EXTRA: Executive Training Program

Project title: Together We Build: A Culture of Person-Centered Care at CancerCare Manitoba

This project aims to strengthen oncology nurses’ understanding and application of person-centered care (PCC) approaches across CancerCare Manitoba. Led by a dedicated team of nursing professionals, the initiative seeks to advance a culture of equitable PCC, nursing leadership, and nursing-led research across the healthcare system. 

In its first phase, the team is conducting a scoping review of PCC approaches, tools, and integration strategies in oncology practice. The review examines how these approaches consider equity-denied populations, support shared decision-making, and influence patient experience. The findings will inform evidence-based strategies and identify equity-oriented actions, with results disseminated through a manuscript and a knowledge translation plan. 

In phase two, oncology nurses from across Manitoba, the province’s largest health workforce group, will be engaged to identify barriers, facilitators, and opportunities for improvement in implementing PCC. Patient partners are central to this work, ensuring that lived experience informs all stages of design and delivery. The insights gained will guide the development of a PCC framework for future implementation, with potential to scale across professional groups and embed person-centered care organization-wide. 

Project title: Innovation and Value

Like other regions across Canada, CHU de Québec – Université Laval is facing major challenges related to limited resources and a growing imbalance between the supply of and demand for healthcare services. An aging population, a shortage of specialized staff, increasing care complexity, limited funding, and a lack of adequate tools all contribute to widening this gap. 

These pressures lead to longer wait times, lower patient satisfaction, inefficient processes, and persistent health issues that are not addressed within recommended timeframes. 

To help address these challenges, the organization is working to strengthen partnerships that respond to the real needs of patients and care teams. The potential for innovation is significant, but selecting and integrating projects requires careful alignment with organizational priorities. Once those choices are made, the key challenge is integrating clinical innovations in ways that make their value and impact clear. 

Project title: Establishing a Governance Structure for Clinical Excellence

As part of the 2025–2026 EXTRA-FORCES program, the project focuses on creating a cross-departmental co-management structure that unites the organization’s Directorate of Nursing, Directorate of Multidisciplinary Health and Social Services, and Directorate of Medical and Professional Services. 

It seeks to strengthen interdisciplinary clinical governance by integrating value-based care principles, fostering collaboration among directorates, and engaging patients, families, and community partners. The initiative addresses long-standing challenges related to service fragmentation and the coordination of clinical practices. 

By the end of 2026, the team aims to deliver a guidance document based on value-driven care and service indicators, ensuring the optimal use of available resources. Aligned with the strategic priorities of Santé Québec and the recommendations of Accreditation Canada, this work will help establish a sustainable, replicable, and innovative governance model that supports safe, high-quality care and services centred on people’s real needs. 

Project title: Advancing Collaborative, Community-Based Local Governance

The project aims to establish a more agile, transparent, and coherent model of local governance aligned with the priorities of Québec’s health and social services network and consistent with the primary care policy. It seeks to strengthen the autonomy and decision-making capacity of local managers to better meet population needs. 

The model is built on four key pillars: clarifying roles, improving communication, fostering intersectoral coordination, and using data to inform decision-making. 

By focusing action on the territories served by CLSCs, the initiative promotes interdisciplinary and intersectoral collaboration, community support, and local governance that better reflects on-the-ground realities. 

Grounded in continuous improvement and aligned with ministerial directions, the project aims to enhance the accessibility, quality, and integration of services available to the population. It represents a structural lever for transforming the management of local services in a sustainable way. 

Project title: From research to impact: Advancing regional priorities within Santé Québec

This project draws on scientific advances to strengthen the capacity of regional health organizations to meet the targets laid out in Santé Québec’s Plan stratégique 2025-2028, which guides institutional plans across Quebec’s health and social services system. The work will focus particularly on the strategic direction Une santé plus accessible (more accessible health care). 

While this Strategic Plan highlights innovation and research as key drivers of a more effective health and social services system, few structural initiatives have been developed to support organizations in that role. This gap is especially pronounced in rural and remote regions, where resources to capture, adapt and apply research findings are limited despite vast territories to cover. Even though these regions account for just 10 percent of Quebec’s population, they span 90 percent of its land area. 

The project will test and evaluate knowledge-transfer activities designed to inform decision-making and support progress toward achieving the objectives of the Plan stratégique 2025-2028. 

