a daily

supply order board that allows supply depot staff to see at a glance whether supplies need to be

ordered, have been ordered or are on back order and an electronic supply order form that’s part of a

client’s electronic medical record. Keeping the order form with the record allows nurses to see

whether care supplies have been ordered or more are required. Staff no longer wastes supplies

Dr. David McCutcheon, VP

Physician & Integrated Health Services

Hand Hygiene Audit

Regional Compliance Rate


Physician Services & Integrated Health Services


Hand Hygiene

Source: RQHR IPAC

Date: February 2017

Define Characteristics of Culture of

Accountability and Develop an Action Plan

for Physicians (Merging into Clinical Quality Plan)


Physician Services & Integrated Health Services

System Sustainability Indicator -

Culture of Accountability (physicians)

• Appointment of 3 New Department Heads

• Department Head Council retreat held in October

2016

• 6 physicians enrolled in Physician Leadership

Institute (PLI) program.

• 3 physicians enrolled in Saskatchewan Clinical

Quality Improvement Program offered through

HQC and SMA

• Clinical Quality Plan Framework Developed

merging Comprehensive Medical Quality Plan,

Culture of Accountability and Improving

Appropriateness of Care

Portfolio Overview

Medicine Service Line

– Emergency Department/EMS

– Critical Care & Cardioscience Units

– Medicine Inpatient Units

– Regional Infection Prevention & Control

– Transfusion Safety

– Antimicrobial Stewardship Program

Physician Services – Practitioner Staff Affairs

– Department Heads


Portfolio Success

• Integrated three distinct program areas into the Medicine Service Line

• Open new Medicine Inpatient Unit and close Code Burgundy at PH

Emergency Departments

• Modified Primary Nursing in Pasqua ED

• Synergy Tool

• Collaboration with Connecting to Care Team

EMS

• RQHR Comm-Centre: Safe Practice reduction of “Hot Responses”

• Improved response times

• Ambulance Deep Cleaning Process; Uniform Laundering

• Community Paramedicine

Critical Care/Cardiosciences

• Revised the Cardiac Service Model

• Transaortic Valve Implantation – First in Saskatchewan

• Left Atrial Appendage Occlusion

• Replication of ACU model on MSU PH

• Implemented an Appropriateness of Care project in Critical Care Units


MIU

• First in Canada to implement an Accountable Care Unit on Pasqua 4A

• Opened a new Medicine Inpatient Unit on Pasqua 4B

• Standardized MIU program

• Medicine Admission PPO

• SCM usage for electronic charting/audit collection on 4A

Infection Prevention and Control

• Community Physician MDR/IPAC Audit

• Collaboration with Saskatoon Health Region for provincial IPAC

alignment

• Revisions to Regional Hand Hygiene policy and auditing process

Transfusion Safety

• Creation of a Patient Blood Management Program – led by Dr Lett

• Creation of a Red Blood Cell (RBC) ordering Pre Printed Order (PPO)


Antimicrobial Stewardship Program

• Awareness Campaign

• Viral Prescription Pad

• Website developed www.rqhealth.ca/asp

• Asymptomatic Bacteriuria project

Practitioner Staff Affairs

• PSA Review

• Recruitment of 28 specialist physicians and 16 general practitioners

• Core/non-core privileging process review

• Standardized physician onboarding process

• Concern Handling Process

Appropriateness of Care

• 17 projects have progressed to the complete and audit phase

• 4 projects are in the PDCA phase

• 10 projects are in the planning and data gathering phase

• 26 new PPOs were approved; 65 PPOs were updated/revised

Michele Vogt, Acting VP

People and Safety

# of Workers' Compensation Board

Claims per 100 FTE

Michele Vogt, VP

People & Safety

Reduce Number of Workers' Compensation Board

Claims (Lost Time Claims) per 100 FTE


WCB LTCs

Quality & safety Indicators – WCB LTCs

Define Characteristics of a Culture of

Accountability and Develop

an Action Plan for Staff

Michele Vogt, VP

People & Safety

System Sustainability Indicator –

Culture of Accountability (staff)

Culture of Accountability Framework developed

• Multidimensional, cross-functional work ongoing

Portfolio Overview

People and Safety HR Operations and Volunteers

• Labour Relations

• Workplace Accommodation and Attendance Support

• Employment Services

• Volunteers

Legal & Policy

• Privacy

Patient & Employee Safety

• Patient Safety & Risk Management

• Employee health & Safety

Workforce Planning & Development

• Organizational learning and Development

• Central Scheduling

• Workforce Planning

Representative Workforce

• Diversity & Inclusion


Collaboration with Managers to impact: - Safe work practices on the units – daily huddles that focus on

safety

- Violence assessments completed

- Electronic Confidential Occurrence Report rolled out

- New manager orientation checklists for all departments

- Value stream maps and work standards developed to help support

organizational change processes

- The development of a new

scheduling office in Grenfell

- Enhanced volunteer support

screening


Commitment to Quality Improvement: • Leveraging LILT training to enhance H.R. processes to better meet

customer needs

• Developing metrics and data to drive improvement

• Commitment to SLP to build capacity and leadership

• Enhanced financial management

Support for each other. - While vacancy managing

- While dealing with personal loss

- While balancing work and family


WE ROCK THE SOCKS

Darlene Rorbeck & Andre Kroeger

Acting VP’s, Financial Services

Operating Surplus/Deficit

Darlene Rorbeck on behalf of

Robbie Peters, VP

Financial Services

System Sustainability Indicator -

Operating Surplus/Deficit

-3011

-4755

-8165

-5128 -4678

-6629

-3517

-4667

-3291

-2235 -2952

-3546

-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 March 31, 2017

Actual (Year to Date) 2015-16 Actual (Year to Date) 2016-17 2016-17 Target

Date Prepared: May 11, 2017

Report Contact: Darlene Rorbeck

Source: Finance

Refresh Cycle: Monthly

Operational Definition: Total operating revenues less

total operating expenditures at the end of a specified time

period.

