Solution Three: Cultivate excellence on the frontlines
Our plan will build and empower connected care teams as respected entrepreneurs and innovators who have the information, technology, and tools they need to provide a high standard of care.
Our progress on what we will do
Work Ongoing: Started and continues through 2022-26
Complete: The action is complete
Work Underway: The action has been initiated
Not Started: The action has not been initiated yet
- Invest in health equipment, technology, and infrastructure to support a safe, attractive, and healthy workplace
Actions will include Progress Update Status - Develop modern infrastructure to support the health system, including the continued implementation of the QEII New Generation and Cape Breton Regional Municipality Redevelopment projects
- Bayers Lake Community Outpatient Centre construction remains on schedule for final completion in February 2024. The procurement for Halifax Infirmary Expansion Project remains in progress, although a new and faster plan was announced in December 2022. This plan will see an increase in the number Operating Rooms, patient beds and a new ED on the Halifax Infirmary site. It also includes planning work to expand infrastructure supports at the DGH and Cobequid sites, the creation of two Transition-to-Community Facilities in HRM, as well as the entire previous scope (Cancer Care, Heart Health).
- Close of Strategic Assets (including 21 Hogan Court in West Bedford, 18 Acadia and 7 and 11 Mount Hope Avenue in Dartmouth) has been completed. Design and construction have begun at 21 Hogan Court with completion anticipated by year end.
- A new Addictions and Mental Health Campus concept, planning for the NS Rehabilitation and Arthritis centre, and the development for a replacement of the MacKenzie Lab as announced in December 2022, are underway.
- Work has started on the IWK Health Centre’s new emergency department, which will more than double its current size.
- 17 Federally funded (ICIP) infrastructure projects are underway at the IWK and are scheduled to be completed by May 2023.
- A cardiac catheterization lab will be included in the new clinical services building as part of the Cape Breton Regional Municipality Health Care Redevelopment project. It will improve patient outcomes, reduce wait times for cardiac services and free up hospital beds in Cape Breton and across the province.
- An Energy Centre and cancer centre are currently under construction on the CB Regional Development site. The helipad at CBRM has been commissioned with final approval from Transport Canada imminent.
- Dartmouth General Hospital: doubled the ORs from 4 to 8, added 54 beds, and an additional 6 dialysis stations. Construction started in May 2017 and is completed. ORs and additional beds are being activated for patient care.
- Halifax Infirmary 3rd and 5th floor renovations included new Hybrid OR, DI interventional suites, mechanical penthouse, relocation of admin offices, patient/family waiting and consult rooms, PACU isolation rooms, and upgrades to satellite MDR. Construction is now complete and is activated for patient care.
- Halifax Infirmary Emergency Department administration and support area is now operationalized, adding 14,386 sq. ft expansion on top of the existing Emergency Department to relocate amin offices.
- Repairs and renovations have been completed to the Cumberland Regional Health Centre after extensive flooding. The renovated Emergency Department was reopened in March 2023.
- The province reached an agreement in May 2023 to start advanced work on the Halifax Infirmary site of the QEII Health Sciences Centre. This new, modern healthcare building will be built to address the most urgent healthcare needs.
- A six-station dialysis unit is temporarily being established at Cumberland Regional Health Care Centre in Amherst. A pilot project to improve renal dialysis access was launched in Chéticamp.
- Replace and expand medical equipment to support safe, quality care, including upgrades to laboratory services, diagnostic imaging, and cardiac care
- A hybrid operating room, the first in Atlantic Canada, is now in use at the Halifax Infirmary site of the QEII Health Sciences Centre. It includes advanced diagnostic imaging equipment that allows patients having cardiac or vascular surgery to undergo diagnostic tests in the room if complications arise, which is safer for patients. With other operating rooms, a patient would have to be moved to where the diagnostic equipment is located. The QEII Foundation raised $4 million to support the purchase of equipment.
- The first year annual funding for equipment and repairs was increased to $67 million and has resulted in significant gains for patient care including 103 new patient beds, Automated Dispensing Cabinets, 8 digital C-arm x-ray units, 15 ultrasound and echo machines, a Fluoroscopy Unit at Cumberland Regional Health Care Center, a Digital X-Ray Unit at Roseway Hospital in Shelburne, CT scanners at HI and St Martha’s, and Digital X-ray Plates for Twin Oaks and Eastern Shore Memorial Hospital.
- The plan for 2023-24 Capital Grants Funding Envelopes has been submitted, reviewed, and approved.
- Implement IT solutions to improve patient care, access, and flow across the system, such as a transportation scheduling system and a bed placement system in long-term care
- A pilot project is underway to explore community transport as a patient transport alternative. Software options to assist with scheduling are being evaluated.
- A new long-term care e-placement solution, PathWays, has been successfully launched. This will support the placement process for people moving to long-term care.
- Software options for transportation scheduling will be part of the updates to the CAD system. A contract was signed with Logis for 2024 implementation.
