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PROVINCIAL CLINICAL and PREVENTIVE SERVICES PLANNING for MANITOBA Doing Things Differently and Better

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PROVINCIAL CLINICAL and PREVENTIVE SERVICES PLANNING for MANITOBA Doing Things Differently and Better and associates PROVINCIAL CLINICAL AND PREVENTIVE SERVICES PLANNING FOR MANITOBA Doing Things Differently and Better Final Report Submitted to Deputy Minister Ministry of Health, Seniors, and Active Living February 1, 2017 21 Shipping Lane • Halibut Bay • Nova Scotia • B3V 1P6 • [email protected] Provincial Clinical and Preventive Services Planning for Manitoba and associates Note to Reader This report is aligned with Provincial Clinical and Preventive Services Planning for Manitoba: Environmental Scan (December 1, 2016). The scan provides both context and detail that supplement the information and analysis presented in this report. Where relevant, abstractions from the scan have been distilled for inclusion in the report. healthintelligenceinc and associates i Provincial Clinical and Preventive Services Planning for Manitoba and associates Contacts David Peachey C 902.456.7992 T 902.346.2077 [email protected] [email protected] Nicholas Tait C 403.616.9284 T 403.208.3223 [email protected] Orvill Adams C 613.986.6386 T 613.421.6386 [email protected] William Croson C 647.999.7301 T 416.533.9425 [email protected] healthintelligenceinc and associates ii Provincial Clinical and Preventive Services Planning for Manitoba Table of Contents TOC Letter of Introduction 1 Executive Summary 3 ES.1 Overview 4 ES.2 Process and Outcomes 5 ES.3 Recommendations 7 Context 8 1.1 Purpose 9 1.2 Scope 10 1.3 Principles 13 1.4 Data Limitations 15 1.5 Strategic Direction of Government of Manitoba 18 Profiles of Manitoba 20 Key Concepts 27 3.1 Core Services 28 3.2 Rurality and Remoteness 29 3.3 Role Optimization 32 3.4 Patient-Centred Care 35 3.5 Return on Investment in Healthcare 37 Cross-Links and Ten Priorities 39 4.1 Cross-Links to Environmental Scan 40 4.2 Care of Older Adults 44 4.3 Collaborative Care 48 healthintelligenceinc and associates iii Provincial Clinical and Preventive Services Planning for Manitoba 4.4 Consolidated Services 54 4.5 Emergency Medicine and Health Services 63 4.6 Home Care 69 4.7 Indigenous Peoples 73 4.8 Maternal Health 82 4.9 Mental Health and Addictions 87 4.10 Palliative Care 99 4.11 Public and Population Health 104 Vision of Evolving Digital Health 114 5.1 The Art of the Possible 115 5.2 Digital Health Means Change 115 5.3 The Next Generation 116 5.4 Enabling a Real-Time Digital Health System 116 5.5 The Future State 117 5.6 Supporting Transformation 118 Clinical Governance 119 6.1 Fundamentals and Principles of Governance 120 6.2 Clinical Governance 121 6.3 Challenges of Governance 123 6.4 Clinical Governance 125 Clinical and Preventive Services Planning 126 Forecast Methodology 129 8.1 Forecast Period 129 8.2 Current Physician Roster 129 8.3 Roster of Physicians by RHA FY 2014-2015 131 healthintelligenceinc and associates iv Provincial Clinical and Preventive Services Planning for Manitoba 8.4 Future Supply 133 8.5 Population 142 8.6 Relative Burden of Illness 146 Models of Care 149 9.1 Overview 149 9.2 Core Physician Services 151 9.3 Interpretation Key 157 9.4 Diagnostic Services 158 9.5 Emergency Medicine Services 164 9.6 Medical Services 167 9.7 Mental Health and Addiction Services 170 9.8 Paediatric Services 172 9.9 Primary Health Care 174 9.10 Public Health 185 9.11 Surgical Services 190 9.13 Provincial Programs 192 Forecasting 2015-2016 to 2024-2025 195 Recommendations 197 Appendices 209 A.1 Index of Exhibits 210 A.2 Ten-Year Forecasting Tables 213 A.3 Acronyms and Initialisms 233 A.4 Committees 233 A.5 Data Compendium 233 healthintelligenceinc and associates v Provincial Clinical and Preventive Services Planning for Manitoba Applications of the Report This report is the beginning of a planning process to do things differently and better in Manitoba, with the continuing acquisition of quantitative and qualitative data from across multiple sites and healthcare stakeholders in Manitoba. It provides a planning tool that is navigational, not prescriptive, and positions the provincial leadership for an incremental implementation that aligns with the strategic direction of government, its priorities, and the fiscal realities. The multiple forecasting tables provide layers of evidence-based conclusions that offer a predictable future on a rolling ten-year basis for clinical and preventive services planning in the province. The process of transition and implementation will lead to granular planning at multiple levels in the province with flexibility at decision points where variables and assumptions are confirmed or modified using ongoing real time data. The report and its recommendations are founded on the principle that healthcare is a provincial resource that is operationalized regionally, but always in the context of provincial planning and integration. It is a work-in-progress that will continue to be shaped and re-shaped, never with a endpoint. The constant touchpoint for the province is quality care that is patient-centric and provided by healthcare