Promising Practices in Regionalization : Exploring the ... Presentation.pdf · Promising Practices...
Transcript of Promising Practices in Regionalization : Exploring the ... Presentation.pdf · Promising Practices...
Promising Practices in
Regionalization : Exploring the
barriers and facilitators to moving
knowledge into action
Lisa Clatney –Health Quality Council
Michelina Mancuso – South-East Regional Health Authority
Jennifer Miller –Interior Health
Laura Fletcher – Canadian Health Services Research Foundation
Session Overview
• Brief Introduction
• Panel Presentation
• Question and Answer Period
Promising Practices
A series that highlights healthcare organizations that have
invested their time, energy and resources to improve their ability to use evidence in health services
management or policy.
Issue # 9
How an RHA organized itself to better integrate
evidence into decision-makingSouth-East Regional
Health Authority
Soon to be 2 Regions
Issue # 11
How a B.C. health authority is boosting its
research capacity
Interior Health
Issue # 13
Turning the tide on chronic disease: How a province is using evidence to build quality improvement capacity
Four Questions:
1) Why did your organization want to invest in using
evidence?
2) How was this process implemented?
3) Describe the barriers and the facilitators that you
faced while trying to implement your plan of action.
4) What impact has your new practice had up to now
and how you are monitoring it?
Question one:
Why did your organization want to invest in using
evidence?
Rationale for investing in research use
• ~ 30% - 40% of patients do not receive care aligned with current
scientific knowledge and 20% - 25% of care provided is not
needed or is potentially dangerous (Eccles et al., 2005)
• Within Interior Health:
– Regionalization in 2001, minimal research production/support
– Apparent need and internal desire for evidence-informed
decision making and program planning
• Funding allocation
• Service/Program decisions
Initial Needs Assessment (2006)
* Is Research Working for You?: A Self-Assessment tool and discussion guide for health services management and policy organizations (CHSRF)
0
10
20
30
40
50
IH has skilled staff to do
research
IH staff have enough
time to do research
Per
cen
tag
e o
f R
esp
on
den
ts (
%)
Don't Know
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
IH staff have enough
resources to do research
Initial Needs Assessment (2006)
Don't Know
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
0
10
20
30
40
50
Link research results to
key issues facing DM’s
Per
cen
tag
e o
f R
esp
on
den
ts (
%)
Communicates internally/
ensures info exchanges
* Is Research Working for You?: A Self-Assessment tool and discussion guide for health services management and policy organizations (CHSRF)
Why did your organization want to invest in using evidence?• Decisions made
• The public, the staff and the provincial government often asked why certain
decisions were being made
• Some used research evidence to guide their decisions but evaluation of the
decision was not a priority
• Others implemented decisions based on what worked
• elsewhere and again with little or no evaluation.
Evidence-Based Politically-Charged
2 Camps
Our mandate:
To measure and report on and recommend innovative ways to improve the quality of the province’s health
system.
Our goal is to work with health care providers to ensure
that every patient receives the highest quality of health care possible. That means ensuring that care is timely,
efficient, accessible, patient-centered, safe, effective, and equitable.
Our Mission
To improve the quality of care and the
caring experience in Saskatchewan.
Question two:
How was this process implemented?
Support
SPREAD
LW0 LW1 LW2 LW3
Pre-work
Select Topic Participants
Reference Panel
Identify Change
Concepts
Collaborative Process
Regional Improvement Team
CFPractice Site
Practice Site
PracticeSite
PracticeSite
Practice Site
Practice SiteRHA
Leader
Diabetes
Educator
RehabProgram Community
Pharmacist
Several report options to enhance
decision support
2 waves
71 practices
> 500 providers and staff
> 15,000 pts
Implementation of Research Capacity
Building Initiatives in IH• MSFHR/HSPRSN “research capacity enhancement” grant to all 6 BC health authorities (2005)
• Overall Strategic Goals:
1. Achieve sustainable research capacity within IH
2. Translate & apply research in a timely fashion to address health system priorities
3. Build & enhance healthy partnerships within IH, with other health authorities, research networks and researchers to enable relevant applied research
Implementation of Research Capacity
Building Initiatives in IH
• Research Advisory Committee
• Research Facilitators (2)
– Project Support – proposals, methods, ethics, data
– KTE – workshops & seminar series, literature
syntheses, annual conference
– Collaboration/Liaison – collaboration with networks,
MOH, other HAs, academia
IH Research Capacity Building Initiatives
• Brown Bag Lunch seminar series
• Annual IH Research Conference
• Research Skills Training workshop series
– Workshop “road show”
– Mentorship opportunities
• Literature Syntheses
• Collaboration & Networking
– Rural KTE collaborative research team
How was this process implemented?
