2006 – 2009 Health Plan
Table of Contents
Statement of Accountability ...... 1
Leading the Way...... 2
Purpose ...... 3
Core Business ...... 4
Governance...... 6
Making a Difference...... 10 Assessing the Needs of the Population...... 12 Advocate and Educate for Healthy Living...... 14 Provide Quality Health and Wellness Services...... 16 Lead and Participate in Continuous Improvement in the Health System...... 19
Appendix A: Factors and Measures ...... 21
Statement of Accountability
This three year Health Plan for the period commencing April 1, 2006 was prepared under the Board’s direction in accordance with the Regional Health Authorities Act and direction provided by the Minister of Health and Wellness.
The strategic direction and priorities of the Calgary Health Region have been developed in the context of legislated responsibilities, the Ministry of Health and Wellness’ business plan, and provincial government expectations as communicated by the Minister.
Performance measures are included as the basis for assessing achievements.
The Board and Administration of the Calgary Health Region are committed to achieving the planned results laid out in the 3-year Health Plan.
Respectfully submitted on behalf of Calgary Health Region
1 Leading the Way
The Calgary Health Region’s 2006-2009 Health Effective and quality healthcare service delivery Plan is guided by direction received from Alberta requires solid clinical research and Health and Wellness and describes how the demonstrated efficacy for care and practices. Calgary Health Region will fulfill its legislated The Calgary Health Region, in collaboration with responsibilities. It takes the growing population other public, voluntary and private organizations and changing trends into consideration. The and companies will continue to strive for best strategies will be measured and monitored to practice service delivery through technology, ensure residents of the Calgary Health Region innovation, centres of excellence and receive high quality care expected and continuously evolving service delivery deserved. The Health Plan builds on and enhancement initiatives. enhances many of the successful initiatives that were implemented over the last number of years Improving access and increasing effective in efforts to build Canada’s healthiest service delivery are essential components of a community. successful healthcare system. However, the real challenge for everyone in the Calgary Health To manage an increasing capacity requirement, Region is to lead healthier lives. The primary over $1.5 billion dollars will be invested in capital benefit is a higher quality of life and well-being projects over the next five years. This for individuals and families. The Calgary Health necessary funding, supported by the provincial Region will be laying out its strategies for a government’s commitment to improve access to healthier community, as the Board Task Force health services and reduce wait lists, include on Wellness tables its strategy and action plan. constructing a new children’s hospital, a state- of-the-art health campus inclusive of a hospital Recruitment strategies, opening new facilities in south Calgary, a new inner city health centre and enhancing existing centres, creating a and expansions for the Peter Lougheed Centre, wellness strategy, focusing on patient Rockyview General Hospital and Foothills experience and continuously improving service Medical Centre. However, new health facilities delivery are only a few examples of the different are only part of the answer to adding service and diverse areas that the Calgary Health capacity. New community models of care, Region is investing time and energy to satisfy creating networks with primary care practitioners the fundamental goal of caring for its patients. and focus on chronic disease management are While the healthcare system is not without also key service strategies to adding system challenges, the Calgary Health Region wishes to capacity. Adding facilities and services to deal take full advantage of all of the opportunities. with a growing and aging population creates, The fundamental tenet of providing safe, quality another challenge: recruiting enough staff and care in many different ways to many different physicians. people is what drives the Calgary Health Region and its Board of Directors. The Calgary Health Region is already short a significant number of physicians, the majority of whom are family doctors to provide first contact care for Albertans. Addition of new services and facilities will require significant increases in the number of staff. However, increasing number alone is not sufficient, as staff will need to work in new ways, incorporate new skills and embrace interdisciplinary care. The Calgary Health Region is collaborating with key members of the publicly funded educational institutions in South Alberta (University of Calgary, Mount Royal College, Southern Alberta Institute of Technology and the Bow Valley College) with a mandate to highlight the importance required investing, expanding and
changing health care education to meet future workforce needs.
2 Purpose
The Calgary Health Region’s Health Plan is a public accountability document spanning a three year time frame. It describes at a strategic level the actions it will take in carrying out its legislated responsibilities with a primary focus on delivery of quality health services. The responsibilities as set out in Section 5 of the Regional Health Authorities Act are to:
1. Promote and protect the health of the Core Business:
residents of the Calgary Health Region and work towards the prevention of disease and injury. To ensure delivery of quality health services while managing our financial and human 2. Assess on an ongoing basis the health resources wisely, and to encourage and needs of the Calgary Health Region. promote healthy living. The Calgary Health Region provides services to residents living 3. Determine priorities in the provision of within the Region boundaries, as well as health services in the Calgary Health residents of Alberta and other provinces. Region and allocate resources The majority, 88.5 per cent, of patients accordingly. treated live within the Calgary Health
Region. 7.1 per cent of patients reside in
4. Ensure reasonable access to quality Alberta, but outside the Region, while 4.4 health services. per cent of patients come from other
provinces. 5. Promote the provision of health services in a manner that is responsive to the needs of individuals and communities and supports the integration of services and facilities in the Calgary Health Region.
Health Plan development is guided by direction received from Alberta Health and Wellness and is aligned with and supports the Ministry’s business goals. A key feature of the plan is ensuring that mechanisms for measuring and monitoring results and achievements are identified.
3 Core Business
Mission: The Calgary Health Region is committed to excellence in providing an $2.3 billion [2005/06] accessible, accountable, integrated, community-based health system that Annual Budget: promotes shared responsibility for improved health. Facilities: The Calgary Health Region provides services in more than 100 locations Vision: including 12 acute care sites, 40 care centres and a variety of Our community working together for excellence in health. community and continuing care sites.
Values: Hospitals (Acute Care Facilities): Honesty, Respect, Integrity, Responsiveness, Dignity, Creativity, Trust and Learning. Four urban (three adult and one children’s), eight rural [2005]
Established: Comprehensive Community Health Centres: The Calgary Health Region was first established in 1995. In 2003, the South Calgary Health Centre, 8th and 8th Health Centre, Okotoks provincial government combined the Calgary Health Region, Headwaters Health and Wellness Centre. Also plans to build the Sheldon M. Chumir Health Authority and Wheatland County. Didsbury joined the Calgary Health Health Centre in downtown Calgary and has purchased land for a North Region a year later. Calgary Health Centre to be located at Country Hills Boulevard. Current plans also call for building health centres in Airdrie and Cochrane. Geographic Area: 39,260 sq. km [2004] Number of Beds/Spaces: Population by Age Groups: 7,836, including 7,145 urban and 691 rural [2005] <20 yrs: 299,064 or 26 per cent; 20 to 64 yrs: 737,292 or 65 per cent; 65 to 74 yrs: 59,585 or five per cent; Number of Employees: approximately 24,000 [2005] 75 + yrs: 47,427 or four per cent.
Number of Physicians: approximately 2,200 [2005] Growth in Population: Entire Calgary Health Region: 2001: 1,067,058 (increased by 24,992) Number of Registered Volunteers: 3,917 [2004] 2002: 1,098,149 (increased by 31,091) 2003: 1,122,521 (increased by 24,372) 2004: 1,143,368 (increased by 20,847) Total Volunteer Hours: 257,334 [2004]
Projected Annual Population Growth Rate (Next 10 Population Served: Years): Urban: 1.9% Rural: 2.7% 1,143,368 or 36 per cent of Alberta’s population [March 2004] Urban population: 962,810 Rural population: 180,558
Sources of Revenue Areas of Expenditure Expense Growth This chart illustrates the Calgary Health Region’s main sources of The Calgary Health Region’s operating budget will hit The Calgary Health Region’s budget has been growing revenue. The largest share, 87 per cent comes from Alberta Health $2.3 billion this year. Salaries and benefits make up by nine to 10 per cent a year, with some items, such as and Wellness. Six per cent of the Calgary Health Region’s revenue the largest cost, followed by contracted services, drugs and medical and surgical supplies, increasing by comes from charges to non-residents for health services. mostly for continuing care. eight to10 per cent a year. A significant increase in the Calgary Health Region’s budget occurred in 2003/04 when the Headwaters and Wheatland health jurisdictions joined the Calgary Health Region. The fastest growing expense has been salaries and benefits, which are driven by inflation as well as growth as the Calgary Health Region recruits additional healthcare providers to keep pace with increases in population and the demand for more services.
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Facilities and Bed Numbers
Banff Mineral Springs Hospital ...... 22 acute care beds Claresholm ...... 24 continuing care spaces Claresholm General Hospital ...... 16 acute care beds Banff Community Health Centre Willow Creek Care Centre ...... 100 continuing care spaces Claresholm Care Centre ...... 100 psychiatric rehab beds Canmore Canmore General Hospital ...... 21 acute care beds Carmangay ...... 23 continuing care spaces Little Bow Care Centre ...... 20 continuing care spaces Canmore Community Health Centre Cochrane Cochrane Community Health Centre Bethany Care Centre ...... 78 continuing care spaces Calgary City-wide ...... 2,012 acute care beds
City-wide ...... 4,750 continuing care spaces City-wide ...... 245 rehabilitation and recovery beds Didsbury Didsbury Hospital ...... 15 acute care beds ...... 91 continuing care spaces Airdrie Airdrie Regional Health Centre Bethany Care Centre ...... 74 continuing care spaces
Strathmore Strathmore District Health Services ...... 20 acute care beds ...... 23 continuing care spaces Strathmore Health Unit
Okotoks Okotoks Health and Wellness Centre
High River High River General Hospital ...... 27 acute care beds ...... 74 continuing care spaces High River Community Health Centre
Vulcan Vulcan Health Centre ...... 8 acute care beds ...... 61 continuing care spaces
Black Diamond Oilfields General Hospital ...... 15 acute care beds ...... 30 continuing care spaces Black Diamond Community Health Centre
Nanton Nanton Community Health Centre
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Governance
Calgary Health Region Board
Board members represent the rural and urban populations.
Board Chair: David Tuer
Board Members: Courtney Rousseau, Vice-Chair, Longview Diane Caleffi, Calgary Eileen Grant, Calgary George Pinchbeck, Strathmore Gordon McPherson, Vulcan Loreen Gilmour, Calgary Lynn Martin, Calgary Mairi Matheson, Calgary Marjorie Ricketts, High River Myron Kanik, Calgary N.D. (Skip) McDonald, Calgary Sandy Dougall, Calgary
Governance at the Calgary Health Region is a highly collaborative and inclusive process. Urban and rural designated representatives ensure the concerns, needs and requirements of the population within the Calgary Health Region are tabled with Calgary Health Region executives at Board meetings, ensuring service delivery strategies are tailored appropriately. Representatives from the medical community and the Health Advisory Council also participate on committees and at the Board table and contribute to the shaping and evolution of service delivery strategies, such that the concerns of physicians and other health care professionals are addressed. All staff are encouraged to contribute ideas towards more effective healthcare service delivery, or to provide ideas that will enhance operation at any level. Medical Advisory Board Chair: Dr. Ted Braun
Pursuant to s.14 of the Hospitals Act (Alberta), the Medical Advisory Board provides a structure whereby the members of the medical staff can participate in activities designed to maintain the standards of professional medical practice and quality of care, have input into strategic planning, quality assurance for the medical care rendered to patients of the Calgary Health Region, and facilitate the continuing medical education of the medical staff.
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Calgary and Area Physicians Association President: Dr. Michael Giuffre
The Calgary and Area Physicians Association is an independent voice representing the physicians of the Calgary Health Region. The objectives of the Association are to represent and advocate for the interests of the physicians in the Calgary Health Region; to provide an organization for the physicians of the Calgary Health Region that facilitates addressing any issues from a physician’s perspective relating to the care and management of the delivery of health services in the region; and to promote and advance physician involvement in the provision of health services.