Project title: Integrating and Evaluating Indigenous cultural safety training into the Covenant organization

First Nations, Inuit and Métis continue to experience inequities in health and access to healthcare as a result of the enduring impacts of colonialism and forced assimilation. These harms have spanned generations and are compounded by ongoing systemic, ideological and individual racism within healthcare systems. As a result, many First Nations, Inuit and Métis people do not feel safe accessing care. 

To address these inequities and foster culturally safe environments, there is a growing call for cultural safety education across healthcare. While this need is widely recognized, training is not yet mandated or standardized within most healthcare organizations. 

In response, Covenant Health is collaborating with First Nations, Inuit and Métis communities to develop cultural safety training that promotes awareness and drives meaningful behaviour change to improve safe access to care. The initial phase will pilot the training within one unit and evaluate its impact. Future plans include using a Plan–Do–Study–Act (PDSA) cycle to refine both the education and its delivery, while advocating for sustainable funding to support organization-wide implementation. 

Project Title: Bridging the Gaps: A 2SLGBTQ+ Health Equity Project

As community-based organizations, GACPEI and PEERS Alliance recognize the specialized health needs of 2SLGBTQIA+ people. These needs extend beyond culturally competent and responsive care to include transition-related supports, cancer screening, sexually transmitted and blood-borne infection (STBBI) testing and prevention, and adapted family planning services. Currently, there is no department, team or dedicated resource within Health PEI that provides comprehensive guidance on the unique health needs of 2SLGBTQIA+ patients. As a result, healthcare providers often lack clarity on how to navigate appropriate care pathways, creating gaps in service. Limited communication between healthcare providers, community organizations and Health PEI can also present barriers to accessing physical and mental healthcare. 

Through this initiative, GACPEI and PEERS Alliance are collaborating with Health PEI and community partners in 2SLGBTQIA+ health to develop a framework for an interdepartmental team dedicated to advancing health equity within the provincial system. The team will work to improve the continuity, quality and consistency of care across services and departments, serving as a resource for both patients and practitioners, and ultimately improving health outcomes for 2SLGBTQIA+ communities in Prince Edward Island. 

Project Title: The MOTIVE (MObile TIA and Stroke with AdaptiVE Workflow) Interdisciplinary Team for Rapid Assessment and Discharge of TIA and Stroke Patients in Northeastern Ontario

Stroke is one of the leading causes of disability and death in Canada. About one in four strokes is preceded by a transient ischemic attack (TIA), and 30 to 40 percent present as minor strokes. Currently, patients with TIA or minor stroke seen in the emergency department or on non-stroke units are typically admitted to the Stroke Unit for testing and interdisciplinary assessment. While effective, this model often leads to emergency department congestion, longer hospital stays, and poorer patient experiences. 

Alternative approaches – such as outpatient Stroke Prevention Clinics or emergency observation units – focus primarily on diagnostics, with interdisciplinary assessment still concentrated within the Stroke Unit. To bridge this gap, the MOTIVE team brings together stroke neurologists, an advanced practice physiotherapist, an occupational therapist, a speech-language pathologist, and a stroke nurse to deliver coordinated care directly across emergency and inpatient settings. 

Using a phased, two-year plan guided by IHI improvement methods, this model aims to reduce admissions, shorten hospital stays, lower costs, enhance patient satisfaction, and improve the overall quality of healthcare delivery. 

Project title: Creating a Centre of Excellence Implementation Model for New Brunswick Long Term Care

New Brunswick’s long term care sector is remarkably diverse, ranging from small 30-bed rural homes connected to community hospitals to 90-bed suburban facilities and large urban innovation hubs with more than 200 residents. This diversity brings strength but also complexity, especially as aging infrastructure, workforce shortages, and financial pressures make operations increasingly challenging. Recruitment and retention issues, slim budget margins, and inflation contribute to significant and sustained turnover across the province’s long-term care homes. 

Loch Lomond Villa, recognized across New Brunswick as a leader and innovator in long-term care, is collaborating with partners to develop a shared services model that supports small and mid-sized homes facing operational and staffing challenges. Through this EXTRA project, the team aims to design and test a Centre of Excellence implementation model that strengthens collaboration, enhances sustainability, and helps restore the quality of care and support that New Brunswick’s long-term care sector is known for. 

Project title: Safety Event Classification and Learning

Michael Garron Hospital (MGH) maintains a robust incident reporting system, with staff across all clinical areas – including the Emergency Department, Diagnostic Medicine, Mental Health, Medicine, Maternal Newborn Care, and Surgery – actively submitting detailed reports. Over time, this process has generated a rich database of thousands of incident reports, capturing years of valuable safety intelligence. 

