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Strategic Planning Environmental Assessment Sept. 12, 2016
Strategic Planning
Environmental Assessment Sept. 12, 2016
Timeline Overview
Learn From Our People
Learn From The Public
Organizational Direction
Strategy Formulation
Annual Implementation Plan
Scorecard Metrics
Completing Phase 1 (Feb.-Aug.)
Beginning Phase 2 (Sept.-Dec.)
Environmental Assessment • Surveying • Interviews • Workshops • Presentations
Environmental Assessment • Surveying • Interviews • Workshops • Presentations • Secondary research
Organizational Direction ½ Day Workshop Board & CEO-Driven, Senior Leadership Team Planning Task Force Reps
Strategy Formulation 1 ½ Day Workshop Board & CEO, Senior Leadership Team Planning Task Force Community Members Strategic Plan Developed
Annual Implementation Plan Target setting and Workplans set with Directors, Managers, Senior Leadership Team.
Cascading Scorecards
Evaluation - Ongoing
Feb.-Jul. Feb.-Aug. Sept. Oct. Oct.-Dec.
Our People, Our Patients...
100 People
participated in
coffee clubs
250 People helped
create external
survey
515 Staff responded
to internal
survey
65 Staff involved in
CEO Coffee
Hour
380 People
responded to
external
survey
35 People added to
our patient &
family
database
80 Internal people
participated in
SWOT sessions
= 1550 Input Opportunities
& more to come...
90 People invited
to Planning
Retreats
35 Internal Content
Experts
Consulted
Patient Demographics
District Acute Care Services
Pop. 129,111
30,717 km2
Regional Mental Health
Pop. 565,000
400,000 km2
44% of Ontario’s overall land mass
Compared to the Province,
NE Ontario has higher number of:
• Francophone (23%) and Aboriginal, First Nation,
or Metis (11%)
• Orphaned patients
• People who are smokers, obese, arthritic, diabetic
• People who have COPD, high blood pressure
• Senior population (20% age 65 and over)
• Patients with mental health and addiction issues
• People living in rural areas
Secondary Research Overview
The Task Force reviewed many documents to help inform the
discussion taking place today, on Oct. 6/7 and throughout
Implementation Planning.
Key documents include:
• Ministry, NE LHIN Plans and External Frameworks, Studies
e.g. NE Mental Health & Addictions Services Blueprint
• Strategic Planning Methodology and Comparator Hospital
Information
• Internal Department Strategic Plans, Master Planning and
the Integrated Risk Management System
http://intra.nbrhc.loc/Site_Published/intranet/StratPlan_Research.aspx
Aligning with Ministry
Patients First: Action Plan for Health Care
Improve access: providing faster access to the right care
Connect services: delivering better coordinated and
integrated care in the community closer to home
Inform: support people and patients – providing the
education, information and transparency they need to make
the right decisions about their health
Protect: protect our universal public health care system –
making decisions based on value and quality, to sustain the
system for generations to come
Aligning with NE LHIN
NE LHIN Integrated Health Service Plan
2016-2019 (ISHP)
Improve Access and Wait Times: Faster access to
services you need in shorter wait times
Increase Care Coordination: Connecting care across the
system to enhance patient-centred care
Strengthen System Sustainability: Protecting the
Northeastern Ontario health care system so Northerners
can receive quality care today and tomorrow
Primary Research Overview
• Conducted an Internal Survey and External Survey, as well
as numerous group and one-one-one qualitative sessions.
• Statistically significant data for both internal and external
• Broad sample representation
Internal survey
– Representation of MH and Clinical was fairly equal
– Representation from Physicians, Leadership, Managers
– 82% of respondents were Frontline
External survey
– representation mix between patients, family and service providers
and community stakeholders was good.
Ranking
Respondents were asked questions on a 4 point
scale (plus a Don’t/Know category) whether...
• 1=We really don’t do well in this area
• 2=We don’t do well in this area
• 3=We do well in this area
• 4=We do really well in this area
Low scores, indicate we don’t do as well in that area and may consider focusing on
it as part of the 2017-19 Strategic Plan.
High scores, indicate we do well in that area and perhaps we can leverage these
strengths when we think of strategies for the next Strategic Plan.
