STRATEGIC INITIATIVES STRATEGIC INITIATIVES UPDATEUPDATEUPDATEUPDATE

Prepared for Compliance and MonitoringPrepared by Strategy and Performance

May 23, 2012

Health PEI’s Strategic Direction Health PEI’s Strategic Direction

Vision“One Island Community, One Island Future, One Island Health System”

Care will be delivered through a single, integrated system of care, one grounded in evidence-based decision making and focused on improving health, enhancing access and refocusing the

h i f th d li t i h lth d i th t i t lemphasis of the care delivery system on primary health care and services that can appropriately and safely be provided locally. The system will be more focused on meeting needs in the most appropriate setting, by the most appropriate provider and in the most cost effective manner.

ValuesCaring: We will treat all people with compassion, respect and fairness. Excellence: We will work together in an environment of trust as team members and partners in

care, and be dedicated to continuous improvement based on sound evidence.Stewardship: We will make decisions responsibly, act with integrity and be accountable.

GoalsQuality – Above all else we must ensure that our health system has the capacity to provide safe,

dependable, quality care which promotes good health outcomes. Equity – We will provide fair allocation and timely access to services based on need so that

Islanders get the services they need, and need the services they get. g y , y gEfficiency – We will use health care resources and information as efficiently as possible, ensure

value for money, and make best use of workforce skills. Sustainability – We will ensure that the health system is stable and here to meet the needs of

current and future generations.

Alignment of Strategic Work to Realize VisionAlignment of Strategic Work to Realize Vision

Strategic Initiatives reconfirmed on an annual Strategic Initiatives reconfirmed on an annual b i d it d i tb i d it d i tbasis and monitored as appropriatebasis and monitored as appropriate

Strategic Initiatives Leadership Committeesg• Integrated Chronic Disease Prevention

and Management• Mental Health Services Strategy

p• Advisory Committee on Organizational

Development• IM/IT Steering Committee

• Primary Healthcare Networks• Cancer Coordination• Stroke Care Model• Home Care Renewal

IM/IT Steering Committee• Provincial Medical Advisory Committee• Provincial Nursing Advisory Committee• Wait Times Strategy Steering

• Home Care Renewal• Manor Replacement Program• Ambulatory Care Centre

Redevelopment

Committee• Quality and Patient Safety Council• Utilization Management / Patient

Leadership Committeep• Provincial Emergency Services• Collaborative Model of Care• Computerized Provider Order Entry

Leadership Committee

p y

Progress to Date for Strategic Initiatives Progress to Date for Strategic Initiatives (2009(2009--2013)2013)

2009‐2010 2010‐11 2011‐12 2012‐13Current Strategic Initiatives

2009 2010 2010 11 2011 12 2012 13

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Integrated Chronic Disease Prevention & Management 

Mental Health Services Strategy 

Primary Healthcare NetworksPrimary Healthcare Networks 

Cancer Control Coordination 

Stroke Care Model 

Home Care Renewal 

Manor Replacement Program 

Medical Leadership

b l d lAmbulatory Care Centre Redevelopment

Provincial Emergency Services 

Provincial Surgical Review 

Collaborative Model of Care 

Utilization Management / Patient Flow 

Transition Management Strategy 

Clinical Information System 

Computerized Provider Order Entry (CPOE)

Wait Times Strategy

New Governance Model 

System Enablers `System Enablers

Budget Directives 2012/13 from DoHWStrategic Initiatives that were closed as projects and transferred to a Committee for ongoing oversight.  

