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ACCREDITATION CANADA ENVIRONMENTAL SCAN SUMMARY MAY-JULY 2008 RÉSUMÉ DE L'ANALYSE DU MILIEU DU AGRÉMENT CANADA MAI-JUILLET 2008 Category Accountability and Performance Issue AB Alberta has launched a searchable online database of 550 licensed supportive living facilities and seniors’ lodges in the province. People can review a facility’s license status, view inspection results, and find out about any complaints about accommodations. Information on supportive living facilities is available at www.seniors.gov.ab.ca/ContinuingCare, by clicking on the Supportive Living Public Reporting Information link. Health Edition 2008/07/18 Health Care Restructuring/ Systems Issues AB Alberta Health and Wellness Minister Ron Liepert released a progress report on items that were tagged as immediate initiatives or three-month action items. Most of the 27 items are still in progress, and some of the activities underway include development of an Alberta Patient Navigation System to create “the first-ever” approach to guiding patients through the entire health system. As of the end of June, more than 500 health providers were scheduled to have completed education sessions on this new approach put on by McMaster University. Teams have also been set up to monitor compliance with infection prevention and control standards, as well as continuing care service standards. A policy framework for primary health care is in development, and an implementation plan will be developed this September based on consultations with stakeholders. The timeline has been revised for setting up a virtual campus and rural mentoring program for Strategic Directions/ Implications Although we do not have specific standards for community living at this time, organizations providing such services could become accredited using the Home Care or Community Health Services standards. For information. . 2 medical students which would allow third-year students to complete eight-month rotations in rural areas. Health Career Centres are opening in Edmonton and Calgary to help young Albertans and internationally-educated health professionals choose a health care career in the province. The status report can be accessed at www.health.alberta.ca/key/health-action-plan-2008.html . The next report will be released by September 15. Health Edition 2008/07/11; Health Action Plan status report – Alberta Health and Wellness Health Policy Issues AB Some health organizations in Alberta are looking at LEAN principles. Follow this link for a description of LEAN from the perspective of Alberta Finance: http://www.albertacanada.com/productivity/lean/index.html Judith Dyck Health Care Restructuring/ Systems Issues AB Alberta is scrapping its nine regional health authorities and creating a new Alberta Health Services Board (AHSB) responsible for health service delivery for the entire province. Voluntary Community Health Councils will be appointed by the AHSB to provide input on local health issues. The AHSB will report directly to Minister of Health and Wellness Ron Liepert whose ministry will continue to be responsible for setting, monitoring and enforcing provincial health policy, standards and programs, as well as for managing health capital planning, procurement and outcome measures. “Moving to one provincial governance board will ensure a more streamlined system for patients and health professionals across the province,” Mr. Liepert said in a news release. The AHSB will also take over the functions of the Alberta Mental The principles of LEAN are aligned with the principles of quality improvement that are threaded throughout the Accreditation Canada’s standards. With the major restructuring in Alberta, it may be necessary to reshape how surveys are organized, scheduled, and conducted. Accreditation Canada will work collaboratively with the key Alberta stakeholders to identify solutions and next steps. 3 Patient Safety BC Health Board, Alberta Cancer Board and Alberta Alcohol and Drug Abuse Commission. Health Edition 2008/05/16 Twelve per cent of patients who rush to the emergency room at Vancouver General Hospital are there because of adverse effects from medications, according to study published in the Canadian Medical Association Journal. The 11 international authors of the study said patients with medication-related complaints are more likely to be admitted to hospital after they've been seen in the ER and occupy beds far longer than others, a result the authors described as "striking." The study estimates that 70 per cent of such visits are preventable through better prescribing, dispensing and monitoring of patients. "We've proven in this study that we've got a problem in the health care system with patients who experience bad effects from medications, and we have to figure out how to reduce those problems," said lead investigator Dr. Peter Zed, who was working at the hospital during the study but is now at the Queen Elizabeth Health Sciences Centre in Halifax. "The solutions will involve better communication among doctors, pharmacists and patients," Zed said in an interview. "Simply handing out a pamphlet at the pharmacy that lists all the potential side effects doesn't work. Patients don't read them or they don't understand the information." Problems stemmed from a variety of issues, including patients being prescribed the wrong drugs, given wrong dosages, allergic reactions, interactions between drugs and patients not following instructions for how or when to take their medications. The province plans to establish a patient safety and quality council The ROPs include the requirement for established processes for reporting adverse events. New Medication Management standards have been incorporated into Qmentum. 