Internal Survey Analysis
LOWEST MEAN SCORES
Staff/Physician Wellness 2.33
Cultural safety training as part of onboarding orientation 2.40
Sensitivity training and education 2.48
Engage Others e.g. foster development in others, communicate effectively 2.59
Follow trends and use social networks 2.62
Physician/Staff recruitment 2.62
Discharge planning and transition to community 2.67
Safety trends are communicated and inform decisions at all levels 2.67
Staff/Physician involvement in safety 2.71
Use of technology 2.73
INTERNAL SURVEY
HIGHEST MEAN SCORES
Consistent use of evidence-based standardized safety practices 3.10
Safety orientation for new employees 3.06
Compliance regarding mandatory education e.g. NVCI, GPA 2.97
Communication about patient safety 2.96
Culture of continuous improvement 2.91
Patient engagement 2.90
Transparency about patient safety 2.90
Patient/Family needs are met. 2.89
Interprofessional collaboration 2.89
Awareness about the diverse cultures we serve 2.87
INTERNAL SURVEY
Regarding Patient and Staff Safety
AVERAGE SCORES ON DIMENSION
Staff/Physician Wellness 2.33
Safety trends are communicated and inform decisions at all levels 2.67
Staff/Physician involvement in safety 2.71
Pt/Family involvement (development & implementation of care plans 2.85
Compliance regarding mandatory education e.g. NVCI, GPA 2.97
Safety orientation for new employees 3.06
Consistent use of evidence-based standardized safety practices 3.10
INTERNAL SURVEY
Regarding “Cultural Safety” for our Patients
AVERAGE SCORES ON DIMENSION
Cultural safety training as part of onboarding orientation 2.40
Sensitivity training and education 2.48
Policies reflect the diverse populations we serve 2.85
Awareness about the diverse cultures we serve 2.87
INTERNAL SURVEY
Regarding a “Just Culture” (where we learn from safety events to improve)
AVERAGE SCORES ON DIMENSION
Policies reflect the diverse populations we serve 2.85
Understanding of human factor principles 2.85
Interprofessional collaboration 2.89
Transparency about patient safety 2.90
Patient engagement 2.90
Communication about patient safety 2.96
INTERNAL SURVEY
Regarding Leadership
AVERAGE SCORES ON DIMENSION
Engage Others e.g. foster development in others, communicate effectively 2.59
Achieve results e.g. align strategy, set direction and expectations 2.76
Demonstrate Systems/Critical Thinking
e.g. Support Continuous Improvement 2.78
Collaborative e.g. build partnerships and networks, politically astute 2.81
Lead Self e.g. demonstrate character, self aware 2.83
INTERNAL SURVEY
Regarding Innovation and Growth
AVERAGE SCORES ON DIMENSION
Follow trends and use social networks 2.62
Proactive approach to problem-solving e.g. Ask what if? 2.77
Learn from peers and other industries 2.77
Idea generation is encouraged 2.82
Understand how patients use our services 2.85
Patient/Family needs are met 2.89
Culture of continuous improvement 2.91
INTERNAL SURVEY
Regarding Quality and Availability of Services
AVERAGE SCORES ON DIMENSION
Physician/Staff recruitment 2.62
Discharge planning and transition to community 2.67
Use of technology 2.73
Evidence-based Models of Care e.g. Hospitalist 2.74
Partnership with community providers to find efficiencies 2.75
Coordination of care plans for patients with complex needs 2.76
INTERNAL SURVEY
Improving Pride in Our Organization
INTERNAL SURVEY
Qualitative Internal Themes
n=569
INTERNAL SURVEY
Select Quotes
“I think that my team has found it stressful
trying to keep our performance...while having
less staff/capacity”
INTERNAL SURVEY
Staffing & Balance
Staff Respect & Support
“Trying to help all members realize that
this hospital does work without every
member involved. Everyone should be on
a level playing field and every time
member should feel respected by others.”
“When you nurses feel heard and
respected the pride in the
organization will blossom.”
“Not consistently communicating with all
stakeholders who need involvement in
decision-making.”
Training & Quality
“There is no education or recognition
of diversity. No sensitivity training for
working with diverse populations...”
Community Engagement
“Listen to community concerns, work
together to come up with a solution...”
“Active promotion of good news
stories...”
Funding & Government
“Insufficient support systems in the
community, inappropriate
housing...increase in senior citizens.”
INTERNAL SURVEY
“Fiscal restraint will always be an issue, but
at some point need to invest - way behind
in our technology for patients and for
employees’ ability to do their job.”
“Transfer of information poorly done. We
are way behind in our technology.”
Discharge & Flow
“Hospitalist GP model, physician lead to
make others accountable especially with
bed pressure ie; discharge orders”
“Pharmacy Hospitalist to facilitate medical
care and expedite discharges.”
“Before elderly patient is discharged make
a face to face appointment with the
family/caregiver. it would improve
communication and cut down on re-
admissions.”
Internal Communication
“Greater transparency of actual and
projected goals”
“Have a very clear focus and wrap all our
initiatives around it. Communicate that
focus consistently.”
Technology
“Family and Friends involved in treatment
planning from the beginning...”
“I think patient/family involvement is
important and can help us understand
their care through the Health Centre.
However, it needs to be meaningful and
not just a token representation to get a
checkmark.”
