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Session D: Sharing success – spreading to sustain

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Session D: Sharing success – spreading to sustain

Moderator:

• Dr. Nick Kates, Professor and Acting Chair, Dept. of Psychiatry and

Behavioural Neurosciences, McMaster University; Senior Advisor, Health Quality Ontario

Panelists:

• Bernie Blais, President and CEO, Bruyère Continuing Care
• Ru Taggar, Vice President Quality and Patient Safety, Chief Nursing and

Health Professions Executive, Sunnybrook Health Sciences Centre

• Terry McCarthy, Executive Director, Hamilton Family Health Team
• Dr. Bruce Baskerville, Senior Scientist, Propel Centre for Population

Health Impact, Faculty of Applied Health Sciences, University of Waterloo

• Josie d’Avernas, Vice President, Schlegel-UW Research Institute for

Aging

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Disclosures

Moderator and panelists have nothing to disclose

• Dr. Nick Kates
• Bernie Blais
• Ru Taggar
• Terry McCarthy
• Dr. Bruce Baskerville
• Josie d’Avernas

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Session format

Moderated panel format Panelists will present their message utilizing a few slides to illustrate the key strategies and or tactics needed to move towards a common quality agenda. The audience will have an opportunity to participate by asking question in two ways:

• Use the microphones located throughout the space
• Use the cards found on your table and staff will pick them up

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Moderator presentation

Nick Kates

Professor and Acting Chair, Dept. of Psychiatry and Behavioural Neurosciences, McMaster University; Senior Advisor, Health Quality Ontario

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Spread ... not used to encourage this concept ...

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What is spread?

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The degree to which learning, best practice or improvement is adopted across an

• rganization/system/region by those who would

benefit from the change.

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Laying the groundwork for spread

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For spread to succeed there needs to be

• A recognised need that something requires

improving

• A proven and sustainable idea
• A connection to an organisation’s strategic

directions or priorities

• Leadership

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And the idea should be …

• An improvement on the current situation
• Compatible with the system adopting it
• Simple (relatively)
• Testable/adaptable
• Able to produce visible benefits

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Key enabling factors

• For the spread of new ideas to happen in a timely way, the

process needs to be managed

• Communication, to raise awareness, attract early adopters, and

share the technical aspects of the change itself

• Leadership to support the spread effort and allocate sufficient time

to succeed

• Measurement – is it really better? Leads to evidence
• Influencers or opinion leaders in the social system serve as the

best messengers

• Making the success of early adopters visible makes it easier for

the later adopters

Source: Langley, G., Moen, R., Nolan, K., Nolan, T., Norman, C. & Provost, L. “The Improvement Guide.” Jossey-Bass: San Francisco, 2009. www.HQOntario.ca

Questions to ponder

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Spread Sustainability Continuous improvement infrastructure

• How do we transfer improvements and

learnings across organizations, practices, and the system?

• How do we sustain the improvements
• ver time?
• How do we use the learnings and skills

developed during a QI initiative to continuously improve?

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Panelist presentation

Bernie Blais

President and CEO, Bruyère Continuing Care

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Behavioural Supports Ontario (BSO) is a catalyst for large-scale change

Make a plan, then lead the way

Province-wide, within a LHIN, and at the bedside, BSO knits together clinical best practices that already exist and embeds them into care for every client, every time.

Pillar 1: System Coordination Pillar 2: Interdisciplinary Service Delivery Pillar 3: Capacity Building

The BSO vision

• QI training and techniques
• Consult and empower the front-line
• Integrate across sectors
• HQO coaching

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Smiling is infectious and so is BSO!

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Panelist presentation

Ru Taggar

Vice President, Quality and Patient Safety, Sunnybrook Health Sciences Centre

Catalyzing Spread at Sunnybrook ...

