Wait Times : A Quebec experience

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Wait Times :

A Quebec experience

Carolina Rossignuolo, BSc., MSc. (A) Carolina Rossignuolo, BSc., MSc. (A)

Program manager Program manager

Communication Disorders Program Communication Disorders Program Motor Developmental Delays Program Motor Developmental Delays Program

Marie Enfant Rehabilitation Center Marie Enfant Rehabilitation Center CHU Ste.-Justine, Montreal, Quebec CHU Ste.-Justine, Montreal, Quebec

CAPHC Conference, Winnipeg, October 17, 2010 CAPHC Conference, Winnipeg, October 17, 2010

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Presentation Outline

!

Quebec By-law: Contextual setting

!

Quebec By-law: Access to services

!

Quebec By-law: Changes in the clinical

practices

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Quebec By-law:

Contextual setting

AERDPQ:*

" regroups 21 rehab establishments (physical disabilities and regroups 21 rehab establishments (physical disabilities and

intellectual disabilities network) intellectual disabilities network)

" promotes access to rehab services promotes access to rehab services

Reported :

Reported : in 2007in 2007

" LONG WAIT TIMESLONG WAIT TIMES

" REHAB CENTERS:REHAB CENTERS:

# Differences in access criteriaDifferences in access criteria

# Differences in priorisationDifferences in priorisation

*AERDPQ=Association des établissements de réadaptation en déficience physique du Québec *AERDPQ=Association des établissements de réadaptation en déficience physique du Québec

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Quebec By-law:

Contextual setting

$

For WHOM ?

Provincial data*

8970 Individuals in need of rehab services

Children 3486

*

*AERDPQ , 2007AERDPQ , 2007

(5)

Quebec By-law:

Contextual setting

QUEBEC HEALTH MINISTRY:

Plan d’accès

"

Introduced in June 2008

"

Implementation in November 2008

$

WHY the by-law?

Improve access to rehab services

" To optimize organisation of services To optimize organisation of services " To harmonize access managementTo harmonize access management

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Quebec By-law:

Contextual setting

Prevailing philosophy:

$

Services

continuum

$

Shared

responsibility

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Quebec By-law:

Contextual setting

$

WHERE

does the by-law apply?

_{does the by-law apply?}

For the paediatric services: For the paediatric services:

Centers

Centers for special needs servicesfor special needs services

" COMMUNITY LEVEL (CSSS)COMMUNITY LEVEL (CSSS)

" Children with identified functional concernsChildren with identified functional concerns " In need of assessments and early interventionIn need of assessments and early intervention

Centers for specialized services Centers for specialized services

" REHAB CENTERSREHAB CENTERS

" Children with persistent and significant developmental concernsChildren with persistent and significant developmental concerns " In need of specialized multi-disciplinary teamsIn need of specialized multi-disciplinary teams

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Quebec By-law:

Contextual setting

$

HOW

does the by-law

_{does the by-law}

apply to the

_{apply to the}

paediatric rehab centers?

"

ACCESS STANDARDS

Maximun wait time period

Priority Levels

Age Category

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Quebec by-law:

Access standards

(AERDPQ(AERDPQ guidelines)guidelines)

Definition of priority level

Definition of priority level Maximum wait Maximum wait _time_time Age categoryAge category

URGENT

! Integrity and security is currently threatenedIntegrity and security is currently threatened.. ! Situation is critical.Situation is critical.

! Absence of an immediate intervention compromises Absence of an immediate intervention compromises

development. development.

! Natural environment cannot compensate beyond 72 hours.Natural environment cannot compensate beyond 72 hours.

Access to Access to services within services within 72 hours 72 hours

Any age group Any age group

HIGH

! Integrity and development present a risk of being Integrity and development present a risk of being

threatened

threatened..

! Absence of intervention within 3 months compromises Absence of intervention within 3 months compromises

development development

! DeteriorationDeterioration of the situation is predictable of the situation is predictable..

Access to Access to services within services within 3 months 3 months Children 5 years Children 5 years or less or less MODERATE MODERATE

! DeteriorationDeterioration of the situation is not predictable of the situation is not predictable.. ! Intervention is necessary.Intervention is necessary.