4 Health Policy Issues BC to reduce adverse events, promote transparency and identify best practices to improve patient care. Times Colonist (Victoria) 2008/06/03 Twelve pieces of health legislation passed during the spring session of British Columbia’s provincial legislature. This is significant not only in the number of bills passed but the underlining direction/focus of legislation as it pertains to changing how the existing system operates. Other provincial governments are likely to follow suit. Legislation covered cost recovery (re class action suites), MSC transparency, Medicare Protection Act, public health, Health Professions Act, e-Health, Bill 29, labour mobility (TILMA), patient care quality review boards, ambulance fees, MHA “not in my backyard,” and smoking. Much of the impetus behind the legislation is from the provincial consultation on the “Conversation on Health.” Issues being addressed include 1) transparency for the public (patient care quality review boards MSC transparency; 2) ability to overrule professional bodies, i.e the Colleges of Physicians and Surgeons, nursing, etc. (health professions act) 3) breaking down barriers to provide more flexibility in the system ( Bill 29, ability to outsource, Health Professions Act, Labour mobility TILMA, e-health and 4) sustainability, Medicare protection act). With the reshaping of how health services are provided in different provinces, it is important that Accreditation Canada continue to work with the provinces and their ministries to ensure the accreditation program remains relevant and responsive, respecting provincial/territorial differences yet ensuring the integrity of the program.. Murray Ramsden Health Trends CDA Health issues are a growing concern for employers, a survey by Mercer Human Resource Consulting and the Canadian Alliance on Mental Illness and Mental Health has found. Fully 80 per cent of 452 people interviewed, mostly human resource professionals, reported that mental health issues have increased in importance The accreditation program includes standards for mental health. The standards also emphasize quality of worklife, recognizing its relevance to 5 Accountability and Performance CDA compared to three to five years ago. However, only 13 per cent said senior executives in their companies have a strong awareness of the impact of mental health issues. It has been determined that mental illness is estimated to result in 35 million workdays lost every year in Canada. Health Edition 2008/07/18 According to Health Data 2008, an OECD report released in June: Canada is among eight countries that spent 10 per cent or more of GDP on health care in 2006. Canada has higher per capita expenditures for health care ($3,678 as measured on a U.S. dollar purchasing power parity basis) than the OECD average of $2,824. This was also a higher outlay than any other G7 country. Canada has fewer physicians per capita than in most other OECD countries. In 2006, Canada had 2.1 physicians per 1,000 population, well below the OCED average of 3.1. The supply of registered nurses was also lower (8.8 versus 9.7 per 1,000 population). The number of acute care hospital beds per 1,000 population in Canada was substantially lower than the OECD average – 2.8 versus 3.9 (as was the number of long-term care beds in 2005) and the supply of MRI machines and CT scanners in Canada was also below the international norm. The proportion of public health expenditures spent on home care (3.2 per cent) was about middle of the pack. Life expectancy in Canada is a year-and-a-half higher than the OECD average, but infant mortality is somewhat higher. Obesity rates are also higher than most other OECD countries. The $532 U.S. in Canadian household out-of-pocket health spending in 2006 was above the OECD average. Also, 67 per cent of the quality of health care. For information. 