2015/16 q1 report on strategic plan june 23, 2015 · { q1 report on strategic plan { current year...
TRANSCRIPT
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2015/16 Q1 Report on Strategic Plan
June 23, 2015
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Session Notes Worksheet
• Instructions:
1. Throughout the session please make notes when you
listen to the VP report out:
– What encourages/excites you?
– What makes you nervous?
– What needs to be done differently (for this multi-year plan)?
– What you can do differently?
2. Table discussions & report outs at end of the day.
3. Worksheets will be collected and collated for VP to
consider for course correction.
4. Take personal action items/ideas back to incorporate
into your work plans.
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Housekeeping
• Parking:
– Please register your plate # if you drove
• Washrooms
• Connect to WiFi:
– Select “attwifi_meeting” network
– Open Internet Explorer
– Go to google.ca
– Log in using the instructions on your table
– Connect to RQHR network using Cisco
AnyConnect/VPN
If you have issues connecting, please let the registration table know
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How to Access Today’s Information
• RQHR Intranet Site:
http://rqhshrpntwebprd:4604/sites/DocShare/Reporting/For
ms/AllItems.aspx
Or, from the RQHR intranet home page Click on Strategic
Framework Click on Sharepoint Site Click on Reporting Select
2015-16 Q1 Report on Strategies - June 23 2015 folder
Other information posted at: RQHR intranet home page Click on
Strategic Framework Click on Sharepoint Site Click on Data to
Support Planning folder
• Public RQHR Lean Website:
http://www.rqhrlean.com/quarter-1-review---june-23-
2015.html
Or, from the Lean website home page Click on Strategic Direction
Click on Quarter 1 Review – June 23, 2015
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CEO INTRODUCTION
Keith Dewar, President & CEO
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Our Purpose
Why we are here
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Strategic Hierarchy
Government of Saskatchewan
Ministry of Health
Regina Qu’Appelle Health Region
Provincial Health System
Patient, Staff and Physician
Input
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Planning And Reporting Flow Chart
ClinicalBest
Practice
• Initiatives and projects cascaded down from the strategic
plan and one-year business plan• Other important work identified to mitigate risks, fill gaps,
and improve performances
Budge
Risks/Gaps/Challenges
Other E-Scan Data
Accred. Standards
CIHI Data
• Q1 Report on Strategic Plan
• Current year course correct
Q1
• Q2 Report on Strategic Plan
• Review inputs into next year plan
Q2
• Q3 Report on Strategic Plan
• Finalize next year plan
Q3
• Year end report (annual report)
• Celebrate successes
Q4
Feedback/
challenges/gapsbrought back to
the MOH and PLT tables.
Initiatives and
projectscascading down
to service lines and departments
where they are able to contribute
to achievement of strategic
outcomes and targets.
• Includes high priority, cross functional initiatives, measures, and targets that require regular monitoring by the Senior Leadership Team
• Identifies the annual priority areas of focus for the region
Portfolio, Service Line,
Department Multi-Year Plans
Key Support: SPBIU/KPO/KOTs
Use Lean tools to support implementation of operational plans wherever applicable: RPIW, 5S, Kanban, Standard Work, Replication, etc. Ongoing review of operationalization of Lean tools and training on the use of Lean tools will take place throughout the year rather than
Provincial
Outcomes & Targets
Patient, Staff, and Physician Feedback
Strategic Planning Inputs
Strategic PlanningOutput 1:
Strategic Planning Output 2:
Cascading
Plans
RQHR Multi-Year Strategic Plan
Key Supportt: SPBIU
RQHR One-YearBusiness Plan
Key Support: SPBIU
• Daily work of service delivery
• Current year initiatives and projects cascaded down from service line/department multi-year plans
Service Line, Department, Unit
One-Year Operational Plans
Key Support: KPO/KOTs
DRAFT RQHR Planning and Reporting Input/Output
Kaizen Plans/Integrated
TimelinesKey Support: KPO/KOTs
Hard copies are on your
table to see the details
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• Quarterly Report on Strategic Plan:
– VP Lead of multi-year plans report on outcome
measures and progress towards targets
RQHR Strategic Plan Reporting Mechanism
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STRATEGIC MULTI-YEAR PLANNING &
REPORTING
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RQHR Strategic Plan
• RQHR Multi-year Strategic Plan includes:
• Provincial Strategies • ED Waits and Patient Flow (prov. Hoshin)
• Mental Health and Addictions (prov. Hoshin)
• Seniors
• Infrastructure
• Primary Health Care
• Wait 1/GP to Specialist
• Appropriateness
• Financial Sustainability
• Culture of Safety
• RQHR Internally Identified Strategies • Patient Family Centred Care
• Engagement
• Academics and Research
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RQHR Strategic Plan – Cont’d
• We are confident in the strategic direction we are taking as
a province and organization
• Each strategy is led by a Vice President (VP) who is
accountable for achieving the outcome
• Each strategy is supported by a multi-year plan
• Each strategy is being monitored and reported out
quarterly
• Funding restraint will slow the progress of multi-year plans
and delay achievements and could potentially result in a
deterioration in our gains to date
• We have significant capital and infrastructure deficiencies
(facilities, equipment and information technology systems)
that could impede our ability to meet strategic, business
plan and operating budget targets
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2015/16
THE CURRENT YEAR
BUSINESS PLAN
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2015-16 RQHR Business Plan
• 2015/16 RQHR Business Plan (One-year Regional
priorities):
– Continues to focus on:
oQuality and Safety
oPatient Flow (also a 15/16 provincial Hoshin)
oPrimary Health Care
– Added one more focused area:
oMental Health & Addictions (also a 15/16 provincial
Hoshin)
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Link RQHR Strategic & Business Plan
• RQHR Multi-year Strategic
Plan includes: • Provincial Outcomes
• ED Waits and Patient Flow (prov.
Hoshin)
• Mental Health and Addictions
(prov. Hoshin)
• Seniors
• Infrastructure
• Primary Health Care
• Wait 1/GP to Specialist
• Appropriateness
• Financial Sustainability
• Culture of Safety
• RQHR Internally Identified Strategies
• Patient Family Centred Care
• Engagement
• Academics and Research
• RQHR 2015-16 Business
Plan has 4 Focused Areas:
o Quality and Safety
o Patient Flow (also a 15-16
provincial Hoshin)
o Primary Health Care
o Mental Health & Addictions
(also a 15-16 provincial
Hoshin)
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• Focuses on the work of the Senior Leadership
Team (SLT)
– It includes regional work that SLT has to lead, monitor,
and report
• Supports alignment across the RQHR
– It is supported by work plans at the portfolio, service
line and unit level
• Focuses SLT support for daily management
– Quality care, safe care, and financial sustainability
• Business plan can and will change during the year
– When targets are met, initiatives can be replaced by
other work appropriate for SLT
2015-16 RQHR Business Plan – Cont’d
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2015/16
WHAT HAS CHANGED SINCE OUR BUSINESS
PLAN WAS APPROVED
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2015/16 Preliminary Operating Budget
18
Regina Qu'Appelle Health Region
2015-16 Operating Budget
In $000's
2014-15 2015-16 Budget $ Change % Change
Revenue
Ministry of Health Funding - Base 863,515 901,502 37,987 4.40%
Ministry of Health Funding - Other 67,382 31,044 (36,338) -53.93%
Other Gov't & Agency Revenue 25,830 25,513 (317) -1.23%
Patient & Service Fees 24,745 24,108 (637) -2.57%
Other Revenue 32,485 30,527 (1,958) -6.03%
Total Revenue $1,013,957 $1,012,694 (1,263) -0.12%
Expenses
Salaries & Benefits 664,424 684,107 19,683 2.96%
Medical Remuneration 86,930 86,763 (167) -0.19%
Operating Grants 68,175 69,111 936 1.37%
Medical Supplies 94,529 97,173 2,644 2.80%
Infrastructure 48,768 48,504 (264) -0.54%
Clinical & Operational Supports 52,588 50,561 (2,027) -3.85%
Admin & Other 14,689 14,744 55 0.37%
Total Expenses $1,030,103 $1,050,963 $20,860 2.03%
Preliminary Deficit ($16,146) ($38,269) ($22,123) 137.02%
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Service Volume Changes Has
an Impact on Costs
19
Hospital Care Utilization
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015P % Change
Admissions
34,123
34,549
35,281
36,595
38,282 12.19%
Average Daily Census
642.40
655.60
645.70
650.67
650.01 1.18%
Average Lenth of Stay (Days)
6.90
7.0
6.70
6.30
6.30 -8.70%
Births/Newborn Admissions
3,771
3,954
4,087
4,234
4,253 12.78%
Emergency Visits
106,755
108,900
110,000
107,033
113,805 6.60%
Surgeries
21,683
22,774
23,232
26,615
26,216 20.91%
Diagnostic Imaging Procedures
274,490
272,759
305,956
312,977
257,129 -6.32%
Laboratory Tests Performed
3,555,074
3,662,535
3,783,155
3,952,096
3,952,096 11.17%
Home Care Service Workload Units
168,106
334,791
361,498
357,718
360,000 114.15%
Emergency Medical Services Calls
23,598
23,764
24,870
24,811
25,028 6.06%
# of Influenza Immunizations provided by
Public Health
34,487
33,076
35,447
52,346 n/a 51.78%
Ambulatory Care & Medical Outpatient
Procedures
86,056
99,906
108,445
112,025
118,899 38.16%
# of Long Term Care Beds n/a
1,989
1,961
1,963
1,963 -1.31%
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Primary Driver – Paid Hours
20
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Regional Focus to a Balanced Budget
Regina Qu'Appelle Health Region
2015-16 Operating Budget
In $000's
2014-15 2015-16 Budget $ Change % Change