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BSO’s design supports visible leaders at all levels

Early Adopter LHIN 9 LHIN Project Lead LHIN Steering Committee Project Working Group 4 LHIN Early Adopter Steering Committee (SC) Early Adopter LHIN 4 LHIN Project Lead LHIN Steering Committee Project Working Group Early Adopter LHIN 12 LHIN Project Lead LHIN Steering Committee Project Working Group Early Adopter LHIN 10 LHIN Project Lead LHIN Steering Committee Project Working Group Coordination and Reporting Office (CRO) Project Management Health Quality Ontario (HQO) * Quality Improvement Guidance * Coordination between BSS and

• ther related local QI initiatives

* System alignment * QI Evaluation/ measurement Provincial Resource Team (PRT) * Resource and Advisory Quality Improvement Teams

LHIN 6 LHIN 7 LHIN 1 LHIN 2 LHIN 3 LHIN 5 LHIN 8 LHIN 11 LHIN 13 LHIN 14

Alzheimer Knowledge Exchange (AKE) Communication and Knowledge Dissemination

Quality Improvement techniques + issues management + empower front-line staff + physician engagement + buddy system coaching + acknowledgment & recognition

= better care, spread, sustainability

Buddy LHINs BSO supports project manager (NSM LHIN)

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Broad dissemination ...

Quality Improvement Plan

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Broad dissemination ...

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Panelist presentation

Terry McCarthy

Executive Director, Hamilton Family Health Team

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Building the culture and the capacity for quality improvement

• What is your compelling vision?
• Pursuit of perfection is the enemy of the good
• Pull – don’t push
• Partner to create leadership and infrastructure
• Invest in dedicated change management
• See one, do one, teach one
• QI Plan – keep it simple

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A simple QIP

Quality Aim Process Goal Outcome Goal Patient-Centred Care Obtain patient feedback on there they receive

• Town hall, focus group

survey Based on feedback, introduce two improvements to the care received by patients Timely Access to Care Measure supply and demand Improve patient access to care Population-Focused Care Identify patient populations within the panel Use a registry to intervene earlier with patients

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Panelist presentation

• Dr. Bruce Baskerville

Senior Scientist, Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University

• f Waterloo

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Effective spread of innovations in primary care – practice facilitation

Learning collaboratives

Practice facilitators/ coaches

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Strategies & IT support Local consensus building

Academic detailing

(literature & exemplar methods)

Performance feedback

Primary care practices

Practice facilitation impact

Results

• Meta-analysis of 23 high quality practice

facilitation studies with 1,398 participating practices

• Overall effect - facilitated practices are

2.97 times more likely to adopt evidence- based guidelines to improve quality

• Evidence that the effect is sustained
• Adaptation is key – facilitation tailored to

the context had greater impact

• Intensity is key - the more facilitation the

greater the impact

Spread

In the last 10 years:

• IMPACT BC, AIM Alberta, MPAN (MB),

BETTER Project & IDOCC (Ont), TRANSIT (Que), Building a Better Tomorrow (NB & NS)

• Multiple facilitation projects in the U.S.

(e.g. California, Oregon, Oklahoma, etc.)

• Patient-centered Medical Home models

high-quality primary care using Medical Home Facilitators

• Agency for Healthcare Research and

Quality is anticipating a national primary care extension program, making facilitation available to practices across the U.S.

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Baskerville NB , Liddy C , Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Annals of Family Medicine, 10 (1), 63-73. Liddy, C., Laferriere, D., Baskerville, B. et al. An overview of outreach facilitation programs in Canada: Current perspectives and future directions. Healthcare Policy. (In Press).

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Panelist presentation

Josie d’Avernas

Vice President, Schlegel-UW Research Institute for Aging

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From data to information

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From information to dialogue

• Annual Indicators Report
• Pick 5 things your neighbourhood does really

well

• Pick 5 things your neighbourhood really needs

to improve

• Root cause analysis
• Consult with teams doing it well
• PDSA cycles for QI

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What we now know, is opening up exciting new avenues e.g. Java Music Club

From dialogue to action

14 17 28 Schlegel 2011 Schlegel 2012 Canada % responding “most of the time”

• r “always” to

“staff ask for my help or advice”

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Questions to ponder

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Spread Sustainability Continuous improvement infrastructure

• How do we transfer improvements and

learnings across organizations, practices, and the system?

• How do we sustain the improvements
• ver time?
• How do we use the learnings and skills

developed during a QI initiative to continuously improve?

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Thank you

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