Item Annual Business Plan Update Progress & Risk Update

Transcription

1 BRIEFING NOTE MEETING DATE: May 28, 2015 ACTION: TOPIC: Information Item Annual Business Plan Update Progress & Risk Update PURPOSE: To provide the Board with a monthly Annual Business Plan (ABP) update highlighting milestones, risks, and ABP dashboard progress. Initiative: All BACKGROUND INFORMATION: The Waterloo Wellington Local Health Integration Network (WWLHIN) actively monitors achievements, risks and dashboard progress related to the Annual Business Plan. As a system we celebrate our accomplishments and identify and mitigate risks that get in the way of creating a highquality, integrated health system for our residents. Briefing notes structure: Pages 1-4 include ABP milestones since the last Board update. Appendix A is the ABP dashboard with current our performance. The dashboard will be updated with the 2015/16 metrics and targets (expected by June 2015) once Ministry LHIN Performance Agreement targets are received. Milestones Appendix B outlines recent ABP initiative developments. May 26 th Event: Growing Patient and Family Engagement in Waterloo Wellington The Waterloo Wellington LHIN, in partnership with The Change Foundation, hosted a day event for approximately 200 local HSPs staff, leaders and governors. Waterloo Wellington Health Service Providers were involved in the event planning and were participated in the event to share their learnings engaging patients and families. Patients/residents had an opportunity to share their experience and offer suggestions on ways to engage them for needed system change. Participants left inspired and equipped with tools and techniques to actively involve patients and family in service improvement and redesigns. The event ended with a call to action with a commitment for future sessions to continue to grow

2 purposeful and effective engagement. Similar events have been hosted and paid for by the Change Foundation across the province. Primary Care Providers receiving Hospital Patient Data directly into their Electronic Medical Record A significant milestone to improve patient outcomes has launched. Grand River Hospital and St. Mary s hospitals are the first hospitals in South Western Ontario to link their information systems directly with primary care electronic medical records (EMR) so key hospital information can be shared. The platform for which this information is shared is through a tool called Hospital Report Manager (HRM). HRM sends narrative, text-based Medical Record (MR) and Diagnostic Imaging (DI) reports electronically directly into a patient s record within their clinician s EMR. Clinicians with an EMR Specification 4.1 (or higher) can implement HRM to receive reports electronically. There are fifty-five primary care providers in Waterloo Wellington currently connected to HRM. Over 210 primary care providers are working to connect to HRM. Cambridge Memorial Hospital, Guelph General Hospital, Groves, and the North Wellington hospitals are scheduled to complete implementation in This initiative is part of the connecting South West Ontario (cswo) Program (a regional ehealth program, funded by ehealth Ontario). Health Service Providers submitted ideas for the Assess and Restore targeted Funding Assess and Restore (A&R) interventions are short-term rehabilitative and restorative care treatments. They are meant to help seniors and other people who have experienced a reversible loss of their functional ability and who risk losing their independence. In 2014/15, the MOHLTC provided each LHIN with 3 years of targeted funding for Assess and Restore initiatives. WWLHIN invested in 2 Assess and Restore initiatives in 2014/15. Both initiatives are now complete. Online learning modules on senior s care that can be accesses by organizations and teams. These modules include information on Geriatric Addictions, Congestive Heart Failure, Falls, Medication Review, Frailty, Pain, Incontinence, and Cognition. These modules are part of a broader set of learning modules used provincially, nationally and internationally to provide further education to healthcare providers on geriatric syndromes. A simple assessment tool called the Assessment Urgency Algorithm (AUA) helps to identify older adults in need of geriatric assessment and helps to guide the professional to the right level of services for the senior based on their needs identified in the assessment. This tool was 2