Total Revenue $1,013,957 $1,012,694 (1,263) -0.12%
Total Expenses $1,030,103 $1,050,963 $20,860 2.03%
Preliminary Deficit ($16,146) ($38,269) ($22,123) 137.02%
Regional Focus to Reducing Long-Term Cost Structure VP Responsible
3sHealth and Other Contracts 2,500 Peters
Cost Savings from Reduced Surgical Volumes 8,000 Garratt
Reduction of VAC Beds if No Funding for Alternative use 1,300 Redenbach
Clinical Appropriateness 1,000 McCutcheon
Quality & Safety Initiatives 1,000 Smadu
Patient Flow / 95% Occupancy 1,000 Neville
Improve on Ambulatory Care
Sensitive Condition Indicators 3,000 Earnshaw
Reduce Orientation Costs by 20% * 1,300 Higgins
Reduce Sick Costs by 15% * 2,500 Higgins
Reduce Overtime Premiums by 33% * 3,929 Peters
Workforce Optimization - 152 FTEs at average salary of $85,000 ** 12,740 All
Revised Surplus (Deficit) $0
* Expected payback from daily management initiatives
** Done through attrition, does not contemplate layoffs
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ACCREDITATION
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Accreditation Items before Sept. 17, 2015
Standard Set Due Date
June 15-19
June 22-26
June 29-July
3 July 6-
10 July 13-
17 July 20-
24 July 27-
31 Aug 3- 7 Aug 10
- 14 Aug
17-21 Aug
24-28 Aug 31- Sept 4
Sept 7-11
Dr. McCutcheon
Emergency Department Sep-15
Emergency Medical Services Sep-15
Medicine Services Sep-15
Cancer Care and Oncology Sep-15
Critical Care Sep-15
Michael Redenbach
Mental Health Sep-15
Population Health and Wellness
Sep-15
Long-Term Care Sep-15
Sharron Garratt
Ambulatory Sep-15
Obstetrics Sep-15
Perioperative Sep-15
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Accreditation Items before Sept. 17, 2015
Cont’d
Karen Earnshaw
Hospice, Palliative, and End-of-Life
Sep-15
Home care Sep-15
Public Health Sep-15
Rural (Imbedded in other CQI Teams)
Emergency Department
Ambulatory
IPAC
Reprocessing
Medication Management
Perioperative
Long -Term Care
Keith Dewar
Leadership: Medication Reconciliation
Sep-15
Leadership: Workplace Violence Prevention
Sep-15
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Accreditation Items before Sept. 17, 2015
Cont’d
Dawn Calder
Reprocessing Sep-15
Rehabilitation Sep-15
Medication Management Sep-15
Medication Reconciliation
Antimicrobial Stewardship Program
Concentrated Electrolytes
High- Alert Medications
Heparin
Narcotics
Infusion Pump Training
Marlene Smadu
IPAC Sep-15
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PATIENT FLOW VISIONING SESSION
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Current Year Course Correction
• Listen and take notes throughout the day
• Note changes to things that will influence your
area and your plan, e.g. budget restriction.
• Dedicate time after the session to work in your
teams and look at your plans to see what needs
to be adjusted for this year and the following
years
• Who will you need to talk to/link in with to
connect your work?
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Portfolio Planning & Deployment
ClinicalBest
Practice
• Initiatives and projects cascaded down from the strategic
plan and one-year business plan• Other important work identified to mitigate risks, fill gaps,
and improve performances
Budge
Risks/Gaps/Challenges
Other E-Scan Data
Accred. Standards
CIHI Data
• Q1 Report on Strategic Plan
• Current year course correct
Q1
• Q2 Report on Strategic Plan
• Review inputs into next year plan
Q2
• Q3 Report on Strategic Plan
• Finalize next year plan
Q3
• Year end report (annual report)
• Celebrate successes
Q4
Feedback/
challenges/gapsbrought back to
the MOH and PLT tables.
Initiatives and
projectscascading down
to service lines and departments
where they are able to contribute
to achievement of strategic
outcomes and targets.
• Includes high priority, cross functional initiatives, measures, and targets that require regular monitoring by the Senior Leadership Team
• Identifies the annual priority areas of focus for the region
Portfolio, Service Line,
Department Multi-Year Plans
Key Support: SPBIU/KPO/KOTs
Use Lean tools to support implementation of operational plans wherever applicable: RPIW, 5S, Kanban, Standard Work, Replication, etc. Ongoing review of operationalization of Lean tools and training on the use of Lean tools will take place throughout the year rather than
Provincial
Outcomes & Targets
Patient, Staff, and Physician Feedback
Strategic Planning Inputs
Strategic PlanningOutput 1:
Strategic Planning Output 2:
Cascading
Plans
RQHR Multi-Year Strategic Plan
Key Supportt: SPBIU
RQHR One-YearBusiness Plan
Key Support: SPBIU
• Daily work of service delivery
• Current year initiatives and projects cascaded down from service line/department multi-year plans
Service Line, Department, Unit
One-Year Operational Plans
Key Support: KPO/KOTs
DRAFT RQHR Planning and Reporting Input/Output
Kaizen Plans/Integrated
TimelinesKey Support: KPO/KOTs
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VP Quarterly Report on Strategies
Q1 – 2015/16
Vision:
Healthy people, families and communities.
Acting VP: Dawn Calder
Integrated Health Services – Clinical Support
Multi-year Plan:
ED Waits and Patient Flow
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Portfolio Overview
• Patient Flow
• Pharmacy & Respiratory Services
• Medical Imaging
• Lab Services
• Rehabilitation, Spiritual Care & Native Health
Services
• HealthLine
• Support Services, Central Scheduling & Sterile
Processing
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Multi Year Strategic Plan
VP leading on:
• Corporate Patient Flow Multi-year Plan:
Provincial Hoshin ED Waits & Patient Flow
Implementation Strategy
RQHR Multi Year Strategic Plan & Business
Plan
RQHR Patient Flow Program / Framework
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Patient Flow Multi-year Plan
2015/16 Provincial Outcome & Improvement Targets for
Patient Flow
• By March 31, 2017, no patient will wait for care
in the emergency department.
- (Hoshin) By March 31, 2016, 90% of patients
waiting for an inpatient bed will wait <= 17.5 hours.
- By March 31, 2016, the length of stay (LOS) in the
ER for 90% of admitted patients will be <= 22.3
hours
- By March 31, 2016, the LOS in the ER for 90% non-
admitted patients will be <= 5.9 hours
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Hoshin Measure – Combined
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Hoshin Measure - RQHR
10
20
30
40
M A M J J A S O N D J2015
F M
Regina
Date Prepared: 02Jun2015
Report Contact: Sheena McRae, MoH
Source: 06May2015 cut of NACRS/DAD
Operational Defini tion: The time from the decis ion to admit to the time the patient leaves the ED for an inpatient bed.
Time waited in the ED for an inpatient bed: 90th percentile in hours
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Patient Flow Multi-year Plan
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Patient Flow Multi-year Plan
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Status of Strategy Implementation
Successes
Successes/What is working
- Recognized Provincially and Nationally for our Success - Improved occupancy and ANB #
- Continued Shift in Culture and Ownership: Flow is “our” issue
- Patient Flow Visibility Wall - Corrective Action Plans
- Improves understanding of system view and connection
- Patient Flow Analytics - Improving access to data
- Excellent engagement from operational areas
- FloCast
- Accountable Care Unit- early results - Improved patient care, participation and awareness of care plan
- Staff and physician engagement
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RQHR FloCast
Accuracy
39
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Medicine
Program Occupancy
104%
Target: 95% Occupancy
14 day trend
80%
100%
120%
Unit Occupancy
Unit 3E 106%
Unit 5E 100% ▲
Unit 6F 108%
Patient Flow Dashboard > RQHR > RGH >
Last Updated: Today at 11:50am
6 month average
Past 24 hours
Avg. ED Pull Time
7.0 hours
Target: < 4.0 hours
Transfers from ICU
2 patients
Typical: 4 Patients 0
10
20
Admitting Pressures
6 month average
Medicine Avg. LOS
7.5 days
Target: < 6.0 Days
Off-Service Beds
29 patients
Target: < 6 Patients
Inpatient Performance
28 patients admitted over 31 days Target: < 30 Patients
Past 24 hours
20
30
40
50
Past Week Net Flow
+18 patients
Target: < 0 Patients
D -1 Accuracy
61%
Target: > 70%
Discharging Performance
1 discharge before 11:00 Target: > 5 Discharges
Past 24 hours
6 month average -50
-25
0
25
50
Infl
ow
O
utf
low
M
an
ag
em
en
t
Admitting Pressures
10 ANB patients Target: < 5 Patients
40
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Unit 3E
Program Occupancy
106%
Target: 95% Occupancy
14 day trend
80%
100%
120%
Last Updated: Today at 11:50am
6 month average
Past 24 hours
Avg. ED Pull Time
6.3 hours
Target: < 4.0 hours
Transfers from ICU
1 patient
Typical: 4 Patients 0
10
20
Admitting Pressures
6 month average
Medicine Avg. LOS
7.2 days
Target: < 6.0 Days
Inpatient Performance
16 patients admitted over 31 days Target: < 30 Patients
Past 24 hours
20
30
40
50
Past Week Net Flow
+1 patient
Target: < 0 Patients
D -1 Accuracy
67%
Target: > 70%
Discharging Performance
0 discharges before 11:00 Target: > 3 Discharges
Past 24 hours
6 month average -50
-25
0
25
50
Infl
ow
O
utf
low
M
an
ag
em
en
t
Admitting Pressures
3 ANB patients Target: < 3 Patients
Patient Flow Dashboard > RQHR > RGH > Medicine >
41
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42
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Significant Work Required to Achieve Targets
• Consistent Use of Patient Flow Standard Work and Tools
• Shifting from Reactive to Proactive
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Next Steps
Next Steps
- Visioning Session - Validation of targets and activities
- Incorporation of actions into each areas multi-year plan
- Continued coordination of activities
- Patient Flow Analytics - Initial unit/system level dashboard functionality ( next 3-4
months)
- Patient Flow Standard Work Coaching Support for IP
Units.
