HSN BOARD MEETING MINUTES May 8, 2012 Cancer Centre Board Room 5:30 p.m. Open Session

Transcription

1 HSN BOARD MEETING MINUTES Cancer Centre Board Room 5:30 p.m. Open Session Voting Members Present: Boyles, Russ, Chair Everest, Nicole Byck, Peter Pitblado, Roger Spencer, Jean-Marc Fildes, Deborah Bald, Roberta Voting Members Excused: Marsh, Dr. David Non-Voting Members Present: Roy, Dr. Denis Bourdon, Dr. Chris Toffanello, Paul Petrovic, Stephen Sawyer, Patrice McCann, Mike Prpic, Dr. Jason Prudhomme, Rachel Zalan, Dr. Peter Non-Voting Members Excused: McNeil, David Staff: Pilon, Joe Lapointe, Viviane Petersen, Ben Watson, Rhonda Diaz-Mitoma, Dr. Francisco Recorder: Antoine, Sharon 1.0 CALL TO ORDER The meeting was called to order at 5:31 pm by R. Boyles in the chair. No conflicts of interest were declared. 2.0 Board Education 2.1 MRI Performance Improvement Project R. Boyles welcomed Tyler Speck, Administrative Director of Medical Imaging to the meeting and invited him to present on the MRI Process Improvement Project (PIP). The presentation served to inform members of the Board and the public of the process and outcomes of the LEAN Process Improvement Project undertaken by MRI staff and physicians at HSN. HSN s MRI has been considered a top efficiency performer since the service was initiated over 12 years ago. In 2011, given inconsistent MRI performance across the province, the Ministry of Health requested that all MRIs go through a LEAN PIP. The objective of the project was to maximize limited resources and improve access to MRI services for patients.

2 2 The project principles focused on process, working differently, patient centred care, collaboration and sustainability. Performance management and process optimization tools and infrastructure were provided to support and create a culture of continuous improvement. Staff and physicians participated in a value stream mapping exercise which entailed a comprehensive review of current processes, elimination of unnecessary steps and identification of major areas for improvement. The team outlined the structure and timelines for implementing solutions. The MRI booking process, schedule and patient flow on the day of the exam were streamlined, trialed and implemented as a new standard. Approximately 700 hours of staff time (technologists, management and administrative support staff) and $30,000 (consultants funded by the Ministry) were invested in the project. All aspects of change were driven by the staff with consultants and managers acting as facilitators. Outcomes of the MRI PIP: The overall wait time for an MRI procedure was reduced from 109 to 25 days; The revised scheduling template predicts access to an additional 40 patients per week (40 additional hours of scan time per week). The potential added capacity has given the MRI over $5000,000 worth of extra scan time; The MRI Department has undergone a shift to sustain continuous quality improvement; Weekly mini PIP meetings are held to review data and ensure they stay the course. T. Speck reported that imaging staff are extremely excited about this initiative and are looking forward to employing the PIP in all modalities; CT Scan is next. R. Boyles thanked T. Speck for his informative presentation. T. Speck was excused from the meeting. 2.2 Patient Satisfaction J. Pilon presented on Patient Satisfaction - the process, the results and how they are communicated throughout the organization. Under the Excellent Care for All Act, 2010 hospitals are required to conduct surveys to assess satisfaction with services, have a patient declaration of values and a patient relations process to address patient experience issues. HSN participates in the Patient Satisfaction Surveys available through NRC Picker- Canada. Inpatient areas surveyed include Medical, Surgical and Mental Health units; outpatient services include Emergency, Obstetrics, Surgical Day Care, Oncology, Pediatrics, Rehabilitation and Ambulatory Care. Each survey is comprised of 50 to 80 questions and measure 8 dimensions of patient centred care. Results are reported quarterly. Data is benchmarked against both Ontario best performing and provincial averages. For the most part patients are satisfied with their care at HSN; with the exception of the ED where patients are frustrated with the wait times.

