[CUPE healthcare list] CCHSA Leading Practices database

["Irene Jansen" <ijansen@cupe.ca>]

http://www.cchsa.ca/LPContent.aspx
The Canadian Council on Health Services Accreditation (CCHSA) has a searchable database on "leading practices" in accredited institutions. The database provides summaries of "leading practices" identified by CCHSA in the last two editions of the Canadian Health Accreditation Report, with contact information for each project. You can search by theme and accreditation standard area.

You have to wade through a lot of entries, and CCHSA fails to identify the project scale or ownership structure, but there are some good examples of public sector innovation. Below are some examples:

One of the team's service providers visits high-rise apartment buildings where many elderly people live to
offer the day centre's activities on site. This program, known as "Centre de jour chez vous" [day centre in
your own home], is an effective way of reaching many elderly persons at once, and helps to keep clients
in their own homes.
Centre de santé et des services sociaux de Laval
Email address: andrée_morin@ssss.gouv.qc.ca

The BC Provincial Renal Agency team has done a spectacular job with the development and use of the
PROMIS database system. This all-inclusive database is used to register all patients on dialysis and all
patients registered with chronic renal disease throughout the province. The system is online and in real
time so that units receive all the lab data on individual patients as soon as the lab has it ready. These lab
results are then compared to the provincial average, giving this service excellent access to comparison
data. The PROMIS system is used for quality assurance, quality improvement, budget projections, and
research. It is a first in the renal community in Canada and is a leading practice for the country to follow.
Provincial Health Services Authority
Email address: kgustavson@cw.bc.ca

Patients' records are computerized. This allows access to information that is up-to-date and timely delivery
of services to clients in a territory that covers a great distance.
This innovative project that involved the contribution of the multidisciplinary team allows the organization
to offer specialized services to better meet the needs of the community.
Confidentiality is well respected thanks to limiting access to files to authorized individuals only.
Régie régionale de la santé Beauséjour
Email address: mireillel@health.nb.ca

The Breast Pathway Project supported by the Breast Multidisciplinary Team of the London Regional Cancer
Program completed an audit of the continuum of care experience of 60 breast cancer patients where
service wait times and system bottlenecks were identified. The wait for ultrasound was found to be a
bottleneck and the process was changed to allocate one trained technologist to focus only on breast
ultrasound. This investigation has led to the development of a London Community Breast Pathway Project
with the ultimate goal of expanding the project to the remainder of the region. A draft pathway from
suspicion of abnormality to treatment initiation, including timelines, has been developed based on literature
review and best practices.
London Health Sciences Centre
Email address: lynn.chappell@lhsc.on.ca

The comprehensive cost/benefit analysis that was completed to introduce ceiling lifts is commendable.
This thorough study involved a host of departments including both clinical and administrative departments
throughout the Interior Health Authority (IHA). Occupational Health took a leading role in the review of related
incidents and looked at the costs of status quo options compared to the management of various risks and
costs associated with the purchase of ceiling lifts. The identification of various criteria was completed for
the pre- and post-evaluation. The report then outlined the actual reduction of incidents, the injuries
eliminated, the cost savings, and the staff satisfaction with this initiative. It also highlighted further
recommendations for maintaining the benefits, including a more comprehensive inventory and database
of the authority's ceiling lifts, and ongoing client and staff satisfaction regarding the equipment and
reduced injuries.
Interior Health Authority
Email address: Petra.Heppner@interiorhealth.ca

The integrated model of care for total joint replacement is an example of the leadership exercised by this
team in bringing the various health dispensing organizations together to improve the care trajectory for
patients. The partnership includes nine hospitals, five rehabilitation hospitals, five Community Care Access
Centres, and other partners. The initiative has resulted in increased accessibility, cost savings and
efficiencies, and improved integration and seamlessness of the patient care experience.
University Health Network
Email address: anita.tepfers@uhn.on.ca

The home support team implemented an innovative program in a private home under contract and seven
non-profit community-owned houses. The program allows elderly people to live in their own homes by
providing support services tailored to their needs on site. The multidisciplinary team, in conjunction with
community workers, provides active listening and monitors the overall health status of the residents.
Centre de santé et des services sociaux de Laval
Email address: Christiane_Caron@ssss.gouv.qc.ca

The Emergency Program at London Health Sciences Centre partnered with the local Community Care
Access Centre (CCAC) to undertake a pilot project that assigns the Community Care Access Centre
caseworker to the emergency department as a Case Manager. The main goal was to improve the overall
experience and care of the patients as they travelled through the system. An analysis of the project's
effectiveness was undertaken after 900 patients were assessed. The results of the pilot study show that
the majority of the patients were elderly and that about 55 readmissions were avoided. The overall return
rate to emergency was 2.2% for CCAC-managed patients versus an overall readmission rate of 10.7%.
London Health Sciences Centre
Email address: Carol.Young-Ritchie@lhsc.on.ca

It is through the Comité des thérapies du cancer (CTC) [cancer treatment committee] of the Centre
hospitalier régional de Trois-Rivières that the regional interdisciplinary cancer team assumes its duties as
a consultant for people with cancer and the service providers in the Mauricie and Centre-du-Québec areas.
Established in 1999, this committee seeks to improve the quality of care provided to people with cancer,
support clinicians, and coordinate cancer activities. The CTC meets every two weeks and all cancer cases
in the area with specific problems are submitted to the committee. At these meetings, the participants
review the appropriateness of the investigation, the accuracy of the diagnosis and the staging, and provide
advice about the treatment plan and follow-up (standardization and rationalization). The CTC acts as an
adviser to the CMDP [council of physicians, dentists, and pharmacists of Quebec]. It also has a teaching
role which is recognized by the Royal College as an ongoing medical education activity.
Centre hospitalier régional de Trois-Rivières
Email address: louise_lavigueur@ssss.gouv.qc.ca