University of Calgary Faculty of Medicine Dean: Dr. Grant Gall
The Calgary Health Region and the University of Calgary’s Faculty of Medicine have major programs in common which involve undergraduate education; post-graduate and continuing education for physicians; clinical, health services and community health research; clinical consultation and patient care. These programs have provincial mandates and many have a national impact.
Health Advisory Council Chair: Dr. Ray Graham
The 19 members of the Health Advisory Council represent over 50 health care professional groups (other than physicians) who provide direct patient and client care services in the Calgary Health Region. Each Council member represents a specific grouping of health care providers, must be actively working in patient/client care delivery, and serve a two-year appointment on the Council. The Council offers ongoing advice to the Region’s Board and management teams based on the viewpoints, issues, concerns and suggestions of health care professionals working in the Calgary Health Region.
Up to three Council members attend all regular Board meetings as non-voting representatives. The Council also has representatives serving on the Board’s standing committees. In addition, Council members provide valuable input while serving as members on a number of Regional committees.
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Governance
Institutes
A major focus has been the development of institutes in seven key areas. These institutes are a joint collaboration between the University of Calgary and the Calgary Health Region and in some circumstances created from the generous support of prominent community members. The primary mandate of the institutes is to enhance research and accelerate the translation of proven clinical research from the bench to the bedside. The areas of focus are:
Alberta Bone and Joint Health Institute Hotchkiss Brain Institute Southern Alberta Cancer Research Institute Libin Cardiovascular Institute of Alberta Institute of Maternal and Child Health Institute of Infection, Immunity and Inflammation Institute for System Research in Health Foundations
Calgary Health Trust
The Calgary Health Trust (the “Trust”) is considered a controlled foundation as the Calgary Health Region appoints the majority of the voting members of the foundation’s Board of Directors. The purpose of the Trust is to benefit the Calgary Health Region, each facility within the Calgary Health Region and individual health programs and services operated by the Calgary Health Region, and to hold funds for its own account and without restriction to manage endowment funds received from any source. The Trust is a registered charity under the Income Tax Act (Canada).
Alberta Children’s Hospital Foundations
The Alberta Children's Hospital Foundation as the official fundraising body for the Alberta Children's Hospital. The Foundation supports excellence in pediatric health care by funding family centred child health programs, specialized life-saving equipment and advanced research and education. The Foundation works closely with the Calgary Health Region to support the work and mission of the hospital. Representatives of the hospital serve on the Foundation Board of Directors. Likewise, the Foundation is represented on the Hospital Research Board, Hospital Management Council and the Child Health Advisory Committee. The Foundation is a registered charity under the Income Tax Act (Canada).
Rural Foundations
The Calgary Health Region has economic interests in several rural foundations which raise funds to benefit the Calgary Health Region and other health related entities. The resources held by these foundations are not necessarily limited for use by the Calgary Health Region. The foundations are registered charities under the Income Tax Act (Canada). The foundations are:
Canmore and Area Health Care Foundation Claresholm and District Health Foundation High River District Health Care Foundation Oilfields/Okotoks Health Foundation Rosebud Health Foundation Strathmore District Health Foundation
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Community Health Councils
Seeking community input is an integral part of assessing health needs in Calgary Health Region. Rural Community Health Councils gather information including public input with respect to health, health needs and health services; provide advice to the Calgary Health Region regarding health issues, needs and priorities, access to health services, the promotion of health, and other matters as requested by the Calgary Health Region; and promote and participate in activities that enhance the health of communities and their citizens.
Health Service Directors and Board members provide ongoing support and liaison to the Community Health Councils by attending Community Health Councils meetings and providing reports and updates.
The Calgary Health Region has six established rural Community Health Councils:
Bow Valley Community Health Council, Claresholm and Area Community Health Council. Banff-Lake Louise Community Health Council, Black Diamond/Okotoks Community Health Council, High River/Nanton Community Health Council and Vulcan/Carmangay Community Health Council.
Calgary Health Region Aboriginal Community Health Council
Formed as an advisory body in 1995 and a Council in 1999, the Council promotes and advocates culturally appropriate health services for Aboriginal people served by the Calgary Health Region. These services strive to enhance the ability of Aboriginal people and their families to achieve optimal spiritual, mental, emotional and physical health.
The Council’s members come from the Aboriginal community at large, community-based service agencies, the Calgary Health Region and independent health service providers.
9 Making a Difference
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I. Assessing the Needs of the Population
For our region to be the healthiest population in Canada, it must engage its residents, partners, communities and governments to address the health gaps that exist among urban, rural and aboriginal populations, the highest and lowest income communities, focus on health in birth and early childhood years and implement comprehensive strategies for the major preventable causes of death.
II. Advocate and Educate for Healthy Living
We have a responsibility as a health system to promote good health and well-being as an actively sought out goal, consistent with Section 5 of the Regional Health Authorities Act (Alberta). Recognizing the greatest determinants of health and well-being are beyond the control of the health system, the Calgary Health Region has adopted a working definition of wellness as “the balanced experience of physical, mental, spiritual, and social well- being and requires the active participation of the individual and the community.”
III. Provide Quality Health and Wellness Services
The Calgary Health Region is committed to building Canada’s healthiest community by designing a modern healthcare system that delivers the right service from the right provider at the right time. The primary tenet within the system design is about capacity. During the next five years the Calgary Health Region will need thousands of additional healthcare professionals to fulfill our service capacity requirements. Meeting public expectations for delivering quality and accessible healthcare will require innovative reforms and workforce strategies.
IV. Lead and Participate in Continuous Improvement in the Health System
Achievement of the Calgary Health Region’s mission relies heavily on the integration of information from many community and acute care based programs, services and clinics that are widely distributed across the Calgary Health Region. Information and the technology that supports collection and management of information are integral components in the delivery of safe, efficient and quality patient care. Tracking expenditures and performing comparative analyses for all programs and services within the healthcare system will help the Calgary Health Region better understand strategic service planning.
11 I. Assessing the Needs
Needs Assessment The plan moves beyond daily service delivery and sets out strategic priorities. THE CHALLENGE: The population Three priority areas were identified for action served is greater than the populations of in the first three years of the plan: Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick, or Saskatchewan. Focus on childhood; Projections for the Calgary Health Region Focus on reducing health indicate that the population will also be disparities; and greater than the current population of the Focus on enhancing public health province of Manitoba within the next three advances. years. These priority areas were selected to align with Alberta Health and Wellness’ initiatives. The population growth is occurring in the In addition, strategies were priorized as Region’s rural areas as well as in the city of years one to three, years four to six and Calgary. The migration from rural to urban years seven to ten using feasibility, risk, cost areas experienced in many other health effectiveness, clinical effectiveness and regions is not occurring here, meaning that access as decision making criteria. Every demand for health services will be effort was made to align the increasing across the entire region. recommendations of the Population Health Strategic Plan with those emerging from The Calgary Health Region is expected to other planning studies in the Calgary Health grow for the next several years in all age Region including East Calgary Planning groups. The highest percentage increases Initiative, the Regional Wellness Plan, the will be seen in seniors aged 65 to 74 (60 per Rural Health Plan and the Mental Health cent) followed by adults aged 45 to 64 (40 Plan, with a view to creating the synergies per cent) and seniors 75 and over at 30 per and critical mass necessary to realize the cent. These age groups historically have the “preventive dose”. greatest demand for and use of health-care services.
The Calgary Health Region is comprised of populations such as aboriginals, immigrants, refugees and socio-economically disadvantaged where pockets of health disparities occur requiring enhanced initiatives to build a comprehensive service offering.
WHAT THE CALGARY HEALTH REGION IS DOING: a Population Health Strategic Plan for improving population health was developed from the broad number of programs and service units involved in performing needs assessment in the community. The development also included a review of recommendations from recent national and international studies of public health. It specifically considered the work related to the development of Pan Canadian Health Goals and Alberta Health and Wellness’ draft Population Health Strategic Plan. The process also included urban and rural consultation sessions.
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TOTAL POPULATION 2004: 1,144,678
PROJECTED POPULATION 2010: 1,286,720
PROJECTED POPULATION 2020: 1,528,333
POPULATION PROJECTIONS
The population projections presented in the population pyramids are based on death and birth rates as reported by the Alberta Vital Statistics Registry.
The growth scenarios used to calculate the population estimates use the average migration rate for the Calgary Health Region from 1991/92 to 2001/02.
13 II. Advocate and Educate for Healthy Living
Healthy Living Wellness Strategy To improve the well-being of all the people THE CHALLENGE: Data gathered from it serves, the Calgary Health Region has the Calgary populous confirms that factors adopted a Wellness Strategy. The five core such as inactivity, diet, tobacco, obesity and strategies are: hypertension are causing chronic diseases and premature death. The Calgary Health Advocating for healthy public policy, and Region’s poorest citizens are being hardest mobilizing communities to take action. hit. For example, a city-wide active living program is being developed in partnership The Calgary Health Region’s is analyzing with community agencies and groups. the data to identify disparities in health Emphasizing wellness in all health outcomes within its communities. Of services. Examples include the Calgary particular concern, is the gap of 6.5 years in Health Region’s Chronic Disease life expectancy that exists among communities within the Calgary Health Management program, a Healing Garden at Region. Based on published research it was the new Alberta Children’s Hospital, and anticipated that such a gap was likely to supports for children facing health threats exist, but until this time, there was no local such as inactivity and stress. data to confirm its existence. Other areas of Inspiring individuals and families to look concern include the high number of low birth after themselves and each other. Current weight babies in the Calgary Health Region initiatives include Apple, the Calgary Health as well as an increase in infant mortality. Region’s health and wellness magazine The challenge is to better understand the promoting healthy living, and an in-hospital factors contributing to Calgary Health television network. Future initiatives will Region’s infant deaths. While there have include promoting information in priority been improvements in some healthy behaviours, such as a reduction in smoking areas, such as physical activity, healthy rates supported by the passage of smoke- eating and stress/resiliency. free public places, there are fewer children Developing innovative services and who are protected against vaccine- alliances. The Calgary Health Region is preventable diseases. There has also been actively collaborating with other agencies an increase in the number of people who are and networks, such as the Integrative Health overweight. Institute of Mount Royal, the University of Calgary, the United Way and is part of the For almost all the areas where data Southern Alberta Child and Youth Health illustrates improvements are required, Network to identify and act on health and proven effective strategies exist. The community priorities. challenge for everyone is to use this knowledge to improve health. Leading by example. The Calgary Health Region is developing ways to create healthy WHAT THE CALGARY HEALTH workplaces for our staff and physicians REGION IS DOING: Action on the recommendations will require the Together we will be able to move towards participation and co-operation of individuals, our vision of being the healthiest region in families, the Calgary Health Region, local Canada. governments, the provincial government, businesses, community groups and associations and religious groups.
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Regional Population Health Framework The Regional population health framework functions within an integrated health system to achieve the healthiest community in Canada. As one of the determinants of health, the health system impacts the health of individuals and populations and responds to the broader socioeconomic and physical environment.
