Enhancing Patient Flow: Strategic Healthcare Improvements

1. Vision: Healthy people, families and communities. VP Quarterly Report on Strategies Q3 – 2015/16 Acting VP: Dawn Calder Integrated Health Services – Clinical Support Multi-year Plan: ED Waits and Patient Flow

2. Portfolio Overview • Patient Flow • Pharmacy & Respiratory Services • Medical Imaging • Lab Services • Rehabilitation, Spiritual Care & Native Health Services • HealthLine • Support Services, Central Scheduling & Sterile Processing

3. Multi Year Strategic PlanVP leading on: • Corporate Patient Flow Multi-year Plan: • Provincial Targets/Priorities - Hoshin ED Waits & Patient Flow • RQHR Multi Year Strategic Plan & Business Plan – Patient Flow • Patient Flow Program / Framework

4. 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

5. Hoshin Measure – ED LOS Admitted

6. Hoshin Measure – ED LOS Non-Admitted

7. Hoshin Measure – Time Waiting for an Inpatient Bed

8. RQHR– ED LOS All Patients Result of Collective Work

9. RQHR – ED LOS Admitted Opportunity to understand root cause of increase when overall LOS and Time Waiting for an Inpatient Bed and ED admission volumes have decreased 2014/15 vs 2015/16 ( YTD)

10. RQHR– ED LOS Non-Admitted Result of Collective Work

11. Root Cause Analysis – Common Themes Service Line/Area Driver Diagram • Appropriateness • Patient Waiting for Service • Bed, Consult, Tests/Diagnostics, etc.. • Staff waiting for information • Results, Orders, etc.

12. Root Cause Analysis – Common Themes Service Line/Area Driver Diagram • Service Levels Not In-line with Demand • Monday to Friday Business to meet a 24/7 demand. • Variation and lack of Standard Work/Process

13. Root Cause - Demand and Capacity * FY2015 to FY2016(Projected). Source SCM

14. Root Cause - Demand and Capacity * Complete FY2015 to 2016 Q1&Q2 only Source HIMS

15. Key Outcomes-Q3 Our Collective Work is Making a Difference

16. Key Outcomes-Q3 Reduced Overall ED LOS by 20 min. despite 2.63% increase in ED volumes 2014/15 vs.2015/16 (YTD) 13 min Decrease Time Waiting for an Inpatient Bed 2014/15 vs 2015/16 ( YTD)

17. Key Outcomes-Q3 Proactive Seasonal Planning

18. Key Outcomes-Q3 Accountable Care Unit – January 2016 Pilot Kick Off “This is the way healthcare should be” 4A Patient “ We can already see how this model will improve patient care and our overall work day ” 4A Hospitalists “ For the first time I feel I have contributed to and understand the plan of care for my patient” 4A RN

19. Key Outcomes – Q3 Unit Coaching of Inpatient Flow Standard Work 60%Improvement patients pulled from ED by 14:00 - Planned Vs Actual 100% of inpatient units showed improvement in the application of Patient Flow SW

20. Key Actions - Q4 Alignment to Activities to Multi-year Hoshin Targets Integrated Timeline Outcome Targets Service Line/Area Driver Diagrams Provincial and Regional Targets & Outcomes

21. Key Actions Q4 Debrief: Seasonal and Capacity Planning:

22. Key Actions Q4 ACU Pilot Implementation • Pilot Kick off Jan 15th – Covenant • Research • Localization of Physicians to 4A • ACU Patient Care Processes • Monthly Communication

23. Key Actions – Q4 Unit Coaching of Inpatient Flow Standard Work 25% of IP units at PH and RGH achieve observed compliance with of all 6 pieces of patient flow SW by March 31, 2016

24. Thank You & Questions