The CHA Advisory Committee Your leadership and guidance of the process was exceptional.

Transkript

1 Comprehensive Community Health Assessment 2010

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3 Acknodwledgements Thisreportcouldnothavebeenpublishedwithoutthe dedicatedeffortsofmanypeople.weappreciatetheefforts ofthefollowingpeoplewhohavegiventheirtime,energy andexpertisetotheinterlakeregionalhealthauthority s thirdcomprehensivecommunityhealthassessment. TheresidentsoftheInterlakeAnyonewhoattendedthecommunity discussionsorfocusgroups,allthosewhotookthetimetoparticipateinthe communitysurveyandanythattalkedaboutthechatotheirfriends,familyor neighboursbecamepartoftheprocessandwethankyouandaskforyour continuedinvolvement. StaffoftheInterlakeRegionalHealthAuthority YourparticipationintheCHA processisessential.thankyoutoallwhowereinvolvedincoordinatingand facilitatingthefocusgroupsandcommunitydiscussions.yourcontributionsare invaluable. TheCHAAdvisoryCommittee Yourleadershipandguidanceoftheprocess wasexceptional. DoreenFey KevinO Donovan ShannonMontgomery Dr.TimHilderman Dr.CaryChapnick JanO Flanagan PatOlafson KristinStewart LoriCarriere DianneMestdagh LeanaSmith DaveCain IngaBjarnason,DecisionSupportClerk,forherunwaveringdedicationand focustothisprojectandfinalreport. TheCommunityHealthAssessmentandHealthInformationManagementUnits atmanitobahealthandhealthliving. ThestaffoftheManitobaCentreforHealthPolicy. Formoreinformation,pleasecontact: TannisErickson IRHAHealthSystemsAnalysisManager PH:(204) terickson@irha.mb.ca Acknowledgements

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5 Table of Contents Chapter Page # CHA Report Indicator Index i-vi 1 Introduction 1 2 Regional Accomplishments Who We Are What keeps Us Healthy? (Determinants of Health) How Healthy Are We? (Population Health) How Well Does the Health System Meet the Needs of the Population? (Health System Performance) What does the Health System Look Like? Health System Characteristics What we have learned (Priority Areas & Recommendations) Appendices 183 List of Figures and Tables 199 References 203 Table of Contents

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7 CHA Report Indicator Index Community Health Assessment (CHA) reporting requirements state that each Regional Health Authority (RHA) must include core indicators in their CHA report. All other indicators are reported at the discretion of the RHA. The following list summarizes the indicators that are included in this report. *the core indicators are indicated in bold type in the following index and include the page numbers where they can be found. **additional indicators are indicated in normal type in the following index and include the page numbers where they can be found. Some of the optional indicators found in the following list have not been included in this report. Category Ref. No. A. Well-Being A-1 Core vs Non-Core vs Other Indicator Name Dimension: Population Health Page Numbers Where Indicator Reported B. Functional Status C. Health / Social Conditions B-1 Non-Core Activity Limitation B-2 Core Self-rated Health 76 B-3 Core SF36 - Functional Physical Health 76 B-4 Core SF36 - Functional Mental Health 76 B-5 Other C-1 Non-Core High Birth Weight C-2 Non-Core Low Birth Weight C-3 Other Birth Weight Prevalence of: AHD, ADHD, Disabilities, Congenital Heart Defects C-4 Core Preterm Birth Rate 78 C-5 Other Size for Gestational Age 88 C-6 Core Arthritis Treatment Prevalence 79 C-7 Core Osteoporosis 79 C-8 Non-Core Asthma Prevalence C-9 Core Total Respiratory Morbidity Treatment Prevalence 80 C-10 Core Cancer Incidence 80 C-11 Non-Core Cancer Prevalence 162 C-12 Other Diabetes Incidence 162 C-13 Core Diabetes Treatment Prevalence 81 C-14 Non-Core Lower Limb Amputation due to Diabetes 82 C-15 Core Hypertension Treatment Prevalence 82 C-16 Non-Core Acute Myocardial Infarction (AMI) Incidence Rates 83 C-17 Core Ischemic Heart Disease Treatment Prevalence 82 CHA Report Indicator Index i

8 C-18 Core Stroke Incidence Rates 83 C-19 Core Injury Hospitalization Rates 83 C-20 Other Hip Fracture Incidence Rate C-21 Other Injury Hospitalization or Death C-22 Core Treatment Prevalence of: Mental Illness Cumulative Disorder C-23 Core Treatment Prevalence of Depression 84 C-24 Core Treatment Prevalence of Anxiety Disorders 85 C-25 Core Treatment Prevalence of Substance Abuse 85 C-26 Core Treatment Prevalence of Personality Disorder 85 C-27 Core Treatment Prevalence of Schizophrenia 86 C-28 Core Treatment Prevalence of Dementia C-29 Core C-30 Non-Core Proportion of Adolescents / Teenagers on SSRIs & stimulants Communicable Disease Outbreaks for: - E Coli - Salmonella - Shigella 87 C-31 Non-Core Cultural Indicators C-32 Other Children in Care C-33 Other C-34 Other Prevalence of children in families receiving protection or support services from CFS Treatment Prevalence for: -Infertility, Renal Failure, Inflammatory Bowel Disease D. Mortality D-1 Non-Core Total Mortality Rate 92 D-2 Core Infant Mortality 93 D-3 Other Top 5 Causes of Infant Mortality D-4 Other Child Mortality D-5 Non-Core Top 5 Cancer Mortalities D-6 Non-Core Injury Mortality Rates 94 D-7 Non-Core Injury Causes of Hospitalization D-8 Other Causes of Hospitalization and Death due to Injury D-9 Core Unintentional Injury Deaths 94 D-10 Core Suicide Rates 95 D-11 Other Suicide or Suicide Attempt Rates D-12 Core Life Expectancy 91 D-13 Core Top 5 causes of Mortality 92 CHA Report Indicator Index ii

9 D-14 Other Top 10 causes of Mortality D-15 Core Premature Mortality Rates 91 D-16 Non-Core Top 10 causes of premature mortality D-17 Other Mortality Rates for Women with Diabetes D-18 Non-Core D-19 Non-Core Mortality Rate Comparisons of those with and without: -hypertension -arthritis -total respiratory morbidity (TRM) -diabetes -ischemic heart disease (IHD) -cumulative mental illness (CMI) -osteoporosis (50 + years) Premature Mortality Rate Comparisons (of those who have or do not have mental illness disorders) 93 D-20 Non-Core Potential Years of Life Lost (PYLL) due to all deaths D-21 Non-Core D-22 Non-Core D-23 Non-Core D-24 Non-Core Potential Years of Life Lost (PYLL) due to all cancer deaths All Circulatory Disease Deaths Potential Years of Life Lost (PYLL) All Respiratory Disease Deaths Potential Years of Life Lost (PYLL) Unintentional Injury Deaths Potential Years of Life Lost (PYLL) D-25 Non-Core Suicide Potential Years of Life Lost (PYLL) Dimension: Determinants of Health and Social Well Being E. Health Behaviours E-1 Core Body Mass Index (International Standard) 52 E-2 Core Nutrition: Fruit and Vegetable Consumption 53 E-3 Non-Core Frequency of Heavy Drinking E-4 Core Smoking 53 E-5 Core Leisure-time Physical Activity 54 E-6 Other Women meeting Canada's Physical Activity Guide (PAG) E-7 Non-Core Breastfeeding Practices (initiation) E-8 Core Childhood Immunization Rates: -1 year olds -2 year olds -7 year olds 61 E-9 Core Adult Influenza Immunization Rates 62 E-10 Core Adult Pneumococcal Immunization 62 E-11 Other Reproductive Health years: sexual activity; condom use; birth control pill use CHA Report Indicator Index iii