3 3 The Patient Declaration of Values is posted on the HSN Website. The values were developed from a surveying that asked patients what they valued the most. There were 600 responses to the survey. HSN has a very robust patient relations process with two patient representatives who meet with patients that have a need to examine the care they are given and to improve their care. Feedback (complaints) data is collected through the patient relations process. There is an average of 1200 complaints received annually. The complaints are viewed as opportunities to improve care. The NRC Picker Survey results are shared with the Quality Committee and across the organization. The Quality Improvement Plan has identified the Improvement of the Patient Experience as one of its goals for APPROVAL OF MINUTES The minutes of the April 10, 2012 Open Session Meeting were reviewed and the following motion was presented: MOTION: P. Byck/J. M. Spencer THAT the minutes of the Board of Directors open session meeting held on April 10, 2012 be adopted as circulated. CARRIED 4.0 ENSURE PROGRAM QUALITY & EFFECTIVENESS 4.1 Report on Emergency Department Pressures R. Boyles invited Dr. C. Bourdon and J. Pilon to present the report on Emergency Department Pressures. While there has been much public interest and concern about wait times in the Emergency Department at HSN, Dr. Bourdon emphasized that it is extremely important to identify the risk associated with inaccurate reporting of wait times. The HSN Emergency Department is one of the busiest in the province with just under 60,000 visits/year; 78% of its patients are high acuity patients; and 50% of the 21,000 admitted patients come from the ED ( 25 to 30 admissions/day on average). The MOH uses two main calculations for wait times. 90 th percentile (maximum amount of time 9 out of 10 patients spend in the ED) and Average Wait Time (total time all patients spend in ED divided by number of patients). HSN s wait time is measured from the time the patient arrives in the ED to the time the patient is discharged from the ED or admitted to a bed. What is important to note with both of these wait time calculations is that they capture the total time spent in the ED including registration, triage, diagnosis, testing, treatment and discharge. So when the public hears wait time it is important to understand that this means the total length of stay people spent in the ED, including being seen, treated and discharged. Of note, some hospitals begin measuring their wait times from the patient s first point of contact with the nurse.

4 4 A patient s Length of Stay can be affected by a number of factors. Volume of patients in the ED at any given time Acuity of patients in the ED at any given time Availability of diagnostic equipment/laboratory services/other services Availability of physician to sign discharge orders Availability of transportation from hospital if patient is being discharged home Availability of acute care bed if patient must be admitted to hospital. **Availability of hospital beds is often largely dependent on the number of ALC patients occupying acute care beds. HSN s Lengths of Stay are longer than the provincial average. The LOS for high acuity patients admitted to hospital is: 90th Percentile: HSN - 40 hrs / Province 30.5 hrs Average Wait Time: HSN 18 hrs / Province 14.8 hrs The LOS for high acuity patients, not admitted to hospital is: 90th Percentile: HSN hrs / Province 7.4 hrs Average Wait Time: HSN hrs / Province 4 hrs The LOS for all high acuity patients combined is: 90th Percentile: HSN 16.1 hrs / Province 11.1 hrs Average Wait Time: HSN 8.1 hrs / Province 5.8 hrs It should be noted that in 72.4 percent of cases, HSN is able to treat high acuity patients within the provincial target of 8 hours. The figures for the month of March 2012 are the stats that received extensive media coverage and requires some education and understanding. 90th percentile: Complex conditions 19.7 hours Minor or uncomplicated conditions 8.3 hours By this definition, 9 out of 10 complex patients received care in under 19.7 hours. Average wait time: Complex conditions 9.5 hours Minor or uncomplicated conditions 4.3 hours By this definition, on average, patients with complex conditions were triaged, treated and discharged from the ED in 9.5 hours. Dr. Bourdon emphasized that patients should not be deterred by the reports of 19.7 hour wait times as these can be misleading and have the potential to lead to poor decision making by patients. For reasons of public safety, he urged people who need care to come to the ED. J. Pilon confirmed that these figures tell us the overall wait times, by any measure, are above the provincial targets. Our patients are waiting too long to be treated in the Emergency Department. The largest contributing factor to our ED wait times is the inability to flow patients out of the ED and into a hospital bed. The lack of available beds is primarily an issue of Alternate Level of Care or ALC patients who are being cared for in acute care beds while awaiting placement in the community.

