Rural Surgical and Obstetrical Networks Improving Rural Access, Sustainability and Satisfaction

Dr. Nancy Humber, MD, FPESS Lillooet| Jude Kornelsen, PhD CRHR

on behalf of the RSON Team (Kim Williams, PSBC, Dr. Ray Markham, RCCbc, Dr. Victoria Vogt, MD, FPESS Revelstoke, Dr. Bob Woollard, DFP UBC, Dr. Kirstie Overhill, UBC CPD, Dr. Kirk McCarroll, FPA, Revelstoke)

Quality Forum 2017 | Vancouver, March 1

Disclosure

Dr. Nancy Humber does not have any conflicts of interest to disclose.

Jude Kornelsen, PhD, does not have any conflicts of interest to disclose.

Management of Potential Bias Strong commitment to sustainable rural services that meet the needs of rural residents (including providers)

Have both led and been involved in primary research projects yielding evidence to inform rural health service modeling and planning

Have approached the development of RSON from an expanded and triangulated definition of evidence including ◦ Individuals‟ knowledge

◦ Community-based knowledge

◦ Scientific and expert knowledge

◦ Policy and planning knowledge

Objectives 1) Introduce the context of rural surgical and maternity care in

BC and illustrate with 2 patient journeys

2) Discuss Networks as a mechanism to meeting the needs of rural residents and describe component parts

3) What networks can deliver

4) „We don‟t know what we don‟t know‟: learning through a research and evaluation lens

THE RURAL REALITY

WHAT NETWORKS CAN DO

WHAT A NETWORK IS NOT

PULL NOT PUSH

RIGHT CARE, RIGHT TIME

Minimize geography Relationships Sustainable Adaptable Cross boundaries Professional satisfaction

Rural Surgical & Obstetrical Networks: A Rural Health Services Imperative

“Whereas the formalization of interprofessional service networks between small surgical programs and those in regional and tertiary settings through network models of rural surgical care is the optimal health human resources solution to meet the surgical needs of rural residents, we recommend that network models of integrated rural surgical services be established and maintained by all key professions in rural Canada.”

Royal College of Physicians and Surgeons of Canada The Future of General Surgery (2014) …strong support for generalism, for the “rural imperative”, and for training suited to anticipated practice needs

College of Family Physicians of Canada creation of a Community of Practice (CoP) section of Enhanced Surgical Skills with a promise of credentialling (CAC).

Canadian Association of General Surgeons

Component Parts Increased Scope and Volume for local services (necessary for sustainability)

Clinical Coaching and Training (for rural teams at smaller volume rural sites to maintain and improve their skills sets through collaboration with specialists at regional sites; enhances CQI)

Remote Presence Technology (enables teams, separated by distance and by training, to stand shoulder to shoulder and operate together/clinical coaching/CQI/benefit for ER, Critical Care & trauma)

Continuous Quality Improvement

Evaluation (network development, process/surgical outcomes)

INCREASED SCOPE AND VOLUME

INTEGRATIVE NETWORKED CLINICAL COACHING TEAMS

REMOTE PRESENCE TECHNOLOGY

CQI

RURAL NESTED IN REGIONAL ROUNDS MORE OB JOURNAL CLUB CURRENCY TEAM EXPERIENTIAL LEARNING SIMULATIONS

Anticipated Outcomes 1) Increased access to health care choices for BC‟s rural communities;

2) Increased „closer to home‟ access to surgery and obstetrical services for patients in rural communities;

3) Increased sustainability of rural health care programs particularly those with smaller volume surgical and obstetrical services;

4) Increased ability to recruit and retain health care providers for BC‟s rural communities;

5) Increased provider satisfaction;

6) Increased access to screening procedures for BC‟s rural communities;

7) A greater understanding of the holistic/comprehensive cost-efficiencies of rural surgical networks in meeting surgical demand;

8) A greater understanding of the efficacy of networks on rural health care outcomes and their ability to reduce wait times throughout the province;

9) Enhanced quality of rural health services for rural citizens through the development of a multi-professional CQI system appropriate to the privileging of rural smaller volume generalist, surgical and perinatal services;

Facilities

Population Health

Outcomes

Qualitative Data on Network

Function

Shared Measures

Comprehensive Costing

Potential (additional) areas of system transformation Surgical wait times

Increased uptake of rural screening?

Other?

Moving forward How do we engage with regional (HA) planning to actualize the networks?

What would this look link in your Health Authority?

Network Infrastructure and Relationships

Remote Presence CQI Increased Scope and Volume Clinical Coaching

Provincial Funding Sources

Rural Surgical and Obstetrical Networks

Receiving Organization RSON Committee

Project Manager

Increased Operational Capacity

Anesthetists

Surgeons

OR Nurses

NSQIP Nurse

CME

Regional Departmental CQI

Virtual visits

Elective Intraoperative

Emergency Triage

IT/HA

NSQIP RN

First Nation Health Council

Maternity

Anesthesiologists

Surgeons

OBGYN

UBC CPD

Community Specific Working Group

GP, Maternity provider/ESS HA, network coordinator

Specialist Surgeon, nurse, first nations patient advocate

Patient advocate

Network Evaluation

HA

Perinatal BC Representative

Physician Vacancies Physician Vacancies If everyone is moving forward together, then

success takes care of itself