10 E-12 Other Age at first pregnancy E-13 Core Sexually Transmitted Infections: Chlamydia 62 E-14 Core Sexually Transmitted Infections: Gonorrhea 62 E-15 Core Sexually Transmitted Infections: HIV 62 E-16 Core Breast Cancer Screening (Mammography) 63 E-17 Core Cervical Cancer Screening (PAP Smears) 63 E-18 Non-Core Complete Physical Exam E-19 Non-Core Pharmaceutical Use E-20 Other Number of Different Prescription Drugs Per User E-21 Non-Core Antibiotic Use E-22 Non-Core Antidepressant Use E-23 Other Prescription Drug Use by Children E-24 Other -Statin Use -ACE Inhibitors Use F. Socio- Economic Conditions F-1 Other Socio-economic Factor Index (SEFI) Score F-2 Core Income Inequality: Income Status (LICO) 64 F-3 Core Income Inequality: Median income of Individuals & Households F-4 Non-Core Income - Average Household Income 65 F-5 Other Family receipt of income assistance F-6 Non-Core Labor Force Participation Rate F-7 Non-Core Occupation 32 F-8 Non-Core Percentage of Population Scoring High on Work Stress Scale F-9 Core Unemployment Rates 66 F-10 Non-Core Youth Unemployment 66 F-11 Non-Core High School Completion 89 F-12 Core Education Level 67 F-13 Core Housing - Housing Affordability 68 F-14 Non-Core F-15 Non-Core F-16 Non-Core Number of Supported Living Beds (community housing 55+) Number of Assisted Living Beds (community housing 55+) Number Independent Senior Living Beds (community housing 55+) F-17 Non-Core Adolescent / Teenage Pregnancy Rates 88 F-18 Core Teen Birth Rates 68 CHA Report Indicator Index iv

11 G. Environmental Factors G-1 Core Second-hand Smoke Exposure 69 G-2 Non-Core Number and length of Boil Water Advisories or Orders 70 G-3 Non-Core Any other Environmental Factors of Significance 69 H. Personal Resources H-1 Non-Core Life Stress 76 H-2 Non-Core Life Satisfaction H-3 Non-Core Social Support: Living Arrangements H-4 Non-Core Social Support: Marital Status H-5 Other Licensed child care spaces H-6 Core "Readiness for School" Indicators from "EDI" 70 H-7 Other General information on kindergarten children from: EDI" results H-8 Non-Core School Retention Rates 71 H-9 Core School Changes 70 H-10 Non-Core Grade 12 Standards Exam Performance: - Language Arts - Maths Dimension: Governance (RHA Governance for CHA) 70 I. Stewardship I-1 J. Leadership J-1 Non-Core New Programs/Services or program/service revision as a result of findings of 2004 CHA K. Accountability K-1 L. Responsibility L-1 M. Population Focus M-1 Dimension: Health System Performance N. Accessibility N-1 Core Operational Hospital Beds per 1000 Residents 100 N-2 Non-Core Acute Care Occupancy 101 N-3 Non-Core Data from Crisis Mobilization Units / Programs 144 N-4 Non-Core Number of Community Health EFT N-5 Core In & Out Flow of RHA Inpatients 100 N-6 Core Use of Physicians 103 N-7 Core Ambulatory Visit Rate 103 N-8 Core Ambulatory Consultation Rates 104 N-9 Non-Core Ambulatory Visit Rate to Specialists 104 CHA Report Indicator Index v

12 N-10 Core Where RHA Residents went for visits to GP/FPs 104 N-11 Core Where RHA Residents went for visits to Specialists N-12 Other Travelling to Give Birth N-13 Core Families First Program Risk Factors, i.e. the % of families with newborns: -with 3 or more risk factors -alcohol use by mother during pregnancy -maternal smoking during pregnancy -maternal depression and anxiety disorders combined -income support or financial difficulties -mother with less than grade 12 education. N-14 Core Screening For and Use of Families First Program 105 N-15 Core Supply of PCH Beds 102 N-16 Other Admissions to PCH N-17 Non-Core Residents in PCH by RHA N-18 Non-Core N-19 Non-Core Median Length of Waiting Time Before Admission to PCH, from hospital Median Length of Waiting Time Before Admission to PCH, from community N-20 Non-Core EMS Response Time 106 N-21 Non-Core Wait Time for Home Care N-22 Non-Core Wait Time for Diagnostic Procedures: - Ultrasound - MRI - CT Scans - Angiograms N-23 Non-Core Wait Time for Community Programs / Rehab Services 107 N-24 Non-Core Primary Health Care Initiative Programs N-25 Non-Core Translation & Interpretive Services N-26 Non-Core Response Time to Requests for Access to Patient Charts under PHIA N-27 Non-Core Reviewed and Revised Corporate Policies O. Safety O-1 Non-Core Staff Flu Immunization 121 O-2 Other Polypharmacy Rates for Community-Dwelling Seniors O-3 Non-Core Themes of Critical Incidents P. Work Life P-1 Non-Core Organizational Chart 198 P-2 Non-Core Staff Orientation 117 P-3 Non-Core Job Descriptions 117 P-4 Non-Core Performance Management Process CHA Report Indicator Index vi

13 P-5 Non-Core Teamwork Process for Planning 117 P-6 Non-Core Staff Participation on Internal Committees 117 P-7 Non-Core Regular Staff Meetings P-8 Non-Core Staff / Management Committees P-9 Non-Core Internal Newsletters P-10 Non-Core Information Resources P-11 Non-Core Staff Education Budget 119 P-12 Non-Core Staff Education Activities 118, 119 P-13 Non-Core RHA Support of Employees' Professional Competency Requirements P-14 Non-Core Family Friendly Workplace P-15 Non-Core Subsidized Health Related Programs P-16 Non-Core Workplace Wellness Initiatives 120 P-17 Non-Core Number of WCB Claims 119 P-18 Non-Core Staff Satisfaction Survey P-19 Non-Core Staff Turnover Rate P-20 Non-Core Exit Interviews / Surveys Q. Client-Centered Services Q-1 Non-Core Annual General Meeting (AGM) Q-2 Non-Core Easily Accessible Information on Services by Community Q-3 Non-Core PHIA Training (staff, volunteers & students) 131 Q-4 Non-Core Participation in Planning & Delivery of Programs/Services 117 Q-5 Non-Core Spiritual Care Services Q-6 Non-Core Palliative Care Services 143 Q-7 Non-Core Respite Care Services Q-8 Non-Core Promotion & Support of Corporate & Employee Involvement in Community Events Q-9 Non-Core Results of RHA-Initiated Client Satisfaction Surveys Q-10 Non-Core Complaint Management Process R. Continuity of Services R-1 Core Continuity of Care 124 R-2 Core Anti Depressant Prescription Follow Up 124 R-3 Other Asthma Care: Controller Medication R-4 Other Diabetes care: eye exams R-5 Other Potentially inappropriate prescribing benzodiazepines for older adults CHA Report Indicator Index vii

