supporting specialist physicians and the health system to innovate and improve patient care

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

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.

SSC Mandate:

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. Brenda Wagner (VCH)

* Dr. Ken Hughes

* Dr. Ron Chapman (NHA) * Dr. Steve Gray (PHSA) * Dr. Alan Stewart (IHA) * Dr. Roy Morton (FHA) * Alternates

Committee Members:

• Improving the patient and provider experience of care. • Improving the health of populations. • Reducing the per capita cost of health care.

IHI Triple Aim

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 Physicians2 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

Context

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.

Quality & Innovation Strategy

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

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.

Quality Improvement Support

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)

Current Quality & Innovation Project Examples

RebalanceMD 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 Agree

Base 2011: All GPs (n=537)

In 2011, GPs were asked on their views on how the specialist telephone advice fees have helped GPs

2011, Ipsos Reid, SSC Midterm Evaluation Survey

“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 telephone advice fees

“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 health authority system redesign funding

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

Feedback on Group Medical Visit fees

$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

New SSC Initiatives

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.

Summary

Questions?