3 introduced in Grand River Hospital Emergency Department and 2 primary care family health teams (Mount Forest and New Vision). Other primary care providers have signaled interest to use this tool. To help guide the LHIN in the investments for , an expression of interest (EOI) went out to HSPs, requesting project proposals. Responders were asked to focus on ALC, chronic disease prevention and management and improved patient transitions. Seven EOI s were received. An advisory group of physicians and the Geriatric System lead participated in the review of the proposals. The selected initiatives were forwarded along to the MOHLTC on May 22 nd for final review. Waterloo Wellington LHIN on the shortlist for Integrated Funding Models in Ontario Waterloo Wellington Mental Health and Addiction Integrated Funding Model proposal is one of 14 selected proposals of 50 submissions received by the MOHLTC. Of the 14 proposals, WWLHIN is the only proposal for Mental Health and Addiction. The MOHTLC announced a call for proposals early February 2015 that could demonstrate improved patient transitions from hospital to home with bundle payments for services. Bundled payment means funding follows the patient with one pay master for the episode of care. The primary funder works diligently to ensure the patient is cared for and supported in the community, avoiding unnecessary Emergency room and hospital re-admissions and ensuring value for money. There are 2 Integrated Funding Models in Ontario; St. Joseph s health care (hospital and home care) Hamilton and KW s Mary s Hospital with CCAC. Both models have shown improved patient experience, health outcomes and value for money. Mental Health and Addictions (MH&A) account for 5-10% of Emergency Department visits to our local hospitals. Commissioned reports by the WWLHIN note that there are extensive wait lists for intensive MH&A services in our community and limited suitable housing. On April 29 th, the MOHLTC review team (Health Quality Ontario, St. Joe s Health System, Health System Performance Research Network, MOHLTC) came to WWLHIN to meet with over 20 health leaders representing each sector. The morning meeting was positively received by the reviewers. By the end of May we will learn if we are an approved pilot site. The MOHLTC funding is up to $175,000 for one time project start up seed money up to 3 years. The MOHLTC team will provide support through evaluation, communication and change management. There is a high degree of commitment to this work with WWLHIN partners. We will proceed with this initiative even if WWLHIN is not selected as a MOHLTC pilot. 3

4 Monitored Risks Diagnostic Imaging The Integrated Diagnostic Imaging Program Council is moving from planning to implementation. The two year programmatic strategic plan recommendations have been endorsed by the council. Key change initiatives related to reducing wait times for DI services include: development of a governance model to guide implementation and ensure engagement across the system common, centralized intake for diagnostic imaging increased patient choice and primary care education on wait times physician engagement in dialogue with radiologists on appropriateness of scans and requirements for improved patient experience and care alignment of information technology and image management infrastructure to facilitate quality improvement agenda and reduce unnecessary duplicate scans development and implementation of a diagnostic imaging quality program Choosing Wisely Initiative: an initiative that aims to ensure practitioners ordering medical imaging diagnostics are using leading practice guidelines to prevent overuse of diagnostic imaging. It has been noted that up to 20% to 50% of all high-tech imaging provide no useful information and may be unnecessary 1. These change initiatives will result in an optimized use of our local CT and MRI capacity, including the allocation of dedicated operational dollars to achieve reduced wait times and in our ongoing dialogue with the MOHLTC for an additional MRI machine in WWLHIN. A business case is under development. Hospital Readmission for Chronic Conditions The WWLHIN monitors admissions and readmissions for chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), pneumonia and gastrointestinal). The performance of observed readmissions is compared against calculated expected rates. The observed readmission rate has continued to exceed expected rates particularly for COPD and CHF. The WWLHIN has established a table of primary care practitioners who have been challenged to review the 1 The Overuse of Diagnostic Imaging and the Choosing Wisely Initiative. Vijay M. Rao, MD; and David C. Levin, MD October 16,

5 system performance and make recommendations to improve resident care and offer solutions to better manage chronic conditions in the community and decrease readmission rates. The focus on targeting primary care participation was based on the notion that the up to 80% of care provided for these patients with chronic conditions is managed by primary care. The WWLHIN CDPM Advisory Group held its first meeting April 23 rd and will meet monthly. Palliative The WWLHIN continues to monitor high ALC rates attributed to palliative care including ensuring residents are able to die in their place of choice. Working with the Waterloo Wellington Hospice Palliative Care Council, a strategy is being developed to address challenges in being better able to meet the needs of residents who are at their end of life. This includes working closely with our hospital and community partners to identify the challenges and ensure all appropriate options are available. Hospital physicians lack trust in home and community palliative services. CCAC is working with these physicians directly to better understand their concerns. See Briefing Note on investments specific to palliative care. Hospice bed allocation per 100,000 populations is well below recommended what leading practice suggests. Funding is proposed for additional hospice beds. Innisfree hospice centre will open June 2015 however this will not result in a net gain of community based palliative services. NEXT STEPS: The WWLHIN will continue to monitor, manage and address areas of risk as well as celebrate the successes in our system. RECOMMENDATION: N/A 5