14 S. Efficiency S-1 T. Effectiveness T-1 Core Ambulatory Care Sensitive Conditions 125 T-2 Non-Core Post Myocardial Infarction Care: Beta-Blockers T-3 Non-Core 30-day In Hospital AMI Mortality Rate. T-4 Non-Core 30-day In Hospital Stroke Mortality Rate T-5 Non-Core 365 Day net Survival Rate for AMI T-6 Core Cancer Survival Rates: - all cancers - melanoma - colorectal - breast - cervical - prostate - lung T-7 Core Re-admission Rate for Acute Myocardial Infarction 126 T-8 Other Hospitalization Rates: -for infant readmission -for immunizable / preventable infections T-9 Core Caesarian Section 126 T-10 Core Vaginal Birth after Caesarian Section 127 T-11 Non-Core Mid-Wifery T-12 Other All inductions of labour T-13 Other Any analgesia / anesthesia during birth T-14 Other Assisted vaginal birth T-15 Other Maternal hospital readmissions T-16 Core Hysterectomy 127 T-17 Core Tonsillectomy/ Adenoidectomy 128 T-18 Other Dental extractions T-19 Non-Core Health Links Contact Dimension: Health System Characteristics U. Demographics U-1 Core Population Attributes - Population U-2 Core Population Pyramids 29, 30, 34, 37, 40, 43 U-3 Core Population Projections 32, 33 U-4 Core Population Attributes - Dependency Ratio U-5 Core Population Attributes - Aboriginal Population (by region) 31 U-6 Core Population Attributes - Lone-parent Families 31 CHA Report Indicator Index viii

15 U-7 Core Population Attributes - Language Spoken in the Home U-8 Core Internal / External Migration 31 U-9 Core Geographic Attributes - Internal Migrant Mobility U-10 Core Geographic Attributes - Urban Population 31 U-11 Core Geographic Attributes - Population Density 31 V. Utilization V-1 Core Physician Visit Rates by Top 10 Causes 133 V-2 Core V-3 Other Physician Visits 'for' Mental Illness Disorders: - from acute care hospitals - from mental health centers Physician Visit Rates by Causes by Physician Specialty V-4 Core Total Hospital Separation Rates 134 V-5 Other V-6 Other V-7 Core Hospital Separation Rates: -For Short Stays -For Long Stays Hospital Separation Rates: -For Inpatient Care -For Day Surgery Separations for Mental Illness Disorder, from: -acute care hospitals -mental health centers V-8 Non-Core Separations by Cause V-9 Non-Core Total Hospital Days Used V-10 Core V-11 Non-Core V-12 Other V-13 Non-Core Hospital Days Used: -For Short Stays -For Long Stays Population-based Prevalence of Individuals in contact with MHMIS High Profile Procedures: Computed Tomography (CT) Scans High Profile Procedures: Magnetic Resonance Imaging (MRI) Scans V-14 Core High Profile Procedures: Cataract Surgery 139 V-15 Core High Profile Procedures: Hip Replacement Surgery 138 V-16 Core High Profile Procedures: Knee Replacement Surgery V-17 Core High Profile Procedures: Cardiac Catheterization 137 V-18 Other High Profile Procedures: Angioplasty Rates V-19 Other High Profile Procedures: Coronary Stent Insertion Rates V-20 Core Percutaneous Coronary Intervention Rates , CHA Report Indicator Index ix

16 V-21 Core High Profile Procedures: Coronary Artery Bypass Graft (CABG) Surgery V-22 Core Home Care: New Cases ("Incidence") 141 V-23 Core Home Care: Open Cases ("Prevalence") 142 V-24 Core Home Care: Case Closing Rates 142 V-25 Core Home Care: Average Length of Home Care Cases 141 V-26 Other Home Care Days Used V-27 Core PCH Utilization: Level of Care on Admission 143 V-28 Core PCH Utilization: Median Length of Stay at PCH, by level of care W. Human Resources W-1 Non-core Position Vacancy Rate W-2 Non-core Length of Time Position is Vacant W-3 Non-core Staff Education Needs Assessment W-4 Non-core Career Advancement W-5 Non-core Successor Planning, including gender analysis W-6 Non-core Program Inventory W-7 Non-core Volunteer Contribution X. System Capacity X-1 Non-core Regional description of public health surveillance systems X-2 Non-core Regional Research Relative to Population Health X-3 Non-core Regional Capacity to Conduct Research X-4 Non-core Staff/Management Ratio X-5 Non-core Management and Leadership Training 151 Y. Fiscal Y-1 Core Percent Operating Budget Spent on: - Acute - PCH - Community Costs 132 Y-2 Non-core Percent operating budget spent on Administration 132 Y-3 Non-core Information System Costs 132 Y-4 Non-core Total Medical and Surgical Supply Costs 132 Y-5 Non-core Patient Medical and Surgical Supply Costs 132 Y-6 Non-core Resident Medical and Surgical Supply Costs 132 Y-7 Non-core Total Food Services Costs Y-8 Non-core Drug Costs Per Patient Day 132 Y-9 Non-core Drug Costs Per Resident Day 132 Y-10 Non-core Average Cost per Person CHA Report Indicator Index x

17 Y-11 Non-core Percent of Expenditures -Manitoba compared to other Provinces Y-12 Non-core Percent spent on programs per program area Z. Information Technology AA. Physical Structure & Equipment Z-1 Non-core IT Strategic Plan 152 Z-2 Non-core Percent Budget Spent on IT Support Z-3 Non-core Allocated IT Funding AA-1 Non-core Physical Structure and Equipment by Priority Area 152 BB. Other BB-1 BB-2 BB-3 BB-4 BB-5 CHA Report Indicator Index xi

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19 Chapter 1 - Introduction HealthyPeople HealthyCommunities What is a Community Health Assessment? ACommunityHealthAssessment(CHA)identifiesandmeasuresthehealthstatusof thepopulationofagivenhealthauthority.itisadynamic,ongoingprocessundertaken toidentifytheassetsandneedsofthecommunity,toenablethecommunitywide establishmentofhealthpriorities,andtofacilitatecollaborativeactionplanningdirected atimprovingcommunityhealthstatusandqualityoflife. CHAisanongoing processtoidentify thestrengthsand needsinthe communityinorder tofacilitatethe establishmentof prioritiesthat improvethehealth statusofthe population. CHAincludesthreedimensions: Itisatechnicalprocess,becauseitusesanalyticaltoolsand technologiestogenerateandevaluateevidence. Itisasocialprocess,becauseitinvitesparticipationfrom citizensandhealthcareprovidersindecisionmaking. Itisanethicalprocessbecauseitdealswithissuesofthe worthofhealthandlife,societalfairnessandresource priorities. CHAisafoundationalprocessinourprovincethatstrivestoensureaccountabilityin thehealthsystemasatoolforhealthplanning,andtoensureresponsiveness.cha activitiesinvolvemeasuring,monitoringandreportingonthehealthstatusofthe population,whileexaminingcontributoryfactorstohealthorhealthdisparity.cha thusstrivestoensureaccountabilityinthehealthsystem. Chapter 1 Introduction Page 1 of 203