Despite its potential, much of this data remains underused for proactive, organization-wide quality improvement, primarily due to an outdated classification system and limited analytical tools. Historically, incident reporting at MGH followed the WHO safety event classification method, which is no longer considered best practice. In 2025, the hospital’s quality team began transitioning to the updated HPI safety event classification method for new incidents. 

To fully leverage this wealth of historical data, two key priorities have been identified: the retrospective reclassification of past incidents, and the systematic identification of safety trends and patterns. Together, these efforts aim to strengthen organizational learning and support continuous improvement in patient safety. 

Project title: Reducing Falls with Harm in a Post-Acute Setting

The Kew Beach Unit (KBU) is an 86-bed transitional care unit operated off-site from Michael Garron Hospital (MGH), a community teaching hospital located in Toronto’s east end. The unit is staffed by VHA Home HealthCare. Currently, KBU experiences a significantly higher rate of patient falls and falls with harm compared to other MGH units. 

This quality improvement initiative aims to strengthen the partnership between MGH and VHA by identifying and addressing the root causes of the higher fall rate, while fostering a culture of patient safety and continuous quality improvement at KBU. This cross-organizational collaboration will also serve as a foundation for addressing other patient safety and quality challenges at the site, helping to ensure equitable care and safety for all patients – regardless of location within the organization. 

Project title: Offload Delay in Acute Care Emergency Departments in Newfoundland and Labrador

Offload delay (OLD) refers to the delay in transferring a patient’s care from paramedics to hospital staff in the emergency department (ED) due to limited ED capacity. While sudden surges in patient volumes can create immediate pressures and trigger OLD, the issue most often reflects broader hospital flow challenges – with admitted patients held in EDs while awaiting transfer to inpatient units. 

A high-performing healthcare system depends on the timely availability of ambulances to respond to emergencies and provide appropriate care. When paramedic teams experience offload delays, they are unable to respond to new calls in the community, reducing ambulance availability, increasing response times, and compromising patient safety. 

The factors contributing to OLD span the continuum of care – from access to pre-emergency care and ED operations to inpatient flow and discharge pathways. In Newfoundland and Labrador, these challenges are compounded by the realities of rural and remote healthcare delivery. This project focuses on identifying measures to mitigate OLD and developing strategies to improve system flow, ensuring care that is safe, timely, and appropriate. 

Project title: Caring with Purpose: Elevating Fundamentals to Enhance Patient and Nurse Experience

The Caring with Purpose initiative focuses on strengthening the delivery of essential nursing care – communication, dignity, comfort, hygiene, nutrition, and mobility – to ensure patients consistently receive compassionate, person-centered care. Through the EXTRA program, the team is applying evidence-informed strategies and co-design methods to close gaps in care and enhance both patient and family experiences. Three acute medicine units have been selected as initial test sites in response to observed missed care and related patient concerns. 

Supported by senior leadership and an interdisciplinary team, the initiative brings together patients, families, and frontline staff to identify priorities, test small changes, and build capacity for continuous improvement. High-quality fundamental care is recognized as the foundation of patient safety, satisfaction, and improved health outcomes. 

By embedding this work into organizational strategy and engaging those with lived experience, the project aims to develop a sustainable model to guide the delivery of nursing fundamentals across the province – starting locally and expanding system-wide. 

Project title: Stronger Together: Partnering with Mi’kmaq Communities for Better Access to Primary Care

Across Nova Scotia’s rural landscapes – particularly among Mi’kmaq and other Indigenous communities – enduring barriers continue to limit access to timely, culturally safe primary healthcare. Geographic remoteness, a shortage of healthcare providers, and widening digital divides have further eroded both access and trust in the healthcare system. 

This initiative seeks to change that reality by strengthening the uptake and impact of a virtual care platform tailored to the needs and rhythms of Northern Zone’s rural and Indigenous communities. Grounded in respectful collaboration with local leaders and organizations, the project aims to enhance digital literacy, build community trust, and promote equitable access to virtual care. 

Healthcare providers will be supported to deliver culturally safe care through virtual means, blending technology and human connection in ways that honour the values, traditions, and lived experiences of the communities they serve. By September 2026, the initiative aims to increase virtual primary care visits by 15 percent, reduce pressure on emergency departments, and advance a more inclusive, responsive, and culturally grounded healthcare system. 

Project title: Virtual Therapy in SHA 

In Saskatchewan – particularly in rural and remote areas – both patients and therapists (PT, OT, SLP) face significant challenges in accessing and delivering essential therapy services. Patients encounter geographic and logistical barriers, including long travel distances and service gaps, which limit their access to therapy and affect their quality of life, independence, and overall health. 