With the closure of System Enablers as a project, key strategic areas under its umbrella were transferred, including:   Human Resources Framework and Leadership Development 

transferred to Advisory Committee on Organizational l

Medical Leadership transferred to Provincial Medical Advisory Committee

Wait Times transferred to Wait Times Strategy Steering Committee Utilization Management transferred to Utilization Management / 

Development IT/IM Framework transferred to IM/IT Steering Committee

g g /Patient Flow Steering Committee

Definition (Business Case / Charter)Planning Phase (Model & Implementation Plan)

Implementation (Control and Monitoring focus)Close Out (Evaluation, spread plan, hand over to operations

Primary Health CarePrimary Health CareKey Areasof Focus

Planned Outcomes Key Accomplishmentsof FocusCancer Control Coordination

• Define the model (still in preliminary planning stage)

• Recommendations brought to ELT in November 2011• No resources available to implement recommendations• Recommendation to defer further work until the next Strategic

Planning Cycleg y

Integrated Chronic Disease Prevention and Management

• Reduce admission for ACSC• Improve management of chronic

diseases

• Diabetes: integration within PHC networks, collaborativepractices with physicians, provincial pediatric diabetes nurse specialists, registry being implemented

• COPD: clinics in all networks, standardized documents• Hypertension: Lifestyle Behaviour Change InterventionManagement • Hypertension: Lifestyle Behaviour Change Intervention

implemented at Queen’s, coordinator position posted

Mental Health Services Strategy

• Improved care coordination• Improved access

• Centralized children’s and standardized adult intake for CMH implemented

• Concurrent disorders and Seniors Mental HealthE al ation of s stem acco ntabilit nearing completion• Evaluation of system accountability nearing completion

• Continued refinement of accountability framework.

Primary Health Care Networks

• Reduce admission for ACSC• Improve access to services

• Infrastructure and continued staffing including policies• Queen’s East Network – formal structure implemented &

operationalp• Collaborative practice including: INR management and

osteoporosis and fracture research in networks & obesity project• Primary Care Service Survey

Stroke Care Model

•Reduce incidence , death and disabilities due to stroke

• Provincial Stroke Rehabilitation Ambulatory Clinic and district outpatient stroke rehabilitation teams (QEH and PCH)Model due to stroke

•Reduce the financial burden of stroke•Optimize recovery and improve quality of life for stroke survivors

outpatient stroke rehabilitation teams (QEH and PCH) implemented November 14, 2011

• Secondary prevention pilot completed.

Home CareHome CareAn enhanced system of delivery for home based care is critical to the future sustainability of PEI’sAn enhanced system of delivery for home-based care is critical to the future sustainability of PEI’s health system, allowing citizens to age at home and maintain their independence and dignity.

Key Accomplishments: • Collaborative Model of Care N B i P i l i t f• Falls Management Program

Pilot in Kings Home Care has been evaluated with overall positive outcomes

Majority of clients showed decrease in t

New Business Process – single point of intake, integration/ care coordination, introduction of LPN

Implemented in Summerside (showcase site 2010) and Queens (2011)assessment score

Rate of acute admission for falls for program clients 1.5% compared to 6.3% provincial average

• LTC Partnership

site 2010) and Queens (2011) Kings and West Prince – April 2012

• Integration Model – Care Coordination• Integration Model extends care

coordination to all clients• LTC Partnership Home Care now completing all

assessments in community for nursing beds, including private

Currently working on mapping LTC

coordination to all clients • All clients will have primary coordinator• High/Med/Low to describe need for

coordination• Model is finalized; focus now on tools toCurrently working on mapping LTC

admission business process Formal partnership agreement re: IV

administration and wound care in public LTC facilities

Model is finalized; focus now on tools to support

Manor Replacement ProgramManor Replacement Programa o ep ace e t og aa o ep ace e t og a

Purpose: To respond to the recommendations of the Corpus Sanchez and Accent• To respond to the recommendations of the Corpus Sanchez and Accent Reports by replacing the aging LTC facilities of Colville, Maplewood, Riverview, Summerset and Prince Edward Home with current, code meeting facilities.

