NSHA president and CEO Janet Knox's opening remarks at the Nova Scotia Standing Committee on Health
I welcome the opportunity to be here with you along with my colleagues Tim Guest, vice-president of health services; Colin Stevenson, vice-president of quality and system performance; and Dr. Mark Taylor, who is interim co-vice president of medicine.
In October 2017, a team of 30 surveyors and one patient surveyor from Accreditation Canada visited Nova Scotia Health Authority (NSHA). They spent time in our hospitals and facilities across the province observing and talking with employees, physicians, volunteers, patients, learners, clients, families and community partners. This occurred through both structured meetings and through their site visit and assessment process.
The visit was part of Accreditation Canada’s peer-review process, which helps health care organizations like ours assess the services they provide to their patients and clients based on national standards of quality. It is a snapshot of how well an organization is doing at a given point in time. It provides an opportunity for us to test where we are doing well and where we need to improve.
The overall accreditation process is based on a combination of self-assessment, compliance with national standards and required organizational practices and the development and implementation of quality improvement plans and activities.
This was Nova Scotia Health Authority’s first province-wide survey after transitioning from nine district health authorities into one single health authority. It was an incredibly valuable experience for our organization. We learned a lot.
The surveyors visited 53 sites from Yarmouth to Sydney and everywhere in between – assessing the organization on 28 evidence-based, system-wide and service excellence standard sets. In total, they reviewed 4,014 quality and safety criteria in areas ranging from governance and leadership to risk management, infection prevention and control, and medication management.
Overall, we met 92.9 per cent of the criteria and were granted “accredited with report” status. That meant that we succeeded in meeting the fundamental requirements of the accreditation program, but still had some work to do. We have since completed all the necessary requirements and in December of 2018 received notice that we have maintained our accreditation status.
Given that this was our first province-wide survey and that we were only in our third year as an organization, we were very pleased with the decision and felt that we had met the goals we had set for ourselves at the start of the process.
We wanted to focus on consolidating and standardizing our practices to enhance quality and outcomes; to identify best practices and help spread them across the province and to ensure we had the right foundation for the alignment of policies and clinical practice, and to identify areas for improvement. We saw this as an excellent opportunity to highlight our progress as a provincial organization and to gain valuable insight as we moved forward. The feedback we received from our surveyors, and from within the organization, has indicated that we are on the right path.
The accreditation process is not intended to be an end to improvement activities. It is a point in the improvement journey. The survey team helped us to identify, or confirm, areas that we needed to focus on. These included the process of transferring patient information between units and departments when a patient moves through the system; our patient identification practices; our medication reconciliation process; our falls and suicide prevention strategies; and our management of patient flow.
The report also noted a need to enhance focus on people, pace and resiliency; continue to reduce variation across the organization; strengthen public and community partnerships; address building and infrastructure challenges; and advance our health service planning – all things which we have been working diligently on.
We know we have more work to do – that is a constant in health care – and we are using the information provided by Accreditation Canada to help move our quality improvement efforts forward.
At the same time, we’re very proud of our teams and what they have accomplished and what they do every single day. The accreditors noted many strengths, including the commitment of our staff, physicians and volunteers and a strong and committed leadership team, as well as meaningful patient and family engagement. They also acknowledged the diverse, experienced, competency-based Board of Directors – who met 100 per cent of their governance standards.
The surveyors saw much to be proud of, including enormous progress since the creation of Nova Scotia Health Authority, a demonstrated commitment to our work and a solid vision for the future of health and wellness in Nova Scotia. Despite the challenges we are facing in the health system, we can’t lose sight of the tremendous efforts and commitment of our teams to high quality care, safety and service.
The organization was also recognized for five leading practices – which are essentially innovative solutions to improve quality. A leading practice is determined by the National Health Standards Organization, which is affiliated with Accreditation Canada.
The teams recognized for leading practices are:
1. Dartmouth General Hospital's pressure ulcer team;
2. A client-centred waitlist management model for ambulatory care;
3. An ambulatory medication reconciliation process for our renal program;
4. A Seniors LINCS walk and roll program; and
5. Our patient stories initiative.
These are just some of the great projects that are happening every single day throughout our organization.
We value the accreditation process, as it provides a road map for our ongoing quality improvement efforts and helps ensure we continue to develop as a quality-focused organization with consistency in the delivery of care across the organization.
Accreditation provides an opportunity for self-reflection, learning and improvement. The words of our colleagues from Lakeridge Health in Oshawa serve as an important reminder:
We are not working on meeting accreditation standards because the surveyors are coming tomorrow. We are working on meeting accreditation standards because our patients are here today.
Janet Knox, President and CEO, Nova Scotia Health Authority