Winnipeg Regional Health Authority
2016-17 Annual Report
Winnipeg Regional Health Authority
2016-17 Annual Report
The time for change – Improving patient care and the system that delivers it
At the WRHA, providing the best patient care possible is at the heart of all we do. Our staff and physicians come to work intent on doing exactly that – but our system, the framework within which our staff and physicians work, has itself failed to deliver. The evidence is in unacceptably long wait times and lengths of stay in hospital, key measures of service delivery that, in Winnipeg, have lagged behind national averages for years.
“We know that fundamental and comprehensive change is needed in order to address our challenges,” says Réal Cloutier, WRHA interim President and CEO. “That kind of change, while necessary, creates a lot of disruption. We can’t shy away from that, though. These challenges erode the quality of care we provide, with very real clinical implications.”
To address the challenges our region introduced Healing our Health System in spring of 2017, a sweeping plan aimed at consolidating services, matching patient populations to appropriate staffing and building system sustainability.
“It’s about providing the right care at the right time and in the right place,” says Lori Lamont, WRHA Vice-President, acting Chief Operating Officer, Vice-President for Nursing and Allied Healthcare Professionals. “Our staff and physicians need a system they can work with, not around.”
The clinical consolidation aspect of Healing our Health System groups patients with like needs at specific sites with the staff and diagnostic resources needed to deliver the right care. “Larger urban centres like Vancouver and Calgary have fewer emergency departments than Winnipeg yet our wait times are longer. Our specialty staff and diagnostic resources are spread too thinly across too many sites. Clearly more is not always better,” adds Lamont.
Cloutier agrees. System transformation means focusing squarely on the value our health system delivers to patients every day, and asking the right questions instead of adhering to the status quo. “Are we convinced that every step in a patient's journey system adds value? Are we always looking at more efficient ways to deliver service without compromising safety? What would we ourselves expect, if we were in need of care? Our community deserves nothing less.”
What lies ahead:
Initial Healing our Health System changes to clinical services at Winnipeg hospitals.
Phase 1 – Begins Oct. 3, 2017
Phase 2 – Begins early 2018
HSC heliport helps speed patients to life-saving care
In January, Kelby Sprung, a 14-year-old hockey player from Manitou, suffered a compound fracture of his leg after crashing into the boards with an opposing player. Kelby was initially brought to the Carman Hospital by ground ambulance, where it was quickly determined that he needed specialized care. He was then flown by STARS air ambulance to the heliport at HSC, where the team at HSC Children's Hospital repaired his leg.
As Kelby’s mother, Jenn, explains, “He was lacking a pulse in his foot, and they needed to get that circulation back because they were saying that the limb was compromised. His transport from the hockey arena to Carman Hospital was very traumatic for him because he was in so much pain. He felt every little bump on those winter roads, so he was very happy to have the helicopter drop him off in Winnipeg with as little disruption as possible to his injury site. And to be moved right into the operating room on arrival was amazing for him.”
Kelby’s air ambulance flight was one of approximately 300 that have occurred since the provincial government joined the WRHA and STARS air ambulance in January 2016 to introduce plans for Winnipeg's first downtown heliport, located at HSC.
The heliport, which officially became operational in November 2016, significantly improves access to care for critically ill and injured patients being airlifted to HSC. The heliport routinely saves up to 30 minutes transport time for critically ill and injured patients, while reducing the risks involved with transferring patients in and out of ground ambulances.
HSC is the first health facility in Manitoba to have a heliport. The heliport sits on the roof of the new, 91,000-square-foot Diagnostic Centre of Excellence (DCE), located between pediatric inpatient units of HSC Children's Hospital and the Ann Thomas Building, which houses critical care services including intensive care units, operating theatres and emergency departments. The 60-by-60-foot rooftop-landing pad meets an H1 Heliport Standard and accommodates twin-engine helicopters.
In May of 2017, the heliport expanded its capacity by accepting incoming air ambulance transfers from Ornge Air Ambulance services from Ontario. Ornge co-ordinates all aspects of Ontario's air ambulance system.
Making a Commitment to Improve Family Presence
One year ago, Dee Dee Budgell picked up her ringing phone at 2 a.m. to hear a nurse say, “You need to come here. Harry’s not doing well.”
