The strategic future of the Patient Access & Flow “One Number” protocol

as approved and endorsed by partner organizations

April 2013

Content

• Benefits of the “One Number” protocol• Strategic Directions and Priorities to guide the

future• Opportunities for Improvement - priorities– Recommendations

• Organizational structure to support the future– Recommendation

• Financial and staffing support strategy– Recommendations

Benefits of “One Number”

To summarize:• Using “One Number” is the “new normal”• It makes a positive difference every day• It helps patients get to where they need to using a timely,

coordinated ,system-wide process• It’s a coherent, system-wide approach to a system issue• It has on-going support from clinicians and other key

system users and stakeholders

(details at the back)

Strategic Directions

Five strategic themes have been identified through input from stakeholders:

• Scope and Structure• Technology• Education• Continuous process improvement• Evaluation

Five Complementary Strategic Themes

Education

Evaluation

Process Improvement

Technology

Scope & Structure

Strategic Direction – Scope & Structure

• Move to make the “One Number” a more inclusive protocol

• Increase the capacity of “hub” hospitals within the region

• Move all Level 3 ICU hospitals into a position where they are able to offer 24x7 “One Number” services

Strategic Direction – Technology

Move away from using paper based forms, clinical information and fax communications to using electronic and web-based communications

Use technology to access current information about bed availability by type of bed by hospital site

Use technology to access clinical information, especially on patients ready for repatriation

Strategic Direction - Education• Provide opportunities for all users of the “One Number” protocol

to be current and informed about what they “need to know” – reinforce key messages - especially when any changes are forthcoming

Strategic Direction - Continuous Process Improvement• Identify and address opportunities to improve the quality,

effectiveness and efficiency of the “One Number” protocol

Strategic Directions - Evaluation• Develop the capacity to measure and report on agreed upon

system indicators to evaluate system performance of the “One Number” protocol

• Ensure alignment of “One Number” with the LHINs’ IHSP strategic priorities

Strategic Direction PrioritiesSummary feedback from the on-line survey – Part 2

31 people from 10 different hospitals completed the survey8 were physicians and 8 were front line nurses

26/27 supported the technology strategic direction as stated26/27 supported the education strategic direction as stated25/27 supported the continuous process improvement strategic direction26/27 supported the proposed scope and structure strategic direction26/27 supported the strategic direction of evaluation

10/24 thought all five strategic directions were equally importantOf those that ranked the strategic directions

13 ranked technology as 1st or 2nd priority11 ranked continuous process improvement as 1st or 2nd priority9 ranked education and 9 ranked structure as 1st or 2nd priority6 ranked evaluation as a 1st or 2nd priority

Rank order of Opportunities for Improvement

Top priorities (high + medium priority)Technology – investigate and act on opportunities to access critical clinical information electronically (24/24)

Education – use the provincial Life or Limb protocol implementation in 2013 as an opportunity to reinforce “One Number” basics as well as any changes associated with Life or Limb and use of CritiCall (24/24)

Rank order of Opportunities for Improvement Second Tier (high + medium priority)Process Improvement - continue to use existing “One Number” groups to get input and address issues (21/24)

Process Improvement – develop a template script for One Number calls to standardize information shared and protocols to use during calls (21/24)

Process Improvement – develop a process to direct physicians to consultants/specialists when “One Number” is not needed – e.g. when looking for a timely consultation (21/24)

Rank order of Opportunities for Improvement Third Tier (high + medium priority)Technology advocate for electronic loading of information to provincial information systems, including PHRS (20/24)

Technology - Apply the current capabilities and functionality of PHRS – the Provincial Hospital Resource System developed and supported by CritiCall (19/24)

Process Improvement – work with physicians at LHSC to document, clarify and define ‘appropriate’ role of residents in taking “One Number” calls (19/24)

Rank order of Opportunities for Improvement Third Tier (high + medium priority)Structure - identify a specific resource to provide decision support to the “One Number” protocol (data and evaluation lead) (19/23)

Structure - expand “One Number” to include mental health/ psychiatry, obstetrics and pediatrics (19/24)

Structure – Develop a business case for the expansion (as required) for the following hospitals to provide 24x7 “One Number” services – LHSC, STEGH, HPHA-Stratford, GBHS-Owen Sound, CKHA, Bluewater Health and Woodstock (18/22)

Structure – expand role of GBHS and HPHA to serve as regional hubs for receiving and managing repatriation requests (16/21)

Recommendations

• THAT, the five strategic directions of technology, education, continuous process improvement, structure/scope and evaluation be adopted by the “One Number” Steering Committee as complementary directions to advance and improve the “One Number” protocol

• THAT, the Opportunities for Improvement as stated be endorsed as specific ways in which the strategic directions will be implemented – this does not preclude taking advantage of opportunities not yet known

Recommendations• THAT, in F2013/14 the following five initiatives be undertaken to

improve the “One Number” protocol

1. Education: use the provincial Life or Limb protocol implementation in 2013 as an opportunity to reinforce “One Number” basics as well as any changes associated with Life or Limb and use of CritiCall

2. Structure: Recruit a part-time resource to provide decision support services with a focus on “One Number” evaluation and performance reporting – to include alignment with LHIN IHSP priorities

3. Scope: Investigate the implications and impact of expanding the “One Number” protocol to include mental health, obstetrics and pediatrics – followed by a Steering Committee decision

Recommendations

4. Technology : Implement technological applications that will improve access to clinical information and improve process flow – especially repatriation

