[Quality Improvement Plan]

Transcription

1 [Quality Improvement Plan]

2 Ornge is pleased to submit this 2012/13 Quality Improvement Plan. This is Ornge s first annual QIP, as part of our agreement with the Ministry of Health and Long- Term Care. It lays out the organization s priorities for quality improvement. Our mission is to provide high quality air ambulance services to Ontario patients. Our commitment, shared by more than 600 Ornge employees, is to put patients first and to be there, wherever we are needed, for the people of Ontario. Our mandate is to provide year-round, 24/7 coverage to calls we receive. Each call we receive in our Operations Control Centre requesting service is answered and the most appropriate action is determined between the communications officer and requester. In the average month, about 70 per cent of the patients we are called about are transported by one of our aircraft, critical care land ambulances and standing agreement carriers. Of these calls: Approximately 93 per cent are inter-facility transfers, which were confirmed within 20 minutes 96 per cent of the time from October to December 2012; and 7 per cent are scene calls, which were confirmed within 10 minutes 90 per cent of the time from October to December Of the 30 per cent of calls that are not serviced: Half are cancelled by the originator or EMS land crews One-third are cancelled because of changes to the patient s condition, duplicate bookings or other changes; 10 per cent are cancelled due to weather; 3 per cent are because Ornge vehicles are out on other calls; 3 per cent are due to staffing issues; and Less than 1 per cent are due to mechanical issues We strive to respond to all calls that need service, as soon as possible which is why we will continue to improve response times, resource availability, staffing levels and mechanical issues. Page 2 of 1 4

3 We are in the process of rebuilding Ornge, and it is an exciting and rewarding process. We have new leadership, and a knowledgeable new volunteer Board of Directors made up of individuals with wide-ranging experience in business, health care and government. The new directors are helping to improve the quality of our service and will guide the organization through the necessary changes to come. We also have an amended Performance Agreement with the Ministry of Health and Long-Term Care that requires stronger quality improvement measures and gives the Government of Ontario greater oversight into operations at Ornge. For more details on the performance agreement, please consult Appendix A accompanying this plan. Our plan sets out targets for improvements as well as justification for those targets. It links Ornge executive compensation to the achievement of those targets. It demonstrates our commitment to make this organization a model for accountability, transparency, integrity and high quality patient care in Ontario. We are taking action to ensure a bright future for our organization and a high quality air ambulance system for Ontario. Along the way, we will be providing Ontarians with regular updates on our progress. This quality improvement plan represents an important step on our journey. Page 3 of 1 4

4 About Ornge Ornge provides high quality air ambulance service and critical care land transport services to patients who are ill or injured. Ornge serves more than 13 million people living in a landmass that covers more than one million square kilometres, which is the size of France, Spain and the Netherlands combined. More than 60 per cent of Ornge transports happen north of Sudbury. Our employees include paramedics, paediatric transport paramedics, pilots, aircraft maintenance engineers, physicians, communications officers, researchers and corporate support staff, and we have the largest air ambulance fleet in Canada. Every year, we perform approximately 18,000 patient transports more than twice as many as any other province. The vast majority 93 per cent of Ornge transports are interfacility transports (including two per cent organ transports). Seven per cent of our calls are scene calls (i.e., landing at the scene of a medical emergency), and the remainder of the calls are for transportation of organ retrieval teams. Unlike emergency medical service providers, Ornge is not accessible to the public through 911. Our services can be requested only by hospitals, nursing stations or other healthcare facilities for interfacility transfers, and by local land ambulance dispatch centres for emergency scene calls. We would not be a successful air ambulance service without the support of our Standing Agreement (SA) carriers who provide services for our non-urgent patients. These SA carriers are on contract to Ornge and provide approximately 40 per cent of total patient transports each year, much of that in the north. Over the past year, Ornge has addressed the most important issues relating to patient safety. We are working to ensure that the experience of being transported by Ornge is as safe, comfortable and reassuring as possible. Page 4 of 1 4