- Expand the 'command centre' model to Central Zone and eventually province-wide
- The Care Coordination Centre (C3) is now operational at the QEII Health Sciences Centre and being expanded to hospital sites across the province. Overall, the project is ahead of schedule and now moving to provincial expansion.
- Clinical implementation (e.g., training, workflow improvement, standardization of operating procedures) is ongoing.
- Capacity Expediter and Patient Manager tiles are live across Central Zone with work ongoing to integrate into clinical practice by Fall 2023.
- In March 2023, C3 accelerated the provincial implementation (saving 5 months of schedule) and successfully added Capacity Expeditor to every hospital in the province. Work is on-going to fully operationalize.
- This advanced technology will build upon new and existing processes, clinical pathways, operational routines, and accountabilities, and the new technology, processes and team will help improve access and flow of patients through the system and improve the quality of patient care delivered.
- Increase professional development and practice supports
Actions will include Progress Update Status - Develop a mentorship program to support early-career nurses entering the workforce
- A transition-to-practice program provides new graduates with a residency program including access to simulation training, mentorship, e-modules, and simulation learning modules.
- A new Nurse Mentorship Program pilot has been implemented. It has already been scaled up to all medicine and inpatient units. Further changes are underway to include EDIRA.
- Mentorship and transition to practice supports have been implemented at IWK Health.
- Implement the Work and Learn Continuing Care Assistant Education Model
- As of March 2023, 658 students had enrolled in work and learn programs, which allows students to work two days per week and study three days per week.
- Nova Scotia will be increasing capacity for Work and Learn seats due to high interest.
- Ensure health providers have access to addictions and mental health training and education
- IWK Learning Link now provides capacity-building opportunities for health providers. Access will be made available for NS Health and community partners.
- NS Health continues to provide access to consultation support to health care providers, including primary care, through Addictions Medicine and the Provincial Centre for Training, Education, and Learning.
- NS Health provides access to educational opportunities through the Nova Scotia Learning Institute for Health Care Providers. Staff can learn from non-traditional stakeholders, interprofessional key partners, external stakeholders, and internal departments to develop and deliver education programming. This program was originally known as Registered Nurses Professional Development Centre.
- Enhance access to development opportunities for underrepresented healthcare providers
- The province is collaborating with NS Health and Doctors NS on professional development initiatives for underrepresented healthcare providers and an action learning project.
- IWK is developing a mentorship program and future leaders’ development program for employees from underrepresented groups.
- Increase the number of care teams working together to maximize resources and provide safe, quality care
Actions will include Progress Update Status - Leverage information and technology to connect care teams and enhance collaboration
- NS Health’s Innovation Hub has launched a six-month pilot program with Virtual Hallway, a Nova Scotian company that connects primary care providers with specialists to improve patient access to specialist care.
- Electronic Medical Record (EMR) improvements are being explored.
- Just-in-time practice support pilots started in Central Zone Emergency Departments in February 2023. This includes enhanced clinical educators / leader supports to resource emergency developmental needs. Clinical support for after-hours care especially in rural communities and in specialized programs through simulation learning, tele-mentoring, virtual point of care tools for clinical decision making, and resuscitation quality improvement program.
- The Health Innovation Hub unveiled its new collaborative space in June 2023. The hub focuses on delivering better healthcare, faster, by partnering with medical companies to accelerate clinical trials, test and try new technology, and launch market-ready solutions.
- Continue efforts to standardize and simplify how health providers work
Actions will include Progress Update Status - Implement best practices to reduce variation in surgical procedures to improve patient care
- Best practice activities are ongoing, including development of evidence-based toolkits and improved patient education pamphlets.
- In collaboration with the Online Learning Group at Queen's University, a Shared Decision Making (SDM) module has been developed and is ready for asynchronous education of health care providers. After completion the health care providers will know the steps to support SDM and have practiced their ability to hear patients’ concerns, assure comprehension, and facilitate expression of treatment preferences.
- Address barriers and optimize the ability of health providers to work to their full scope of practice
Actions will include Progress Update Status - Review and assess restrictions limiting health providers from working to their optimal scope of practice
- Examples of work completed and underway include:
- Legislative changes to allow Nurse Practitioners to admit patients to hospital at six pilot sites
- RN prescribing has been implemented and is expanding
- Pharmacy Collaborative Clinic in Primary Care
- Paramedic role optimization in Emergency Care
- Review of the role of Pharmacy Technicians provincially
- Review of Anesthesia Technician role in CZ
- Maximizing the role of the Care Team Assistant in acute medicine units
- LPN role optimization in acute medicine units
- Advanced practice roles in MHA
- Work is underway with Dalhousie Family Medicine Clinics to optimize roles and scopes within current practice, such as Family Practice Nurses.
- The Office of Addictions and Mental Health is working to create a comprehensive Mental Health and Addictions Health Human Resources strategy to support a Universal Mental Health and Addictions Care Framework. Work underway includes understanding current supply of Occupational Therapists, Registered Nurses (and Nurse Practitioners), Registered Counselling Therapists, and Registered Social Workers to optimize their roles and scope of practice within mental health and addictions care.
