Towards Quality and Accountability in the BC Mental Health System Presented by: June 3, 2003

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

2. 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

3. 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.

4. Our Vision Transforming Mental Illness Into Mental Wellness

5. Profile: Riverview Hospital • BC’s 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

6. 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 ???

7. 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

8. 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.

9. HR Team Balanced Scorecard

10. 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

11. 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.

12. 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

13. 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

14. 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

15. FPSC - The Environment • Dramatic shift in the environment at FPSC – in terms of the organization’s 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.

16. FPSC - The Environment • External Forces • Accreditation • Change in Governing Body • Fiscal Constraints • Internal Forces • New Leadership • Infrastructure Development

17. Committee Structure

18. 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

19. Joint Efforts in QI/Accountability • Health System Restructuring • Accreditation • PHSA Reporting Requirements • Challenges & Lessons Learned • A Look to the Future

20. 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

21. 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

22. QI/Accountability Framework RIVERVIEW ACCREDITATION FPSC PHSA TQM QI

23. 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)

24. 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

25. PHSA Accountability Requirements Availability and Access: • Access: Patient/client easily obtains required services in the most appropriate setting

26. PI: Average Number of Days on FPH Waitlist

27. PI: Average Wait Times by Program (RVH)

28. 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

29. PI: Average Number of Days to Complete PSR Assessments (FPSC)

30. 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

31. PI: Number of Patients Admitted vs. Diverted (RVH)

32. 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

33. PI: Utilization as % of Available Beds (RVH)

34. 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

35. PHSA Accountability Requirements Resources: • Providers, Equipment, Space Planning Satisfaction: • Patient, Providers, Community Value: • Services: Cost per case Innovation: • Not Defined

36. 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

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

38. 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”

39. 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

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

41. Questions ?