Lakeridge Health - CentralEastLHINcentraleastlhin.on.ca/~/media/sites/ce/uploadedfiles/... ·...

Excellence – every moment, every day

Strategic, Quality Improvement and

Performance Improvement Plan

Lakeridge Health


Who is Lakeridge Health?

• 3 acute sites with Emergency Departments

• 1 specialty hospital for complex continuing care and rehabilitation

• Specialty addiction and mental health services

• 4,000 staff and physicians • 1,200 volunteers

• Serve 1,600 patients/day • 559 inpatient beds

Slide 2


Leading in partnerships

Lakeridge Health

Thoracic (LHIN-wide)

Cancer Services

(LHIN-wide)

Code STEMI, Cardiac rehab

(RVHS – Cardiology)

HR, payroll, ALF, data centre, purchasing

(RVHS – Admin)

Train paramedics in

five regions Nephrology

(DRDN)

Vascular

(Peterborough)

Mental Health

(Five Counties)

Home first & GAIN

(LHIN-wide)

Slide 3


Our journey to quality

PCOP + Buildings

PIP

2008/09 2009/10 2010/11 2011/12

QIP

Financial recovery

MAC Quality Priorities

Regeneration

Oldest MRI in province

TP4

No LHW

Rising debt

Interim Balanced Scorecard

Balanced Scorecard

Slide 4

Strategic Plan


Our road to excelling in performance

Strategic plan

Quality Improvement Plan


2008

Strategic Plan 2011-16

Slide 5


Listening to our stakeholders

Comprehensive consultation:

+500 colleagues

41 partner organizations

1,500 community members

• 587 internal surveys • Focus groups in five locations • Online community survey

• 1,300 telephone polls • 41 HSP interviews • 5 internal task forces

Slide 6


Listening to our stakeholders

• Independent analysis of programs (SWOT)

• Consultation with CCO + CE LHIN hospitals (RVHS, TSH)

• Strategic task forces:

1. Academics

2. Health Human Resources

3. Information Management

& Information Technology

4. Revenue Generation

5. Rural Health

Slide 7


What we learned

Lakeridge Health is:

• Well-regarded by our communities

• Well-regarded provincially:

One of the top five cancer programs

One of the top three nephrology programs

One of the top integrated addiction services

A large acute tertiary critical care referral centre

4th largest community teaching program

Slide 8


What we learned

Over 90% of Lakeridge Health patients live in

Durham Region. In ten years…

• Total population will increase from 591,309 to 707,346

• Proportion of population age 65+ will increase from 11.7% to 15.9%

• Trend continues for 20+ years

Slide 9


Our Mission, Vision & Values

VISION

VALUES

MISSION


Creating and delivering a seamless system of care embracing every patient

Compassion Innovation

Courage Trust

Slide 10


Our Strategic Directions

• Enhance the patient and family experience

• Become the safest hospital in Ontario

• Develop provincially leading, integrated systems of care, along the continuum

OUR PATIENTS

Strategic Direction 1:



Slide 11



• Become the healthiest hospital workplace in Ontario

OUR COLLEAGUES


Slide 12



• Develop a satellite interprofessional health sciences centre

• Invest in leading facilities, equipment, technology and IT

• Enhance our financial capability to deliver

OUR ENABLERS




Slide 13


Our Strategy

• Establishing performance improvement targets and initiatives

• CE LHIN engagement: beds and buildings

• Regional engagement: buildings

• 2011/12 priorities and QIP designed to drive strategy

Slide 14


Strategic plan



2008



Slide 15



• Lakeridge Health drives many successful, quality initiatives

• QIP must:

Advance our safety agenda

Drive our strategic plan

Meet provincial and CE LHIN priorities

Be manageable

Build our capacity for learning and improvement

• Supports Board/Mgmt. philosophy

Slide 16


Quality Targets & Initiatives

Slide 17

• Reduce incidence of VAP (from 0.68 to zero)

• Improve hand hygiene compliance (from 72.2% to 86.1%)

• Hold central line infections (to 0.09% or less)

S A F E T Y • Become the safest hospital in Ontario • Become the healthiest hospital workplace

in Ontario

S T R A T E G I C D I R E C T I O N S



Slide 18

• Unnecessary deaths in hospitals - HSMR (hold to 92 or better)

• Reduce hospital readmissions (from 16.7% to 14.7%)

• Reduce % ALC (from 21.7 % to 20 %)

• Total margin to be zero or better

EFFECTIVENESS • Become the safest hospital in Ontario • Enhance our financial capability to deliver • Enhance the patient & family experience




Slide 19

ACCESS & PATIENT-CENTRED

• Enhance the patient and family experience

• Develop provincially leading, integrated systems of care, along the continuum


• Reduce 90% wait times in ED:

• Admitted (from 70.4 to 63.4 hrs.)

• Non admitted (hold at 6.3 hrs.)

• Mental Health (from 62.5 to 50 hrs.)