• To adopt a person-centred care approach throughout the LTC sector.• To implement the provincial model of clinical care at the new LTC facilities.• To replace the Summerset Manor dialysis unit with an expanded service, p y p

located in new construction at the Prince County Hospital.• To provide 15 new long term beds through an addition to the current

Margaret Stewart Ellis Home at Community Hospital O’Leary.• To replace the current palliative care unit at the Prince Edward Home with a

stand alone, expanded provincial service.

Manor Manor ReplacementReplacement Program (Program (cond’tcond’t))

Project Status Update:

Project Planned Finish Date

ExpectedFinish Date

Occup- Status NotesFinish Date Finish Date ancy

Colville Jul 2011 Aug 2011 Nov 2011 Occupancy and full operation Nov 23, 2011

Maplewood Jul 2011 Aug 2011 Nov 2011 Occupancy and full operation Maplewood g p y pNov 23, 2011

Summerset Summer ‘12 Summer ‘12 Dec 2012 On or slightly ahead of schedule

PE Home Winter ‘13 Winter ‘13 Spring ‘14 1 month behind schedulePE Home Winter 13 Winter 13 Spring 14 1 month behind schedule

MSEH Exp Feb 2012 Apr 2012 Apr 2012 3 months behind schedule

PCH Dialysis Mar 2012 Mar 2012 Apr 2012 On schedule

Palliative Care TBD TBD TBD TBD – see Budget Directives

Riverview Spring 2016 Fall 2017 Fall 2017 Fn design complete. Design will copy Maplewood

QEH Ambulatory Care Centre RedevelopmentQEH Ambulatory Care Centre RedevelopmentQ bu ato y Ca e Ce t e ede e op e tQ bu ato y Ca e Ce t e ede e op e t

• To improve access to existing same-day health care services and also meet the community’s demand for a broader range of services (e.g. provincial sleep lab, pain management services, stress echocardiogram, etc.), a new Ambulatory Care Centre is being developed, which will house all these services together

• Overall project benefits include: Improved quality and safety of patient care in the areas of infection

control and prevention, privacy and confidentiality, etc. Improved access to services and coordination of patient visits Increased overall efficiency of QEH by creating more functional and

integrated services- decrease impact on Emergency Department and In-patient Unitspatient Units

Co-location of services that have a relationship to each other (Blood Collection and ECG)

Optimized costly space by sharing spaces: clinics waiting roomsOptimized costly space by sharing spaces: clinics, waiting rooms

Ambulatory Care Centre Redevelopment (Ambulatory Care Centre Redevelopment (cond’tcond’t))bu ato y Ca e Ce t e ede e op e t (bu ato y Ca e Ce t e ede e op e t (co d tco d t))

Key Dates Key Accomplishments for ACC Redevelopment ONLY*

November 2009 • Completed site preparation for the Ambulatory Care Centre (ACC)

April 2010 • Construction of ACC initiated

August 2011 • Operational funding approvedAugust 2011 • Operational funding approved

December 2011 • QEH main entrance and lobby opened

Aug-Oct 2012 • Commencement of staggering of relocation of services begins in August

Note: The ACC redevelopment project is the second of three stages in Phase I of the QEH Redevelopment. The QEH Master Program (which was completed in 2005) anticipates this Phase I redevelopment to be completed in 2013. This capital infrastructure program is multi-pronged so while construction was starting on the ACC (stage 2), work was nearing completion on the new Emergency Department (stage I) Stage 3 includes renovations to day surgery and pre surgery clinic and anDepartment (stage I). Stage 3 includes renovations to day surgery and pre-surgery clinic and an updated functional program.