professionals committed to collaborative models and role optimization. The convergence of qualitative and quantitative analyses is further adjusted through innovative models of care with the potential to be transformative. All of the requirements to succeed are in place in Manitoba in the context of care driven by a belief in the values of a safe and sustainable healthcare system that is equitable and accessible. While all sectors in the plan are important, some have been identified as priorities by the consultancy and without argument from the stakeholders and organizational leadership. The challenges are not insignificant; some sectors in healthcare face the imperative for change to a degree much greater than that in other sectors. Some of the pressures are immediate and have been identified for early action by an implementation group. The long-term success of the plan will reflect policy persistence, provincial thinking, and clinical governance that measures outcomes and adjusts for standards and best practices as lessons are learned. If it is not being done for the patient, why is it being done? healthintelligenceinc and associates vi Provincial Clinical and Preventive Services Planning for Manitoba Letter of Introduction LOI February 1, 2017 Ms. Karen Herd Deputy Minister Ministry of Health, Seniors, and Active Living Government of Manitoba Dear Deputy Minister: Attached is the final report of Health Intelligence and associates on Clinical and Preventive Services Planning for Manitoba. Using an adjusted population needs-based methodology, this report has progressed through phases of a project charter, qualitative and quantitative acquisitions and analyses, and a detailed environmental scan, underpinned by a data compendium that has been provided as a companion document. The overview schematic and recommendations are provided as an executive summary. The details are within the report and reflect the environmental scan, modeling, and forecasting that converge into the plan. The data that inform the report have been acquired with careful attention to validation and harmonization. The merger of data with informed qualitative observations is the basis of assessing the current state in Manitoba and forecasting the future state in a ten-year rolling model that is founded on evidence and incorporates redesigned models of care. It is notable that even the most thorough examinations of Canadian healthcare are based on remote data, a fact particularly relevant in times of rapid change and fiscal constraint. Much of what has been presented here is a cross- sectional picture of a constantly evolving, often reactive, group of stakeholders, the structures they have developed and on which they depend, and the economic and societal forces shaping their decisions. This plan is the beginning of a journey, not the end. Throughout, stakeholders have urged boldness; the forecasting and recommendations are far-reaching. It has been our experience, however, that a carefully considered clinical and preventive services plan can be implemented in an incremental fashion that is sensitive to government policy and fiscal reality, while upholding evidence-based decisions that are patient-centred and reflect articulated principles. Further, the shaping of health policy is more dependent on interactions among different components and sectors of the system than on determining the best solution for any one group in isolation. Change can be difficult in a large, complex organization; that notwithstanding, there are immediate pressures that warrant attention, and these have been stressed. It has been observed that upfront costs in health care, if carefully selected, will not only improve the quality of outcomes, but also can decrease system costs, both directly and through redistribution. However, the downstream direct and healthintelligenceinc and associates Letter of Introduction 1 Provincial Clinical and Preventive Services Planning for Manitoba indirect savings can be difficult to quantify as healthcare often does not lend itself to typical cost- benefit models. It will be prudent, however, to embark on clinical and preventive services planning with a parallel process of measuring clinical outcomes and their subsequent longitudinal analyses as a central piece of clinical governance. Successful planning provides better services for patients and their families, and opportunities to address inequities. To achieve successful planning in the long-term requires commitment across the system, belief in the values of the system, and the imperative for change that maintains the patient at the centre of that system. Making progress will be incremental and the full engagement of stakeholders across the system will be inevitably staggered; however, policy persistence and an unwavering dedication to “our system” will lead to a successful endpoint. It must be noted that failure to support an expanded reach of public health in Manitoba will diminish the overall impact of clinical and preventive services planning. Further, the plan must transform the sectors of mental health and addictions, palliative care, care of the older adults, home care, and primary care.
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