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From Strategy to Action - Our Focus on Access and Quality
Ken Hughes
Edmonton Chamber of Commerce
March 9, 2010
Since I became Chair of Alberta Health Services, everybody – believe me, everybody – is asking, “What are you people doing?”
Well, the answer is this: we are moving quickly from strategy to action – action on access and quality. Our goals are to reduce wait times, and to implement the innovations that are making our province a national leader in health and wellness.
I’m going to share with you some of our success stories. I do so because I’m proud of the people across our health system and all they have done to earn our thanks and support.
I’ll talk about where we have been and how we got here. Also about where we are going and what all of that means for our patients and for you, your families, your friends and your colleagues.
I’ll talk about a 5-Year Funding Plan that is the first of its kind in Canada. More importantly, what that means on the frontlines of health care which is where I want to begin today – with one of those innovative ideas to reduce wait times.}
Recently, we announced the opening of two new Medical Assessment Units in Alberta, one at the Rockyview General Hospital in Calgary and a second to open in May at the Royal Alexandra Hospital here in Edmonton.
The concept of these Medical Assessment Units (or MA UNITS’s) is straightforward: Instead of waiting in the Emergency department, patients who need admission to hospital will be transferred to MA UNITS after they have been assessed in Emergency. There they will be treated by physicians, not emergency physicians, but other physicians, to begin the patient’s ongoing care in the hospital.
Opening these new 12-to-16 bed MA UNITS units takes pressure off of Emergency Departments by freeing up Emergency beds, physicians and other care providers.
These are new beds, and we will hire additional staff to support them. They are a first in Alberta. By the time they are rolled out in hospitals across the province over the next year or so, Alberta will be a clear national leader in improving the way patients are assessed and treated in Emergency and admitted to hospital when they need further care.
It is a significant investment: - the annual operating cost for the Rockyview General and Royal Alexandra MA UNITSs will be about one and three quarter million dollars each.
But equally importantly, it is also a change in the way we provide health services, ensuring more people get the care they need more quickly. This is a concrete example of how we must not just do more, but do what we do “smarter” as well.
Another example: We recently announced an $8-million dollar push to add some 2,300 more surgeries across Alberta in six weeks alone, from mid-February to the end of this month, March. This is the first stage in a six-month blitz to bring surgical wait lists down. That work has already started.
Looking ahead, you should expect additional growth in the number of community beds, including long-term care beds for seniors, and improvements to primary care, so that every Albertan has timely access to a family doctor. Again, smarter, strategic investments.
All of this and more is possible because the Government of Alberta, and Premier Stelmach, personally agreed that we needed predictability. The provincial budget released last month provides Alberta Health Services with a new, stable, sustainable budget platform.
We now have a five-year funding envelope, and no deficit. That commitment is also unprecedented - certainly in Alberta and by most accounts a first in Canada.
Not only do we know our budget parameters BEFORE the start of the next fiscal year – which is just a few weeks from now - but we can plan for the following four years as well. The businesspeople in this audience, like me, will appreciate the many benefits of forward planning.
Now we can plan long term for programs and services more effectively. We also have a timeframe that allows for meaningful consultation on those plans with patients, families, healthcare professionals and other stakeholders.
With five-year funding, we can look at programs that might take two or three or five years to yield results. The old model of year-by-year funding made that incredibly difficult to achieve.
Stable funding also means we can target additional funding to areas where we know we must make a real difference in as short a time as possible.
As a result, you are seeing that transition from strategy to action.
As you know, Alberta Health Services, through a Board on which I serve as Chair, reports directly to the Minister of Health and Wellness.
We have the responsibility to deliver all health services to 3.5 million Albertans.
We are now the largest single healthcare provider in Canada and the largest employer in Alberta with 90,000 staff. We have an $11 billion dollar budget and $5 billion worth of capital projects “in flight.”
That scale – and the ability to drive the best ideas and innovations across the province – positions us to launch a series of initiatives to reduce waitlists and increase access.
