Transcript Document

Shared System of Care COPD HF
Prototype Session 4
February 28, 2013
Wireless: Westin-Meeting
Wireless Code: bcma2013
www.pspbc.ca
Session Opening
Dr. Gordon Hoag
Brian Deakin
The Good The Bad The Ugly
www.pspbc.ca
4
My Health
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COPD
Heart Failure
Ischemic Heart Disease
Diabetes
Renal Problems
Hypertension
Barretts Esophagus
Sleep Apnea
Former Smoker
Reformed Alcoholic
5
How Many Health Professionals Share My Care?
2007
 Uncoordinated
 Sporadic
 Loosely Structured
2012
 Coordinated
 Continuous
 Comprehensive
& proactive
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Comparing My Care … Then and Now
Now
Then
 As I saw fit
 Shared Coordinated
 Loosely structured
 Continuous
 Sporadic
 Comprehensive
 Incomplete
 Complex
 Easy
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My experience with COPD & HF
My care has really developed over the past few years
 COORDINATED
› I know where things are leading to
 COMPREHENSIVE
› I know that someone is going to look after my heart, and that
someone is going to check my lungs
 CONTINUOUS
› I don’t need to chase the health professionals because they
are following up with me on a regular basis.
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This WAS my Experience THEN
 “A growing number of sub-specialties and … physician teams …
have contributed to care that is comprehensive… often
disjointed, especially for the most complex patient populations.”
https://www.bcma.org/files/SharedCare_Backgrounder.pdf
This IS my Experience NOW !
 Shared Care initiatives foster mutual trust, respect, and
knowledge of each physician’s expertise, skills, and
responsibilities…
 It’s not just mutual trust between physicians, it’s mutual trust
between them and the PATIENT!
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My Self Management…
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Now
Communication
Education
Resources
Active interest
› in my life
› in my health
Then
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Invincible
Self-Denial
Smoked
Drank
Medications?
Huh?
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What Has Happened?
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I have taken charge of my health
Group medical visits
I learned how to communicate
I ask questions, and I record answers
My GP and I have mutual trust & respect for each other.
That has absolutely has an impact on my experience with
specialists
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Shared Care
12
Break Out Sessions – Part 1
 Predictive Modelling and PROOF - Ella Young, Dr. Bruce
McManus and Janet McManus
Steveston
 Updated HF and Co-morbid materials - Drs. Sean Virani and
Mark FitzGerald
Bridgeport
 Partners in Care - Aman Hundal, Clay Barber
Lulu Island
 Brief Action Planning - Connie Davis
Gulf of Georgia
13
Break
Break Out Sessions – Part 2
Creating Shared Care in a Northern
Health Practice
Shared Care – Heart Failure
Prototyping in Maple Ridge
July – December 2012
Our Team
 Dr. Ken Burns – Family Physician Champion
 Dr. Winston Tsui – Cardiologist
 Carol Galte – Nurse Practitioner, Co-Lead Regional Health
Failure Strategy, Fraser Health
 Marleen Ouellette – Clinical Nurse Specialist, Heart Function
Clinic, Fraser Health
 Patti Scott – Practice Automation Coach, PITO
 Dr. Christopher Rauscher – PSP Specialist Lead, Fraser Health
 Kathy Riyazi/Jennifer Montgomery – PSP Project Coordinator,
Fraser Health
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Our Goals
 Focus on clinical pearls
 Build the Network
 Connect with resources
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What We Did
 2 team meetings to plan learning
sessions
 2-2 hour learning sessions
 Optional Practice/Support visits
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Content of Learning Sessions
 Clinical Review
 Case Studies
 Registry Building
 Boardwalk Activity
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Content of the Learning Sessions
 Patient Self Management
› Local Community Resources
› Heart Failure Zones
› Smoking Cessation
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Support Visits
 Registry building
 Smoking Cessation
 Case Finding
 Resource Access
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The Future
 Shared Care COPD Module to begin in April
24
For more information
Jennifer Montgomery
[email protected]
Sophia Tanaka
[email protected]
25
Lunch
Idea BONANZA!