Access to Access to services within services within 12 months 12 months Children 6 years Children 6 years and older and older

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Quebec By –law:

Changes at the MarieEnfant

rehab center

OBJECTIVES/CHALLENGES

:

"

Reducing wait times

"

Improving services organisation

"

Improving services efficiency

ACTIVITY

:

BRAIN STORMING

"

Where are we loosing time?

"

How can we be more efficient?

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Quebec By –law:

Changes at the MarieEnfant

rehab center

CENTERWIDE

MEASURES PROPOSED

:

_:

"

Centralized Access (Access Agent)*

"

Centralized Booking

"

Flexibility of staff assignement

"

Professional productivity level

"

Increased clerical support

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Quebec By–law:

Program Experience

Contextual Setting:

wait times in 2007

_{wait times in 2007}

"

Language Program =18 months

"

Motor Program =12 months

Ultimate goal:

application of the By-law

"

5 years or less = access within 3 months

"

6 years or older = access within 12 months

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Quebec By–law:

Program Experience

WITHIN EACH PROGRAM

MEASURES TAKEN

"

Addition of human ressources

"

Changes in the clinical practices

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Program experience:

Changes in the clinical practices

$

QUEBEC BY-LAW

:

"

An opportunity to make changes

"

The changes were facilitated by

:

#

A law which applies to all rehab centers

_{A law which applies to all rehab centers}

#

Supported by AERDPQ

_{Supported by AERDPQ}

% Clinical projects :PNOT*Clinical projects :PNOT*

% Innovation: Collaborative ApproachesInnovation: Collaborative Approaches

*Projet Novateur en organisation du travail

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Program experience:

Changes in the clinical practices

In both Programs: In both Programs:

" Increasing the number of group interventionsIncreasing the number of group interventions

" Increasing « break time » between intervention periodsIncreasing « break time » between intervention periods " Focusing on priorised client-centered objectivesFocusing on priorised client-centered objectives

" Moving from complete to screening evaluations Moving from complete to screening evaluations " Reviewing the clinicians’ caseload every 3 monthsReviewing the clinicians’ caseload every 3 months

" Reviewing the clinicians’ attendance to case discussionsReviewing the clinicians’ attendance to case discussions " Maintaining the focus with our rehab mandateMaintaining the focus with our rehab mandate

GOAL= A greater flow of new clients GOAL= A greater flow of new clients

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Program experience:

Changes in the clinical practices

$

LANGUAGE PROGRAM:

"

Collaborative approach (UNISSON) between the

SLP and the technician in special education (TSE)*

$

MOTOR PROGRAM

:

"

Multidisciplinary group interventions

GOAL= A greater flow of new clients

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Program experience:

Changes in the clinical practices

PERSISTANCY of the changes?

$

LANGUAGE PROGRAM:

" The Unisson Approach is integrated in the SLP servicesThe Unisson Approach is integrated in the SLP services

" An emergence of a collaborative approach between the TSE An emergence of a collaborative approach between the TSE

and OT and OT

$

MOTOR PROGRAM

:

" The number of mutlidisciplinary group interventions have The number of mutlidisciplinary group interventions have

doubled doubled

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Program experience:

Changes in the wait lists?

Number of Clients on Wait List

0 50 100 150 200 250 2007 2008 2009 Year Num b e r LANG MOTOR

Number of Clients Served

300 500 700 2007 2008 2009 N u m b er

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Program experience:

Changes in the wait lists?

Wait Times 0 5 10 15 20 2007 2008 2009 Year M o n th s LANG MOTOR

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Access to services:

What we can’t control

"

Maternity leaves

"

Staff Retention

"

Sick leaves

"

Retirement

"

Budget

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2 years post Quebec By-law:

Some thoughts

1st PHASE:

$

How can we be more efficient and

maximize our time?

"

Making clinicians

aware

of reduced access to

services

"

Moving from “Refinement” to Function

"

Setting TX priorities according to social

participation

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2 years post Quebec By-law:

Some thoughts

2nd Phase:

$

Maintaining the changes

"

Involving clinicians in the

shared responsibility

of

increasing access to services

"

Marking the relevancy of the IIP

"

Ensuring that clinical activities reflect IIP goals

"

Determining end of Tx /follow-ups (guidelines)

"

Increasing parents’ empowerment

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2 years post Quebec By-law:

Provincial data*

Rehab Centers 5872 8970 3486 2011 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 2007 _Year 2009 N um be r of Ind iv idua ls All Children * *AERDPQ , 2010AERDPQ , 2010

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