Patient/Family Involvement
INTERNAL SURVEY
Positivity & Celebrations
“We can continue to inspire pride in
staff by increasing recognition to
individuals...”
“There are many positives that I can
say occur everyday, but they have
been masked by the challenges that
all staff have been facing recently.
There is hope for all to pull through
these changes, learn from it, be
stronger for it, and benefit those we
provide quality care to.”
“Perhaps sharing the good, positive
events (and there are many I am sure)
would promote pride both internally
and externally.”
Seniors
“Mindfulness practice for seniors ACTT
team approach for seniors Counselling
services for seniors who suffer from
depression which is very rampant More
Preventative strategies to prevent acute
care”
“Tsunami of seniors needing services to
stay in their home as long as possible.
This is what most seniors want and it is
more cost effective than in hospital
services.”
“Offer more in-home services for
seniors”
“Expand and support current and new
geriatric support services.”
External Survey Analysis
LOWEST MEAN SCORES
Behavioural/Dementia supports 2.33
Providing seamless continuity of care from hospital to home 2.35
As a patient, my information was adequately shared between providers to avoid having to repeat it 2.43
Engaging families, patients and communities at transition points of care 2.43
Geriatric services 2.48
Helping seniors stay at home 2.54
Information provided during transition from hospital to community was frequent enough 2.54
Identifying patient journey gaps 2.55
Addressing patients with multiple medical conditions 2.55
Coordination end of life care or the "Western Doorway" as it's called in indigenous cultures 2.59
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
HIGHEST MEAN SCORES
Information was provided in my preferred language at all points of care 3.43
Patient safety 3.03
Patients' essential needs are met 2.97
Quality care to patients 2.95
Indoor spaces at the Health Centre promote wellness 2.92
Outdoor spaces at the Health Centre promote wellness 2.89
Information provided during hospital stay was clear 2.86
Ensuring respect for patients and family members 2.84
Involving patients in their care 2.81
Access to traditional health and healing services 2.77
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Regarding Coordination of Services
Providing seamless continuity of care from hospital to home 2.35
Engaging families, patients and communities at transition points of care 2.43
Coordination end of life care or the "Western Doorway" as it's called in indigenous cultures 2.59
Clear roles and responsibilities between hospital and community health providers 2.67
Hand-off of care needs between health providers 2.69
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Regarding Services for Seniors
Behavioural/Dementia supports 2.33
Geriatric services 2.48
Helping seniors stay at home 2.54
General supports for seniors and caregivers 2.64
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Regarding Understanding Patient Needs
Identifying patient journey gaps 2.55
Addressing patients with multiple medical conditions 2.55
Understanding of diverse populations and their cultural needs 2.74
Involving patients in their care 2.81
Ensuring respect for patients and family members 2.84
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Regarding Communication needs
As a patient, my information was adequately shared between providers to avoid having to repeat it 2.43
Information provided during transition from hospital to community was frequent enough 2.54
Information provided during transition from hospital to community was clear 2.62
Information provided during hospital stay was frequent enough 2.71
Information provided during hospital stay was clear 2.86
Information was provided in my preferred language at all points of care 3.43
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Regarding Cultural Safety and the Human Connection
Patients' and families' holistic, physical, mental, emotional and spiritual needs are met 2.73
Awareness of cultural safety with staff 2.75
Access to traditional health and healing services 2.77
Outdoor spaces at the Health Centre promote wellness 2.89
Indoor spaces at the Health Centre promote wellness 2.92
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Regarding Quality of Care
Patients without a family doctor receive good quality care 2.65
Quality care to patients 2.95
Patients' essential needs are met 2.97
Patient safety 3.03
AVERAGE SCORES ON DIMENSION
EXTERNAL SURVEY
Qualitative External Themes
n=400
EXTERNAL SURVEY
Select Quotes
“intake...to admission...to unit bed...I was
amazed to hear the same questions being
asked of my friend 3 times...”
“Each nurse I saw in Emerg, I had to re-explain
my injury, my medications etc. When I was
admitted to the surgical floor, some of the
nurses were not aware of my ongoing
medications...”
EXTERNAL SURVEY
Clinical Communication
“People are sent home too soon and there
are not enough nurses to properly take care
of patients”
“The amount of work load on the orthopedic
surgeon seems to be too high. The doctor
seemed exhausted... Doctor and staff are
doing a fantastic job but seem to be spread
too thin.”
Staffing & Balance
“intake/Triage in Emerg – there is
absolutely no privacy...”
“Addiction and mental health training
for emergency room.”
“Better training related to cultural
safety specifically with indigenous and
francophones”
“Sometimes it takes a long time to
answer the call bell.”
“Do a third-party qualitative
assessment of emerge staff. The
registration/triage staff are consistently
rude, cold, frustrated, completely
unwelcoming.”