5 5 Each week in April of 2012, there were on average 110 ALC patients at HSN. There was an average of 76 patients occupying acute care beds at the Ramsey Lake Health Centre. This meant that 17 % of acute care beds were occupied by ALC patients. HSN has demonstrates that the ED wait times are better than the provincial benchmark when there are less than 10 patients admitted in the ED. The inability to flow patients out of the ED is the biggest contributor to wait times. The number of ALC patients admitted to acute care beds is gradually increasing. There are many concerned citizens who are recommending that the temporary beds at the Sudbury Outpatient Centre be reopened. Key health care providers from the region have looked at the viability of keeping the temporary beds open and all have concluded that housing ALC patients in a hospital setting is not optimum for patients. Nor is it an effective use of resources. It is an extremely expensive solution that does not provide optimum patient care. Shifting resources from the hospital to the community provides a better quality of care for patients, is more economical and sustainable. Despite the challenge of admitted patients in the ED, HSN continues to look at ways to improve and manage inpatients. Several patient flow solutions have been implemented within the hospital to help alleviate the pressures in our ED. However, recent data clearly shows that a flow of ALC patients beyond just hospital-based mechanisms is required. The ED wait times are a symptom of a health care system that is not working; as a last resort patients come to hospital ED when there are no community resources to keep them in their homes. System-wide solutions to improve access and timeliness of care in the ED were discussed at a meeting of the NELHIN, NE CCAC and HSN on May 7 th. As the data indicates, improving ED performance must largely involve improving patient flow within the acute care system. The biggest challenge faced by the hospital in terms of patient flow is ALC. The temporary beds at the Sudbury Outpatient Centre were essentially a reservoir, a mechanism where ALC patients could be flowed out of the acute care system. The data today confirms that the system still requires a flow mechanism for ALC patients, but that reservoir can and should be created outside of the hospital. Creating pockets of these reservoirs in the community will allow us to provide better suited care for ALC patients at a significantly lower cost. It was agreed that each partner would identify three top strategies that could be implemented within an immediate to short timeframe. The partners will be meeting later this week to review the proposed strategies. HSN will be focusing on strategies that will ensure less than 10 admitted patients in the ED. It will be evaluating processes and resources, looking at facilitating discharges, means of accelerating transition into the community and/or repatriation back to community hospital. Dr. Zalan was invited to present the Report of the President of the Medical Staff given its relation to this agenda item. He noted that his report includes a letter to

6 6 the Editor of the Northern Life back in December 2008 that highlights the same problems with ALC that are raised today. He added that Doctors Lepage and Bourdon have been passionately speaking about issues in the ED; the physicians and nurses are doing a great job; that is most difficult to do under the circumstances of overcrowding in the ED. HSN is not promoting reopening 30 beds at the Sudbury Outpatient Centre - another temporary solution. He expressed his support for the hospital, NECCAC and the NELHIN working collaboratively on solutions. He added that he has canvassed the hospital medical staff and is convinced we will come up with useful short-term solutions. J. Pilon and Doctors Bourdon and Zalan were thanked for their informative presentations. N. Everest emphasized that the solutions developed must be tied to goals/targets; given that HSN was built on a zero ALC patient model, the number of ALC patients occupying acute care beds should be defined as a target for the hospital, NELHIN and NECCAC to work towards. J. Pilon noted that past analysis has confirmed that the hospital can function superbly with 28 or less ALC patients in the hospital. Dr. Roy noted that the Drummond Report clearly states investment should be made in community and rehab beds and that no new long-term care institutions will be built in Ontario in the near future. The role of the Family Health Teams in reducing ED visits given one of their principles is to help reduce the number of ED visitations was discussed. Dr. Bourdon reported that one of the reasons HSN s ED patient acuity is so high is that less acute patients are seeking care in the large number of walk in clinics that are accessible throughout the city. He confirmed that the patients that are presenting to the ED have true emergent problems. R. Boyles reported that the HSN Board Chair, Vice-Chair, HSN CEO and COS have requested a meeting with the NELHIN and NECCAC counterparts to engage in further dialogue on how we can work together to implement effective solutions that will ensure the delivery of safe and effective care for the residents of Northeastern Ontario. P. Toffanello queried whether anyone at the table making decisions and devising strategies that compensate for ALC challenges, has considered supporting people who want to keep their parent at home in a place they want to be. On behalf of the Board, R. Boyles thanked management and staff for their ongoing efforts to resolve issues within their means, and especially under the tremendous pressure of the last few months. He confirmed the Boards full support and encouraged them to move forward. Dr. Roy further recognized the staff and physicians in the ED, for their dedication and continued efforts during these trying times, and commended their innovative ideas used to facilitate flow.

