The story: an inpatient discharge model initiative

In February 2012, Alberta's minister of health issued three directives aimed at improving acute care hospital overcrowding. In response to one of these directives, Alberta Health Services (AHS) executives convened operational leaders, patients, clinicians and other service providers to design a standardised provincial approach to inpatient service delivery and discharge planning. The result was ‘Path to Home’ (P2H), an initiative that emphasised interdisciplinary collaboration and alignment of services to optimise hospital-based care and discharge. P2H incorporated elements of other successful patient care initiatives in Alberta, and was expected to reduce inpatient length of stay, lower hospital occupancy rates and ultimately improve waiting times for patients requiring hospital admission. Patients and families would also benefit from better coordination of care, thereby easing the difficult transition from hospital to home. The process of developing P2H and preparing for implementation was swift and thoughtful. Timelines were tight, but with the support of AHS senior leaders, the steering committee enthusiastically pressed on with a plan to roll out P2H in seven Alberta hospitals starting in April 2013. AHS leaders promoted P2H to staff and physicians, and momentum was building for this large-scale provincial healthcare initiative.

However, in late March 2013, the AHS Executive Committee determined that P2H overlapped with two similar initiatives, Care Transformation and Workforce Model Transformation (see table 1 for a description of each initiative).1 Each project was seeking organisational resource support for province-wide implementation. Budgets were frozen on all three initiatives pending a strategic re-evaluation. Uncertainty set in, and stakeholders at all levels began to ask questions about what happened, and what was going to happen. Excitement and enthusiasm were slowly replaced by frustration, doubt and resignation.

In June 2013, the AHS Executive Committee decided to merge the three initiatives into a …