# data[].attributes.body
TARGET/FOCUS:

Demographic Socio-Economic Change

DIRECTION:

Partner (Diversify) Share Resources

SCOPE:

Operational strategies, practices, processes, tools

Infrastructure / Development Investments

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TARGET/FOCUS:

First Nations Black Nova Scotians New Comers LGBTQ2S+ Seniors Differently Abled ESL Rural

DIRECTION:

Increase availability and/or access to culturally relevant, trauma informed, safe care Increase availability and access to care for co-occurring conditions Meet or exceed accessibility standards

SCOPE:

Care (Treatment, supports, approaches) Providers Language / Communication Spaces Channels Locations

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✓-How we provide culturally competent care

✓-How we measure/monitor/shift populations in seclusion/restraints

✓-Co-occurring disorders, esp. substance use

✓-Home Hospitalization

✓-Culturally relevant care (how do we define?); relationships would help it co-create authentically

✓-Foster more humanity

✓-Need granular disaggregated data on demographics, etc.; I felt respected, heard, safe, etc.

✓-Need to look at extended hours (could be smaller capacity over the weekend)

✓-Support for family/care partners

✓-Extending services of Allied Health beyond M-F (including RT)

✓-Infrastructure to increase safety, including for vulnerable populations, disabilities, etc.

✓-Patient cohorting

✓-More single rooms

✓-Service gaps by zone? Get away from zone-based entirely and move to domain based operations

✓-digital innovation

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Right care, right place, right time—expansion of day hospital alternatives and home-like transitional care.

# data[].attributes.body
Patients describe inpatient and day hospital stays as humane, respectful, and hopeful, not just “safe” or “necessary.”

# data[].attributes.body
Example for other programs to emulate

Measure success by emulation

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All patients leave acute or day hospital care with coordinated follow-up

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Domain exclusive leadership (not zone based)

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Domain exclusive leadership (not zone based)

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-sharing data, bed management, processes, etc.

-different levels of care depending on different resources

-Still can have flexibility unit-to-unit

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Reduce Cost of Care to Clients / Increase Choice

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Reduce Cost of Care to Clients / Increase Choice

# data[].attributes.body
-Data gathering to know where services should go (if we were to open more)

-Explore decision to admit via Zoom

-Some similar to Reduce Service Gaps goal (increase hours of service, home hospitalization)

-Have a physician involved with mobile crisis team so they can make admission decisions and avoid police/emerg/stigma; look to MOSH as example

-Collab with homeless shelters; site visits with mobile crisis for decisions to admit/ ipta / treatment

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Are they APS domain?

Can we collab with outpatient/mobile crisis to make it happen?

Look to UK as model -- ACT work with mobile crisis

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Better integration with broader system: C3; Discharge Hub (Health Beyond Hospital); OPOR

# data[].attributes.subject
Better integration with broader system: C3; Discharge Hub (Health Beyond Hospital); OPOR

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Day hospitals in other areas

Extention of recovery support programs

# data[].attributes.body
Building capacity with our staff

Future of RPNs / nursing scope

Physical infrastructure

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Rapid Reconnect Clinics for Post-Discharge

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Rapid Reconnect Clinics for Post-Discharge

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Offer 48–72 hour follow-up (phone/virtual/in-person) for discharged patients. Use to triage early warning signs, ensure medication access, and prevent ED return.

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Patient Journey (before and after our care) - collab with community, we don't own

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Patient Journey (before and after our care) - collab with community, we don't own

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getting people to and from appointments, etc.