5 Reflecting Patient Priorities Our agreement with the Ministry of Health and Long-Term Care requires us to develop quality improvement plans that reflect the views and opinions of patients. We are building an air ambulance service that directly responds to the needs of the people we serve. Ornge has surveyed approximately 8,500 patients since April In recent surveys, we included specific questions about what patients value most in our services. We used their responses to establish the top five priorities for Ornge patients, and these are the foundation of our first Quality Improvement Plan. The top five priorities are: Excellence in Medical Care Delivering the best possible care to the patients we are transporting. Highly Skilled Staff Behind the scenes with our operations control centre crew and on the front lines with our paramedics, we need people with world-class knowledge and skills. Safety We have an excellent safety record, both with respect to aviation incidents and on-thejob injuries and illness. We have introduced a safety culture and we will continue to improve on our existing record. Staffing and Transport Whenever and wherever a call for help comes, we want to have the right medical crew, right vehicle for transport and the appropriate level of expertise at the right time to move the patient. Urgency According to Patient Needs When there is a call for help, we need to be able to respond as quickly as possible. When it is a critical emergency, we need to be able to respond even faster. Once we had established our priorities for this Quality Improvement Plan, we developed initiatives that would contribute to improvement in these specific areas. Performance objectives were established, as well as the means for performance measurement. Finally, specific performance targets were set, and a reporting/monitoring plan was put in place. Page 5 of 1 4

6 Improvement Targets Excellence in Medical Care When we talk about excellence in medical care, we are focusing on two areas: clinical (the actual care) and environmental (the space in which our care is delivered). Objectives Clinical Care Maintain or improve current quality of care score of 90 per cent Environmental Care Have new interim interiors installed in 100 per cent of AW139 helicopters by February 2013 Clinical care at Ornge is measured using the Quality of Care Metric, a detailed review of care provided in eight key clinical areas 1, based upon evidence-based care or industry standards. Ornge s quality of care score, based on this metric, is currently at 90 per cent. Our target is to maintain or improve on our 90 per cent rating. Environmentally, Ornge is focused on improvement to the medical interior in the AgustaWestland AW 139 helicopters. The original layout in these helicopters made it difficult for paramedics to perform certain procedures effectively. An interim solution placed the stretchers closer to the floor during flight if the patient required those procedures. This solution required a special exemption by Transport Canada that was effective until February Currently, the new interim interiors have been installed in 100 per cent of the AW 139 helicopters. 1 cardiac, neurological, trauma, sepsis, paediatric, obstetrics, intubation, mechanical ventilation Page 6 of 1 4

7 Highly Skilled Staff There are two areas of focus this year: the Ornge Operations Control Centre (OCC) staff and frontline paramedics. Objectives OCC Training Ensure that 100 per cent of Ornge OCC staff complete new specialty training by March 31, 2013 Paramedic Education Ensure that 90 per cent of Critical Care Paramedics and Advanced Care Paramedics complete their 2012/2013 courses by April 30, 2013 Ensure that 100 per cent of Ornge paramedics complete their 72 hours of Continuing Medical Education (CME) training by March 31, Currently, the OCC operates in a generalist model where each Communication Officer assumes responsibility for all components of call-taking and planning. In the interest of quality improvement, the future direction is a specialist model with four categories of staff defined in the OCC: Medical, Flight Planning, Flight Following and Patient Transfer Authorization Centre (PTAC). New training programs have been established to ensure that consistent competencies are developed in these four specialty areas. Training is in process and our target is to have 100 per cent of Ornge OCC staff complete this training by March 31, Moving to a specialist model will ensure Ornge s human and aviation resources are organized more efficiently which will ultimately result in better care for patients. The second area of focus is paramedic education. Ornge employs Critical Care Paramedics (CCP), Advanced Care Paramedics (ACP) and Primary Care Paramedics (PCP), all requiring different levels of training and education. In order to become a PCP, individuals must graduate from an accredited paramedic training program available at several colleges. Historically, Ornge s training and education to get paramedics to the ACP and CCP levels has taken a long time to complete, which has affected our ability to staff our bases at the desired levels of care. We have redesigned programs and increased controls and coordination with the Ornge Operations department to speed the training and education process while maintaining the high quality of these programs. This year there are 12 paramedics training to become ACP level and nine paramedics training to become CCP level, our highest trained paramedics. This Quality Improvement Plan sets a target of 90 per cent of this cohort successfully completing their 2012/2013 courses by April 30, Page 7 of 1 4