20 PopulationHealthPerspective CHAisbestunderstoodandconductedwithinthepopulationhealthperspective. Populationhealthdescribesanapproachtoimprovinghealththatfocusesonthehealth ofcommunitiesorpopulations.itexaminesfactorsthatenhancethehealthandwell beingoftheoverallpopulation.fromthispointofview,healthisdefinedas: theextenttowhichanindividualorgroupisabletosatisfyneeds,realizeaspirations,andto changeorcopewiththeenvironment.healthisthereforeseenasaresourceforeverydaylife,not theobjectiveofliving;itisseenasapositiveconceptemphasizingsocialandpersonalresources, aswellasphysicalcapacities. (OttawaCharterforHealthPromotion,WorldHealthOrganization,Geneva,1986). Thepopulationhealthapproachisaimedatpositivelyinfluencingconditionsthat enablepeopletomakehealthychoicesandservicesthatpromoteandmaintainhealth. PurposeofaCommunityHealthAssessment ThepurposeofaCHAistocollect,analyzeandpresentinformationsothatthehealth ofthepopulationcanbeunderstoodandimprovedandthathealthservicescanbe plannedaccordingtoevidence.theinformationfromthechahelpsto: Providebaselineinformationaboutthehealthstatusofcommunityresidents(i.e.the patternsofhealth,illness,injuryandthedifferencefrom community,regional,andprovincialtrends) Acommunityhealth Encouragecollaborationwithcommunitymembers,stakeholders assessmentprovides andawidevarietyofpartnerswhoareinvolvedinthedecision astructuredand ongoingprocessto makingprocesseswithhealthcaresystem linkhealthneeds Focuspublicdiscussiononhealthissuesandexpectationsofthe withtheresources healthsystemandincreaseunderstandingaboutdifficultchoices availabletoachieve thatneedtobemadei.e.servicepriorities,resourceallocation positivehealth outcomes. Provideinsightintothefundamentalcausesandpathwaysof diseaseandillhealthandprovidepopulationbasedinformationtoidentify opportunitiesfordiseaseprevention,healthpromotionandhealthprotection Influencehealthsystemdecisionsandprioritiestobeinformedbyevidence Assesshealthoutcomesandresultsinthelongerterm Provideinformationonwhichtobasefundingallocations Guidepolicyandprogramdevelopment Assistinmappingoutlinksandopportunitiestocollaboratewithothersectors Chapter 1 Introduction Page 2 of 203

21 The Community Health Assessment Process AroadmaptonavigateCHAiscreatedbyestablishingaprocessfortheactivities.A processhelpstoensurethatthechacanbeaccomplishedwithintheavailabletime andresources.developingachateamwithvariedstakeholderinvolvementisakey foundationtotheprocess.ensuringthatappropriatepeopleareawareof,andinvolved with,theprocesshelpstoincreasetheopportunitiesforchatobesupported,andfor findingstobeintegratedintothecommunity/healthregion. ACommunityHealthAssessment consistofeightsteps,whicharein turnembeddedintofive contextualconsiderations.the entiremodelispredicatedonthe assumptionthatconsultation withrelevantstakeholdersand communitymembersoccurs alongsidethesesteps.for example,manyhealthauthorities setupregionalcommunity HealthAssessmentCommittees withbroadrepresentationfrom variousstakeholders. Figure1.1 ENGAGE WITH COMMUNITY & STAKEHOLDERS Determine the Purpose Determine the geographic scope Determine the population Determine who should be involved CHA CORE STEPS 1. Decide what information is needed 2. Review existing information 3. Gather new information 4. Analyze the information to identify needs and strengths in communities 5. Select priorities from the needs identified 6. Invite feedback from community and stakeholders 7. Share and facilitate use of CHA findings 8. Evaluation of the CHA process AdditionalinformationoneachoftheseeightstepscanbefoundintheCommunity HealthAssessmentGuidelines2009(1). ThestepsthattheIRHAtookinconductingits2009CHAwere: EstablisharegionalAdvisoryCommittee TheAdvisoryCommitteewasmadeupofstafffromacrosstheregion (representingprogramareassuchasmedicine,nursing,publichealth, Chapter 1 Introduction Page 3 of 203

22 healthpromotion,seniorsservices,planning,education,andpublic relations)andcommunityrepresentatives Developacommunicationplanthatincludesobjectives,stakeholders,messagesand timelines MeetingoftheregionalAdvisoryCommitteeheldtobrainstormonissues/questions thattheregionanditspopulationwerecurrentlyfacing Identifydatasourcescurrentlyavailableandreviewexistingdata Analyzeavailablequantitativedatatodetermineemerginghealthissues Determinewhatthedatagapswerebasedontheissuesidentifiedandhowthese gapswouldbefilled Collectadditionaldataasrequired(othersourcesofquantitativedata,community survey,focusgroupsandcommunityforums) Analyzealldatacollectedtodetermineemerginghealththemes Conductaprioritysettingexercisetodetermineregionalhealthpriorities Developrecommendationsbasedonthesepriorities PresentrecommendationstotheBoardintheformofaCHAreport(tobeused duringtheirstrategicplanningprocess) Presentfindingstoregionalmanagementtoassistinevidencebaseddecision makingandprogramplanning Developplansforongoingmonitoringandevaluationofpopulationhealthinthe Interlake Initial Topics Identified Requiring Further Study TheresultoftheinitialworkdonebytheAdvisoryCommitteeledtoapreliminary prioritylistofquestionsthatwouldrequirefurtherstudy.theyareasfollows: Seniors InformationtosupporttheAginginPlaceModel EarlyChildhoodFocus(0 5years) Howhealthyareourchildren? HealthofIRHAstaff Chronicdiseaseriskfactors Chronicdisease Chapter 1 Introduction Page 4 of 203

23 Riskfactors Diseaserates Francophonepopulation Healthstatus Women shealth Accesstoservices ERutilization AppropriateuseofER Mentalhealthclients/families Mentalhealthfocusonstress Healthsystemperformance Accessibility Determinantsofheath Whatkeepsyouhealthy? Whentheseissuesandquestionswereidentified,areviewwasundertakento determinewhatinformationwascurrentlyavailableandwhatinformationwasstill neededinordertofullyunderstandthem.themainquantitativedatasourcesthatwere reviewedwere: RHAAtlas2009(ManitobaCentreforHealthPolicy) InterlakeRHAProfile(ManitobaHealthandHealthyLiving) IndicatorsfromvariousStatisticsCanadasurveys Census2006 CanadianCommunityHealthSurvey Internallycollectedregionalstatistics Utilizationinformation YouthHealthSurvey(2005&2009) CommunityHeathSurvey(2007) Informationgapswerethenidentifiedandaprocesswasestablishedforcollectingthis missinginformation.themissinginformationwasobtainedbyadditionalquantitative dataanalysisandaseriesofcommunityconsultations.theirhaconductedastaff healthsurvey,acommunityhealthsystemperformancesurvey,atotalof24focus groups,anerchartauditandaphotovoiceproject. Chapter 1 Introduction Page 5 of 203