Collab with community/commercial (e.g. MOUs)

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-orientation to staff

-orientation of patients to unit (incl. expectation setting around agression

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Programs underway through college, mentorship (CZ)

Neighbour program (navigation in community and in workplace)

EDI Committee, someone sits in all interviews and support newcomers

Domain/MHAP can advocate for expanding

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Exists for physicians in CZ

Includes activities

"Replicate and celebrate", e.g. Lanes have a summer BBQ with staff and patients (funded by Foundations)

Team away days

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invest in staff goals and succession planning early

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Pay equity between inpatient and outpatient

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Pay equity between inpatient and outpatient

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Culture of prestige; become a coveted place to work

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Culture of prestige; become a coveted place to work

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Domain - consistency between units provincially

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Domain - consistency between units provincially

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Balancing workload with AI/digital innovation

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Balancing workload with AI/digital innovation

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PLANS program encouraging African Nova Scotians to study medicine

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PLANS program encouraging African Nova Scotians to study medicine

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-Participate in these kinds of initiatives

-Do more talks/outreach

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Encourages indigenous students to study medicine

We can involve them in our recruitment

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vs navigator

not specific to our domain

advocate for black nova scotian navigator again (like Mario Rolle used to me)

Do we fund brotherhood/sisterhood vs trying to own it?

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Lived Experience Positions / Peer Supporters

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Lived Experience Positions / Peer Supporters

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-Include in UHCP review

-Collab with community vs hiring

-Cultural humility

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Future of Security (Guards) on our units

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Future of Security (Guards) on our units

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-Safewards, environmental factors, culture shift, deescalation training/skills to reduce fear/increase preparedness of staff

-Collab with NSH on safety (code responses, etc.)

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"Above and Beyond" nominations for Headlines magazine (phys to phys)

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"Above and Beyond" nominations for Headlines magazine (phys to phys)

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e.g. communication skills for bad news

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Opportunities for staff to work a combo of inpatient and DH or outpatient

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Opportunities for staff to work a combo of inpatient and DH or outpatient

# data[].attributes.body
Cross training benefits staff flexibility, org scheduling flexibility, recovery-orientation

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Less documentation as a perk of inpatients

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Less documentation as a perk of inpatients

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e.g. discharge e-summary (CZ model) (OPOR), incl resources to educate

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Reframe inpatient psychiatry as a calling, not just a hardship.

# data[].attributes.headline
Newcomer Clinic, Friendship Center Clinic

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Newcomer Clinic, Friendship Center Clinic

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Social Policy and Advocacy Chair

We could enhance collaboration

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-wrap around for patients with substance use cooccurring

-training and competencies

-concurrent disorders working group (existing) Funded through Health Canada, coming up with recommendations

-Across system

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-Currently only in CZ

-Expand to other zones

-Collab with other domains

-Important for medication reasons

-Guide for providers for patients who use high dose opiates (underway)

-Pharmacy has also printed guidelines

-Lower confidence in guidelines than consult with expert

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-Code White responses - need to have consistent training and pathways

-Code Blue - need simulations/training across province

-Less prominent for Day Hospitals (Except Code White - but might not be an issue)

-Need to have consistent SIMS reporting (reinforcing systems that already exist)

-SIMS might be the way to capture demographic data? (e.g. overrepresentation in Seclusion events)

-NEWS2/medical assessment - gap in training and access/pathways to other care

-Just Culture approach

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Piloting IWK's Trauma Informed Care program

Collab with other Domains to roll out across the program/province

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-Different names and different models in pockets around the prov

-Needs standardization or existing programs, not necessarily just adding a new team without looking at existing

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-scales will be incorporated into OPOR

-Greenspace isn't the way, at the moment

-Use mood disorders scales from Furbow research

-Psychosis Care pathway recommending some scales

-May use a combo of self-administered scales and scales administered by competent staff

-Preference for unlicensed scales (but we should get funding if the best scales cost money) e.g. MOCA

-MBC continuity with outpatient / post-discharge

-Supports patients and families as well

-We shouldn't wait for Care Pathways to decide on scales -- Strike a working group to standardize scales that everyone will use across all diagnoses and across the province

-Timing: OPOR next phase of improvement

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-Insurance only covers 4 days - huge bills

-We treat and don't worry about the bills (we can send to collections, but don't)

-May have visa issues from unpaid bills

-Follow-up care can't be provided if they can't pay

-Government funding issues that we can't resolve ourselves; we can advocate

-It's not rare anymore

-Could look at other options, like LTC, overstay policies...

