September 26, 2017

WRHA updates Healing our Health System plan

First phase of change rolls out October 3

Today, the Winnipeg Regional Health Authority (WRHA) provided a detailed overview of the planning and preparation that has gone in to ensuring the health care system is prepared for the first wave of changes associated with the consolidation of health care services intended to improve quality and timeliness of patient care.

“Winnipeggers have been forced to endure some of the longest emergency wait times in Canada. Our city’s hospitals have fallen behind their counterparts when compared to the national average in other key measurements, such as length of hospital stay and access to diagnostics and specialty services,” said Kelvin Goertzen, Minister of Health, Seniors and Active Living. “The current system has long been in need of changes to make it more effective and efficient. On October 3, the last several months’ worth of planning, capital investments and clinical reorganization will be implemented and will begin to address a number of the factors that have led to these poor outcomes.”

Changes to the health system were announced in April 2017 and closely follow the recommendations of a report commissioned in 2015 by the then-provincial government. That report – Provincial Clinical and Preventive Services Planning for Manitoba, Doing Things Differently and Better – was written by Nova Scotia-based health care consultant Dr. David Peachey following hundreds of conversations with Manitobans from across the province and analysis of extensive data.

The report identified excessive wait times, high numbers of patient transfers between hospitals and limited physician and diagnostic resources spread across too many sites. It called for improved patient care through regional consolidation of health services to better leverage clinical expertise, diagnostic resources and staffing. Regional clinical leaders were guided by Peachey’s recommendations as they created the clinical services consolidation plan.

“Our report really marked the beginning of a journey as Manitoba begins to address some of the challenges associated with its health care system, many of which are directly related to the dilution and duplication of care and services and the absence of a provincial plan,” said Dr. Peachey.  “I am pleased to see evidence of the enthusiastic implementation of changes focused on quality of care and improved outcomes. The rate of progress, infrastructure development and clinical oversight demonstrate that Manitoba is moving forward with the correct priorities.”

Changes in Phase I, slated to begin October 3, include:

  • the conversion of Victoria Hospital’s emergency department to an urgent care centre. Pre-conversion, Victoria’s emergency department saw on average 88 patients per day, more than half of whom will still be appropriate for treatment at an urgent care centre.
  • the closure of urgent care at Misericordia Health Centre. Pre-conversion, Misericordia urgent care saw on average 106 patients per day, half of whom could be appropriately treated by their primary care physician, and many patients from south Winnipeg who have access to Victoria Urgent Care.
  • in advance of these moves, additional changes have been made to accommodate additional volumes at St. Boniface, Grace and Health Sciences Centre emergency departments, including eight new treatment spaces at St. Boniface and improved processes in all three departments.

In addition, the following initiatives are underway to support consolidation and improve patient flow:

  • opening of clinical assessment units at St. Boniface and Grace hospitals and the expansion of the existing clinical assessment unit at HSC. These units support emergency department patients who require longer assessment and observation, thereby freeing up space and staff resources.
  • redeployment of lab and diagnostic services to ensure resources are available in the right places to support patients who are currently not grouped according to the care they require.
  • opening of 65 new transitional care beds for medically stable patients who are ready to be discharged from hospital but who require time to make long-term arrangements for their care.
  • creation of 28 transitional care beds at Victoria Hospital to accommodate clients requiring enhanced supports.
  • provision of intensive home care to patients as part of a new transitional home care service. Priority Home begins November, 2017. Programming will be provided for clients for up to 90 days to support individuals at home, thereby reducing the length of time clients spend in hospital. Additional transitional care services will be offered by community hospitals once the region’s consolidation plan is fully implemented.
  • introduction of updated ambulance protocols to ensure paramedics are fully informed of the appropriate destination hospital, depending on the care required. In many instances, ambulance protocols remain the same. For example, St. Boniface Hospital will remain the destination for most cardiac patients
  • ongoing conversations with union leadership regarding plans that match patient populations with the correct staffing mix and the specialized diagnostic resources needed to treat them.

Phase II changes affecting other sites across the region will begin in spring 2018. These changes will be supported by capital investments, including enhancements to emergency departments and improved treatment spaces for seniors, mental health patients and the most seriously ill patients at city hospitals.

The Healing our Health System plan creates clear roles for each of the region’s six hospitals. Winnipeg will support three acute-care emergency departments (Health Sciences Centre, St. Boniface Hospital and Grace Hospital); while two urgent care centres (Victoria Hospital and Seven Oaks Hospital) will provide 24/7 care for non-life threatening health concerns requiring same-day treatment.

“Dr. Peachey’s report clearly indicates that more is not better in health-care systems and planning,” said Réal Cloutier, WRHA interim president and CEO. “Winnipeg has lagged behind national averages for years on a number of key measures of care, including emergency department wait times. Creating a critical mass of clinical expertise and specialty diagnostic resources in fewer sites will improve access and efficiency, allowing our facilities to see a higher volume of patients, faster.”

Consolidating clinical services will bring Winnipeg in line with how services are successfully provided in other cities of the same size that experience shorter wait times and more timely access to specialists, diagnostic testing and treatment, particularly for the most acutely ill patients, with fewer emergency departments, added Cloutier.

Phasing in the changes, rather them implementing them simultaneously system-wide, will permit monitoring of the implementation, allowing staff movements to take place in a gradual, orderly way, says Lori Lamont, WRHA vice president and chief nursing and health professionals officer.

“This is a complex process, so a targeted roll-out permits us to plan for each step, assess the success of implementation and adjust as required,” said Lamont. “Our goal throughout the planning process has been to minimize impact to patient care during transitions. We are pleased with the level of engagement demonstrated by our site leadership, staff, physicians, and unions as we work together to improve our capacity for excellent patient care.”

In addition to the changes slated to begin October 3, other phase I initiatives to begin implementation over the next six weeks, include:

  • the shift of mature women’s services from Victoria Hospital to Health Sciences Centre.
  • the addition of critical care beds at Grace Hospital.
  • the movement of geriatric-rehab patients from St. Boniface Hospital to Victoria Hospital.
  • the opening of a special needs behavioural unit at Deer Lodge Centre.

The movement of staff to align with the changes underway – including the introduction of standardized models of care – is critical and intended to improve both the quality and efficiency of care while enabling a full scope of practice for staff within an enhanced clinical work environment, added Lamont.

Human resource processes designed to minimize disruption and provide for continuity of employment are progressing and staff response to the selection process for nurses at Grace and Victoria Hospitals has been extremely encouraging, with meetings now underway for support staff.

“The region’s plan is based on a wealth of research, best practices that have been proven successful in other jurisdictions, ongoing dialogue with staff and union leadership, and countless hours of careful planning, testing and evaluating for success by clinical leaders,” said Goertzen. “We believe the system is ready and patients, their families, staff and the sites will have access to information about the changes. Implementation will be closely monitored and additional resources and support will be provided as patients and staff adjust.”

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