8 Meanwhile, all of our paramedics must maintain their qualifications by completing 72 hours of Continuing Medical Education (CME) training every year. This Plan sets a target of March 31, 2013 for completion. To ensure full staffing at the highest level of care, we aim to have 100 per cent completion of Annual Continuing Medical Education (CME) for paramedics this fiscal year. It is also a requirement of the base hospital for paramedics to maintain certification. Ornge s Medical Advisory Committee determines the number of CME hours required of our paramedics. The current requirement is 72 hours each year and this is broken down by clinical shifts in hospitals, monthly online courses and 32 hours of in-class time with Ornge educators and physicians. Safety Our two areas of focus in this category are aviation safety and employee safety. Objectives Aviation Safety Reduce the number of aviation-related incidents from 0.19/100 flight hours to 0.17/100 flight hours Employee Safety Lower our injury/illness rate to 3.86, which is the provincial average. A standard measure of aviation safety is the number of incidents logged with the Civil Aviation Daily Occurrence Reporting System. These incidents vary from a bird strike or labour issue to a runway being out of service or unavailable. Our target for the coming year is to reduce the number of incidents from 0.19/100 flight hours to 0.17/100 flight hours. From April to December 2012, we significantly exceeded that target, with a rate of 0.13/100 flight hours. Ornge is committed to employee safety. While there are inherent challenges in the transport environment, Ornge has targeted 3.86 as the provincial Workplace Safety and Insurance Board (WSIB) average for Lost Time and No Lost Time injuries and illness rate. The WSIB average represents the average injuries over total number of covered workers in the province, called the LT/NLT rate. For Ornge the LT/NLT rate represents injuries over total number of employees. Ornge s current rate is 4.7 with ergonomic injuries continuing to be the highest volume of reportable incidents. Principles of Safe Lifting programs are being developed for medical and aviation staff. Additionally, Ornge has completed a workplace Hazard Assessment for all aviation staff and has just launched a new Employee Wellness program. Page 8 of 1 4

9 Staffing and Transport In order to have well-organized patient transport, our three areas of focus are pilot and aircraft availability, and paramedic staffing. Ensuring availability of all three requires a significant amount of complex planning and organization, but we have been successful. In the average month, about 70 per cent of the patients we are called about are transported by one of our aircraft, critical care land ambulances and standing agreement carriers. Of the 30 per cent of calls that are not serviced: Half are cancelled by the originator or EMS land crews One-third are cancelled because of changes to the patient s condition, duplicate bookings or other changes; 10 per cent are cancelled due to weather; 3 per cent are because Ornge vehicles are out on other calls; 3 per cent are due to staffing issues; and Less than 1 per cent are due to mechanical issues Objectives Pilot and Aircraft Availability Ensure that both pilot and first officer and aircraft are available Currently, from October to December 2012, we are at 97 per cent and 97.3 per cent respectively and will continue to strive for 100 per cent. Paramedic Staffing Ensure that each base has two paramedics with the designated level of care, even during off-service hours In January 2013, we reached this level-of-care target (i.e. two paramedics with the right mix of training and certification) 71.per cent of the time (63.9 per cent October to December 2012); our goal is to increase paramedic staffing and training to reach the target 75 per cent of the time by March 2013 and ultimately to exceed that target in future years. In order for Ornge to respond to requests for patient transports, our paramedics, pilots and vehicles need to be in a constant state of coordinated readiness. The air ambulance standards in Ontario are such that in order to fly either a helicopter or airplane, it is mandatory to have two pilots at all times: one captain and one first officer. Ornge has been successful in recruiting new helicopter and airplane pilots to the organization, and in October to December 2012, we were able to staff our aircraft at this level 97 per cent of the time. Actions put into place over Page 9 of 1 4

10 the past few months to accomplish this include recruitment to optimal staffing levels, as well as centralized scheduling to better coordinate paramedic and aviation resources. As well, there was 97.3 per cent base aircraft (helicopter and airplane) availability over the same three month period, which has been a goal for the entire Ornge fleet since March Paramedic staffing is more complex. As noted previously, Ornge employs three types of paramedics critical, advanced and primary care paramedics. Different combinations of paramedic crews are able to deliver different levels of care. For example, in a situation where a patient requires critical care, Ornge sends either two CCPs or one CCP and one ACP. For an advanced care crew, we need either two ACPs or one ACP and one PCP. Our focus for the coming year is to increase the number of available CCPs and ACPs, in order to meet any potential mission profile with greater frequency. In January 2013, we reached this levelof-care target (i.e. two paramedics with the right mix of training and certification) 71.3per cent of the time (63.9 per cent October to December 2012). Our goal, even though there are relatively few calls requiring critical care teams, is to increase paramedic staffing and training to reach the target 75 per cent of the time by March 2013 and ultimately to exceed that target in future years. Urgency According to Patient Needs We want to set and meet the new response times that have been established in the Performance Agreement they reflect the level of urgency for both interfacility patient transports and emergency scene calls. Objectives Patient Transports Provide confirmation of our ability to respond within 20 minutes of receiving call 95 per cent of the time Scene Calls Provide confirmation of our ability to respond within 10 minutes of receiving the call 100 per cent of the time Ninety-three per cent of the calls Ornge receives are for transports between facilities. A number of steps must occur before we are able to confirm our ability to service the call. These include: 1) The sending facility confirms a bed at a receiving facility. Page 10 of 1 4

