The Board of Directors initiated dialogue with 4 other hospitals within our region to explore opportunities for collaborative governance. Collaborative governance is an emerging model and set of practices that Boards are deploying to accelerate change in an increasingly complex health services environment – it asks that we recognize that many of the challenges faced by health service providers cannot be solved independently.
The first step was to conduct a joint environmental scan which was completed in December 2016. The scan identified potential opportunities for collaboration. At our Board Retreat last week Board Chairs and CEOs from each hospital attended the retreat and agreed on the following partnership guidelines:
Collaborative Governance – Shared accountability and service delivery where it makes sense
Open Dialogue – A true partnership develops slowly and shall be nurtured, without fettering the organizations. All efforts will be made to continue ongoing dialogue between parties
Proactive Engagement -The Board and Senior Management a proactive role in engaging potential partners in discussion of partnership opportunities
Alignment -The Board and Senior Management will be kept current with all communications and direction from the LHIN and MOHLTC.
Focus on Quality -Integration and partnership opportunities will endeavor to promote patient experience, quality of care and improved value to the system
We are still in the exploratory phase of the initiative and another facilitated meeting will be scheduled in the near future.
We have approximately 89 admitted patients designated as alternative level of care and of those 58 are awaiting for LTCH placement. We have a shortage of nursing home beds in our community. We partnered with Community Housing to develop an 80 unit seniors supportive housing complex that will provide 24/7 Personal Support Worker care for 50 of the residents. 20 of the units will be designated for discharge planning. The goal of this initiative is to build capacity in the system and to support the frail elderly to remain in the community. Clustered care is an alternative to traditional care for patients requiring assistance with activities of daily living. Community Housing is funding the capital for the building and the Local Health Integrated Network is funding the on-going operating funds for the care services. The complex will serve as a hub for other healthcare services. The residents old age security will cover the monthly charge.
The local health integrated network has developed a system that supports palliative patients to die at home by choice and spend 15,000 fewer days in hospital by increasing the number of patients discharged home with support by 17% by 2019. We recently signed a MOU with 5 other health care agencies to support care in the community. The hospital usually has a shortage of palliative care beds as the demand is greater than our capacity. The Hospital Palliative Care Coordinator visits patients in their homes to assess their need for admission to hospital. The Palliative Care Physicians also support the community on-call roster.
Have you considered partnering with a Family Practice Residency Program – the residents could complete a rotation at the rural hospital sites and support the Nurse Practitioners. Patients from the rural sites could be repatriated back once their acute phase of their hospitalization is completed. Perhaps the smaller hospitals sites market share should be targeted at patients requiring sub-acute, rehabilitation and convalescence care.
We have implemented a high risk for discharge team, that includes a ALC Resource Nurse, Social Worker, Home Care Coordinator, and other care providers as required. The role of the team is to engage the patient and significant others in the discharge planning process. Due to the shortage of nursing home beds, we have partnered with Community Housing to establish a Seniors Supportive Housing Complex – 20 of the 80 units will be dedicated for discharge planning purposes. The cost per unit will be approximately $1200/month which will be covered by old age pension.
What is the new nurse-patient ratio for the night shift. How did you evaluate the effectiveness of this initiative?
These are amazing results. Did you trial alarming devices that sound when the patient exits their bed or chair?
How did you get the buyin from the nurses to sustain the purposeful rounding? Brenda