5. Process Improvement: Develop and define alternate process for physicians to use when they need a timely consult – but do not need to use “One Number”; and, work with LHSC to clearly define the role of residents in the “One Number” protocol

6. Implementation: It is proposed that with the direction of the Steering Committee that task groups be formed to

address each of these initiatives

Current Organizational StructureSouth West LHIN CEO Leadership Forum- CEO lead for “One Number”

“One Number “Steering Committee- Chair – CEO lead

“One Number” Operations Group- Chair – Regional Consultant

Regional Physician Leaders & Chiefs of Staff Group- Chair – Regional Consultant

“One Number” Evaluation CommitteeChair – Regional Consultant

Proposed Organizational StructureSouth West LHIN CEO Leadership Forum- CEO lead for “One Number”

“One Number” Steering CommitteeChair – CEO lead

“One Number” Operations Group- Chair – Regional Consultant

Regional Physician Leaders & Chiefs of Staff GroupChair – Chief of Staff

Meet quarterly

Members to include Chiefs of Staff (organization-wide)

“One Number” Evaluation CommitteeChair – Decision Support Consultant

Change Steering Committee to a representative model to meet quarterly to address strategic issues – include physician leaders Move operational issues to the Operations Group

Hold bi-monthly “face-to-face” or videoconference Operations Group meetings

Recommendation

• THAT, the proposed organizational structure as presented be endorsed

• Revised Terms of Reference for the Steering Committee are attached for CEO endorsement

Staffing Support and Financial Strategy

Financial Background• Initial contribution in 2011 of $326,838 for two years

SW LHIN = $163,000 (50%) SW LHIN hospitals = $153,838 (47%) SW CCAC = $10,000 (3%)

Hospital contributions were allocated using a formula - Acute inpatient discharge volumes x hospital using F09/10 data

• Funds on hand will support protocol to March 31, 2014 – 2 ½ years

Staffing Support Plan F13/14

• Staffing Support Continue with regional consultant role (FT contract) Continue with admin support role (part-time) NEW Recruit a Decision Support role (part-time) –

role to be assessed at the end of F13/14 Build a more robust data collection, analysis and

reporting system Allow senior consultant to focus on strategic priorities

Financial and Staffing Support Strategy F14/15 and F15/16

• Staffing Support in F2014/15 and F2015/16 Continue with regional consultant role (FT contract) Continue with admin support role (part-time) Continue with decision support role (pending role reassessment)

• Financial Strategy for F14/15 and F15/16 – in early 2014: Use the same cost sharing approach as was used in 2011 (LHIN,

hospitals and CCAC) Apply the same cost sharing formula among all hospitals as in 2011

Acute inpatient discharge volumes x hospital using F12/13 data

Ask for a two year financial commitment at the same level as in 2011 - $ 326,838

Recommendations

• THAT, the Steering Committee support the proposed staff support structure to March 31, 2016

• THAT, the Steering Committee approve the recruitment of a part-time decision support role in 2013 and that LHSC be asked to take the lead in the recruitment process and work in collaboration with the “One Number” protocol Evaluation Committee

• THAT, the Steering Committee approve the proposed financial strategy to March 31, 2016

Other Recommendations• THAT, the Steering Committee recommend to the CEOs that the expiry

date of the current Patient Access & Flow “One Number” protocol Agreement be extended from September 30, 2013 to March 30, 2014.

• THAT, the Strategic Future of the Patient Access & Flow “One Number” protocol - be presented to the April 12, 2013 meeting of the SW LHIN Hospital and CCAC Leadership Forum for endorsement

• THAT, in early 2014 a status report on the strategic priorities, financial and staffing support, and performance evaluation of the “One Number” protocol as well as the financial request for F2014/15 and F2015/16 and strategic priorities for F2014/15 be presented to the Steering Committee for review and approval and then to the CEOs for endorsement

The End

Welcome to the future of the “One Number”

protocol

Background Information

The Process

• A broad cross section of partner organizations responded to the on-line survey and provided input to the survey form – at least 70 people provided input

• People with many different roles provided suggestions and comments – clerical staff, management and physicians

• At least 30 physicians responded

The Process• The “One Number” protocol Steering

Committee held a day-long session on January 24, 2013 to address evaluation issues and major themes emerging from the input received

• The results from the January 24th session were sent out to all stakeholders and a second on-line survey was conducted to get input on each of the strategic and operational priorities

The Process

• The “One Number” protocol Steering Committee met on March 27th, 2013, discussed the findings and made recommendations about the strategic priorities for the next three years – to March 31, 2016 and initiatives to be undertaken in F13/14

Findings - Major benefits of “One Number”

• Fewer phone calls to make – has applied to CritiCall too – fewer calls/case and reduced inpatient accept times

• Huge gains and efficiencies in people’s time and resources – huge time saver knowing who to call• Improves patient flow – allows for planned work and priority setting • Gets access to the care our patients need – able to move seriously ill and injured patients• No Refusal works well• More collaboration among different parts of the system• Able to speak directly to a consultant• Know where to call• Improved communication – more aware of where the pressures are across the system• A clear process for sending and receiving patients• Improved repatriation• It’s an organized system – has changed the way people move across the system• Works really well for patients who require urgent care• Streamlines things• Relationships developed among hospitals has been key – did not exist before – key to working

together and moving forward• More understanding of what hospitals can truly provide and do, availability of medical and

nursing staff• IT has engaged people at every level - Chiefs of Staff, clinical leaders, operational leaders, front

line staff