Performance Report

This performance report has been constructed to demonstrate the progress of Alberta Health Services (AHS) towards meeting the targets and 5-year priorities as outlined in the 2011-2015 Health Plan.

AHS intends to become the best performing publicly-funded health care system in Canada. This means that we have to improve both the well-being of Albertans as well as the quality of health services delivered. The combination of performance tracking in both areas will set us apart from other provinces.

AHS is building measurement of health service quality across six dimensions; accessibility, appropriateness, efficiency, effectiveness, safety, and acceptability. We are also examining the well-being of populations across the life cycle from early childhood to youth, adult and seniors.

This balanced review of where we are ‘the best’ and where we need to improve is contained in our planning documents and strategic analysis. We update these improvement targets every three years within a five-year rolling cycle.

By design, this report is not intended to be a balanced scorecard on service quality and well-being; it is focused very much on the areas where we need to improve. There are other measures of performance where Alberta is the best or among the best performing provinces, which are not included in this report. This is not because they are less important, it is because they require less attention in our goal of becoming the best performing health care system in the country. This report will always be a transparent reflection of areas to improve, and by definition reflects a journey of committed action. In most areas these improvements are not a quick fix but require foundational changes to how and when services are delivered.

The targets – how far and how fast – are set in consultation with clinical leaders, Alberta Health and Wellness (AHW), and a review of national benchmarks. Our 5-year Health Action Plan provides a road map on major strategies and initiatives to deliver on these targets. These strategies and initiatives are organized around four major clinical priority areas: (1) wellness and prevention; (2) strengthening primary care; (3) improving access and reducing wait times; and (4) providing more choice for continuing care. Several efforts are underway in order to deliver on these priority areas; for example:

• Seniors – continued capacity building in home care (providing services to more clients), as well as the addition of new continuing care spaces. With a target date of March 2012, work is already underway to implement programs in Emergency Departments to enable Seniors to return home with added home care support rather than remain hospitalized. This initiative will have the added benefit of freeing up beds within Emergency to assist in reducing ED wait times.
• Programs have been put in place to increase the rates of seasonal influenza immunization. This includes mail outs to families to advise them of the importance of Childhood immunizations for children aged 6 to 23 months and new processes which include immunization pilots at day care centers and school sites at end of business day as parents present to pick up children.
• Access and wait times – AHS and AHW are developing a comprehensive wait times policy and measurement approach combined with innovation in the pathways of care and capacity building.
• Emergency Department wait time improvements continue with focused attention on new capacity and processes in each Zone and a dedicated process improvement collaborative.

Reporting our Performance: July 1 – September 30, 2011

Designed to gauge performance and drive improvement, this report provides a snapshot in time and shows us where we are performing well and areas where we need to take action to improve.

There are a number of areas where AHS has met or is on track to meet our performance targets for this year. These include: reducing Emergency Department (ED) use for family practice sensitive conditions, Health Link access time, cataract surgery wait time, wait time for radiation therapy (ready-to-treat status until first therapy), and patients discharged from ED within 4 hours (all sites). It is worth noting that these targets have been met in spite of increases in ED visits year to date (3%). Existing urgent care sites saw an increase in visits of 1.5% with an overall increase of 13% when including the additional service available at the new Urgent Care center in Cochrane. Health Link calls have increased significantly as well (6% year to date) since the same period last year. In addition:

• Patient satisfaction measures and incidents of harm are within the target level for the system.
• Coronary Artery Bypass Graft (CABG) wait times (90th percentile) have seen significant improvement within the Semi-urgent category dropping from 10.8 weeks to 3.5 weeks.
• In terms of human resources, AHS continues to improve the ratio of employees in full time positions and the numbers of Registered Nurses hired.

We are also responding to a number of priority areas with immediate and aggressive actions to improve performance. These areas include: emergency department lengths of stay, access to continuing care beds, as well as wait times for hip replacements, knee replacements, and urgent coronary artery bypass graft surgeries.

Highlights of actions underway to improve performance in priority areas:

• Ongoing implementation of ED surge capacity protocols to provide additional capacity when demands on Emergency and across the health system reach critical thresholds. When reached, the new protocols trigger immediate action to reduce wait times.
• Implementing new technologies to improve efficiency and reduce wait times; for example:
  • The Real-Time Emergency Department Patient Access & Coordination system (REPAC) uses real-time information on patient volumes and the severity of patient conditions in Calgary and Edmonton hospitals to direct ambulance crews to the most appropriate locations. This helps to manage capacity across each city and allows EMS to get back on the street faster. In addition, public access to estimated ED wait times has recently been provided in Calgary as the first phase of a provincial initiative to help people decide where to access care, with a goal to expand the service to other communities in the province. This initiative has been expanded with the recent addition of the Smart Phone “app” which allows users to quickly see the wait times at city EDs, call the appropriate facility and “map” from their current location to the ED of their choice.
  • New ‘smart cards’ which allow ED physicians to quickly and securely access patient health records, medication prescription information, laboratory results, X-rays, CT scans and MRI images from one of several workstations (previously, physicians would have to log in and out of multiple systems and terminals – each requiring its own username and password – to access this same information). A successful trial at the Rockyview General hospital in Calgary was shown to save doctors up to one hour per shift, which has helped to lower wait times. The technology is rolling out to other Calgary hospitals, as well as to other zones, starting with the Edmonton Zone.
  • Increase and improve the timeliness of Repatriations of patients from urban and regional facilities back to their home community or referring site within 24 hours of decision that patient can be repatriated. This will assist in facilitating needed capacity for those patients who require a higher level of care in an urban or regional hospital
• Adding 1,000 new continuing care beds in 2011/12, in addition to the more than 1,000 beds added during the 2010/11 year. This additional capacity allows us to free up hospital beds currently occupied by Albertans whose health needs would be better met outside of the hospital. More open hospital beds will help improve ED length of stay for many patients requiring admission.
  • Note: as most of the additional continuing care capacity is planned to open between October, 2011 and March, 2012, performance on the number of people waiting for continuing care is not expected to improve significantly until closer to year-end.
• New Designated Assisted Living (DAL) facilities have been opened and new Supportive Living (SL) capacity is being added.
• Expanding Home Care services in an effort to keep seniors safe, healthy and independent in their homes and reduce the number of avoidable ED visits. Additional hours will be provided to allow at least 3,000 more people to receive Home Care services by the end of the current Fiscal Year.
• Increasing funding and implementing care pathways for patients requiring hip or knee replacement. An additional 1,000 hip and knee replacement surgeries have been approved for 2011/12 as a means of reducing wait times for these procedures. Care pathways will also enable a central intake of referrals in offering a “next available surgeon and site” option to interested patients. The project is now underway in all 12 facilities performing hip and knee replacements.

In addition to these high priority areas, there are others that also require more attention and action. These are highlighted in the report and information on actions being taken can be found in the summary page for each measure.

In order to transform the way we deliver health services across the province, we need a vision for the future, transparent and accountable action plans, reliable measures, and specific targets. We need to know how well we are doing and where we need to improve. As we make improvements, we need an ongoing process to measure effectiveness.

This report is more than just numbers, it is a dynamic road map for the future and an essential tool to reach our goal of becoming the best publicly-funded health-care system in Canada.

With the release of each quarterly report, AHS reaffirms our commitment to provide timely and relevant information to the public. While the figures presented here measure our progress to date, the most important measure of our success in the future will be the health and overall satisfaction of Albertans.

For more information on actions we are taking and the programs we have in place to transform our health system, I encourage you to visit our website at www.albertahealthservices.ca.

Dr. Chris Eagle
President & Chief Executive Officer
Alberta Health Services