Emergency ServicesEmergency Servicese ge cy Se cese ge cy Se ces

Strategic Initiative Key Accomplishments

Provincial Emergency Services • Improved policy and practices to facilitate patient flow for example: First Available Bed Policy, ALC Policy and Discharge Transfer Policy

• Diversion Policy reviewQEH S t ti /D t d t t• QEH Saturation/Decant procedures to support improved patient flow through hospital

• Successful contract bid for LEAN Project

Collaborative Model of CareCollaborative Model of Care• Key Outcomes - Units appropriately and sustainably staffed and safe• Key Accomplishments:• As of May 2012, CMOC work has begun at more than 20 sites across the

Island, including all Primary Care Networks

Collaborative Model of Care cont’dCollaborative Model of Care cont’dCo abo at e ode o Ca e co t dCo abo at e ode o Ca e co t dKey Accomplishments• CMOC has led to an increase of 78,400 patient care hours (more

than 40 full time equivalent front line staff)than 40 full-time equivalent front-line staff)

• We continue to grow our Registered Nurse (RN) workforce. Due to f 9increasing demand for services, we have created an additional 95

full-time equivalent (total of 125) RN positions from 2007 to 2011.

• There were fewer seasonal bed closures in our hospitals during the 2011 summer vacation period, down to 40 compared with 75 in 2009

• RNs who completed a health assessment course at UPEI in the fall of 2011 have reported a positive impact on patient care

CPOE CPOE –– Key AccomplishmentsKey Accomplishments• Pre requisite CPOE projects involving electronic credentialing of CIS users and introduction of• Pre-requisite CPOE projects involving electronic credentialing of CIS users and introduction of

functionality that will enhance the introduction of electronic ordering including Pharmacy documentation, Patient Profile, Med List and Enhanced View functionality.

• Intraoperative documentation was implemented provincially at the two Island hospitals with surgicalIntraoperative documentation was implemented, provincially, at the two Island hospitals with surgical departments, the QEH and PCH, finalizing the roll-out of the surgical solution.

• CPOE Phase 1 was implemented at all 8 Island hospitals. Phase I CPOE includes electronic processing of lab, diagnostic imaging and allied health consult orders for inpatients and ED patients. Physicians , g g g p p ycontinue to write their orders per current practice then the orders are entered electronically on the nursing units rather than a paper requisition being sent to the department.

• Use of a system-generated paper medication administration record by nursing at Souris Hospital was implemented as a pre-cursor to the electronic medication administration functionality that will be introduced for nursing as part of CPOE Phase 2.

• CPOE Phase 2 planning, design and build commenced. In Phase 2 doctors will stop writing orders on d i dditi t l b di ti i i d lli d h lth lt d d t ill l dpaper, and in addition to lab, diagnostic imaging and allied health consult orders, doctors will place drug

orders and patient care orders electronically. Nurses will use the computer to chart when medication was given and the care they have provided to the patient. The patient’s electronic chart will have all this information, including all the test results and other medical history so that doctors, nurses and other health professionals taking care of this patient can access it at any time.p g p y

Budget Directives 2012/13Budget Directives 2012/13Category 3-YR DRMs Description

Specific Program Areas, etc $ -- M Dialysis, Dental, Out-patient SMH, Physician billing, Ambulance UserPhysician billing, Ambulance User fees, Generic Drug pricing, DCAP

Allocation of new LTC Beds $ 0.7/1.2/1.7 M Allocation over 4 year period

Modified Hospital Plan (UM) $ 1.1/2.2/2.5 M QEH, PCH, CH, HH, DIp ( )Facility Based Investments $ 1.2/0.8/0.4 M Manors, Palliative, ACC, 5th OR

Investment Delays until receipt of independent review and evaluation

$ 1.5/2.0/3.5 M Areas identified include Home Care, Primary Care Phase 3, St k Ph 3 d CBSindependent review and evaluation Stroke Phase 3 and CBS

PEMAT $ 1.1*/1.3/1.3M Prof Services, Equipment, Grants, Admin Costs, Travel & Training

Asset Management $ 0.0/0.5/0.5 M TIR to lead system-wide asset Asset Managementmgmt strategy (RM, SMH & HH)

Various $ -- M Budget items not id’ed in Letter

* $1.1 M is in addition to the $641,200 already identified in the Management Plan

Questions