History that brought us here
We have completed several planning exercises since 2012 to provide us with the opportunity to examine what we are doing, what we expect the future of health care will look like for our community and region, and to ensure we are providing access to the right care for our patients today and tomorrow.
Our newly-defined Master Program will support, improving quality maximizing efficiencies, improved length of stays, patients receiving care in the most appropriate place, the right sizing of beds and a balanced budget.
The hospital move and transferring health care dollars into the community
Initially we were focused on the development of the new hospital and amalgamation of the former North Bay General Hospital and the Northeast Mental Health Centre. Our recent and current planning activities are critical as we move forward in response to a healthcare system challenged by the growing needs of our patients and limited by the fiscal realities of the province and an ever evolving healthcare system.
The pace of system change, the move to the new hospital along with our focus on the amalgamation caused us to fall behind from where we need to be regarding service delivery modeling and efficiency. As a result, the hospital must continue to manage major change processes while continuing with normal operations. Our work thus far is beginning to move us from a reactive approach of doing business to a proactive approach.
There is a movement by the government to invest more dollars in community-based care while acute care investment decreases. As a team, we at NBRHC have made many positive improvements over the past two years by increasing community and out-patient services, reducing the need for hospitalization through more ambulatory services, and working with community partners to improve the transition patients make from hospital discharge to community.
Operational Review conducted in 2012
In the Fall of 2012 an independent review was conducted of NBRHC operations to maximize opportunities associated with the unique operating structure and services of the amalgamated district acute and regional mental health programs established in the newly formed organization.
This Operational Review provided a solid overview of where NBRHC excels and where it falls below its peer comparator hospitals. The hospital committed to improving operations and finding efficiencies that would put NBRHC at the median of its peer comparators while ensuring quality patient care remains our number one priority. Our plan was to deal with the report’s 13 recommendations, within the following 3 themes: Performance Management, Access and Partnership.
The Operational Review identified issues associated with our length of stay and admission practices along with a number of other opportunities for improvement. It became clear that if we are to manage in an environment of zero or negative funding increases we need to consider how we can do things differently. In order to make changes in our service delivery model, we require approval from the LHIN (Local Health Integration Network) and the MOHLTC (Ministry of Health and Long term Care).
Strategic Plan developed in winter 2013
The outcomes and recommendations of the Operational Review formed the baseline for a Board led process to develop a new multi-year Strategic Plan including refreshing of the Mission, Vision and Values, Strategic Directions and Objectives. The hospital used the NE LHIN’s IHSP (Integrated Health Services Plan) for the development of the Plan. The strategic planning process involved significant input from partners, staff, volunteers and physicians.
The strategic directions and associated objectives identified by the Board in the Strategic Plan were translated into metrics and captured on a Corporate Scorecard for monitoring. These items were also used to develop 80+ departmental scorecards cascaded throughout the organization. These scorecards ensure that everyone in the organization understands their role and how their improvement work ties back to the strategic priorities of the organization. We have incorporated the reporting of our performance on the Corporate Scorecard into the routine business of the Quality Committee and the full Board of Directors.
Master Program Development 2014
The Master Program reflects the vision and mission of the North Bay Regional Health Centre, and incorporates the current understanding of best practices in service delivery. Participation in the planning process represents a unique opportunity to mould future service provision and make major changes to the working environment to accommodate new service delivery models.
The need to complete a Master Program was first identified following the move of our 31 patients to Kirkwood Place in Sudbury. When the decision regarding the move was made in 2010 by the LHIN, we made it clear to the LHIN/MOHLTC that we had to develop a facility development process for that site. As such a plan for the development of appropriate facilities would need to be developed. The MOHLTC established the process relative to proposed Capital projects. We submitted a Pre-capital submission for Kirkwood Place in October 2011 and received approval to proceed with a Stage 1 submission in December of the same year. The completion of a Stage 1 submission necessitates having a current Master Program and Master Site Plan. These documents did not exist for the organization therefore work commenced in January 2012 to secure a consulting firm to assist with this work.
The impetus for this Master Program endeavor was originally the examination of short and long-term needs for Kirkwood Place. The project was then expanded in scope to include the organization as a whole, which allowed the hospital to think more globally and thoughtfully about its needs, opportunities and constraints going forward.
The healthcare needs of our population have changed significantly as has the way in which service is delivered. To adapt to these changes, we needed to redesign our service delivery systems. We completed an updated Master Program for the organization. This aligns directly to our strategic plan and associated mission, vision and values. This work commenced in August 2013 and was approved by the Board and LHIN in the spring of 2014. The plan that was approved identified that a further work effort was required relative to our Regional Mental Health services.
NBRHC Service Realignment 2014
The outcome of the Master Program highlighted the need for significant service realignment. The goal of realigning our services is to improve access to care, transitions and fiscal stewardship. All decisions regarding realignment were made to provide care for our patients today and tomorrow. To ensure this continues to occur, we have implemented a continuous quality improvement system and defined quality targets. We will be closely evaluating our performance and keeping our community aware of how we are doing. NBRHC has been working to change the services it provides to meet the needs of the community. A short video entitled Reshaping Care literally draws the picture of service realignment at NBRHC.
