AHS Performance Review Implementation Plan

Oct 13, 2020

The AHS performance review was announced on May 30, 2019, with the results of the review announced on February 3, 2020. It was the first review of its kind since AHS was formed in 2009.  There were 57 recommendations and 72 savings opportunities identified to improve the quality and long-term sustainability of health services.

AHS is implementing a portion of the recommendations, prioritizing Alberta’s COVID-19 response. The Implementation Plan proposes a multi-year road map for the implementation of sustainability initiatives across five improvement themes: People, Clinical, Clinical Support, Non-Clinical and Governance.

Initiatives stemming from the review’s recommendations that are already underway, include:

  • Moving forward with virtual care options.
  • Consolidating regional dispatch operations.
  • Development of a 30-day plan for initiatives that could start immediately, as well as a long-term implementation plan.

There will be no job losses for nurses or for other front-line clinical staff during the COVID-19 pandemic, and likely beyond. Any reduction in full-time equivalent positions will be in keeping with proactive disclosures announced in the fall of 2019.

AHS’ costs will be streamlined over the next few years to save about $600 Million dollars annually.

  • Surgical Care will be expanded through chartered facilities.
  • A minimum of 100 management positions will be eliminated and a full review of senior AHS executives will be completed before the end of the fiscal year, with previously announced contracting work continuing. Attrition will be the most utilized strategy in optimizing AHS’s workforce going forward.
  • Several services will be contracted to private operators, and currently, 68% - 70% of AHS laundry services are under contract. Laundry and lab services will be sub-contracted through RFPs, by the end of 2020.
  • AHS will proceed with developing business cases for both environmental and food preparation services in 2022 and 2023. Both business cases will be subject to review and approval by the Government of Alberta.
  • AHS will also streamline non-clinical and back office operations, including optimizing distribution and inventory management and strengthening staff scheduling and overtime management systems. Job losses will be minimized in these areas.
  • Changes will ultimately result in about 9,700 AHS positions shifting to the private sector.

CONTINUING CARE

Recommendations pertaining to Continuing Care will be implemented in light of the Continuing Care reviews currently underway in the province and expected to be completed by 2021.

CU11 LTC - Eliminate Funding Floor

The AHS Performance Review Report recommended Initiative: CU11 LTC - eliminate funding floor.

AHS will be looking at opportunities to streamline the funding system and accountabilities for long term care (LTC) operators. This initiative eliminates the funding floor that protected operators from seeing a decrease in funds provided by AHS. Eliminating the funding floor refers to the difference between actual funding and what the Patient-Care Based Funding model calculated the funding ought to be. Most operators will experience a small adjustment, and have already, or will need to adjust their staffing levels accordingly.

CU13 Optimize Home Care Contracts

This initiative strives to improve consistency, standardization and accountability related to services provided by Home Care providers. A focus will be on aligning components of our system of care and supports to ensure client-centred care in an effective, efficient and sustainable way. This work is a mechanism to achieve the desired vision per the Advancing Home Care to the Next Level draft defining the future evolution of home care.

CU10 LTC to DSL reconfiguration

This initiative is putting plans in place to transition some Long-Term Care (LTC) beds to Designated Supportive Living (DSL) beds across the province. This service adjustment intends to better align service levels to population needs and prevent overserving but maintaining health outcomes. This change is intended to increase the choices and options available to seniors and their families.

SENIORS HEALTH

Rec20, Rec22, Rec33

There are several AHS Performance Review initiatives that evaluate improvement opportunities around continuing care and seniors’ health. This includes reviewing delivery models around LTC, designated supportive living (DSL), home care, and patients in hospital settings noted to be ready for an alternative level of care. Alberta Health will be undertaking a Continuing Care Program and Services Review to understand the impact COVID-19 has had on the continuing care (CC) environment and how AHS and other CC providers can best adapt going forward to meet the changing needs of Albertans. To ensure our overall system operates efficiently, remains sustainable and continues to maintain or improve quality of life for clients and residents — including supporting people to live in their own homes, a priority for many seniors — there is a need to consider the interdependencies within these initiatives and to develop a forward-looking view that supports seniors in our new environment. The initiatives focus on growing, innovating and rightsizing the continuing care system, including associated services such as the linkages with acute care and pharmacy business models. These initiatives will support Albertans aging in the community; receiving timely and needed supports in appropriate care settings, including transforming the home care system; and introducing new costing and funding approaches in line with other provincial peers associated with the provision of home care programs and continuing care accommodation fees, while protecting low-income seniors.

All initiatives will be assessed for further direction and implementation consistent with the Public Health Continuing Care Program and Services review once the review has been completed to ensure strategic alignment with potential recommendations; this includes any potential sale of LTC assets. The seniors health and CC initiatives are spread across improvement themes with primary leadership provided through the AHS provincial Seniors Health and CC team, ensuring a co-ordinated approach (including with organizational stakeholders and various government ministries) while monitoring and evaluating overall impact to Albertans served and the continuum of care.

SHORT TERM IMPLEMENTATION AND COVID-19

The Government of Alberta has directed Alberta Health Services (AHS) to proceed carefully in implementing a portion of their plan, putting patient care above all else. Only a portion of the actions identified in the implementation plan are to proceed immediately, with implementation to consider an environment where AHS must continue to ensure it has the capacity and support needed to respond to ongoing pandemic activity. This has already resulted in some initiatives being delayed, which has impacted AHS’ ability to achieve financial targets across the next three years.

The planning process will continue with immediate next steps over the next 60 days, including:

  • Creation of a quality and access monitoring dashboard to support implementation.
  • Finalize communication and engagement plans for the release of the implementation plan with Alberta Health, and finalize communications strategy for moving forward on approved initiatives. Determine roles and responsibilities for stakeholder engagement by AHS and Alberta Health.
  • As required after approval of this plan and following the expiration of the letters of understanding with unions that provide job protection, AHS will engage union bargaining units to provide timely disclosure if necessary, to unions on initiatives expected to proceed. Union notification in accordance with collective agreement and legislative requirements on specific workforce changes will be provided as initiatives are further planned and implemented.
  • Begin support service contracting, where applicable.
  • Commence implementation of care model and delivery practice changes in acute care that allows patients to receive high-quality care in the most appropriate setting.
  • Evolve the virtual care strategy for AHS to reflect both changing patient expectations as a result of COVID-19 and the future needs of Albertans.