Regional Population Health Framework
15 III. Provide Quality Health and Wellness Services
• Continue to implement the Calgary Health Quality of Services Region’s 10-Year Seniors Health Strategic Plan. This includes a new care centre, designated assisted living capacity and new THE CHALLENGE: The Calgary Health community services. The focus will be on Region is committed to building Canada’s maximizing an individual’s independence healthiest community by designing a modern and supporting their quality of life. and effective healthcare system that delivers • Continue to improve accessibility via the right service from the right provider at Health Link to healthcare services 24/7 for the right time. This requires a disciplined clients seeking help with medical questions focus on all stages of a community’s or concerns. healthcare requirements. Staying healthy, • Review and make recommendations for getting better after an episode of illness, improvements in the structure, process and living effectively with chronic illness or outcomes for dealing with concerns. disability and elevating the quality of life • Expand Home Care services so patients while in the end stages of life are the can be discharged from hospital sooner and specific areas of need within the community. cared for in their own homes. • Continued focus on challenges that limit To achieve successful service delivery, the flow of patients through the system quickly Calgary Health Region recognizes the and efficiently, to match treatment with aforementioned areas of healthcare need. need. Numerous strategies have been created to • Work to maximize existing rural health care ensure the quality of service is suited to the programs, services and facilities so community, uses evidence based practices individuals can be treated close to home. with proven results, is delivered with the • Continue to expand Telehealth services to intention of safety as a primary tenet, and ensure rural constituents have accessible utilizes the most effective staffing mix while healthcare options. meeting or exceeding public expectation. • Create new geographically based Achieving success will require innovative community health centres, which will be reforms. based on the successes of the South Calgary Health Centre and the Okotoks WHAT THE CALGARY HEALTH REGION Health and Wellness Centre. Future plans IS DOING: Better access to health care is include the downtown Sheldon M. Chumir about developing new ways of delivering Health Centre, the North Calgary Health better services. Some of the Calgary Health Centre and the Airdrie Health Centre. Region’s priorities are: Planning for other sites, including Cochrane, • Align satisfaction questions from Health will continue. Quality Council Association (HQCA) surveys • Develop programs to support individuals with internal patient feedback survey with chronic diseases. process to provide more timely and relevant data that can be used to improve the patient experience. • Ensure quality care for individuals facing life-limiting illnesses by launching an initiative that invites the values of a patient and their family to guide their decision- making. • Continue to engage Community Health Councils to align delivery to the needs of the community. • Enhance the Calgary Health Region ability to view the services needed “Through the Eyes of the Patient” with a series of initiatives in collaboration with patients, families and other regional partners.
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• Develop an Aboriginal Health Centre to • Provide community care for individuals focus on the unique needs of this who have complex health needs, but don’t community. need to be in a hospital. • Implement the Five-Year Mental Health • Ensure quality of services is maintained by Plan; a comprehensive strategy that upholding full accreditation through emphasizes community-based care. Canadian Council on Health Services • Continue to strive for centre of excellence Accreditation for regional and contracted status within the Calgary Health Region’s acute and long term care facility services. seven institutes where clinical research will • Create ideal work environment with translate into proven effective healthcare groups of family physicians working practices. together efficiently through Primary Care • Continue to be innovative on workforce Networks with rapid access to patient utilization initiatives. information and timely access to specialists • Develop a comprehensive workforce such as mental health providers. strategy and plan which focuses on four key • Ensure measurement framework aligns areas: attract the required health care workforce, create a culture that emphasizes with the Calgary Health Region’s four long- a healthy and respectful workplace, develop term goals of providing safe access to the the health care workforce and utilize the system, creating a responsive organization, skills and talents of the health care building a culture of caring and fostering an workforce. engaged and knowledgeable community. • Develop an evidence based, robust model Commit to focus on monitoring and reporting for departmental Physician Workforce Plans of performance indicators. to ensure a comprehensive strategy to meet • “Safety First” is an integral part of the the needs of the Calgary Health Region and Region’s major shift in advancing patient its partners. safety and ensuring that safety is foremost • Participate in “Physicians’ Well Being: A in our planning and in the care and services Study of the Calgary Health Region” to we provide. understand the factors that are critical to • The development of new safety policies decreasing work-related stress and that relate to reporting hazards, creating a increasing satisfaction. just and trusting culture in which hazards • Create a new program for foreign trained can be reported without fear of reprisals, physicians to work as clinical assistants. disclosing harm to patients and informing • Continue to development of alternate stakeholders about safety issues relationship plans for physicians to support demonstrates that the Calgary Health innovative approaches to health care Region is leading the way in patient care. delivery.
Keeping up with demand While this chart illustrates that overall capacity has increased by 18 per cent from 2000 to 2005, it is apparent that growth in some areas has been more easily achieved than others. In particular, acute care growth is not keeping pace with population growth. Major capital projects at Rockyview General Hospital, Peter Lougheed Centre, Foothills Medical Centre and the South Health Campus; outlined on page18 are designed to meet the need.
Urban capacity Number of 2000 2001 2002 2003 2004 2005 2006 Beds/Spaces Acute Care 1,816 1,878 1,893 1,922 1,960 2,012 2,017 Rural capacity
Special Care Nursery 68 68 78 78 78 78 78 Acute Care 145 (NICU/SCN)
Continuing Care 4,094 4,106 4,436 4,594 4,656 4,750 4,887 Mental health rehab beds 100 (Spaces)
Rehab and Recovery 52 150 150 170 223 245 280 Continuing Care (Spaces) 446
Palliative and Hospice 30 30 30 30 46 60 60 Total 691
Total 6,060 6,232 6,587 6,794 6,963 7,145 7,322
17 III. Provide Quality Health and Wellness Services
Our Future
To keep pace with our increasing population and its needs, the Calgary Health Region will spend $1.5 billion to build and expand facilities and upgrade existing ones. Recently approved projects within our Long- Term Capital Plan include:
Alberta Children’s Hospital South Health Campus The first freestanding pediatric hospital to be Our international reputation for leading-edge built in Canada since 1985 will open in the clinical care will shape the new South Health fall of 2006. This state-of-the-art facility is 60 Campus. The hospital is part of a campus per cent larger than the existing Children’s concept that will support people in the Hospital and boasts an enhanced community, provide research and Emergency Department, more private educational opportunities for health care rooms, healing gardens and a 750-stall professionals, and possibly include other parkade. Children inspired the design of the medical and wellness offices. The half $253 million hospital. billion-dollar facility will have approximately 350 beds in its first phase. Rockyview General Hospital Construction is underway at the Rockyview Sheldon M. Chumir Health Centre General Hospital to add about 100 beds, as Plans are in place to re-develop the site at well as new surgical space and diagnostic 4th St and 12th Ave to serve the inner city. imaging facilities. Future expansion includes The new community health centre will be more emergency beds, operating rooms, a named the Sheldon M. Chumir Health larger lab, cardiac care beds, additional Centre and feature programs and services renal dialysis stations and expansion to focusing on chronic disease management, diagnostic imaging. The estimated cost is sexual and reproductive health and mental $180 million. health. It will also serve as the new home for the 8th and 8th Health Centre, and include Peter Lougheed Centre an Urgent Care Centre, Home Care Clinic Expansion plans include adding about 140 and public health. Estimated cost is $72 more beds for intensive care, cardiac care million. and emergency beds, as well as more operating rooms, a lab expansion, additional Richmond Road Diagnostic and renal dialysis stations and diagnostic Treatment Centre imaging expansion. Estimated cost is $200 Plans are being developed to convert the million. existing Children’s Hospital into a centre to provide care that does not require overnight Foothills Medical Centre stays for patients with complex health The Foothills Medical Centre plan includes needs. This might include day surgery, construction of a new intensive care unit, a audiology and chronic pain clinics, larger Emergency Department, more diagnostic imaging and mental health intensive care beds, surgery expansion, and services for children. Estimated cost is $48 more diagnostic and treatment space. million. Estimated cost is $265 million.
18 VI. Lead and Participate in Continuous Improvement in the Health System
Continuous Improvement WHAT THE CALGARY HEALTH REGION IS DOING: The electronic Enhanced by Technology health record is the most comprehensive and sophisticated program to be launched in THE CHALLENGE: In efforts to Canada. Doctors, nurses and other implement an electronic health record, the clinicians will have access to up-to-date Calgary Health Region has changed the way patient information, lab results, diagnostic patient data is collected, from being facility- images, drug management and prescription centric or provider-centric, to being patient- alerts. By 2007, more than 1,500 physicians centric. What is crucially important is that a and residents, and 10,000 clinicians will be patient is treated in the best manner trained to use the system. possible across the entire spectrum of service delivery. This translates into striving Further, the Calgary Health Region has to deliver better and more secure patient adopted a technology renewal plan where information at the point of care when it is by all desktop computers are on a four year needed most. By getting the right evergreening refresh and laptops are on information at the right time and having three year refresh. access to complete, real-time, detailed information, providing the best care in the Plans for data quality has been developed safest environment is achievable. and documented Challenges to running the system include unlearning existing system practices, and in Telehealth can help identifying health some cases, becoming comfortable with problems early, thus insuring timely computers. Recognizing the complexity of interventions, which in turn improve patient our environment, implementing an electronic outcomes and reduce healthcare costs. health record in a cost effective manner maybe one of the most formidable The Calgary Health Region is committed to challenges facing the Calgary Health continuing its support of the development of Region. improved costing of health services, both Tracking expenditures and performing through participation in the Alberta Costing comparative analyses for all programs within Partnership and through the Finance the healthcare system including resource Costing Group within the Calgary Health input such as salaries, drug costs and Region. The Calgary Health Region is a key participant in the annual Costing Round equipment burdens will facilitate more Table Review process facilitated by Alberta effective service planning. Health and Wellness. Specifically within the Calgary Health Region, an example of the commitment to enhanced costing information is the Ambulatory Care Classification System and Costing Redevelopment Project. The project’s purpose is to standardize, simplify and improve the flow and quality of Ambulatory Care Classification System and costing data that is submitted to Alberta Health and Wellness and also utilized for the costing of health services in support of the Calgary Health Region’s annual planning and budget processes. This costing information is also utilized for numerous data requests for costing in support of research studies.
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Benefits of Collaborating
The Calgary Health Region achieves its current service delivery goals and third way initiatives though its partnerships and collaborative arrangements with private, public and other government organizations. A partnership called Reach! between the University of Calgary and the Calgary Health Region was launched in October 2005. Reach! will target philanthropic dollars to attract and retain the world's leading medical minds, and give them the resources to design new discoveries and treatments to deliver excellence in patient care. The vision of Reach! is supported through a strong collaboration between the Calgary Health Trust and the development offices of the University of Calgary Division of Health Sciences.
Other examples of collaborations formed to serve more effective patient care include areas like education collaboratives with the Health Knowledge Network and the Health Learning Institute. Injury Prevention and Control staff are also working on priority injury issues across the Calgary Health Region and with key community partners through coalitions such as the Calgary Injury Prevention Coalition (CIPC), Safer Calgary and the Calgary and Area Healthy Living Alliance. Regional injury prevention activities are also well linked to provincial efforts through groups such as the Alberta Occupant Restraint Program (AORP), the Alberta Injury Control Alliance and the Alberta Centre for Injury Control and Research (ACICR). “Stronger Together,” the theme of the Alberta Drug Strategy, reflects the collaborative spirit of Albertans, including provincial government ministries, regional health authorities, community agencies such as the Alberta Alcohol and Drug Abuse Commission (AADAC), drug coalitions, families, and individuals, working together to find solutions to current problems caused by alcohol and drug use, and preventing future ones.
Pandemic Plan
The Calgary Health Region, in collaboration with the provincial government and other health authorities, is addressing a possible future outbreak of influenza by creating a Pandemic Plan. Since fall 2004, an advisory committee including representatives from public health, operations, human resources, support services, rural, disaster services, physicians, occupational health and safety, infection prevention and control and communications are working to find the best solutions to managing this important and complex issue.
For a more comprehensive listing of the collaborative arrangements refer to Appendix A.