Christina Southey
Pa, I think these folks have
some ideas in ‘em.
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If you were 10 times bolder,
what would you test to improve
shared care for HF/COPD in
your community.
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Step 1
Write 1 idea on the cue card provided.
Do not put your name on it
1 cue card for each person. Each person must write one idea.
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Step 2
Walk around the space trading cards
with everyone you pass
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Step 3
When asked to stop,
read the idea on the cue card you hold
and rate it from 1-5, on the back of the card.
1 = This idea is not for me
5 = I love this idea and want to try it!
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Step 4
Repeat 4 more times
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Step 5
After 5 rounds tally up the numbers
on the back of the 5th cue card.
Give a score out of 25.
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Planning for Sustainability
aka Holding the Gains
Connie Davis
www.pspbc.ca
Objectives
 Define sustainability
 Describe what ‘sustainability actions’ to take during testing and
implementation
 Create a sustainability plan
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What is Sustainability?
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What is Sustainability?
› The ability to be maintained at a certain rate or level.
› The ability to be upheld.
- Oxford English Dictionary
› Maintaining the process
- National Health Service Modernization Agency, 2002
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The challenge is not starting, but continuing after
the initial enthusiasm is gone
Ovretveit, 2003
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Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Langley et al,
The Improvement Guide,
2009
Act
Plan
Study
Do
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Testing vs Implementation vs Spread
 Testing: Trying and adapting existing knowledge on a small
scale. Learning what works in your system.
 Implementing: Making a change a part of the day-to-day
operation of the system in your pilot population. Holding the
gains.
 Spreading: adapting change to areas or populations other than
your pilot populations
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The Sequence for Improvement and Spread
Make part of
routine
operations
Test under a
variety of
conditions
Theory and
Prediction
Testing a
change
Developing a
change
Spreading to other
locations/processes
Implementing a
change (HTG)
Act
Plan
Study
Do
Robert Lloyd
42
Creating a New System
Improvement Hold Gains
Spread
BETTER
Improvement
Hold Gains
Design Spread
Spread
Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. San Francisco: Jossey-Bass; 2009
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During Testing— Before We Even Implement!
 Purposefully test the changes under a wide range of conditions
(robust design)
› Regular staff/temp, experienced/ inexperienced staff
 Foolproof the new process/procedure
› Look for ways to use constraints, affordances, reminders,
differentiation
 Use technology where appropriate
› Look for opportunities to use computers/EMR, bar coding
,etc.
 Think about reliability and change concepts related to reliability
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Think of a Time
 When an improvement was implemented
 Are the gains still there?
› If yes, what was done to make that happen?
› If no, why weren’t they sustained? What got in the way?
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During Implementation
 Use multiple PDSA cycles to implement the change
› Testing is not de-facto implementation!
 Collect data over time when conditions are expected to change
› Continue use of run chart
 Redesign support processes for new process
› Training, getting forms, etc.
 Address the social aspects of change
› WIFM, appreciation, publicity, resistance
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Collect Data Over Time When Conditions are
Expected to Change
Baseline
Begin implementation
on pilot unit
Testing
Successful
Testing
Evidence of improvement
during implementation
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Description of change:
Implementation Cycle
Implementation dates: From
to
.
Predicted impact of change on key measures:
•Current Level of
Performance
•Measure
ACT
PLAN
•1
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•5
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Processes or Products affected by the change:
•Processes or
Products
Affected
- Objective
- W hat changes are to
be made?
- Questions and predictions
- Next cycle?
- Plan to answer the
questions (who, what,
where, when)
STUDY
- Complete the analysis
of the data
- Compare data to
predictions
- Summarize what was
learned
DO
- Carry out the plan
- Collect the data
- Begin analysis of the
data
•Predicted Level
after Change
•Process or Product
Owner
•Number
of People
Affected
•Change in
Standard?
