In this section :
EXTRA™ Cohort 18 (2023): Fellowship Teams
Alberta Health Services (AHS)
Fellowship team
- Doran Walker, Patient Care Manager, Specialized Rehabilitation Older Adults, The Glenrose Rehabilitation Hospital
- Lynette Lutes, Senior Operating Officer, Alberta Health Services
With COVID-19 now endemic, the pre-existing faults in our healthcare system have been exacerbated, including staff burnout, psychological safety and staff wellness, which have been stretched to unhealthy levels¹.
Through a pulse survey, AHS found that staff engagement dropped significantly pre- to post-COVID. Specifically, issues of being short staffed, psychological safety, patient safety and feeling a lack of community. Survey results at the Glenrose Rehabilitation Hospital, part of AHS, showed low patient experience with only 68 percent of patients being always satisfied with their care. Patients felt a lack of being listened to and being involved in decision-making related to their care.
These results show that the pandemic, healthcare system stresses and societal pressures have created a disconnect between patients, staff and employers. This has led to an increasingly uncollaborative, psychologically and physically unsafe healthcare system for both patients and staff. Essentially, an unhealthy workforce.
To resolve these issues, AHS will use the Institute for Healthcare Improvement’s Framework for Improving Joy in Work to rebuild connection, purpose and community in the workforce. AHS will work with the EXTRA program to learn from best-in-class engagement tools and models to improve engagement on pilot units. Learnings will then be scaled-up to apply a hybrid project management model for the Glenrose Rehabilitation Hospital, AHS and beyond.
Nova Scotia Health - Central (NSH Central) and Emergency Medical Care Inc. (EMCI)
Fellowship team
- Lorianne MacLean, Manager, Integrated Access and Flow Clinical Service Network
- Melissa Buckler, Manager, Planning, Development and System Performance, Integrated Acute and Episodic Care Network
- Kate Melvin, Director, Integrated Acute and Episodic Care Network
- Paige Moorhouse, MD, Senior Medical Director, Integrated Acute and Episodic Care Network
- Derek LeBlanc, Senior Manager - Provincial Programs, Operations
NSH Central is implementing the SAFER Patient Flow Medicine Bundle (SAFER)² within acute medicine and surgical units across the province. SAFER has demonstrated reduced length of stay (LOS) by 0.4 days and improved discharge rates through daily consultant rounds (+29 percent), discharges before noon (+20 percent) and documented early discharge plans (+29 percent).
Generally, patients experience unnecessarily longer LOS due, in part, to delays in access to community supports. NSH Central, in partnership with EMCI, are planning to integrate two evidence-informed interventions to enable sustainability of SAFER principles. Implementation will initially occur on an inpatient unit with the goal to reduce LOS, using two programs.
- Bridge to Home: An evidence-based framework to improve care transitions from hospital to community using patient-oriented discharge summaries.
- EHS Integrated Health program: Patient support for interventions or diagnostic tests carried out from a patient’s home, to support admission avoidance or supportive early discharge. A telecare registered nurse conducts an initial virtual visit and/or a community paramedic visits the patient at home within the first 12 to 72 hours of discharge.
This improvement project aims to enhance the patients’ ability to return home safely, receive care outside of the hospital and self-manage at home. Anticipated outcomes include reduced LOS in hospital, reduced readmission rates and improved patient and provider satisfaction.
Nova Scotia Health - Eastern (NSH Eastern)
Fellowship team
- Andrew Heighton, Director, Integrated Rural Health
- Sarah O'Brien, Eastern Zone Director, Primary Health Care
- Michelle DePodesta, Executive Director, Acute Health Services – Eastern Zone
- Rhea MacDonald, MD, Physician
NSH Eastern's strategic priority is to transform a rural model of care by enhancing timely and appropriate access to care. This improvement project will foster a responsive and resilient system in rural Cape Breton, while enhancing a culture of collaboration among physicians, nurse practitioners, nurses and staff to cultivate excellence within team-based care.
NSH Eastern seeks to develop and implement an operational framework that will create formal pathways from the emergency department (ED) to the primary healthcare collaborative team. This partnership would be the foundation of a sustainable rural health model of care.
The project will occur in a phased approach.
- Phase one: A focused approach on evolving the health home in the primary care setting. A health home is a sustainable hub that provides access to timely, coordinated and comprehensive health services based on the needs of the practice population. The evolution of the health home will include practice support implementation enhancing scope of practice, EMR utilization, and operational review to enhance capacity for same day/next day access.
- Phase two: Develop and implement an operational framework that discharges lower acuity patients to the collaborative care team within primary care.
