No Patient Left Behind: Development and Implementation of a System Accountability Framework for Nova Scotia Health.

Background: Population growth and comorbidity are driving demand for episodic care and extended community supports creating backlogs in access, particularly for emergency care in Nova Scotia. The System Accountability Framework is designed to ensure a shared approach with clear accountabilities at all levels of leadership and operations, initially focusing on the acute care sector within three defined zones of accountability: Emergency Department, Inpatient, and Community.

Approach: The Integrated Acute & Episodic Care Clinical Services Network, with engagement from internal partners (e.g. Access & Flow Network, the Primary Health Care Network,  Performance and Analytics, Research and Innovation, Continuing Care) and external partners (e.g. Emergency Health Services, Department of Health and Wellness, Department of Seniors and Long Term Care, Department of Community Services) developed and implemented a cross-sectoral Framework to help move patients through their acute care journey by identifying three clear Zones of Accountability: Community, Emergency Department and Inpatient. Network and operational teams collaborated to develop and implement shared metrics and local models and policies that can be mapped to each metric. Patient Family Advisors are integral members of the Clinical Service Networks (including the Integrated Acute & Episodic Care Network) and provide ongoing input and feedback into the design of the initiatives and policies that comprise the overall Framework. Tools included models of care, streamlining and standardizing processes, integrating Nova Scotia Governments Action for Health Initiatives, policies and reporting templates. Weekly communications and check-in meetings including operational leaders across health sectors provide an opportunity to report on progress and share early successes and opportunities for spread and scale. A dashboard and predictive modeling tool provides operational teams with line of site to weekly performance and anticipated upcoming seasonal and staffing challenges. The Framework has been integrated as a key support for a larger organizational initiative called Operational Excellence which provides structured reporting and operational grip. 

Results: Currently in week 37, implementation has already shown impact including: 50% overall reduction in 90th percentile ambulance offload times; and a 30% reduction in time to transfer. Over 8000 ambulance hours have been returned to Nova Scotia’s communities. EHS has reported a decrease in their ambulance response time over the past six months and current ambulance response times for emergency calls are averaging 20 minutes. Efforts continue to address surge capacity, through strategies and processes to improve provider response times and patient stays. This involves streamlining discharge processes for smoother patient flow.

Implications: The challenges that the System Accountability Framework aims to address are common to many health jurisdictions. This initiative demonstrates a real life implementation of the recommendations supported by the national CAEP EM-POWER report and a view to how providing a system-wide accountability framework can help teams at all levels of care, develop and implement improvements that are based on a common shared goal: each patient receives the right care at the right time in the right setting, and from the right provider. The presentation will explore challenges and opportunities related to the development and implementation of a cross-sectoral systems Framework.