Promotions
From Planning to Action - Our Focus on Access and Quality
Ken Hughes
Calgary Chamber of Commerce
Feb. 16, 2010
Thank you Heather. As a long time member of the Calgary Chamber of commerce, I appreciate your interest in the work of Alberta Health Services. Thank you for being here today.
We have reached a turning point in the history of health care in Alberta. A watershed moment.
Today we are poised to move quickly from strategy and planning to action on access and quality – to reduce wait times and implement the innovations that are making Alberta a national leader in health care.
We are in a better position than any other health system in Canada.
Today I’m going to talk about where we have been and how we got here, where we are going and what all of that means for our patients and for you, your families, your friends and your colleagues.
A little over an hour ago I joined a conference call to announce an 8 million dollar push to add some 2,300 more surgeries across Alberta in the next six weeks alone – the first stage in a push through the first six months of this year to bring surgical wait lists down.
Next month we will provide more detail on an announcement made just last month at our Board meeting here in Calgary at the Sheldon Chumir Centre.
That announcement will be about a drive to improve what’s known on the frontlines as Emergency Department flow – which simply means making sure that people get the care they need more quickly when they show up in an Emergency Department.
Looking ahead, you can anticipate improvements to primary care, so that every Albertan has timely access to a family doctor, and significant expansion in community care beds for seniors.
All of this and more is possible because the provincial budget released last week provides Alberta Health Services with a new, stable, sustainable foundation.
We now have a five-year funding envelope, and no deficit. It is unprecedented - certainly in Alberta and by most accounts it is a first in Canada.
Not only do we know our budget parameters BEFORE the start of the next fiscal year just a few weeks from now, but we can plan for the following four years as well.
We now have the ability to implement long-term for programs and services. We have a timeframe that allows for meaningful and wide ranging consultation on those plans with patients, families, healthcare professionals and other stakeholders.
You are seeing the transition from strategy and planning to action that in many ways has been two years in the making, going back to the amalgamation of 12 former regions in May, 2008.
The former regional system had real strengths, but it was also subject to needless structural duplication.
It created competition between regions that too often led to inequitable access across the province and an inability to translate success from one part of Alberta to another.
Under the current system, Alberta Health Services, through a board, on which I serve as Chair, reports directly to the Minister of Health and Wellness. We have the responsibility to deliver all health services to 3.5 million Albertans.
Just to provide context for you, also reporting to the Minister is the Department of Health and Wellness, with a mandate to advise the Minister on policy, legislation, funding and other matters.
Alberta Health Services is now the largest single healthcare provider in Canada, the largest employer in Alberta with 90,000 staff, with an $11 billion dollar budget and $5 billion worth of capital projects “in flight.”
That scale – and the ability to drive the best ideas and innovations across the province – positions us to launch a series of initiatives to reduce waitlists and increase access.
We can accelerate the implementation of our strategic plans because we have demonstrated to the Government of Alberta, and Albertans, the value of amalgamation.
The strategic plan developed last year is guiding the actions we are taking today and will unfold in the 6 months ahead. We identified our highest priorities and we created metrics to drive our highest priority outcomes.
Alberta Health Services strategic plan has three key goals: access, quality and sustainability – the third of which necessarily consumed a great deal of energy in the past two years.
It was imperative. We had to streamline back-shop processes, reduce unnecessary duplication and waste, and effectively leverage the buying power of a provincewide health system.
The reality of a budget deficit required us to borrow money – with financing costs that would have required us to find further cost savings to service the debt until it was paid back.
We did not shy away from that challenge. We identified and have moved quickly to capture $700 million in cost savings in non-clinical areas through intensive work by the Alberta Health Services Board, executive, and staff.
All of this was captured without decreasing the front line services provided to Albertans.
$700 million dollars. That’s what it costs to run a major urban hospital for a year.
It has been a difficult time and we are grateful to every person on the AHS team who helped make it possible.
We made a commitment to be fiscally responsible, but not at the expense of quality and access.
We reined in some expectations, challenged conventional thinking, began breaking down silos between parts of the province and within the health service, and emphasized a performance culture.
Improved efficiency in back-office (non-clinical) areas will remain a priority. Historically, health spending has increased at a rate of 10 per cent a year.
Our funding envelope does not provide for that level of growth and we are by no means in a position to relax our commitment to financial discipline.
Just as some examples, we have achieved $74M in annual savings in Finance, HR, Communications, Information Technology, and Legal. Another $210M in savings from strategic procurement.
The merger savings are currently around $420M, which was our budget target, and will rise to $660M. That is $660 million dollars in savings every year. That is quite material, for anybody, in any service activity.