The Alberta Health Services strategic plan has three key goals: access, quality and sustainability. I’ve talked about the first two – access and quality.
The third is equally important, and enables the first two goals.
Sustainability was imperative. We had to streamline back-shop processes, reduce unnecessary duplication and waste, and effectively leverage the buying power of a province-wide health system.
We did not shy away from that challenge. This year we budgeted savings of $420 million, and in fact when everything is included, we will have captured $700 million dollars annually in cost savings in non-clinical areas. Think of that as the back office.
And think about that number for a moment - $700 million dollars – or roughly what it costs to run a major urban hospital for an entire year. And all of this was captured without decreasing front-line services provided to Albertans.
It has been a challenge and I am grateful to every person on the AHS team who helped make it possible.
We made a commitment to be fiscally responsible, but not at the expense of quality and access. We reined in some expectations, challenged conventional thinking, began breaking down silos between parts of the province and within the health service, and emphasized a performance culture.
Improved efficiency in back-office, non-clinical areas will and must remain a priority. Historically, health spending has increased at a rate of 10 per cent a year.
Our five-year funding envelope does not allow for that level of expenditure growth. We are by no means in a position to relax our commitment to fiscal discipline.
Albertans expect that fiscal discipline. What’s most important, however, is what we do with those savings: how we put them to work on access and quality; how we use the opportunity of stable funding to sharpen our focus on patient care.
At the end of the day, what matters to Albertans is the result: Every program or service, in every setting, has to be about the patient.
It’s about a pregnant woman who needs good prenatal care.
It’s about an asthmatic child who needs consistent primary care, counseling and support.
It’s about your next-door neighbour, in Emergency with chest pain after shoveling the sidewalk.
And it’s about your aging parents, needing the supports that will enable them to stay healthy and safe in their own home for as long as possible.
There is no public service more personal than health care. Every one of us wants to know that it will be there for us, and for our loved ones, when we need it.
That’s really what access is all about.
We also want to know that the care is safe and effective.
That’s really what quality is all about.
One of our immediate priorities in the surgery blitz is to increase access to cancer and cardiac surgeries. We are not going to promise overnight results. But we can commit to reversing the wait list trends.
Let me talk for a moment about the people we need to make all of this happen. People like nurses. You may know that we are entering discussions with the United Nurses of Alberta. Our guiding principles for those upcoming negotiations are:
One: We will make sure we have as many nurses as we need working in the appropriate places in Alberta. Patient care, safety and high quality health services are our highest priorities.
Two: Alberta will be competitive with other provinces, ensuring that we attract and retain nurses.
Three: We want to organize and manage the workforce to optimize the skills and expertise of nurses.
And Four: We want to engage nurses in the process of improving access, improving quality and safety, and assuring the sustainability of the system.
We need top quality people, because health care is an increasingly complex system.
Harvard Medical School Professor Dr. Atul Gawande puts this into perspective. He says the new edition of the International Classification of Diseases identifies more than 68,000 diagnoses.
That’s 68,000 different ways in which the human body can fail. No other industry in the world has to deliver on so many “service lines.”
Modern medical knowledge is bigger than any one person – doctor, nurse, or other care provider – can manage or even grasp.
Dr. Gawande often talks about the absence of a single coordinating body that can take responsibility for the deployment of life-saving knowledge, and – interestingly, in the Alberta context – cites the World Health Organization’s “safe surgery checklist,” developed by his own team at Harvard.
This 90-second checklist was tested in eight hospitals around the world, and found to reduce complications and deaths by more than one-third.
But the fragmentation of modern health care in nearly every country creates barriers to the adoption of even this kind of simple, compelling and low-cost innovation.
What makes that so interesting to me and to all of us, is that it’s a different story in Alberta.
Recently, Alberta Health Services introduced the Canadian version of that Safe Surgery Checklist to every hospital, and every surgical team, in the province.
These surgical teams are being equipped to incorporate this simple but effective practice – a practice that has been proven to reduce errors, complications and infection. It works for the airline pilots, and it now also works for Alberta surgery teams.
