Presentation to the Quality Forum February 28, 2014 SSC Co-Chairs: Dr. Sean Virani, Doctors of BC Kelly McQuillen, Ministry of Health www.sscbc.ca
SSC Mandate: To facilitate collaboration with the Government of BC, Doctors of BC and the Health Authorities on the delivery of specialist services, and to support the improvement of the specialist care system.
Committee Members: Ministry of Health Doctors of BC Kelly McQuillen (co-chair) Dr. Sean Virani (co-chair) Jeremy Higgs Dr. Ken Seethram Kevin Brown Dr. Gordon Hoag Dr. Ian Courtice Health Authorities * Dr. Andrew Attwell Dr. Taj Baidwan (Island Health) * Dr. Ahmer Karimuddin * Dr. Patrick O’Connor/ * Dr. Ken Hughes * Dr. Brenda Wagner (VCH) * Dr. Ron Chapman (NHA) * Dr. Steve Gray (PHSA) * Dr. Alan Stewart (IHA) * Dr. Roy Morton (FHA) * Alternates
IHI Triple Aim • Improving the patient and provider experience of care. • Improving the health of populations. • Reducing the per capita cost of health care.
Context 2013/14 MOH Health Program Spending (est.) 1 68% ($11.12 billion) on Regional Services 24% ($3.98 billion) on MSP 7% ($1.18 billion) on Pharmacare BC Physicians 2 ranked the following as most important in terms of needing support and action: #1: Quality and Patient Safety #2: Ensuring Physician Consultation #3: Adequate Resources and Access for Patients 1 Ministry of Health, Revised 2013/14 - 2015/16 Service Plan 2 BCMA Membership Survey, April 2012
Quality & Innovation Strategy Supporting physicians to engage in quality and help lead improvements to patient care and to health system. Objectives: Improve physician engagement and coordination between physicians and health authorities, Support specialists to deliver timely and valued patient care, and Support the pursuit of quality improvement in the health system, based on partnership between physicians and health authorities.
SSC Work Plan
Engage and improve relationships between specialists, health authorities, and other partners Work with physicians and health authorities to jointly identify opportunities to make system improvements, with SSC support and funding. Local, regional and provincial consultation to confirm priorities for SSC strategic plan to support improved health system coordination and integration
Improve on existing SSC initiatives: Programs: Health authority system redesign participation, Practice support, Leadership training scholarships Fees: Telephone Advice, Patient Telephone Management, Group Medical Visits, Discharge Care Planning, Advance Care Planning, and section specific Labour Market Fees Implement specialist's role in prevention (via brief interventions to address smoking, alcohol and obesity)
Offer training in leadership, quality improvement & clinical skills enhancement (e.g., mentoring, sub-specialist advice) Fund and support local Quality and Innovation initiatives, and spread best practices and approaches provincially though collaboratives and pathway development Fund specialists to address care caps and provide coordination and multidisciplinary care for patients with complex & longitudinal care needs
Quality Improvement Support Provide quality improvement infrastructure and resources provincially, regionally and locally. Support specialists to lead quality improvement initiatives with QI methodology and data analytical support. Leverage and bolster existing infrastructure and expertise of collaborative committees (Practice Support Program), and within health authorities, the Quality Council and other partners.
Current Quality & Innovation Project Examples System Change: Pooled patient referrals & ’first available surgeon’ models Provincial hip fracture care redesign Enhanced Recovery After Surgery (ERAS) Multidisciplinary Care: Cancer survivorship program Young adults with chronic health conditions and disabilities transitioning out of tertiary paediatric care Integration of allied health providers and multidisciplinary clinics IT/EMR Initiatives: Electronic tracking and reporting of wait times and surgical booking systems through surgeon EMRs Expand Telehealth for cardiology, wound care & mental health Adopt Computerized Physician Order Entry (clinical decision support)
Rebalance MD Multidisciplinary Orthopedic Clinic (Victoria)
Enhanced Recovery After Surgery (ERAS) - Interior Health Trial at Kelowna General Hospital to implement ERAS pathway for colorectal surgery patients: LOS reduced from 12.8 to 4 days, Cost per case reduced from approximately $16,000 to $8000. With funding and support of SSC and Interior Health, ERAS is now being implemented at 8 sites in IHA To scale up change, SSC is also establishing a provincial Collaborative to standardize ERAS provincial pathway for participating sites in each HA.
Evaluation of SSC Initiatives In 2011 SSC began evaluating initiatives launched in 2010, including the telephone advice fees. In 2014 SSC will complete evaluation of other initiatives (e.g., discharge care planning, advance care planning, health authority system redesign, leadership scholarship) All SSC initiatives going-forward will have evaluation component to measure level of achievement towards IHI Triple Aim.
Evaluation of Telephone Advice Fees In 2011, GPs were asked on their views on how the specialist telephone advice fees have helped GPs Agree 2011, Ipsos Reid, SSC Midterm Evaluation Survey Base 2011: All GPs (n=537)
Feedback on telephone advice fees “Phone advice is very helpful, particularly in hospitals that serve a large geographic area. Our members have been able to provide advice to physicians in smaller communities and in many cases prevented unnecessary transfers of patients to the regional hospital. The telephone consultations have also served a significant role in enhancing physician-physician communication. On the whole, the telephone fees were utilized widely by members of our section with a significant benefit to patient care.” - Section of General Surgery, 2011
Feedback on health authority system redesign funding “On behalf of Northern Health, I would like to express our sincere gratitude for the generous support provided by the tripartite service committees (SSC, SCC, and GPSC). This support is critical to involving physicians in quality improvement redesign activities, which in turn, ensures that these initiatives are enhanced by the creativity and expertise of general practitioners and specialist physicians.” - Northern Heath Authority, 2011
Feedback on Group Medical Visit fees GMV for colonoscopy patients in FHA: Patients in GMVs seen 4-5 months sooner compared to one-on-one appointment. 100% patient satisfaction (patient survey results) “This is an invasive procedure. Having the surgeon and endoscopy nurse educate the patients [in a group] about the procedure seems to diminish any lingering anxiety patients might have.” - Dr. Cowie, Surgeon
New SSC Initiatives $15 million Quality & Innovation Fund Expression of Interest launch in April 2014 Generate ideas and collaboration between specialists and health authorities Advance strategic priorities of Ministry of Health and Doctors of BC Funding to support specialist-led quality improvement prototypes, projects, and initiatives to address patient care gaps
New SSC Initiatives Provincial Enhanced Recovery After Surgery (ERAS) Collaborative Surgical Improvement Pooled Patient Referrals/First Available Specialist
Summary Engagement of specialists and improving the relationship and coordination between physicians and health authorities is a key objective to achieving better patient care and ensuring value for taxpayer dollars. This objective requires a cultural shift of both physicians and those that fund and administer the system to work collaboratively to align focus on the common goal of improving patient care. The role of the SSC and the other collaborative committees is to help build better partnerships and integration within the health system to achieve this goal.
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