better together frontline physicians &...
TRANSCRIPT
Better Together – Frontline
Physicians & Administration
October 12th, 2017
“We have no conflict of interest nor any financial
relationships/ interest with commercial entities such as
pharmaceutical, medical device, or communication firms”
Disclosure Candice Manahan – Prince George, BC
Dr. Curt Smecher - Abbostford, BC
Disclosure Dr. Gordon Hoag – Victoria, BC (past 2 years)
Type Details
Speaker’s Bureau no disclosures
Honoraria no disclosures
Advisory Board Member: Sanofi-Aventis, Amgen
Recipient of unrestricted
educational grants:
no disclosures
Pharmaceutical Sponsor trials
participant as a Principal
Investigator:
Boehringer Ingelheim, Esperion, Gemphire,
Kowa Research Institute Inc., Luitpold,
Merck, Pfizer, Rogerenon, Sanofi-Aventis
Perspectives
SSC…
• Dr. Gordon Hoag
Health Authorities…
• Candice Manahan
Clinically Active Physicians…
• Dr. Curt Smecher
Ministry of Health • Dr. Ron Carere (Co-Chair)
• Brendan Abbott
• Ryan Murray
• Marilyn Copes
• Dr. Georgene Miller – PHSA
• Dr. Brenda Wagner – VCH/PHC
• Dr. Dayan Muthayan – FHA
• Dr. Rod McFadyen – VIHA
• Dr. Alan Stewart – IHA
• Candice Manahan – NHA
• Dr. Rob Parker – FNHA
SSC LeadershipDoctors of BC• Dr. Sean Virani (Co-Chair)
• Dr. Matthew Chow
• Dr. Kathy Lee
• Dr. Frank Ervin
• Dr. Gordon Hoag
• Dr. Ahmer Karimuddin
• Dr. Ken Hughes
3. Supporting Physicians
SSC Strategy & Work-plan
Physician Leadership & QI Training
Service Delivery (Fees)
SSC Resources (Staff Support)
2. Enabling System Improvement
1. Engaging Physicians
Facility Engagement Staff Quality Improvement Teams SSC Leaders
Facility Engagement (FE)
Physicians Quality Improvement (PQI)
SSC Provincial Projects &
Spread
Quality & Innovation Projects
Health System Redesign Fund
Gap• Physicians passionate about improving care - many ideas:
o Past SSC Quality/Innovation Funding (EOIs)
o SSC funding towards Shared Care (Partners in Care & Transitions in Care)
o Recent surveys and member engagement
• BC health authority VP’s of Medicine have told SSC
o “nurses, clinicians and other staff participate in quality activities, but we
struggle with physician participation….we welcome your (SSC) support…”
• MoH awareness and need to go beyond Health Redesign Funds…
Leadership
• While the JCC’s had some good programs or initiatives underway,
including the Practice Support Program, but at SSC there was a feeling
that more was required to close this “Gap”
Steering Committee
Technical Staff
Training
QI Project
Slightly different
approaches/models (NHA,
IHA, VIHA, FHA, VCH,
PHSA).
$1.3
m p
er
HA
per
year
PQI
• Dedicated Technical Staff, embedded in the health authority
• Serve exclusively the PQI file and other SSC initiatives where needed
• Data Analyst, QI Consultants/Coordinators, Evaluation, Physician QI Advisors
• Approximately 40 individuals
Collective Target – F2017/18 Work Plan
100Physician QI Projects
500Physicians QI Training
25 Technical staff
“The goal of PQI is to create the capacity and the culture within the
physician community to enable widespread system improvement in
the quality of care for patients, using the IHI Triple Aim as a guide”
Alignment/Integration
STRATEGY 3:
Quality
Enable effective quality improvement
capacity across the health system –
strengthen quality assurance to effect
meaningful improvements in patient
outcomes.
• Strategic Priorities: 1; 4; 5; 7; 8
• Strategic Enablers: 1, 3, 5
Perspectives
SSC…
• Dr. Gordon Hoag
Health Authorities…
• Candice Manahan
Clinically Active Physicians…
• Dr. Curt Smecher
SSC Physician Quality Improvement
at Northern Health
Candice Manahan,Executive Lead, Physician Quality Improvement
Overview• Where we started and what we heard
• Process: Proposal development and approval
• Principles and approach
• Steering Committee: Spirit of collaboration
• New team and roles
• How we fit in the health authority?
• Where we are at now?
Pre Consultation 2016Four Major Themes
1. Shared Understanding of QI Concepts
2. Data Feedback & Reflection
3. Making Connections
4. Celebration & Raising Awareness
Lots of driving!
Local/Unit Level Themes
• Provide support for the existing
• CME and/or reimbursement for time
• Local voice to regional
• Access to local/individual data to look for areas for improvement
• Local access to supports for follow-up on quality issues or ideas in the facility
• Physician Lead or collective (sub-committee) specific to quality improvement
Process: Timeline & Activities
1. HA to share vision, interest and need for resources June 2015
2. HA & SSC to sign-off on “Letter of Intent” July 2015
3. Jointly develop plan Mar-June 2016
(4 meetings)
4. Starting at NHMAC, consulting the broader stakeholders June-Aug 2016
5. Take to Medical Directors and Executive for approval, then submit to SSC Sept 2016
Principles & Approach
• Create a joint governance structure to support collaboration and integrate with the various existing structures at NH.