- Continued Implementation of ACU
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VP Quarterly Report on Strategies
Q1 – 2015/16
VP: Carol Klassen – Knowledge & Technology Services
Multi-year Plans:
- IT/IM/Equipment Multi-year Plan
- Academic & Research Multi-year Plan
Vision:
Healthy people, families and communities.
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Portfolio Overview
• Information Technology
• Research & Health Information Services
• Clinical Engineering
• Academic Health Sciences
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Multi-year Strategic Plans
VP is Leading on:
• IM*/IT*/Equipment Multi-year Plan
• Research/Academic Multi-year Plan
*IM - Information Management
*IT - Information Technology
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IM/IT/Equipment Multi-year Plan
2015-16 Provincial Outcome
By March 31, 2017, all infrastructures (information
technology, equipment & facilities) will integrate
with provincial strategic priorities, be delivered
within a provincial plan and adhere to provincial
strategic work.
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IM/IT/Equipment Multi-year Plan
Provincial Improvement Targets
2015-16 Improvement Target
• By March 31, 2016, have delivered results on 3 high impact
capital areas that address high risk for critical failure using
alternative funding/delivery options.
• By March 31, 2016, common criteria and options for
investing are used to vet all capital investments.
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2015/16 RQHR Outcome Measures
1. Key projects on schedule – Milestone Chart
2. Responsive support services • # of Users of SunRise Clinical Manager
• Turnaround time for discharge summary
• # of unplanned repair/replacement of critical equipment
3. Multi-year Plan for Equipment Replacement
IM/IT/Equip Multi-year Plan
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Background: IT/IM Vision
Vision IT/IM
Better health by empowering patients and
enabling providers with the right information
at the right time through a provincially
standardized system that is sustainable and
secure
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Background: IT/IM Key Strategies
Key Strategies
– Supporting Patient and Family centred care
– Connecting care across the Region and
integrating with the provincial E.H.R.
– Advancing clinical decision supports for safer
care
– Turning data into actionable information
– Ensuring system integrity and usability
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RQHR IT Project Status
as of June 15, 2015
Connect Care Across the Region and the Electronic Patient Record
Patient Care Through Automation and Innovation
Ensuring System Integrity and Usability
Turn Data into Actionable Information
Provincial/Mandatory Projects
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0
5
10
15
20
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30
35
40
45
50
55
60
65
70
75
80
85
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eb-1
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-15
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# D
ays W
ait
ing
to
QA
Health Record Chart Assembly Backlog
BaselineDate Prepared: Mar 30, 2015
Report Contact: Kim Fichter, CHIM
Source: HIMS QA Backlog
Refresh Cycle: Weekly Plan Baseline
Dec 6, 2013 started to send 2 buckets to Pasqua (ER Coding and
Assembly/QA). Jan 20, 2014 started sending 4 buckets to Pasqua (2 for
Front Office, 2 for IP Coders) [Janelle off for surgery month of February]
OT done May 3, 2014 No QA going to Pasqua on a regular basis. August
25, 2014 started with 1 ER coder in Conference Room.(Sep 30 started
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Number of Open Work Orders –
Clinical Equipment [2013 to current]
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Status of Strategy Implementation -
Successes
• Key Project - Replacement of Enovation on
schedule
• Growing use of electronic clinical information
• 6,400+ staff and physicians with access to SCM
• Availability of discharge information
• Achieving turnaround times for Priority (24
hours) and Non-priority (14 days) dictation
• Improved chart availability in physician dictation
room to 7 days after patient discharge.
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• Improving reliability of Clinical Equipment
• The backlog of preventive maintenance is
ALMOST eliminated
• As anticipated, seeing a direct correlation
between preventive and decreasing corrective
maintenance needs
• Successful 5S projects at PH and RGH
• All positions filled – our 2 NAIT Coop students
from last year are now employees of CES
Status of Strategy Implementation –
Success Continued
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
High need and demand for services
High workload with limited resources
Lack of processes to prioritize work
Lack of work standards
Impact of Provincial Projects on resources
Key Deadlines and Regulatory Requirements in
HIMS need organizational (including physician)
support to achieve
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Next Steps / Link to 2014/15
• Continue implementing approved IT projects
• Begin process to update IT disaster recovery
plan
• Continue to work with 3S and eHealth
• Complete planning and begin roll-out of
new Hospira pumps
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Next Steps / Link to 2014/15 -
continued
• Identify a partner and develop a model for
embedded data analysis support
• Value Stream Map processes in Health
Records to identify areas for improvement
• Continue to reduce wait for discharge
summary information for the community
physician (#days)
• Develop plan for eliminating duplication of
electronic information in paper health record
chart
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Next Steps / Link to 2014/15 -
continued
• Continue work on a region wide equipment
evergreen process/work standards
• Successful launch and completion of the bed
lift maintenance program
• Create a baseline and targets for critical
downtime – upgrade in AIMS will allow us
to track
• Staff morale – significant gains and will
continue with work and annual staff survey
• Monitor and track unused vacation
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RESEARCH and ACADEMIC
Research/Academic Multi-year Plan
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RQHR Outcomes & Improvement Targets
By March 31, 2017 RQHR will:
- Have the necessary infrastructure in place to grow
patient oriented research
- Enhance its role as an academic health science
centre
• By March 31, 2016, RQHR will have confirmed
strategies and multi-year plan to enhance patient
oriented research and grow as an academic health
science centre.
Research/Academic Multi-year Plan
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• Vision/Strategy and multi-year Plan • Research and Academic Health Science Centre
Milestone chart(s)
• Increase research and academic
contribution and visibility • Impact measure showing value add to patient
outcomes/experience of research
• 15% increase in use of Simulation Centre
Research/Academic Outcome Measures
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Research/Academic Multi-year Plan
Outcome Measure
• Under Development
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Status of Strategy Implementation
Successes
• Research Showcase 2015 on June 22nd
• RQHR participating in the provincial application to
CIHR for funding Saskatchewan Centre for
Patient-Oriented Research (SCPOR)
• Initial discussions underway with College of
Medicine regarding a new Affiliation Agreement
with RQHR to support Regina as 2nd campus
• Renovation of space (5B) underway to improve
capacity for residents’ participation in call
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Lack academic-RQHR agreements specific to
research and academic partnerships
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Next Steps / Link to 2014/15
Launch new research impact measurement tool
and profile value of Research
Continue dialogue/planning to refine the
Research vision and multi-year plan
Continue development of partnerships and
affiliation agreement(s)
Finalize RQHR’s commitment for SCPOR
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Next Steps / Link to 2014/15 -
continued
Monitor renovations to meet timelines for fall
students
Launch ATLS program in the Simulation
Centre
Continue planning for expansion of
geographically based residents and transition
to 2+2 curriculum
Continue development of Family Medicine
Unit partnership with Primary Health Care on
‘Connect to Care’ project –targets in progress
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QUESTIONS
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VP Quarterly Report on Strategies
Q1 – 2015/16
Vision:
Healthy people, families and communities.
Acting VP: JP Cullen
Human Resources & Communications
Multi-year Plans:
- Workplace Safety Multi-year Plan
- Employee Engagement Multi-year Plan
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Portfolio Overview
• Workforce Strategy, Safety & Wellness • Employment Services
• Workplace Health & Safety
• Attendance Support
• Volunteer Services
• Workforce Planning
• Employee Relations & Development • Labour Relations
• Employee Relations
• Learning and Mentorship
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Portfolio Overview
• Security & Parking Services • Security
• Parking
• Communications • Corporate Communications
• Medical Media
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Multi-year Strategic Plan
VP is Leading on:
• Workplace Safety Multi-Year Plan
• Employee Engagement Multi-Year Plan
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Workplace Safety Multi-year Plan
2015-16 Provincial Health System Outcome To achieve a culture of safety, by March 31, 2020, there
will be no harm to patients or staff.
• By March 2018, fully implement a provincial Safety
Alert/Stop the Line (SA/STL) process throughout
Saskatchewan
• By March 31, 2018, all regions and the Cancer Agency will
implement the six elements of the Safety Management
System. (SMS)
• By March 31, 2019, all regions and the Cancer Agency
receive a 75% evaluation score on the implementation of
the elements of the Safety Management System
• By March 2019 there will be zero shoulder and back
injuries.