Albertans expect that fiscal discipline. What’s most important, however, is what we do with those savings: how we put them to work on access and quality; how we use the opportunity of stable funding to sharpen our focus on patient care.
Rising health costs are not unique to Alberta. Every health system in the developed world is confronted with the reality of skyrocketing rates of chronic disease and continually increasing drug and technology costs.
With five-year funding, we can plan programs that might take two or three or five years to fully implement and yield results. Year-by-year funding made that incredibly difficult to achieve.
Stable funding means we can target additional funding to areas where we know we must make a real difference in as short a period of time as possible. I’ll give you a few examples in a moment, but let’s stop to take a look at this from the personal level.
Every program or service, in every setting, has to be about the individual patient: their experience, the outcome of their care, their ability to have the best possible health at every stage of life.
It’s a pregnant woman who needs good prenatal care. It’s an asthmatic child who needs consistent primary care, counseling and support.
It’s your next-door neighbour, in the Emerg with chest pain after shoveling the sidewalk.
It’s your aging parents, needing the supports that will enable them to stay healthy and safe in their own home for as long as possible.
There is no public service more personal than health care. Every one of us wants to know that it will be there for us, and for our loved ones, when we need it.
That’s really what access is all about.
We also want to know that the care is safe and effective. That’s really what quality is all about.
So what does that look like in Calgary, if we’re working to improve Emergency wait times, surgery wait times, and primary care.
One of our immediate priorities is to increase access to cancer and cardiac surgeries. We are not going to promise overnight results. But we can commit to reversing the wait list trends.
If you are waiting for surgery to remove a cancerous tumour, or to repair damage to your heart, you have to have the fastest possible access to that surgery. We all expect that.
Those are incredibly vulnerable moments in which you have to be able to trust that your healthcare providers will make sure you get the care you need in time. We will live up to that trust.
Because we have an aging population combined with better medical techniques, the demand for many elective surgeries has doubled over a generation.
Our hip and knee replacement program is one of the best in the country. It’s innovative, it’s effective, and the change it makes in patients’ lives is remarkable.
By streamlining the processes and incorporating a team approach, we’ve made measurable gains in improving access and reducing wait times – though, because of the volume of demand, we know we have to do a great deal more.
During the pilot phase - involving more than 1500 patients across the province, about half of them here in the Calgary area - the wait time to see a specialist went from an average of 145 days to an average of 21 days.
The wait time for surgery went from an average of 290 days, to an average of 37 days.
It’s not just about moving patients through faster, though. The program’s team approach includes presurgery exercise and nutrition counseling, including support to quit smoking if that’s needed.
The team includes dietitians, physical therapists, counselors, and – most importantly – the patient.
Patients make a written commitment to follow the care plan, which they’ve been actively engaged in designing.
Through tracking the outcomes of this program, we’ve been able to establish that nine out of 10 patients were up and mobile the day of their surgery; and hospital stays were cut by about a day and a half.
A shorter wait time, and a quicker recovery. A team-based approach that actively engages the patient. A procedure that replaces a painful, damaged joint so that patients can return to an active, independent lifestyle.
More patients are being treated for a wider range of health needs. And they are getting better outcomes, individually and collectively. That’s access and quality.
I talked earlier about innovation in reducing Emergency Department wait times.
Allow me to share with you some specifics from right here in Calgary.
At the Rockyview General Hospital, Emergency Medical Technicians are teamed with registered nurses in a pilot that makes sure patients are assessed and treated more quickly, while getting ambulances back on the road as soon as possible.
The RNs assess the patient, and get the ball rolling on diagnostic tests like xrays or bloodwork. The EMT manages the patient’s care, taking over so the team from the ambulance doesn’t have to wait with the patient.
The pilot began in December, and will be evaluated in six months, but it’s already making a difference in the department. The EMTs are a valuable part of the team, helping out throughout Emerg where they’re needed.
Right now in all three adult hospitals in Calgary, physicians provide waiting room care, with private assessment areas right in the waiting room.
They’re not treatment spaces, but they get the assessment process moving faster. Again, this might mean x-rays, or bloodwork, or other tests.
Since these waiting room changes were introduced to the Foothills, Rockyview and Peter Lougheed centre, the Emergency Departments have recorded:
- shorter waits for physician assessment for urgent patients,
- fewer patients waiting to be seen,
- reductions in the average length of time people are in the Emergency Department from assessment to discharge or admission,
- and a reduction in the number of patients who leave without being seen by a physician.
These are all important indicators that people are getting the care they need quicker.
We’re improving access in the Emergency Department at Alberta Children’s Hospital, too.
