better together frontline physicians &...

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

Contact

Aman Hundal, SSC Liaison - ahundal@doctorofbc.ca (604) 812 3231