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Workforce Safety Multi-year Plan
Outcome Measure
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Workplace Safety Outcome Measure
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Status of Strategy Implementation
Successes
Successes/What is working • Did not meet targets in 2014-15, but did sustain gains
from previous years
• Increased communication at department visibility walls
regarding patient/staff safety issues
• Self Serve Run Charts
• Increased participation in safety training for leaders
• Improvements in incident investigations and remedial
action plans
• Safety interventions at Unit Level aid reduction in lost
time incidents
• Safety Remains a Priority
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Management Capacity
• Safety Resource Capacity
• Information Technology – tracking, especially for
training
• Need more direct, front-line management of injury (a
la Unit 3-2, Unit 2-5 Strategies)
• Extremely resource intensive
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Workplace Safety Multi-year Plan
Priorities for 2015-16:
• Hazard / Risk Assessment
– SMS
• Shoulder / Back Injury Strategy
– TLR / SMART
• Co-Lead Stop the Line
• Violence Prevention
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Workplace Safety Multi-year Plan
• Focus on smaller number of initiatives
• Work Standards
82
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Next Steps
Next Steps • Finalize A3s
• Continue Work Already Begun:
• Unit Level Work
• Action Plan
• Violence Policy / Programme
• Complete Phase 2
• Begin Phase 3
• Stop the Line
• PDCA Cycles
• TLR Audits
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Employee Engagement Multi-year Plan
RQHR Outcome
By 2017, RQHR will reach an average employee
and physician engagement score of 80%
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Status of Strategy Implementation
Successes
Successes/What is working - Pockets of Excellence
- High Engagement at Local Levels
- Strong Committed Teams
- Lean Processes
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Manager Capacity
• Structural issues that are hard to fix
• Resources
• Span of Control
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Next Steps
Next Steps
• Priorities: Resources, Performance Management
• Focus Areas: Management Capacity; Workforce
Optimization; Performance Management /
Accountability; Lean Tools
• Engagement Training for Leaders
• Information Resources, Tools
• Strategy to Address Span of Control
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BREAK
Resume at 2:05pm
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VP Quarterly Report on Strategies
Q1 – 2015/16
Vision:
Healthy people, families and communities.
VP: Marlene Smadu,
Quality and Transformation
Multi-year Plans:
- Patient and Family Centered Care Multi-year Plan
- Patient Safety/ Stop the Line Multi-year Plan
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Portfolio Overview
• Regional Infection Prevention and Control
• Patient Safety Office—Risk, Privacy and
Access to Info, Emergency Planning
• Transfusion Safety
• Patient Advocate Services
• Kaizen Promotion Office
• Clinical Quality and Professional Practice
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Multi Year Strategic Plan
VP leading on: Patient and Family
Centred Care
RQHR Outcome
By March 31, 2017 RQHR will have
created a culture of Patient and Family
Centered Care that leads to zero defects, no
waits and waste from the perspective of
patients and families, and that incorporates
the core concepts of Patient and Family
Centred Care (dignity and respect,
information sharing, participation and
collaboration).
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A3 TEMPLATE - RQHR STRATEGY
Title: Patient and Family Centred Care Which provincial hoshin/outcome does this strategy support: Primary Owner (SLT Lead): Marlene Smadu Team Lead(s) (Leaders of key initiatives): Shelley Hoffman, Debra Wiszniak, Kateri Singer, Alan Chapple, Paula Van Vliet, Dona Braun Expert Advisor (if applicable): Tamara Quine
Date of Original Draft: February 26, 2014 Date Last Updated: Estimated Budget Requirements: Estimated Resource Requirements:
1. Problem Statement (Current state and the reason for action.) [Explain what and how big the problem is and why strategic action is required to address it.]
4. Implementation Plan (What are the high-level actions that will be taken to address the problem within the given timeframe? What actions need to be taken to achieve the future state?) [More detail can be included in a separate implementation plan.]
Over the years the health care system has evolved to one where the processes, policies, services, scheduling, approaches and other aspects have become increasingly provider-centred The Patient First Review conducted in Saskatchewan provided many examples of how the current health care system is not patient and family centred.
Lean principles are based on viewing the system from the perspective of the patient and family journey, eliminating waste and waits, and aiming for zero defects for the patient and family. .
Key Areas to Work On
(fill out supporting multi-year summary as well – attached)
Who Date
1. Accountability Framework—will include appropriate policies,
services and initiatives that support patient and family centred care
region-wide, and consequences when policies are not adhered to.
Clear process on how to incorporate patient and family feedback for
service delivery improvements
SLT
2. Human Resources—Ensure appropriate mechanisms (per diems,
travel allowances, etc.) to support full patient and family advisor
engagement in development, implementation and evaluation of patient
and family centred care
3. Facilities (and/or other major infrastructure requirements)—Signage,
parking, etc to support patient and family centred care
C. Klassen/R.
Peters, M. Smadu
4. Technology ( IT/IM/Heath Technologies/Equipment)—Public and
patient portals for information
Updated RQHR website for easy placement of information for and
access by the public, patients, residents, clients, families.
C. Klassen
5. Policy/Legislation—policy development including consequences SLT
6. Budget
(For strategies of large scale this section can be supplemented by project plans or other plan template. See example of
Multi-Year Plan template the MOH is using.)
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RQHR demonstrates a culture of PFCC that incorporates the core concepts of dignity, respect, information sharing,
participation and collaboration and leads toward zero defects, zero waits, and zero waste from the perspective of patients and families at every level of interaction
PRIMARY DRIVERS SECONDARY DRIVERS ACTIONABLE
Staff educated on PFCC
Educate family and patients
Culture demonstrated by leaders (belief that we serve patients)
Support infrastructure (process pathways)
Accountable for behaviour (HH,TLR)
Adequate and appropriate staffing
PFCC part of performance appraisals
Patient and family engagement
Patient and Family Centred Care (PFCC) – A3Driver Diagram CatchballQuality and Transformation Leadership Team March 17, 2015Cityview OfficesV.April 23, 2015
IT solution to enable to speak to each other
Training staff to listen how to speak
Awareness , expectation of behaviour
Celebrate, recognise when things go right
Replicate model behaviour
More simplified process for patient
Policy to ensure patient involvement
Right Person, Right time, Right Place
Staff communication with multi disciplinary team
Mon – Fri , 8 – 5 Staff for 24/7 service
Human contact expectation – greet people
Patients in committee meetings
AIDET, SBAR Training
Train for leadership
Develop Standard work / Work standard
Welcoming Signage
Parking Access
Patient Experience survey
Engage patient family on selection committee
Patient given handout expectation document
Standards of care document
Incorporate into healthcare education – nursing school, docs, reg. bodies, etc.
5 Votes (Debra) 6 Votes (Debra, Tamara)
Awareness and Education
Family Presence Policy
Rounds at the bedside
5 Votes (Debra, Tamara)
4 Votes (Tamara)
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2015-16 Multi-year Plan
• Transforming the system
– Supporting family presence
– MDR and shift to shift at the bedside
– 100% use of whiteboards
– Intentional rounding
– Appropriate patient centred signage
– ID badges
– Patient Experience Survey in RGH / PH / Rural
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2015-16 Multi-year Plan
• Transforming the system – Cont’d
– Patient and family advisory groups
– Coordinating with provincial partners
– Staff education on PFCC
– Policy on patients/families on interview panels
– Patients and families engaged in improvement /
lean work
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Successes/What is working • Completed driver diagram for this year—will focus on key drivers
• Patient and family advisors educating public on HH, region orientation, board
meetings, flow visioning, patient experience survey/whiteboard presentations
to staff, patients on the quality and safety admin committee, patients leading
gemba walks
• Initiatives such as multidisciplinary rounds at the bedside, white boards,
safety huddles, manager rounding, Accountable Care Unit
• Consent for transfusions great improvement
• Engagement of RQHR leadership in placing patients first through initiatives
such as HH, Immunization, SSI prevention
• Developing family friendly and evidence based PPE protocols for visitors
and families of colonized isolated patients.
• Beginning implementation of “real-time concern handling” with Medicine
Service Line
Patient and Family Centered Care
Multi-year Plan
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• Challenges/Gaps/Risks/
- Much work to spread and replicate practices redesigned
by patients and frontline staff and physicians.
- Lack of EHR and difficulty getting RQHR forms on
physicians’ EMR, e.g. Accuro
- Have not yet implemented many best practices, e.g.