24 Focusgroupdiscussionsconductedacrosstheregionscoveredthefollowingtopics: Mentalhealth Children(0to5years) Stress Women shealth Seniorshealth Francophonehealth CommunityWellness Communitydiscussionswereheldin12communitiesintheregionduringwhich preliminaryinformationfromthechawaspresented,generalhealthinformationwas displayedandfurtherdatacollectionwasundertaken(healthsystemperformance survey seeappendixb). Theresultsofthereviewofthesepriorityareaswillbefoundinthefollowingchapters ofthisreportwhereappropriate.copiesofthefocusgroupquestionsandthesurveys usedcanbefoundintheappendicestothisreport. Chapter 1 Introduction Page 6 of 203

25 Data Sources Used ManysourcesofdatawereaccessedandanalyzedduringthecourseofthisCHAand arelistedbelow. Internal Departmentalstatisticalreports Utilizationandpatientactivitydata ContinuousImprovementindicators Indicatorscoveringresponsiveness,systemcompetency,client/community focus,andworklife ERChartAudit Communitylevelriskfactorsurveillance YouthHealthSurvey 2005&2009 CommunityHealthSurvey2007 External ManitobaHealth InterlakeRegionalProfileDocument o IndicatorscoveringHealthStatus&Determinants,HealthSystem Performance,HealthSystemInfrastructureandCommunity& HealthSystemCharacteristics DiabetesReport InjuryUpdate ManitobaCentreforHealthPolicy RHAIndicatorsAtlas&OtherReports o IndicatorscoveringHealthStatus&Determinants,HealthSystem Performance,HealthSystemInfrastructureandCommunity& HealthSystemCharacteristics StatisticsCanada 2006Censusdata CanadianCommunityHealthSurvey(CCHS) Chapter 1 Introduction Page 7 of 203

26 CommunityConsultations FocusGroups Women shealthissues FrancophoneHealth MentalHealth Stress Children0to5yearsold CommunityWellness PhotovoiceProjects CommunityDiscussions 12CommunityDiscussionswereheldacrosstheregionduringwhich informationfromthechawaspresented,generalhealthinformationwas displayedandfurtherdatacollectionwasundertaken: o CommunitySurveyonHealthSystemPerformance o StaffSurveyonChronicDiseaseRiskFactors Manitoba s Health Performance Framework Aperformanceframework,collaborativelydevelopedbyManitobaHealthandHealthy LivingandManitoba sregionalhealthauthorities,wasusedtoorganizetheindicators thatweretobeincludedinthehealthassessmentandthequestions/issuesthatwere identified.thepurposeofusingtheperformanceframeworkistohaveanorganized methodofpresentingthehealthindicatorsandissuesunderreview.theperformance frameworkwithindicatorsisincludedasappendixa. Chapter 1 Introduction Page 8 of 203

27 Interlake RHA Planning Process ThedataobtainedthoughtheCHAprocessbecomespartoftheoverallregional planningprocessasillustratedbelow. Figure1.2 Monitor and review health plan progress annually New information is collected Community Health Assessment Planning teams Planning Partners Strategic Plan is developed Implementation of the Health Plan Health Plan developed & submitted to Manitoba Health Staff & Health Partners Community Board & Executive Consultation process with planning partners ongoing Teams use the information to formulate annual steps to accomplish strategic plan directions Severalstepsareinvolvedintheoverallplanningcycleoftheregion.Astrategic planningprocessoccurseveryfiveyearswithannualupdatesprovidedforthe operatingplan.theregioninvolvesmanypeopleinitsplanningprocess,suchasstaff andhealthpartners,thecommunitytheirhaboardofdirectorsandsenior management. Chapter 1 Introduction Page 9 of 203

28 CHA Activities since 2004 ThecurrentCHAprocessrepresentsthethirdcomprehensiveassessmentundertakenby theirha.thefirsttookplacein1998andthesecondin2004.duringtheintervening yearstherehasbeenongoinganalysisandassessmentactivitiestakingplace.the followinglistofreportsrepresentsstudiesconductedsince2004: AnimalExposureReport MentalHealthReport ReportontheMiniRuralHealthDay ChronicDiseaseandInjuryPreventionintheInterlake InterlakeYouthHealthSurveyReport2005 Plus38schoollevelreports CommunityHealthSurveyReport2007 Plus6communitylevelreports InterlakeYouthHealthSurveyReport2009 Schoollevelreportstobereleasedin2010 Chapter 1 Introduction Page 10 of 203

29 Chapter 2 - Regional Accomplishments: 2005 to 2009 Anumberofpopulationhealthrecommendationsweremade inthe2004chareport.theserecommendationswere presentedtotheboardtobeusedasthefoundationfortheir strategicplanningactivitiesof2005/2006. Developmentof6strategicprioritiesresultedfromtheseBoardplanningactivities.These strategicprioritiesservedtoguidetheplanningactivitiesandprovisionofhealthservices overthefollowingfiveyears.the strategicprioritieswere: Strategic priority #1 Integrated Primary Health Care Model DevelopmentandimplementationofanInterlakeRHAPrimaryHealthCareModelthat encompassesappropriatedeliverymethodstoensureaccessibilityandsustainability. Strategic priority #2 Population Wellness & Disease Prevention Healthprogramsthatfocusonpopulationwellnessanddiseaseprevention,includingthe physical,social,andmentaldimensionsofhealthareanintegralcomponentoftheservices offeredintheinterlake. Strategic priority #3 Appropriate, Accessible and Sustainable Resources Provisionofappropriateandaccessiblehuman,financialandinformationresourcesto supportandsustainourhealthprogramsandservices Strategic priority #4 Engaged Community and Stakeholders Effectivecommunitypartnershipsexistingthroughaninclusive,twowayprocessof communicationandinteractionwithstaff,healthpartners,stakeholdersandthe communitywithafocusonatriskpopulations. Strategic priority #5 Socially Responsible Health (retired in 2006/07) Initiativesandcommunitypartnershipspositivelyimpactingthesocioeconomic determinantsofhealth(income,employment,status,socialsupports, housing,educationandtheenvironment).thisstrategicpriority wasretiredin2006/07bytheirhaboardandsomecomponents wereintegratedintostrategicpriority#2and#5. Strategic priority #6 Provide a Safe Healthcare Environment Providequalityhealthprogramsandserviceswhicharesafeand effectiveforclientsandstaffoftheinterlake. Therehasbeenconsiderableworkundertakeninthesestrategicpriorities overthepastfiveyears.someofthemajoraccomplishmentsareasfollows. Chapter 2 Regional Accomplishments Page 11 of 203

