Frequently Asked Questions

Why is it important to focus on patient flow from an acute medicine unit to the community?

Directing improvement efforts at the issue of patient flow is important from an access, integration and quality of care perspective. More than 1600 acute hospital beds are occupied on any given day in Ontario by patients awaiting subsequent care destinations (e.g., long-term care, home with home care, rehabilitation, complex continuing care, etc.). Excessive wait times in the emergency department for inpatient beds to become available, paramedics waiting to offload patients to emergency stretchers and elective surgical cancellations are all symptoms of problems with patient flow in Ontario's healthcare system. When patients are kept waiting for treatment and appropriate levels of care, they are at risk of experiencing adverse events and poor outcomes. We can improve patient flow by identifying opportunities to improve communication among care providers across the transitions of care, removing duplication of effort, and eliminating bottlenecks

How can we see process improvements if we have insufficient long-term care bed capacity in our LHIN?

We recognize that there are a variety of issues that contribute to the current pressures on acute care beds in Ontario, including, but not limited to, long-term care capacity and supportive housing options. We also know from past experience in Ontario and elsewhere that only adding beds to the healthcare system has not always resulted in sustained improvements. Adding capacity is only one part of the equation. Making improvements to the process is another critical component.

We know from initial exploration that there are opportunities for improving processes involved in the transitions from acute care to subsequent care destinations. These include unnecessary delays in patient assessment, duplication in roles and documentation, inconsistent communication to patient and family regarding hospital discharge policy and long-term care home placement processes, non-standardized processes for assessment, referral, and delays in arranging final discharge, bottlenecks due to hours of operation for some services both in acute care and in the community, etc.

Improvement Teams in the Flo Collaborative mapped their processes to help them focus their improvement efforts and decide on simple measures to assess whether the changes they made resulted in improvement.

How did the Flo Collaborative integrate with other MOHLTC initiatives?

The Ministry of Health and Long-Term Care (MOHLTC) has initiated several strategies that target different components of the care continuum:

• Wait Time Initiative
• Ontario Wait Time Strategy

OR Efficiency Teams

• Critical Care Strategy

MRI/CT

• Diagram showing the relationship between the Flo Collaborative and similar MOHLTC initiatives (PDF)

What indicators were used to measure the success of the Flo Collaborative?

There were a number of measures used to gauge the success of the Collaborative. The vast majority were available through routinely collected data sources and were monitored "behind the scenes" with the assistance of decision support people within participating organizations who reported data centrally to CHQI. Some examples of these measures include total length of stay stratified by discharge disposition, bed turns (a measure of throughput), Alternate Level of Care (ALC) days, and percentage of patients readmitted to hospital within 7 days of discharge.

• Number of ALC patients on the targeted medical unit on a twice weekly basis

• Process measures that Improvement Teams developed to measure improvements resulting from tests of change conducted within their organizations.

How will improvements be sustained now that the 16-month Collaborative is over?

The issue of sustainability was a key focus in planning the Flo Collaborative. The three streams - Improvement Team, Improvement Advisor, and Senior Leadership - contributed to building the infrastructure for sustainable quality improvement for each participating organization. Now that the Collaborative has reached a conclusion:

• Participating partnerships have one employee certified as an Improvement Advisor, to help them sustain their efforts over the long-term and be deployed for future improvement activities;
• Senior Leaders, through their participation in the Senior Leadership Series, have enhanced capability to support quality improvement within their organizations;
• Participants have increased capability related to sustainability and spread. The final sessions for the Improvement Team and Senior Leadership Series Streams focused on spread and sustainability (one of the strategies for maintaining gains within an organization is ensuring that key metrics are integrated into the set of measures monitored by senior management and the Board on an ongoing basis);
• The final sessions for the Improvement Team and Senior Leadership Series Streams focused on spread and sustainability (one of the strategies for maintaining gains within an organization is ensuring that key metrics are integrated into the set of measures monitored by senior management and the Board on an ongoing basis);
• This website includes downloadable change ideas and regular project updates that organizations who did not participate in the Collaborative can freely access;
• The LHINs will be actively involved in helping to ensure sustainability and spread beyond the scope of this project.