6 6 APPENDIX A

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8 APPENDIX B Our Priority: Enhancing Your Access to Primary Care Health Links Build on the four Waterloo Wellington Health Links to improve coordinated access to care for residents with complex conditions The MOHLTC continues to refine the details and direction of the Health Links maturity model. As outlined in the Briefing Note for the Investments, the MOHLTC has allocated one time funding of 1.35 Million dollars for our 4 Health Links. This funding is directed for change management, project management and sharing of electronic information. The funding has been flowed to the Health Links. As mentioned in the March 2015 ABP update the ministry is focused on an end-state of Health Links that will clearly define the patient experience, ensure sustainability and cost savings, drive broader health system integration, and inform health system investments. These goals will be accomplished through an enhanced governance structure with shared accountability with the LHINs, integrated performance management framework, and a quality and best practices framework. As the Health Links evolve and mature to ensure residents with the most complex health conditions receive appropriate access to care, complimentary mechanisms to organize coordinated care regionally for a wider patient population group are being explored in Guelph with a focus on population health based interventions. System leaders in Guelph will look at what is possible in the current regulatory and policy environment and what cross sector integration is required to impact population health outcomes. Ensure residents with complex conditions have access to primary care Attachment rates of complex individuals to primary care continue to be high (95-100% attachment rate) across the four Health Link geographies. In KW4, performance has improved from that reported in March but improvements are still required to reach the target. The KW4 Health Link is working with the providers and Health Care Connect to ensure those still without a primary care provider are attached quickly. The changes to the Physician Services Agreement between the Ministry and the OMA may impact the attachment rates to primary care doctors given some incentive payments physicians receive related to this population will cease as of June 1 st,

9 Social Determinants & Collaboration Outside of Health Care Continue to grow partnerships amongst and between health, housing, social services, education, justice, and other community partners to improve population health The WWLHIN is engaging in regular discussions with the Region of Waterloo and the County of Wellington to identify areas where our housing strategies align for further collaboration. The municipalities are the largest provider of subsidized, social and affordable housing for our highest needs residents who are frequent users of the health system; especially in the area of mental health and addictions. Housing stability has been identified as a key requirement for successful mental health and addiction recovery therefore our strengthened partnership with the municipalities allows us to better serve these high needs clients. WWLHIN is directing new funding to targeted vulnerable neighbourhoods. Staff are also exploring how to direct our 1 billion HSP funding to ensure services are targeted those most vulnerable neighbourhoods and residents. This is part of the WWLHIN commitment to ensure equitable services to residents. System Coordinated Access/Enabling Technologies Build, enhance, and sustain coordinated access to services through the System Coordinated Access project which includes access to Community Support Services, Rehabilitative Care, Palliative/End of Life Care, Mental Health and Addictions services, Diabetes Education, and others. The CCAC (system lead for SCA (System Coordinated Access) has now completed its future state and gap analysis through an external consultant. The SCA steering committee plan to release a market sounding document to local innovators and e-health vendors has been delayed from April 2015 to June 2015 as it awaits decision on innovative procurement from the MGCS (Ministry of Government and Consumer Services). WWLHIN is one of 2 pilots that MGCS is working with to bring about new and innovative ways to procurement. Innovative procurement was a commitment made in the report, A catalyst towards an Ontario Health Innovation Strategy. This was the first report released by the Ontario Health Innovation Council to the Government of Ontario. Support primary care in ensuring coordinated, equitable, informed access to specialist care and explore options for shared care planning A Medical Specialist Referral project has been scoped and advisory committee being put in place to get an aligned approach for Orthopedics, Cardiology and Psychiatry referral. 9

10 Access to Care Close to Home/Enabling Technologies Review and optimize use of telemedicine and telehomecare WWLHIN has reviewed business case for telehomecare and in process for evaluating a system lead for telehomecare. Chronic Disease Prevention & Management & Diabetes Improve access and implement best practice guidelines for diabetes care and chronic disease prevention and management focused on chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Waterloo Wellington Diabetes Central Intake reported year over year an 8% increase in total referrals, including a 29% increase in self referrals to diabetes education programs. Referrals made through the central intake process to specialists - endocrinology, ophthalmology and nephrology - saw an increase of 43%, 44% and 63% respectively. Average wait times for urgent referrals have decreased from 3.9 to 3.0 days from Q1 to Q while referrals for semi-urgent and non-urgent are all on target. Prior to the Waterloo Wellington Diabetes Central Intake process, wait times typically averaged 16 weeks, now the 90 th percentile wait time for non-urgent diabetes education program referral is 21.3 days. The target set is days. 10

