Mission: To support the development and implementation of health system innovations that improve patient access to appropriate care (right care, right place) in emergency departments, hospitals or communities. We would strive to be seen as an improvement catalyst, policy advocate, and trusted information source.
Objective: The “No Patient Left Behind” fund will provide annual peer-reviewed grant funding to develop and implement promising access-related health system innovations, particularly those that incorporate concepts of patient care accountability or accountability framework implementations. High priority grant proposals could fall into several categories (see Box 1).
Primary Benefactors for the “No Patient Left Behind” fund: Linda and Tom Stevenson (Green Valley, AZ)
Oversight: Oversight would be by a board of 8-10 volunteer members with appropriate healthcare experience, board experience, or marketing-social media expertise. Board members would agree to a minimum two-year commitment, and would oversee board reappointment and renewal. The board would oversee the expert panel re future curriculum evolution, expert speaker solicitation, content control, budget and management, and approval of projects, grants, conference support and other funded initiatives. The Board may choose to form ad hoc expert panels for specific tasks, such as advising the Board re evolving vision for the fund, assisting with strategies to involve nursing, allied health and non-EM physician leaders in supporting system change, establishing and fostering strategic alliances and synergies.
The fund should leverage effectiveness through collaboration but avoid redundancy with other organizations. Key collaborations will ideally include the Canadian Medical Association, the National Emergency Nurses Association (NENA), hospital and health leadership organizations, provincial medical and EM organizations, community and philanthropic groups, ministries of health and others.
Proposed Board Members:
Sherry Stackhouse (Emergency nurse, lifetime board member, and proxy for Grant Innes),
Eric Grafstein (Regional Head of Emergency Medicine and Chief Medical Information Officer,
Vancouver Coastal Health),
Howard Ovens (Chair, Ontario Emergency Services Advisory Committee, Schwartz/Reisman Emergency Medicine Institute, Toronto),
Alecs Chochinov ( Specialty Lead for Emergency Medicine in Manitoba; Chair, CMA Council on Education and Workforce; lead author,Canadian Association of Emergency Physicians EMPOWER Report)
Lorraine Kane (rural family physician, Oliver, BC),
Anton Helman (founder, and chief editor, Emergency Medicine Cases, Mt. Sinai Hospital, Toronto),
Lynn Garrow (Executive Director, Canadian Association of Emergency Physicians–or board designate?),
Shelley McLeod (Clinical epidemiologist and research director, Schwartz/Reisman Emergency Medicine Institute, Toronto),
Jason Sutherland (Director, Centre for Health Services and Policy Research, UBC Faculty of Medicine),
Emma Helman (Board intern. Non-voting, medical student)
Funding: Funding would arise through the formation of the Grant Innes, No patient left behind endowment fund. Initial funds would come from our primary benefactor and from a donation program at the time of my death. Possible goals for this fund are:
A. $1M ($727K USD), which would allow for annual system improvement grants totalling $40-$50k
B. $750,000 ($545K USD), which would allow for annual system improvement grants totalling $30-$38k
C. $500,000 ($364K USD), which would allow for annual system improvement grants totalling $20-$25k
D. $250,000 ($182K USD), which would allow for annual system improvement grants totalling $10-$12k
Grant dollars would be divisible based on the availability of funds and the quality and potential impact of grant applications, as determined by the board or a grant review committee. Successful grants would be awarded at the Canadian Association of Emergency Physicians annual conference; they would acknowledge the SREMI/CAEP/“No Patient Left Behind” collaboration and specifically name the Grant Innes “No Patient Left Behind” fund and its mission. Ongoing awareness of the fund through CAEP and SREMI and the “No Patient Left Behind” board would hopefully lead to some ongoing level of annual tax-deductible donation.
Grant selection Process: All grant applications will be reviewed by the Board or a Board-determined ad hoc review committee. The CAEP Board will approve the final award winner. The Stevenson family representatives will be informed prior to a public announcement of the selected grant recipient (s).
Obligations of the Canadian Association of Emergency Physicians (CAEP): CAEP will assume all costs for two nights’ accommodation at the conference hotel, round-trip travel to and from the conference according to CAEP’s travel guidelines, and free full-conference registration.
Obligations of the Schwartz/Reisman Emergency Medicine Institute (SREMI): SREMI will provide oversight and management of the Endowment Fund, as well as provision of a yearly report of the Endowment Fund to the Stevenson family and CAEP.
About Dr. Grant Innes:
Dr. Innes did emergency medicine (EM) training under Dr. Peter Rosen in Denver, CO and worked 42 years as an emergency physician in Calgary, Vancouver and Oliver, BC. He is an internationally recognized expert in emergency care and visiting professor to many academic EM centres in Canada, the US and Asia. He has received numerous awards, including the University of Alberta’s RF Shaner Gold Medal (1980), the 3M National Healthcare Quality Award for Canada (team award), the UBC Distinguished Service Award for Knowledge Translation, the BC Ministry of Health Award for Innovation in Health Care, and the Canadian Association of Emergency Physicians’ (CAEP) Presidents Award for lifetime contributions to Emergency Medicine.