The framework aims to promote timely access to care, and a person and family-centred approach to optimize care in a rural setting. It will be cost-effective, collaborative, adaptable and enhance continuity and coordination of care - allowing rural hospitals to meet the specific services their populations require, and further improve or implement tailored ED services (i.e. emergency care, telemedicine, access to tertiary care through transfer). In parallel, the rural hospital can support primary care services of preventive medicine, chronic disease management and have the potential to expand social services such as home healthcare, visiting nursing care, behaviour health and assessment of social needs.
Anticipated outcomes are timely access to appropriate care, more capacity in primary care, optimize existing resources, role clarity and improvement of the patient and family experience. Ultimately, this work will lead to an effective primary healthcare model and alleviate pressures and strains on the ED.
Government of Yukon
Fellowship team
- Sheila Thompson, Director, Community Nursing Branch, Health and Social Services
- Todd Pryor, Manager, Community Mental Wellness and Substance Use Services, Health & Social Services
- Cathy McNeil, Director, Care & Community, Health & Social Services
- Cheryl Kates, Manager – Projects/Health
This project aims to improve the coordination of care for clients within a broad range of health and social services in the Yukon territory. An integrated, needs-based, holistic and culturally safe inter-professional model of care will be created at a pilot site in a rural Yukon community. This project will then spread throughout the Yukon health and social system.
The team, in partnership with the local community, will develop a scalable model of care and implementation toolkit for integrated wellness centres within the territory. The model will be rooted in research, cultural competency, patient and client stakeholder engagement and ethical decision-making. The team will trial and implement the model of care at their pilot site.
To help the Government of Yukon reorientate the health and social services system to focus on integrated person-centred care, this model will support the creation of wellness centres that provide a holistic, person-centred and culturally safe level of care to all Yukoners.
CHU de Québec – Université Laval
Fellowship team
- Marie-Frédérique Fournier, Director, Surgical and Perioperative Clientele
- Julie Maranda, Assistant to the Director, Surgical and Perioperative Clientele - Care Trajectory
- Pascal St-Germain, Surgeon - General Surgery Department
- Philippe Lachapelle, Director, Clinical and Organizational Performance
- Danielle Goulet, Deputy President and CEO
The clinical deterioration of a patient awaiting surgery remains a major concern for the care teams, but especially for the patient and their family. While this was already problematic before COVID-19, it was only made worse by the pandemic, leading to much longer waiting lists, especially for non-oncological diseases. In turn, this has led to considerably longer wait times.
The CHU de Québec – Université Laval hospital is currently working on a number of initiatives, many successful, to expand surgical services. However, capacity is limited by the ongoing labour shortage.
Not only is there an imbalance between the services offered and what patients need, but there are issues with the current system of prioritizing patients on the surgical waiting list. Patients are prioritized for surgery based on a single, static, clinical assessment done by their surgeon during their initial visit. There is no effective way to monitor or influence the patient’s condition during the wait time, which can last several months and sometimes more than a year.
The fellowship team is proposing setting up a dynamic process for managing patients on the surgical wait list. This process will directly involve the patient, who will be able to report any changes in their physical or mental health. Additionally, it will allow for better communication between the patient and the care team. It could also lead to changes to the way patients are prioritized for surgery, resulting in an approach that’s better tailored to the real needs of our clientele.
CIUSSS Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ)
Fellowship team
- Catherine Neault, Assistant to the Director, DQEPE
- Vincent Robichaud, Assistant Director, Quality and Contractual Relations
- Mylène Raymond, Department Head, Development of Professional Practices, DSM
- Corinne Brosseau, Manager, Nursing and Care Assistance Professional Practices, DSI
- Nathalie Thiffault, Executive Nursing Consultant - Critical Care, Cardiology and Neurology - North Shore
The CIUSSS MCQ fellowship team's improvement project aims to enhance the quality of care and services offered in accordance with the institution’s LEADS model, in support of the performance model.
To do this, the fellowship team would like to produce an organizational framework document that both defines the concept of quality, and explains how to put it into practice. The challenge will be to make sure that all CIUSSS MCQ professionals—employees, physicians and managers—are equipped to improve the quality of the care and services they provide to patients or partners.
A limited trial in a specific sector will allow the fellowship team to bridge the gap between strategic orientations and operations. This project will determine the winning conditions for implementation at the institutional level.
CISSS Montérégie-Est (CISSS ME)
Fellowship team
- Mélanie Malenfant, Direction de l’accès et la coordination des partenariats avec la première ligne (Access to and Coordination of Frontline Partnerships)
- Caroline Loranger, Director, Multidisciplinary Services
- Émilie Boisvert, Assistant Director, Professional Services, Frontline Partnerships
- Éric Tremblay, Director, Critical Care and Coordination of Hospital Activities
The CISSS de la Montérégie-Est recently created the Direction de l’accès et la coordination des partenariats avec la première ligne. The mission of this department is to improve access to quality care and services for the population.
