PQI Themes in Interior Health Disclosures No disclosures No - - PowerPoint PPT Presentation

PQI Themes in Interior Health

Disclosures

• No disclosures
• No conflict of interest

Geographical and Clinical Diversity

ENABLE

Online Training Resources

Co-Creation

Dyads

PQI meets MSA

Overview of Physician Quality Improvement (PQI) at Northern Health

Disclosure

I have no conflicts or disclosures

Our Vision

κ Physician champions: Physician

engagement, empowerment and leadership.

κ Patient and family centered κ QI Infrastructure/support synergizing with

existing HA framework/program

κ Weaving QI at every level to create

culture of QI “To deliver exceptional care for Northerners”

Our Journey

First Steering Committee Meeting – November 2016 Staff Hired – February 2017 Education first session – June 2017 Seed Grant Process launched– September 2017 May 2018 - First physicians to complete intermediate QI Ongoing for 22 months now –

Organization # of Reps Perspectives Members Patient Representative 3 Patient Partners Edwina Nearhood KD Taylor Millie Percival Practicing Physicians & Physicians Groups 9 Rural GP or Nurse Practitioner Operational Chief of Staff Quality Program Lead Physician Medical Staff Association Division of Family Practice Practicing GP & SP; Varying geographic/regional perspectives Physician Mentors VACANT

• Dr. Dawid van Rensburg
• Dr. Shyr Chui and Dr. Singh
• Dr. Amin Lakhani
• Dr. Bill Clifford
• Dr. Denise Jaworsky NW,

NE VACANT NI Dr. Shyr Chui

• Dr. Jamil Akhtar, Dr. Laura Brough

Specialist Services Committee 3 Physician Representative Senior Staff Representative

• Dr. Kathy Lee

Aman Hundal VACANT Northern Health 5 Medical Director or NHMAC Executive team and/or Operational HA PQI Sponsor Quality & Innovation Primary Care Clinical Quality Program Co-Lead

• Dr. Anurag Singh

Penny Anguish Candice Manahan Tanis Hampe

• Dr. Paul Murray, Pam Mulroy

Steering Committee

Staff NH PQI Staff Photo: Summer, 2018

We love our patient partners

NH PQI Education Photos

Our Achievements

κ Integration with HA Quality infrastructure

leadership and program

κ Region-wide impact κ Increasing physician participation and

interest in QI education and projects

κ PQI Steering Committee and Staff

subscribe to a common vision

κ Highly motivated and engaged PQI support

staff

Our Opportunities

κ Physicians leading large scale transformative

QI projects – Physician Mentors

κ Expansion of PQI network and collaborating

with other HA- PQI

κ Role clarity between PQI support staff and

physicians

κ Utilize patient partners in individual

projects

What’s Next for our PQI Program?

κ Recognition: NH Research and QI Conference Nov 6-8, 2018 κ Education: Implement this year’s PQI education workshop series

(including new brief skill building workshops)

κ Staff: Continue our staff learning plan; Monitor staff resource

capacity challenges

κ Collaborate: UNBC, UBC, PHSA, Doctors of BC. κ Program Improvements: Further develop the PQI learning journey

from beginner to intermediate, to advanced training, embed milestones for physician recognition

κ Evaluation: Embedding provincial and local evaluation

recommendations into team planning/steering committee

Questions?

Island Health PQI experience:

• Dr. Jason Wale

I have no conflicts of interest to declare. I receive no honorariums or finance.

Fraser Health Set a pretty high standard…

“We’re #2!”

Island Health Fraser Health

HAL Smechner

Island Health PQI experience:

3rd year and growing up fast!

2016 Now

First challenge is we are a long and skinny geography In person meeting is challenging.

