Disclosure Presenter / Faculty Dr. Gordon Hoag Relationships with commercial interests: Merck Frosst, Amgen,Sanofi, Pfizer, Grants / Research Regeneron, Boehringer Ingelheim and Support GlaxoSmithKline Speakers Bureau/ Merck Frosst, Amgen and Sanofi-Aventis Honoraria Consulting Fees Merck Frosst, Amgen and Sanofi-Aventis Other None 2
Managing Potential Bias Not Applicable 2
• Joint Collaborative Committees Doctors of BC Ministry of Health 7 Health Authorities Physician Master Agreement (PMA) General Practices Joint Standing Shared Care Specialist Services Services Committee Committee on Committee (SCC) Committee (SSC) (GPSC) Rural Issues (JSC) PQI
• SSC Strategy & Work-plan 3. Supporting Physicians 2. Enabling System Improvement Physician Leadership & Health System QI Training Redesign Fund 1. Engaging Physicians Quality & Innovation Projects Service Facility Physician Quality SSC Provincial Delivery (Fees) Engagement (FE) Improvement (PQI) Projects & Spread Facility Engagement Staff Quality Improvement Teams SSC Leaders SSC Resources (Staff Support)
• Getting the Physician Involved • Physicians have great ideas and are passionate about improving patient care • The Opportunity: Physician Quality Improvement (PQI) • Endorsement: Specialist Services Committee • The Culture: The IHI Triple Aim • The Organization: Health Authority • The Outcome: The physician gets training, financial resources, protected time, and team support
• PQI Steering Committee Slightly different approaches/models $1.3 - $1.6M per HA per year (NHA, IHA, VIHA, FHA, VCH, PHSA). Technical Staff Training QI Project
• Key Ingredients Hierarchical Collaborative 1) Accountability 1) Mentoring/Facilitating 2) Auditing/Monitoring 2) Empowering 3) Empowering 3) Auditing/Monitoring 4) Mentoring/Facilitating 4) Accountability Teams Need : Clear purpose; individuals empowered; respect all opinions/ participants; ownership, responsibility, high morale
• The Shift
• Opportunities for PQI Improvements • Focus on: • Data • Role Clarity • The SSC PQI Program • SSC PQI Provincial Meetings
• 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”
Challenges ƒ Flexibility ƒ Accessibility ƒ Ownership ƒ Alignment Deliverables Roles Clarity RACI Championship Mindset
Co-Creation of Value …the customer is always a co-creator of value.
Disclosures • No disclosures • No conflict of interest
Why Co-creation? • ‘Transactional’ becomes ‘interdependent’ • “….of, by and for stakeholders.” • Shift from ‘work processes’ to ‘engagement’
Value co-creation behaviour scale Participation Behaviour Information seeking Information sharing Responsible behaviour Personal interaction Citizenship behaviour Feedback Advocacy Helping Tolerance
Benefits of Co-Creation • Relationships • Interactions • Engagement • Alignment • Assets • Appropriateness • Self-management • Satisfaction
Quality in Co-creation • Customer defines value • Interactivity • Relationships • Respect • Listening • Resources • Engagement
Enabling Co-creation • Be intentional about the value • Establish the user as Co-creator • Bridge language issues carefully • Create a range of ways to voice opinion
Challenges: Listening
Challenges: Time • Trust • Safety • Provocation • Silence • Recruitment • Teamwork
Challenges: Hierarchy
SSC Physician Quality Improvement at Northern Health Candice Manahan, Executive Lead, Physician Quality Improvement
No conflicts to disclose
Overview κ Where we started and what we heard κ Proposal development κ Guiding Principles κ Steering Committee κ Our approach
Pre Consultation 2016 κ Lots of driving! κ 4 major themes: – Shared Understanding of QI Concepts – Data Feedback & Reflection – Making Connections – Celebration & Raising Awareness
Local/Unit Level Themes o Provide support for the existing o CME and/or reimbursement for time o Local voice to regional o Access to local/individual data to look for areas for improvement o Local access to supports for follow-up on quality issues or ideas in the facility o Physician Lead or collective (sub committee) specific to quality improvement
Process: Timeline & Activities 4. Starting at NHMAC, consulting the broader stakeholders June-Aug 2016 2. HA & SSC to sign-off on “Letter of Intent” 5. Take to Medical July 2015 Directors and Executive for approval, then submit to 3. Jointly develop plan SSC Sept 2016 Mar- June 2016 (4 meetings) 1. HA to share vision, interest and need for resources June 2015
Principles & Approach κ Create a joint governance structure to support collaboration and integrate with the various existing structures at NH. κ Raise awareness around the current resources available and enhance those successful structures to strengthen a culture of quality improvement. κ Empower providers to drive quality from the edge of health care.
NH/SSC QI Steering Committee: Spirit of Collaboration κ Bring the varying perspectives together to create a team “ we ” to the region: – Patients – Physicians – Northern Health (Primary Care, Quality & Innovation, Physician Services, Programs, and Operations), – Specialists Services Committee, new Medical Staff Associations and Division κ Provide overall accountability, ensuring alignment and use of existing resources
Our Approach κ We are a bit different in the North…..
“Just in Time” education
Our Stats: Workshops & Supports Education # of Total # Type Requests Physicians Participants Attending QI 9 Projects Support 35 Principles of QI 24 40 Requests IHI training in 7 n/a Data 8 Terrace Requests Yellow Belt 17 50 NH Intermediate QI 3 n/a Skill Building 1 15 Workshops Clinician Academy 5
New! New! North East Physician Mentor Coach Dr. Jamil Akhtar Andrea Goodine
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