This new department was created in the wake of data that indicate difficulties in accessing frontline services. For example, in Richelieu-Yamaska, 45 percent of patients triaged as level 4 or 5 periodically visit the emergency department. Yet 76 percent of the population on the same territory has a family physician.
The fellowship team’s proposed improvement plan involves identifying and analyzing the bottlenecks or the root causes of problematic access to care and services. The objective is to ensure timely access for patients registered with an FMG, which would avoid needless visits to the emergency department.
More specifically, the fellowship team’s project will allow us to work with patients and our FMG partners to co-design effective solutions that reflect their respective realities. The innovative measures put in place must meet the patients’ needs and align with their experiences, knowledge and involvement throughout their care trajectory.
CISSS de Chaudière-Appalaches (CISSS CA)
Fellowship team
- Julie Emond, Assistant Director, Direction du continuum soutien à domicile et partenariat communautaire-SAPA (Home Care and Community Partnerships Continuum)
- Paméla Laforest, Logistics Coordinator, Production and Distribution, Direction de la logistique (Logistics Department)
- Renée Berger, Assistant Executive Director, Performance, Support and Administration (DGPSA)
- Anne-Marie Goulet, Clinical-Administrative Coordinator, Direction des soins infirmiers - volet pratiques professionnelles et développement clinique (Nursing - Professional Practices and Clinical Development)
In the Chaudière-Appalaches region, and specifically in the Bellechasse sector, there is an increase in the proportion of the population aged 70 and over. And in nearly half the communities in this sector, the proportion of the population aged 70 and over is higher than the Québec average.
Given the aging population and the growing number of interventions with patients with physical health problems, the fellowship team has identified a problem with access to home care and support services for people aged 70 and over experiencing a loss of autonomy.
Several studies show that service users stay healthier when they are allowed to live at home. With the Plan santé du Québec laying the groundwork for a massive shift toward home care and support services, the fellowship team feelsit is essential to meet the growing health needs of the population, especially seniors and their loved ones.
The fellowship team’s project aims to offer home care services adapted to people in the Bellechasse sector aged 70 and over experiencing a loss of autonomy—at the right time, by the right person, using the right tools, thereby providing better access to services.The goal is a 10 percent increase in the number of service users seen by the home support team.
Through this improvement project, the fellowship team hopes to redefine a model of care that integrates, for example, activity planning based on the needs of service users, a sharing of responsibilities that draws on the expertise of each professional on the home support team, a reduction in non-clinical activities, and the use of technology.
CISSS de la Montérégie-Centre (CISSS MC)
Fellowship team
- Vincent Desjardins, Director, Financial Resources
- Nancy Beaulieu, Director, Home Support Services
- Sonia Joannette, Senior Advisor, Nursing
- Xavier Tanguay-Rioux, M.D., MHSc, FRCP, Emergency Medicine Specialist
Cancer patients must contend with symptoms related to the disease and their treatments. The CISSS MC offers a 24/7 telephone nursing service to help people manage their symptoms at home. More than 28,500 calls are received annually. The goals of this service are early intervention, better referrals, fewer visits to Emergency departments or clinics, and a lower risk of hospitalization.
Some telephone assessments may require in-person follow-up by the nurse, for example, to take vital signs and neurological signs or perform a visual exam. Outside of business hours, the caller may need to be referred to a clinic or an emergency department. The fellowship team’s improvement project aims to reduce the number of calls that require a trip to the Emergency department by 50 percent. Frontline teams could play a bigger role to make sure the person is able to stay at home safely.
As a pillar of a positive health experience, several studies have cited the importance of access to timely support services for patients and their loved ones. Home support paramedicine is currently being developed in Québec and more specifically at the CISSS MC. The involvement of paramedics, with their diverse scope of practice, would be one way to round out the current offer of oncology care and services.
¹Grimes K, Matlow A, Tholl B, Dickson G, Taylor D, Chan MK. Leaders supporting leaders: Leaders' role in building resilience and psychologically healthy workplaces during the pandemic and beyond. Healthc Manage Forum. 2022 Jul;35(4):213-217. doi: 10.1177/08404704221090126. Epub 2022 May 21. PMID: 35603437; PMCID: PMC9127620.
²Nova Scotia Health. SAFER Patent Flow Medicine Bundle. Retrieved from: https://library.nshealth.ca/SAFERf/Bundle