Some of our First Cohort: 2016/17

Some of our First Cohort: 2016/17

Balance

Physician Interest Local culture Novel ideas Physician Education HA Priorities

Challenges:

• Role clarity
• Education versus commitment ( especially surgeons)
• Balance HA needs with physician interests
• New admin structures
• What admin endorsement means
• What to do with grads after cohort

PQI Summit Physician Quality Improvement VCH/PH

Vinay Dhingra MD Chair PLQI VCH/PH

Disclosure

Presenter Dr Vinay Dhingra Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria None Consulting Fees None Other None

Goals of Physician Led QI VCH/PH

To create the capacity and capability for physicians to engage and lead quality improvement To engage the VCH and PHC physician medical staff to further a culture of quality improvement To support the local needs

• f physicians with

improving the quality of patient care

Primary Goals

PLQI Joint Steering Committee

Medical Administration

Specialist Services Committee

Medical Staff

Quality Patient Safety

Patients Advisors

Alignment

VCH/PHC Physician Led Quality Improvement

• Collaboration between VCH, PHC, and the Specialist Services Committee (SSC)

1 Day QI Training

• Offered 4 times per year
• 130+ VCH PHC physicians since Jun 2018
• Next dates:
• Nov 27, 2018
• Feb 6, 2019
• Mar 6, 2019
• Funded PLQI Cohort Projects
• Cohort 1 (17/18FY): 24
• Cohort 2 (18/19FY): 38

Funding for projects, training and sessionals QI Support and Physician Advisors for mentorship & coaching

Physician-Led QI Initiative – Advanced Training

Tech support Including data analysis Steering Committee provides

• versight

Online Module – Intro to QI

• In development – target 2019

1-day QI Training

Objectives:

• Develop a culture of engagement in QI among physicians in PHC/VCH
• Enhance QI understanding for physicians in PHC/VCH
• To provide fundamental skills, tools and resources for QI

134

Total physicians trained

7

One day 1-day QI training sessions held between Mar 2017 – Jun 2018

Spread the word! Upcoming dates:

• Nov 27, 2018
• Feb 6, 2019
• Mar 6, 2019

PLQI Cohort Timeline

Aug: PLQI Launch Cohort 1 24 projects

2017 2018

June: Cohort 1 Graduation July/Aug: project charter start

2019

Jan: Cohort 3 intake May: Notification of acceptance cohort 3 May: Cohort 2 projects chosen (14 continuation +22 new = 36 total projects) Sept – May 2019: Cohort 2 Ongoing advanced training and project support Apr-May: Cohort 2 Project Presentations

PLQI Project Specialties

General Practice Critical Care Medicine Psychiatry Emergency Medicine Physical Medicine and Rehabilitation Anesthesiology Cardiology Internal Medicine Laboratory Medicine Neurology Infectious Diseases Radiology Palliative Medicine Dermatology Pediatrics Community and Rural Obstetrics and Gynecology Thoracic Surgery Orthopedics Otolaryngology

20

specialties

September October November December January February March April May June

Cohort Training – 2018/19 Training Schedule

#1

Sept 12 #2 Sept 19 #3 Sept 26

#4

Oct 30

#5

Nov 29

#6

Jan 16

#7

Mar 5

#8

Apr 3

#9

May 16

Graduation TBD

One Day Training

Nov 29

One Day Training

Feb 6

One Day Training

Mar 6

One Day Training

Aug 23

One Day Training

Jun 12

Cohort Training

Cohort Training - PLQI Team

PLQI Support Staff PLQI Physician Coaches PLQI Physician Cohort Alumni

• Model for Improvement
• Overview of DMAIC
• Project Charters
• Ethics in QI
• Project management
• Considering Cause and Effect: Driver Diagrams, Ishikawa,

5Whys

• Human Side of Change - Stakeholder Engagement, Patients,

Colleagues, Administration, Leadership, Public

• Data planning
• Testing Changes
• QI Communications
• Overcoming early barriers and road-blocks
• Variation – The measurement and clinical perspective
• Team Work & Communication
• Sustaining and Spreading Improvement
• Identifying Change Ideas – moving forward post-project

Teaching Topics Covered Include:

AND MORE!!!!