Dr. Innes is passionate about reducing care delays and adverse outcomes for Canadians. His recent work addresses causes and solutions for the growing crisis in emergency care, which relate largely to “domino effect” access failures elsewhere in the system. He proposes that the core flaw in Canadian healthcare is a lack of patient care accountability frameworks that define program accountability zones (populations) and care expectations. He believes that system care gaps can be substantially mitigated by introducing patient care accountability frameworks and operational improvement initiatives.
Dr. Innes has previously led successful large-scale change in the form of demand-driven overcapacity care protocols regionally (Vancouver) and provincially (Alberta). He served as Chair of Vancouver Coastal Health Emergency Services Council (2002-2008), then as Professor of Emergency Medicine and operational/academic Head for the Calgary Region and University of Calgary from 2008-2014. He spent 8 years on the Board of the Canadian Association of Emergency Physicians, and was founding editor of the Canadian Journal of Emergency Medicine from 1998-2007. Dr. Innes was a founding director of Alberta’s Shock Trauma Air Rescue Society (STARS) in 1985, and had a second term on the STARS Board from 2008-13. He recently served as a senior editor of the CAEP EMPOWER Report on the future of emergency medicine in Canada. Annually since 2007, in recognition of his work advancing EM research, CAEP presents the Grant Innes Research Award.
Dr. Innes has, unfortunately, developed metastatic cancer of the pancreas and hopes to establish an endowment fund that will promote system innovation and reduce care delays for Canadians.
Appendix: A note on accountability frameworks: Canadians face prolonged and harmful delays to emergency care, hospital care and community care. Many are forced to wait for care in the “wrong” locations (e.g. long-term care patients left in acute hospital beds and hospital inpatients in emergency department stretchers). When this happens, the resulting blockage of hospital beds and emergency stretchers leads to even longer care delays, “domino effects” elsewhere in the system, overfull hospitals, bad patient outcomes, and emergency waiting room disasters. This occurs largely because healthcare lacks an accountability framework.
An accountability framework would clarify which health programs are expected to assure care for which patients. Mental health programs would require plans to assure mental health care; emergency departments would require plans to rapidly assess seriously ill patients; and community programs would require plans to care for patients who need community (not hospital) care. Program expectations to provide care would apply even if the system is under stress.
The education system provides an excellent example of an accountability framework. When a family moves into a community, there is an expectation that all children have access to a school. Indeed, the education system ensures every child has a school and no children are left behind. Healthcare access is similarly important but not similarly assured, because our system lacks an accountability framework and health programs do not have defined care delivery accountabilities. This means, when patients cannot get the right care in the right place, it often seems unclear who will have to deal with the care shortfalls.
For example, when patients cannot access mental health care, mental health programs often expect that emergency departments will step up and deal with unmet mental health needs. Stressed emergency departments often assume paramedics will assure emergency care for sick patients in ED hallways. When patients cannot get community or rehabilitation care, community programs often assume that acute hospital physicians will provide this care, even if they are not trained or staffed to do so. When programs are under stress, the easy solution is often to let waiting patients become “someone else’s” problem. There are substantial opportunities for system improvement,and we could do better, but without defined expectations to optimize systems and close care gaps, innovation and change become optional. “Sorry–We’re full” becomes a default operating model and prolonged queuing becomes the norm.
Accountability frameworks would clarify that all programs have accountability zones (population responsibilities) and accountability expectations, including timely patient assessment and disposition; budget, space, and nursing care for program patients, and contingency plans for managing surges and queues. The lack of accountability frameworks is the most critical missing piece in system design. Accountability is the evolutionary stressor required to drive necessary system change. It forces people and programs to ask: How would you change your care systems if blocking access was not an option.
Box 1. Suggested grant funding priorities*
Health policy change | Including measures supporting the implementation of facility- or system-level patient care accountability frameworks, or the introduction of demand-driven overcapacity protocols. |
Leadership | Physician engagement and leadership is a major system shortfall. Many physicians and physician leaders now feel disillusioned, marginalized and helpless. Leadership programs to identify, inspire and training of future leaders is critical. |
Education, social media and provider-public engagement | Within society and among healthcare leaders, there is a limited awareness of key system improvement opportunities, including the need to plan for populations (not just patients), the importance of population-capacity alignment, care accountability frameworks, rationing strategies (ethical care allocation), queue management and surge contingency plans, and for the elimination of redundant or low-value care whenever possible. Digital and social media/podcast educational offerings presented by credible physician (and nursing) opinion leaders should become powerful drivers of culture, system optimization, policy advocacy, and public engagement that drive future system change. |
Operational improvement | Inflow prioritization, expanded use of triage and reverse triage strategies (in all programs), enhanced knowledge of operations management principles, particularly in the areas of access and flow transitions (ED–inpatient, ED–community, and rural–tertiary connections) will significantly improve system performance, even in the absence of new capacity. Shifting the default from “Sorry we’re closed!” to “No patient left behind” is a critical paradigm shift. Ask your leaders, “How would you change your systems if you were not allowed to manage demand stress by blocking access?” |
*The “No Patient Left Behind” fund is not a research initiative but rather an endowment fund to support access-related health system improvement. | |