Presentation Overview

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Presentation Overview

• Organizational profiles and the Journey to
  Quality Accountability
• Riverview Hospital
• Forensic Psychiatric Services
• Joint efforts in Quality Accountability
• Challenges lessons learned
• A look to the future

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Our MissionTo improve the quality of life of
adults affected by persistent or severe mental
illness by providing excellent, specialized care
for individuals with unique treatment challenges
and by increasing service capability within BC
through clinical service, education and research
partnerships.
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Our Vision Transforming Mental Illness
Into Mental Wellness
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Profile Riverview Hospital

• BCs largest tertiary psychiatric facility
• Located in Port Coquitlam serving all of BC
• 600 beds as at May 2003
• 3 major clinical programs
• Adult Tertiary Psychiatry
• Geriatric Psychiatry
• Neuropsychiatry
• Full range of clinical logistical support
  services
• 582 admissions, 683 discharges in 2002/03

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Riverview - The Quality Journey

• First accredited in 1979 by Canadian Council on
  Health Services Accreditation (CCHSA)
• Traditional quality assurance focus up to 1980s
• Functional/departmental quality standards
• Largely a paper-based audit system
• Evaluative, problem-oriented approach
• Dilemma How to assure quality ???

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Riverview - The Quality Journey

• Shift to CQI/TQM approach in early 1990s
• Board, CEO senior management endorsement
• CQI Council, Department QI Plans, ad hoc QI
  projects
• CQI Facilitator Training
• Orientation to CQI methods for all staff
• Shift to program management structure in 1998
• Designed to reinforce high quality,
  inter-disciplinary, patient-focused care

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Riverview - The Quality Journey

• Current approach
• CQI focus across all aspects of care service
• QI activities integrated with organizational
  structures and strategic operational planning
• Modified balanced scorecards aligned with
  accreditation teams
• Committee structure provides additional QI
  support
• Medical Advisory Committee sub committees
• Discipline Inter-disciplinary Professional
  Practice Councils
• Program Planning/QI Teams
• Partnership committees stakeholders,
  union/management, etc.

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HR Team Balanced Scorecard
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Riverview - The Environment

• Many changes in leadership/governance since 1996
• On-again, off-again downsizing/redevelopment
  plans
• On-going financial constraints
• Increasing consumer/family expectations for care
• New medications evidence-based care
• Significant information technology enhancements
• External CCHSA Accreditation visits every 3 years

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Profile Forensic Services

• FPSC Mandate
• Responsible for the provision of psychiatric
  assessment, treatment and community case
  management to mentally disordered adults who are
  in conflict with the law.

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Profile Forensic Services (cont.)

• Inpatient Services
• Forensic Psychiatric Hospital
• 211 bed secure psychiatric hospital in Port
  Coquitlam
• 460 Admissions for 2002/03

• Outpatient Services
• Regional Clinics
• Vancouver, Surrey/FV, Kamloops, Prince George,
  Victoria, Nanaimo
• 2279 Admissions for 2002/03

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FPSC - The Quality Journey

• 1970s-1990s Strong strong tradition of
  providing high quality forensic psychiatric
  assessment and treatment services to patients and
  to the courts
• 1990s quality improvement accountability not
  a key strategic thrust of the organization lack
  of formal QI program and organization not
  accredited
• 1997 new Forensic Psychiatric Hospital opened
• 1998 (late) decision to pursue accreditation
  for FPH
• 1999-2000 heavy organizational focus on
  preparing for accreditation

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FPSC - The Quality Journey

• 2000 (early) new CEO for FPSC
• 2000 (fall) accreditation survey visit by CCHSA
• 2001 (early) FPSC granted Accreditation with
  Focused Visit
• Develop Quality Improvement program
• Develop a formal Information Management plan
• Clarify committee structure for the organization
• Develop a Communications plan
• 2001 Regional clinics joined accreditation
  process
• 2002 focused visit by CCHSA all areas
  addressed
• 2002 new governing body for FPSC PHSA

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FPSC - The Environment

• Dramatic shift in the environment at FPSC in
  terms of the organizations focus and emphasis on
  quality and accountability.
• This shift has been driven by a number of factors
  or forces, both internal and external to the
  organization.

