Model of Care Initiative in Nova Scotia. National Symposium on Integrated Care 10 October 2012

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1 Model of Care Initiative in Nova Scotia National Symposium on Integrated Care 10 October 2012

2 Overview Mandate Change Drivers Design of Collaborative Care Model Provincial Project Structure Evaluation Highlights Lessons Learned, Remaining Challenges

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4 Model of Care Initiative in NS Provincial Mandate To design, implement and evaluate a viable provincial model of care for Acute Care in-patient services that is patient-centered, high quality, safe, and cost-effective. Starting with medical surgical units

5 Change Drivers Population Health Status Fiscal Sustainability Health Human Resources

6 Inter-Departmental Expenses (estimates)($ thousands) source: NS Budget Estimates

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8 Why Change the Model of Care? If we continue to work with current policies and delivery models, the gap between health care needs and our ability to address them will grow Canadian Nurses Association The Next Decade: CNA s Vision for Nursing and Health September 2009

9 Provincial Design Team

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11 Goal of the Collaborative Care Model To provide high quality patient care in hospitals more efficiently by making the best use of staff knowledge, skills, and competencies, improving processes, and better supporting access to information and modern technology.

12 Travelers there is no path. Paths are made by walking. -Antonio Machado

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14 Communication - Senior MOCINS is a partnership of the Department of Health & Wellness & District Health Authorities (DHA) Through MOCINS Senior Advisory Committee communication occurs with, between, and across provincially organized operational, labour and regulatory groups. Council of CEOs - VPs Patient Services VPs Community - VPs Medicine VPs Operations - Senior HR Labour Relations Group NS Regulated Health Professions Network

15 Communication - Local MOCINS DHA/IWK Leads Key Roles Responsible for Local Roll Out of the Model Interprofessional Composition Varied levels of roles (Directors, Managers, Staff) Come together as a Provincial Network High level of commitment over a long time

16 MOCINS Timeline ( ) Phase 1 Implementation begins in 14 Medical Surgical Showcase Units Phase 2 Implementation expands to additional Medical/Surgical Units Phase 3 Implementation further expands to include Maternal- Child Units Phase 4 Peri-operative Services & Emergency Departments 2008/ / / /12 Provincial Standardized Role Development Began Model of Care Research Evaluation Completed (1 st 14 Showcase Units) Inter-professional Documentation Standards

17 Evaluation Highlights External Research Team Implementation of the model has resulted in better patient care and improved job satisfaction for health care providers, and provides significant potential to reduce health human resource shortages. Partnerships among the DHW and DHAs/IWK are critical and are making a difference for patients and families, health providers, and the system. Full report

18 Benefits of a Provincial Approach Efficiency, Effectiveness, Shared Learning Common role design at optimal scope Provincial approaches to education Coordinated stakeholder engagement Provincial research Effective change management in one health care system

19 Key Provincial Enablers Standardized Role Descriptions Building a Better Tomorrow Together- Interprofessional Education Nursing Role Optimization Education, Guidelines, Regulatory Frameworks Provincial Interprofessional Clinical Documentation Standards / One Patient, One Care Plan Research Evaluation Common Policy & Legislative Changes

20 Post Entry Nursing Education Supports

21 Remaining Challenges Ongoing scope of practice clarity for RNs & LPNs Acceptance of assistive roles Working hours of allied health care providers Operationalization of interprofessional practice Some gains in entry level preparation of providers, more needed. Shrinking budgets Competing system priorities Differing regulatory frameworks across health professions.

22 Lessons Learned The status quo is often comfortable. Change often isn t. Engage stakeholders early and often. First do no harm, and prove it. Second make things better, and prove it. Slow and steady wins the race. Someone's sitting in the shade today because someone planted a tree a long time ago. Warren Buffett

23 MOCINS Promising Practice

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25 Cindy Cruickshank Senior Advisor, Health System Workforce Branch, NS Department of Health & Wellness Beth Snyder Director of Interprofessional Practice, Annapolis Valley Health Authority

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