family presence policy, signage
• What isn’t working/What can be improved
• Timely disclosure to patients/families and resolution of
client concerns in real time
• “Concern handling is not a department – it is everyone’s
responsibility” – processes need to evolve
Patient and Family Centered Care
Multi-year Plan
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• Next Steps
– “Full court press” on HH continues—aim 100%
– Region-wide spread and replication of best practices in
patient and family centred care
– Continue to focus on zero defects, no waste/waits
– Increased communication/education of staff,
physicians, public, patients, residents, clients, families
– Patient Experience Survey – medicine, critical care,
surgery, rural facilities
– Family presence policy
Patient and Family Centered Care
Multi-year Plan
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Patient Safety/ Stop the Line
Multi-year Plan
2015-16 Provincial Outcome & Improvement Targets
o To achieve a culture of safety by March 31, 2020 where there
will be no harm to patients or staff
o By March 2018, fully implement a provincial Safety Alert
System / Stop the Line (SAS/STL) process throughout
Saskatchewan
o By March 31, 2018, all regions and the Cancer Agency will
implement the six elements of the Safety Management System
(SMS)
o By March 31, 2019, all regions and the Cancer Agency receive
a 75% evaluation score on the implementation of the elements
of the Safety Management System
o By March 2019 there will be zero shoulder and back injuries
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Getting to Green:
SAS/STL Model Implementation
• Status: Spread of SAS/STL to Saskatoon City and Royal
University Hospitals - in progress
• Measure: Progress of Implementation and Spread of the Safety
Alert System Model Line
• Corrective Actions: Improvements to data base in process,
increase leadership and staff focus, and investments in
SAS/STL through elevation of work to 90 Day Hoshin in 2015
• PLT Action Required:
Continue to support resource sharing between eHealth and SHR to continue to
PDCA SHR data base
Actively support SAS/STL implementation in all RHAs and Regional participation in
the Safety Network to coordinate and align SAS/STL across the province
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Patient Safety/ Stop the Line
Multi-year Plan
• Challenges/Gaps/Risks/
What isn’t working/What can be improved – The region is waiting on a provincial decision regarding
the purchase of an Adverse Event Management System
that will be critical to the success of STL
– Front line engagement has been great in some trials and a
struggle in others in STL PDSA trials. This may relate to
the cultural readiness of individual units in relation to the
change
– Psychological safety for patients/families, staff and
physicians
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Patient Safety/ Stop the Line
Multi-year Plan
• Successes/What is working – STL Algorithm, Roles/Responsibilities document and
Tool Kit have been developed and are being used by
other RHAs
– STL PDSA has been completed on 4 units and 1 trial
remains underway at the WRC
– STL working group has patient/family representation
– RQHR STL is moving forward as planned—e.g. have
done design RPIW on STL re equipment and supplies
– Confidential Occurrence Reporting Database is being
kept current—trending occurring in real time and trials of
an electronic COR are underway
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Patient Safety/ Stop the Line
Multi-year Plan
Next Steps
• Complete a cultural readiness survey and
replication/roll-out plan prior to implementing
STL throughout region
• Heighten awareness of STL as a priority &
continue culture change
• Provide leadership on multi-year plans for the two
highest COR concerns: medication errors and
falls
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VP Quarterly Report on Strategies
Q1 – 2015/16
VP: Michael Redenbach – Integrated Health Services
Multi-year Plans:
- Seniors Multi-year Plan
- Mental Health &Addictions Multi-year Plan
Vision:
Healthy people, families and communities.
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Portfolio Overview
• Facility Based Continuing Care Service Line
– Pioneer Village
– Extended Care/ Veterans Program
– Continuing Care, Programing & Utilization
– Health Services Organizations
• Mental Health & Addiction Service Line
– Outpatient Adult Mental Health Services
– Outpatient Child & Youth Mental Health Services
– Inpatient Mental Health Services
– Outpatient & Inpatient Addiction Services
– KOT
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Multi-year Strategic Plans
VP is Leading on:
• Seniors Multi-year Plan will focus on:
– Community-based services – Home First/Quick
Response, Home Care opportunity analysis,
standard work
– Long-term care – Purposeful Hourly Interactions
(Rounding), Gentle Persuasive Approach,
Enhanced Dining
– Acute care – Seniors Friendly Hospital approach
– Proposal for multiple facility replacements
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Seniors Multi-year Plan
2015-16 Provincial Outcome & Improvement Targets
• By March 31, 2020, seniors who require community
support can remain at home as long as possible, enabling
them to safely progress into other care options as needs
change
– By March 31, 2017, the number of clients with a Method of
Assigning Priority Levels (MAPLe) score of three to five
living in the community supported by home care will increase
by 2%
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Seniors Multi-year Plan
Outcome Measure
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Status of Strategy Implementation
Successes
Successes/What is working
RPIW #76 Post Fall Huddles Implemented on 3West, Regina
Pioneer Village – Improved communication to the family when they are able to participate in a
huddle
– Improved resident safety by getting to the root cause of a fall
– Improved quality of care results when all care staff contribute to a residents falls
prevention plan
RPIW #79 reduce the variation of resident information and
eliminate defects in shift handovers on Unit 2-6 WRC – Shift handover reports decreased from 6 to 5.
– Patients now feel they have a voice in their care with the implementation of
weekly patient rounds. Changes in shift handover, so that every patient is discussed
at each report, are expected to result in safer patient care.
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Status of Strategy Implementation
Successes
Successes/What is working • Antipsychotic without a diagnosis project on the 2nd floor of Santa Maria
Senior Citizen’s home.
– Initial Project Co-hort (n=38)
• 74 % discontinued (28)
• 13% decreased dosage (5)
• 13% residents deceased or transferred (5)
– Project team held a kaizen session to prepare for spread to the 3rd and 4th
floor of Santa Maria. Staff and resident’s family were involved in creating
a driver diagram.
– Comments from family:
• “Reduction has been great for my husband”,
• “ noticed a good change in my mother – brighter, more alert and healthier”
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Status of Strategy Implementation
Successes
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Status of Strategy Implementation
Successes
Successes/What is working
• Regional Pilot at RPV to determine impact
of Nurse Practitioner on the delivery of
appropriate care to residents in LTC
Facilities.
– April 20, 2015: Nurse Practitioner hired.
– Education and SBAR completed
– Developing standardized clinical tools for staff
to complete comprehensive assessment
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Status of Strategy Implementation
Successes
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Status of Strategy Implementation
Successes
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Immense financial pressure the Region is currently
experiencing. Service Line understanding that there will be
many excellent things we are not able to accomplish due to
limited funding, people and time.
• Accreditation – Required evidence submitted September 17,
2015 for 4 ROPs for compliance
• Severe physical infrastructure needs in several long-term care
facilities
• Importance of “Quality of Life” measures in LTC – No process
or oversight for Quality of Care in LTC
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Next Steps
Next Steps • Ombudsman’s Report on Long-Term Care, RHAs agreed to
review the current state of implementation of the Program
Guidelines for Special-care Homes in their regions. This is a
starting point for further discussions with the ministry to look
at: – Develop and implement policies and procedures to operationalize the standards of care
in the Program Guidelines for Special-care Homes.
– Identify, track and report on specific and measurable outcomes that ensure the
standards of care in the Program Guidelines for Special-care Homes are met
consistently for each long-term care resident.
– Include those specific and measurable outcomes as performance requirements in their
agreements with long-term care facilities.
• Continue roll-out and embedding of Purposeful Hourly
Interactions and Enhanced Dining Experience
• LTC Service Line Planning Session to develop work plan
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Next Steps
• New Ministry LTC Initiatives
– Geriatric Program
• Recruiting for a Geriatrician
• Steering committee in the process of developing a framework
• Conducting an inventory of all services and programs in all regions.
– Specialized Dementia units/behaviour Unit
• Pulling environmental scan and lit search data together and collate.
• Complete gap analysis
• Identify suggested program models based on leading practice
• Set up steering committee meeting to pull team together and present
foundational work, and plan next steps
• Work with the KOT to help create plan and steps, including use of lean tools
– Spread LEAN in remaining 50% - DVM
• LTC KOT along with the RQHR KPO will be rolling out a plan to implement
in areas without a DVM and/or working with the units to improve their current
DVMs.
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Portfolio Overview
• Mental Health & Addiction Service Line
– Outpatient Adult Mental Health Services
– Outpatient Child & Youth Mental Health Services
– Inpatient Mental Health Services
– Out patient & Inpatient Addiction Services
– KOT
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Multi Year Strategic Plan
VP leading on:
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Mental Health and Addictions
Multi-year Plan
2015-16 Provincial Health System Outcome
• By March 2019, there will be increased
access to quality mental health and
addictions services and reduced wait time
for outpatient and psychiatry services
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2015-16 Provincial Improvement Targets
• By March 31, 2016, waits for contract and
salaried psychiatrists will meet benchmark
targets to a threshold of 50%
• By March 2016, 85% of Mental Health and
Addictions clients will meet the wait time
benchmarks based on their triage level.
• By March 31, 2017 wait time benchmarks for
mental health and addictions will be met 100%
of the time.
Mental Health and Addictions
Multi-year Plan
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Mental Health & Addictions
Multi-year Plan Outcome Measure
50%
0%
20%
40%
60%
80%
100%
A M J J A S O N D J F M A
Child and Youth Psychiatry
50%
0%
20%
40%
60%
80%
100%
A M J J A S O N D J F M A
Adult Psychiatry
Percentage of Clients Meeting the Triage Benchmarks in Psychiatry Programs
Triage Benchmarks
Very Severe - 24 hrs Severe - 5 working days
Moderate - 20 working days Mild - 30 working days
Goal - 85%
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Mental Health & Addictions
Multi-year Plan Outcome Measure
Percentage of Clients Meeting the Triage Benchmarks in
Addictions Outpatient
Triage Benchmarks
Very Severe - 24 hrs Severe - 5 working days
Moderate - 20 working days Mild - 30 working days
Goal - 85%
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Mental Health & Addictions
Multi-year Plan Outcome Measure
Percentage of Clients Meeting the Triage Benchmarks in Outpatient
Mental Health
Triage Benchmarks
Very Severe - 24 hrs Severe - 5 working days
Moderate - 20 working days Mild - 30 working days
Goal - 85%
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Status of Strategy Implementation
Successes
Successes/What is working
• Value stream mapping, daily visual management,
using PQA and other data to better understand the
service line issues
• Distributed Leadership in projects – tap into the
expertise of many, leadership characterizes the team
• Implementation Science – set up projects to sustain
outcomes
• Cross-functional work and support especially with
ED and IT
• Collaborative work with Ministry of Health
• Patient partnership with Canadian Mental Health
Association
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Challenges: • Communication – we don’t do enough
• Change Management – we don’t always get it right
• Demand from other areas, both internal and external to the
region
• Gaps: • Resource realities – demand exceeds capacity
• Risks: • Change fatigue
• Loss of momentum in projects
• Temporary dip in capacity at some points of program
change
• Meeting wait time target must not compromise quality
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Next Steps / Link to 16-17
Next Steps
• Continue work on referral management, psychiatry
redesign, crisis and outreach services, and the
program for people with severe mental illness
• Collaboration with IT on Clin docs project
• Continued implementation/refinement of daily
work boards (daily visual management) and
cascade metrics that facilitate problem solving
• Prepare for major changes to Mental Health
Services Act (proclamation expected Fall 2015
sitting)
• Work on smaller point improvements using Lean
tools – med error reduction on inpatient
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VP: Karen Earnshaw – Integrated Health Services
Multi-year Plan:
Primary Health Care Multi-year Plan
VP Quarterly Report on Strategies
Q1 Report – 2015/16
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RQHR Primary Health Care Vision
Right Service, Right Provider, Right Place…
All the Time
RQHR Primary Health Care Mission
Primary Health Care is the everyday support for individuals and communities to better
manage their own health. Our commitment is to provide coordinated health services
that are client centred, community designed
and team delivered.
