Mission Critical Corporate Priorities
The evolution of a program-based health provide
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- Focus on those we serve
- Bring out the best in each other
- Build strong and successful relationships
- Create a better way
- Use our resources wisely
Focus on those we serve
Maturation of Program Structure and Clinical Service StructureEvolving our health-care system from a site-based hospital service provider to a program-based health provider is absolutely crucial for the Niagara Health System to optimally leverage all of its constrained resources to provide the most appropriate and best quality of care possible – that being care which is effective, efficient, equitable, safe, humane, and timely. This past fiscal year, NHS continued to make inroads in evolving its program-based model of care and service delivery.
Eight core clinical programs, namely Operative/Perioperative, Medicine, Maternal/Child, Mental Health, Oncology, Transitional Care, Hospitalist/Family Medicine and Emergency, along with the clinical service structure, Diagnostic Imaging, Laboratory, Pharmacy and Clinical Nutrition, have been defined and confirmed under the leadership of the Program Management Steering Committee. Each clinical program and clinical service area continues to work towards establishing its philosophy of care, defining service delivery standards and patient care commitments.
Some of our future steps towards evolving our program structure include developing and implementing the means and vehicles to engage broader dialogue and input within our own hospital family, with our health-care partners and across patient populations and the communities we serve.
Recommendations of accreditation and plan for oncology and renal accreditation
The accreditation process was successfully completed, with the surveyors from the Canadian Council on Health Services Accreditation commending the outstanding efforts of NHS staff and leadership and noting our commitment to quality and teamwork. The team-specific detailed information contained in the focused visit report will be provided to the 12 accreditation teams so they can continue to build on their strengths and develop action plans that address recommendations to improve patient care and services. They have already received the initial accreditation survey report, and are reviewing it on an ongoing basis to keep the positive momentum going.
Accreditation of our oncology and renal programs was not part of this process due to the timing of the program transfers with Hotel Dieu Health Sciences Hospital, Niagara (now Hotel Dieu Shaver Health and Rehabilitation Centre). Program planning teams in oncology and renal have been established to complete the self assessment for accreditation, which we anticipate to take place in April 2008.
Utilization
Utilization continues as a key driver of hospital performance and quality improvement. A vital utilization undertaking for NHS this past year was the creation and adoption of order sets within clinical programs. Order sets are standardized best practice routines for patient treatment specific to a particular diagnosis that can be modified by a physician for an individual patient. Work commenced in the fall of 2006 to develop and implement a series of order sets and results to date have been highly successful.
The NHS is extremely pleased with our progress to date in increasing volumes and decreasing wait times under the Wait Time Strategy. We have received almost $10 million since this strategy was introduced in April 2005, which enables us to continue to improve access to care for a wide range of patients in Niagara. There will be many additional benefits to patient care once the Wait Times Information System is up and running. With this single comprehensive system, primary care physicians will be able to make more informed decisions about their patients' care by accessing both provincial and individual surgeons' wait times for surgical procedures.
Bring out the best in each other
Nursing Strategic Plan
A new, collaborative and comprehensive nursing strategy and work plan was developed and implemented in fiscal 2006-2007 to elevate and respond to the issues and opportunities for nurses and nursing across the NHS. Central to the strategy and work plan was the development and adoption of a vision for NHS nursing, Inspiring leadership and excellence in nursing through living the values and sharing the knowledge. Prepared for the present - challenging the future. More than 300 NHS nurses were directly involved in developing this vision – a truly collaborative effort. The division of nursing has also developed a nursing philosophy statement and has adopted a professional practice model as part of a further evolution of the nursing strategy at the NHS.
Critical actions underway as part of the nursing strategy and work plan include:
- Selection of a model of care: adoption of RNAO patient/client-centred care model of care and integration of this model of care with the allied health-care professionals to enhance collaborative interdisciplinary teamwork among all health professionals;
- Focused attention on developing and sustaining nursing leadership within the organization though education to the NHS Charge Nurses as part of the Healthy Workplace Initiative, modification to the Nursing leadership meeting format to include monthly leadership development and sponsor nursing managers to attend the Dorothy Wyllie Institute;
- Working with Human Resources to address nursing recruitment and retention issues; secured funding for the New Grad and Late Career initiatives, in partnership with regional partners secured funding for interprofessional mentorship development, and have begun a project to examine base-line staffing across the clinical programs;
- Enhancement of quality of patient care through adoption of the new model of care and the implementation of best practice guidelines and together with Organizational Development working to create a supportive workplace environment. In addition to the above projects and strategies, the division of nursing has revisited and revised the terms of reference and membership of its functional committees to ensure these committees support nursing and professional practice. And lastly, during the Nursing Week celebrations, a new image and logo for nursing at the NHS was revealed and launched.
Organizational Stability
» Recruitment and Retention
It is well known that the shortage of health-care professionals is already being felt not only locally, but provincially, nationally and internationally. With limited human capital (demand outstripping supply), the need for a comprehensive NHS human resources strategy cannot be overstated as all health-care facilities enter the "War on Talent."
Significant work was undertaken in 2006-07 to create a people strategy to attract, select, develop and retain the best so that care can be provided to the residents of Niagara by the right people, with the right skills, at the right time, in the right place.