•Yes/No
•Predicted
Acceptance
•High/Med/Low
•1
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Documentation of change:
Materials/forms defined. Comments:
Procedure defined. Comments:
Equipment defined. Comments:
Change request procedure. Comments:
Changes in job descriptions or role statements. Comments:
Impact on training:
Training procedure defined for implementation. Comments:
Training resources allocated. Comments:
Training schedule complete. Comments:
New employee training procedure complete. Comments:
Measurements required:
New measurements defined. Comments:
Measurement procedures defined. Comments:
Measurement responsibilities defined. Comments:
Measurement review scheduled with responsibilities. Comments:
Analysis of data responsibility assigned. Comments:
Source: Improvement Guide, Pg 185
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Key Factors for Holding the Gains
1. Clarify what you are sustaining
2. Engage leaders
3. Involve and support front-line staff
4. Communicate the benefits of the improved process
5. Ensure the change is ready to be implemented and sustained
6. Embed the improved process in your electronic and human
processes.
7. Build ongoing measurement
Health Quality Ontario
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What are You Sustaining?
Leadership for Sustainability
 Identify clinical champion
 Champion has time to participate
 Business leader supports improvement (if applicable)
 Leaders have skills and knowledge about the change
 Leaders have
› removed barriers
› can state the benefits
› provide required resources (especially time)
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Involving Front Line Staff
 Information about purpose and significance
 Participate in identifying issues with change
 Are involved in developing solutions
 Right people are involved
 Communication process clear
 Skills enhancement is addressed
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Communication Strategy
 WIIFM for each group identified
 Data is tracked real-time and shared
 Stories, updates and visual display of data routinely shared
 Information on benefits
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Readiness to Implement
 The change is an improvement
 It has been widely tested
 No further testing needed (at this time)
 Targets have been achieved
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Embed the Improved Process
 Necessary supplies, facilities, forms etc. are available
 Staff have been trained and job descriptions updated
 Policies and procedures updated
 New process is now standard
 The new process is monitored and ongoing adaptation planned
 Required electronic or paper based changes have been made
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Measurement Strategy
 Skills and culture of measurement
 Measures set defined
 Staff assigned to measurement
 Regular reporting established
 Communication plan established
 Plan for responding to data
 Celebrate accomplishments!
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Sustainability at Every Stage
 Still in the planning process: consider how you can integrate
these concepts into your design and testing?
 In the early testing stages: can some of these concepts be
integrated or added to what you're doing?
 Close to being implemented: what might you need to address
before you consider moving to 'sustain'?
 Changes implemented: what might you need to go back and
address before you move on?
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Evaluation Introduction
Marcus J. Hollander, PhD
Evaluation Overview
 Hollander Analytical Services Ltd. has been contracted to
conduct the evaluation of the PSP program.
 There are two aspects to the evaluation: a Train-the-Trainer
evaluation and our evaluation of the Learning Modules once they
are rolled out.
 In terms of the Train-the-Trainer or Prototyping evaluation, a
report of findings is produced quite quickly and is used as input
to plan future activities. Thus, the information provided is actually
used to improve future planning.
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Evaluation Overview (cont’d)
 The Learning Module evaluations have shown very positive
results and have been instrumental in giving both a national and
international profile to the PSP.
 The most recent publication of the Learning Module Evaluation
is:
› MacCarthy, D., Kallstrom, L., Kadlec, H., & Hollander, M.J. (2012). Improving
primary care in British Columbia, Canada: Evaluation of a peer-to-peer continuing
education program for family physicians. BMC Medical Education, 12, 110.
 You will be asked to complete the prototyping evaluation in the
breakout groups. Please hand them in to the breakout group
leader who will give them to us.
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Evaluation Overview (cont’d)
 The evaluation survey may appear to be long but it is broken into
sections so not everyone will be asked to complete the full
survey.
 We would like to thank you in advance for your cooperation in
completing the survey forms.
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Next Steps
Fraser
Health
Lulu
Island
Interior
Health
Bridgeport
Northern
Health
Gulf of
Georgia
Vancouver
Coastal
VIHA
Steveston Steveston B
A
Report Out