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NEW NETWORK VISUALS
Primary Health Care
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Portfolio Overview
(Transitional Structure)
Primary Health Care Service Line
• Networks and Services
– Urban Networks
– Rural Networks
– Home Care/ SWADD
– Palliative Care/ Midwifery
– Population & Public Health
– Eagle Moon Health Office
• Quality, Planning and Resource Management
- KOT
- Strategic Engagement and Decision Support
- Program and Resources Management
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VP is Leading on:
Primary Health Care Multi-year Plan
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Primary Health Care Multi-year Plan
Provincial Health System Outcome
By March 31, 2017, people living with chronic conditions will experience better health as indicated by a 30% decrease
in hospital utilization related to 6 common chronic conditions.
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Age and sex-adjusted hospitalization rates
for 6 ACSCs per 100,000 population aged <75
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2015-16 Provincial Improvement Targets
– By March 31, 2017, there will be a 50% improvement in the number
of people who say "I can access my PHC Team for care on my day
of choice either in person, on the phone or via other technology"
– By March 31, 2020, 80% of patients with 6 common chronic
conditions (diabetes (DM), coronary artery disease (CAD), chronic
obstructive pulmonary disease (COPD), depression, congestive heart
failure (CHF) and asthma) are receiving best practice care as
evidenced by the completion of provincial templates available
through approved electronic medical records (EMRs) and the eHR
viewer
– By March 31, 2016, TBD% of patients with 4 common chronic
conditions (DM, CAD, COPD, and CHF) are receiving best practice
care as evidenced by the completion of provincial flow sheets
available through approved EMRs and the eHR viewer
Primary Health Care Multi-year Plan
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Item Key Work/Initiative/Project Monitored Status (Red/Green)
1 Strengthen Home Care Quarterly Green
2 Navigation Platform Quarterly Green
3 Chronic Disease/ COPD Platform Quarterly Green
4 Build Interdisciplinary Primary Health Care Teams Quarterly Green
5 Chronic Disease Prevention Quarterly Green
6 Hand Hygiene/ Flu Shots Quarterly Green
7 Eliminate Unfunded Positions Quarterly Red
8 Physician (and other Provider) Resources Quarterly Red
9 Community Engagement Quarterly Yellow
2015-16 Key Work/Initiative/Project
To Achieve Multi-year Plan Outcome & Targets
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Status of Strategy Implementation
Successes
Successes / What’s Working?
A few examples….
• Regular Home Care Huddles – Urban and Rural
• RPIW #81: Med Rec Acute Care to Home Care
• Reassignment of all urban case managed clients complete in June
• COPD A3 and Work plan created
o Inventory of equipment, education and rehab services
nearly complete
o Practices selected for kaizen work
• Health Promotion and Therapies staff transitioning to Rural
• 5 Physicians soon at Meadow PHC Centre
• Reorganizing payroll and budget system for better use and
functionality
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• Ongoing recruitment and retention of family physicians and
other providers
• Data/ Information Flow
• Funding Models
• Tight Budget Year
• Rollercoaster of Change
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• Continue to Strengthen Home Care
• Complete re-alignment of PHC leadership team and begin asking teams to work differently
• Reduce ER waits and improve pt. flow
PHC Actions
• Improve accessibility to PHC; integrate Mental Health and PHC services
• Improve HIV testing and Immunization rates
• Safety: Hand Hygiene and Flu Shots
• Support seniors at home
• Recruit family physicians
• Strengthen Open Access in Moosomin
• Eliminate unfunded positions; establish a priority list of redeployed positions
Next Steps: 2015-16 Work Plan
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2015-16 Key Work/Initiative/Project
• Roster Realignment
• Establish Network Hubs and supply chain
• Mobile Technology
• Inter-disciplinary Case Conferences
• Establish Network Production Boards
• Clinical Standards Review
• Medication Reconciliation on Admission
Strengthening Home Care
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2015-16 Key Work/Initiative/Project
Complete re-alignment of PHC leadership team and begin asking
teams to work differently • PHC Center and Open Access Clinic in Moosomin
• Redesign Home First, Connecting to Care and Seniors Home Visiting into single team focused on preventing ER visits and Acute Care Admissions.
• Network Analysis
• Home Care Transition
• Public Health Transition
• PHC Chronic Disease Teams
• Business Admin and Support
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2015/2016 Focus
Focus for PHC:
- Complete alignment into Networks and start to build on our foundation
- Support leaders in their new roles - Support staff in working differently
- Continue work towards achieving
improvement targets
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VP Quarterly Report on Strategies
Q1 – 2015/16
Vision:
Healthy people, families and communities.
VP: David McCutcheon – Physician Services & Integrated Health Services
Multi-year Plans: - Wait 1/Access to Specialists and Diagnostics Multi-year Plan
- Appropriateness Multi-year Plan
- Physician Engagement Multi-year Plan
- Medicine Service Line Multi-year Plan
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Portfolio Overview
• Medicine Service Line
– Emergency Department / EMS
– Critical Care & Cardiosciences Units
– Medicine Inpatient Units
– Medicine KOT
• Physician Services
– Senior Medical Office
– Department Heads
– Practitioner Staff Affairs
– Practitioner Advisory Committee
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Wait 1 Multi-year Plan
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Wait 1/ Access to Specialist & Diagnostics
Multi-year Plan
2015-16 Provincial Outcome
• By March 31 2019, there will be a 50% decrease
in wait time for appropriate referral from primary
care provider to all specialists or diagnostics.
– By March 31, 2016, the provincial framework for an
appropriate referral to specialists or diagnostics will
be implemented in at least four new clinical areas
within two service lines.
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Wait 1 Outcome Measure
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Wait 1 Multi-year Plan
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Status of Strategy Implementation
Successes
Successes/What is working
Program is on target for eight of the ten parameters
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
1. Data issue with access to diagnostics wait time
information (awaiting resolution corrective action
plan suggests a September resolution)
2. Ministry Staffing issue with regard to the patient and
provider satisfaction survey conducted within the Hip
and Knee Treatment and Research Centre
3. Issue with referral data set as percentile needed to be
re-calculated. (Date seen may not be accurate for date
that patient could have been seen).
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Appropriateness Multi-year Plan
(Better Care, Made Easier)
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Appropriateness Multi-year Plan
2015/16 Provincial Outcome & Improvement Targets
(Note: New language still under review)
• By March 31, 2018, 80% of clinicians in 3
selected clinical areas within one or more service
lines will be utilizing agree upon best practices.
– By March 31, 2016, at least one clinical area within a
service line will have deployed care standards and
will be actively using measurement and feedback to
inform improvement.
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Appropriateness of Care
Progress to Date:
Wall Walk Charts: “Green”
Framework Development
MRI Prototype underway
Awareness Campaign continues: SMA, SHR, MoH, PLT, SMOC, RQHR
RHQR DHC meeting on June 30th, 2015
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Appropriateness of Care
Better Care, Made Easier
VISION STATEMENT –permission sought from the CMA
“The right care, provided by the right providers, to the right
patient, in the right place, at the right time, resulting in optimal quality care.“
OUTCOME TARGET
By March 31, 2018, 80% of clinicians in 3 selected clinical areas within one or more service lines will be
using agreed upon best practices
(Subject to Revision)
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The Framework Purpose is to create:
• A shared understanding of what Appropriateness of Care means,
• A common approach to improving Appropriateness of Care across the system,
• A roadmap for the health system to adopt this common approach within a broad range of patient-centered clinical areas.
Key Guiding Principles
•Clinician-led
•Evidence-based Care
•Effective Care
•Patient- and Family-Centered Care
•Information Sharing
•Equitable Care
•Standardized Care
•Continuous Learning and Improvement
•Interdisciplinary team (care team)
Value to Patients and Clinicians
•Eliminate unnecessary referrals, testing and treatments, thereby reducing wasted
time for both clinicians and patients
•Improve transparency in clinical decision making
•Greater involvement and collaboration of clinicians in developing new knowledge
•Standardized care does not mean “exactly the same care”, rather consistent care
that makes it easier for clinicians to provide and for patients to understand.
•Reduced wait times by ensuring only the right (best) tests or treatments are
provided to patients.
•Reduce potential risks to patient harms associated with unnecessary testing and
treatments
.