At the same time, therapists manage high caseloads and extensive travel requirements, contributing to burnout, moral distress, and high vacancy rates. To help close these gaps in care accessibility and better support therapists across large geographical areas, this project introduces a provincial approach to expanding virtual therapy options. 

By enhancing access to care through virtual delivery, the initiative aims to improve patient outcomes, reduce strain on healthcare providers, and strengthen the overall accessibility and sustainability of therapy services across the province. 

Project title: Enhancing and Embedding Home Health Nursing Competencies at SE Health: Strengthening Confidence, Retention, and Organizational Excellence

SE Health is launching a quality improvement initiative to enhance the confidence and capabilities of home care nurses across the organization. The initiative builds on SE Health’s leadership in developing the 2024 Home Health Nursing Competencies in partnership with Community Health Nurses of Canada (CHNC), and aligns with the organization’s commitment to continuous improvement, person-centered care and workforce excellence. 

The work will unfold in three phases. The first phase involves a comprehensive readiness assessment to identify current strengths and gaps in applying the updated competencies. The second phase will focus on developing strategies to support workforce retention, learning and continuous quality improvement. The final phase will implement and evaluate these strategies to assess their impact on nurse confidence, client outcomes and organizational performance. 

Aligned with SE Health’s H.O.P.E. Model® and its pursuit of accreditation excellence, this initiative reinforces the organization’s commitment to delivering exceptional care in the home and community. 

Project title: Strengthening a Culture of Safety Through a Two-Eyed Seeing Approach

This project builds on work initiated in Cohort 19 (August 2024) to develop a culturally safe and informed Patient Safety Learning System (PSLS). The initiative continues through Soonats’ooneh’s operational teams, with implementation of the PSLS supported by the Clinical Engagement and Quality Coordinator as part of an ongoing quality improvement effort focused on fostering a culture of safety and open reporting. 

Cohort 20 offers an opportunity to expand this work by integrating new knowledge and wisdom, including an Elder’s trauma-responsive perspective on creating culturally safe environments and the Executive Director’s leadership in building a sustainable safety reporting system. 

This initiative reflects Soonats’ooneh Health Society’s commitment to building a safer, more inclusive healthcare environment for all. 

Project title: Development of an Implementation Framework for Model of Care Redesign: Piloting an Approach in an Urban Academic Centre Emergency Department

Existing model of care redesign efforts and available tools tend to focus on staffing ratios and skill mix, often within professional silos and without an interprofessional lens. This narrow focus limits the ability to create recommendations that support collaborative care and optimized scopes of practice. In addition, there is a lack of evidence and suitable tools to guide this work, particularly in ambulatory and emergency settings. 

Through the Interprofessional Models of Care initiative, Unity Health Toronto is developing a scalable and replicable framework to support the design of models of care that reflect patient needs, promote collaboration across disciplines, and optimize professional practice. The framework will be piloted in the emergency departments at St. Joseph’s Health Centre and St. Michael’s Hospital, with the goal of enhancing the effectiveness, efficiency, and person-centeredness of healthcare delivery. 

Project title: VON Canada Health and Wellness Integration Pilot 

VON Canada is piloting a co-designed, integrated model of care in North Bay, Ontario, to help older adults age in place. As the first baby boomers turn 80 in 2026 – and more than 90 percent of older Ontarians express a preference to remain at home – this initiative offers a proactive alternative to fragmented, crisis-driven care. 

The pilot integrates services across VON and partner organizations, embedding a Nurse Practitioner and Navigator within a Neighbourhood Model and Community Nursing Clinic. This wraparound, client-directed approach enables early identification of unmet needs, improved access to coordinated health and social services, and stabilization of conditions before escalation. 

Co-designed with key stakeholders, the model strengthens capacity through system and process integration and by engaging community volunteers. Expected outcomes include fewer emergency department visits and hospitalizations, as well as increased uptake of preventive care and social prescribing. The model aligns VON’s home care, primary care, and community supports, and will be evaluated using the Quintuple Aim. This scalable, community-based approach aims to improve outcomes and reduce system strain in rural and underserved areas. 

Project title: Listening and learning from Indigenous health leaders to create a culturally safe space that strengthens recruitment and retention

The Canadian Health Leadership Network (CHLNet) and its partners met with Indigenous health leaders to discuss their concerns and hopes for leadership in Canada’s healthcare system. The 2020 “In-Plain Sight” report stressed the need to increase Indigenous leadership roles and decision-making in both Indigenous health governance and the wider healthcare system.

