qi for interdisciplinary teams
TRANSCRIPT
Simplifying the Journey:
QI For Interdisciplinary Teams
March 1st, 2017
Physicians Quality Improvement (PQI)
“We have no conflict of interest nor any financial relationships/
interest with commercial entity such as pharmaceutical,
medical device, or communication firms”
Disclosure
Dr. Gordon Hoag - Victoria, BC
Dr. Rod McFadyen - Victoria, BC
Dr. Curt Smecher - Abbostford, BC
Perspectives
SSC…
• Dr. Gordon Hoag
Health Authorities…
• Dr. Rod McFadyen
Clinically Active Physicians…
• Dr. Curt Smecher
7 Health
Authorities
Doctors of BC Ministry of Health
Physician Master
Agreement (PMA)
General Practices
Services
Committee (GPSC)
Shared Care
Committee (SCC)
Specialist Services
Committee (SSC)
Joint Standing
Committee on
Rural Issues
(JSC)
Joint Collaborative Committees
PQI
Ministry of Health
• Dr. Ron Carere (Co-Chair)
• Brendan Abbott
• Ryan Murray
• Marilyn Copes
• Dr. Steve Gray – PHSA
• Dr. Brenda Wagner – VCH/PHC
• Dr. Dayan Muthayan – FHA
• Dr. Rod McFadyen – VIHA
• Dr. Malcolm Ogborn – IHA
• Candice Manahan – NHA
• Dr. Rob Parker – FNHA
SSC Leadership Doctors of BC
• Dr. Sean Virani (Co-Chair)
• Dr. Matthew Chow
• Dr. Kathy Lee
• TBD
• Dr. Andrew Attwell
• 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 • We know physicians are passionate about improving care, they have many ideas,
and very interested:
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 the same things in slightly
different words…
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, 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
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…
• Dr. Rod McFadyen
Clinically Active Physicians…
• Dr. Curt Smecher
Physician Quality Improvement
Health Authority Sponsors
Dr. Dayan Muthayan
Dr. Ron Collins
Ms. Georgene Miller
Ms. Vivian Chan
Ms. Candice Manahan
Dr. Rod McFadyen
SSC PQI Leadership funding
SSC has allocated up to $1.3m per HA per year
to support physician engagement in QI activity
aligned with Health Authorities
What’s not to like?!
VIHA Multi Year Plan 2016-19 – Board Approved
16/17 Commitment
2.5.3
Establish the process to
ensure Specialist
Services Committee
(SSC) funding reaches
eligible physicians to
support quality initiatives
Deliverable / Milestone
• Align SSC funded initiatives with
HA Medical Quality Committee
• Support implementation of the
Regional Quality Improvement
initiative and the development of
criteria to fund physician-led QI
activities in alignment with Island
Health Strategic priorities
• Support the Facilities Engagement
initiative to increase opportunities
for collaborating with physicians on
quality initiatives
17/18 Direction
Ensure SSC Quality
initiatives
align with Island–
wide and local
quality structures
PQI Launch in Island Health
1. May 2015 Initial meetings SSC, Island Health and MoH
2. Jul 2015 Letter of Intent signed
3. Oct - Dec 2015 Working Group meetings (5) to develop plan
4. Jan 2016 Plan approved at SSC
5. Feb 2016 Working Group transitions to Steering Committee
Recruiting Physicians for PQI
140 physicians participated
November 3rd, 2016 Victoria
Rapid Fire introductions of available QI supports
Speed networking at
resource tables
Supporting Physicians for QI
PQI Implementation Feb 2016 to Present
Form Joint Steering
Committee
Hire Technical
Staff QI Training
Invite QI Projects
Evaluation
Joint PQI Steering
Committee
Patient Reps
SSC
Physician Champions
HA
Oversight
Perspectives
SSC…
• Dr. Gordon Hoag
Health Authorities…
• Dr. Rod McFadyen
Clinically Active Physicians…
• Dr. Curt Smecher
What it takes
Will
Ability Ideas
Will
Ability Ideas
Why Not? • 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…)
• Do I really know how to do this any better?
• This is Complex
• I don’t know everything that goes into this
• … and countless other barriers
What it takes
Will
Ability Ideas
Why Not?
• 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
Ability Ideas
Why Not? • Physicians will engage from a position of
Strength
• We are EXPERTS in our fields
• 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 understand Science
• We hate pointless meetings
What it takes
We need to address these barriers; we need:
1. Training
2. Access to Data
3. Training
4. Experience in QI
5. Training
6. Time
7. Mentoring
8. Partners
(… and Training)
(… another form of Training)
Moving the Agenda Forward
• 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)
Different Training Approaches Introduction Core Advanced
• IHI Open School
• Evening sessions with
dinner (NHA, VIHA)
• 1 day crash course (VIHA,
VCH, PHSA, FHA, IHA)
• 5 day program (VIHA)
• TBD (VCH, PHSA, IHA)
• 13 day program (FHA)
Fraser Vancouver Island Interior Northern Provincial
Geography Easier Easier Some
Challenges
More
Challenges
Very
Challenging Challenging
Stage Established Starting 1st yr Organizing Starting Organizing
Project
Based Yes Yes Yes Yes Yes Yes
Resources Variable
Training
Days
13 cohort
1 intro
TBD
1 intro
5 cohort
1 intro TBD Mentored TBD
Teaching Snapshot
• IHI, Model for Improvement
• LEAN
• Six Sigma
• Mixes
Teaching Models
• Basic Improvement Science
o History of Improvement Science
o Profound Knowledge
Systems Thinking
Understanding of Variation
Theory of Learning
Psychology, Teamwork and working with People
o Project Design
o Use of Data
• Advanced Topics
Teaching Topics
• Project Based Learning
• Learn how to do QI
• Learn how to navigate the HA
• Learn about using real data
• Learn the Supporting Structures in place
• Leadership development
Experiential Learning
Projects Physician Name Specialty/ Location Brief Aim Description
Greg Lewis Vascular Surgery
Abbotsford Timely access to Surgery after Stroke
Sean Keenan ICU
New Westminster Reduction in unnecessary ICU testing
Lee Ann Martin Oncology
Surrey Improved use of Febrile Neutropenia Protocols
Erica Phelps Obstetrics
Langley Access to OR for Emergency C Sections
Nigel Aspinall Emergency Medicine
New Westminster Improve Door to Doctor Time in busy ER
Raj Johal Family Practice
Delta Improve Time to be seen by GP after ER initiated Admission
Ali Akbar-Zadeh Hospitalist
New Westminster
Reduce the medical complications among hospitalizations for ischemic stroke at
RCH
Caroline Mariano Internal Medicine
New Westminster
Improve outpatient services to decrease acute utilization in patients prior to cancer
diagnosis
Dave Williams Internal Medicine
Abbotsford
Implement a comprehensive management system for patient safety reporting
incidence by physicians at ARH
Diana Stancu Family Practice
New Westminster Reduce LOS on admitted patients at RCH with COPD
Donna Sue Family Practice
Burnaby Reduce unwanted medical interventions for elderly patients in Burnaby ED
Frank Ervin Respirology
Maple Ridge Improve access to spirometry at RMH
Physician Name Specialty/ Location Brief Aim Description
Hector Baillie Internal Medicine
Nanaimo
To standardize Obstructive Sleep Apnea assessment in patients presenting with
heart failure
John Galbraith Microbiology
Victoria
To improve pneumococcal vaccination rates for medical patients prior to discharge
from acute care.
Samuel Kohen Internal Medicine
Comox
To improve central line insertion standardization, documentation and procedural
efficiency.
Dustin Loomes Gastroenterology
Victoria
To improve uptake of Azathioprine therapeutic drug monitoring for clinical decision
making for pts with Crohn’s and Ulcerative colitis
Valorie Masuda Palliative Care
Duncan
To improve implantation of meaningful Medical Orders for Scope of Treatment in
Residential Care
Jessica Otte Palliative Care
Nanaimo To improve correct medication orders documentation processes on discharge
Rohit Pai Gastroenterology
Victoria To improve outpatient treatment documentation following paracentesis for ascites
Terrence Paul Physician Services
Victoria To increase the number of completed MOST forms for patients discharged from ICU
Gustavo Pelligra Neonatal Intensive Care
Victoria
To standardize delayed umbilical cord clamping processes in term and preterm
infant deliveries
Corey Tomlinson General Surgery
Comox
To improve and standardize documentation and protocols for patients presenting
with GI bleeding
Jason Wale Emergency Medicine
Victoria
To improve access to opioid substitution therapy for ER patients presenting with
opioid addiction
Karen Wong Anesthesia
Nanaimo
To improve patient triage by comprehensive screening and scoring well in advance
of surgery
Projects
Aim Statement:
Within the next 6 months to be able to offer 100% of opioid addicted patients presenting to the ER in withdrawal the option for opioid substitution therapy with suboxone expeditated follow up.
Projects – Jason Wale, Victoria
Feb 20, 2017, CBC “How do we
solve B.C.'s opioid overdose crisis”
QI is a Team Sport
• ER Site Chief
• Nurse manager ER
• Medical Director
• Clinical Director
• Clinical Pharmacist
• Suboxone Clinic coordinator for CoolAid;
• Youth Clinix Suboxone coordinator
• Hopitalist
• Addiction medicine fellow
• Coordinator of inpatient suboxone treatment
• Canada Research Chair in substance abuse
• Outreach worker for Umbrella Society
Projects – Jason Wale, Victoria
Projects – Steve Ligertwood, Fraser
LOS decreased from
11.3 days to 4.9 days
• Improve communication between health care providers regarding suitability for transfer to a Rehabilitation Unit:
1. Hospitalists to anticipate the medical stability of patients for transfer to a Rehab Unit.
2. Institute a white board on the Stroke Unit as a tool to communicate between Hospitalist, Nurses, Physiotherapist, Occupational Therapist.
3. Change the central triage procedure in order to streamline the triage process.
2nd Intervention
Whiteboard
LOS decreased from
40.4 days to 18.6 days
Projects – Steve Ligertwood, Fraser
Projects – Dr. Carolyn Shiau, Fraser
Projects – Dr. Carolyn Shiau, Fraser
Projects – Dr. Carolyn Shiau, Fraser
Projects – Dr. Carolyn Shiau, Fraser
• Improve Resources to Physicians in All Health Authorities
• Spread the Word in 2017/18
o Over 100 Physician Lead QI Projects
o Over 500 Physicians receiving some level of QI training
• Coordinate the work each HA is doing
• Share Learning and Experience
• Develop both HA and Provincial Resource Pools
• Become more sophisticated in our Management and Execution of this very significant effort
And now What?