"Oh, my God. You get that call and your heart is racing. I’ve been told all along that my husband won’t survive this," Dee Dee explains. "So of course you get in the car and you try to settle yourself down. Then I get into the parking lot, I go to the front door of the hospital and it’s locked and I think, 'Are you kidding me?' My daughter and I run to the emergency entrance and the security guard stops me. I thought, ‘I can’t deal with this.’ I needed to get upstairs and I couldn’t even barely breathe."
Her daughter, Kati Budgell, stayed behind to talk to the security guard while Dee Dee rushed to her husband's bed. After Dee Dee reunited with her husband, Harry Budgell, she took a moment to let the medical staff know that the front door was locked overnight. The staff had never considered this.
When Harry was 64, he suffered a massive stroke after having a triple by-pass heart valve replacement. RHC said that he would never walk or talk again and gave him a year to live. That was 11 years ago, and he walked out of the facility.
He did lose his speech though. Harry has aphasia.
"People who have aphasia won’t be saying things that make any sense. Their family members will."
Harry's lack of speech can be dangerous since he cannot communicate his pain well. Years after his original stroke, Harry fell while at home. He was taken to a hospital where they treated his congestive heart failure and within hours Harry was breathing normally again and would be discharged in a few days.
But Dee Dee interpreted his hand gestures and insisted on getting an X-ray of his hip. The medical staff assured her that there was no need for an X-ray, but when the results arrived they learned that Harry had broken his hip and needed a hip replacement.
Dee Dee is one of the volunteers on the WRHA's Patient and Family Advisory Council. During her time on the council, she has shared these stories and others similar to it where she has faced roadblocks as a family member and advocate.
The council evaluates these shortcomings in acute care, community health services and personal care homes and advises the WRHA on where to implement changes. In the past, they have been involved in many projects, from the emergency department wait times webpage, to participating in a Dignity in Care video, to providing input on the Clinical Practice Guidelines for Pain Assessment and Management.
Later this year, the council looks forward to working on a comprehensive implementation and education plan for the Family Presence Policies that are being developed.
The WRHA signed the Better Together pledge on April 5, 2016. Better Together focuses on encouraging the inclusion of patients and family members as partners in care. The WRHA's new policies will allow designated family members and caretakers to regularly access patients in the hospital 24-7 instead of just during visiting hours, and enable them to more fully participate in the patient's care and feel welcome to be present during physician rounds.
"I think family presence is so important because, honestly, if your family member is sick and unable to think straight, you can be that conduit. You can interpret the information, make sure the medications are right and notice things right away that maybe a nurse might not notice at first, because that nurse doesn't know the patient like you do."
Family presence isn't a new concept, but it is evolving as we learn just how much it can benefit patients. If you are interested in becoming a volunteer for the Patient and Family Advisory Council, visit www.wrha.mb.ca/about/engagement/pfac/index.php for more information. Volunteers can participate in person or electronically.
For more information about the Better Together pledge, visit www.cfhi-fcass.ca/WhatWeDo/better-together/pledge.
Kim Baessler, OTReg (MB)
WRHA Program Consultant Home Care Equipment, Supplies & Wheelchairs
Through collaboration with other departments, I was able to implement new clinical and monitoring processes for the rental of therapeutic sleep surfaces (specialized mattresses) for home care clients resulting in cost savings exceeding $952,000 over about a two-year period.
In health care, we use specialty air or gel mattresses to prevent pressure injuries. Sometimes clients need them only for a short term after a surgery or injury, and we would arrange for a daily rental from a vendor, but we had no formal process for a clinical reassessment so the mattress would end up staying in the client's home for years.
Now clients get reassessed every six months to see if they still need the specialty mattress, and we also started utilizing a rent-to-own program with the vendor that we didn't know was available.
Other savings were realized by developing a process to recycle overhead lift slings.
Home care provides slings for transferring clients with an overhead lifting system in their home. When the lifting system was no longer needed and removed from the client's home, we used to throw the slings out for hygienic reasons. Unlike slings used in hospitals that are laundered with the rest of the hospital linens, our slings in home care weren't laundered because our vendor for overhead lifts doesn't provide laundering. The slings are about $300 each.
So in April 2016 I developed a process. I arrange for the overhead lift slings to go to the WRHA laundry facility on Inkster, and when they've been laundered, they are inspected, repackaged and then used again. We estimate the initiative saves about $10,000 annually.
There are two slings in each household and I actually find a lot of clients, after they've had a laundered one, say, "Can I have another recycled sling? They're softer.” When the sling comes out of the package, they're all stiff and uncomfortable. It's like breaking in blue jeans.