In October 2023, CHLNet hosted a Listening Circle. The event aimed to explore how non-Indigenous employers can create culturally safe environments for hiring and supporting Indigenous health leaders. This project will build on those discussions to improve leadership practices at both system and organizational levels.

Project title: Implementing a culturally safe patient safety learning system to improve culture and client care

Central Interior Native Health (CINHS) understands the need for a patient safety learning system (PSLS) to meet professional standards and be accountable to the communities it serves. A PSLS will help track organizational learning and system changes needed to prevent medical errors.

CINHS provides safe, high-quality care to all patients, while ensuring a supportive and safe environment for staff and contractors. To better improve the system, CINHS aims to ensure workplaces and care settings are trauma-informed and culturally safe. They also expect partner organizations to follow the same standards.

This project strengthens accountability for both clients and staff by promoting fair and safe services. It also helps CINHS build leadership skills to handle complex changes, while keeping the focus on clients and culture.

Project title: Clinical culture and communication: Supporting reassuring aeromedical transfers to Nunavik

The Quebec aeromedical evacuation program (EVAQ) at the CHU de Québec–Université Laval carries outpatient medical transfers to specialist centres across Quebec, including Nunavik’s Inuit communities. The fact that these patients, who make up 19% of transfers, are often far from their family and community creates significant challenges. To improve quality of care, EVAQ proposes developing in-flight communication services that are sensitive to Inuit culture. Patients’ ability to speak their native language is critical to establishing a trust relationship with health professionals, and to obtaining culturally safe care.

The project aims to facilitate simultaneous interpretation and other modes of communication to empower patients as active participants in their care in accordance with the Inuit concept of pigunnasiarniq, which emphasizes the importance of competence and control over one’s life. The project also aligns with the objectives of Healthcare Excellence Canada’s 2022–2026 Truth and Reconciliation Action Plan by building partnerships with Indigenous communities to promote cultural safety in healthcare.

Project title: Improving manager experiences for patient benefit

The CHU’s development project has determined that the key to its path to the future is putting both patient AND healthcare worker as its stars to steer by. We believe that achieving our mission of providing the people of eastern Québec with cutting-edge healthcare and services requires us to focus on directly connecting patients to our 18,000 workers, including our managers, to impact health and drive change.

Consequently, we hope to influence the value chain by improving manager experiences, which will directly impact employee experiences and improve patient experiences. Through their leadership, managers play a critical role in the health network. However, they also deal with risk factors that can affect both their own health and their ability to be a positive influence. Our objective:

Leverage changes to managers’ working conditions to improve employee experience and patient experience.

Human resources leadership has conducted a diagnostic process in recent months to accurately document the situation and find potential solutions. Work-life balance and challenges onboarding, integrating and supporting new hires over the first two years have been identified as major reasons why our managers leave. Our project aims to positively affect these aspects to improve our retention rate and benefit patients.

Project title: EXTRA journey – Seniors

The aging population is creating significant challenges for healthcare systems worldwide. In Canada, the number of adults aged 85 and older is rapidly growing and will triple by 2046. In the Capitale-Nationale region, this demographic transformation is forcing healthcare organizations, like the CHU de Québec-Université Laval and the CIUSSS de la Capitale-Nationale, to review their strategies to guarantee equitable access to care. One strategy involves improving the flow of care pathways for seniors by integrating patient-reported health indicators to better meet patients’ needs and support their self-reliance.

Under the EXTRA Project, we propose a regional combined clinical/administrative flow governance for seniors. Its aim is to actively engage with patients and their loved ones using Patient-Reported Outcome Measures (PROMs) to optimize care pathways between the CIUSSS de la Capitale-Nationale and the CHU de Québec-Université Laval. PROMs shed light on the patient experience and thus promote better interactions between patients and clinicians. This project is specifically focused on seniors aged 85 and older who visit the emergency room for falls and, using operational governance that includes a variety of actors from both institutions, advocates for patient-side decision-making. This shared operational governance will help support and guide patients and their caregivers more effectively through their episode of care by working to meet their specific needs.

Project title: Performance management and continuous improvement: Keeping it simple in a complex environment

This project aims to improve coaching for managers by developing their performance management skills. More specifically, it aims to develop a useful, efficient and sustainable method for hands-on support. We hope to boost skill development for middle managers and generate a positive impact on their ability to assess their environment and better manage employee performance. The issue is at root: how do we improve their ability to take in information, make decisions and solve problems on the ground? How can they integrate simple, accessible foundations of continuous improvement and performance into their day-to-day work?