This is a good example of how you can improve the quality of care with a very small financial investment that reaps exponential rewards – most importantly, in every patient who recovers without infection or other complication, and goes home healthy.
In another initiative underway here since December, a Home Care coordinator has been part of the Misericordia Emergency Department team, working with elderly patients to find out whether a simple adjustment to their routines, care or medications could prevent repeat Emergency visits.
In the past year, more than 9,000 seniors visited Misericordia’s Emergency, and provincially, seniors account for up to 20 per cent of all emergency department visits.
Falls, digestive problems, circulatory issues, heart problems and diabetes are among the most frequent issues that bring them in, and can affect their ability to live safely and independently in their own homes.
The addition of the Home Care coordinator has improved the level of care provided to elderly patients; especially in ensuring the safe discharge of patients and follow-up support once they are back home.
Another example: For some of our youngest patients, the expansion and separation of the Emergency Department shared by the University of Alberta Hospital and Stollery Children’s Hospital will have a real impact on our pediatric emergency capacity.
And we’re coming up quickly on the opening of the Lois Hole Hospital for Women, on the Royal Alex campus. It will offer state-of-the-art technology and innovative, fully integrated care, education and research.
There are many good things already underway in health care, here in Edmonton and across the province. I’ve only been able to tell you about a few.
We have the best and the brightest, right here. What we need to do is make sure that the system in which they work properly supports them to do their jobs.
We know that their expertise and experience are critical to achieving our quality and access goals, because every one of the initiatives I told you about started with them.
We know that we have to engage the community better, as well. Patients, families, partners… all of our stakeholders need to be consulted as we work to create this new Alberta health system.
Our Health Advisory Councils are up and running across the province, comprised of a diverse group of volunteer community members who share a passionate commitment to health care.
In the weeks and months to come, you will see much, much more. Please stay tuned.
The most important thing I want to leave you with is my certain conviction that the care provided by the doctors, nurses, and other healthcare professionals in this province is as good or better than that provided anywhere in the world.
I am proud of them, all of them. I’d ask you to join me in again taking the opportunity to thank them. (Start applause.) And when you see them in your daily lives, if you happen to see them, please thank them for the work they do.
Albertans rightly have high expectations. And so do we at Alberta Health Services.
Some of you may have seen recent media coverage about the Tom Baker Cancer Centre in Calgary.
I’d like to make three things very clear on that issue:
First, we are committed to providing the best possible cancer care in Alberta and our cancer care providers are recognized as being among the best in the world.
Second, we erred in commenting last week on the capital budget before it is finalized and we recognize that capital polices and priorities are the responsibility of Alberta Health and Wellness and the province.
Third, capital budgeting is a complex, long-term process. Discussion and decisions must contemplate both capital expenditures and the government’s long-term commitment to operating expenses.
Proposals for a new cancer care centre have been discussed for many years and there are several options to meet increased demand for cancer care. No decision has been made or will be made before the province has provided direction and we have consulted with clinical leaders.
Let’s also remember that we have made a great deal of progress in recent years. We will be taking some pressure off of Calgary as we open the radiation facility at the Lethbridge Cancer Centre in June this year. We are also expanding the Central Alberta Cancer Centre in Red Deer to provide radiation therapy.
As part of the same initiative, The Cross Cancer Institute in Edmonton is examining the radiotherapy process for patients with some cancers that have spread to the brain. The Tom Baker Cancer Centre and the Cross Cancer Centre will share the information and the initiatives they identify.
The way health care is delivered continues to evolve. Quality is measured today by both increases in capacity and in innovation – finding new ways to improve care. No one should think we are not fully committed to the welfare of our patients.
So in conclusion, the turning point we have reached is an incredible opportunity . . . no, an obligation and a responsibility . . . to reach our goals and then strive for even more.
I welcome your feedback, your observations, your constructive criticisms and – I hope – your ongoing support as we work toward a sustainable system with high quality care accessible to all.
Thank you
