Evidence Based Approach to Provincial Urology Services Philip - PowerPoint PPT Presentation

Evidence Based Approach to Provincial Urology Services Philip Belitsky MD Peter MacKinnon MHSA CHE Rachelle O’Sullivan MBA

Today’s Presentation 1. Urology Care Today 2. Urology in Nova Scotia 2006 3. New Delivery Concept 4. From Concept to Actuality

Yesterday’s Urology

Today’s Urology

Criteria for Quality Care 1. Contemporary Standard of Care • Including technology and skill sets 2. Readily Accessible 3. Fiscally Responsible 4. Positive Environment • Recruitment and Retention

DHA Populations Provincial Total 939,000 130,000 32,500 47,000 46,000 73,500 404,000 82,500 60,500 63,000

Where are our hospitals ? 130,000 32,500 47,000 46,000 73,500 404,000 82,500 60,500 63,000

Are all hospitals the same ? 130,000 Sydney Amherst 32,500 Antigonish New Glasgow Truro 47,000 46,000 73,500 Kentville 404,000 82,500 Halifax Bridgewater 60,500 63,000 Yarmouth

Where are the Urologists ? 2 130,000 0.5 Sydney 0.2 Amherst 32,500 Antigonish New Glasgow 73,500 47,000 3 46,000 Truro Kentville 404,000 82,500 Halifax Bridgewater 60,500 63,000 13 Yarmouth

2 Where do patients receive Urologic Care ? 0.5 Sydney 0.2 9% Amherst Antigonish New Glasgow 3 Truro Kentville 55% Halifax Bridgewater 13 Yarmouth

Is it easy/quick to get urology care ? Sydney Amherst Antigonish TruroNew Glasgow 2.1 hrs 2.6 hrs s 2.75 hrs r h 2 Kentville . 1 Halifax Bridgewater Yarmouth

Do We Have Quality Urology Care In Northern NS? � 1. Contemporary Standard of Care • Including technology and skill sets � 2. Readily Accessible 3. Fiscally Responsible ? � 4. Positive Environment • Recruitment and Retention

New Concept Step 1 Change Geography Cape Breton Region 161,000 Northern Region 183,000 Capital Region 404,000+ Western Tertiary Care Region 206,000

New Concept, Step 2 – Determine Cape Urology Centres Breton Region Sydney Northern Region Truro Kentville Capital Region Halifax Western Region

New Concept Step 3 - Create Functionality 3-4 Urologists Amherst Antigonish New Glasgow Truro Major Centre Satellite Centres • Clinics • Clinics • Diagnostics Halifax • Diagnostics • Minor Surgery • Minor Surgery • Major Surgery • Supporting • Major Technology Infrastructure & Infrastructure

Does Concept Fit Definition of Quality Care? � 1. Contemporary Standard of Care • Including technology and skill sets � 2. Readily Accessible � 3. Fiscally Responsible � 4. Positive Environment • Recruitment and Retention

Building the Model - History • DoH initiated surgical services plan for the Northern Region • Critical meeting in Northern Area – Summit of multiple stakeholders – Visioning exercise for northern region – Created buy in for concept of a shared service for urology – Siting for inpatient unit determined by DoH • Planning for shared service in northern region indicates the need for a broader, more provincial focus

Building the Model – Buy In • Established project team led by DoH • Engaged consultants with credibility for physician engagement in development of model • Developed Steering Committee Structure – Government – DHA representation • senior leadership • management • health disciplines – Academia – Urologists – community and academic

Building the Model – Project Objectives • Develop a provincial multiple-site shared service model for urology with implementation plan for Northern Area • Identify the role of CDHA both as the academic and tertiary/quaternary care centre • Identify service requirements, including HHR and equipment needs • Identify processes that will enable provision of consistent standards of care throughout the province

Building the Model – Engagement • Consultation with stakeholders – During the development of the model – Validating the model • Steering Committee – Effective Sounding Board – Inclusive/Open/Participatory – Mutual Benefits understood – Patient focus +++ – Document Creation & Sign – Off • Senior leaders – government and DHA’s – Approval of model/report – Support for moving forward with next steps

Building The Model - Physician Champion • Wide consultation throughout process • Demonstration of improved access and care to family physicians, hospital administration, staff, stakeholders of better access • Patient focus/better care for referring physicians

Building the Model -Where are we now • Patient Focus – majority access, i.e. travel – < 30 minutes • Consult with specialist • Workup • Minor surgery – <1 – 1.25 hours for major surgery and care • Implementation Starting at CRH – Recruitment – Connection with CDHA – Renovations – Equipment – New Facility Planning – Work in Progress

Summary • Complex initiative • Several years to come to fruition • Starts next month • Next Steps – Determine additional costs and get through funding approval process – Staged for full program implementation – Evaluation Framework