• Demographic Socio-Economic Change

DIRECTION:

• Partner (Diversify) Share Resources

SCOPE:

• Operational strategies, practices, processes, tools

• Infrastructure / Development Investments

• MHAP Program

DIRECTION:

• Increase Efficiency

SCOPE:

• Process

• Practices

• Allocation

• Workforce and Infrastructure

DIRECTION:

• Off-Set Impact of AI on Carbon MHAP Footprint

SCOPE:

• MHAP: Spaces, Practices, Tools

• All Clients, Tiers & Services

DIRECTION:

• Reduce Inefficiencies

• Increase Flexibility

SCOPE:

• Points of Access (Intake)

• Points of Delivery

• Resource Model

• Time Lost to Documentation

• 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

• 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

✓-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

Measure success by emulation

-different levels of care depending on different resources

-Still can have flexibility unit-to-unit

-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

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

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

Extention of recovery support programs

Future of RPNs / nursing scope

Physical infrastructure

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

Neighbour program (navigation in community and in workplace)

EDI Committee, someone sits in all interviews and support newcomers

Domain/MHAP can advocate for expanding

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

Includes activities

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

Team away days

-Do more talks/outreach

We can involve them in our recruitment

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?

-Collab with community vs hiring

-Cultural humility

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

We could enhance collaboration

-training and competencies

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

-Across system

-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

-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

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

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

-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

-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...

-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

✓ -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

-

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

-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