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

60,500 63,000 82,500 73,500 32,500 47,000 46,000 404,000 130,000

DHA Populations

Provincial Total 939,000

60,500 63,000 82,500 73,500 32,500 47,000 46,000 404,000 130,000

Where are our hospitals ?

60,500 63,000 82,500 73,500 32,500 47,000 46,000 404,000 130,000

Are all hospitals the same ?

Sydney Antigonish New Glasgow Truro Amherst Bridgewater Yarmouth Kentville Halifax

60,500 63,000 82,500 73,500 32,500 47,000 46,000 404,000 130,000

Where are the Urologists ?

Sydney Antigonish New Glasgow Truro Amherst Bridgewater Yarmouth Kentville Halifax

13 3 0.2 0.5 2

Where do patients receive Urologic Care ?

Sydney Antigonish Bridgewater Yarmouth Kentville Halifax

13 3 2 0.2 0.5 9% 55%

Truro New Glasgow Amherst

Is it easy/quick to get urology care ?

Sydney Antigonish Bridgewater Yarmouth Kentville Halifax TruroNew Glasgow Amherst

2.75 hrs 2.1 hrs 1 . 2 h r s 2.6 hrs

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
• ?

Western Region 206,000 Capital Region 404,000+ Tertiary Care Cape Breton Region 161,000 Northern Region 183,000

New Concept Step 1 Change Geography

Western Region Capital Region Cape Breton Region

New Concept, Step 2 – Determine Urology Centres

Sydney Truro Kentville Halifax

Northern Region

New Concept Step 3 - Create Functionality

Antigonish Truro New Glasgow Amherst

Major Centre

• Clinics
• Diagnostics
• Minor Surgery
• Major Surgery
• Major Technology

& Infrastructure Satellite Centres

• Clinics
• Diagnostics
• Minor Surgery
• Supporting

Infrastructure

Halifax

3-4 Urologists

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