Beyond the Big Six Alberta Health Services Innovative Approach for Improving Access to Scheduled Services

Transcription

1 Beyond the Big Six Alberta Health Services Innovative Approach for Improving Access to Scheduled Services Grace Bole-Campbell Director Path to Care Leading Access Practice BSc, MBA, CHE

2 Alberta s Issue Albertan s identify access to health services as their number one health concern. Historically, wait time measurement and management focused on retrospective wait time reporting of a few key measures: 1. Hip & Knee Arthroplasty 2. Cataract Surgery 3. Coronary Artery Bypass Graft Surgery (CABG) 4. Radiation Therapy 5. Community Children s Mental Health 6. Continuing Care Living Options 2

3 Alberta s Solution: A Program Developed to Tackle Access Issues Building from 10 years research and development of leading access practice, Alberta has embarked on a broad-reaching initiative to improve access to all scheduled services. This initiative is known as Path to Care 3

4 To Solve the access puzzle In order to manage equitable access, appropriateness criteria and benchmarks must be developed for services (based on population/diagnosis and/or urgency). Appropriate access: in primary care paving smoother highways into specialty care preventing people from using ED as the entry point into the health system Are patients receiving the right service at right time for their unique diagnosis & urgency? Are they at the right place? Are they seeing the right person? Define the access goal, measure & improve The Challenge is how do you do this when scheduled services = clinics across Alberta? 4

5 A Multipronged Solution is Needed Develop a Foundational Policy Implement Policy Automate Evaluate Smaller Scope: Performance Measurement Shift acats (Adult Coding Access Targets for Surgery) Broader Scope: Path to Care: Leading Access Practice Provincial Referral Pathways Using current IT resources (Scheduling Systems, Alberta Referral Directory) Enhance these resources Develop & Deploy ereferral 5

6 Start with a Policy The policy looks at the foundational components of healthcare: Who needs to see who? How long is it taking? How long should it take? Unlike building a house from scratch, we are repairing the cracks in an existing foundation. For many scheduled services, determining appropriateness and creating target times was never a consideration. In the beginning, it probably wasn t necessary. But now with growing demands on healthcare, we need to take a closer look and begin answering these questions. AHS Level 1 Policy Wait Time Measurement, Management and Reporting for Scheduled Services Referral standardization and automation and the consistent, use of accurate wait time data is. foundational to improving appropriate access and patient outcomes 6

7 Implement the Policy in Small Bites acats adult Coding Access Targets for Surgery : Diagnosis and urgency based access targets for surgery Creation of 3900 clinically adjudicated diagnosis and urgency based access targets Quality data that is comparable across hospitals that demonstrates percentage of surgeries (by specialty) completed in and out of window Ability to prioritize waitlist based on access targets Standardized surgical waitlists across 63% of surgical services within 2 years time Wait list cleanup across all project sites 7

8 Implement the Policy in Small Bites Performance Measurement Shift: Removing Patient Unavailable Time from Reported Wait Times Process Focus on was on big six 18 months of work to implement provincially Technology changes Business process changes Extract & reporting standardization Enablers Finding right people then working up the chain Ensuring leadership awareness and buy in Establishing a target date and sticking to it Structure Small tri-weekly working groups (x 6) over a year Monthly Leadership meetings with whole group Embedding Path to Care Senior Access Leads 8

9 Then Go for the Gusto! Goals of Path to Care: Referral Management Create a consistent referral experience no matter where the patient is in the province Wait Time Management Develop a standardized approach to how we measure wait time in the patient journey Measurement and Reporting Identify where delays occur in the patient journey and make changes to improve patient access 9

10 How Do You Scale to 5000 Scheduled Services? 10 The Path to Care Program codifies leading access practice and hosts this information on an online

11 How to Bridge the Gap Between Policy and Online Learning The Access Assessment Tool (AAT) 3 assessment areas: Referral Management Wait Time Management Measuring and Reporting Helps scheduled services understand/evaluate current clinic processes (self assessment) Identifies opportunities for improvement Directs clinics to specific Path to Care resources based on results Aggregated results available for program/site level Creates a benchmark to measure progress against 11