Last September the Emergency Department there opened what are called “flow beds” — a transitional triage area where physicians can quickly assess children and determine the need for further treatment.
The results were dramatic. During typical peak times in the previous year, more than 200 children a day visited ACH’s emergency department, waiting as long as eight hours.
During the busiest point of the second wave of H1N1 second wave, they were seeing about 315, up from 200 patients each day - but on average the wait time was less than four hours.
The reduced wait times were sustained after H1N1 subsided.
The team there had looked at the movement of patients through the department. They found that there were efficient processes for patients who are very acutely ill and for those with minor illnesses and injuries, like lacerations or broken bones.
But they found that the patients who come in with needs somewhere in the middle – which were 60 per cent of the kids coming through – were having the longest wait times.
Now, they are spending less time waiting, while freeing up beds that can be used for sicker kids.
Interestingly, some of the access improvement initiatives for Emergency Departments happen nowhere near an Emergency Department.
Falls prevention programs keep seniors out of Emergency Departments with broken hips.
Reliable advice from a HealthLink nurse might save a worried parent a middle-of-the-night trip to the hospital.
Effective discharge counselling at the end of a previous hospital stay and good home care supports can prevent recovery from a surgery or illness from going wrong and prompting a trip to the Emerg.
At the Sheldon M. Chumir Health Centre, where the Alberta Health Services Board met last month, we learned about The Southern Alberta Renal Program, which provides comprehensive care for people with kidney disease: assessment, treatment, education and counselling, home dialysis. Even dialysis while working out on a treadmill.
It’s meant to keep patients as healthy as possible, leading normal, active lives to the best degree possible.
These are innovative approaches designed to meet the very different health needs of a changed society.
Harvard Medical School Professor Dr. Atul Gawande puts this into perspective. He says the new edition of the International Classification of Diseases identifies more than 68,000 diagnoses.
That’s 68,000 different ways in which the human body can fail. No other industry in the world has to deliver on so many “service lines.”
Modern medical knowledge is bigger than any one person – doctor, nurse, or other care provider – can manage or even grasp.
Gawande often talks about the absence of a single coordinating body that can take responsibility for the deployment of life-saving knowledge, and – interestingly, in the Alberta context – cites the World Health Organization’s “safe surgery checklist,” developed by his own team at Harvard.
This 90-second checklist was tested in eight hospitals around the world, and found to reduce complications and deaths by more than one-third.
But the fragmentation of modern health care in nearly every country creates barriers to the adoption of even this kind of simple, low-cost innovation.
What makes that so interesting to me is that it’s a different story in Alberta.
Last month, Alberta Health Services introduced the Canadian version of that Safe Surgery Checklist to every hospital, and every surgical team, in the province.
These surgical teams are being equipped with the templates and training materials they need to incorporate this simple but effective practice that has been proven to reduce errors, complications and infection. It works for the airline pilots, and it now also works for Alberta surgery teams.
Other health authorities across Canada are looking at implementing it, but through the integration of Alberta Health Services, we will ensure every person who has surgery in this province will benefit.
This is a good example of how you can improve the quality of care with a very small financial investment that reaps exponential rewards – most importantly, in every patient who recovers without infection or other complication, and goes home healthy.
There are so many good things already underway in health care, here in Calgary and across the province. I’ve only been able to tell you about a few.
I think the most important thing I want to tell you about all of them, though, is that the care provided by the doctors, nurses, and other healthcare professionals in this province is as good or better than that provided anywhere in the world.
Let me again take the opportunity to thank them.
We have the best and the brightest, right here. What we need to do is make sure that the system in which they work properly supports them to do their jobs.
We know we’ve got work to do on that. We’re putting the framework in place to engage our clinicians and staff in a meaningful, systematic way.
We know that their expertise and experience are critical to achieving our quality and access goals, because every one of the initiatives I told you about started with them.
We also know that we have to engage the community better, too. Patients, families, partners… all of our stakeholders need to be consulted as we work to create this new Alberta health system.
Our Health Advisory Councils are up and running across the province, comprised of a diverse group of volunteer community members who share a passionate commitment to health care.
They’ll each be establishing their own ways of engaging their communities - providing information and updates, gathering feedback, and channeling it into AHS.
In the weeks and months to come, you will see much, much more. Stay tuned.
We have reached a turning point. With that turning point we have an incredible opportunity, no, an obligation and a responsibility for turning our strategy and planning into even more action. Albertans rightly have high expectations. And so do we at Alberta Health Services.
We will not rest until we have greatly improved productivity and access, and quality. And even then, I doubt we will rest, because as Albertans, we have an unquenchable thirst for improving our community.
Thank-you.