Purpose, Guiding Principles & Value
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Appropriateness of Care Program Roles
Provincial Program Roles
• Leadership
• Integration
• Provide support structure
• Consultation
• Replication
• Monitoring
• Benefit realization
Healthcare organization roles
• Develop own facility plan
• Adopt provincial methodology
• Collaborate with the provincial program
• Monitor and report own progress
• Measure the impact
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Provincial Program Strategies
– Data and measurement
– Stakeholder engagement
– Toolkit development
– Model line project (MRI)
– Communication and consultation
– Customize support
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MRI Lumbar Spine
• The main proposed Service Line for 2015-16 includes Medical Imaging: MRI of the lumbar spine
• In 2011-12 there were 1.7 million MRIs performed in Canada (volume doubled in less than a decade) (CIHI data).
• Approximately 5000 MRs performed on lumbar spine in SK annually
• A recent JAMA study found:
29% of the MRI requests for lumbar spine
were considered “inappropriate”
(Emery et al January, 2013)
If applicable to Saskatchewan, this represents an unnecessary expenditure of $833,00.
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Appropriateness Multi-year RQHR Plan
(Better Care, Made Easier)
• The 2015/16 completion of design phase by
end of June
• Research generation phase by end of
September
• Implement first project set by end of March
• Monitoring and evaluation by end of March
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Projects
1) Drawing from evidence and with the
awareness of the Choosing Wisely
initiative, Department Heads and Section
Heads are developing and renewing their
Pre Printed Orders (PPOs)
2) Standardization of practices
• Sets and trays in the OR
• Equipment and supplies
3) Evidence based practice
4) Pathways implementation
• Spine
• Stroke
• Pelvic floor
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RQHR examples
• New PPO admission orders for medical
inpatient units (elimination in unnecessary
blood work and radiology exams,
codification of VTE prophylaxis)
• Appropriate use of the Emergency
Department
• Review of laboratory, echocardiography,
stress testing, and radiology in
Cardiosciences
• Plan to standardize trays in Orthopaedic
procedures starting with knee replacements
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Physician Engagement Multi-year Plan
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Physician Engagement Multi-year Plan
RQHR OUTCOME
• Biennially, the physician engagement survey will
be completed with an engagement score of 55%
in 2016
• By 2017, RQHR will reach an average employee
and physician engagement score of 80%.
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Physician Engagement Multi-year Plan
The elements of the Multi-year Plan are:
• Communication Plan
– Providing timely information
– Involvement in decision making
– Listening
– Resolving important issues affecting medical staff
• Collaboration Plan
– Oversight Group Strategy
– Development of Compacts (RAHD and in Orthopaedics)
• Accountability plan
– Performance development
– Complaints management
– Bylaw and rules enforcement
– Leadership development
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Status of Strategy Implementation
Successes
Successes/What is working - The Senior Medical Office (comprised of Drs. Gill White,
David McCutcheon and George Carson) is committed to
improving physician engagement which is evident by the
work that has been completed to date.
- Department/Section retreats have been instrumental in
discussing and creating solutions to current issues and
trending
- Physicians are being empowered in their dyad and
physician leadership roles
- New service models have been implemented in
Cardiology and Psychiatry
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
- The Department of Family Medicine structure needs to be
redesigned to provide better support and communication to
community based family physicians
-Departments of Surgery and Medicine need further support to
be able to affectively deliver on the expectations of the
organization.
-The Department Heads have very limited administrative time
to fulfill their duties and accountabilities. Not enough time
provided to engage their members on a daily/weekly basis. As
a result, communication and/or dissemination of information is
sometimes stalled
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Next Steps
Next Steps
- Publish a quarterly newsletter, commencing in September
2015
- Second DHC retreat (scheduled for the fall 2015)
- DH performance assessment completed by Senior
Medical Office during summer of 2015
- Development of a business plan to remunerate DHs in
accordance with the ACFP model
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Medicine Service Line Multi-year Plan
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RQHR Multi-year plans that Contributes
to 15/16 Patient Flow Hoshin
2015/16 Provincial Hoshin
• By March 31, 2016, 90%
of patients waiting for an
inpatient bed will wait <=
17.5 hours.
• RQHR Supporting
Multi-year Plans:
Patient Flow
Primary Health Care
Seniors
Mental Health &
Addictions
Medicine Service Line
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Medicine Service Line Multi-year Plan
2015/16 Provincial Outcome & Improvement Targets for
Patient Flow
• By March 31, 2017, no patient will wait for care
in the emergency department.
- By March 31, 2016, the length of stay (LOS) in the
ER for 90% of admitted patients will be <= 22.3
hours
- By March 31, 2016, the LOS in the ER for 90% non-
admitted patients will be <= 5.9 hours
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Hoshin Measure - RQHR
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Hoshin Measure - RQHR
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RQHR Multi-year plans
Medicine Inpatient Units (MIU)
Medicine Inpatient Units Goal of 95%-0-0:
The work will focus on:
1) advancing a high quality daily plan of care for each patient.
2) Identifying and removing barriers to advancing the care plan
3) Preventing iatrogenic effects of hospitalization for seniors
4)Preventing harm to all hospitalized patients (i.e. falls, med
errors, infection transmission)
5)Driving to goal of admitting patients to the unit from the ER
within 30 minutes of decision to admit (assuming bed ready and
available)
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RQHR Multi-year plans
Medicine Inpatient Units (MIU)
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RQHR Multi-year plans
Medicine Inpatient Units (MIU)
Principle Strategies
1)Implement Accountable Care Units
- Model Line is unit 4A at Pasqua Hospital (6-12 month pilot). Replication to follow
to all MIUs
- Interdisciplinary in-room patient rounding with unit based physicians
- The rounds follow a standard process to advance the plan of each patient’s care
- Patient safety issues are addressed within the process
- Concurrent planning for discharge is incorporated
- Patient and family members are participants in the rounds
2)Seniors Friendly Hospital
- 33% of seniors over the age of 85 admitted to RQHR die.
- Care issues include:
- functional decline - medication toxicity
- altered consciousness(delirium) - care transition
- malnutrition/dehydration - polypharmacy
- Gentle Persuasive Approach has been demonstrated to be the most effective strategy
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Medicine Service Line Multi-year Plan
Critical Care and Cardio Sciences
• Ongoing assessment of Cardiology service model and diagnostic
scheduling management
• Understanding ED flow and pull times with establishment of
production boards starting on one nursing unit and one
diagnostic area
• Occupancy and surge is manageable – now tracking wait times
for transfers out.
• Ongoing development of Medical Surveillance Unit model.
• New database established to manage volumes within the EP
Program
• Work ongoing for development of Electronic ECG system
which will streamline information flow and access to cath lab.
• Agency nursing to support vacancy management in both areas.
• Team is involved in Hospira IV Pump implementation.
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Medicine Service Line Multi-year Plan
Critical Care and Cardio Sciences
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Medicine Service Line Multi-year Plan
Emergency and EMS
Emergency and EMS:
• e-Primary Assessment • RPIW #69 – decreased time to complete and document primary
assessment in SCM from 25 minutes (average) to 10 minutes (average)
• Urban EMS Offload: • May 2015:
Leading practice in Western Canada (urban)
Average: 90th P
Pasqua ER 12:19 30:29
RGH ER 12:24 39:41
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Emergency Departments:
• Major occupancy pressures
• Increase volume of visits
• Restricted space
• “To Meets” waiting to be seen by Consultant (RPIW #74)
• Admit no bed patients
• Results in:
• Increased patient complaints
• Lack of space for clinical assessment
• Privacy and dignity concerns
• Risk of delirium in seniors
• Increased patients leaving without being seen
• Delays for ED patients
• Innovation
• Use of community paramedic to do at home assessments thus
avoiding ED admission
Medicine Service Line Multi-year Plan
Emergency and EMS
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VP Quarterly Report on Strategies
Q1 – 2015/16
Vision:
Healthy people, families and communities.
VP: Sharon Garratt – Integrated Health Services
Update on Surgical Initiative
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Portfolio Overview
• Surgical Service Line
– Perioperative Services
– Surgical Access & Inpatient Services
• Women’s & Children’s Health
• Specialized Ambulatory Care
– Ambulatory Care & Medical Outpatients
– Kidney Program
• KOT
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Saskatchewan Surgical Initiative
Transform the patient experience through
sooner, safer, smarter surgical care
• By March 31, 2014 100% of patients have the
option of receiving surgery within3 months
• By March 31, 2015, 100% of cancer
surgeries/treatments done within consensus
timeframe from the time of suspicion or diagnosis
of cancer
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Surgical Initiative Outcome Measure
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Status of Strategy Implementation
Successes
Successes/What is working
• Good tracking systems are in place
• Surgical Team understands the contributors
to volume, what is within control and not
within control
• Weekly and monthly monitoring identifies
need for course correction
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Status of Strategy Implementation –
Challenges & Risks
Challenges/Gaps/Risks
• We need to match capacity to demand, however demand is a
projection – which is an educated guess about the future based
on a variable that fluctuates widely throughout the year.
• There is a risk that patients will experience longer wait times as
our budgeted volumes assume demand growth under 1% and as
of June 1st we were at 2.2%.
• It takes time to course correct – OR allocation changes take
months to implement
• It was much easier to achieve cooperation when the program
was adding capacity and resources. Now that those two things
need to be constrained it is more difficult.
