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.

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

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

Seniors Multi-year Plan 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%

Seniors Multi-year Plan Outcome Measure

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.

Status of Strategy Implementation Successes Successes/What is working Antipsychotic without a diagnosis project on the 2 nd 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 3 rd and 4 th 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”

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

Status of Strategy Implementation Successes

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

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

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.

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

Multi Year Strategic Plan VP leading on:

Mental Health and Addictions Multi-year Plan 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

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

Mental Health & Addictions Multi-year Plan Outcome Measure 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%

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%

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%

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

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

Next Steps / Link to 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