Will developing processes for and competence in reading their environment via a process of hands-on learning help support them in developing performance management skills? How do we keep this simple, concrete and useful in day-to-day work? Those are the questions our project addresses.

One of our strategies will be rooted in the principle of learning to learn: using principles of adult pedagogy and applying a method that focuses on experience and self-regulation. A method that needs to adapt to various management contexts within the same organization, rather than a single, unchanging magic recipe. This is a sizable challenge, but our improvement project could yield significant results for organizational performance.

Project Title: Déstig-MADO: A compassion-based model for supporting patients with notifiable diseases throughout their care and services pathway and the potential impacts of stigmatization

The proposed project stems from the observed fact that patients with a notifiable disease (ND, or MADO in French) often experience stigmatization. NDs, of which Québec has approximately 60, are a population health hazard and may lead to problems such as potential epidemics. NDs require control measures such as screening, vaccination, isolation at home and contact tracing (LSP, 2024). Stigmatization arises when differences are labelled and negative stereotypes applied to people, creating a distinction between “us” and “them” (ASPC, 2022). Such stigmas can lead to worse access to healthcare, worse health outcomes and lower quality of life for patients (Marra et al., 2004).

Furthermore, although public health authorities oversee investigation into cases of NDs and coordinate follow-ups, there is no efficient and integrated care trajectory with all partners in the health network and community to ensure full and local care for ND patients and their contacts in Montérégie. This means that patients’ treatment, health and quality of life is less closely monitored, in addition to creating a great deal of back and forth between various partners. It can even delay protection measures from being put in place, endangering population health. A centralized, personalized approach has also been shown to reduce the delay in intake and increase treatment adherence (Abebe et al., 2020).

The core hypothesis of the proposed project is that patient experience can be improved, and that stigma can be reduced and mitigated by providing people with NDs and their contacts with a personalized, compassionate, integrated, centralized and community-based trajectory of care that includes a model for supporting patients experiencing stigmatization. The project is divided into four parts:

• Part 1: Setting up a compassionate, integrated and centralized care trajectory at the CISSS de la Montérégie-Centre.

• Part 2: Co-creating a patient care and services pathway based on actual needs, including the co-development of a model to support ND patients and their contacts experiencing stigmatization.

• Part 3: Strengthening community-based management that considers patients’ social and cultural contexts.

• Part 4: Consolidating community partnerships.

Lessons learned would be transferrable to the entirety of Montérégie as a second phase of the project (regional public health mandate and responsibility, sharing experience through issue tables and regional coordination) as well as elsewhere in Québec and for other populations whose care experience is impacted by stigmatization.

Project Title: Using a CO-5 command centre to improve the flow of care for seniors, both in-hospital and outpatient

Montérégie-Est’s over-75 population is on the rise (+68% by 2036), leading to a surge in demand for health and social services. This increase in the senior population is particularly noticeable in our hospitals (+30% beds by 2036), our CHSLDs (+100% beds by 2036) and our home care (+100% new clients by 2036).

To ensure that the services we offer align with patient needs, our organization recently deployed a command centre with operational, tactical and strategic levels in order to support patient flow throughout the care journey, both upstream and downstream.

To improve care for patients 75 and over, both in the hospital and in outpatient settings, we are aiming to reduce the average length of stay (ALS) by 5%. For a short-term care facility with 800 beds, a 5% reduction in ALS means a 5% increase in capacity. The current ALS for patients 75 and over is 15.2 days. For the emergency department, the ALS with hospitalization is 34.9 hours.

To achieve our objective, we are drawing on our multidisciplinary team and our command centre to coordinate our work. Our improvement project aims to streamline the work of our command centre so that it can sustainably support our objective and enable us to respond to our patients’ growing needs.

Project Title: Optimizing telework: A practical guide for management at the CISSS de la Montérégie-Ouest

Our organization is grappling with a significant difficulty: we do not have any guides, decision aids, eligibility criteria, or concrete indicators for managing and evaluating telework performance. This shortcoming hinders both employers and employees in their ability to effectively manage, assess and improve telework and make the best possible use of it.

Data on telework at the CISSSMO for 2022–2023: 1,278 telework requests the departments of disability programming (391 requests), mental health and addiction (221) and youth programming and public health activities (146) have received the greatest number of requests. The departments with the smallest number of requests are housing for seniors (7), technical services (8) and communications (21).

