Wait Times : A Quebec experience

Transcription

1 Wait Times : A Quebec experience Carolina Rossignuolo, BSc., MSc. (A) Program manager Communication Disorders Program Motor Developmental Delays Program Marie Enfant Rehabilitation Center CHU Ste.-Justine, Montreal, Quebec CAPHC Conference, Winnipeg, October 17,

2 Presentation Outline! Quebec By-law: Contextual setting! Quebec By-law: Access to services! Quebec By-law: Changes in the clinical practices! Quebec By-law: Some thoughts 2

3 Quebec By-law: Contextual setting AERDPQ:* " regroups 21 rehab establishments (physical disabilities and intellectual disabilities network) " promotes access to rehab services Reported : in 2007 " LONG WAIT TIMES " REHAB CENTERS: # Differences in access criteria # Differences in priorisation *AERDPQ=Association des établissements de réadaptation en déficience physique du Québec 3

4 Quebec By-law: Contextual setting $For WHOM? Provincial data* 8970 Individuals in need of rehab services 39% Children 3486 *AERDPQ AERDPQ,

5 Quebec By-law: Contextual setting QUEBEC HEALTH MINISTRY: Plan d accès " Introduced in June 2008 " Implementation in November 2008 $ WHY the by-law? Improve access to rehab services " To optimize organisation of services " To harmonize access management 5

6 Quebec By-law: Contextual setting Prevailing philosophy: $ Services continuum $ Shared responsibility $ Accountability for services delivery 6

7 Quebec By-law: Contextual setting $ WHERE does the by-law apply? For the paediatric services: Centers for special needs services " COMMUNITY LEVEL (CSSS) " Children with identified functional concerns " In need of assessments and early intervention Centers for specialized services " REHAB CENTERS " Children with persistent and significant developmental concerns " In need of specialized multi-disciplinary teams 7

8 Quebec By-law: Contextual setting HOW does the by-law apply to the paediatric rehab centers? $ HOW " ACCESS STANDARDS Maximun wait time period Priority Levels Age Category 8

9 Quebec by-law: Access standards (AERDPQ guidelines) Definition of priority level URGENT! Integrity and security is currently threatened.! Situation is critical.! Absence of an immediate intervention compromises development.! Natural environment cannot compensate beyond 72 hours. HIGH! Integrity and development present a risk of being threatened.! Absence of intervention within 3 months compromises development! Deterioration of the situation is predictable. MODERATE! Deterioration of the situation is not predictable.! Intervention is necessary. Maximum wait time Access to services within 72 hours Access to services within 3 months Access to services within 12 months Age category Any age group Children 5 years or less Children 6 years and older 9

10

11 Quebec By law: Changes at the MarieEnfant rehab center OBJECTIVES/CHALLENGES: " Reducing wait times " Improving services organisation " Improving services efficiency ACTIVITY : BRAIN STORMING " Where are we loosing time? " How can we be more efficient? " What about complimentarity of work? 11

12 Quebec By law: Changes at the MarieEnfant rehab center CENTERWIDE MEASURES PROPOSED: " Centralized Access (Access Agent)* " Centralized Booking " Flexibility of staff assignement " Professional productivity level " Increased clerical support 12

13 Quebec By law: Program Experience Contextual Setting: wait times in 2007 " Language Program =18 months " Motor Program =12 months Ultimate goal: application of the By-law " 5 years or less = access within 3 months " 6 years or older = access within 12 months 13

14 Quebec By law: Program Experience WITHIN EACH PROGRAM MEASURES TAKEN " Addition of human ressources " Changes in the clinical practices 14

15 Program experience: Changes in the clinical practices $ QUEBEC BY-LAW: " An opportunity to make changes " The changes were facilitated by: # A law which applies to all rehab centers # Supported by AERDPQ % Clinical projects :PNOT* % Innovation: Collaborative Approaches *Projet Novateur en organisation du travail 15

16 Program experience: Changes in the clinical practices In both Programs: " Increasing the number of group interventions " Increasing «break time» between intervention periods " Focusing on priorised client-centered objectives " Moving from complete to screening evaluations " Reviewing the clinicians caseload every 3 months " Reviewing the clinicians attendance to case discussions " Maintaining the focus with our rehab mandate GOAL= A greater flow of new clients 16

17 Program experience: Changes in the clinical practices $ LANGUAGE PROGRAM: " Collaborative approach (UNISSON) between the SLP and the technician in special education (TSE)* $ MOTOR PROGRAM: " Multidisciplinary group interventions GOAL= A greater flow of new clients 17

18 Program experience: Changes in the clinical practices PERSISTANCY of the changes? $ LANGUAGE PROGRAM: " The Unisson Approach is integrated in the SLP services " An emergence of a collaborative approach between the TSE and OT $ MOTOR PROGRAM: " The number of mutlidisciplinary group interventions have doubled 18

19 Program experience: Changes in the wait lists? Number of Clients on Wait List Number Year LANG MOTOR Number of Clients Served Number LANG Year MOTOR 19

20 Program experience: Changes in the wait lists? Wait Times Months LANG Year MOTOR 20

21 Access to services: What we can t control " Maternity leaves " Staff Retention " Sick leaves " Retirement " Budget " Number of admissions 21

22 2 years post Quebec By-law: Some thoughts 1st PHASE: $ How can we be more efficient and maximize our time? " Making clinicians aware of reduced access to services " Moving from Refinement to Function " Setting TX priorities according to social participation " Maximizing collaborative approaches 22

23 2 years post Quebec By-law: Some thoughts 2nd Phase: $ Maintaining the changes " Involving clinicians in the shared responsibility of increasing access to services " Marking the relevancy of the IIP " Ensuring that clinical activities reflect IIP goals " Determining end of Tx /follow-ups (guidelines) " Increasing parents empowerment 23

24 2 years post Quebec By-law: Provincial data* Rehab Centers Number of Individuals Year All Children *AERDPQ AERDPQ,

25