I was new to this role three years ago. I'm an occupational therapist in a role looking at equipment and supplies for home care and trying to apply clinical best practice. In the past, we didn't always translate clinical evidence to equipment provision such as determining which client would benefit from a hospital bed, special mattress or other equipment. The decision-making was usually left up to each individual health-care professional without a lot of resources. Now we are looking at evidence and applying it to the equipment we order and provide to patients to ensure that we are providing the best clinical care possible and at the same time being fiscally responsible.
Clerk Typist V, Health Information Services, SBGH
With the support of my transformation coach and co-workers, I was able to reduce training time in my area from 12 weeks to three weeks or less, which played a significant role in reducing our overall training costs by over 75 per cent.
I am a late reports clerk, and our responsibility is to put the reports that come down to health information services (HIS) into each patient’s corresponding chart. Our standard is 3.5 inches of paper per day, per person.
My area was frequently backlogged (taking longer than two weeks to process), which caused pain for patients, HIS staff and primary care providers because they did not have the most updated information in the patients’ charts when they needed it.
When the region announced that each area would need to work within their budget allocation, we were no longer allowed to use overtime as our “Band-Aid” to fix backlog; we had to find a real solution to this problem otherwise reports would pile up even more.
In a February 2017 sample, reports were coming in at approximately 200 inches per month, but we were only able to process about one third of that amount within that time.
We needed to hire new staff to take on this work, but it took 12 weeks to train a person to become a late reports clerk and training time cost $12,000.
After I had discussions with my team, supervisor and coach, we decided training time needed to be reduced. We accomplished this this by creating deliberate training objectives, and updating our system of filing reports for the first time in 20 years. Now our tabs have been updated to represent current reports and we file our reports by date where the most current results are always on top.
We reached our goal of reducing training time from 12 weeks to three weeks or less. In one case, we were able to train a person in four days. We reduced training costs from $12,000 to $3,000 or less. We increased the speed that records were being processed, due to our newer, simpler system of filing. Some late reports clerks are now filing closer to four or 4.5 inches a day per person instead of 3.5 inches.
Today we are no longer backlogged in this area and are processing reports well within two weeks of arriving to HIS.
Everyone has the power to make a positive impact within their department if they commit to it, no matter your position within the hospital. You will always have pushback from some individuals when introducing change. This is simply part of the process. Do not let that discourage you from making a change. We as a region are truly working on functional solutions that are sustainable and patient-focused.
Clinical Nurse Specialist for Geriatrics and Advance Wound Care, Grace Hospital
The soaker pad removal was a regional project. Historically, soaker pads were thought to keep patient’s skin dry by absorbing moisture from incontinence, post-surgical discharge and weeping skin. Research shows no benefit of soaker pads related to improving patient care. The problem with soaker pads is their inability to properly pull fluid away from the skin, thereby leaving skin sitting in fluid and causing skin breakdown.
They were put on every bed.
Sometimes you have to ask the question, “Why are you doing that? What’s the purpose?” and “Is it beneficial to patient care?”
We audited the units to see why and how many were used. The number of soaker pads used but not required was staggering.
After removing the soaker pads we brought in absorbent disposable sheets that wick moisture away from the skin, thus preventing skin breakdown. And now units are only putting them under the patients that need them. The sheets cost about $1.50 each. Soaker pads cost us about $3 each after we account for laundering and transporting to laundry services and back.
Another instance where we made improvements was after the revised constant care guidelines came out January 2016. We educated staff, showed the statistics and our philosophy became “constant care is the last resort, not the first option.” It could be only used for a specific behavior, and once the specific behaviour was gone, so was constant care.
For a bit of background, instead of restraints we use constant care to ensure the patient isn’t pulling out lines (for example, removing epidural), which can be very dangerous.
The key piece for this project was education and auditing. So we decreased the time of constant care and we audited every instance of constant care, every morning, seven days a week.
If you look at our stats, they went down so low to the point at regional meetings for Chief Nursing Officers, they wouldn’t even put us on the graph showing costs for constant care. One month, we were under $2,000.
I'm a nurse, I’m an old nurse. I was taught by the nuns at SBGH and it really is all about the patient. I have a lot of pride in my job, I have a lot of pride that I’m able to give people the care that they deserve and they expect when they come into a hospital because they have so many other crisis’s in their life, the last thing they need to worry about is somebody leaving a soaker pad under them and getting a pressure ulcer.