6 Canadian population was covered by some sort of private health insurance in that year – only France and the Netherlands had a higher proportion among countries where this information was collected. Even the proportion of Americans with private health insurance (65.2 per cent) was lower. The summary report can be found at: http://www.oecd.org/dataoecd/46/33/38979719.pdf. (Access to the database is available by subscription only.) Health Edition 2008/07/04 Accountability and Performance CDA Highlights from the Conference Board of Canada’s annual report card include: Increasing levels of mortality due to diabetes should be raising alarm bells, not only among Canadian policy makers but also among the public. Canada eclipses even the U.S. in deaths due to diabetes despite that country’s higher obesity rates. Mortality rates on a number of diseases have improved in Canada – as they have in other countries – but progress has not been made everywhere. Aside from diabetes, it said mortality rates from mental illness have steadily increased. Canada received a “B” in the health category, ranking ninth out of 16 countries. This has been the same grade the Board has awarded since the 1970s but it warns it might slip in future reports. Japan and Switzerland are “A” performers in health as far as the Conference Board is concerned, and it said Canada has a lot to learn from them. Most of top-performing countries have achieved better health outcomes through actions on the broader determinants of health such as environmental stewardship and health promotion programs focusing on changes in lifestyle, including smoking cessation, increased activity, healthier diets, and safer driving habits. Leading countries also focus on other determinants of health—such as For information. 7 education, early childhood development, income, and social status—to improve health outcomes. The Board is concerned that Canada is not ready for the growing burden of chronic disease. It encourages governments to adopt a new business model of health care that encompasses both preventing and managing chronic disease. Targets set by governments in the Public Health Agency of Canada’s Integrated Pan-Canadian Healthy Living Strategy are the building blocks of a prevention-oriented strategy. Developing a report card that assesses Canada’s progress on its health care goals would be another important step. The summary report on health, part of How Canada Performs: A Report Card on Canada, can be found at http://sso.conferenceboard.ca/HCP/overview/default.aspx. Health Edition 2008/07/04 The Toronto Star takes issue with the Conference Board’s approach to assessing Canada’s quality of life which the Star says puts an inordinate emphasis on innovation and productivity. This leaves other important things out of the equation, the Star says. “It is true, for example, that health care wait times are longer in Canada than in the U.S., where an MRI can be had on demand. Is the difference just a sign that the Americans are more innovative or technologically adept than we are, or is it a reflection of the fact that only those with the money or insurance can get an immediate MRI in the U.S.? If you could measure the value to society of universal health care, then the points we would get for our social innovation would offset to a degree the points we lose for having longer wait times.” Toronto Star 2008/07/02 Health Trends CDA There have been some encouraging developments to home care in The aging population will have 8 Accountability and Performance CDA the past several years, the Canadian Home Care Association says in an update of its 2003 report, Portraits of Home Care in Canada. Over the last decade, there has been an over 50 per cent increase in the number of people receiving home care. The report provides a detailed analysis of home care in each jurisdiction, but it notes that it is difficult to make comparisons between them “because of the absence of data definitions and the variation of data collection methods and reporting across Canada.” Still, it says governments are recognizing the importance of home care in service delivery. Initiatives taken include linkages with primary care, new approaches to chronic disease management, and offering new and enhanced programs for populations with specific care needs. There is also more use of information and medical technology for inhome care which the association says will have an impact on human resource requirements for the sector, training needs, as well as “the overall approach to the delivery of home care in the very near future.” The number one challenge for the sector is health human resources, and it says the sector will be “disproportionately impacted” by the requirements of an aging population. Details on how to obtain the report can be found at www.cdnhomecare.ca . Health Edition 2008/07/04 A report by the House of Commons Standing Committee on Health concluded Canadians deserve better accountability for how governments are spending the $41 billion invested in the 10-Year Plan to Strengthen Health Care, an accord reached by First Ministers at their health summit in September 2004. The Committee held four hearings and its report chronicles the significant implications for Canadian home care programs. Accreditation Canada currently has standards for home care that may be enhanced as the demand for home care increases. For information. 