• Raise awareness around the current resources available and enhance those successful structures to strengthen a culture of quality improvement.
• Empower providers to drive quality from the edge of health care.
NH/SSC QI Steering Committee
Spirit of Collaboration
Bring the varying perspectives together to create a team “we”
• Patients
• Physicians (new Medical Staff Associations and Divisions)
• Northern Health (Primary Care, Quality & Innovation, Physician Services, Programs, and Operations),
• Specialists Services Committee
Provide overall accountability, ensuring alignment and use of existing resources
Communicating across and tying together
Chair
How does PQI fit with other QI supports?
Northern Health
VP Planning Quality & IM
VP MedicineVP Primary &
Community Care
QI Advisors & Leads QI Coaches PSP Coaches
Quality Vision
Where are we at?
7
5
4
4
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
Emergency
Surgery
OB/GYN
Radiology
Internal Medicine
All Departments
Inpatient Acute
Community Health Centre
IPU
Health Records
Psychiatry
Pediatrics
Endoscopy Program
Respirology
NICU
Diabetes Education
ICU/HAU
Education
Laboratory
DI
D&T Centre
Facility
Facility Departments Involved in PQI Projects in Northern Health, January to July 2017
Perspectives
SSC…
• Dr. Gordon Hoag
Health Authorities…
• Candice Manahan
Clinically Active Physicians…
• Dr. Curt Smecher
What it takes
Will
AbilityIdeas
Will
AbilityIdeas
Barriers?• Why bother, no one listens.
• They will just do what they want anyway…
• I’m not opening that “Can of Worms”
• I can’t afford the:
1. Time
2. Energy
3. Frustration
• I don’t want ALL THOSE MEETINGS
• I don’t need someone else telling me how to do my job
• I don’t trust them…
• I can’t work with them…
• It’s none of their business anyway…
• Privately (to ourselves only…)
o Do I really know how to do this any better?
o This is complex
o I don’t know everything that goes into this
• and countless other barriers
What it takes
Will
AbilityIdeas
Barriers?
• We have LOTS of Ideas
• Every assembly of Physicians will tell
you what is wrong with the system (ad
nauseum)
• Some of these ideas are even:
• Reasonable
• Practical
What it takes
Will
AbilityIdeas
Barriers?• Physicians will engage from a position of Strength
• We understand Science
• We are EXPERTS in our fields
But:
• QI is not part of most of our Medical School
Training
• There is a lot of “Crap” out there
• What “really” is:
• LEAN
• PDSA
• The whole alphabet soup out there…
• We hate pointless meetings
What it takes
In order to address these barriers, we need:
1. Training
2. Access to Data
3. Experience in QI
4. Time
5. Mentoring
6. But, especially… Partners
Moving the Agenda Forward
QI is a TEAM Sport
• 6 Health Authorities
• Mostly, doing their own thing
• There are some basic principles, but nobody KNOWS the BEST way
• So, we are running 6 Experiments
Physician Quality Improvement (PQI)
But we are
working together
And Sharing our
Experiences
Different Training Approaches Introduction Core Advanced
• IHI Open School
• Evening sessions with
dinner (NHA, VIHA)
• 1 day crash course
(VIHA, VCH, PHSA,
FHA, IHA)
• 7 day program (VIHA,
VCH, PHSA, IHA)
• 13 day program (FHA)
Team Work
• PQI involves MULTIPLE Teams
The Provincial Team
• SSC Staff
• Provincial Physician Champion
• From Each Health Authority
o Physicians
o PQI Staff
Our Steering Committees
At the Health Authority Level
• Health Authority
• SSC
• Physicians
o PQI
o Facility Engagement
• Patient Reps
Island Health
Our Support Team
• Patient Representatives
• Improvement Coaches
• Data Access
• Data Analysis
• HA Advocates
Our Classroom Team
• Each Cohort has a wide range of Representation:
o Specialties,
o Hospitals
• All Learn, All Teach
• We are our own support group
• Group cohesiveness and support is a critical factor
The Project Teams
• Administrative Sponsors
• Medical Sponsors
• Patients
• Nurses
• Students, through the SFU IHI Open School Chapter
• Support Staff
Our PQI Alumni Team
• We keep our Alumni engaged and active
• They engage in more projects
• They help teach and mentor the current Cohort
• They are very involved in the Facility Engagement efforts
• Their continued involvement is one measure of our success
The Bigger Picture
We are creating alliances between the Teams and:
• IT – Privacy, Data Access, Data Governance
• The Executive Suite
• Clinical Administration
• Medical Administration
In very real, tangible ways
Sep 2017, Grad Cohort 1
The Bigger Picture
As we demonstrate success,
• More Physicians want to take part
• Administration gets more interested and more actively engaged
• Our opportunities to work together expands
Quality Improvement is a TEAM Sport
Improved Quality of:
• Patient Care
• Services to the Community
• Value to the public
• Our Work Environment
ARE THE COMMON DENOMINATORS
That allow Physicians and Health Authorities to work together
AS A TEAM