- Team-based care and redesign priorities include:
- Primary Health Care
- Mental Health and Addiction inpatient psychiatry
- Mental Health and Addiction youth program
- Integrated palliative care and expanding inpatient units
- Cohorting of inpatient medicine population provincially and nursing team redesign and optimization
- Roles in surgical services
- Explore opportunities to expand the role of health providers, such as nurses, pharmacists, and paramedics, to support delivery of health services
- 26 Pharmacy Primary Care Clinics have been implemented. Planning is underway to open more clinics across the province.
- Innovative staffing models are being implemented with rapid training programs to support required competencies for pharmacists, advanced care paramedics and emergency support aides.
- The fall intake for the Critical Care Paramedic program at NS Health’s Learning Institute has been increased, and enrollment doubled.
- Many innovative models of care are being implemented through the Health Innovation Hub to support providers to work to their full scopes of practices, including Mobile Primary Care, Pharmacist Walk-in Clinics+, and VirtualCare NS.
- Starting in April 2023, nurses are now part of the clinical team responding to 911 emergency calls, alleviating pressure on ambulances and emergency departments.
- Expand the registered nurse prescribing pilot to improve access to approved services and medications
- Health system partners are working with Dalhousie to expand the training program. Intake was 9 students for September 2022 and 4 for January 2023.
- The full time Registered Nurse Prescribing pilot is starting in May 2023, and expanding to Seniors and Long-Term Care, and Mental Health and Addictions populations in September 2023, with a goal to add 60 Registered Nurse prescribers to the health system from April 2023 to May 2024.
- Ensure diversity, inclusion, and representation at all levels of the health system, including leadership, to generate a workforce that represents the people being served
Actions will include Progress Update Status - Develop measurable diversity, equity, and inclusion frameworks and assign accountability at all levels of the health system
- A Health Equity Metrics and Data Indicators Working Group has developed indicators to measure EDIRA in four areas of the healthcare system: patient experience, HHR, community/population health and health policy and programs.
- After the Health Equity Framework is released in July 2023, work will begin to assign accountability at all levels of the health system for the selected metrics and new indicators to emerge with the implementation of the framework.
- Review health policies, programs, and services to understand equity gaps and develop solutions
- Health system partner discussions are occurring through the health equity partnership table.
- Create designated African Nova Scotian health consultant positions to provide leadership and guidance in the delivery of culturally specific health services
- An African Nova Scotian health consultant was approved for the IWK in the 2023-24 budget.
- There are now African Nova Scotian health consultants at the IWK and NS Health, and an African Nova Scotian Health Equity Advisor at Department of Health and Wellness, working collaboratively on strategies for supporting the delivery of culturally specific health services to the African Nova Scotian Community in the health care system.
- Focus on keeping current healthcare workers through retention efforts and supports aimed at rebuilding the resilience of the health workforce
Actions will include Progress Update Status - Continue to engage health providers and support staff, including those who have moved within and outside of the province, on factors that influence retention
- Plans for stakeholder engagement and recruitment and retention are being developed, including an inventory of retention strategies created from stakeholder engagement, and a guide for leaders on improving staff retention for NS Health and IWK.
- Develop or enhance existing policies, strategies, and initiatives through a lens of retention, including onboarding of new hires and matching physicians to opportunities in communities that fit their lifestyle
- Paramedic Temporary License & Shift Ending Policy has been implemented, meaning paramedics are guaranteed to be released at the end of their shifts. Development of a nurse mentorship program is underway.
- IWK and NS Health are working to expand their existing nursing mentorship program.
- Level the playing field with respect to remuneration and pay family doctors at a rate that is in line with that of hospitalists
- Project planning and data gathering are underway.
Solution Three Results
We said we would invest in health equipment, technology, and infrastructure to support a safe, attractive, and healthy workplace.
We will monitor employee satisfaction scores from Nova Scotia Health and the IWK, which will provide an indicator of how well these changes are helping improve the employee experience.
The Worklife Pulse Survey asks employees: “Overall, how would you rate your organization as a place to work?” We are reporting the percentage of employees who provide a score of at least 8-out-of-10 for Nova Scotia Health and the IWK.
The Worklife Pulse Survey asks employees: “Overall, how would you rate your organization as a place to work?” We are reporting the percentage of employees who provide a score of at least 8-out-of-10 for Nova Scotia Health and the IWK.
67.4 %
IWK
42.4 %
Nova Scotia Health
We said we would focus on retaining our current healthcare workers.
We will monitor how many of the current workforce of Registered Nurses have stayed employed at NS Health and IWK for at least five years in a row. This will provide a clear picture of employment stability among this priority health profession.
89.6 %
Baseline 2021-2022
89.4 %
2022-2023
90 %
Target
We will also monitor how well the health system is able to fill necessary positions through the vacancy rate at NS Health and IWK.