Sustaining a Healthy Healthcare System

The Quality Worklife – Quality Healthcare Action Strategy

Draft for Consultation

Stakeholder Summit

Ottawa, Ontario

December 12th 2006

Working Together to Make Health Workplaces Healthier

“A fundamental way to better healthcare is through healthier healthcare workplaces; and it is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces.”

QWQHC, 2006

The Quality Worklife – Quality Healthcare Action Strategy

Key Messages regarding the Quality Worklife – Quality Healthcare Action Strategy …………….4

Executive Summary ………………………………………………………………………………..5-7

The Issue………………………………………………………………………………………….....8

Background to the QWQHC………………………………………………………………………...9-11

QWQHC Key Deliverables

Healthy Healthcare Leadership Charter & Follow-Up Self Assessment Tool…………..12-15
Proposed Priority Activities……………………………………………………………..16-24
Proposed Standard QWL Indicators……………………………………………………..25-29
Pan-Canadian QWL Knowledge Exchange Framework………………………………...30-32

Conclusion…………………………………………………………………………………………..33

Appendices

List of experts on the QWQHC………………………………………………………….34
Overview of the Change Process…………………………………………………………35
Samples of Key Knowledge Exchange Vehicles………………………………………...36-37

References…………………………………………………………………………………………...38-39

Proposed Deliverables of the QWQHC Action Strategy

Key Messages

The Quality Worklife – Quality Healthcare Collaborative (QWQHC) was formed because there is consensus that more urgent action and collaborative efforts are required across the country to coordinate, integrate and share learning about improving the quality of worklife (QWL) in healthcare. Eleven national health partners and over 45 experts have come together to develop a Pan-Canadian QWQHC Action Strategy on QWL to improve health system delivery and patient/client outcomes.

While respect is given to the complexity of the issue, the QWQHC believes that we can achieve success in the near term if health leaders and their organizations commit to:

Measuring QWL (and include standard indicators with common definitions to allow for Pan-Canadian benchmarking)
Implementing one or more strategies to improve QWL and evaluating these initiatives.
Building good knowledge exchange tools both internally and externally to continue to share, learn and improve.

To support these fundamentals, the QWQHC has identified evidence-informed practices that provide leaders with some ideas as to where to begin and how to achieve success. The QWQHC has also identified how the Partners and other key national stakeholders can work together to support organizations. These ideas are coalesced into the Pan-Canadian Quality Worklife – Quality Healthcare Action Strategy and presented in this document.

The Pan-Canadian Quality Worklife – Quality Healthcare Action Strategy includes:

The Healthy Healthcare Leadership Charter:

All publicly funded health organizations and provincial health systems will be encouraged to become involved and to signal their commitment by signing a Healthy Healthcare Leadership Charter.

Priority Activities for Improvement:

Eleven Priority Action Areas for health organizations and 4 Priority Action Areas for health system leaders are proposed. A Self-Assessment Checklist is provided for organizational leaders to determine their strengths, areas for opportunities and potential leading practices for each priority action area. For each of these action areas, "menus" of essential practices as well the overall recommended change process for implementing these QWL initiatives are also presented.

A Standard Set of Quality of Worklife Indicators:

Nine Standard QWL Indicators are presented (including 2 System level indicators and 7 Organizational level indicators). Standard definitions for each of these indicators are also proposed.

A leading-practice knowledge exchange structure to promote the sharing of research and leading practices on QWL in healthcare organizations across the country.

This proposed QWQHC knowledge exchange network will actively connect explicit knowledge (i.e. research findings) and tacit knowledge (i.e. frontline experiences); and will provide a “one-stop-shopping” approach for individual change agents, organizations, policy-makers and researchers to connect on QWL issues in healthcare.

The National Steering Committee of the QWQHC has approved these proposals to go forward to a broader stakeholder group (including policy makers, governors, managers, providers and community members) for consultation and validation at an upcoming Pan-Canadian Stakeholder Summit (December 12th, 2006).

Proposed Key Deliverables of the QWQHC Action Strategy

Executive Summary

The health and well-being of the health workforce and the quality of the healthcare work environment has a profound impact on the effectiveness and efficiency of healthcare services. In recent years, there have been numerous reports listing hundreds of recommendations for improvement; however we are not seeing enough concentrated action and outcomes.

The ability to reduce wait-times and ultimately, the sustainability of the Canadian healthcare system depends on a strong supply of healthy healthcare providers. With staffing shortages affecting more healthcare professions and evidence that shortages will only get worse in the near future, there is a broad consensus that employers must do more to support and develop their current employees.

In June 2005, 11 national healthcare organizations partnered to form the Quality Worklife – Quality Healthcare Collaborative (QWQHC) with consensus that Canadian health system employers must urgently do more to retain its health human resources in healthy and supportive work environments. By working together to support and implement a pan-Canadian action strategy to improve the health of the healthcare workforce and their workplaces, we aim to also improve patient and system outcomes.

