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.
Primary Benefactors for the “No Patient Left Behind” fund: Linda and Tom Stevenson (Green Valley, AZ)*
Award Winner Entitlements:
Two nights’ accommodation at the conference hotel
Round-trip travel to and from the conference according to CAEP’s travel guidelines
Fee full-conference registration.
Project funding (amount TBD)
*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.
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.