30 Strategic Priority #1 Integrated Primary Health Care Model DevelopmentandimplementationofanIRHAPrimaryHealthCareModelthat encompassesappropriatedeliverymethodstoensureaccessibilityandsustainability. Thisprioritywasdevelopedbasedonrecommendationsmadetofurtherexplorechronic diseasepreventionandhealthpromotion.preventionactivitiesdirectedtothefollowing weresuggested: 1.Primary(activitiestocombatriskfactorsforillnessbeforeanillnesseverhasa chancetodevelop) 2.Secondary(activitiesdesignedtosloworstoptheprogressofadiseaseduringits earlystagesandtopreventothercomplicationsfromarising) 3.Tertiary(activitiesdesignedtosloworstoptheprogressofadiseaseduringits advancedstages)activities. TheIRHAhasachievedthefollowingaccomplishmentsinthisarea: DevelopmentofanInterlakePrimaryHealthCare(PHC)modelwhichwasapproved byirhaboardofdirectors(2005/2006) RivertonCommunityHealthCenterbuiltandopenedasaPrimaryHealthClinic PHCImplementationPlanandpoliciesdevelopedandapproved(2007/08) TwopermanentNursePractitioner(NP)positionsdeveloped(LundarandRiverton) SelkirkTeenclinicdevelopedusingthePrimaryHealthCaremodelandopenedinthe SelkirkJuniorHighSchool(2007) ProposalforNursePractitionerfundingapproved,unabletofillpositionatthistime FormalEvaluationofNursePractitionerprojectfundedbytheFederalPrimaryCare TransitionFund PHCmodelintegratedwithNewCommunityWellnessprogram PHCmodelpresentedatallRegionalDiabetesWorkshops(2008) Chapter 2 Regional Accomplishments Page 12 of 203

31 Strategic Priority #2 Population Wellness & Disease Prevention Healthprogramsthatfocusonpopulationwellnessanddiseaseprevention,includingthe physical,social,andmentaldimensionsofhealthareanintegralcomponentoftheservices offeredintheinterlake. Thisprioritywasdevelopedbasedonthefollowing2004CHAReportrecommendations: ChronicDiseasePreventionandHealthPromotionspecificallyconcerningthe3major riskfactorsofobesity,physicalactivityandsmoking Developmentofadditionalavenuesforcommunicationandeducationonprevention activities;developmentofaspecificstrategyforteen/youthhealthpromotionbasedon theiridentifiedissues Recommendationsaroundeducationandprogramsforseniors;workingwith communitiestoenhanceindependentliving/housingandsocializationaswellas focusingonpreventionprogramswereaddressedhere TheIRHAhasachievedthefollowingaccomplishmentsinthisarea: ChronicDiseasePreventionInitiative(CDPI) CDPIisafiveyearprojectfundedbyPublicHealthAgencyandManitobaHealthto enhancehealthylivinglocally CDPIprogramsestablishedin4communities:Lundar/Eriksdale,Riverton/Arborg, SelkirkandLittleSaskatchewanFirstNation Numerouscommunityinitiativeshavebeenimplementedtopromotehealthyliving RiskFactorSurveillance YouthHealthSurveycompletedinmostInterlakeschools.Thesurveywascompleted by85%ofallgrade612studentsintheinterlake.theirhaisaleaderintheprovince withrespecttolocalriskfactorsurveillance YouthHealthSurveyreportscompletedanddistributedtoeachschool,alsoaRegional Reportwasprepared CDPICommunitiesusedYouthHealthSurveyreportsandanevidencebased planningprocessduringworkshopstoplanlocalactivities CommunityHealthSurvey(Adult)mailoutsurveyrandomlydistributedin3CDPI communitiesand3controlcommunities.reportspreparedandusedforplanning healthylivingprograms FederalgrantfundingwasreceivedtoreviewtheYouthHealthSurveytooland methodologyinpreparationforresurveyinspring2009(2007/08) Chapter 2 Regional Accomplishments Page 13 of 203

32 CCHSAidentifiedourYourHealthSurveyasa BestPractice whichisanational distinction(2008) MobileWellness Establishedin2005andeventshavebeengrowingannually SuicidePrevention Forumsheldin2006,2007.StaffandpartnerstrainedinSuicideprevention(ASSIST) programwhichoccursannually Nutrition HealthyChoicesNutritionGroupformed(2006),preparedresourceinventoryfor IRHAwebsite,assistedschooldivisionswithnutritionpoliciesandisworkingwith EvergreenSchoolDivision HealthySchoolscommittee.Twoworkshopswereheldfor communitystakeholders(2006/07) FourNutritionWorkshops( FoodforThought )hostedin4cdpicommunities.each workshopservedasacatalystforfurtheractionandevaluationwillbedoneinspring (2007/08) SelkirkandAreaWorkplaceWellnessCommitteepilotedaworkplacenutrition effectivepracticewithheart&strokefoundationofmanitobadietitians(2007/08) PhysicalActivity 3ActiveLivingFacilitatorTrainingEvents(2006) ContinuingeducationsessionforpeopletrainedinFallsPrevention(2007/08) (ALCOA)ActiveLivingCoalitionforOlderAdultsoffersspeakersbureautrainingfor fallsprevention(2008) 5staffattendedProvincialFallsPreventionForum(2007) FallsPreventionplandeveloped(2007) SmokingCessation SmokingcessationprogramsraninGimliforhealthstaff(2006/07) LungsareforLifesessionheldthroughouttheyearinelementaryschools( ). LakeManitobaFirstNationhostedsessionin2007 MANTRAsuccessfulinsmokingcessationfundingproposal(IRHApartner)(2008) IRHASmokingpolicydraftedbyTobaccoTaskGroup(2008)andimplemented(2009) Chapter 2 Regional Accomplishments Page 14 of 203

33 WorkplaceWellness RegionalWWcommitteeestablishedand14localsitesareactive.TheCommittee organizesandholdsaworkplacewellnessconferenceforstaffannually StressManagementincorporatedintoMobileWellnessprogramasariskfactor(2005) SMART(StressManagement)Groupsheldinregion,invariouslocationsannually since2006/07 InterlakeTeenHealthCommitteeestablished(2005) TeenDrugStrategygrantobtained.Fourcommunitiesbeganimplementation:Ashern, Selkirk,Teulon,Gimli(2006/07) HealthPromotionGrantsestablishedwithIRHAfundingin2005/06.Eachyearatotal of$15,000hasbeenallocatedtocommunitygroupsforlocalhealthpromotionactivities PartnersinPlanningforHealthyLiving IRHAwasaninauguralpartnerintheprovincialinitiative.PartnersinPlanningfor HealthyLiving(PPHL)worktogethertosupporttheuseofevidenceinplanning interventionsaimedatpromotinghealthylivingincommunitiesacrossmanitoba.we sharecommonmandatesforthepreventionofchronicdiseases.theirhaisoneofthe fivefoundingpartnersalongwiththefollowing:allianceforthepreventionofchronic Disease,CanadianCancerSocietyManitobaDivision,CancerCareManitoba,andthe HeartandStrokeFoundationofManitoba. Other DiabetesCoordinatorhiredtoimplementRiskFactorComplicationAssessment HealthPromotionAwardsprogrambeganand3awardsaregiveneachyearto innovativegroupsattheirhaannualgeneralmeeting IRHAPreventionInventorycompletedbythePopulationHealthPlanningTeam. DistributedtoallIRHAsites,partners,intranetandphysicianoffices(2007) Strategic Priority #3 Appropriate, Accessible and Sustainable Resource Provisionofappropriateandaccessiblehuman,financialandinformationresourcesto supportandsustainourhealthprogramsandservices. Thisprioritywasdevelopedasaresultofthefollowing2004CHAReport recommendations: HealthSystemPerformanceasitrelatestoIRHAhospitalbedsupply PCHbedsupplytomeetcurrentandfutureneedsaremet Chapter 2 Regional Accomplishments Page 15 of 203

