Driving Patient-Centered Innovations throughout the Ontario Cancer - - PowerPoint PPT Presentation

Driving Patient-Centered Innovations throughout the Ontario Cancer System

Helen Angus Esther Green Cancer Care Ontario June 2007

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CCO Mission

We will improve the performance of the cancer system by driving quality, accountability and innovation in all cancer-related services

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Outline

• 1. CCO definition of innovation?
• 2. Overview of CCO’s innovation strategy
• 1. Provincial Palliative Care Integration Project
• 2. Implementing a new role: Nurse Endoscopy
• 3. Lessons Learned

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CCO’s Definition of Innovation

• H2. Build & test

new ideas that have potential to transform care

• CCO’s Innovation

Strategy

• H3. Nurture options

for breakthrough

• pportunities
• Cancer research

program

• H1. Improve

quality and performance of existing activities

• Local CQI activities
• Provincial programs

Adapted from McKinsey & Co. “Three horizons model of business competitiveness”

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CCO Innovation Strategy

• A dedicated innovation directorate
• Focus on pushing out successful innovations
• Palliative Care Integration Project (Kingston)
• RN endoscopists
• Focus on building capacity in process

reengineering – new skills to reach wait time targets in radiation and systemic therapy

• Sustainability factors
• Recognition program

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Palliative Care Integration Project

• Standardize use of Common tools

– Edmonton symptom assessment system – Palliative performance scale – Collaborative care plans – Symptom management guidelines

• Formal Evaluation Framework

– Capturing process and outcome information

• Quality Improvement Methodology

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Local Project to Province Wide Initiative and Back Again

Provincial initiative built on this regional solution to produce a project with 3 lofty aims Proof of concept incubated locally in Kingston

Adapted from McKinsey & Co. “Three horizons model of business competitiveness”

Expectation is for the RICs to translate this back into their regions

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Nurse Endoscopy Project

• Goal

– To increase screening capacity for colorectal cancer through clinics that provide flexible sigmoidoscopy procedures.

• Project

– Model after existing international program design – Core course to develop knowledge and clinical expertise for nurses – Establish nurse-led clinics providing flexible sigmoidoscopy procedures in 6 locations across Ontario. – Evaluate the program with recommendations for improvement and sustainability.

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Learning: Overview

• A balance of pull and push projects increases

the yield from scarce innovation funding

• Achieving system-wide impact requires a

significant scale of effort and appropriate level of

• funding. Be entrepreneurial in looking for

funding.

• Expect and plan for important differences

between the initial site and provincial scale effort

– Different work processes – Evaluation and measurement requirements – Expect the unexpected

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Learning 1: Aim for a Balanced Portfolio of Innovation

Initial Site

• A proposal call was

issued and applications were reviewed by a panel with priority placed on proposals with high likelihood of impacting wait times in the short term Provincial Project

• More focused process
• Project parameters were

defined provincially and

• rganizations were
• ffered the opportunity to

implement locally

• Projects selected on the

basis of a readiness assessment re:

• rganizational

commitment and implementation strategies

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CCO Cycle of Innovation

R & D funding Full funding Implementation & evaluation Review & recommendations: Select initiatives for broader diffusion Implementation & evaluation Review & recommendations Further development

Best Practice recommendations

“PULL” “PUSH”

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Learning 2: Be Entrepreneurial in Looking for Funding

Initial Site

• Small amounts of seed

funding was enough to stimulate local interest

• $100K from the Change

Foundation for RN Endoscopy

• $200K from the

Innovation Fund for Palliative Care

• MOHLTC funding critical

Provincial Project

• Small amounts of funding

have been enough to stimulate local interest

• Appeal to the priorities of
• thers

– PPCIP re-profiled as a QI project – RN endoscopy profiled as an HR innovation to increasing screening capacity

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Learning 3: Adapt Work Processes

Initial Site

• Local leadership key

to success

– Clinicians – Senior Administrators – Organizations

• Work processes can

be less systematic Provincial Project

• Structured approach

to work required

– Clarify roles and responsibilities

• Additional skills, tools

– Project management – Structured collaboration – Rapid cycle quality improvement

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Palliative Care: Central Support Structure

• Project Planning
• Expert Coaching and Guidance

– Learning Improvement Sessions – Provincial improvement coordinator – Quality Improvement advisor – Kingston coaches including the provincial palliative care program lead

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RN Endoscopists: Project Structure

Education Team Evaluation Team Project Sponsors Erin Hughes Annette Ellenor Steering Committee Helen Angus/, Joshua Tepperp/Linda Rabeneck*

• Program Manager/

Project Implementation Coordinator Catherine Montgomery

• Site Leads

Site Implementation Teams Communication Service Provider Support Team Funding Payment Administrative Support or project coordinator TBC Nursing Clinical Adviser CCO Esther Green Stakeholder Advisory Group

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What are we trying to accomplish? How will we know a change is an improvement ?

Plan Do Study Act

What change can we make that will result in improvement?

Palliative Care: Model for Improvement

Aim Measures Change CYCLES for Testing and Implementing Change

Langley, Nolan, Nolan, Norman, Provost; Improvement Guide, 1996

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Learning 4: Invest in Measurement and Evaluation

• Initial Site

– Focus of measurement defined centrally, e.g. wait times – Metrics defined locally – Performance reported through progress status reports

• Provincial Project

– Central evaluation framework – Metrics defined provincially – Data collection tools provided provincially – Scheduled data submission requirements – Provincial and local analysis of outcomes

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Palliative Care: Quantifiable Improvement Aims

To improve care for palliative patients

• 1. 90% target

population screened for symptom severity (ESAS)

• 2. 90% target symptoms

are controlled. (SMGs)

• 3. 90% functional status is

assessed (PPS) and coordinated support provided (CCPs).

WHY? HOW?

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Final Thoughts

• Expect that local business relationships may not

be able to grow with the project

• Pay attention to and address intellectual

property issues from the outset

• Knowledge transfer and sustainability need

equal attention and effort

• Acknowledge local leaders and find ways to

keep them engaged

• Both success and failure are important ways to

learn