The 11 National Health Partners include:

Canadian Council on Health Services Accreditation (CCHSA) (Coordinating Secretariat)

Health Canada- Office of Nursing Policy (main funding partner)

CanadianCollege of Health Service Executives (CCHSE)

Canadian Nurses Association (CNA)

Canadian Healthcare Association (CHA)

Canadian Federation of Nurses Unions (CFNU)

Canadian Medical Association (CMA)

Canadian Health Services Research Foundation (CHSRF)

Association of Canadian Academic Healthcare Organizations (ACAHO)

Academy of Canadian Executive Nurses (ACEN)

National Quality Institute (NQI)

The QWQHC mandate is until March 2007. Our goal is to develop a Pan-Canadian Quality Worklife – Quality Healthcare Framework and Action Strategy. Success to us means that Canadian Healthcare Stakeholders will be receptive to this action strategy and will actively engage in the sustainable uptake and implementation well beyond the end of our mandate.

This report highlights the key deliverables of the QWQHC. We have identified three action strategies that embrace evidence-informed management and accountability practices. These strategies are intended to help the Canadian healthcare community work together to build healthy workplaces and link improvement to patient care outcomes.

The Proposed Quality Worklife – Quality Healthcare Action Strategy

First, the QWQHC has identified standard QWL indicators that we think all health organizations should build into their management information systems, performance agreements and accountability reports. A national benchmarking report of these QWL indicators would help organizations to identify areas for focused improvement and to set annual targets. It would also allow us to identify potential leading practices to develop and share across the country. This parsimonious group of indicators was selected because they are practical and feasible to collect, applicable to the all health organizations and have evidence to support that they are related to QWL and patient-care.

The Standard Pan-Canadian QWL Indicators with proposed standard definitions include:

2 System level indicators: provincial healthy workplace targeted funding; organizational healthy workplace program spending
7 Organizational level indicators: turnover rate, vacancy rate, training & professional development, overtime, absenteeism, workers' compensation lost time, provider satisfaction (pulse survey tool)

Second, the QWQHC have identified priority actions that are known to improve the workplace and that can be put in place without delay. The actions focus on both system wide and organizational performance improvement on specific areas that relate to QWL.

The 4 System-Level Priority Action Areas include putting in place:

A national QWL database and support for reporting of standard QWL indicators
Enhanced Performance/Accountability Agreements, Accreditation Standards
A pan-Canadian QWQHC Knowledge network to recognize and share leading practices
A national workplace health program for healthcare

The QWQHC believe that all health organizations will succeed it they a) put in place a strategic management system for QWL, b) implement a comprehensive and integrated HR, Workplace Health and Organizational Development strategy, c) measure QWL and link it to other organizational performance management systems and, d) develop internal and external knowledge exchange capacity. Within these broad areas, the QWQHC have identified 11 Specific Priority Activities. A Self-Assessment Checklist is provided for organizations to determine their strengths, areas for opportunities and potential leading practices. For each of these action areas, evidence-informed "menus" of leading practices as well as an overall recommended change process for implementing these QWL initiatives are provided.

The 11 Organizational-Level Priority Actions include putting in place:

A Strategic foundation for a QWL Initiative,
Organizational data systems to track and analyze QWL,
Organizational structures and processes that facilitate collaborative working practices,
Healthy leadership support and development programs,
Strategic training and development programs,
Fatigue management policy and programs,
Innovative approaches to workload and staffing systems,
An integrated disability prevention and management system,
A comprehensive support system for employee wellness,
A healing environment.
Support QWL champions to build knowledge exchange relating to priority areas for improvement.

Third, the QWQHC have set out a framework to exchange and apply knowledge, leading practices and research on healthy workplace strategies between all healthcare organizations across Canada. In order to know where to begin and then how to succeed in implementing positive change, healthcare organizations need easy access to research, advice and leading practices. The proposed knowledge network would actively connect explicit knowledge (i.e. research findings) and tacit knowledge (i.e. frontline experiences) and will provide a “one-stop-shopping” approach for individual change agents, organizations, policy-makers and researchers to connect on QWL issues in healthcare. The QWQHC proposes to identify existing knowledge exchange vehicles/initiatives wherever possible, and to provide a clearinghouse for key target knowledge users. The knowledge would also be presented in a format that allows stakeholders to find explicit and tacit knowledge for key areas that they have prioritized for action.

The QWQHC recognizes that committed leadership and sustainable efforts are required to realize our shared vision….where Canadian health providers achieve optimal health; and work in health settings that demonstrate healthy workplace leadership, management and accountability practices. The Healthy Healthcare Leadership Charter has been developed for health leaders to signal their commitment to act now. The QWQHC will work over the last few months of its mandate to encourage all health leaders to join others across the country and actively engage in improving QWL in order to retain health providers and improve patient care.

The QWQHC anticipates that if health organizations implement the recommended priority action strategies outlined in this report, QWL in healthcare will undoubtedly improve. The QWQHC Steering Committee and the National Health Partners recognize that we can achieve more success, with greater efficiency if we continue to work together to improve the health of healthcare across the country. Since the QWQHC’s current mandate is until March 2007, we are also proposing strategies for the sustainability of a Pan-Canadian Approach to improving QWL in healthcare.