Significant increase in requests between 2021–2022 and 2022–2023. The number of requests was even higher in the same two departments. Category 4 staff (professionals) telework in larger numbers. CUPE union employees (para-technical, care aide, trade and administrative staff) are the next highest, at only a third of the number of professionals. Executives telework in significant numbers as well. In total, 68% of teleworking employees work remotely for less than 50% of their week, 21% for work remotely over 50% of the time, and 10% work remotely full-time.

Below are the hypotheses and initial observations that spurred the proposal of the FORCES project:

• Lack of evaluation methods: Managers do not have clearly defined methods for evaluating the performance of teleworking employees.

• Granting criteria: The choice to grant telework privileges is not based on criteria linked to performance or appropriateness. The primary considerations are ones such as a lack of desk space or staff retention during a labour shortage.

• Lack of in-depth analysis: Telework is seen as a perk or a recruitment or retention strategy, but its actual impact on performance remains little studied. An in-depth analysis of its usefulness in connection with required duties and staff capacity to meet the requirements of their work contracts is needed, but managers have largely not conducted such an analysis.

Evaluation criteria similar to those for in-person work: Performance evaluation criteria for telework do not seem to be tailored to the specific context of telework but are the same as those used for in-person work.

Adaptability of telework: It is essential to determine whether telework is suitable for all employees and all types of work. Some tasks are better suited to telework than others. In the current context of reforms to the healthcare system, it is critical to explore best practices in telework management and evaluation.

Our objective: Enable informed decisions about telework, based on performance and appropriateness criteria, to yield the best results for the organization.

Project title: Transitioning to patient-based funding to meet the needs of the population

Like many agencies around the world, the Ministère de la Santé et des Services sociaux is increasingly turning to patient-based funding (PBF). This payment model links outcomes, population health and the cost of interventions to respond to health needs.

The goal of PBF is accessibility and equity of access. Nursing-specific clinical indicators will be developed and used for classification of PBF models, to allocate funds based on each patient’s care and service's needs, above and beyond diagnosis at hospitalization. The specific biopsychosocial characteristics of the CCSMTL’s patient population require a tailored approach to achieve the best possible health outcomes, such as an urban health approach modified to suit the population's socioeconomic circumstances. Promoting health and disease prevention is of foremost importance for empowering patients and their families.

The evidence shows that PBF’s efficiency as a funding model rests on the granularity of classification of hospital stays. This is because the classification system must be an accurate representation of the care and services provided and the characteristics of the patients who receive it. Nursing staff play an undeniably crucial part in achieving objectives for improving performance and clinical appropriateness. It is clear that PBF, in parallel with field of practice optimization, provides a window of opportunity for identifying essential nursing-specific indicators for institutional performance.

Project title: Enhancing Workforce Efficiency Through Innovative Care Models

Covenant Health, like jurisdictions worldwide, is facing a health workforce shortage. To address these challenges, two emerging trends have shown promise: models of care and optimal scopes of practice. Both approaches have demonstrated workforce efficiencies and improved patient outcomes. Models of care outline how services are delivered and by whom, across a patient’s journey through the healthcare system. This approach helps streamline the delivery of services to ensure that care is provided effectively and efficiently. Optimal scopes of practice explore opportunities for practitioners to maximize their practice and identify where task sharing and shifting can be used to enhance care delivery. This optimization can also be expanded to include unregulated healthcare providers and caregivers, broadening the potential workforce and improving service delivery.

Covenant Health is launching its primary care strategy, including the opening of a new Covenant Wellness Community in 2025. This will be Alberta’s first community-based wellness hub providing integrated health and social supports. The project team plans to leverage a care process framework to develop an optimized model of care in primary care and in-patient services settings. Identifying these needs will enable Covenant Health to address workforce difficulties, improve access to care, and ensure high quality patient outcomes.

Project title: Strengthening leadership and governance in primary care

Nova Scotia Health (NSH) is working to change how primary care is delivered, moving from stand-alone clinics to a model called health homes and health neighborhoods. In this new model, primary care leaders will need to work more closely within the organization and with outside partners to improve patient care and offer more meaningful services.

Currently, the leadership and management structures at NSH were designed for the old model, which has led to differences in how clinics are run. Some clinics are more efficient than others. As part of the transformation, there’s an opportunity to improve how clinics operate by strengthening their leadership and structure.