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Surgical Demand – Surgical
Bookings by Section
Section 2014 2015 Growth Rate
DENTISTRY 170 240 41.2%
NEUROSURGERY 200 247 23.5%
OTOLARYNGOLOGY 211 252 19.4%
VASCULAR SURGERY 63 72 14.3%
OBSTETRICS GYNAECOLOGY 559 623 11.4%
UROLOGY 252 273 8.3%
PLASTIC SURGERY 164 176 7.3%
ORTHOPAEDIC SURGERY 1391 1473 5.9%
ONCOLOGY 11 11 0.0%
THORACIC SURGERY 39 39 0.0%
OPHTHALMOLOGY 992 879 -11.4%
GENERAL SURGERY 682 595 -12.8%
CARDIOVASCULAR SURGERY 67 57 -14.9%
PAEDIATRIC SURGERY 83 53 -36.1%
TOTAL 4884 4990 2.2%
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Surgical Targets
Uncontrollable Controllable
Month Emergencies C-Sections
Electives TOTAL IP OP IP
Apr-15 366 50 73 1612 2101
May-15 432 34 83 1599 2148
Jun-15 423 49 76 1667 2215 Jul-15 429 55 85 1118 1687
Aug-15 455 44 97 1491 2087
Sep-15 416 44 80 1665 2205
Oct-15 391 47 83 1661 2182
Nov-15 384 50 85 1594 2113
Dec-15 395 48 79 1466 1988
Jan-16 415 48 84 1597 2144
Feb-16 368 37 68 1349 1822
Mar-16 443 45 83 1669 2240
Total 4917 551 976 18488 24932
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Surgical Waitlist
31.2% 23.2%
68.8% 76.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Waitlist Snapshot: April 1st, 2014 Waitlist Snapshot: April 1st, 2015
Waitlist: IP/OP Mix
IP OP
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Next Steps
Next Steps
- Continue to monitor volume to target weekly
- Proceed with summer, Christmas and February
slowdowns as planned
- Review IP/OP mix
- Deep dive on reasons for increase in emergency
surgeries
- Close vacated OR time
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BREAK
Resume at 3:40pm
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VP Quarterly Report on Strategies
Q1– June 23, 2015
Robbie Peters,
Vice President, Financial Services &
Chief Financial Officer
Vision:
Healthy people, families and communities.
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Portfolio Overview
• Finance
– Accounting & Financial Reporting
– Payroll & Benefits
– Decision Support
• Facilities Management
• Materials Management
192
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Multi-year Strategic Plans
VP is Leading on:
• Financial Sustainability Strategy
Multi-year Plan
• Facilities Strategy Multi-year Plan
193
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Financial Sustainability
Provincial Outcome
2015-2016
• By March 31, 2017, Ongoing, as part of a multi-
year budget strategy, the health system will
bend the cost curve by achieving a balanced or
surplus budget.
194
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Financial Sustainability
Provincial Targets
2015-2016
• All health system partner organizations will be in
a balanced or surplus year-end financial position
in 2015-16.
• Shared services activities will produce $10M net
new savings in 2015-16
195
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Financial Sustainability –
RQHR Results as of May 31, 2015
196
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Financial Sustainability –
Shared Services Reported at PLT Wall
197
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• Carry forward of financial deficiencies of prior years • Continually exceeding budget by approximately 140 FTEs
• High level of employee movement
• Reduced funding over last 5 years through
efficiency targets in an effort to bend the provincial
costs curve • In the range of $60 - $70 million
• Increasing population and demographic changes
resulting in growing demand for services • Estimated cost of $70 million last 4 years
• Planned investments to respond to growing complex
and changing environment • Physician leadership structure and service expansion
• Sask. Healthcare Management System
• 3sHealth shared service opportunities
Financial Sustainability
RQHR Challenges
198
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• Board Approved Priority Areas
- Quality and Safety
- Patient Flow
- Primary Health Care
- Mental Health and Addictions
• Long-term Sustainable Initiatives RQHR continues to focus on developing a strong and
sustainable foundation
• 11 initiatives addressing $38 million deficiency
• 5 initiatives of ETI steering committee (some overlap with 11
initiatives)
• Diligent Daily Management
shared responsibility and accountability for all decision
makers on daily decisions we make
Financial Sustainability
Recap of Strategy Implementation
199
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Recap of regional focus to a 2015-16 balanced
budget and reducing long-term cost structure
Priority focuses and preliminary targets to achieve a balanced budget in 2015-16
Regina Qu'Appelle Health Region
2015-16 Operating Budget
In $000's
2014-15P 2015-16B $ Change % Change
Preliminary Deficit ($13,921) ($38,269) ($24,348) 174.90%
Regional focus to a 2015-16 balanced budget and reducing
long-term cost structure VP Responsible
3sHealth and Other Contracts 2,500 Peters
Cost Savings from Reduced Surgical Volumes 8,000 Garratt
Reduction of VAC Beds if No Funding for Alternative use 1,300 Redenbach
Clinical Appropriateness 1,000 McCutcheon
Quality & Safety Initiatives 1,000 Smadu
Patient Flow / 95% Occupancy 1,000 Neville
Improve on Ambulatory Care
Sensitive Condition Indicators 3,000 Earnshaw
Reduce Orientation Costs by 20% * 1,300 Higgins
Reduce Sick Costs by 15% * 2,500 Higgins
Reduce Overtime Premiums by 33% * 3,929 Peters
Workforce Optimization - 152 FTEs at avg, salary $85,000 ** 12,740 All
Revised Surplus (Deficit) $0
* Expected payback from daily management initiatives
** Done through attrition, does not contemplate layoffs
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1. Management Capacity
2. Accountability Frameworks
3. Master Roster Reviews
4. Overtime Deep Dive
5. Workforce Optimization
Reminder of Efficiencies Targets Initiatives
(ETI) Steering Committee Focuses
201
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• Significant budget challenge ahead of us – creating a mechanism to
monitor and report on success of the $38M deficit mitigation strategies
and ETI work
• Monthly SLT and Finance/Business Manager budget meetings
• Wall walk format
• Trialing a virtual wall next week and will be rolled out widely when ready
– want to make this work visible to the organization and other
stakeholders
• Continue to build on the themes of Accountability and Shared
Responsibility throughout the organization
• Monthly meeting and virtual wall will also hold VPs accountable through
monitoring and reporting of portfolio financial results, paid hours, service
volumes, etc.
• Daily management by everyone is key to our success
• Continue to support and lead initiatives such as 3sHealth business cases
• Continued commitment to on-going continuous improvement work (lean,
other)
• Exploring options to develop a temporary dedicated task team to address
immediate financial challenges and operational outliers
Financial Sustainability Going Forward
202
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Financial Sustainability
Questions?
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Facilities Strategy
Provincial Improvement Outcome
• By March 31, 2017, all infrastructures (IT,
equipment & facilities) will integrate with
Provincial strategic priorities, be delivered with a
Provincial plan and adhere to Provincial strategic
work.
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Facilities Strategy
Provincial Improvement Targets
• By March 31, 2016, have delivered results on 3
high impact capital areas that address high risk
for critical failure using alternative
funding/delivery options.
• By March 31, 2016, common criteria and
options for investing are used to vet all capital
investments.
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Provincial Model - Infrastructure
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Provincial Deliverables -
Infrastructure
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Provincial Timeline - Infrastructure
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• Lack of Regional involvement in provincial strategy and targets
development and related action plans
• Improvements needed in developing RQHR specific facilities
outcomes and targets which link to provincial and other RQHR
strategies
• Traditionally focusing on upcoming priorities for the
department
• Initiating work with KPO and SPBIU to further develop a
comprehensive strategy plan for Facilities Management
• Significant facility infrastructure deficiencies identified across the
province requiring significant sustained investment
• Minimal annual funding to address deficiencies and no multi year
funding commitments
Facilities Strategy
RQHR Challenges
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Immediate to Short-Term:
•Working with KPO and SPBIU to enhance overall strategy and
action plans
•Development of comprehensive capital plan to address most critical
areas over the next 3 years and beyond including: • Optimization of annual capital funding to address greatest
operational risks while maximizing ROI ($5.3 million for 2015-16)
• Advancing major capital renewal of critical electrical systems at PH
and RGH and energy upgrades at PH and WRC
• Advancing renewal and building capacity of residential, primary care
and community infrastructure
•Planning workshop in the next quarter with Board/SLT and other
stakeholders to develop an action plan to advance the most critical
areas identified above
Facilities Management Going Forward
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Immediate to Short-Term (continued):
• Department restructuring to better respond to organizational
operational and capital project requirements, risk mitigation and
maximizing return on investments for limited dollars available to
us, and capitalizing on market opportunities
• Developing / enhancing policies and procedures on space
planning, utilization and alterations
Longer-term:
• Taking a longer term outlook on aligning our facilities, property
and infrastructure management to optimally sustain, critically
enhance and strategically support change and innovation to
increasing demands of better health care for our communities
Facilities Management Going Forward
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Facilities Strategy
Questions?
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DEEP DIVE SESSION
Course Correction for Current Year
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Table Discussion & Report
• Instructions:
1. Table Discussion (20 minutes): Use your Session
Notes Worksheet and focus table discussions on:
– What needs to be done differently (for particular multi-year
plans)?
– What you can do differently (for your work plan)?
2. Group report out (15 minutes).
3. After Q1 Session:
o Leave your Session Notes Worksheets on the table – we will
collate information for VPs to consider for course correction.
o Take personal action items/ideas back to incorporate into
your work plans.
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CLOSING REMARKS
President and CEO, Keith Dewar