The shared care maternity program provided by the team in Stony Plain is an excellent example of how
services can be integrated and coordinated for the population served. Prenatal care and education is
provided by a team of physicians, midwives, and nurses to low-risk obstetrical clients in the rural western
part of the region. This team provides comprehensive services, and close links are established with
public health. Care is seamless and client-centred. Demand for the service has increased far beyond
expectations, with clients actively seeking care at this site even though they reside far away from Stony
Plain. The facility has doubled the birthing space to accommodate this demand.
Capital Health
Email address: dtowers@cha.ab.ca

Commendation is given for forming a common waiting list for the various programs. The process includes
a common intake for all mental health services in the community. An interagency intake committee,
that includes community partners and clients, meet to determine what is the best service for them.
The committee works hard to connect clients to the most appropriate service, even calling to arrange the
appointment and ensuring that the receiving service agrees this is the appropriate service. This approach
and system prevents clients from being on multiple waiting lists and being bounced around from service
to service. The system provides faster access to service. The case manager will physically bring a client
to the service if this is necessary.
Thunder Bay Regional Health Sciences Centre
Email address: tysont@tbh.net

The NetCARE program in Chilliwack provides a wide range of health services for frail older adults and
their caregivers. Clients attend a day program and receive a comprehensive range of health, social, and
recreational services provided by a multidisciplinary team. The clients are monitored when they leave the
program and the services are connected with the local hospital and community. This program has been
operational for three years and demonstrates significant health improvements in a population group
that is generally declining.
Fraser Health Authority
Email address: elaine.dyck@fraserhealth.ca

The joint reconstruction surgery clinical pathway is extremely well done and crosses the continuum of
health. The Acute Average Length Of Stay (ALOS) has declined for some period of time and is now below
the national benchmark. A presentation has been made on this project and several organizations across the
country want to access this protocol.
Vancouver Coastal Health Authority
Email address: Susan.Ardekany@vch.ca

One of the greatest challenges facing tertiary mental health services is the discharge of the severely and
persistently mentally ill clients to their home communities.
St. Joseph's Health Care, London's specialized mental health service, has a program to reintegrate clients
through vocational rehabilitation programs such as Choice Opportunities in Rehabilitation and Education
(CORE) which is a community-based clubhouse program offering rehabilitation, occupational therapy, and
employment opportunities. The program fosters and supports the appropriate discharge and sustainability in the community through
the step-up mental health consultation and evaluation in primary care program that is offered at five family
medical centres and provides direct care to clients. This is further supported through the step-down
transition into primary practice program that transitions care back to the family physician over an 18 to 24
month period with education, backup consultation, and collaborative appointments every three months.
St. Joseph's Health Care, London
Email address: phyllis.brady@sjhc.london.on.ca

The district palliative care program is excellent. It provides seamless shared care between the community
and the hospital. The role of navigator that accompanies cancer patients is a model for the province and
the country.
Pictou County Health Authority
Email address: dennis.macdonald@pcha.nshealth.ca

The organization has developed support tools for use during transfer of a large number of clients
to new premises.
The program is called "Évoluons vers le changement" [moving toward change]. This well documented
program consists of six components: clinical aspect, personal care, meals and snacks, social/recreational
activities, environment, and employee support.
This model may be used for various changes that organizations are facing. Moreover, the cycle of transition
is described in the following manner: refusal, resistance, exploration, involvement.
Hôpital Sainte-Anne
Email address: judi.newnham@vac-acc.gc.ca

The Eating Disorders team has developed a comprehensive family-focused program across the continuum of
care which includes primary and secondary prevention, outpatient assessment and follow-up, and intensive
Day Treatment Services. Their Program Evaluation has been a model for other Eating Disorder Programs
across the province, and the outcome results have been presented internationally. The team developed a
Quality Improvement Initiative and produced a learning module for pediatric nurses who care for eating
disorder patients on the medical ward.
Children's Hospital of Eastern Ontario
Email address: tataryn@cheo.on.ca

As part of the Child and Adolescent Mental Health Program, there is a Patient Advocate who works
with clients to inform them of their rights, advocate on their behalf, and create linkages with community
agencies and groups to support clients in the community. The Patient Advocate also works collaboratively
with stakeholders to make improvements from a global perspective. This role has included active
participation in such endeavours as the development of provincial mental health standards and
participating in improvement initiatives within adult mental health. It is believed to be a unique
role at this facility and not present in any other similar program in Canada.
Izaak Walton Killam (IWK) Health Centre
Email address: susan.mercer@iwk.nshealth.ca


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And on the other hand, a reference to P3s ....

A very comprehensive residential facility review was completed by BCBC-HSC Group. On completion of this
review, some facilities were identified as "keepers, fixer uppers, or to be closed" while others would be
replaced as new facilities. Sound financial and risk management approaches were used throughout the
study. This study then explained the plan to redesign both the Long Term Care system and the residential
bed configuration using a variety of funding options, such as PP3 operating funds, capital funds, and
fundraising.
Espanola General Hospital
Email address: jpogue@esphosp.on.ca