Regional policy and procedure development: a seven-step process.

In October 1997, Nova Scotia's Eastern Regional Health Board undertook the development of regional policies and procedures relating to both its governance and management responsibilities. The process that was adopted included delegation of tasks to work groups; development of general administrative policies and procedures in accordance with accreditation guidelines and present health restructuring initiatives; coordination of the development of the policies and procedures within a specific framework; and development of standardized clinical policies. A steering committee initiated the project, which involved 24 subgroups.

Mobilizing toward regional accreditation.

In January 1999, the Eastern Regional Health Board began planning for a Regional Accreditation scheduled in November 1999. This would be the first time that our two programs (Addiction Services and Public Health), and two of the nine acute care facilities in our Region would be accredited. This article describes a regional accreditation planning process. It suggests the resources required for such a project, suggests a workable time line, and indicates a communication strategy. Mobilizing over 1000 staff, physicians, and the communities toward Regional accreditation was a challenge for the Steering Team. Defining a plan of action with defined time lines proved helpful; defining team chairs who were flexible and positive was vital, and engaging the communities in our review was rewarding. Informing the public was completed using strategies borrowed from our Newfoundland counterparts (an accreditation mural and a regular newsletter), and our own creative strategies such as "Sharing Day" and engaging community health board involvement on accreditation teams. The project development was initiated by a steering committee, and spanned 21 teams. Both a communication and education plan were important in keeping the board, staff, physicians and residents of the Region informed.

Initiating regional quality management.

In June 1999, the Eastern Regional Health Board began to structure a regional quality management program that included quality, satisfaction and risk management initiatives. A regional plan for our two programs (Addiction Services and Public Health) and nine acute care facilities was needed. All had internal quality programs in place, at varying levels of maturity. Synthesis into a regional quality management plan was required. This article describes how one region planned and implemented this task over 10 months. Suggestions are included relating to required resources, a workable timeline and a communication strategy.

Bed utilization: a regional trial.

In mid-1992 a bed utilization study was implemented in four hospitals in Cape Breton. Over four months, 260 patients and charts were reviewed using the Appropriateness Evaluation Protocol (AEP). Results suggested that 21.5 per cent of the population was inappropriately admitted, had inappropriate days of care, or both. Pros and cons of the AEP were identified, and plans for implementing the AEP, together with clinical questions, have been endorsed by Cape Breton's Regional Services Committee. A subsequent study, to be published in the next issue of Leadership, discusses a review of the discharge planning process in Cape Breton Region.

Discharge planning in Cape Breton Region: standardizing the process.

In the fall of 1991, Cape Breton's Regional Services Planning Office conducted an exploratory study of discharge planning within the region. The review compared the personnel involved in the discharge planning process and noted the strengths and weaknesses of the discharge procedures in the region's hospitals. The study recommended the development of a uniform discharge planning information tool and a common matrix for collecting discharge information for all the hospitals in the region. The recommendations were subsequently addressed by a utilization subcommittee established in February 1992. The results were the development of a regional discharge planning form, a guide for implementation and a suggested approach to improving hospital bed utilization within the region.

Expert approaches to communicating violence risk.

There has been virtually no empirical study of the way in which evaluating clinicians communicate their conclusions about the risk of violence toward others. Risk communication has become particularly important in recent years, serving as the link between empirical data from recent studies and the understanding and use of such data by evaluators and decision makers. The present study considered how psychologists and psychiatrists, identified as experts in violence risk assessment, responded to eight vignettes that systematically measured preferences for risk communication. The vignettes involved the presentation of the following factors in a 2 x 2 x 2 within-subjects design, counterbalanced for order: (1) risk model (prediction vs. management), (2) risk level (high vs. low risk of the individual being assessed), and (3) risk factors (the predominance of static vs. dynamic risk factors). A total of 71 individuals (41 psychologists, 2 sociologists, and 28 psychiatrists) responded to a survey mailed to 100 individuals, for a response rate of 71%. Participants were asked to rate the value of six forms of risk communication for each of the eight vignettes. There were few significant differences between the ratings assigned by psychologists and those assigned by psychiatrists. The most highly valued form of risk communication involved identifying risk factors applicable to the individual and specifying interventions to reduce risk. A repeated-measures multivariate analysis of variance yielded a main effect for risk level and an interaction between risk level and risk factors. The implications of these findings for research and practice are discussed.