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What is service alignment?
Saskatoon Health Region is reorganizing and aligning the delivery of health services in the city of Saskatoon. Service alignment focuses heavily on the provision of acute care services, but goes well beyond that both in terms of its effect on many parts of the system and in proposing new models for ambulatory services (day procedures and outpatient visits to hospital) and care of people with conditions requiring complex continuing care in the region.
Service alignment is happening across Canada as health regions are faced with the pressures of improving quality and safety of care; adapting to demographic change that affects service needs, recruitment and retention; growing demand for service; aging infrastructure and significant capital and technological investment requirements.
A centrepiece of service alignment is the distinct role of each hospital in Saskatoon. St. Paul’s and Royal University Hospital will provide inpatient care for those who require high acuity care for a short period of time. Saskatoon City Hospital will specialize in large volumes of surgery that do not require overnight care; inpatient care for people who no longer require high acuity are but need continuing complex care for a prolonged period of time, including those requiring rehabilitation; and the majority of the outpatient hospital care provided in Saskatoon.
All three hospitals in Saskatoon will continue to be busy acute care facilities that play important, better defined and co-ordinated roles to meet the health service needs of the community.
Services have been realigned previously in Saskatoon Health Region, including the consolidation of maternity services at RUH and the consolidation of orthopedic and general surgery. Rehabilitation services were also consolidated at City Hospital from RUH and Parkridge.
History of service alignment
For many years Saskatoon Health Region has experienced a growing misalignment between acute care hospital capacity and demand for hospital care from the people and communities it serves. The increasing population in Saskatchewan, the introduction of new health care technologies, and shortages of specialized care providers have also placed pressure on the Saskatoon Health Region hospital system. The existing facilities and arrangement of acute care services in our three hospitals in Saskatoon do not meet our current or future needs.
In 2003 the senior leadership team embarked on a service alignment review. A project leader was assigned to work with physicians, general managers, directors and staff to develop and analyze service alignment options. Based on the input from staff and physician focus groups, teams were challenged to develop three broad alignment options. Each option was analyzed to assess the impact of the proposed service changes; to determine the impact of placement of a designated maternal and children’s hospital at one of the sites; to assess the feasibility of consolidating services currently duplicated across the system; and most importantly to analyse the impacts on the quality of care for those coming to our doors now and into the future.
Creating sustainable change
The first phase of the work confirmed that, with the size and complexity of Saskatoon Health Region, “tinkering around the edges” did not create sustainable change. This first phase also confirmed that people were ready for change and there was agreement that our system needed to change. This first phase of work led to the conclusion that another level of work was required to:
- assess population projections and demographics and better determine hospital service needs now and into the future
- incorporate planning specialists, space planning and health care facility design
- develop an infrastructure master plan to make maximum and appropriate use of current capital infrastructure
The role of consultants
The steering committee - established in 2005 to complete the second phase of work - hired Resource Planning Group (RPG) and Hay Group Health Care Consulting to project the service volumes Saskatoon would experience in 2021, develop a clinical service plan and propose options for the distribution of services to be provided in the Saskatoon hospitals in 2021. The consultant report was released in spring 2006 after considerable consultation with eight clinical advisory groups (medicine, surgery, mental health, paediatrics, emergency and pre-hospital care, obstetrics and newborn, therapeutic services, laboratory and diagnostic imaging) and other people. Four options were presented as to how services could be configured to best meet the objectives of patient-focused, cost effective care that supports academic and research excellence, and makes maximum and appropriate use of existing capital infrastructures.
Moving forward
The Region was then ready to begin implementing that recommendation. The first consolidations are already complete. Orthopedics is now consolidated at SCH and RUH, general surgery is consolidated at SPH and RUH, and the intensive care units have been consolidated from three to two, located at SPH and RUH. The long range plan is for orthopedics to be at SPH. This fits with the intent for SPH and RUH to be the location of inpatient acute care and SCH to be the site for ambulatory care, rehab and medically complex care. However, given the current situation, orthopedics needed to consolidate before it was possible for orthopedics to be consolidated at SPH. Acute inpatient medicine services will be consolidated at SPH and RUH, and inpatient urology services will be consolidated to SPH.
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