20
Appendix A: Factors and Measures
21 Part 1: Assessing the Needs of the Population
1.1 Needs Assessment: Assess on an ongoing basis the health needs of the health region.
Reference: Section 5 (a) (ii) Regional Health Authorities Act
Factors Measures Targets Strategies
Consult with communities and stakeholders on health Utilize the following comprehensive plans to response to needs of the communities. Include Community Health Health Plan incorporates health service needs: Council (CHC) input in developing the plan. identified health needs • Population Health Plan assessment findings in the • Rural Health Plan Provide a health plan for the region, based on an development of health plan • Health Surveillance assessment of strategies to: improve resident Develop comprehensive • East Community Needs Assessment plan which integrates all • health status of the population health status, improve utilization • Wellness Strategy and Action Plan health service strategic • environmental influences on health and well-being and meet health service needs. • Wellness Partnerships plans by March 2007. in communities and the region as a whole • Chronic Disease • current health service utilization and • Oral Health • estimated health service needs. • Seniors Health Strategic Plan • Mental Health Strategic Plan Assess regional ability to respond to health service • Long Term Care Capacity Plan needs.
1.2 Community Health Councils (CHC): Compliance with the legislation for the establishment of at least one Community Health Council.
Reference: Section 9 (4) (c) Regional Health Authorities Act
Factors Measures Targets Strategies
Where no Community Health Council (CHC) is Bylaws for established CHCs Ensure bylaws are up to Support six rural Community Health Councils (CHCs) to established, the health plan makes provision for at least are up to date and approved by date and in compliance achieve the following: one Community Health Council (CHC). the Minister. with provincial • bylaws are established and approved, legislation by March • membership approved, 2007. • mechanisms for involvement into local and health service planning established, Continuously improve the role Reviewed annually. • advisory to the Calgary Health Region Board, and relationship of CHCs. (for • minutes are circulated to Calgary Health Region Board example, business plan, annual members and report, areas of accountability). • Board members meet with CHCs twice a year.
The Calgary Health Region Aboriginal Community Health Council is dedicated to promoting culturally appropriate health services that enhance the ability of the individual and family to achieve optimal spiritual, mental, emotional, and physical health. The Council serves the Aboriginal people of Calgary Health Region, and those from other Regions utilizing the services of Calgary Health Region.
22 Part 2: Advocate and Educate for Healthy Living
2.1 Wellness and Healthy Living: Regions will set targets and implement strategies to achieve the objectives and targets set out in the Framework for a Healthy Alberta and the Third Way initiatives.
Reference: Section 5 (a) (i) Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and the government Expectation
Factors Measures Baseline 2012 Strategies Target
By March 2007:
• establish “GO2 Community Mobilization” strategy; Percent of residents age 12 • develop interactive website; and 1. Active Living. and over who report being 57% 64% • establish baseline and target utilizing the Calgary Health Region Population Surveys “active or moderately active”. (CHRPS).
Conduct three focus groups (preschool, children 6 to 12 years old, and adults), develop and implement resultant action plans by March 2009.
By March 2007:
• develop and distribute health education materials on healthy nutrition; Percent of residents age 12 • support Nutrition and Active Living Department telephone helpline; and over who report eating 2. Healthy Eating. 17% 30% • implement a nutrition screening tool for older adults; at least 5-10 servings of fruit and vegetables daily. • develop and implement healthy eating strategies for adults in the workplace; and • develop a new strategic plan to re-orient service to incorporate best practices.
Implement new strategic plan and establish targets by March 2009.
From 2006 to 2009: • conduct growth assessment from 75% of pre-school children (4.5 years); and • provide health education and materials to care givers.
By March 2008: • implement childhood obesity growth initiative; and • complete pilot intervention program “Make It Happen” for at risk children. Percent of residents 3. Healthy Weights. 51% 51% reporting a healthy BMI. By March 2009: • revise and adopt best practices from “Make It Happen” pilot; • develop and implement active living community mobilization strategy for adults in the workplace; • establish baseline and targets for children 12 to 15 years of age; and • develop a strategy to address needs, gaps and opportunities by the Community Prevention of Childhood Obesity Coalition.
23 Part 2: Advocate and Educate for Healthy Living
Factors Measures Baseline 2012 Strategies Target
Complete “Young Family Wellness” funded initiative, the Circle of Friends which is a youth Percent of resident women strategy regarding fetal alcohol syndrome (FAS) prevention by March 2008. who reported consumption of 4% 1%
alcohol during pregnancy. Maintain “Best Beginning” outreach and counselling program for at risk pregnant teens and 4. Alcohol Consumption. pregnant women living on a low income by March 2009.
Percent of residents who Identify future initiatives through a new collaborative between Calgary Health Region and report regularly drinking 17% 17% Alberta Alcohol and Drug Abuse Commission (AADAC) to address issues across the heavily. continuum of care by March 2009.
Implement a mass media campaign aimed at 12 to 18 year olds by March 2007. Execute strategic plan developed by Calgary Health Region in collaboration with Alberta Alcohol and Drug Abuse Commission (AADAC) to address cessation, prevention, legislation, research, evaluation and surveillance by March 2009. Percent of residents who 20% 18% report smoking. Maintain from 2006 to 2009: • all Calgary Health Region properties including rural sites comply with the smoke free policy; 5. Tobacco Use. • smoking cessation programs through Tom Baker Centre and Living Well Program; and • participation in provincial coalitions, such as Smoke Free Calgary and Smoke Free Alberta, to advocate for smoke free workplaces and public places. Maintain from 2006 to 2009: • the “Best Beginning” outreach and counselling program to support women’s capacity to Percent of pregnant women 18% 12% make healthy choices during their pregnancy; and who report smoking. • the “Expecting to Quit” smoking cessation and reduction programs for women thinking about becoming pregnant, are pregnant or having recently delivered a baby.
Develop strategies, working groups and community action plans resulting from the rural community task force by March 2007; implementation complete by March 2009. In Percent of residents conjunction reporting they are in Initiate training for the “Mental Health First Aid” program to build community capacity for mental 6. Self-reported mental with Alberta “excellent, very good or good 67.9% health, reduce stigma and increase mental health literacy by March 2007; expand program until health status. Health and mental health” by age group March 2009. Wellness (18-64; 65+). develop Develop web based resources and distribute printed mental health promotion resources. mental
health
provincial Percent of residents at risk of 9.3% standards depression. By March 2009: and 7. Enjoy good mental • develop measurement definition, tools and survey process; and definitions health. Percent of residents by March • explore best collection approach within the Calgary Health Region. reporting “quite a lot” of 26.5% 2009. stress.
24 Part 2: Advocate and Educate for Healthy Living
Factors Measures Baseline 2012 Strategies Target
Support key coalitions such as the Calgary Injury Prevention Coalition (CIPC), Safer Calgary Rural = and the Calgary and Area Healthy Living Alliance by March 2009. Percent of residents using 86.3% 95% seat belts. Urban = Participate in regional injury prevention activities are also well linked to provincial efforts 83.9% through groups such as the Alberta Occupant Restraint Program (AORP), the Alberta Injury Control Alliance and the Alberta Centre for Injury Control and Research (ACICR).
Develop and implement injury prevention strategies as part of the “Early Child Development Three Cheers” project by March 2008. Targets to Implement the following strategies by March 2008: be • regular promotion of child safety seat use as part of well child program “Million Messages” determined; No CHR protocols birth to six years; once Percent of children traveling baseline regional • twice a month hold car seat and booster seat classes; in child safety seats. data data is • monthly car seat Check Stops held with Calgary Police Service; available. obtained • car seat “YES” test series of self-help brochures available in print format and on website; by March • educate car seat use in regional prenatal classes and in publication “From Here Through 2009 Maternity”; and • check and redistribute used car seats to low income families through “Car Seat Round Up” program with Interfaith Thrift Stores.
8. Injury Prevention. Develop and implement the following by March 2008: • injury prevention strategies as part of the “Early Child Development Three Cheers” project; Rate of hospitalizations due • a child and youth falls prevention resources and strategies focusing on playgrounds, sport 282 258 to falls per 100,000. and recreational activities; and • implement childhood fall prevention series “Babies Don’t Bounce, Kids Don’t Bounce” target awareness of childhood falls and prevention measures.
Rate of hospitalizations due Implement older adult falls prevention initiative project with linkage to community groups and to falls per 100,000 aged organizations providing programs and services to seniors by March 2009. 1,502 1,352 65+. (Regional initiative.)
Create a culture that emphasizes a healthy and respectful workplace. This focus area of the Provincial workforce strategy will begin to deal with the important element of retention and creating the Lost time claims rate per 100 4.05 target for desired culture. years worked (2003/2004) 2012 is 2.0. Develop targets and routine reporting by March 2007.
25 Part 2: Advocate and Educate for Healthy Living
Factors Measures Baseline 2012 Strategies Target
Mortality rates due to motor vehicle collisions (land Maintain strategies including awareness, education, social marketing and enforcement 6.8 5 transport accidents) per partnerships by March 2009. 9. Mortality Rates: 100,000 people. (Injury) Action: Align prevention strategies with the Alberta Suicide Prevention Strategy By March 2009: where appropriate. Suicide per 100,000 • develop and implement suicide response plan and protocols ; population / rates and trends 13.3 12.3 • target groups include suicide survivors, youth and aboriginal groups; and per 100,000. • develop youth suicide website for professionals, parents and youth in partnership with the Centre for Suicide Prevention.
Implement Living Well Program group education and multi-cultural education for secondary Number of new cases of type prevention by March 2009. II diabetes per 1,000 people 3.6 4.1 at risk in the general Note: A higher target than the baseline reflects an increasing aging demographic exhibiting population. increasing prevalence.
10. Diabetes.
Number of new cases of type Research appropriate services and programs for continuum of primary and secondary chronic II diabetes per 1,000 people No data disease prevention by March 2009. 8.5 at risk in the First Nations available. population.
Develop appropriate services and programs for continuum of primary and secondary chronic disease prevention to be explored by March 2009.
Mortality rate from heart 11. Heart Disease 173 140 Meeting these targets would require strategies to increase diagnosis and treatment disease per 100,000 (investments in technology). Approximately ten to fifteen years are required to begin to see the results of population health initiatives for heart disease.
26 Part 2: Advocate and Educate for Healthy Living
Factors Measures Baseline 2012 Strategies Target
Percent of women age 50 to
69 screened for breast Participate in the Alberta Breast Cancer Screening Program. cancer within the 75.5% 80%
recommended screening Educate, diagnose and treat people with breast health problems through the Breast Health guidelines. Program.
Mortality rate from breast 23.5 22 cancer per 100,000.
Percent of women aged 18 Participate in the Alberta Cervical Cancer Screening program. 82.8% 95% 12. Cancer. to 69 screened for cervical cancer. Facilitate marginalized women in obtaining a pap test at the Women’s Health Centre offered four to five times a year. Mortality rate from cervical 1.2 1 cancer per 100,000. Educate marginalized women in the necessity of pap tests.
Rate at which people get Implement Tobacco Reduction Strategy including: smoke free policies, social marketing, 50.7 48 lung cancer per 100,000. supporting coalitions and cessation programs by March 2009.
Reduce Mortality rate from prostate Distribute educational videos to physicians and health professionals by March 2007. Develop 26.3 baseline cancer per 100,000 males. standards by March 2009. Maintain social marketing annually. rate.
By March 2009:
Provincial • implement Living Well Program group education and multicultural education for secondary 13. Chronic Obstructive Mortality rate from COPD per 24.6 Target = prevention; and Pulmonary Disease 100,000. 20 • implement Tobacco Reduction Strategy including: smoke free policies, social marketing, (COPD). supporting coalitions and cessation programs. In conjunction with Alberta Age adjusted rate of newly Health and Wellness Maintain “Safe Works”. Investigate other strategies and opportunities across the Calgary 14. HIV Rates. reported HIV cases per develop provincial Health Region by March 2008. 100,000 population. baseline and target by March 2009. In conjunction with Alberta Rates and type of newly Health and Wellness Maintain surveillance system, clinic service, advertising and promotion of safe practices. 15. STI Rates. reported infections per develop provincial 100,000 population baseline and target by March 2009.