9 Health Trends CDA largely critical comments it received from various groups about what has been accomplished on the 10 components of the plan. Among other things, these groups said there has been uneven progress on the development of multidisciplinary primary care teams, there is no clear picture on the state of home care, and there has been a relative lack of progress on a pan-Canadian National Pharmaceuticals Strategy. Despite repeated warnings about a looming health human resource shortage of crisis proportions, the nationwide collaboration envisioned in the plan has not yet resulted in coordinated planning. Even on the wait-time focus of the plan, described by First Ministers as a national priority, efforts received a mixed grade. The failure of federal and provincial-territorial governments to come to terms on a set of comparable indicators to measure progress was a focus of the Committee’s report plus the fact that they have not lived up to their promise to be accountable. Both levels of government have failed to honour their commitment to report on progress being made. The report can be found at: http://cmte.parl.gc.ca/cmte/committeehome.aspx?selectedelementid =e1_&lang=e&parlsession=392. Health Edition 2008/07/20 Home care programs are not getting enough attention in provincial e-health initiatives, the Canadian Home Care Association says in a report sponsored by Canada Health Infoway. The report is based on cross-country consultations with hundreds of home care leaders. Their overriding message is that hospitals are on the receiving end of most of the e-health or Information Technology (IT) investment Accreditation Canada has developed supplementary criteria for telehealth. The supplementary criteria will be available in Qmentum in 2009. Accreditation Canada has 10 and this is going to have to change if governments are to make good on their efforts to shift the emphasis from acute to community-based care. “Most home care programs have not been given priority in provincial and/or regional IT plans, nor do they have dedicated budgets for technology,” the report says. As a result, they are left with fragmented approaches often done on a pilot project basis. Most governments have launched programs to promote “aging at home” to lessen seniors’ need for institutional care and even their reliance on hospital ERs. This could be substantially aided by information and communications technology for such things as remote monitoring of their conditions, the report says. This technology also has the potential to improve access to care for the almost one-in-four Canadians who live in rural, remote and northern communities, it claims. The report, containing nine recommendations for further activity and investment in this area, is available at www.cdnhomecare.ca. positive relationships with both the Canadian Home Care Association and Canada Health Infoway. Health Edition 2008/07/13. Accountability and Performance CDA According a report from the Health Council of Canada, Canadian taxpayers have a right to expect better value and greater accountability from the health care system they pay for, and they clearly have not got full measure out of the $36 billion First Ministers invested in the 2003 health accord. At best, the Council says the glass is half full. While the report chronicles a number of achievements which have been made, its overall message is that the health reform agenda lacks cohesion, as does the common front First Ministers talked about to tackle the problems they share with their respective health systems. “To date, Canadian health care reform has largely created a For the third year in a row, the Health Council of Canada has said that “accreditation should be a mandatory condition of public funding and that institutions should make their accreditation reports public. This important measure would help health care institutions become more accountable to the public they serve.” 11 patchwork of pilot projects, not system-wide change,” the Council says. The $800 million federal Primary Health Care Transition Fund, set up in 2000, has been mostly used to implement “small initiatives rather than invest in long-term, sustainable change,” the report comments. With home care, governments have provided two weeks of postacute care, as they said they would, but “progress in ensuring access to broad, equitable home care services has been slow and piecemeal.” As a result, a number of Canadians must pay out of pocket for the services they need. Despite imminent shortages with an aging workforce, “the nationwide collaboration envisioned in the 2003 accord has not yet resulted in coordinated planning.” Provinces are doing their own thing and outbidding each other for the health professionals they need. Governments have fallen short on their promises to be accountable for the vast amounts of taxpayers’ money they are spending on health reforms. “Too much of current reporting takes place in isolation, and most governments do not use or report the standardized data to which they committed,” the report says. In all, the Council found deficiencies in nine areas “where action has been slower, less comprehensive, and less collaborative than First Ministers originally envisioned in their 2003 accord.” Health Edition 2008/06/06 Patient Safety CDA According to a study published in the May issue of the journal Infection Control and Hospital Epidemiology, the re-use of single-use medical devices is still common in Canada. The study found 28 per cent of 398 hospitals are following this practice. This is down only The accreditation program includes standards for the Reprocessing and Sterilization of Reusable Medical Devices. 