This project will create and test a framework for healthcare homes, with the goal of standardizing both clinical and administrative leadership. This will support multidisciplinary care teams and improve access to care and health outcomes for patients.

The project will focus on:

• Setting up key management and leadership structures at the clinic level.

• Developing clinical and administrative best practices for operating procedures.

• Defining performance indicators and procedures for data entry and reporting, so health homes can be actively managed by their leaders.

• Creating a plan to grow and improve leadership and management development for NSH primary care leaders.

Project title: Using a computerized clinical decision support system to reduce hospital-acquired pressure injuries

Healthcare systems around the world have gone through huge digital changes and one of the biggest is the use of electronic health records (EHRs). EHRs have made it easier for healthcare providers to follow clinical guidelines, reduced medication errors and increased awareness of patient safety.

Nova Scotia’s health system will soon introduce a new clinical information system called One Person One Record. This system will actively work to monitor and prevent harm in hospitals. A key feature is the clinical decision support system (CDSS), which helps doctors and nurses by alerting them to possible safety risks, like pressure injuries.

Even though CDSS can improve patient safety, it hasn’t been widely used because of challenges in healthcare culture. This project plans to combine CDSS with other quality improvement efforts to help prevent pressure injuries in patients.

Project title: “Health beyond hospital”: addressing access and flow challenges to improve care for patients on discharge

Efficient patient flow through the health system is essential for improving access to care. Nova Scotia hospitals are dealing with more patients coming in than leaving, which affects their ability to provide timely care.

Nova Scotia Health (NSH) and the provincial government are working on new strategies to stabilize health and social systems, provide timely care for Nova Scotians and address these patient flow issues. A new program called “Health Beyond Hospital: Integrated Discharge Hub” (HBH) is being put in place. This initiative aims to improve patient flow, enhance patient experiences and bring together the different agencies involved. It follows NSH’s strategic direction and builds on the government’s Action for Health plan.

The project will set up a governance structure and focus on improvements at specific sites. The HBH governance structure will be formed through agreements between NSH and government agencies. Best practices for shared governance will be studied and recommendations will be made to a steering committee to help guide the work. This will include processes like conflict resolution, problem escalation and better coordination between different geographic areas.

A partnership called the Care Coordination Centre (C3) will also be created and the team will work alongside a government partner. Currently, the C3 team only works with NSH and Emergency Health Services. By co-locating with other partners, the project will break down patient flow barriers and improve collaboration.

Project title: Improve patient outcomes through implementation of ERAS protocols to optimize pre, intra, and post operative surgical care

Through this improvement project the project team seeks to develop and implement a sustainable operational framework to support the development, implementation, and evaluation of Enhanced Recovery After Surgery (ERAS) care pathways. Enhanced Recovery After Surgery is an interdisciplinary approach to optimize patient experience and outcomes after surgery. It provides a framework for the optimization of care across all the phases of surgical intervention, including pre-operative preparation, intra-operative conduct of surgery, and post-operative care. ERAS recognizes that excellent surgical outcomes result from high functioning teams of nurses, surgeons, anesthesiologists, and allied health care professionals. It relies on standardization of evidence informed care plans through clinical pathways and order sets and empowers patients and families through effective education and communication to take an active role in their care and recovery. Initial phase of this improvement project will create a framework to translate evidence into practice and:

• Support a cultural shift in how surgical care is provided.

• Optimize care across all phases of surgical intervention, including pre-operative preparation, intra-operative conduct of surgery, and post-operative care.

• Provide guidance to multidisciplinary teams on how to implement ERAS protocols.

• Develop a set of core metrics to monitor implementation and evaluate the effectiveness of the ERAS protocols.

• Spread, scale, and sustain improvements.

Phase 2 will focus on collaborating with a surgical speciality to implement ERAS for an identified set of surgical procedures.

Project title: Reimagining the small home model to enrich the lives of residents in care

The Good Samaritan project aims to rethink the current small home model that has been in use for many years. The goal is to expand and strengthen the “being and belonging” philosophy, showing a commitment to improving quality while enriching the lives of residents in care.

For the West Village project, the model will include small homes within a larger care facility to maintain cost efficiency. The care model will have small neighbourhoods of 14 residents in each pod, with four pods per floor, using the Good Samaritan being and belonging model of care.

This updated small home model will focus on resident-centered, culturally safe care and improving the experiences of employees, residents and their families. It will also include recreational and rehabilitation activities.

The key parts of the model will explore design, philosophy, services, staffing, funding and care approaches. Current model examples include the Green House and Butterfly models and dementia villages.