As part of this, a comprehensive workforce planning analysis was completed by NHS Human Resources this past fiscal year as one part of an overall human resources strategy. The workforce planning analysis identified the need to develop comprehensive response plans for a number of program/clinical areas such as Perioperative, Maternal/Child, Mental Health and Transitional Care. In the service areas, the departments most in need of immediate workforce recruitment plans include Hospitality, Engineering, and Laboratory.
» Healthy workplace initiatives
NHS undertook a comprehensive approach to responding to the findings of the 2003 Healthy Hospital Survey. As part of an ongoing commitment to further transform the workplace, the 2007 Employee Feedback Survey has been launched. The 2003 survey findings indicated that there was much to do if indeed the NHS was to transform itself and achieve the designation as both an employer and provider of choice. Key areas of focus that came out of the original survey upon which response plans were developed and implemented include: Leadership Performance; Quality of Worklife; Workforce and Replacement Planning; Health Promotion and Illness Prevention; Safety and Injury Prevention, Recruitment and Retention. It is our expectation that the results of the 2007 survey will further inform and advance the development and effectiveness of future HR planning.
Build strong and successful relationships
LHIN Partnerships
Exceptional involvement was achieved through 2006-2007 by NHS representatives serving on a broad cross section of LHIN 4 hospital and community sector committees. Throughout the year, NHS demonstrated that it is highly engaged in the development of our local LHIN, positioning us well to represent the best interests of our patients and the communities we serve here in Niagara.
Create a better way
Quality Framework
Patient safety and quality improvement are areas of critical importance to the NHS.
A new Quality Framework was created and put in place for the NHS this past fiscal year. The Quality Framework is an integrated means by which our organization undertakes standardized and coordinated reporting, monitoring and improvement of quality across all sites, programs and services. A key element of the Quality Framework is the establishment of a Quality Council to oversee the process of quality monitoring and improvement. The Quality Council has established a number of 'Mission Critical' quality indicators to be monitored in the coming year. In addition, the various clinical programs have identified program-specific indicators to monitor. The following list represents a sampling of the 'Mission Critical' indicators:
- Patient falls
- Infection rates
- Medication adverse events
- Complaints and compliments
- Patient satisfaction
- Security – incidents of violence
- Patient ID bracelet breaches
The Quality Framework has received positive endorsement by the Canadian Council on Health Services Accreditation (CCHSA) at its recent survey visit. Education on the roles and responsibilities of the various committees and programs identified in the framework has been provided to staff and physicians. The role of a Quality Facilitator has been created to support the implementation of the framework and the education of the various programs and teams. In addition, PEERs within the various departments are being utilized as a 'resource' to provide education and support for the Quality Framework within the various departments.
Use our resources wisely
Organizational Stability
Preparedness is a central theme across the NHS and through the past year tremendous work has been done in the area of pandemic planning. An excellent working relationship has been established between NHS and the Niagara Region as lead agencies for pandemic response, and with collaborative partnerships with key agencies in place, this past year a framework for pandemic planning was developed based on the Incident Management System. With the groundwork in place and the development of the first draft of the NHS Pandemic Plan, this living document will be advanced through 2007 and 2008 with continuous modification as information becomes available.
» Patient Safety, Enterprise Risk and Financial Enterprise Risk Management
NHS is continually striving to improve quality and patient safety and is a full participant in a number of national and provincial initiatives that aim to improve patient quality outcomes and experiences across the hospital sector. Through this past year under the Risk Management portfolio, NHS moved towards a comprehensive proactive approach to enterprise risk management by taking part in the HIROC (Health Insurers Reciprocal of Canada) risk survey. The findings of the survey will serve as a cornerstone to a well developed and pro-active enterprise risk management program for our organization.
Under the leadership and humanity of our Board of Trustees, NHS took bold actions in 2006 -2007 to contend with the unrelenting pressures resulting from the shortage of long-term care beds available in communities across the region and alternate level of care patients residing in hospital acute and chronic beds as a result of the significant shortfall of beds in community settings. More than $4.5 million was allocated to cover the cost of opening up a number of unfunded in-patient beds at our various sites to help relieve the patient gridlock experienced in our five emergency departments and across the full spectrum of in-patient clinical areas. As was the case this past year, ongoing advocacy across all levels of government at a LHIN level continues towards finding appropriate, immediate and longer-term solutions to these bed pressures.
» Reduce overtime
The nursing shortage in particular had a significant impact on the cost of operations in fiscal 2006-07. The hospital continues to focus on vacancy reduction strategies to address the overtime issue. Efforts continue to find effective and innovative ways to manage overtime pressures, including the conversion of part-time to fulltime positions.
» New Health-care Complex
We have celebrated a number of significant milestones in the planning for the new health-care complex, and, in doing so, have seen our municipal leaders in Niagara come together to support this vitally important cause.
Most recently, together with our local government partners we achieved great momentum in securing $60-million of the $100-million local community share for the project, receiving unanimous support from the City of St. Catharines, the Regional Municipality of Niagara, the City of Thorold and the Town of Niagara-on-the-Lake to finance the project.
Before a capital hospital project can be approved by the province to go to tender, commitment is required from the local communities that they will support their portion of the local share. Timelines are extremely tight, and we remain on target for the province to release the Request For Proposals to the short-listed project teams in summer 2007. Site plan approval by the City of St. Catharines is expected to be complete in July as well.
We have held a number of community open houses to share with the public our progress on the planning for the complex and seek feedback on our plans to date. Additional open houses will be held across the region throughout the summer, and the Project Management Team is committed to engaging the public on a continuing basis throughout the planning process.