12 Accreditation Canada CDA slightly from 31 per cent in 1986. Furthermore, 85 of hospitals who re-use these devices reprocess them in-house. Only 15 per cent send them to regulated U.S. companies for reprocessing under the watchful eye of the FDA. Health Canada does not regulate reprocessing. Canadian Press 2008/05/25 Canadian hospitals will have to audit hand-hygiene if they want to receive accreditation. New rules from Accreditation Canada will come into effect next January. Hospitals will also need to have a plan to maintain or improve hand-washing compliance. Globe and Mail The standards make specific reference to the issue of reusing single-use medical devices. The new ROP on auditing hand hygiene will be applied to accreditation surveys beginning in 2009. 2008/05/23 Patient Safety CDA Almost one-in-five hospital nurses admit making medication errors occasionally or frequently, Statistics Canada said in a report based on the 2005 National Survey of the Work and Health of Nurses. Factors related to medication error included regularly working overtime, role overload, perceived staffing shortages or inadequate resources, poor working relations with physicians, lack of support from co-workers, and low job security. Medication error was significantly related to overtime. Of those nurses who worked overtime, 22 per cent reported medication errors versus 14 per of those who did not work overtime. Health Edition 2008/05/16 Accountability and Performance CDA The Public Health Agency of Canada has been found to come up short in being able to protect Canadians from the threat of infectious disease. In her annual report, Auditor General Sheila Fraser devoted an entire chapter to surveillance of infectious diseases and whether the government had addressed serious concerns raised in past Five ROPs address medication use. Two new ROPs that will apply to surveys starting in 2009 are on heparin safety and narcotic safety. There are two ROPs on adverse events, sentinel events, and near misses—establishing a reporting system and implementing policies and procedures. Many of the contributing factors cited in this report are identified within our existing standards. Accreditation Canada plays a key role in fostering quality improvement. Through our Patient Safety Performance Measures that are integrated 13 reports. While PHAC has laid the groundwork for the sharing of essential information in the event of a public health emergency, Ms. Fraser said procedures for “notifying other parties, and protocols affecting the collection, use, and disclosure of personal information” still have to be sorted out. “Consequently, faced with a public health threat that could affect other countries, the Agency may be unable to notify the World Health Organization within the times specified in the revised International Health Regulations and to keep it informed of subsequent events,” she said. The situation is worse for routine surveillance information. PHAC has only just signed a data-sharing agreement with Ontario, but not with any of the other provinces and territories. “This limits its ability to provide Canadians with a complete and consistent national picture of infectious diseases as a basis for public health actions,” Ms. Fraser said, although she acknowledged the fact that PHAC depends on the goodwill of its provincial-territorial partners to collect the information it needs. Health Minister Tony Clement said he will use the Auditor General’s report as a “springboard” for getting the different jurisdictions to sign the data-sharing agreements he has been after them to do for the past two years. PHAC itself said it has been working on the issue for three years, and has participated in a number of forums to address issues of surveillance information. It also said it is in the process of developing a framework for the management of privacy issues which it expects to complete in March 2009. In a five-year action plan responding to Ms. Fraser’s audit, the agency said it will deal with all her principal points by the end of next year. into Qmentum, we are exploring the most practical, effective approach for organizations to collect and share information on measuring and preventing infection. 