Prairie North Health Region held a quarter regional review in North Battleford last week where managers gathered to discuss quality improvement challenges and opportunities.
On the agenda were presentations highlighting work that has improved the patient and care provider experience.
Among the presentations was an update on the project to build a new facility for Saskatchewan Hospital North Battleford. Presented by Linda Shynkaruk, director, and patient representative Wade, the audience heard how patients have been involved in the process of planning the new facility and how rapid response improvement workshops (RPIWs) have been used to further the provincially mandated lean initiative.
"One of the things we will be doing for the next three years in terms of lean processes is RPIWs," said Shynkaruk. "We want to make sure our processes going into the new building are sound, that we are not carrying old habits into the new facility."
The SHNB director told fellow Prairie North managers present, "We’ve been planning a facility that will have a therapeutic home-like environment, individual rooms, one bathroom shared between two patients instead of one bathroom being shared by 10 or 12 patients like they do now," said Shynkaruk. "We want lots of natural light and good temperature control. These are the priorities for our patients."
Those priorities have been identified by the patients themselves, she said. They were learned through several meetings with the patients, through surveys and by having them participate in three production-preparation-process (3P) design marathons held in 2013 and 2014.
In April of 2014, the announcement was made that the new hospital facility would include a correctional component and would be built as a P3 project – public-private partnership.
It was to become a 284-bed mental health facility with 188 non-secure beds and 96 secure beds. The idea of having "criminals" using the same facility as SHNB patients was alarming to Shynkaruk and her team at first.
"We talked about it, and eventually we embraced that idea and we realized we ourselves were stigmatizing those individuals who were sitting in the jails who have mental health issues, who could use our help, who could access our services and use our services," said Shynkaruk.
"We need to advocate for those individuals … as well as our own patients in the current facility."
Shynkaruk says her team began working with Saskbuilds and the ministries of health, justice and social services shortly after the announcement to put forward requirements they wanted included in the project agreement.
When three proponents for the project put forward their designs, the team also met with them.
"We met four times with each of those three proponents and gave them feedback on how well they were meeting the standards outlined in the PA," said Shynkaruk.
When the final evaluation was done in July of 2015 and Access Prairies Partnership was announced as the successful proponent, more meetings were on the agenda.
"We began meeting with them in August and we established a number of user groups," she said. "Those user groups were inclusive of front line staff and patients."
Each user group represents a specific area, and each is looked at very closely, Shynkaruk explained. Those areas included pharmacy, dietary, housekeeping, nursing units and more.
An effort was made to include the staff and the patients that were involved in the 3P process, so the work that had been done in those sessions could play a part in the new facility design.
From each user group, feedback is provided on APP's design – "what’s going to work in their design and what’s not and they go away and try to change things up and come back to us."
She added, "It’s really back and forth.”
Shynkaruk said, "We also started program development in August. So currently we are evaluating and developing patient programs, especially focusing on the secure side of the hospital because it’s new to us. This work is based on patient needs and while we are doing this work we are also working on our staffing plan. Our hope is this facility will be the first of its kind of in Canada, if not North America."
Shynkaruk says her team put forward the idea that the facility be a one-operator model. Instead of Prairie North contracting its services to the corrections minister, she said both secure and non-secure beds should be operated under health.
The questions, she said, was "Do we want a mental health facility with the flavour of corrections or do we want a correctional facility with the flavour of mental health.”
Definitely the former, she indicated.
"We did tour some facilities last summer down in Toronto," said Shynkaruk. "We went to a new facility in Brockville and they are [operating] a service much like what we are planning on doing in this hospital. When we brought up the idea of us being under health versus justice they said that was absolutely right thing to do.
They told her, "We correctionalized our nursing staff and our clinical staff, so you need to de-correctionalize your correction staff."
"So I think we are on the right track on being able to establish a therapeutic environment right off the top," said Shynkaruk.
"On Sept 21, we had our official groundbreaking ceremony," she continued. "It was a very exciting, emotional, cold day, but there were seven ministers there, and apparently that has never happened before. So this is a huge deal for us, for the Battlefords, and for the province. We’re very proud to be a part of it."
Shynkaruk said, "The construction has already started, the golf course is gone, we had a last golf tournament in July and that was really emotional. There have been lots of tears over this thing, but lots of smiles as well."
She added, "The hole is has been dug, they’ve already started pouring cement. I did ask in our conference, 'How can you guys start pouring cement when we don’t even have a final plan?'"
She was told, "We do it all the time. We pour what we know is not going to change and we can finish the rest later on as we go."
Shynkaruk said the planning will continue for the next three years as the new facility is built.
"It’s a lot of work, but it’s exciting work and, as I said, we are all proud to be a part of it. And we’ll be starting the next century of caring."
Patient representative Wade also spoke at the regional review.
"I’m honoured to speak to you today," said the young man who was diagnosed with bipolar disorder when he was 17.
"Before coming to Saskatchewan Hospital I didn’t think there was much hope. I’ve gained self-confidence. I feel confident there is hope for people with mental health issues," he said.
He said a new facility will benefit the patients, but he also had praise for the staff.
"Nurses are very important to the process. Without them the process would be almost nonexistent. They help the patient transition from being unhealthy to being healthy and ready for discharge," he said.
In thanking the Shynkaruk and other presenters, Vicky Smart, vice-president of primary health services, said they had seen beautiful examples of working together with patients and families.
"We’ve always said if you have the patients and family involved in the process the conversation changes," said Smart.
Other presentations at the regional review included: improving access to pediatric services through Prairie North and North West School Division; and improving efficiency and quality – Battlefords Mental Health Centre Health Records.
