Overview

Clinical care services are at the core of Alberta Health Services (AHS). The performance review examined clinical services across the continuum of care:

  • acute hospital care
  • post-acute and long-term care
  • community-based and home care services

Improvements outlined in the report primarily focus on adjusting resources and operating rooms to allow patients to be cared for in the best place, at the right time. All of the recommendations together seek to improve care delivery across the province so Albertans can be confident they're receiving the best care available no matter where it's delivered.

No hospitals will be closed and urban trauma centres will not be consolidated.

AHS review recommendations

The AHS performance review report made 21 recommendations (numbers 14-34 of 57) related to clinical care, including:

  • the use of services, procedures and resources in clinics
  • how care is delivered across the province
  • support services such as diagnostic imaging, pharmacy and emergency medical services

Clinical utilization

  1. Prioritize the further provincial standardization of clinical care pathways and protocols to ensure all Albertans have access to evidence-based, outcomes-focused and cost-effective care.
  1. Continue to strengthen AHS’ integration with primary care through the expansion of community-based and home care programs to care for patients in the most appropriate setting.
  1. Expand a bed flow program, such as the CoACT Collaborative Care Framework, to standardize and manage beds effectively across the province, improve length of stay and allow for patient care in the right place, at the right time.
  1. Internally establish a province-wide performance monitoring and management framework for the governance, accountability and reporting of surgical services.
  1. Within a provincialized surgical framework, reassess the level of investment needed to achieve the Alberta Surgical Initiative volumes based on utilization improvements and potential for alternate treatment pathways for patients.
  1. Create a fit for purpose operating model for ambulatory care and outpatient clinics and develop a strategic vision and governance model to support AHS’ objectives in both the hospital and the community.
  1. Consider realigning bed resources within acute, long-term care (LTC), designated supportive living, and community care to support an immediate reduction in alternative level of care, ensuring patients are cared for in the most appropriate setting.
  1. *Reconsider long-term care (LTC) facility ownership in cases where private delivery may be more efficient and appropriate.

*Parameter: Sell Capital Care and Carewest only if there is an appropriate return on the assets and a high quality delivery partner assumes operations.

  1. Transition from volume-based and transactional home care oversight model to one where providers are held to account for patient outcomes and quality of care for those they serve.

Service configuration

  1. *Alberta Health and AHS should establish provincial clinical access guidelines and further develop clinical standards to enable an affordable and safe configuration of acute care facilities across the province.
  1. *Consider reconfiguration of small/medium community sites based on the validated and agreed access guidelines.

*Parameters (for 23 and 24) AHS should work closely with communities in configuring hospital and emergency departments appropriately, with no closures.

  1. Review existing virtual health initiatives and consider development of a provincial plan to leverage virtual health technology to provide care across remote populations.
  1. Ensure trauma is managed as a provincial service, with stronger adherence to trauma triage and referral protocols to avoid bypass of regional centres where not clinically appropriate.
  1.  *Consider consolidating Edmonton’s two major trauma centres to a single site.

*This recommendation has been rejected. There will be no consolidation of urban trauma centres.

  1. AHS and Alberta Health should assess opportunities to expand the use of non-hospital surgical facilities across the province.

Clinical support services

  1. Expand and scale clinical appropriateness initiatives to reduce unnecessary tests to improve patient safety, experience and access across Alberta.
  1. Further leverage private contracts for the provision of laboratories services across Alberta. While an initial focus should be on community-based testing, subsequent consideration should be given to expanding to specialty test options.
  1. Optimize capacity across diagnostic imaging services by consolidating underutilized radiography facilities and increasing throughput of CT and MRI modalities to help manage wait lists where appropriate.
  1. Consider and assess options related to a Managed Equipment Service approach to major diagnostic imaging equipment to provide more timely equipment replacement and access to innovations that can drive further efficiencies.
  1. *Review and optimize AHS’ commercial business models for pharmacy including retail pharmacy options (e.g. owned, lease, profit share) and LTC delivery models. Consideration should be given to co-pay options and expanding the Calgary private LTC model in order to maximize financial benefits province-wide.

*Parameter: Consider co-pay in long-term care only to the extent that it aligns with other provinces and does not affect low-income patients.

  1. *Rationalize EMS dispatch and air ambulance operations including the relocation and decommissioning of underutilized airbases and a review of service agreements where services can be more efficiently delivered by AHS.

*Parameter: Consider the consolidation of air ambulance bases closer to the termination of the existing contract.

More recommendations

See the other AHS performance review recommendations: