Evidence Based Approach to Provincial Urology Services

Philip Belitsky MD

Peter MacKinnon MHSA CHE

Rachelle O’Sullivan MBA

Today’s Presentation

1. Urology Care Today

2. Urology in Nova Scotia 2006

3. New Delivery Concept

4. From Concept to Actuality

Yesterday’s Urology

Today’s Urology

Criteria for Quality Care

1. Contemporary Standard of Care• Including technology and skill sets

2. Readily Accessible

3. Fiscally Responsible

4. Positive Environment • Recruitment and Retention

60,50063,000

82,500

73,500

32,50047,000 46,000

404,000

130,000

DHA PopulationsProvincial Total 939,000

60,500

63,000

82,500

73,500

32,50047,000 46,000

404,000

130,000

Where are our hospitals ?

60,500

63,000

82,500

73,500

32,500

47,00046,000

404,000

130,000

Are all hospitals the same ?

Sydney

AntigonishNew GlasgowTruro

Amherst

Bridgewater

Yarmouth

Kentville

Halifax

60,500

63,000

82,500

73,500

32,500

47,00046,000

404,000

130,000

Where are the Urologists ?

Sydney

AntigonishNew Glasgow

Truro

Amherst

Bridgewater

Yarmouth

Kentville

Halifax

13

3

0.2 0.5

2

Where do patients receive Urologic Care ?

Sydney

Antigonish

Bridgewater

Yarmouth

Kentville

Halifax

13

3

2

0.2 0.5

9%

55%

Truro

New Glasgow

Amherst

Is it easy/quick to get urology care ?

Sydney

Antigonish

Bridgewater

Yarmouth

Kentville

Halifax

TruroNew Glasgow

Amherst

2.75 h

rs

2.1

hrs

1.2

hrs

2.6

hrs

Do We Have Quality Urology Care In Northern NS?

1. Contemporary Standard of Care• Including technology and skill sets

2. Readily Accessible

3. Fiscally Responsible

4. Positive Environment • Recruitment and Retention

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Western

Region

206,000

Capital

Region

404,000+

Tertiary Care

Cape

Breton

Region

161,000

Northern Region

183,000

New Concept Step 1 Change Geography

Western

Region

Capital Region

Cape

Breton

Region

New Concept, Step 2 – Determine Urology Centres

Sydney

Truro

Kentville

Halifax

Northern Region

New Concept Step 3 - Create Functionality

Antigonish

Truro

New

Glasgow

Amherst

Major Centre

• Clinics

• Diagnostics

• Minor Surgery

• Major Surgery

• Major Technology & Infrastructure

Satellite Centres

• Clinics

• Diagnostics

• Minor Surgery

• Supporting Infrastructure

Halifax

3-4 Urologists

Does Concept Fit Definition of Quality Care?

1. Contemporary Standard of Care• Including technology and skill sets

2. Readily Accessible

3. Fiscally Responsible

4. Positive Environment • Recruitment and Retention

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Building the Model - History

• DoH initiated surgical services plan for the Northern Region

• Critical meeting in Northern Area– Summit of multiple stakeholders

– Visioning exercise for northern region

– Created buy in for concept of a shared service for urology

– Siting for inpatient unit determined by DoH

• Planning for shared service in northern region indicates the need for a broader, more provincial focus

Building the Model – Buy In

• Established project team led by DoH

• Engaged consultants with credibility for physician engagement in development of model

• Developed Steering Committee Structure

– Government

– DHA representation• senior leadership

• management

• health disciplines

– Academia

– Urologists – community and academic

Building the Model – Project Objectives

• Develop a provincial multiple-site shared service model for urology with implementation plan for Northern Area

• Identify the role of CDHA both as the academic and tertiary/quaternary care centre

• Identify service requirements, including HHR and equipment needs

• Identify processes that will enable provision of consistent standards of care throughout the province

Building the Model – Engagement

• Consultation with stakeholders– During the development of the model

– Validating the model

• Steering Committee– Effective Sounding Board

– Inclusive/Open/Participatory

– Mutual Benefits understood

– Patient focus +++

– Document Creation & Sign – Off

• Senior leaders – government and DHA’s– Approval of model/report

– Support for moving forward with next steps

Building The Model - Physician Champion

• Wide consultation throughout process

• Demonstration of improved access and care to family physicians, hospital administration, staff, stakeholders of better access

• Patient focus/better care for referring physicians

Building the Model -Where are we now• Patient Focus – majority access, i.e. travel

– < 30 minutes • Consult with specialist• Workup• Minor surgery

– <1 – 1.25 hours for major surgery and care

• Implementation Starting at CRH – Recruitment– Connection with CDHA– Renovations– Equipment– New Facility Planning– Work in Progress

Summary

• Complex initiative

• Several years to come to fruition

• Starts next month

• Next Steps

– Determine additional costs and get through funding approval process

– Staged for full program implementation

– Evaluation Framework