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-Enforcement

-Saving inpatient days

-Collating ALC to bed day costs

-BUT patient-centered (not billing patients, etc.)

-More as a talking point

-Social Worker could put together a patient pamphlet for "So you're ALC and looking for a placement..." + program standard/policy for accepting placements (we shouldn't accept keeping patients just because they choose not to accept placements)

-Issue with nursing homes/placement options declining to accept patients -- they shouldn't be able to say no based on e.g. chart review, locked unit, code white. - we could be more careful about documenting so we don't scare the placement staff

-Advocate for complexe cases (position such as discharge case coordinator who would have to meet criteria for DSP)

-C3/C4 has a complexe case review group + Home Beyond Hospital will have a resolution group

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✓-Need standardized process for readmissions -- e.g. a meeting to figure out what we could have done differently to prevent from happening again

✓ -Could be collab with a discharge coordinator

-Accountability for Human Rights Remedy

✓-Data for LOS by diagnosis, by location, by physician, etc. to recognize patterns and address - we have the data, but need accountability of what we do with it

✓-Examine why major differences in case mix groups (e.g. adjustment disorders)

✓ -Do we need guidelines for admission criteria?

-Mitigate anxiety of physicians with magnifying glass on their admissions/practice

-Compare to population level data on needs

-Reality of housing/social determinants that we can't solve -- we are necessarily discharging into precarity

-Administrative discharges to ease the burden on physicians (these days, tent discharge is considered a safe discharge)

-Transitional bridging program rarely works for our patients - can't meet housing timelines

✓ -Preparing for re-presentation to ED post-discharge - Care Indicators flag in Meditech. CZ has an alert form to PES, could make provincial. Make sure also sharing care plan/RPP/CMP (NB this is going to be more accessible through Crisis work)

-CIT trained officers will have access to health information

-

# data[].attributes.body
-Group programming could include efficiencies (e.g. making food/doing laundry in-house)

# data[].attributes.body
-Maximizing staff time by having staff interacting with patients more

-ANSU has a tool for tracking staff time use (but cumbersome) - maybe there's a better workload measurement tool

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✓ -Deinstitutionalization (fewer beds) vs increasing needs for expanding access/higher population + complexity

-Mixed units vs gendered units

✓ -Needs based planning: based on wellness survey info (WellNS)

✓ -Advocate for increased bed numbers based on need (balance of population growth with alternatives to inpatient admissions/better discharge etc)

-More admission to Day Hospital based on early warning signs rather than as a step-down

✓-Psychologist support to units (for complex patients, and bridges gaps to outpatient resources, case formulation, specialized testing ) - consider provincial resource that can do virtual

✓-Best Case Scenario - resource sharing between API and DH, e.g. patients who are in DH during the week then come to API on weekend days

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Reduce Cost of Care to Clients / Increase Choice

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Reduce Cost of Care to Clients / Increase Choice

# data[].attributes.body
TARGET/FOCUS:

All clients: Time, Stress, Financial

DIRECTION:

Increase alignment (matching) with individual preference and need

SCOPE:

# of Steps to care

# points of contact to care

Approach

Providers

Channels

Locations

Times

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Improve Wait Times & Meet or Exceed All Wait Time Standards

# data[].attributes.subject
Improve Wait Times & Meet or Exceed All Wait Time Standards

# data[].attributes.body
TARGET/FOCUS:

All Clients, Tiers & Services

DIRECTION:

Reduce Inefficiencies

Increase Flexibility

SCOPE:

Points of Access (Intake)

Points of Delivery

Resource Model

Time Lost to Documentation

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TARGET/FOCUS:

Workforce and Infrastructure

DIRECTION:

Off-Set Impact of AI on Carbon MHAP Footprint

SCOPE:

MHAP: Spaces, Practices, Tools

# data[].attributes.body
TARGET/FOCUS:

MHAP Program

DIRECTION:

Increase Efficiency

SCOPE:

Process

Practices

Allocation