By March 2007: Low Birth Weight (% live 16. Regional Initiatives. 7.3% 5.5% • implement interpretation translation strategy in East Community to increase access; and births < 2,500 g.). • develop strategy following in depth review of contributors to low birth weight. Target strategies based on findings constructed by March 2009.
27 Part 3: Provide Quality Health and Wellness Services
3.1 Access to Services: Timely access to services is a key provincial/territorial initiative, outlined in the Sept 2004 First Ministers’ Agreement. The areas identified through the Agreement align closely with existing provincial initiatives, identified in the Ministry Business Plan, in response to the Premier’s Advisory Council on Health Report (2002). Reference: Section 5 (a) (iv) Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and Government Expectation Action: Identify strategies to reduce the gap between targets and actual performance. Identify additional projects through improvements to access are being addressed.
Factors Measures Baseline Provincial Targets Strategies
Wait Times Median Wait Times: Wait Times (median): Median wait times based on Provincial Access Standards Cardiac Grade A - 6 days Grade A - ( 0 - 7 days) Services Sub-Committee Report and differ from the Alberta Wait List People Waiting Grade B - 10 days Grade B - ( 8 - 14 days) Registry. Grade C - 17 days Grade C - (15 - 42 days) Patients Served Coronary Artery Bypass People Waiting: People Waiting: Graft (CABG) 152 < 200 people
Patients Served: Year to date as of September 30, 2005; 170 CABGs
Wait Times Wait Times (average): Wait Times (90th As of September 30, 2005: percentile): People Waiting FMC – 13 weeks* Emergencies: ≤ 24 hours HRC – not available* Urgency 1: ≤ 4 week Patients Served PLC – 26 weeks* Urgency 2: ≤ 13 weeks RGH – 36 weeks* Urgency 3: ≤ 20 week Hip Replacement People Waiting: 1,054
Patients Served: Evaluate the Alberta Hip and Knee Replacement Project. The strategy of Year to date as of July 31, the project is to redesign the way the Calgary Health Region organizes 2005; and delivers the entire continuum of care for the patient and to determine 556 the human, information and financial resources for each continuum.
Wait Times Wait Times (average): Wait Times (90th Implement what was learned from the pilot population and apply to As of September 30, 2005: percentile): general population to impact wait times by March 2009. People Waiting FMC – 19 weeks* Emergencies: ≤ 24 hours HRC – not available* Urgency 1: ≤ 4 week Patients Served PLC – 31 weeks* Urgency 2: ≤ 13 weeks RGH – 36 weeks* Urgency 3: ≤ 20 week Knee Replacement People Waiting: 1,942
Patients Served: Year to date as of July 31, 2005; 452 28 Part 3: Provide Quality Health and Wellness Services
Factors Measures Baseline Provincial Targets Strategies
Median Wait Time Regional Wait Time Wait Times (median): (median): Priority 1 - < 7 days Patients Waiting As of September 30, 2005; Priority 2 - < 30 days Priority 1 - < 6 days Priority 3 - < 90 days Patients Served Priority 2 - < 20 days Priority 3 - < 80 days Regional Target People MRI Patients Waiting Waiting:
As of September 30, 2005; Less than 11,400 7,063 Regional Target People Patients Served Served as of September Year to date as of 30,2005: September 30, 2005; 25,163
23,989 Provincial wait list targets follow a set of criteria developed by a joint
committee (Alberta Health and Wellness, Alberta Medical Association,
Regional Health Authorities) and forwarded for feedback through regional Median Wait Time Urban Wait Time Wait Times: medical advisory committees. (median): Priority 1 - < 7 days
Patients Waiting As of September 30, 2005; Priority 2 - < 30 days
Priority 1 - < 8 days Priority 3 - < 90 days Patients Served Priority 2 - < 22 days Priority 3 - < 28 days Regional Target People Patients Waiting (Urban Waiting: CT and Rural): Less than 6,300
As of September 30, 2005; 4,530 Regional Target People Served as of September Patients Served (Urban 30,2005: and Rural): 68,253 Year to date as of September 30, 2005; 64,399
PET/CT Expect rapid increase in demand for access to this new modality over the Patients Served Patients Served Targets to be developed by next three years. The Calgary Health Region is developing a long term Positron Emission Tomography (PET) is an imaging test that can Year to date as of March 2007. strategy, including procurement of a Cyclotron facility, which will greatly demonstrate the chemistry of September 30, 2005; enhance our ability to maximize utilization of existing PET/CT resources organs and other tissues such as 297 Expect approximately and position us to support further growth of this service. tumors by detecting changes in the cellular function, such as how cells 1,680 PET/CT exams per utilize nutrients like sugar and year will be performed, oxygen. PET/CT combines the given currently funded functional information from PET with the anatomical information from CT. hours of operation.
29 Part 3: Provide Quality Health and Wellness Services
Factors Measures Baseline Provincial Targets Strategies
Wait Time Wait Time Targets to be developed By March 2009: with the Western Canada • participate in the Western Canada Waitlist Project including waitlist Children’s Mental Health Patients Waiting Mean wait times at 27 days Waitlist Project. management strategies; Services (4 weeks) in 2004/05, and • integrate and establish central intake; and th Patients Served in the 90 percentile wait • maintain medical education to build capacity of physicians. times are 99 days 14 weeks) in 2004/05.
Wait Time Data not collected to report Breast Cancer Care: Implement standardized definitions upon receipt from Alberta Health and wait times, patient waiting (90th percentile) Wellness.
Patients Waiting or patients served from Breast Cancer Care referral from family Referral to surgery: ≤ 4 Implement comprehensive database for Breast Health Program. • Referral to surgery Patients Served physician to surgery or week • Surgery to radiation or surgery to therapy. system therapy Referral post surgery to
radiation/ systemic therapy: ≤ 8 week
Wait Time Initiate a Prostate Cancer Rapid Access Clinic in Participate in an Alberta Health and Wellness provincial initiative on September 2005 though a partnership between the prostate cancer access and a Provincial Prostate Cancer Subcommittee. Calgary Health Region and the Prostate Cancer Institute, supported by the Calgary Health Trust. Develop indicators and outcomes from the local prostate cancer access project committee by March 2009, designed to: Establish targets by the rapid access clinic to reduce the time from initial referral to an urologist upon abnormal • identify the current care pathway in the Calgary Health Region; digital rectal exam or elevated PSI though to presentation • identify the challenges associated with the current process for of biopsy results to the patient from 15 weeks to 6 weeks. diagnosis, treatment and care; Prostate Cancer Care • identify gaps and redundancies in the care pathway; • develop a new pathway to provide prostate cancer services in order to achieve the access standards currently under development by the Alberta Health and Wellness Access Standards Working Group; • identify the resources and infrastructure needed to support the new pathway; and • include family practice, diagnostic services, surgical services, radiation therapy, and support services to ensure a comprehensive and multidisciplinary perspective.
The median wait time The median wait time for Target for 2005/2006 is 32 Work continuously with the Regional Flow Initiative to address patient flow for Q2 2005/06 for the Q2 2005/06 for the Adult minutes. throughout the system. Adult Urban Urban Emergency Adult Emergency Emergency Departments was 38 Department Waiting Room Departments was 38 minutes. Time for CTAS (Canadian minutes. Triage and Acuity Scale) Level 3
30 Part 3: Provide Quality Health and Wellness Services
Factors Measures Baseline Provincial Targets Strategies
Wait Times: Wait Times: Wait times include emergency cases performed in urban hospitals.
All cases within 48 hours In 2003, the Bone & Joint program initiated a program to improve Average wait times for emergency room flow and care for patients with hip fractures. The 2004/2005 was 26.6 hours. initiative created a bed that was designed to ensure that hip fractures were operated on within 24 hours of admission. The project was part of the Flow Collaboratives with the Quality Improvement and Health Information Department and Institute for Healthcare Improvement (IHI). The results were very successful and in 2004, this initiative was spread Hip Fracture Repair Wait Time across the 3 adult sites.
With the aging population and the ability to reduce and / or prevent Hip Fractures, the Calgary Health Region could achieve improved results with the funding of the Growth initiative for prevention, listed as a joint initiative from the acute care and community portfolios. This funding of 3 million dollars would help to advance the prevention program in the elderly and population at risk and may provide a model for the province in achieving success provincially.
Wait Times (Median): Wait Times: Wait time includes urban hospitals and non hospital surgical facilities but excludes High River General Hospital. Cataract Surgery Wait Time As of December 31, 2005: Priority cases within 18 4 months. weeks (4.5 months). Clarification required on the High Risk Designation.
Proportion of months Surgical and Diagnostic Continue to report data as required. the submissions were Imaging will be submitted 100% on time. 100% by the due dates as Timeliness: data will be submitted to the Alberta Waitlist Registry by the st th set by Alberta Waitlist health authorities on the 21 of each month (exception: May 19 , due to Registry. Good Friday and Easter holiday dates).
Alberta Waitlist Registry
Proportion of months Surgical and Diagnostic Continue to report data as required. the submissions were 100% Imaging will be 100% complete. complete as required by Completeness: monthly submissions including surgeries, MRI and CT the Alberta Waitlist for all facilities contributing to the Alberta Waitlist Registry. Registry.
31 Part 3: Provide Quality Health and Wellness Services
3.2 Quality of Services: The RHA Act provides direction to health authorities that they provide quality services to residents. Reference: Section 5 (a) (iv) Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and Government Expectation
Factors and Actions Measures Targets Strategies Participate in the sequential accreditation program through the Accreditation Date and level of Canadian Council on For CCHSA and CPSA, the target is Canadian Council on Health Services Accreditation (CCHSA), Health Services Accreditation (CCHSA) 100% accreditation status reported and whereby accreditation surveys are conducted yearly to fulfill a Accreditation is a mechanism accreditation. 100% follow up on recommendations or three year award. to demonstrate that quality visit reports. improvement is pursued. The Calgary Health Region has received full accreditation status according to the first completed cycle during the week of Action: Identify accreditation April 10 - 15, 2005. Preparation is underway for the second achievement through the cycle during the week of April 2 - 7, 2006. indicated measures. Date and level of region and contracted Create a baseline of accreditation status of Develop an inventory of all College of Physicians and Surgeons agencies accreditation with College of contracted services by March 2009. of Alberta (CPSA) accreditation schedules, due dates and Physicians and Surgeons of Alberta recommendations for follow up. Develop a process to (CPSA) (Medical Diagnostic Laboratories, continuously monitor and report on accreditation status for Diagnostic Imaging Services, CPSA and Canadian Council on Health Services Accreditation Neurophysiology testing facilities, (CCHSA). Pulmonary function laboratories and non hospital surgical facilities). Quality Matrix
Acceptability Percent of concerns and complaints Maintain greater than 95% response rates; Re-design patient and client concerns and complaints process responded to in three business days. currently, exceeding target. to meet best practice in the industry and align with Alberta Patient Concerns Resolution Provincial Ombudsman recommendations. Regulations.
Percentage of residents, who have The 2004 Health Quality Council of Alberta Align overall satisfaction questions from HQCA surveys with received a service, who are satisfied with (HQCA) results demonstrated 49% of internal patient feedback survey process to provide more timely the way services are provided (source: Calgary Health Region residents were and relevant data that can be used to improve the patient HQCA survey). overall satisfied with the way services are experience. provided. Collect data to establish baseline prior to setting target by March 2009.
Percentage of residents who rate the The 2004 Health Quality Council of Alberta Align overall quality questions from HQCA surveys with Calgary overall quality of health care available in (HQCA) results demonstrated 72% of Health Region Population Surveys (CHRPS) process to provide their community as excellent or good- Calgary Health Region residents rated the sub-regional data on quality of healthcare in the Region. (source: HQCA survey). overall quality of health care services rendered as excellent, very good or good.
Collect data to establish baseline prior to setting target by March 2009.