14 She also noted that PHAC and the Canadian Food Inspection Agency have not come up with a list of the highest priority animal diseases which could affect Canadians. As she pointed out, this is important given that 65 to 80 per cent of new human diseases come from animals. The Auditor General’s report can be found at www.oag-bvg.gc.ca. Health Edition 2008/05/09 Federal Health Minister Tony Clement says he will use this week's Health Trends CDA Auditor General's Report "as a springboard" to urge provinces to share more health-related information to make sure Canada is ready for the next pandemic. The Leader-Post (Regina) 2008/05/08 The federal government should set up a national system of standards for medical testing laboratories as a way to prevent errors that could lead to faulty diagnoses, the Canadian Association of Pathologists says. At its annual conference, the group unveiled a five-point action plan for "an appropriately resourced national system to promote excellence in the laboratory medicine in Canada." The call for new standards comes amid sharp public scrutiny over allegations of botched tests, inadequate professional controls and incompetence in several Canadian provinces. The organization is urging the "creation of a national body, separate from government, to accredit all medical laboratories in Canada and ensure they meet quality and critical mass standards." The proposal also urges mandatory certification for tests performed by medical labs and an external validation system, in which test results from one lab are verified by a separate and independent lab. "We are unique in that we lack a national quality-assurance program to link laboratories, provide support and administer national Our new lab standards are relevant to this issue. Accreditation Canada is ensuring that key stakeholders are aware of this component of our program, and their contribution to this area of concern. 15 Patient Safety CDA standards." The group also calls for the use of a national diagnostic checklist that would serve as a quality assurance system for labs. Antimicrobial wipes commonly used in hospitals to clean surfaces like bed railings may in fact spread bacteria, such as MRSA, if used incorrectly, according to a new study from researchers at Cardiff University in Wales. The study, found that many wipes clean but don't kill bacteria from surfaces, meaning that if the wipe is re-used, bacteria can be transferred from one surface to another. This could lead to the spread of bacteria such as antibiotic-resistant Staphylococcus aureus, or MRSA. This type of staph bacteria is spread via skin-to-skin contact or contact with a contaminated surface. MRSA can lead to life-threatening infections of the bloodstream, bones or lungs if left untreated. As a result of their findings, the researchers, led by microbiologist Dr. Jean-Yves Maillard, recommend a one wipe, one application per surface policy for cleaning surfaces in health-care facilities. "On the whole, wipes can be effective in removing, killing and preventing the transfer of pathogens such as MRSA but only if used in the right way," Dr. Gareth Williams, a microbiologist at Cardiff's Welsh School of Pharmacy and one of the study's authors, said in a statement. "We found that the most effective way to prevent the risk of MRSA spread in hospital wards is to ensure the wipe is used only once on one surface." The researchers observed hospital workers as they used wipes to disinfect surfaces that both workers and patients would come in contact with. They found that one wipe was being used on the same Infection Prevention and Control standards are part of Qmentum. 16 Health Policy Issues NB surface several times and then used on other surfaces before being thrown away. CTV.ca News 2008/06/03 New Brunswick has launched a task force to develop a new mental health strategy. It will start public consultations in the fall, and a mental health forum will be held in October. The final report of the task force is due next February. According to a provincial ranking, New Brunswick had the second-highest rate of spending on mental health among provinces in 2003-04 at six per cent. Health Edition 2008/05/23 Accountability and Performance ON Accountability and Performance ON Ontario’s ombudsman Andre Marin will conduct a full investigation of the province’s monitoring of long term care facilities, as well as its effectiveness in ensuring nursing homes meet government standards, although he does not have the authority to investigate nursing homes themselves. His office has been reviewing more than 100 complaints about long term care since early spring. This includes 50 complaints in the last couple of weeks following media reports that a large number of nursing homes are not meeting provincial standards. Mr. Marin says he will be taking a look at these 400-some standards and ascertain whether they are “piddly bureaucratic rules” that just take time away from patient care. The investigation is expected to take six months. Health Edition 2008/07/18 Over 60 per cent of Ontario’s long term care homes have been cited for violating provincial basic standards of care, Canadian Press reports. Results of inspection reports have been posted online and three-quarters of the 616 nursing homes in the province have been found to be not in compliance with at least some of the 400 standards. However, there are complaints that some of these things The accreditation program includes standards for mental health. A new ROP on assessing and monitoring clients for risk of suicide will apply to surveys starting in 2009. Accreditation Canada’s Ontario team maintains ongoing dialogue with the Ontario Ministry of Health and LongTerm Care regarding the accreditation of long term care facilities and the provincial compliance program. Meetings with Ministry staff will continue in the fall. The accreditation program includes standards for long term care yet only approximately 50 per cent of Ontario long term care facilities participate in our program. 