11 2) The sending facility must obtain a medical transfer number through the Provincial Transfer Authorization Centre at Ornge. This process ensures the patient requiring transport has been screened for infectious diseases. 3) The OCC determines the best resource for the transport and then contacts the pilots at the specific base. 4) The pilot completes a weather check to determine if it is safe to fly to the sending facility or airport and also to the receiving hospital or airport. 5) If the pilot accepts the call, the paramedics are then given the patient information. 6) The OCC confirms with the sending facility or Central Ambulance Communications Centre the acceptance of the call and the estimated time of arrival. Our goal is to provide confirmation within 20 minutes of receiving the first call for an inter facility transfer. Currently, 96 per cent of the time we receive a request we are able to verify with the sending hospital within 20 minutes our ability to service the call. We have currently exceeded our target of a 95 per cent response rate. Seven per cent of our calls are scene calls, but these are usually emergency cases. Our goal in these cases is to provide confirmation within 10 minutes. In September and October 2012, we responded within 10 minutes 90 per cent of the time. Our target is to reach 100 per cent. Page 11 of 1 4

12 Overview of Performance Based Compensation for Executives At Ornge, we understand that we are accountable to the people of Ontario not only for the quality of the air ambulance services we provide, but also for the manner in which we deal with matters like executive compensation. It is important that we be open and transparent, and posting executive compensation is part of our commitment to providing more information to the public. The government is continuing to take action to manage compensation costs by proposing a pay freeze for executives at hospitals, universities, colleges, school boards and agencies for another two years. Ornge will be subject to the regulation to freeze executive pay. Our new Performance Agreement with the Ministry of Health and Long-Term Care also includes a requirement that executive compensation be tied to the achievement of performance improvement targets set out in the annual quality improvement plan. For fiscal 2012/13, with the development of a comprehensive quality improvement plan, Ornge executives will be measured against the targets contained within this plan. Ornge s Performance Based Compensation Plan is governed by the Board of Directors which determines the total funding available for performance pay each year. In addition, payments under the Plan are at the discretion of, and subject to the approval of, the Board of Directors. Page 12 of 1 4

13 Accountability Sign-Off We have reviewed and approved the Ornge Quality Improvement Plan and attest that it meets the spirit of the Excellent Care for All Act and meets the requirements of the amended Ornge Performance Agreement, March 2012 with the Ministry of Health and Long Term Care. Specifically, the Ornge Quality Improvement Plan: 1. Was driven by patient feedback 2. Provides annual performance measurement targets 3. Is linked with executive compensation 4. Was reviewed within the context of operational priorities and planning, as well as Ministry directions Ian W. Delaney Board Chair Barry McLellan Board Quality of Care Committee Chair Andrew McCallum President and CEO Page 13 of 1 4

14 APPENDIX A Amended Performance Agreement On March 19, 2012, Ornge and the Ministry of Health and Long-Term Care (MOHLTC) signed an amended Performance Agreement that set forth expectations for the future. Consistent with the spirit of the Excellent Care for All Act, introduced in June 2010 for all hospitals, the Performance Agreement for Ornge specifies: In every funding year, Ornge shall develop a Quality Improvement Plan for the next funding year and make the quality improvement plan available to the public, including posting it on its public website The annual Quality Improvement Plan must be developed having regard to at least the following: o o The results of the surveys Data relating to the patient relations process The annual Quality Improvement Plan must contain, at a minimum, o o Annual performance improvement targets and the justification for those targets Information concerning the manner in and extent to which Ornge's executive compensation is linked to achievement of those targets The Amended Performance Agreement can be found at: OHLTC_Ornge_March_2012.pdf Page 14 of 1 4