Client’s rating of quality of care received Collect data to establish baseline prior to Implement systematic patient feedback process in all (source: regional patient satisfaction setting target by March 2009. appropriate inpatient settings using the Agency for Healthcare surveys). Research and Quality (AHRQ) survey tools called Hospital- Consumer Assessment of Health Plans Survey (H-CAHPS).
32 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Targets Strategies
Patient Safety Number of health authority projects The current Safer Healthcare Now! Stay actively involved in Safer Healthcare Now! campaign and participating in Safer Healthcare Now! campaign ends in December 2007; provide input on future directions for the campaign. campaign. measures will continue to be monitored to March 2009. Develop metrics and an outcomes improvement plan for the following Safer Healthcare Now projects: • Medication Reconciliation; • Surgical Site Infections; • Rapid Response Team; • Acute Myocardial Infarction; • Central Line Infection; and • Ventilator Associated Pneumonia
Percentage of Albertans who believe that The 2004 Health Quality Council of Alberta Align medical mistake questions from HQCA surveys with during their care in Alberta’s health system (HQCA) results showed that 13% of internal patient feedback survey process to provide more timely they or a family member experienced a Calgary Health Region residents believed and relevant data that can be used to improve the patient medical mistake that resulted in serious they or a family member experienced a experience and establish a target. harm, such as death, disability, or medical mistake. additional prolonged treatment (source: HQCA survey) Targets established by March 2009.
33 Part 3: Provide Quality Health and Wellness Services
3.3 Primary Health Care:
Reference: Section 9 (4) (d) Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and Government Expectation Factors and Actions Measures Targets Strategies
Primary Health Care (PHC) Plan Number of regional PHC plans Prepare the Primary Health Care Present one regional Primary Health Care plan to provide one consistent Action: Develop and implement a 3- in place. Plan strategy and incorporate direction for Calgary. year PHC plan for the region based Primary Care Networks work as on the five PHC reform objectives. well as other Primary Health Care The Plan should: strategies. • address integration of all PHC and Primary Care Network activities,
• coordinate with regional mental Involve mental health staff in the Involve mental health staff and physicians in business planning and health plans, Primary Health Care Plan by implementation efforts for the proposed Primary Care Networks and March 2007. implementation for “live” Primary Care Networks. All approved Primary Care • point out how regional PHC plan Networks and Primary Care Networks in the business planning process have links to regional mental health identified mental health as a priority service area. plan,
• indicate how regional PHC plan Align new Primary Care Network Demonstrate the Primary Care Network business plan addresses the five addresses the five objectives of strategies with the Primary Health objectives before they are signed off. the PHC reform, and Care strategy for March 2009.
• include regional measures and Develop a marketing strategy for health care professionals. targets. Demonstrate each Primary Care Incorporate multidisciplinary team approach in all business plan development Number of health care Network utilizes a for all Primary Care Networks. professionals practicing in multidisciplinary approach by Primary Care Networks March 2009.
Conduct a survey of utilization of the Primary Care Network and address gaps Population understands the Increase understanding by the as identified. Primary Care System and the population of the primary care
programs and services. system by March 2009. Market Primary Care Network services.
34 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Targets Strategies
Primary Care Network Number of Primary Care Operate two Primary Care Work with physician and Calgary Health Region staff to ensure collaborative Networks in operation. Networks by March 2006, two by process in implementing Primary Care Networks. Action: Identify specific plans for March 2007 and one in March Primary Care Network roll-out, 2008. Plan a total of five Primary including how many and when. Care Networks to be in place by March 2009.
Number of Primary Care Complete business plans for two Work with physician and Calgary Health Region staff to ensure collaborative Networks under development. Primary Care Networks, Calgary process in implementing Primary Care Networks. Foothills and Calgary West Central by April 2006. Begin discussions on the fifth and potentially a sixth Primary Care Network in May 2006 with business planning on schedule by the fall 2007.
Residents enrolled in a Involve 100 physicians in Work with physician and Calgary Health Region staff to ensure collaborative Primary Care Network Primary Care Networks in March process in implementing Primary Care Networks. The Health Quality Council 2006, 350 by March 2007 and of Alberta (HQCA) reports 83% of the residents of the Calgary Health Region 500 by March 2009. have a family doctor. The Calgary Health Region expects, at best, to maintain that percentage over the three year window to March 2009.
Promotion of Health Link and other Annual number of calls to Plan for a 7% call volume growth Monitor and report call volume trends. health information services. Health Link by population to 376,200 by March 2006; segment. followed by a 7% growth in March The Calgary Health Region accounts for 90% of the calls with 5% from 2007. March 2008 will be the Palliser Health Region and 5% from Chinook Health Region. fourth year of operation; Capital Health experienced a plateau in the fourth year, which will be expected in Calgary.
Percentage of callers to Health Awaiting results pending from Implement internal satisfaction surveys. Link who rate the service as Alberta Health and Wellness by very good or excellent. March 2007. The Calgary Health Region has been involved in extensive provincial evaluation and satisfaction surveys for the last two years.
35 Part 3: Provide Quality Health and Wellness Services
3.4 Mental Health:
Reference: Section 9 (4) (d) Regional Health Authorities Act, Provincial Mental Health Plan, Alberta Health and Wellness Ministry Business Plan and Government Expectations.
Factors and Actions Measures Targets Strategies
Information Management and Technology Results of participation in Develop core set of standardized data Participate in Information Management provincial developing standardized elements for mental health by March 2009. working group. Access to good data and information is a provincial mental health requirement for demonstrating progress in data. Identify core data elements. provincial and regional mental health plans. This requires active participation by all regions. Establish consensus regarding which core data elements to be collected. Action: Participation in developing standardized provincial mental health data; for example, establish budgets across the continuum; and build capacity to report the number of patients receiving mental health services in continuing care.
Wellness and Healthy Living: Ensure the Mental Health Plan and the Population Mental health promotional Participate in the provincial initiative by Health Strategies address determinants of health as Regional Mental Health Promotion activities activities include programs March 2009. outlined in the Provincial Mental Health Plan. should align with provincial strategies. and initiatives focusing on health determinants. Action: Identification of alignment.
Action: Results of participation in the provincial Maintain network to assist new mothers and families Mental Health Promotion strategies. Number of new mothers Screen 100% of new mothers for dealing with postpartum depression. screened for postpartum postpartum depression by March 2009. depression. Maintain protocols for post partum screening and follow- up.
Implement resiliency questionnaire to assist with service Develop, validate and pilot an Older Adults Resiliency questionnaire. planning for older adults. Resiliency questionnaire by March 2009.
“Mental Health First Aid” Implement “Mental Health First Aid” training program. Develop and “Mental Health First Aid” training program training program by March 2007.
The Alberta Suicide Prevention Strategy Suicide and suicidal Provincial target for 2012 Suicide rate is Provide post-vention for supporting survivors. (ASPS) focuses on suicides and suicidal behaviour rates. 12.3 per 100,000. behaviours. Explore the development of a methodology for suicide . surveillance (including para-suicides). Action: Implement the ASPS at the regional level Ensure the Calgary Health Region suicide prevention strategy is consistent with Alberta Suicide Prevention Strategy (ASPS).
36 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Targets Strategies
th Access to Services Wait time for children to Reduce the 90 percentile wait times for Integrate and establish central intake for children and access mental health first visit from 99 days for children and adolescent mental health services. Strategies are underway to develop provincial services based on the 90th adolescents by March 2007. standards for “acceptable” wait times for percentile for the first visit. Expand Access mental health service to provide support programs across the continuum. Establish wait times for child and in accessing appropriate mental health services in a adolescent program to reduce by 5% each timely manner. First priority: Children year by March 2009. Participate in wait list management strategies.
Develop of wait time methodology and benchmarks for mental health services.
Telehealth: this technology supports access Utilization rate of Telehealth Establish telemental health baseline Provide telemental health services (interdisciplinary to mental health services. Services for mental health number of consultations. teams) to southern Alberta for child and adolescent consults per 100,000 mental health concerns. Action: Include mental health in setting targets population. Increase utilization of telemental health for clinical use of telehealth (Health Plan Goal services by 10% by March 2008. Continue to offer psychiatric consultation services to 4.2). rural areas within the Calgary Health Region.
Service Integration for select co- morbid Proportion of mental health Develop partnerships to ensure services Expand the Addiction Network and the Addiction Centre conditions. delivery sites offering for addictions and developmental Adolescent Treatment program. services for addictions and disabilities are offered at mental health Given the high rates of co – morbidity for developmental disabilities. delivery sites by March 2007. Provide community based assessment and treatment of mental health problems with addictions or high risk dual diagnosis adolescents to prevent developmental disabilities, integration of recidivism. services is desirable. Provide support for dual diagnosis patients aged 18 to 25.
Provide addiction expertise to support Primary Care Network.
Develop initiatives that support clients with complex cases (Mental Health needs and developmental disabilities).
Quality of Services Percentage of clients Demonstrate 80% of clients reported Conduct Client satisfaction survey. reporting overall satisfaction overall satisfaction with mental health Effectiveness, Acceptability with mental health services. services by March 2008. Develop logic models for programs. Action: Report on measures of effectiveness Percentage of programs that Determine valid, reliable, and appropriate and acceptability that are in development such have incorporated client level outcome measures for as Symptom Reduction, Level of Functioning evaluations. programs by March 2008. Conduct System level evaluation. and Quality of Life. Develop system model to simulate effects Current priority is Client Satisfaction. of changes to system of care by March 2009.
37 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Targets Strategies
Research/Evaluation: Regional plans align with Guarantee research initiatives reflect Incorporate recommendations outlined in provincial Regional plans align with provincial research provincial research plan. provincial research plan recommendations. research plan in regional research plan. plan. Changes in mental health Complete research projects focused on Establish linkages and collaborations at the local, Action: Programs have ongoing evaluations. programs based on results program delivery: provincial, and federal levels. of program evaluations. • identify and select performance measures for early psychosis; Conduct full evaluations for all new programs. • utilize performance measures for evaluating an early psychosis service; and • develop risk adjustment for early psychosis performance measures.
Best/Leading Practices Best and leading practices Implement results of research projects at Conduct research projects for mental health service Action: Process in place to support and implemented in mental program level. delivery and clinical practices. implement best/leading practices. health programs. Complete process to determine frequency of best practice review by March 2007.
Primary Care: Number of family physicians Increase the number of physicians Increase the number of physicians within Calgary and participating in shared care involved in shared care by 10% per year rural areas involved in shared care. Increased regional family physician programs (dependent on the renewal and expansion participation in shared care programs. of an Alternate Payment Plan).
Culturally Appropriate Services Targets are associated with Increase the knowledge, skills and Provide the following: Innovation Fund confidence of mental health care providers • cultural and diversity competency education to Action: Report on the development of culturally Applications. to provide culturally effective health care workforce; sensitive programs by 80 to 95% by March 2008. • clinical consultation and referral info; • resource materials; Report patients and families experienced • community outreach and networking; and culturally sensitive care delivery by 70 to • awareness training. 85% by March 2008. Provide Aboriginal mental health services available in the new Aboriginal Health Centre.
38 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Targets Strategies
Collaboration initiated with key Outcomes of partnership Operate the Inglewood Residence Collaborate with Canadian Mental Health Association stakeholders: with consumer groups, other (supported housing) with 90% occupancy; (CMHA) and City of Calgary to provide step down regions, government 80% of residents report satisfaction with services to assist clients in community integration and Action: Report on outcomes of partnerships ministries, universities, service, housing and community maintaining community tenure. with consumer groups, other regions, colleges, Alberta Mental integration by March 2008. government ministries, universities, colleges, Health Board (AMHB) and Participate in provincial collaborations regarding Alberta Mental Health Board (AMHB) and other other stakeholders. Decrease length of stay in acute care sites acceptable wait times, aboriginal mental health stakeholders. (for example, innovative by March 2009. framework, prevention and promotion, and research. collaboration that increases access for children). Outreach: 75% of clients are securely Collaborate with aboriginal community to develop connected to endpoints by March 2008. framework and services.