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FPSC - The Environment

• External Forces
• Accreditation
• Change in Governing Body
• Fiscal Constraints

• Internal Forces
• New Leadership
• Infrastructure Development

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Committee Structure
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FPSC - The Environment

• Positive Aspects of Current Environment
• QI/Accountability framework
• QI/Accountability infrastructure
• Leadership by management
• Staff understanding and involvement

• Ongoing Challenges
• Resource commitments
• Meaningful QI/Accountability indicators

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Joint Efforts in QI/Accountability

• Health System Restructuring
• Accreditation
• PHSA Reporting Requirements
• Challenges Lessons Learned
• A Look to the Future

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BC Health System Restructuring

• Healthcare system restructured in December 01
• Objective To reduce system costs improve
  quality/accountability
• 52 regional boards, councils societies reduced
  to
• 5 regional health authorities
• 1 Provincial Health Services Authority (PHSA)
• PHSA unique in Canada
• Unites all health services with province-wide
  scope
• RVH FPSC included with other key health agencies

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RVH and FPSC Integration

• RVH and FPSC began integrating in May 2002
• Common President/CEO assumed responsibility for
  all mental health services under the PHSA
• Integration of senior management team 1st step
• Efficiencies resource sharing options
  identified
• Looming accreditation surveys for both
  organizations galvanized integration process

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QI/Accountability Framework
RIVERVIEW
ACCREDITATION
FPSC
PHSA
TQM QI
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Joint Accreditation Process

• Integration of Accreditation Teams
• Leadership Partnerships (joint)
• Human Resources (joint)
• Information Management (joint)
• Environment (joint)

• Clinical Service Teams
• Forensic Psychiatric Hospital (FPSC)
• Forensic Psychiatric Community Services (FPSC)
• Adult Tertiary Psychiatry (RVH)
• Geriatric Psychiatry (RVH)
• Neuropsychiatry (RVH)

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Joint Accreditation Positive Outcomes

• Joint preparation has helped to
• build relationships foster teamwork across both
  sites
• acquaint RVH/FPSC partners to relative strengths
• spur integration activities
• accelerate identification of improvement
  opportunities
• identify common CQI processes

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PHSA Accountability Requirements

• Availability and Access
• Access Patient/client easily obtains required
  services in the most appropriate setting

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PI Average Number of Days on FPH Waitlist
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PI Average Wait Times by Program (RVH)
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PHSA Accountability Requirements

• Availability and Access
• Access Patient/client easily obtains required
  services in the most appropriate setting

• Availability Services and resources are
  available to meet the needs of populations

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PI Average Number of Days to Complete PSR
Assessments (FPSC)
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PHSA Accountability Requirements

• Availability and Access
• Access Patient/client easily obtains required
  services in the most appropriate setting

• Availability Services and resources are
  available to meet the needs of populations

• Diversion out of Province Number of patients
  sent out of province for services normally
  available in BC

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PI Number of Patients Admitted vs. Diverted (RVH)
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PHSA Accountability Requirements

• Service Quality and Appropriateness
• Effectiveness Services, interventions or
  actions achieve optimal results
• Safety/Harm Potential risks and or unintended
  results are avoided or minimized
• Utilization Resources are brought together to
  achieve optimal results with minimal waste,
  re-work or effort

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PI Utilization as of Available Beds (RVH)
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PHSA Accountability Requirements

• Service Quality and Appropriateness
• Effectiveness Services, interventions or actions
  achieve optimal results
• Safety/Harm Potential risks and or unintended
  results are avoided or minimized
• Utilization Resources are brought together to
  achieve optimal results with minimal waste,
  re-work or effort

• Critical Incidents
• Clinical Audits, Departmental or Program Reviews
• Complaints Received
• Legitimacy Services conform to ethical
  principles, values, conventions, laws and
  regulations

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PHSA Accountability Requirements

• Resources
• Providers, Equipment, Space Planning
• Satisfaction
• Patient, Providers, Community
• Value
• Services Cost per case
• Innovation
• Not Defined

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QI/Accountability Framework

• Other Common Accountability Areas
• Partnerships with key stakeholders
• Legislative/regulatory compliance/professional
  standards
• Evidence-based practices policy development
• Prudent fiscal management (budgets resources)
• Research capability (academic program/policy)
• Thorough evaluation of organizational initiatives
• Periodic external reviews QI recommendations

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Some Challenges...

• Different approaches to QI/accountability
• Differing organizational mandates/circumstances
• Building working relationships
• Quality accountability continues to evolve at
  PHSA
• Statistical reporting requirements

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Lessons Learned

• Clearly articulated vision strategic priorities
  are key
• Demonstrated commitment by senior management is
  essential
• Adequate data collection/information management
  systems are required for effective decision
  making
• Education and training on quality management
  principles provide staff with tools of the trade

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A Look To The Future...

• Continued efforts to merge Riverview/FPSC
• CCHSA Accreditation survey recommendations
• Continuing to review/improve/streamline processes
• Development of common leadership philosophy
• Integration development of common policies
• Ongoing integration of Riverview/FPSC within PHSA
• Integration with 6 other diverse health care
  agencies
• Use of Riverview/FPSC experience to inform
  corporate integration, accountability and quality
  improvement efforts

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Towards Quality and Accountability in the BC
Mental Health System Presented by June 3,
2003
Lynda Bond Manager Policy Research FPSC Port
Coquitlam, BC
Paul Anderson Director Education
Services RVH Port Coquitlam, BC
Derek Wilson Consultant Policy
Research FPSC Port Coquitlam, BC
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Questions ?