• In developing strategic plan for 2005-2009, consultation
with community, staff and key stakeholders wanted to
see the integration of knowledge, research and
innovation into the organization's operations.
• Became 1 of 4 pillars
• Research was happening and being used ad hoc, the
strategic plan saw the opportunity to guide research
and learning towards our priorities and integrate it into
the culture.
• Research services took on an active role in conducting
an environmental scan and interviewing key
stakeholders to discuss what would be needed.
• Results were twofold:
– Re-organization of Research Services
– Establishment of a new information management
working group
Structure
Health Services Planningand QI
Research Services Utilization Patient Safety
External Partners: Universities
Pharmaceutical & Biomedical Industry
Governments/Other Health Authorities
Research AgenciesCommunity Colleges
Health Services Planning & QI
Health Professionals & Their Groups
Researchers & ResearchCo-ordinators
Research Ethics Board
Medical Education
Programs/Services & Committees
Model: SERHA RESEARCH SERVICES
Key Committee for Organizational Perspective Success
TERMS OF REFERENCE
HEALTH SERVICES PLANNING, UTILIZATION,
RESEARCH AND
INFORMATION MANGEMENT COMMITTEE
Purpose
• The mandate is to support enhancement in population
health outcomes and health care services through
knowledge transfer and integration of planning,
utilization, quality improvement, information
management and research.
Functions• To promote and support evidence informed decision-making.
• To identify and prioritize information needs for decision-makers.
• To provide advice and recommendations to the SERHA E-Health Committee on the management of data and information.
• To develop, implement and maintain an integrated information management system to meet the information needs of both internal and external customers, i.e. support Balanced Scorecard activities), i.e. Sharepoint and Balanced Scorecard.
• To promote timely collection, analysis and interpretation of data.
• To support the development of relevant, outcome-oriented and measurable indicators.
• To improve access to and understanding of information.
• To build capacity to support health services research activity.
• To facilitate enhanced monitoring and accountability.
Membership• Vice President Planning & Professional Services, Chair
• Chief Financial Officer
• Chief of Staff or Designate
• Chief Information Officer
• Chief Nursing Officer
• Director,
• Health Records/Admitting/Telecommun./Central Scheduling
• Director, Health Services Planning and Quality Improvement
• Director, Human Resources
• Manager, Clinical Administrative Information
• Manager, Research Services
• Utilization Management Coordinator
• Workload Measurement Coordinator
• Manager, Library Services
• Program Administrative Director
• Community/Facility Representative
• Guests as required
Question three:
Describe the barriers and the facilitators that you
faced while trying to implement your plan of
action.
Describe the barriers and the facilitators that you faced while trying to implement your plan of action.
What Worked:
• Taking the time to identify what the current culture for research is and build the infrastructure based on the staff's needs.
• Identifying those passionate champions in each and every department that could be the vehicle for change.
• Cross-disciplinary teams performing the research or QI projects and committees
• One on one mentoring and group mentoring to build capacity.
• Celebrate successes.
• Messaging on how things have changed. Marketing for buy-in.
Challenges:
• Everyone speaking the same language when you are speaking about indicators versus outcomes
• Quality improvement versus research
• Evidence-based and level of evidence.
• Statistical Software which is easy to manipulate.
• Integrating databases.
• An inventory of data sources.
• Teaching individuals how to interpret evidence and providing assistance. Ie.Journal clubs.
• Messaging on how things changed. Marketing for buy-in.
What´s Worked?• RITs - flexibility
• Collaborative Facilitators
• Incorporation of Expanded CCM
• Breadth and depth of our team
• Alignment with need
• CDM Toolkit
We Keep Learning…
• Toolkit has been phased in over ‘life’ of Wave
1 and Wave 2
• Understanding and using the data
• Incorporation of flexibility into aims and
measures
– Setting 3-month aimsW here you are
W here you’re going
Focus for next 3 months
And Learning…• Don´t feed the paranoia!
– Much more open disclosure
• Much more time on Model for Improvement
• Language and focus around Improved Access
– Clinical Practice Redesign
– Focus on clerical staff
Research Capacity Building Initiatives
in IH ~ What’s Worked?