11 11 Our Priority: Creating a More Seamless and Coordinated Health Care Experience Community Care Establish efficient and integrated personal support service delivery for residents in the community Lough Barnes Consulting Group (LBCG) was contracted in Q4 of 2015 to work with community stakeholders and the WWLHIN to provide a report and recommendations on the delivery of personal support services in the WWLHIN. LBCG provided numerous engagement opportunities for providers, governors and residents, and used a peer review group of providers throughout their analysis. This report has been submitted to the WWLHIN and is in the process of being internally assessed. On a provincial note, WWLHIN continues to participate in regular meetings with the Early Adopters group, providing updates on local progress while monitoring the implementation of this policy in the four early adopter LHINs. Seniors Care Continue to improve care for seniors through effective assess and restore services, dementia and Alzheimer strategies, and improving access to specialized geriatric services In March 2015, the WWLHIN Board of Directors approved an investment to increase the capacity in Specialized Geriatric Services (SGS) in WWLHIN through the Behavioural Supports Ontario (BSO) Community team by hiring one additional Occupational Therapist, one additional Recreational Therapist, two additional Clinical Intake resources, and a Geriatric Addiction Specialist to support seniors living at home with dementia, addictions and responsive behaviours. The BSO Community Team referrals have doubled and wait times for referrals have increased from hours to an average of 8 days, and this investment is expected to decrease wait times for those residents with behavioural issues, improving client and caregiver support, while decreasing ED visits and LTCH refusals. The Geriatric Addictions and Mental Health Steering Group of the Geriatric Services Network has continued to work diligently towards a goal of developing coordinated, cross-agency, cross-sectorial collaborative partnerships, coordinating outreach and supports across the service continuum, and strengthening the capacity and competency of providers through focused training and transfer of best practice knowledge. Geriatric Addictions training will now be part of education for primary care

12 providers on appropriate screening and referrals procedures for older adults. In March 2015, training was given to geriatricians and primary care providers, in addition to120 Guelph-Wellington EMS staff. Presentations are a collaboration with SGS, psychogeriatric resource consultants, and the Alzheimer Society and topics include Mental health, dementia and SGS services available. Additional sessions were planned for April The University of Waterloo is assisting the Geriatric Addictions Project manager to evaluate the effectiveness of the Geriatric addictions steering committee and to conduct focus groups of seniors in the community. Patient Transitions Improve patient experience and flow by integrated discharge planning and patient transitions practices, including patients with mental health and addictions conditions from hospital. The WWLHIN, in collaboration with partners Guelph General Hospital, Homewood Health Centre and the Canadian Mental Health Association, Waterloo Wellington Dufferin, and North Wellington rural hospitals have initiated an extensive review of the Mental Health Emergency Department (ED) model of care in Guelph/Wellington. The review will identify causes for increased patient volume in the ED for Addictions and Mental Health issues, as well as increased length of stay in ED while awaiting inpatient admission. The review will be complete by August 2015 and will provide actionable recommendations for mental health and addictions system improvements. GGH emergency department has a high number of patients coming for help for Mental Health and Addictions concerns. Alternate Level of Care Remove barriers for people waiting for an alternate level of care The ALC strategy is being refined. Next steps include identifying all the opportunities to improve our ALC performance specifically by areas Palliative, Mental Health and Addiction and Complex Continuing Care and Rehabilitation Care. A re-education of ALC is required. Changing physician practice is a top priority. Many physicians in hospital will designate a patient ALC when really their acute stay is finished and they are ready for discharge. Discharge planning is what is required, not an ALC designation. 12

13 13 Our Priority: Leading a Quality Healthcare System Using Evidence-based Practice Quality Improvement Accelerate best practice care through the system-wide adoption of electronic clinical order sets for Quality Based P procedures. LHIN-wide work is well underway for standardized hospital clinical order sets that are map to the hospital quality based procedures (care pathways). There are a number of standardized clinical order sets that focus on disease or treatments. For example there is a surgical order set that has a pre-printed or computer-generated physician orders that the care team follows. The orders remind the surgeon to order tests or procedures that are sometimes forgotten. The idea with order sets and care pathways is they provide direction for expected length of stay as well helping all the care team to have an understanding of the care during the hospital stay. This initiative is led by the Chief Nursing Officer at Guelph General Hospital. The hospital Chief Nursing Officers are working collaboratively to prioritize the order sets and care pathways across the hospitals so there is consistency of practice. Mental Health and Addictions Create integrated, comprehensive care through improved discharge planning for patients with mental health conditions from hospital See pg. 3 milestones: Waterloo Wellington LHIN on the shortlist for Integrated Funding Models in Ontario. Regardless of MOHLTC acceptance of WWLHIN proposal, the WWLHIN and HSPs are committed to improving the transition of care from hospitals to the community and will continue to develop protocols to meet this ABP goal. Improve access to intensive mental health services including optimizing Assertive Community Treatment Teams and support coordination. The Integrated Mental Health and Addictions Program Council identified the need for more access to flexible and concurrent intensive supports and determined this priority area is in need of redesign. WWLHIN staff in collaboration with HSPs will begin a redesign process that will answer the question: how might residents receive the most appropriate intensive level of care without waiting. This redesign is commensurate with work being completed in many other LHINs and at the MOHLTC on

14 reworking the current ACT model towards a more flexible model of care. See the Board briefing note on for the base funding investments for Flexible ACT teams. This investment will help to immediately accelerate the achievement of this ABP initiative. 14