17 are unrealistic and unrelated to quality of care. “When you are living in a quasi-police state, you’re just focusing on keeping your nose clean and documenting rather than doing what’s important,” Donna Rubin, CEO of the Ontario Association of Non-Profit Homes and Services for Seniors, told CP. Health Edition 2008/07/04 Accountability and Performance ON Better communication is needed in Ontario’s health system, a study by the Ontario Hospital Association’s Change Foundation has found. The organization drew from a number of sources for its study including 10 focus groups with patients and caregivers. Common problems identified were patients knowing who to call, what to ask, and how to move from provider to provider. “Many patients and caregivers expressed confusion and frustration, asking: ‘Who’s in charge? Is anybody listening? And, what are the next steps in my treatment or care?’” Change Foundation CEO Cathy Fooks said in a news release. “Too often, they found that health care providers weren’t communicating with each other – or with patients and their families. And they had trouble trying to coordinate the health services they need, especially when moving from hospital to the community.” She commented that even when care or coordination was excellent, it sometimes seemed to patients and caregivers that it was despite the system – not because of it. Accreditation Canada’s Ontario team maintains ongoing dialogue with the Ontario Ministry of Health and LongTerm Care regarding accreditation of long term care homes and the provincial compliance program. Meetings with Ministry staff will continue in the fall. Accreditation Canada recognizes the impact communication has on patient safety. There are five ROPs that address communication issues, one of which focuses on information transfer. Many other standards also focus on effective communication, both between the health care team and patient/client, as well as among the health care team members. 18 The report makes a number of recommendations including accelerating the implementation of electronic health records so providers can better coordinate patient information, and access to a professional “care coordinator” or system navigator responsible for coordinating care across settings and providers. The report is available at www.changefoundation.ca. Health Edition 2008/07/13 Information Management PE Health Policy Issues QC A new Clinical Information System is now in place at all hospitals in Prince Edward Island. I t is in operation at Registration, Lab and Pharmacy departments and is also being used by nursing staff to record patient vital signs. More features, including physician orders, nursing documentation, and functionality for Surgery and Emergency departments will be introduced later this year and early next year. Health Edition 2008/05/16 New Quebec Health Minister Yves Bolduc is anxious to put “lean” thinking to work for improving the quality and efficiency of health care in the province. The concept, already well entrenched in health care, is based on the Toyota Production System for building cars. What works for the assembly line also has value for the smooth flow of patients through the health system. It is based on the principle of improving work processes based on best evidence and employee input – a cycle of continuous quality improvement where, in the health care context, the “patient comes first.” Reduced waste and costs, and improved quality, are among the results obtained in some applications of lean management thinking at hospitals throughout the U.S. A number of health regions in Canada – particularly in Saskatchewan – have become adherents to this management approach. Information management standards are woven into Qmentum. The principles of LEAN are aligned with the principles of quality improvement that are threaded throughout the Accreditation Canada’s standards. Of interest, Dr. Bolduc is an Accreditation Canada surveyor (inactive due to his current role with the Quebec government). 