PLQI Chairs

Cohort Training – Additional Facilitators

Capturing and Understanding the Patient voice Patient Advisor How to be an effective change agent Change Specialist

PHC – Leadership and Organizational Change

What Matters to You Engagement Leader

BCPSQC

Patient-Centred Measurement in BC (PROMs/PREMs)

VCH QI, Patient Centred Measurement Working Group

Communicating Change (Knowledge Translation)

Director, Health Services and Clinical research and Knowledge Translation

PHC

PLQI Support Staff PLQI Physician Chair PLQI Physician Cohort Alumni Teamwork and Communication Leader, Health System Improvement

BCPSQC

PLQI Physician Coaches

Cohort 1 Graduation & Awards

PLQI Project:

• to provide early access to food

and water in the ED at St. Paul's Hospital in an effort to reduce aggressive behaviour.

• Dr. David Agulnik, Emergency Physician, St. Paul’s Hospital

2018 BC Health Care Hero Award

Steering Committee Members

VCH/PHC

• Dr. Brenda Wagner
• Dr. Janet Kow

Allison Muniak Camille Ciarniello Vivian Chan (HA Sponsor) SSC

• Dr. Ken Hughes

Aman Hundal (SSC Sponsor) Clinically Active Physicians

• Dr. Vinay Dhingra (Chair)
• Dr. Kelly Mayson
• Dr. Julie Baxter
• Dr. Karen Dallas

Patient Partners Lori Pederson Hamid Ghanbari

PQI Summit Session: PHSA Rapid Fire

• Dr. Montgomery Martin
• Ms. Georgene Miller, VP Quality PHSA
• Ms. Bethina Abrahams, Dr. Celine Kim

November 19, 2018

Disclosure

2

Presenter / Faculty

• Dr. Montgomery Martin

Relationships with commercial interests: Grants / Research Support Speakers Bureau/ Honoraria Consulting Fees Other

PHSA PQI Journey:

Lessons Learned:

3

Impact:

3

Cohort #2; 2018-2019:

3

20 Physicians

IN

Five Programs /Agencies:

3

Collaboration Education

Future Plans:

Thank You

3

PQI Across the Province

Fraser Health

Dr Chris Bozek

Chairman Fraser Health PQI Steering Committee

Conflicts

• I have no commercial conflicts in the presenting of this talk

FH PQI Journey

• had 2 “champions” in Fraser Health
• the late Dr Jan Kornder, had initial job of QA/QI 2013
• Dr Curt Smecher, QI since 80’s before medicine, did IHI training in Boston in

2013

• May 2014, meeting of SSC and FH, decided Curt would lead the change to

start PQI in FH

• Apr 2015 first cohort of FH Physicians, trained entirely by Curt, 9 docs
• “ on the run” setting of terms of reference and steering committee

FH PQI Journey

• the budget of 1 million 2015 grew to 2 million 2016
• forged multiple partnerships with privacy office, IT, QA early on
• setting up of formal Steering Committee after cohort 1 under

Dayan Muthayan, EMD at FH

• 2016, cohort 2 had 13 docs, hiring of Crystal Sun and Angela

Tecson to assist Curt and the cohort

FH PQI Journey

• we've grown!
• currently cohort 4 has 26 students
• we've accepted community docs,

medical administrators

• our support staff has grown to 24,

teaching is increasingly being done by cohort graduates

• we have 2 patient representatives

FH PQI Journey

• and we've had results!
• over 100 projects are being managed
• several workshops have been done to promote spread of QI
• a QI network has been established to support ongoing work, collaboration

and spread of successful projects

• through FE, a growing engagement with site administrators already focused
• n QI is clearly occurring, with trained QI doctors sharing the lead
• over 50 percent of our graduates are assuming leadership roles in FH

FH PQI Journey

• but theres more to be done…
• we are reaching a “tipping point” where a culture of QI is getting embedded
• we are increasingly moving to a project management focus
• change from a cohort training model which is based in one site, to bringing the

training to hospitals in modules, easier access

• steering committee to work mainly on steering our PQI, not operations
• and this is all physician led!

STAY TUNED!