As partners in care, we should be doing what is right for our patients – providing them with the quality care they need, where they want it – at home, in the community or in their setting of choice. Patients want to receive care in the community and at home, and only access the hospital when truly required. As a team, we at NBRHC have made many positive improvements over the past two years by increasing community and outpatient services, reducing the need for hospitalization through more ambulatory services, and working with community partners to improve the transition patients make from hospital discharge to community. Because of this improved coordination and transitions of care, we no longer require the same numbers of beds as we did in past years; demand on inpatient services is also decreasing.
Significant Improvements Already Made
Other Opportunities in Progress:
Mental Health Programming Refinement Stage
The typical approach taken for Master Program development uses past performance, market share, demographic forecasts, along with comparison to peers, to forecast what services should look like in the future. This approach is flawed in terms of our Regional Mental Health programs in that we know we are not satisfied with the past performance of the system and therefore a different approach is required. As part of our analysis we are comparing ourselves to the 9 other Regional Mental Health providers.
The context for this refinement is further influenced by the Provincial budget which sees base funding for hospital corporations remaining frozen while funding for community mental health and home care is indicated to rise significantly. As a major provider of mental health services in the Region, this approach is creating the opportunity to focus our attention on supporting the community sector as we confirm our role as the Region’s specialized mental health provider. The following strategies are in progress as we continue to refine our analysis. This work effort will ensure we provide the right care in the right place at the right time, by the right provider while living within our financial capacity.
Global Strategies in Mental Health:
Mental Health and the Law:
Seniors Mental Health:
Psychiatric Rehabilitation and Recovery Program:
Key Challenges as we move forward
While we have made tremendous gains in many areas over the past 2 years, there are key areas we are continuing to address. Recruitment of Emergency and Primary Care physicians remains a crucial issue that we must address urgently. The lack of family physicians in the community drives many residents to seek primary care at the hospital’s Emergency Department as no other alternative is available in the community. Orphaned inpatients create ongoing workload for those general practitioners who provide hospital care as they assume the role of most responsible physician in hospital. This is resulting in more physicians opting out of hospital care and thus a new model is quickly becoming critical. The implementation of Health Links for Nipissing will be key to assist in clarifying this issue and getting consensus on the work that will be required to move this forward.
In the past, the model of care in our mental health program was one of custodial care resulting in excessive lengths of stay and no capacity to support the region. In addition, poor data quality made it difficult to define the need for mental health services in our region. Fragmented and poorly resourced community supports make it extremely challenging to lead health reform. It is crucial that we clearly define our role as a provider to the Northeast region and this must be done collaboratively with key stakeholders. Access to specialized services, development of local capacity in the outlying communities and repatriation all require a concerted work effort.
Mental Health and Addiction Services Review:
Health Sciences North and the North Bay Regional Health Centre (the Partners) will be inviting formal Proposals for a review of the current adult Mental Health and Addictions Services provided throughout the region. The goal is to develop a plan of an optimal inpatient/outpatient and community service model to support people with mental health and addictions issues in the NE LHIN.
Quotes on Health Care in the Provincial Budget speech 2014
“Funding reform is particularly important in the hospital sector to help manage costs as the government is continuing to hold hospitals’ overall base operating funding to zero per cent growth in 2014-15.”
“Ontario is continuing to implement Ontario’s Action Plan for Health Care, which provides the road map for transforming health care services to create a more sustainable and high-quality health care system……increasing investments in [home and community care services] by over $750 million by 2016-17, including over $270 million in 2014-15”
“The government is providing additional funding of $300 million over 10 years to help shift care from hospitals to community settings and ensure adequate infrastructure capacity in the health care sector. This includes the creation of a dedicated Community Infrastructure Renewal Fund that would help community organizations.”
“The government is committed to balance the budget by 2017-18 in a fair and responsible way…Achieving this, however, will require some difficult choices.”
“The Province will continue a careful review of spending to determine which programs should be enhanced or reduced, while transforming public services to increase efficiencies and improve outcomes.”
“Ontario’s hospitals are highly efficient and recognize the province’s financial constraints. That is why we continue to play a leadership role in health system transformation.”
“We have been accelerating our efforts to implement health system funding reform in order to further improve quality of care for patients and drive greater value.”
“These are important initiatives and are part of a strategic effort to expand funding and capacity elsewhere in the system, particularly in the community. But at the same time that the government aims to balance its budget by 2017/18 and hospitals and other providers are implementing very large-scale change initiatives, the system is also preparing for a time of intense pressure. Service demands will continue to grow across the board at the same time that the system moves to further contain cost growth. To help manage this compression, the health system needs a long-term, province-wide capacity plan.”