There is momentum across the country regarding a Pan-Canadian approach to addressing our health human resources (HHR) issues, as described in the Advisory Committee on Health Delivery and Human Resources’ Framework for Collaborative Pan-Canadian HHR Planning. We feel it is important to support the sustainability of the QWQHC’s work through the integration of the proposed QWQHC action strategy into the broader HHR planning framework. The QWQHC has essentially built an evidence-based plan for achieving one of their major goals relating to HHR retention. Ongoing collaboration between key stakeholders willalso be facilitated and supported by the QWQHCNational Health Partners as they are currently identifying activities that each can champion in the future.

This proposed Pan-Canadian Quality Worklife – Quality Healthcare Action Strategy will be shared with broadly represented groups of stakeholders at a series of conferences as well at the Pan-Canadian QWQHC Stakeholder Summit held in December, 2006. The feedback elicited from each of these opportunities will be incorporated into our final Action Strategy, to be released in March 2007. The final report will be broadly disseminated by each of the QWQHC Partner Organizations.

The Issue

The ability to reduce wait-times and ultimately, the sustainability of the Canadian healthcare system depends on a strong supply of healthy healthcare providers. Recently, a startling study of Canadian physicians found that 46% are in advanced stages of burnout.[i] Another study found that 66% of new nurses (less than 2 years into the job) were experiencing "symptoms of burnout, including emotional exhaustion and depression.)[ii]Another study reportedly put burnout rates at 58% of nurses who had been working for a wider range of periods, and 54% of nurse managers.[iii] For nurses and physicians of all ages, reducing workloads is a priority.

With staffing shortages affecting more healthcare professions and evidence that shortages will only get worse in the near future, there is a broad consensus that employers must do more to support and develop their current employees. The Canadian Institute for Health Information projects that by 2006, 28% of the nursing workforce (RNs) will be age 50 or older. If these workers retire at age 55, following the current trend of earlier retirement, then impending losses in the provincial RN workforce could range from 22% to 32%.[iv] The challenge is creating positive work environments that encourage older nurses to delay retirement and keeps others from leaving the profession during the course of their careers.

The 2002 Canadian Nursing Advisory Committee report, Our Health, Our Future: Creating Quality Workplaces for Canadian Nurses observed that after 20 years of research on nursing job satisfaction and retention, we know what needs to be improved.[v] Across the country, many initiatives are underway which aim to improve the quality of worklife for healthcare providers; however, they are often isolated due to a lack of coordination, integration and shared learning. Canada lacks a mechanism for sharing information and coordinating actions on creating healthy healthcare workplaces. Collaborative efforts are required to ensure we can increase the pace and effectiveness of our efforts.

National and provincial human resource initiatives have focused mainly on managing the dynamics of the supply of and demand for health professionals. Now a broader focus is needed, so that health providers are viewed – and treated – as the core long-term assets of the healthcare system. This will only happen by embedding higher standards for health human resources and work environments within strategic plans at the organizational and governance levels.

A higher quality of worklife for healthcare providers leads to greater efficiency and effectiveness in the delivery of health services. The costs of absenteeism, illness and disability of healthcare providers in Ontario[vi] and British Columbia[vii]are both estimated to cost $1 billion dollars each year. The business case is strong; more investment is needed to support health providers to be healthy and productive.

Background to the QWQHC

Over a year ago, the CanadianCollege of Health Service Executives convened a broad group of national health stakeholders to discuss health human resource issues. This group decided that “Canada’s health system needs a comprehensive and collaborative approach to workplace and workforce renewal that does not pit one organization against another in a zero-sum quest for recruitment”. The ideas that were born out of this stakeholder workshop set the stage for the principles of this Quality Worklife-Quality Healthcare Collaborative (QWQHC).

The Canadian Council on Health Services Accreditation received $349,000 of government funding to support the work of the QWQHC Coordinating Secretariat. This 2 year funding is from Health Canada’s Healthy Workplace Initiative (which came out of the 2003 First Minister’s Accord on Health Care Renewal – Recruitment and Retention strategy). Health Canada has allocated over $ 4 million to support a number of healthy workplace interventions across the country. It is hoped that this Collaborative will fill an identified gap of lack of knowledge sharing for healthcare organizations across Canada. Please visit the new website, to find out more information about Health Canada’s work in this area.

In June 2005, 11 national healthcare organizations partnered to form the QWQHC with consensus that Canadian health system employers must urgently do more to retain its health human resources in healthy and supportive work environments. By working together to support and implement a pan-Canadian action strategy to improve the health of the healthcare workforce and their workplaces, we aim to also improve patient and system outcomes.

The 11 National Health Partners include:

Canadian Council on Health Services Accreditation (CCHSA) (Coordinating Secretariat)

Health Canada- Office of Nursing Policy (main funding partner)

CanadianCollege of Health Service Executives (CCHSE)

Canadian Nurses Association (CNA)