Align Aboriginal mental health framework with regional aboriginal health framework and provincial framework by March 2007.
Outcomes of collaboration Ongoing collaborations and partnerships in Collaborate on the following: whole school mental health with organizations providing place. promotion pilot, student health initiative, transition mental health services to classrooms, Woods Homes and Child and Family children such as schools, Decrease length of stay due to Services Complex Kids program. Children’s Services and partnerships by March 2007. community health. Establish co-location of services for children with complex needs by March 2008.
Outcome of innovative changes aimed at Outcomes, strategies and Report 85% of community partners Expand rural mental health services, provide community improving access to services. targets include proposals satisfied with accessibility to services by education services for children’s mental health and put forward in Innovation March 2008. expand outreach services. Outcomes, strategies and targets include Fund Applications. proposals put forward in Innovation Fund Report 85% of clients satisfied with Perform system level evaluation to identify gaps in Applications. services by March 2008. service and model changes to system.
Enhance mental health services in underserved areas of region such as Sunridge Medical Gallery in northeast, and Sheldon Chumir Health Centre.
Expand services to serve children with complex mental health needs. Establish database for automating Accountability Advances in the performance measure calculation and Collaborate provincially to establish performance development of provincial reporting for the Early Psychosis Program. elements and benchmarks including wait times. Action: Report progress of implementing and regional performance Regional Mental Health Plans in the following: elements and benchmarks. Report performance measures on Annual Reports; Quarterly reports; Annual acceptability, accessibility, Collaborate with researchers at the universities to Business Plans. appropriateness, effectiveness and safety validate performance measures. by March 2009.
Participate in provincial initiative by March 2009.
39 Part 3: Provide Quality Health and Wellness Services
3.5 Continuing Care:
Reference: Section 9 (4) (d) Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and Government Expectations.
Factors and Actions Measures CHR Baseline Targets Strategies
Quality of care: Quality of care: 3.4 by March 2006 Continue implementation of Seniors Health Strategic Plan developing capacity in the home living and supportive living Increase of average paid hours in long term Average paid hour per 3.3 streams. 3.8 by March 2007 care facilities to a minimum of 3.4 hours per resident day by quarter. as of July 1, 2005 resident per day by 2005/2006, 3.8 hours Continue implementation of Long Term Care and Rural per resident per day by 2006/07 and 4.1 4.1 by March 2008. Capacity Plans hours by 2007/2008.
Continue implementation of Continuing Progress report including Continue planned implementation of Continuing Care Care System Project. details on terms of phases, System Project to include: activities, and timelines. • steering committee; Develop plan by Complete • three working committees; March 2007. implementation by • educate staff and providers when Canadian Institute March 2008. for Health Information (CIHI) educational support is available; and • introduce software to support point of care data capture.
Quality improvement plan for Maintain quality Continue quality improvement initiatives and incorporate all continuing care services improvement InterRAI data as it is available. Support quality (long-term facilities, initiatives including improvement plans supportive living and home medication and initiatives with care) covering core areas administration, InterRAI and such as medication medication quality indicator administration, medication utilization, care data by March utilization, care planning and planning, case 2008. case management and management and abuse prevention. abuse prevention.
Continue to shift continuing care clients Resident ratio per 1,000 over Continue to develop capacity in the home living and from facility living to community living: 75 years for long term care supportive living streams. facilities measured against 78.82 beds per 75 beds per 1,000 Provincial target facility resident ratio per targets. Explanation of 1,000 residents residents over 75 Implement Long Term Care and Rural Capacity Plans. 1,000 over 75 years, 69.00 in 2005/06 and variance. Calgary Health over 75 years in years by March 68.00 in 2006/07 Region tracks beds per 1,000 2003/04 2009. Utilize Regina Risk of Institutionalization Tool (RRIT) to residents over the age of 75 continue to support admission to Designated Assisted Action: Regions to set regional targets for Living (DAL). resident ratios.
40 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures CHR Baseline Targets Strategies
Access to services Number of persons waiting As of September Continue implementation of coordinated access policies by for long-term care beds by 30, 2005: March 2007. Action: Full implementation of coordinated quarter. Acute Care = 30 access policies by March 2007. Number of persons waiting Acute Care = 42 Rehab and for admission to a long term Recovery = 20 care facility by location in Rehab and which they are waiting: Recovery = 16 Urgent in the • Acute care community = 15 • Rehab and Recovery Urgent in the • Urgent in the community community = 15
Number of individuals As of September Utilize information systems to support choice and access to admitted from acute care to 30, 2005: 35% appropriate care site. preferred long term care
facility. Urban = 49%. Implement Long Term Care and Rural Capacity Plans.
Implement Continue to review requirements of the population to ensure Proportion of admissions on quarterly reporting access supports evolving needs. Action: Improve seven-day access to weekends by quarter Develop baseline mechanism by continuing care services. (suggest from acute care by March 2007. March 2007. only). Access to continuing care services are available seven Develop targets by days a week. March 2008.
Action: Integration of long range planning Include home Continue to integrate Seniors Health, Long Term Care living, supportive process and projections in Health Plan Continuing Care Capacity Requirements Capacity Plan and Rural Capacity Plan into regional living and facility submission. requirements are included in included in Health planning processes. living stream Health Plan. Plan. requirements in the Health Plan. Review plans on a regular basis to ensure the plans reflect population needs.
Continuing care health services Proportion of continuing care Develop 100% Develop plan to implement continuing care standards, standards programs where standards comprehensive which include a staged area, specific roll out and measures have been implemented. plan by March to ensure standards are in place. Action: Full implementation of continuing 2007. care health services standards in fiscal year 2006/2007.
Action: Implement staff training programs Proportion of continuing care Establish plan and implement education of staff involved in on new standards for all continuing care staff educated on new Develop continuing care to receive education on new standards. staff and contracted operators/agencies standards comprehensive plan by March 100% Increase Education Resource Center capacity, to support 2007. province wide education related to standards.
41 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures CHR Baseline Targets Strategies
Compliance to continuing care Continuing care performance Continue to build on lessons learned from the Senior Health standards and monitoring of quality of audit mechanisms Develop Audit to refine audit and performance Implement plan by care established to monitor care of comprehensive March 2007. operators, agencies, and plan. report on progress.
Reporting mechanisms with Continue to refine performance reporting requirements, service expectations Establish reporting Establish including focus of key aspects of the standards that support established on key elements mechanisms and Continuing Care safe and quality care. of standards to ensure requirements for services reporting compliance to standards and specific areas of mechanisms by safe and quality care, and Continuing Care. March 2007. report on progress.
Home care Progress report on Enhance of short-term acute home care, implementing home care short-term acute community mental health commitments agreed to by home care, and end-of-life home care First Ministers September based on First Ministers’ agreement by 2004. December 2006.
Progress report on Home Implement strategic Care Strategic Innovations in direction as a phased in approach in prioritized by the Develop 2005/06 and 2006/07. Provincial comprehensive Continuing Care Implement staged plan of Home Care Strategic Innovations. plan. Leaders Council Progress report made in (CCLC) by March implementing strategic 2007. innovations.
Progress report on impact of changes including changes on other parts of the health system.
Workforce Focus Workforce Strategy on four areas in order to attract Total number of separations and retain our current and future workforce. The areas Action: Develop and implement staff (April to March) over average Assess and include: attract the required health care workforce, create a training, staff recruitment and retention total employee head count as establish culture that emphasizes a healthy and respectful workplace, strategies for continuing care workforce. of March 31. develop the health care workforce, and utilize the skills and Develop baseline. comparisons and targets by March talents of the health care workforce. 2007. The Calgary Health Region feels that the action plans within each of these areas will begin to have a positive impact on the ability to retain health care professionals within the Calgary Health Region.
42 Part 3: Provide Quality Health and Wellness Services
3.6 Aboriginal Health: Reference: Section 5, Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and Government Expectations. Factors and Actions Measures Target Strategies Current limitations to data collection and reporting exist due to Aboriginal Health an inability to accurately identify the Aboriginal population other than those identified as Treaty Status First Nations. Measures do not reflect Non-Treaty Status, Metis, and Inuit populations.
Aboriginal health promotion strategies and measures have also Development of Aboriginal Plan for process been included within the Calgary Health Region Population health indicators will be methodologies and Health Strategic and Mental Health plans. The development of facilitated through relevant timelines will be Aboriginal health program targets will be further supported stakeholder engagement and developed by March through the implementation of these plans. consultation. 2007.
A Calgary Health Region Aboriginal Health Centre has been funded to provide integrated primary health care services that focus on quality while considering the health and cultural needs of Aboriginal peoples in the Calgary Health Region. Planning for the centre is in process.
Diabetes prevention Identify appropriate Partner with University of Calgary to further develop strategies. measures and targets
Action: Identify strategies to provide diabetes prevention by March 2007. Build on learnings from the Aboriginal Health Center and programs to Aboriginal People. Indicate progress made. develop on site delivery mechanisms.
Suicide prevention Trends in para-suicide rate Develop appropriate Partner with Federal Government to identify and develop for First Nations Peoples. measures and targets strategies. Action: Identify strategies to prevent suicides among Aboriginal by March 2007. People (e.g., youth resiliency programs). Indicate progress made.
Fetal Alcohol Spectrum Disorder Continue to partner with the Calgary Fetal Alcohol Network Action: Identify initiatives to reduce and prevent Fetal Alcohol (CFAN) and the Circle of Friends Fetal Alcohol Spectrum Spectrum Disorders (FASD) in Aboriginal People. Indicate Develop appropriate Disorders (FASD) Prevention Project; which includes progress made. measures and targets representatives from Children Services and Alberta Alcohol and
by March 2007. Drug Abuse Commission (AADAC). Action: Identify collaborative initiatives with Children Services and Alberta Alcohol and Drug Abuse Commission (AADAC) on Fetal Alcohol Spectrum Disorders (FASD) preventative program delivery. Indicate progress made.
Infant Mortality Number of Births: 322 Identify appropriate Continue to develop focus on low birth weight infants and Action: Identify strategies in place to reduce infant mortality in Median Time to 1st Contact: measures and targets perinatal health. Aboriginal infants, such as focused infant care training for new 24 hours by March 2007. mothers, additional home visiting etc. Indicate progress made. Percent First contact within 48 hours: 85%
43 Part 3: Provide Quality Health and Wellness Services
3.7 Workforce:
Reference: Section 5 (a) (v) Regional Health Authorities Act, Alberta Health and Wellness Ministry Business Plan and Government Expectations.
Factors and Actions Measures Baseline Targets for March 2009 Strategies
Building Planning Progress report on actions Develop the specific action Develop action plan by March Develop a workforce strategy aligned with the Capacity: indicates actions to develop and implement a plans to support each of the 2007. Provincial Comprehensive Health Workforce Plan. to build the capacity and Workforce Plan that is areas within the workforce continuously improve aligned with the provincial strategy. workforce planning Comprehensive Health Implement and measure action The strategy focuses on four areas in order to attract Workforce Plan. plan by March 2009. and retain our current and future workforce. The areas include: attract the required health care workforce, create a culture that emphasizes a healthy and respectful workplace, develop the health care workforce and utilize the skills and talents of the health care workforce.
Progress report on regional Development of an integrated Ongoing updates to the integrated Conduct formal process to align the workforce strategy planning actions to link plan that links the business plan by March 2008. with other key regional plans to ensure consistency Health Plan to the regional plan, workforce and financial and integration. business plan, workforce plan. plan and financial plan.
