Saskatoon - Just over 90 days ago, Saskatoon Health Region set out on an ambitious patient-first journey. Through
90 Days of Innovation: Ready Every Day, the Region focused all of its attention and efforts on resolving a single problem: to be ready to serve the community by providing people with the right care in the right place at the right time.
"We set out to have the right community services in place to prevent individuals from requiring hospital care and to ensure those who did need hospital services received both timely and appropriate care," says Petrina McGrath, Vice President of People, Practice and Quality and the Process Lead for
90 Days of Innovation: Ready Every Day.
The Region aimed high, setting targets to create an exceptional patient experience, including: no patients receiving care in a temporary setting; no patients waiting for a specialty bed or for a transfer to another hospital closer to where they live; no patients waiting in acute care for placement in long-term care or for other community services; and, no patients waiting in emergency who could have been cared for more appropriately elsewhere.
"To aim for anything less than zero waits wasn't acceptable," explains Dan Florizone, President and CEO, Saskatoon Health Region. "None of us want to see even one patient waiting for a healthcare service. So, we set out to make changes to better anticipate emerging patient waits, and put the right people, services, and resources in place to prevent those waits and eliminate system bottlenecks, all while making wise use of taxpayer dollars."
Three teams, led by three vice-presidents, were tasked to start the Region on its inaugural journey of a 90 day cycle of system-wide improvements. The teams' areas of focus were community strategies, transitions of care within hospital, and information and decision support.
"While we didn't hit zero on our targets, we saw our overcapacity beds drop significantly - from 110 in February to 75 at the outset of this initiative, to 31, a decrease of 58 per cent since March 12," says McGrath. "We identified 20
inappropriate patient care spaces and began to permanently close them. We increased community-based supports by expanding the
community paramedicine pilot, which is now in four long-term care homes in Saskatoon. We identified barriers to progression of care for patients in hospital, and came up with strategies to remove these barriers, such as grouping patients by care team and dedicating space for and operationalizing a new acute stroke unit."
"Overcapacity was becoming our norm. That's not the case anymore," says Florizone. "We now have a new way of checking the pulse of the organization on a daily basis through improved lines of communication from frontline staff through to senior leaders. Couple that with
the predictive model we have created which anticipates surges with 94 per cent accuracy and we are prepared to better manages surges when they occur. But, we know there is still much more to do."
A plan has been developed to ensure that the original goals of the
90 Days of Innovation are met and the gains made are not lost. Work will continue on initiatives started during
90 Days of Innovation. These include:
- completing a system-wide service realignment of bed designation to match patient needs based on historical and predictive needs;
- fully operationalizing the new acute stroke unit at Royal University Hospital;
- ensuring all acute care units have a predictive model with signals warning of potential surges;
- expanding home IV therapy to reduce the need for acute care stays for minor procedures;
the Direct Client Funding program to help those who require support to remain in their home longer;
- opening community
transitional beds for acute care patients waiting for more appropriate services in the community;
- continuing to increase the number of approved community mental health homes and enhancing support to these homes;
- establishing a new HIV hospice and therapy home to improve access to care for patients and reduce readmissions;
- improving access to non-emergent tests to seven days a week to reduce the need for hospital admissions;
- establishing standardized new approaches to meet demand for
specialty beds to reduce waits for admission;
- working with other health regions to build on the process for patients being transferred to their home hospital (e.g.,
- working with physicians and residents on their workflow to improve daily rounding; and
- working with all units to operationalize the Region's new staffing principles to improve staffing strategies and to reduce overtime.
"We are breaking new ground and we could not have accomplished what we have so far without the efforts of everyone," says McGrath. "In the weeks and months ahead, we look forward to sharing additional achievements that benefit our patients and families."
Saskatoon Health Region will continue with 90-day improvement cycles. These condensed periods of activity will begin with a period of preparation and analysis so that evidence-based actions can be undertaken, and will end with the creation of a carry-forward plan to ensure gains are sustained. Preparations are already underway for the next improvement cycle, which will focus on safety, beginning in September.
"We have learned so much during this first-of-its-kind initiative to tackle decades-old, system-wide issues. And we will continue to pursue what was once thought impossible because that's what patients and families deserve," says Florizone. "It's fundamental that we continue to move forward and build on the successes we have seen through this focused, organization-wide effort. Many employees have been instrumental to this work and have devoted themselves to making tangible improvements to patient care. They have changed lives for countless individuals. I am so proud of what has been achieved and I look forward to seeing what we can accomplish next."