12 ... Use AAT to Monitor Progress, Help to Design Implementation Streams & Content 12

13 Tackle Referral Standardization Across Pathways... Stages of Referral Development 0. Variable Referral black hole Lack of standardization Difficulty navigating the system 1. Standardize Standard processes Information requirements, Triage categories Service response times, 2. Automate Tracking of referrals Service matching Transparency Patient choice Wait time capture 3. Intelligence Automated clinical decision support Coordinated events Dashboards Handoffs & Triggers 13

14 ...And Develop Provincial Referral Guidelines Review & Revise Guideline Publication Adoption & Evaluation Clinical Champions Roadmap Assessment Process Provincial Standards is the foundation for referral pathway automation Reduce variability Reduce the number of forms Establish a service inventory to improve navigation Establish a common referral experience, irrespective of reason for referral 14

15 Automate Using Current Technology... Saves Time... Saves Money... 15

16 Across Scheduling Systems... Short Term Leverage existing capability with low investment: Train on existing capability for wait list management to increase adoption Joint presentations for new installs New reports not requiring system upgrades Adding data elements to drop down menus etc Long Term Enhanced capability requiring new investment Enhance existing systems for more comprehensive wait time functionality Develop provincial report templates in each system Direction contingent on bigger IT roadmap (ereferral expansion, Clinical Information System for Edmonton/Province) 16

17 17 Path to Care translates Policy Requirements as they relate to current IT capability - both on the Online Learning Resource as well as in the form of learning supplements.

18 ...And Form Partnerships With Other Important But Lesser Known Tools Like the Alberta Referral Directory Centralized, searchable, webenabled (for physician associated clinics/programs) AHS staff can access directly through Insite or Netcare Primary Care can access through Netcare Submission form available on ARD website 18

19 To Ensure Sustainability, Provincial Access Reports Are Being Developed Using leading access research and stakeholder engagement Result - Provincially adjudicated templates for: Wait time management reports (retrospective) Wait list management reports (prospective) Business process reports (i.e. Number of inappropriate referrals, number of no shows) 19

20 Automating the Referral Process Will Allow Seamless Transition From One Provider to the Next Simple. Timely. Personal. Limited Production Roll Out Spring 2014 Lung and Breast CA Hip and Knee Arthroplasty The Alberta ereferral solution will Leverage Existing Infrastructure: Seamlessly Integrate within Alberta Netcare Portal (50,000 users) Utilize the same look and feel as the Alberta Netcare Portal Use existing Identity and Access Management Resources, Client & Provider Registry Link to Existing Clinical Repositories Provide a common platform across Alberta 20

21 Evaluate Everything Along the Way! Ongoing evaluation while implementing Process evaluation is important and allows program to coursecorrect along the way Outcome evaluation to verify that the work is The Alberta ereferral solution will Leverage Existing Infrastructure: Seamlessly Integrate within Alberta Netcare Portal (50,000 users) Utilize the same look and feel as the Alberta Netcare Portal making a difference Use existing Identity and Access Management Resources, Client & Provider Registry Link to Existing Clinical Repositories Provide a common platform across Alberta 21

22 All in All, Path To Care Will Help To Provide Data to Improve Access Quality & Transparency... From Uncertainty To Transparency I know what to do if I feel worse! What if they forgot? I m worried Why haven t I heard anything? How much longer? I m scared When will I know if I m okay? What should I do? I feel worse! I need to finish my radiation treatments first, then I ll have my surgery Even though I live in High Level, my operation happened in the same amount of time as my brother in Edmonton, who shares my condition I even had it in the same hospital that he went to! My specialist will call me with an appointment time in 2 weeks Okay, now that I know, I feel in control of my life Wow, that was fast! 22

23 ...And Provides Many Benefits Timely access Equitable access regardless of location Improved communication Choice: Next available or specific provider/location Greater transparency into expected wait time Assurance that referral is to appropriate service Wait time is used as action time for the patient 23

24 Thank You! Help yourself to the materials provided. We are always happy to share! To learn more about Path to Care, please contact: or pop us a line at PathtoCare@AlbertaHealthServices.ca 24