19 Previously, Dr. Bolduc was in charge of health operations in the Questions relatives aux politiques en matière de santé publique QC Val-d’Or region in Quebec and was in the midst of a pilot project to use the lean management approach at the local hospital. Surgical volume had already been enhanced while costs had been cut 5 to 10 per cent. Patients’ wait time in hospital had also been substantially reduced by having them come one hour before their scheduled surgery instead of three. They also walked on their own to the operating room instead of being transported on a gurney – saving staff time. Health Edition 2008/07/11 Le nouveau ministre de la Santé du Québec, Yves Bolduc, est impatient de mettre en œuvre une philosophie de « l’allègement » dans le but d’améliorer la qualité et l’efficacité des soins de santé au sein de la province. Le concept d’allègement, déjà bien ancré dans les soins de santé, est axé sur le système de production de voitures chez Toyota. Les facteurs qui permettent notamment à la ligne d’assemblage de bien fonctionner favorisent également le bon cheminement des patients dans le système de santé. Le concept de l’allègement s’inspire donc du principe d’amélioration des processus de travail fondé sur les meilleures preuves actuelles et l’avis des employés; il devient, dans le milieu des soins de santé, un cycle d’amélioration continue de la qualité où « le patient occupe la première place ». La réduction du gaspillage et des coûts, ainsi que l’amélioration de la qualité, se trouvent parmi les résultats obtenus suite à certaines applications de la philosophie de l’allègement au sein d’hôpitaux américains. Un certain nombre d’organismes de santé régionaux au Canada, en particulier en Saskatchewan, ont adopté cette philosophie de gestion. Questions relatives aux politiques en matière de santé publique 20 Le Dr Bolduc était responsable auparavant des opérations en matière Patient Safety QC Sécurité des patients QC de santé dans la région de Val-d’Or au Québec. Il a mis à l’essai dans un hôpital local un projet axé sur la philosophie de l’allègement. Le volume de chirurgies a augmenté, tandis que les coûts étaient réduits de 5 à 10 pour cent. L’attente des patients en milieu hospitalier a été grandement réduite puisque ceux-ci se présentaient une heure, et non trois heures, avant la chirurgie planifiée. Les patients marchaient pour se rendre à la salle d’opération au lieu d’être transportés sur une civière, ce qui permettait aux employés d’économiser du temps. Health Edition 11/07/2008 Some Quebec hospitals are not fulfilling their legal responsibilities to track medical errors which were part of Bill 113 in 2002. The province’s 300 hospitals were supposed to set up boards to manage risks, and 240 have done so as of end of 2005. Furthermore, only 227 have a program for disclosing medical errors. The health ministry says there have been improvements in these rates since then, and this year there will be provincial reporting on the incidence of medical errors. Health Edition 2008/05/14 Certains hôpitaux du Québec n’assument pas leurs responsabilités légales en matière de signalement des erreurs médicales en vertu du projet de loi 113 adopté en 2002. Les 300 hôpitaux de la province devaient mettre sur pied des conseils en vue de gérer les risques; 240 d’entre eux répondaient à cette exigence à la fin de l’année 2005. De plus, seulement 227 hôpitaux sont munis d’un programme de signalement des erreurs médicales. Le ministère de la Santé confirme que ces chiffres ont connu une amélioration depuis 2005 et que cette année, on procédera à la déclaration provinciale de l’incidence des erreurs médicales. Health Edition 14/05/2008 There are two ROPs on adverse events, sentinel events, and near misses—establishing a reporting system and implementing policies and procedures. Il existe deux POR portant sur les événements indésirables, les événements sentinelles, de même que les incidents et accidents évités de justesse, qui établissent un système de déclaration et de mise en œuvre des politiques et procédures. 21 Health Care Restructuring/ Systems Issues SK Saskatchewan’s “patient-first review” of the health system could be underway next month. The Saskatchewan Party committed to this review in last November’s provincial election, and has long talked about the need to redirect health care dollars from bureaucracy, red tape, and unnecessary duplication to improving front-line care. The party, now in government, has made no secret of its dissatisfaction with the province’s regional health structure. NDP Health Critic Judy Junor suspects the government is going to travel down the same path as its Alberta neighbour and do away with regions altogether. While governance issues are not the point of the review, they could possibly be addressed. The review will look at how to improve access to systems, building capacity and new models of care, as well as to improve the workplace and make things more efficient. Health With the reshaping of how health services are provided in different provinces, it is important that Accreditation Canada continue to work with the provinces and their ministries to ensure the accreditation program remains relevant and responsive, respecting provincial/territorial differences yet ensuring the integrity of the program. Edition 2008/07/18 Items have been compiled from Canada’s Health Newsweekly Health Edition, Government of Alberta, CTV.ca News, Toronto Star, Times Colonist (Victoria), Leader-Post (Regina), Globe and Mail, and Canadian Press.