• Early identification of strengths/gaps within organization
• Enthusiasm from front line and management staff
• Support from key senior leaders
• Strong departmental leadership and vision
• Increasing awareness of need/benefits of using research
• Regional academic health research faculty keen to
collaborate with health region staff
• Strong team with complimentary skill sets
Research Capacity Building Initiatives
in IH ~ What We Keep Learning
• Timelines
• Communication
• Funding/support personnel at the project/program level
• Skill set development
• Priority Setting
• Need for RCB/KTE research to support what we do
• Sparks!
• Language - EVIDENCE
Reference: Pat Martens, Need to Know Team
Question four:
What impact has your new practice had up to now
and how you are monitoring it?
Impact & Monitoring• Diabetes
• Wave 1 (March 2006 to March 2008)
• 30% improvement in percent of patients with diabetes screened for microalbuminuria, used for detection of kidney disease.
• 22% improvement in percent of patients with diabetes prescribed antiplatelet therapy to prevent blood clots.
• 14% improvement in percent of patients with diabetes prescribed a statin drug to help control their blood cholesterol levels. Controlling cholesterol can help prevent stroke and heart attack in people with diabetes.
Impact & Monitoring• CAD
• Wave 2 (March 2007 to March 2008)
• 8% improvement in percent of patients with CAD prescribed antiplatelet therapy to prevent blood clots.
• 8% improvement in percent of patients with CAD prescribed a statin drug to help control their blood cholesterol levels. Controlling cholesterol can help prevent stroke and heart attackin people with diabetes.
• 8% improvement in percent of patients with CAD prescribed an ACE-I/ARB to treat high blood pressure.
The Story Behind the Numbers• “These fantastic learning opportunities have enabled me to be a
much better staff person. Increased my abilities to assist doctors
and nurses in their roles, thereby improving care for our
patients.”
• “Our team’s greatest accomplishment was improved
communication between regional improvement team members.”
• “We developed an effective team within our office that worked
very well together with a coordinated plan where we each knew
our role and the others’ roles, and we became complementary
to each other.”
Research Capacity Building Impact
• Preliminary stages only (next steps = formal evaluation of
RCB initiatives using RDCAP tool, Jo Cooke, UK):
– New emerging teams within the region, between health
authorities and clinician-decision makers
– Links with internationally known researchers
– Positive evaluations for workshops, seminar,
conferences
– Research Capacity Building workshop (Oct 2007)
– Key stakeholder feedback
Research 101 (n=117)
Research 201 (n=116)
Lit Search (n=55)
Stats Part 1 (n=32)
Stats Part 2 (n=29)
Plain Language Writing(n=36)
Unaccept-
able Relevance of material
for your job?
Confidence in applying
material to your job?
Design of the workshop material?
Poor
Adequate
Good
Excellent
Research Capacity Building Impact
• “Interacting with the staff of the research team has
stimulated my thinking in ways that no other individual in
the organization has been able to.”
• “I was approached by a sociological researcher from
Thompson Rivers University who learned of [my project]
from the 2nd Annual Research Day.”
– Note: this project has since received funding
What impact has your new practice had up to now and how you are monitoring it?
• Research services went from 40 research projects with
80% being clinical trials. In three years it went to 148
projects with 35% of the projects looking at health
services research.
Example 1
Suggestion to spend money on an anti-coagulation clinic,
after measuring cohort patient outcomes on how family
physicians were performing on achieving therapeutic
levels, they were at par if not slightly better than
outcomes resulting from an anticoagulation clinic and
therefore resources were redirected.
Example 2
• Examples: Study was performed on LWBS form ER which revealed potential for risk since a high proportion of level 3 (sicker) patients were leaving without being seen. The assumption was to work on reducing those who leave by fast tracking. Although this reduced LWBS rate it did not reduce those at highest risk from a patient safety perspective. This required that we continue to find better solutions.
Example 3
• Study was performed on chest pain patients for a whole year
coming through ER which identified over utilizing hospital
Admissions and under utilizing Cardiac Assessment clinic. This
lead to a meeting with Family Physicians, Internal Medicine
Specialists and Emergency physicians in trying to identify a risk
stratification system for these patients. Senior administrators
and key individuals were also invited to this meeting. It was an
excellent experience.
Open Discussion
Thank You!
Lisa Clatney [email protected]
Michelina Mancuso – [email protected]
Jennifer Miller- [email protected]
Laura Fletcher – [email protected]