7 7 4.2 Report from the Quality Committee N. Everest presented the Report from the Quality Committee meeting held April 26, She noted that the four priority focus areas of the QIP are listed at the top of the report and will continue to be displayed to keep them front and centre: (1) Zero Harm to Patients as a Result of Care; (2) Improve Access to Care and Services; (3) Improve Patient Experience with Care; and (4) Reduce Avoidable Admissions/Readmissions to Hospital Key learnings from the IHI Workshop The Role of the Board in Quality and Safety shared with Quality Committee members included Quality Committee Best Practices which included hearing more about the patient experience and committee participation, dashboards and trend review and freeing up the agenda for good discussion. Committee members received a presentation on Quality Improvement Indicators and moving towards the use of a Strategic Scorecard. The Quality Committee work plan will set the course of this scorecard and each month, poor performing indicators will be highlighted as well as other issues for the recording period. These indicators will be reviewed monthly and all of the indicators will be reviewed quarterly. The use of absolute numbers will be implemented in addition to percentages. The Quality Committee has asked for a comprehensive update on ALC at their next meeting that will include progress on initiatives. HSN s Accreditation score is in the high 90s; with 26 unmet items. The Accreditation Steering committee will review unmet items and is required to report back to Accreditation Canada by September. If HSN demonstrates that there are plans in place or have met targets, the hospital may move to a commended state which will mean the next accreditation will occur in four years instead of three. The Accreditation Steering Committee will meet on an ongoing basis to ensure HSN remains in an accreditation ready state. It was requested that employee health and safety information be brought forward to the Board through the Quality committee 5.0 ENSURE FINANCIAL VIABILITY 5.1 Report from the Chair of the Finance Committee J. M. Spencer reported that management continues to work on the 2012/13 budget which would seem to be on target for balancing by September 30 th. The Financial statements for year end will be available towards the end of May. 6.0 ENSURE BOARD EFFECTIVENESS 6.1 Report from the Governance and Nominating Committee

8 8 The report from the Governance and Nominating Committee was received for information. R. Boyles highlighted that the Board Plenary Session has been rescheduled to September 17 th, He added that decision support documents with regard to the 2012/13 Board Education Plan Board Orientation sessions are included in the package and presented the following motions. MOTION #1: R. Pitblado / P. Sawyer THAT the Governance and Nominating Committee recommends to the Board of Directors approval of the Board Presentations Plan as presented. CARRIED MOTION #2: N. Everest / P. Toffanello THAT the Governance and Nominating Committee recommends to the Board of Directors approval of utilizing the orientation time slots to address areas for improvement identified on the Accreditation 2012 Sustainable Governance Quality Performance Roadmap. CARRIED 7.0 ITEMS FOR INFORMATION 7.1 Report of the Chair The Report of the Chair was received for information. The sudden passing of Randy Kapashesit, Chair of the NELHIN Board of Directors was acknowledged. Wally Wiwchar has been named Acting Chair. R. Boyles thanked Board members for volunteering their time to help serve cake and coffee in celebration of Nurses Week and for participating in the Staff Recognition Events. 7.2 Report of the CEO The Report of the CEO was received for information. Dr. Roy highlighted that the Activity Statistics accompanying his report demonstrate that hospital admissions and weighted case have increased over last year, while the patient length of stay has decreased. He noted that this data supports Dr. Bourdon s statements around increased patient acuity. Operating Room statistics demonstrate that OR cases have increased from 2011 by 4.8%; primarily due to inpatient cases. The number of surgeries cancelled because of no beds and other reasons decreased since last year. Dr. Roy was pleased to report that the number of outpatient visits including to the Heart Failure, COPD and Diabetes Clinics has had a significant increase. He added that these clinics are the mid to long-term future for the hospital to carry out its acute care mission. 7.3 Report of the Chief of Staff The Report of the Chief of Staff was received for information. Dr. Bourdon added as a follow-up to last month s request, a tour the Simulation Lab will be arranged for the Fall, at a time when there are active courses running. 7.4 Report of the President of the Medical Staff

9 9 Reported under agenda item OTHER BUSINESS None 9.0 ADJOURNMENT P. Byck / D. Fildes As there was no further business, the meeting adjourned at 7:15 p.m. R. Boyles, Chair