34 Workingtowardshavingasufficient,stablephysicianpoolespecially,inremote communities AdditionalresourcesforEMSstationstoreducegeographicalgapsincoverageandto monitorourhomecareneedstodetermineifcurrentresourcesareadequatetomeet serviceneeds Monitoringresourcestoensurethatprogramneedsaremet TheIRHAhasachievedthefollowingaccomplishmentsinthisarea: SelkirkSurgeryProgram 62%increaseinsurgeriesperformedinSelkirkandDistrictGeneralHospitalovera fouryearperiod.waitlistreducedto4weeksfrom14weeksin2005/06 Recruitmentofadditionalsurgeonshasincreasedsurgicalvolumes Diagnostics MobileUltrasoundserviceestablishedinEriksdaleandArborg(2008) Rehabilitation SpeechLanguagestaffhiredinMay2007focusingonthewesterndistrictsoftheregion ProvincialChildren stherapyinitiative(cti)fundingreceivedandusedtoincrease preschoolandschoolageservicesinthesedistrictwithanadditional.5eft(2007/08) LTCStaffing Provincialstaffingguidelinesestablished.Implementationplandevelopedandrollout ofstaffingguidelinestotakeplaceovernext3years MentalHealthStaffing IntensiveCaseManagementstaffingincreasedby1.0EFT(2006/2007)toaddressthe increaseddischargesfromtheselkirkmentalhealthcentre OneadditionalMobileCrisisandUrgentcaredaypositioncreated.Uponreviewofthe programthispositionwasdevelopedintocentralizedintake/urgentcare(2007/08) CrisisWorkerpositionestablishedtosupportthecrisislinewhichhasacallvolumeof 7,722clientsin2007/08 MentalHealthProgramleadershipstructurereviewedandchangedtoincludetwo clinicalteamsupervisorsandoneprogrammanagerwithincurrentresources(2007/08) PsychiatricLiaisonNursespositionsestablishedinSelkirkEmergencyProgram Chapter 2 Regional Accomplishments Page 16 of 203

35 WestStPaulEMSstationestablished TemporarystationsetupinJune2007,constructionbeganonthepermanentfacilityin October2009 RecruitmentandRetention RecruitmentPolicydeveloped.Physicianrecruitmentactivitiesincreasedwhich resultedin4medicalstudentssigningreturnofserviceagreements(2006/07) RegionalHumanResourcesplanhasbeenupdated ARecruitmentOfficerwashiredandaRecruitmentPlanhasbeendeveloped(2008/09) EMS/ERTraining FundingreceivedfromProvincialRecruitment&RetentionFundtoallowfor specializeder/cardiaccaretrainingforfiveselkirknurses(2005/06) IncreasedtrainingopportunitiesforEMSstaffinadvancedskills( ) IncreasedERskillseducationdevelopedasmandatorysessions( ) LocalOrientationProcessEnhanced LTCeducatorhiredinDecember2005.AllLTCstafforientatedandyearlyupdates introduced(2005to2008) AcuteCarenursingorientationsessionsintroduced( ) RegionalOrientationProgramcontinuesforallnewstaff(ongoing) GrowYourOwnProgram Programdevelopedtoallotfundsforeducational/trainingbursariestoInterlake residents/staff,kickoffforthisprogramannouncedatirhaagm2006 Eachyearapplicantsareselectedforbursarieswithareturntoserviceagreement Selectionsareprioritizedforareasofemploymentingreatestneed NursingEducationPrograms LPNprogramestablishedinAshernthroughAssiniboineCollege5studentsin programandgraduatedinfall2008 RNprogramestablishedinGimlithroughRedRiverCommunityCollege.Theclass beganinoctober2007andgraduated8nursesinmay2008 RegionalInformationCommunicationTechnology(ICT)Plan Prioritysettingexercisewithprovincetoinformprovincialpriorities(2006/07) RegionalPharmacySystemistoppriorityforIRHAandwasimplementedin2009 Chapter 2 Regional Accomplishments Page 17 of 203

36 Intranetsiteestablished TheIRHAintranet(INET)wasestablishedinMay2006and880staffhaveaccess (2007/08),alsolocalkioskswereaddedforgreateraccessbyallstaff TelehealthExpansion hasincludedashern,selkirkandarborg Strategic Priority #4 Engaged Community and Stakeholders Effectivecommunitypartnershipsexistingthroughaninclusive,twowayprocessof communicationandinteractionwithstaff,healthpartners,stakeholdersandthe communitywithafocusonatriskpopulations. Thisprioritywasdevelopedasaresultofthefollowing2004CHAReport recommendations: Continueddevelopmentforcommunityeducationonhealthissuesanddevelopment ofadditionalpartnerships Identificationofspecificemotionalandmentalhealthissuesworkingtowards implementationofprogramsthatmeetthoseneeds Reviewinitiativeswithspecifictargetgroupsandrelateprogramstowhatthey indicatemakesthemhealthy TheIRHAhasmadethefollowingaccomplishmentsinthisarea: CommunicationwithInterlakeresidents CommunicationStrategydevelopedandapprovedbyIRHABoardinDecember2005 andupdatedannually StrategicPrioritiespamphletdevelopedandsentto30,000householdsintheInterlake (2005) BimonthlypublicationsonHealthPromotionsandServicestoSeniorsdevelopedand ongoing(2007/2008) FrenchLanguagePlan BilingualHealthServicesCoordinatorhiredtoworkonFLSplanwithStLaurent communityrepresentation(2006) FLSplanapprovedbyregionalFLScommitteeandIRHABoard(2007) FiveyearstrategicplanforFLShasbeenestablishedwithannualoperationalplans (2007/08) Chapter 2 Regional Accomplishments Page 18 of 203

37 MentalHealth SupportLineestablishedbasedonconsumerneed(2005/06) MentalHealthCooccurringstrategyimplemented.Policiesunderreview,training planforstaffbeingdevelopedandserviceplanformhclientsdevelopedandtrialed (2005/06) MentalHealthstaffCooccurringMentalHealthandSubstanceUseDisordersInitiative (CODI)trainingcontinuesandregionalassessmenttoolbeingreviewed.(2006/07), 100%ofmentalhealthstaffhavebeentrained(2009) AboriginalHealth FirstNationsattendingDiabetesAdvisoryGroup.ClinicpilotsiteestablishedinNW (2006) LittleSaskatchewanbecomesthe4thCDPIcommunity ContinueddiscussionsandpartnershipsdevelopedwithFirstNationscommunities (i.e.mobilewellnessevents,stressmanagementgroups,firstnationscrisisresponse, ServicePurchaseAgreement(SPA)withFisherEMS)(2006/07) AboriginalHealthTransitionFundsubmittedandapproved.Thisgrantisfocusedon knowledgetransferondiabetespreventionandtreatmentwithfirstnationspartners. Theprojectis2yearswith$320,000funding(2007/08) PartnerinplanningnewdialysisunitatPercyMooreHospital(2007/08) FirstChoicePCHtoimproveaccess ContinuousImprovementprogrammonitorsaccesstoPCHbasedonIRHApolicy. 100%ofclientswereofferedtheirfirstchoicePersonalCareHomewithin1yearof theirpaneldate(april June2009) CHA2009 Therewereatotalof24FocusGroupsand12CommunityForumsconducted throughouttheregion TheComprehensiveCommunityHealthAssessmentReportwillbereleasedtothe publicinthespringof Coreindicatorswillbereportedon Chapter 2 Regional Accomplishments Page 19 of 203