Training & Quality
“... Improved communication... with general
public & service providers would be beneficial
to creating an "informed" and better aware
community.”
“I think you are doing a good job, though job
cuts and the reported treatment of nurses'
concerns reported in the Nugget are worrying.
We want to be proud of our hospital!”
EXTERNAL SURVEY
Community Engagement
“The government needs to support this better
financially”
“...the NBRHC cannot improve anything on its
own. The local LHIN seems to have most of
the power, lots of the money, but not much
insight into the needs of our communities.”
“The continuity is better if patients have family
doctors who are involved in their hospital care:
this is an area that needs to be better
supported by the government.”
Funding & Government
Discharge & Flow
“Information not great upon discharge.
Closing the gap between health service
providers in the community and
hospital. Service providers require
significant changes as communication
(lack of) is affecting patient care and
experiences with NBRHC....”
“Improved discharge planning and
supports for transitioning out of hospital
is much needed. Most people do not
want to be in hospital, but in order to
live safely and with dignity out of
hospital, they/and their care
providers/family members require
supports.”
“More assistance at discharge -
sometimes feel very helpless and that
no one cares.”
“Develop better communication paths
between doctors and for staff. May mean
using technology..”
Technology
EXTERNAL SURVEY
“I didn't feel as involved in my care as I
would have liked and that made me lose
trust.”
“Involving family members and having
everything set up before the patient leaves
the hospital is important.”
Patient/Family Involvement
“I have heard very negative things
about the lack of accessible doctors
available, particularly in mental
health...”
“As a provider, I do question what the
quality of care and safety might be for
our mental health patients coming in
from the James and Hudson Bay
region”.
Mental Health & Addictions
Services
Seniors
“Seniors are extremely fearful about their
future hospital and community services
being inadequate in their time of need.”
“Care maps and pathways/options/
services available for seniors could be
provided to patients in written format
that clearly show what is possible when
transitioning back home...”
Summary – Areas of Focus Qualitative Themes Quantitative – Lowest Means
Legend: Internal Data (Green) External Data (Purple)
1. Clinical Communication (20%) • As a patient, my information was
adequately shared between providers to
avoid having to repeat it
• Information provided during transition from
hospital to community was frequent
enough
• Coordination of end of life care “Western
Doorway”
2. Staffing and Balance (19% 11%) • Physician and Staff Recruitment/Retention
3. Staff Respect & Support (15%) • Staff/Physician Wellness
4. Training & Quality (12% 14%)
• Cultural Safety/Sensitivity* Training,
Staff/Physician Involvement in Safety
• Identifying patient journey gaps
5. Community Engagement (11% 5%) • Follow Trends and Use Social Networks
6. Funding & Government (6% 4%)
INTERNAL & EXTERNAL SURVEY
*Note: Cultural Competency is the accepted term
Summary – Areas of Focus Cont’d Qualitative Themes Quantitative – Lowest Means
Legend: Internal Data (Green) External Data (Purple)
7. Discharge & Flow (6% 12%) • Discharge Planning and Transition to
Community
• Providing Seamless continuity of care from
hospital to home
8. Internal Communication (6%) • Safety Trends are Communicated and
Inform All Decisions at All Levels
9. Technology (6% 1%) • Use of Technology
10. Patient/Family Involvement (6% 8%) • Engaging families, patients and
communities at transition points of care
11. Positivity & Celebrations (4%) • Engage Others - foster development,
communicate effectively
12. Seniors (3% 8%) • Behavioural/Dementia supports
• Geriatric Services
• Helping seniors stay home
13. Mental Health & Addiction Services (5%) • Addressing patients with multiple medical
conditions
INTERNAL & EXTERNAL SURVEY
Next Steps Strategy Formulation Stage and Preparing for Implementation Planning
1. Sept. 19-28 Testing - Communications Team and Task Force will refine
ideas from the Board session on Mission, Vision, and Values statements and test them with staff (test group was established through strategic planning process)
2. Sept. 22 Position Papers Completed - Task Force meetings with internal content experts on the main themes arising from the data to create “SBAR Position Papers”. These will inform changes to the “Directions”, “Clarifying Statements” and “Core Concepts” at the Strategic Planning Retreat Oct. 6/7
3. Oct. 6/7 Strategic Planning Retreat
4. Oct. 11-Nov. 7 Implementation Planning – “Hold the Date” meeting invites will be sent to VPs, Directors, Managers and key
stakeholders to block time to build the plan’s objectives and tactics. 5. Nov.-Dec. Strategic Plan Approval
– Nov. Board meeting - Final approval of Mission, Vision, Values and Draft Strategic Plan
– Dec. Board meeting - Final approval of 2017-19 Strategic Plan, including Implementation Plan for 2017-18.