• Improve patient satisfaction:

• “Recommending (IP from 67.5 to 70%)

Lakeridge Health” (ER from 56.6 to 60%)


Current Results & Accountabilities

• Cancer: many targets > provincial

• Nephrology: one of 3 > provincial

• Wait times: overall positive

• H-SAA: overall positive

• Diagnostic wait times

• ER

• ALC

Slide 20

SUCCESSES:

CONCERNS:


Quality in Patient Safety

2009-10 Q2 50.00%

2009-10 Q3 77.20%

2009-10 Q4 73.90%

2010-11 Q1 71.80%

2010-11 Q2 67.70%

2010-11 Q3 71.60%

2010-11 Q4 85.00%

2011-12 Q1 87.70%

2011-12 Q2 70.0%

Hand hygiene

2008-09 110

2009-10 92

2010-11 87

HSMR

2009-10 Q2 4.42

2009-10 Q3 4.4

2009-10 Q4 1.18

2010-11 Q1 0

2010-11 Q2 1.63

2010-11 Q3 0

2010-11 Q4 1.03

2011-12 Q1 1

2011-12 Q2 0

VAP (LHO) Before Patient Initial Patient/Patient Environment Contact

+20.0%

-23

- 4.42

Slide 21


Wait times (monthly)

Cancer Surgery

Hip replacement

Knee replacement

MRI CT

Cataract Surgery

105 days

29 days

42 days

163 days

134 days

101 days

Note: Days are based on 2011-12 Q1 (provincial) and Q2 (Lakeridge Health)

61 days 127 days 189 days 210 days

92 days 36 days

PROVINCIAL WAIT TIMES (AVERAGE)

LAKERIDGE HEALTH WAIT TIMES

LAKERIDGE HEALTH

PROVINCIAL

Slide 22


FINANCIAL

Accountability indicators (H-SAA)

Slide 23

VOLUMES

ALC

REPEAT MH AND SA VISITS

READMISSIONS FOR CHF/COPD

ER LOS

WAIT TIME SERVICES

--

--

2

--

3

1

2

7

--

6

3

6

--

2

--

--

--

2

2 4 --

28

4

8

TOTAL


Quality Cancer Care • Unique features:

Management/services in other hospitals

A radiation machine in another hospital

• RCC/RCP targets: 41% exceed provincial targets

Slide 24

RADIATION SYSTEMIC SURGERY

July-June (2010-11)

WT Ref-Con (% w/in 14 days)

WT RTT-Tr (% w/in target)

WT Ref-Con (% w/in 14 days)

WT Con-Tr (% w/in 28 days)

WT (% w/in target)

Meeting or within 2% of

target, improved

Meeting or within 2% of target,

decreased


target, improved

Not meeting target, improved


target, improved


Strategic plan



2008



Slide 25


Performance improvement plan

Slide 26

CE LHIN & LAKERIDGE HEALTH CONCERNS:

• Emergency and ALC wait times

• Long-term care capacity

• Home First implementation (Oshawa)

• Administration and physician engagement

• ED PIP a challenge with consultants

Long-s tand ing p ressures o f g rowth and sys tem capac i t y con t r i bu te

to the p rob lem


ED & ALC Targeted Improvements

Fo

cu

s

Performance Indicator Baseline (2010

Calendar)

Target Q1 Actual Q1 2011-12

Em

erg

ency D

epart

ment

90th percentile ER LOS (LHO)

Admitted patients 77.1 61.5 75.10

Non-admitted high acuity patients

6.6 Maintain or improve

7.10

Non-admitted low acuity patients

4.3 4.0 5.17

ER LOS of admitted patients 80.10 61.45 75.10

ER LOS of non-admitted high acuity patients 6.82 6.60 7.10

ER LOS of non-admitted low acuity patients 4.48 4.0 5.17

Time to physician assessment 3.0 2.7 3.4

ALC

ALC-LTC volume (Corporate)* 60 60 100

New ALC designations 432

Total ALC designations 165

Slide 27

*ALC-LTC volume (Corporate) target reduction is based on the current ALC-LTC volume and does not include new ALC designations that occur after Q1 (That is we aim to reduce the Q1 ALC-LTC patients by 2 per month. This will not reflect if new ALC designations are present).


Performance improvement plan

Slide 28

OUR STRATEGIES:

• Operate within a quality framework

• Investment in Quality, Safety & Patient Experience Departments

• Improve physician engagement

• Rebuild patient flow as transition management team

• Implement meetings in addition to daily bed/flow meetings

• Reinforce principles of Regeneration the organizational transformation journey

• Delegate to program-specific leadership

• Open the right type of BEDS


Our targets (PIP)

Slide 29

ALTERATE LEVEL OF CARE:

• Working aggressively with CCAC to reduce # waiting

• Establish approval forum for each new LTC case

• Improvement target for ALC-LTC

• LTC: 100 in August; 91 in October; target is 80

EMERGENCY ROOM:

• Learning from ED PIP

• Increasing physician hours

• Speeding up transitions via seven-day model of care

• Target 10% improvement over 90 days (~ 68 hours)


Conclusion

• Lakeridge Health succeeding/leading in regional systems

• Continuing to partner to improve the system

• Building and capital challenges continue

• Emergency wait times proving to be challenging

Slide 30




Lakeridge Health

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