38 Strategic Priority #5: Socially Responsible Health Initiativesandcommunitypartnershipspositivelyimpactingthesocioeconomic determinantsofhealth(income,employment,status,socialsupports,housing,education andtheenvironment).thisstrategicprioritywasretiredin2006/07bytheirhaboard andsomecomponentswereintegratedintosp#2and#5. TheIRHAhasmadethefollowingaccomplishmentsinthisarea: Inventoryofcurrentpurchasing/tenderingpoliciesandpracticescompleted(2005) EnvironmentTeamhasdevelopedanextensivelistofcurrentecofriendlypractices (2007) GimliHealthyCommunitiesForumonHousing(2006) BoardsentlettertoMinisterofHousingtoadvocateforincreasedaffordablehousing stock(2006/07) LTCstrategyforseniorhousingdevelopedandsubmittedtoMHforfunding AllPCHresidentsandfamiliessurveyedinMay2006 FundingannouncedforSt.LaurentandArborgAssistedLivingCenters(06/07) Strategic Priority #6 Provide a Safe Healthcare Environment Providequalityhealthprogramsandserviceswhicharesafeandeffectiveforclientsand staffoftheinterlake. ThisprioritywasdevelopedasaresultoftheincreasedevidencerelatedtoPatientSafety (locally,provinciallyandnationally). TheIRHAhasmadethefollowingaccomplishmentsinthisarea: RiskManagement HIROCRiskManagementSelfAssessmentModules(RMSAM).Auditcompletedand ActionPlandevelopedtoaddressriskareas(April/September2009).Fouryearcycle actionplandevelopedincludinganannualreportingprocess.theriskmanagement SelfAssessmentModules(RMSAM)weredevelopedbyourinsurerHealthInsurance ReciprocalofCanada(HIROC).Participationintheselfassessmentisvoluntaryand stronglyencouragedbothbyhirocandaccreditationcanada.accreditationcanada recognizesitasaneffectiveriskidentificationtool.theselfappraisalmodules challengetheregiontoexamineourpoliciesandpracticesagainstcanadianclaims Chapter 2 Regional Accomplishments Page 20 of 203

39 experienceandleadingpractices.modulequestionsthatarepartiallyornoncompliant requireanactionplantoaddresspotentialgapsinprocess,policyorstandards Overasixmonthperiod,nineteenmoduleswerereviewedwithavarietyof program/teammembers.themodulecontentrangesfromvariousclinicalcareareas suchasmaternalnewbornandemergencyservicestosupportareassuchasfinance, humanresourcesandfacilities.atotalof1,472potentialriskswereassessed.159risks werenotapplicabletoourregion,leaving1,313potentialrisks.therewasfull compliancewith836(or64%),partialcompliancewith318(or24%)and noncompliancewith159(or12%).thebenchmarkisbasedonthenumberofrisks assessedasfullycompliantplusthenumberofyear1actionplanitems.eachyearthe benchmarkwillincreaseastheactionplanitemsarecompleted PatientSafety: Positioncreatedtoleadreviewofdisastermanagementplanning(2006).DisasterPlans, PandemicPlancompleted MedicationSafetyCommitteeestablishedthathastakentheleadtoimprove medicationpractices,orderingandstandardization Disclosure&CriticalIncidentPolicy&Processhasbeenimplemented CultureofSafetypresentationsatnewemployeeorientationandonrequest WoundManagementProgramestablished,partneringwithSmithandNephewto implementwoundcareprogram WoundCareleadersestablishedinfacilities,educationprovided.ARegionalWound CareTeamwasestablishedinFeb2008 TechnologyforDrugAdministration,conversiontosafetypumpscompleted(2007/08) It ssafetoask Campaignlaunchedin2007.Thecampaignencouragespatientsand familiestorequesttheinformationtheyneedinordertobecomeactiveparticipantsin theircarebyaskingthreekeyquestions:1. Whatismyhealthproblem? 2. WhatdoI needtodo? and3. WhydoIneedtodothis?.Itincludeseasytoreadmaterialsfor patientsandinformationkitsforhealthcareprovidersandorganizations The Donotuse medicalterminologyabbreviationslistwasimplemented& promotedregionally MedicationCardsdistributed&promotedregionally ManitobaInstituteofPatientSafetyandIRHAhasestablishedaPatientAdvocacy CommitteeforSelkirk BecominganActivePartnerinyourHealthcare brochuredeveloped Chapter 2 Regional Accomplishments Page 21 of 203

40 MedicationReconciliationonadmissionhasbeenimplementedinallacutecare facilities AcuteMyocardialInfarction(AMI)ProjectisongoingatSelkirkDistrictHospital CriticalIncidentsareinvestigatedandrecommendationsandactionplansaremadeto reducereoccurrence Patientsafetyinformationpostedtointernalwebsiteforstaff CollaborationwithEducationprogramtopromotepatientsafetythroughouttheregion OccupationalHealth&Safety OccupationalHealthandSafetyOfficerpositionestablishedandfilledin2007 RegionalWorkplaceSafetyandHealthCommitteeestablished(2007) AnOccupationalSafetyandHealth( OH&S )Planhasbeendevelopedandsubmitted tomanitobalabour,workplacesafetyandhealthdivision InitialauditsofallIRHAsiteshavebeencompletedandimplementationoftheinitial OH&Splanhascommenced EducationProgramstofacilitatecompliancewithWS&Hregulationsareheldregularly CapitalProjectscompletedandinprocesssince2005 SelkirkDomesticHotWaterUpgrade complete SelkirkHospitalCriticalRepairsPhase1,2&3 inprogress AshernERRenovation complete TeulonAirHandlingUnitRetrofit complete FisherPCHDomesticWaterSystem complete SelkirkBetelPhase1Flooring complete SelkirkHospitalRedevelopment inprogress EriksdaleERRenovations inprogress SelkirkBetelBoilerReplacement&HeatingUpgrade complete WestSt.PaulEMSStation inprogress RegionalTubReplacement inprogress SelkirkBetelFireAlarmUpgrade inprogress AsherFireAlarmSystemandPagingUpgrade inprogress GimliBetelRoofReplacement complete StonewallHospitalRoofReplacement complete ArborgERRenovations inprogress GimliHemodialysis inprogress EriksdaleDomesticHotWaterSystem inprogress Chapter 2 Regional Accomplishments Page 22 of 203