Portfolio Overview

Financial Services

– Accounting

– Payroll & Benefits

– Decision Support

– Materials Management

– Facilities Management

– Security & Parking Services


• RQHR Financial Results

• Enovation replacement

Materials Management

• Procurement Suite and training launched

• Direct order, and inventory management

• Adding racking to Inventory to accommodate additional

high volume items


Facilities Management

• Maintenance and Renewal Projects

• Implemented Space Change Request Process

• Implemented Real Estate Management Plan to advance

real estate strategy and controls

• Developed pilot capital intake and prioritization process

• Negotiated Provincial Natural Gas Purchasing producing

more than $2.4M in savings for the Health Regions of

Saskatchewan

• Preventative maintenance outcomes on beds (Stryker)

• Portfolio Strategic Alignment and Planning Session

Sharon Garratt, VP


Surgical Site Infection Surveillance

Sharon Garratt, VP


0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Q3 Q4 Q1 Q2

SSI Rate, targeted procedures, RQHR, 2015-16 ,2015-17

SSI Rate (%) Target

Quality & Safety Indicator –

SSI Rate

# of Surgical Cases Waiting

Greater than Three Months

Sharon Garratt, VP



Surgical Cases Waiting >3months

Portfolio Overview


– Clinical Quality & Professional Practice

– Specialized Ambulatory Care

– Integrated Renal Program

– Women’s & Children’s Health

– Surgical Services

– Provincial Smart IV Pump Program


• Nursing Orientation revised and is more comprehensive

• Advanced Trauma Life Support (ATLS) training centre

• Endoscopy/GI replaced EMR, revised SCM clinical nursing

documentation.

• Major renovations to scope reprocessing area at RGH to meet

accreditation standards.

• Ambulatory Care re-implemented HALO standby and reduced

late clinics.

• Eye Centre improved patient experience by bundling diagnostic

and therapeutic appointments.

• Infusion Clinic returned to their home space and the Eye Bank

moved to a better designed space.

• Completed evaluation and implementation plan for master roster

review outcomes in Renal Unit.


• Co-authored & implemented Provincial Policy for Dialysis Water

• Fundraising by patients, staff, physicians and HRF to replace the

entire fleet of patient TV’s for the RGH Dialysis unit

• Renal specific patient-family survey to inform strategic directions

• Eliminated flashing in OR’s, collaborated with rural facilities re:

surgical accreditation standards

• AAA & Acute Thoracic Algorithm implemented to move patient

direct from helipad to OR

• Implemented SCM facility boards in OR, decreased preoperative

LOS, Stroke Clinic decreasing wait times for patients.

• Implemented after-hours booking rules for RGH & PH resulting

in 11% decrease in emergency procedures

• 5S in Pasqua OR, procured O-Arm, strategic plan initiated to

address deficit in OR instruments & equipment

• Strengthened teamwork/collaboration between OR’s & MDRD’s


• Pediatric High Acuity Area and Early Pregnancy Assessment

Clinic opened

• Perinatal Advisory Council provided input to development of

Perinatal Loss Response Team & Dept Obs/Gyne approach to

postpartum tubal ligation requests

• Peds Home Care RN trial achieved better skill task alignment

and improved care

• Peds Outpatient Unit accredited by Cystic Fibrosis Canada

• NICU had no needle stick injuries x 1 year and introduced

enteral feeding only products

• MBU revised standards of care for postpartum and c/section

patients and created coinciding charts

• Zoom Zoom Kids – partnership with UofR Engineering to

support mobility of children with disabilities

Keith Dewar,

President and CEO

Emergency Department Length of Stay at 90th

Percentile All Patients

Keith Dewar, CEO


ED LOS at 90th

Percentile

Lunch Break

Building Resilience During Uncertain Times

Dr. James Pappas

Psychologist

Afternoon Break

RQHR Lean Leader Certifications

Amy Strudwick, Specialist

Quality and Strategy Management Office

Lean Leader Certifications

• Alexander Wong

• Andrea Lavoie

• Andriyka Papish

• Brian Danyliw

• Cara Benz-Tramer

• Cathy Peters

• Dan Drummond

• David McCutcheon

• Debbie Sinnett

• Diane Kozakewycz

• Donna Ledingham

• Erin Roesch

• Fiona O’Connor

• Gord Bellavance

• Jessica Minion

• Kateri Singer

• Laveena Tratch

• Linda McPhee

• Lori Hopfauf

• Maggie Petrychyn

• Maurice Hennink

• Mohamed Eisa

• Poornima Murthy

• Roxanne Martin

• Vicki Ehrlich

2016-17 Accomplishments Video

https://youtu.be/tXG7PmA5NS0



Recap and Closing Remarks

Keith Dewar

President and CEO

introduction and logistics

Documents