Sooner, Safer, Smarter: Transforming Surgical Care in Saskatchewan. Taming of the Queue Ottawa March 21, 2013
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1 Sooner, Safer, Smarter: Transforming Surgical Care in Saskatchewan Taming of the Queue Ottawa March 21, 2013
2 About the Saskatchewan Surgical Initiative Four-year timeframe: April 1, 2010 to March 31, 2014 Prompted by recommendations in 2009 Patient First Review Slow progress in reducing surgical waits 3-month surgery target modelled after NHS 18- week promise Simply doing more hasn t worked
3 What was different? Thinking and acting as one Emphasis on patient experience, quality, safety, access and sustainability Looking at every stage of the patient journey Health Promotion Prevention Primary Care Diagnostics Laboratory Referral to Specialist Pre-Op / PAC Diagnostics Laboratory Surgery Post-Op Recovery/ Ward Therapies Home Rehab
4 Thinking and acting as one Surgery delivered in 10 of 12 regions Varying use of OR capacity Pressures on in-patient beds in all regions Competition for resources
5 Thinking and acting as one Initial steps: Create shared ownership across regions and with providers and health care organizations System-wide targets built into RHA pay for performance And then came HOSHIN KANRI
6 Hoshin Kanri and visibility walls System leaders identify strategic priorities for system Staff across organizations engaged in developing implementation plans and annual performance targets Report and review results at provincial, RHA/Ministry, work unit For improvement, accountability, engagement Changing the culture
7 System-wide Hoshin Kanri plan
8 System-wide Hoshin Kanri plan
9 Provincial and regional performance targets Patients waiting for surgery over 18, 12, 6, 3 months Urgent cancer surgeries performed within three weeks. Wait time for cancer treatment (radiation/chemotherapy) completed Achievement of surgical volume targets by region Percentage of acute care beds occupied by patients awaiting longterm care placement Completion percentage of the surgical safety checklist. Completion of medication reconciliation on admission and discharge to acute care. Number of patient falls in hospital. Achievement of patient assessments in hip/knee, spine assessment clinics. Number of specialty practices using pooled referrals.
10 Saskatchewan: All Specialties: Number Waiting by Number of Cases Waiting at Month End ,796 18,946 14,092 8,315 4,789 29,350 18,244 13,118 7,233 4,138 27,591 16,643 11,386 5,648 2,952 26,476 15,798 Wait Time Colour Key (% change from: 31Dec2008 to 31Jan2013, 31Mar2 All (-29%, -27%) > 3 mth (-49%, -46%) > 6 mth (-62%, -58%) > 12 mth (-81%, -77%) > 18 mth (-94%, -90%) 27,417 31Jan Jan Jan Jan Jan ,277 16,284 15,986 10,571 10,672 10,429 5,021 4,848 2,527 2,235 4,156 1,724 25,979 13,445 8,210 3,049 1,008 21,718 9,232 4,751 20,102 8,218 4,185 1, Mar10 to current -27% -46% -58% -77% -90% Month End Dates (Data Source: 03Mar2013 refresh of the SK Surg
11 Surgical Safety Checklist
12 Provincial visibility wall
13 Corrective Action Plan
14 Ministry vis wall
15 RHA Vis-Walls
16 Department vis walls and Unit Daily Visual Management
17 Dozens of indicators covering patient satisfaction, surgical readmissions, public health, wait times
18 Using Data in Saskatchewan Surgical Patient Registry Saskatchewan Specialist Directory Measuring Wait 1 Pooled Referrals
19 Surgical Patient Registry
20 Saskatchewan Specialist Directory
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25 SASKATCHEWAN SPECIALIST DIRECTORY - UNIQUE VISITORS BY MONTHSeries Public launch of Directory June 7, 2010 Relaunch of Directory Sept 29, 2011 TV Commercial airs 2000 # Unique Visitors Median Jun-2010 Oct-2010 Feb-2011 Jun-2011 Oct-2011 Feb-2012 Jun-2012 Oct-2012 Month - Year
26 Measuring Wait 1 Most wait time measures focus on the last half of the patient s journey Wait 2 Wait 1 measures the wait time from primary care referral to the 1 st appointment with a specialist Problem we have the data but within it no way to know when the Wait 1 clock started for the patient Plan create a GP billing code to indicate that a referral was made Challenge 1) educating GPs to use the new code takes time, 2) some specialist s wait times are >12 months so it will take a long time for data to move through the billing system
27 Pooled Referrals
28 Department of Obstetrics and Gynecology Days for elective gyne referral to be seen A B C D E F G H I J K L
29 The Problem- Variation Distribution of Urgent and Elective Gynecology Referrals May % of all urgent and elective gynecology referrals were going to two specialists
30 What s the demand for service?
31 Impact of Pooling Referrals on: Patient choice in Ob/gyn
32 Impact of Pooling Referrals on: Patient choice in General Surgery
33 Impact of Pooling Referrals on: Wait times
34 Think And Act As One
35 Contact Information Mark Wyatt, Executive Director Saskatchewan Surgical Initiative Branch Saskatchewan Ministry of Health (306) Ron Epp, Senior Project Manager Saskatchewan Surgical Initiative Branch Saskatchewan Ministry of Health (306)
36 -surgical-initiative
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