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Réal Cloutier, President and CEO
Jan/Feb 2019

The women and men of the Winnipeg Regional Health Authority come to work each day determined to provide their clients and patients with the best and safest care possible.

And, they do a pretty darn good job of that.

But does that mean that the care we provide as a health region is always perfect?

The answer to that question is, of course, no.

As with anything else in life, the delivery of health care, whether it is here in Winnipeg or anywhere else in world, for that matter, can always be better, and it can always be improved.

Which bring us to the Region's 2019/20 Quality & Safety Plan.

As the name suggests, this document, recently approved by our Board of Directors, was designed to build on our ongoing efforts to provide quality care to our patients and clients. Overall governance leadership from the Board came from the Quality and Patient Safety Committee of the Board of Directors.

In order to do this, our quality and safety team, led by Dr. Bruce Roe, Vice President and Chief Medical Officer, and Kerstin Jordan, Regional Director of Quality Improvement and Patient Safety, launched a review of our performance in several key areas. The team analyzed various sources of data, including patient feedback, internal monitoring and evaluation, and benchmarking reports published by the Canadian Institute for Health Information (CIHI). As a result, the team was able to identify several key areas of focus where we can improve the way we deliver care. These areas of focus include:

Reducing health-care acquired infections. As Health Canada notes on its website, hospitals are supposed to be places where people get well, not where they acquire an infection. Yet, a 2013 report on the website says that as many as 200,000 Canadians acquire a health-care associated infection (HAI) every year, and as many as 8,000 die. Our hospitals and other health-care facilities are not immune from this problem. While much has been done to address this problem in recent years, we are planning to do even more this year to make our health-care facilities safer for patients. It is also one of the reasons why we continue to innovate to reduce unnecessary hospital stays so that we can reduce the risk of infection.

Recognizing and responding to patients with deteriorating conditions. Subtle, yet important, changes in a patient's condition may be missed. This is a problem because even a slight change in a patient's condition could be important and may require immediate attention. We believe we can do more in this area to ensure that we detect important changes and respond in a timely manner.

Closing gaps that occur when patients transition through the health-care system. As a patient moves through the health-care system, points of transition carry greatest risk it is possible for gaps in care to occur. Particularly true for older patients or those with complex health needs Our analysis shows that there is an opportunity to close these gaps and enhance the delivery of care.

Ensuring patient feedback is received and understood. Any health organization that prides itself on providing patient-centred care must have mechanisms in place to gather and implement patient feedback. The Region has made a good start in this regard. For example, it has in place patient advisory councils in a number of areas, including mental health, home care, long-term care, ethics, and emergency services. As I have noted in this space before, research shows that patients and family members can make a significant contribution to improving the delivery of care. But we can do more to ensure we are maximizing efforts to gather and implement patient feedback. For example, as a story in this issue of Wave points out, we have recently invited patients to participate on our collaborative care teams. These teams are made up of health professionals who come together to solve particular problems and improve the delivery of care. It is imperative that we continue to incorporate feedback from patients and their family members as we work to provide better care.

In each of these areas, Region staff members are working to set goals, design improvement activities, and develop processes for monitoring our efforts to enhance care as we move forward. These improvement indicators will complement existing measurements for patient flow and financial sustainability - all of which will be used to chart our progress in the weeks and months ahead.

But the Quality & Safety Plan does not end there.

In addition to looking for ways to improve care, our quality and safety team has also looked for ways to make our hospitals, clinics and other health-care facilities better places to work. Workplace safety is an important issue for health-care providers, one that is directly connected to patient safety. A safe workplace ensures that staff are able to focus on making sure they are delivering the best care possible.

Of course, achieving significant improvement in these areas will not happen by accident, especially in an organization that includes more than 24,000 health-care providers working at dozens of hospitals, clinics, long-term care facilities and programs across the Region. Indeed, the only way progress can be made is by building an organizational culture that emphasizes the importance of sustained improvement and ensures that everyone is on the same page. It also requires a culture where staff and physicians feel safe speaking up about quality and safety concerns they have.

Here again the Quality & Safety Plan offers a way forward.

As the document notes, the Region's success will depend on its ability to adopt a number of "foundational activities" over time. Specifically, the plan urges the Region to:

• Build a culture of continuous improvement throughout the whole organization, from the Board to the first-line staff.
• Build and support capacity for quality improvement across the whole health-care system.
• Engage health-care system leaders and partners, staff and physicians, patients and public.
• Celebrate and profile improvement activities.
• Establish a quality and safety measurement framework.

In addition to these suggestions, we are also planning to deploy a new daily management system, which will ensure that all important activities or issues taking place in the Region are reported to leadership in a timely fashion. This will allow for quicker decisions to alleviate potential problems in delivering care.

It is worth noting that these changes are not taking place in a vacuum. They are part of a much larger transformation of the health-care system that is now underway. That transformation started with the launch of the Healing Our Health System plan in April 2017, and continues this year with phase two, which involves plans to consolidate emergency services at three hospitals - St. Boniface, Grace and Health Sciences Centre Winnipeg - while converting the emergency departments at Seven Oaks and Concordia hospitals into an urgent-care centre and a walk-in connected care clinic. Concordia and Seven Oaks Hospital will also convert to take on their new role in the health-care system supporting a variety of in-patient and out-patient services.

The Region's mandate is also changing. As the newly created Shared Health assumes more responsibility for the planning of clinical and preventive services across the province, the Region will evolve into a Service Delivery Organization (SDO). That means we will be able to pour all our resources and efforts into identifying ways to improve service delivery, and achieving better outcomes for our clients and patients.

Clearly, 2019 is shaping up to be a continued year of change. By this time next year, we will have completed the realignment of services outlined in the Healing Our Health System plan. And we will also have succeeded in making quality and safety a key priority for the Region as we transition to a service delivery organization. In doing so, we will have taken two major steps towards creating a health-care system that is capable of providing our clients and patients with the very best and safest care possible.