Training for health care Results of mental health Collect and analyze follow up data Increase capacity of workforce to deal effectively with staff to serve mental health promotion and training for health on clinical outcomes by March mental health clients and families. clients. care staff. 2007. Provide the following: cultural and diversity competency education to workforce; clinical consultation and referral info; resource materials; community outreach and networking; and awareness training.
Evidence based regional Develop workforce plan. Develop an evidence based Establish standards for physician departmental model for physician regional model for physician workforce plans; the plans will support specific workforce plans. workforce plans and implement strategies to recruit physicians and meet the needs of with six clinical departments by the population. March 2007.
44 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Baseline Targets for March 2009 Strategies Focus areas to apply the Complete participation in nursing Continue implementation of “Staffing Solutions for the st Utilization: indicates Staff mix and staff Staffing Resource Decision turnover study (externally led) by 21 century” and develop series for patient care actions to strive for effective utilization of client group Making Framework in support of March 2007. managers. and efficient utilization of needs. optimal workforce utilization. health workforce providers Complete research project Provide consultation to patient care managers with reference to specific. Conduct Health Human examining job redesign and regarding service delivery models, scopes of practice . Research to determine optimal disseminate results in June 2007. and effective utilization of professional staff. utilization. Conduct research on inter professional education for collaborative practice by March 2008. The purpose of research is to assist with determining changes in practice in the workplace.
Capacity and workforce Baseline identified and Implement the Calgary Clinical Add International Medical Graduates (foreign trained with the Calgary Clinical implementation by March 2007. Assistants Program (CCAP) to add physicians) to the workforce to increase capacity. Assistants Program capacity for using ten full time (CCAP). equivalent foreign trained physicians by March 2007.
Healthy Workplaces: Progress report on mental Baseline identified and Targets identified and Develop Employee Wellness Strategy in support of indicates the outcomes of well-being programs being implementation by March 2007. implementation by March 2007. provincial strategies relating to high quality actions to create workplace delivered to health care workplaces. environments that will have staff. a positive impact on job and professional satisfaction Comparison of individual 2006 Industry rate is $1.43 per Develop targets for some sites to Determine targets with consultation of urban and rural and safety, which in turn Regional Health Authorities $100 of insurable earnings. improve WCB performance targets sites. impact recruitment, (RHA) Worker’s by March 2007. retention and productivity. Compensation Board Urban acute care rate is $1.14 Develop specific strategies to obtain targets. (WCB) premium rate to per $100 insurable earnings, a WCB industry rate for 20.17% discount. Participate in the “Partners in Injury Reduction Hospitals/Acute Care Program”. Centres, Health Units and Rural site specific rates ranged Long Term Care (LTC) from $.70 to $1.41, a discount Centres. range of 51% to 1%; and a $1.63 to $2.33 surcharge range.
Hours of sick leave usage Yearly statistic for 2004/05 sick Assess baseline and establish a as a percentage of total leave rate is 3.76%. This target by March 2007. earned hours. statistic includes Carewest but Create a culture that emphasizes a healthy and excludes contract providers. respectful workplace. This focus area the workforce strategy will begin to deal with the important element Long Term Disability (LTD) Long Term Disability incidents Establish quarterly reports by of retention and creating the desired culture. incidents per 1,000 insured were 498 incidents on 16,700 March 2007 persons. lives insured.
Participate in and financially Support the development of specific strategies to Progress report on study Develop baseline by March support a study on determinants of improve the workplace for physicians with evidence of on determinants of 2007. physician well being in Calgary factors that influence work-related stress and physician well being. Health Region by March 2007. satisfaction.
45 Part 3: Provide Quality Health and Wellness Services
Factors and Actions Measures Baseline Targets for March 2009 Strategies
Separation Rates: Total number of Focus Workforce Strategy on four areas in order to indicates the outcomes of separations (April to March) 1st Quarter 2005/06 separation attract and retain our current and future workforce. actions to recruit and retain over average total rate was 2.4%. The areas include: attract the required health care sufficient numbers of health employee head count as of workforce, create a culture that emphasizes a healthy service providers to meet March 31st and respectful workplace, develop the health care health service workforce, and utilize the skills and talents of the Assess and establish comparisons requirements. health care workforce. and targets by March 2007.
Number of RN separations 1st Quarter 2005/06 RN The Calgary Health Region feels that the action plans (April to March) over total separation rate was 1.57%. within each of these areas will begin to have a positive RN head count as of March impact on the ability to retain health care professionals 31st. within the Calgary Health Region
46 Part 4: Lead and Participate in Continuous Improvement in the Health System
4.1 Cost of Services:
Reference: Section 9 (4) (d)) Regional Health Authorities Act and Government Expectations.
Factors and Actions Measures Target. Strategies
Action: Present a comprehensive plan setting out Develop comprehensive To be determined Work collaboratively with Alberta Health and Wellness and the Regional steps and timelines to build capacity to meet plan by March 2009. cooperatively with Health Authorities to develop a plan to implement enhanced costing of reporting requirements. Alberta Health and services. The factors to be costed, along with the appropriate measures, will Wellness. be identified, defined and a standard methodology for the calculation and Plan to include the following: reporting for the chosen measures will be determined. The Costing Group within Finance will take the lead role in support of this joint initiative with 1. Inpatient cost on a weighted case basis Alberta Health and Wellness and the Regional Health Authorities • Hospital inpatient (budgeted/actual) cost per weighted case using CIHI / provincial guidelines • Targeted weighted cases by facility • Actual costs per bed day in hospitals
2. Diagnostic and therapeutic activity and costs (for region) for selected high profile functional centres - e.g. X-ray, MRI, CT Scan.
3. Emergency room and other clinics - functional centre costs and stats.
4. Continuing care costs • Net expenditure per resident day for all long term facilities • Net RHA home care expenditures • Number of home care visits
5. Nursing workforce • Nursing (nursing inpatient unit producing personnel) working hours per weighted inpatient case • Total nursing hours worked
47 Part 4: Lead and Participate in Continuous Improvement in the Health System
4.2 Information and Technology:
Reference: Alberta Health and Wellness Business Plan and the Government Expectations.
Factors and Actions Measures Targets 2008/09 Strategies
Security Standards Number of ISO 17799 Ongoing business continuity plans and disaster Deploy business continuity tool, business continuity controls implemented recovery plans in place and tested for all business framework and plans. functions. Implement new provisioning tool for access control Implement centralized access control for Calgary Health that provides a more secure and efficient Region assets and applications. authorization process.
Implement single sign on tool for Calgary Health Region Implement a more secure user friendly login applications, mail and network devices. process for accessing multiple applications versus five passwords being used only one will be Achieve targets subject to Alberta Health funding. required.
Electronic health record Progress report on alignment Enterprise Master Patient Index (EMPI) of region-specific plans to provincial IM/IT Plan (EHR Active integration of EMPI with regional ADT (Admitting, Ensure that the patient is uniquely and accurately GEN 2) Discharge and Transfer system) Clinibase at Rockyview identified at each interaction, as it will update the General Hospital by March 2007. Regional Enterprise Master Person Index.
Convert Peter Lougheed Centre to Clinibase by Ensure that encounters and visits are accurately September 2007. tracked in Regional systems to update the Encounter Repository. This is key to accessing the Convert Foothills Medical Centre to Clinibase by appropriate information in the Electronic Health November 2007. Record.
Continuous data quality and data clean up by March 2008.
Participate and evaluate the implications of the provincial EMPI. Determine timelines for implementation by March 2007.
Patient Care Information System (PCIS)
Implement Sunrise Clinical Manager at Rockyview Provide an integrated view of a patient’s complete General Hospital by June 2006, Sunrise Clinical chart with the Patient Care Information System Manager at Peter Lougheed Centre by October 2006 (PCIS). This will include key demographics and and Sunrise Clinical Manager at Foothills Medical visit information, lab results, order entry, Medication Centre by January 2007. Administration Records, flow sheets and work lists, and clinical decision support through alerts and order sets.
48 Part 4: Lead and Participate in Continuous Improvement in the Health System
Factors and Actions Measures Targets 2008/09 Strategies
Electronic health record Progress report on alignment Community Care Information System (CCIS) (continued) of region-specific plans to provincial IM/IT Plan (EHR Replace Home Care Information System by March Implement in phases the Community Care GEN 2) 2007. Information System (CCIS) by program and service (continued) areas. System functionality will include client Implement within community mental health and registration and enrolment, referral and waitlist communicable disease by March 2008. management, scheduling, clinical documentation, clinical decision support, client and provider billing, and contract management.
Number and type of care All health care providers in the Calgary Health Region Provide care providers with the tools to access providers accessing the will use the Electronic Health Record. The Electronic complete and timely information about patient and Electronic Health Record. Health Record team is committed to integrating clients at the point of care via the Electronic Health information across acute, community, and primary care Record. The appropriate clinical reference settings, supporting multidisciplinary care teams across information will be linked in by the Electronic Health distributed geographic areas. Record to support optimal evidence based decisions.
Data Quality Accountability for the Plan is Data Quality Plan is in place. Implement Data Quality Framework. assigned. Action: Develop regional Data Quality Plan, ensuring completeness, including: Data Asset Inventory is Procure third party to review electronic capture, Complete data asset inventory by March 2007. completed. storage and viewing of patient data.
Audit Plan (including Complete audit plan by March 2007. Audit Plan will be underway. schedule) is documented.
Remediation Plan is Complete remediation plan by March 2007. Document remediation plan will be documented. documented.
Audit/Remediation Activity: Implementation schedule Complete audit and remediation activity by March 2008. Develop and implement schedule. developed, which includes planned frequency of review.
Data Quality Targets: Progress report on data Complete data quality by March 2008. Identify targets, monitor and measure results. quality targets.
49 Part 4: Lead and Participate in Continuous Improvement in the Health System
Factors and Actions Measures Targets 2008/09 Strategies
Technology Renewal Technology renewal expenditure as a percent of Work with Alberta Health and Wellness to develop Obtain definition from Alberta Health and Wellness. total technology expenditure. standardized definition by March 2007.
Progress report on strategy Execute an ever-greening process for all current Execute a four-year ever-greening refresh for all linked to business plan. desktop computers, which are four years old or less. desktop computers and laptops will be on a three- year refresh. The next phase of this project (Phase III) will begin in the spring of 2006 as per the table below:
2006 – 1,094 computers 2007 - 1,433 computers 2008 - 870 computers
Total - 3,397 computers
Execute ever greening program for all personal computers and laptops by March 2008.
Clinical use of Telehealth Percentage increase in the Clinical sessions as a percentage of total sessions Provide regular reporting to all clinical departments clinical use of Telehealth. regarding clinical Telehealth usage. Action: Set targets for increased clinical 2004/2005 - 16% (actual) use of Telehealth. 2005/2006 - 20% (projected) Work with Alberta Health and Wellness and other 2006/2007 - 25% (target) Regions to improve efficiency and workflow of the 2007/2008 - 30% (target) province-wide Telehealth scheduling system. 2008/2009 - 35% (target) Provide centralized, region-wide support to Calgary Total number of clinical hours (providing and receiving – Health Region users for Telehealth services, Calgary Health Region sites only) including targeted to support ad hoc (unscheduled) desktop services. 2005/2006 - 1,900 hours (projected) 2006/2007 - 3,000 hours (target) Explore strategic partnerships (private and public) 2007/2008 - 3,500 hours (target) in order to support Telehealth growth and provide 2008/2009 - 4,000 hours (target) effective and efficient end point and bridging support.
Work with external partners such as Southern Alberta Child and Youth Health Network (SACYHN), University of Calgary, Carewest, Children’s Services, and Alberta Learning, to promote cross-sector and cross-jurisdictional Telehealth collaboration.
50