The Impact of Emergency Department Pay-for-Performance on Patient Flow and Access

Michelle de Moor is Operations Director Critical Care, Emergency, Burns Plastics and Trauma, and Patient Flow and Access at Vancouver General Hospital, Vancouver Coastal Health

When Emergency Department Pay-for-Performance (EDP4P) funding was introduced in British Columbia it represented a new model of financing for the health sector that was poorly understood. The intent was to provide financial incentives for good performance as it related to creating access for patients who arrive to the emergency department. The advantage, for organizations that were able to quickly adapt to this new funding model, is the ability to invest in resources, initiatives and systems to achieve improved patient flow.

At Vancouver General Hospital, within Vancouver Coastal Health, the senior leadership team has fully embraced the opportunities within the EDP4P funding model. Enhancing patient flow and access is a strategic priority and is considered to be inextricably linked to quality outcomes for patients. I believe VGH has been so successful with this work as a result of the willingness of the senior leadership team to take risks with the investments related to EDP4P revenues, and the organization-wide commitment to achieving improved outcomes.

In order to be successful, the investments have been diverse, from opening beds in acute care and community, to creating key frontline leadership positions that focus on patient flow and transitions, and putting in place critical infrastructure support in the form of electronic tools. Having said that, the most fundamental and powerful change has been the leadership accountability framework that has accompanied the organization’s commitment.

Through daily leadership rounding, daily reviews of outcomes, and establishing clear expectations for all programs, the organization has achieved a fundamental shift in the culture of flow.

There are still a lot of challenges with respect to ever-increasing demand, and we continue to look for the next opportunity to create access and capacity. However, we are absolutely committed to this work as a united leadership team and will continue to take risks with our resources in order to achieve better outcomes for our patients.

*Watch the video on how Pay-for-Performance has impacted wait times in the Vancouver area.

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