Supercharging Change at the Front Lines of Healthcare

Phillip Morehouse, Director

Performance Excellence

Cape Breton District Health Authority

2014 CADTH Symposium

April 6-8, 2014

Hilton Lac-Leamy, Gatineau, Quebec

Volume of evidence, information & technology

15 - 20 years to reach routine clinical practice

Systematic reviews vs. single studies

Few have resources to find or use evidence

Knowledge or policy on its own will not change practice

Shewart and Deming

Systems thinking- process driven

Starts with a concept of improvement

Testing and learning cycles

Data and feedback driven

Variation exists

Initiated March 2010

MAC/CEO involvement

One test per month alternating between Lab & DI- March 2010

Behavioural Factors

◦ Pre-disposing factors:

Distribution and review of test ordering guidelines

“Do You Need That Scan” (Canadian Association of Radiologists)

◦ Re-enforcing factors:

Identify the top 50% of physicians + peer comparison

Cost of testing

Laboratory Diagnostic Imaging

ESR

PSA

CEA

Folate

Vitamin D 25-hydroxy

Vitamin D 1, 25-dihydroxy

Urine C&S (No change)

Lipid Profile

Throat Culture

Rapid Throat Screen (No change)

ANA

Testosterone

BUN

TSH & Free T4

Liver- ALT

Lumbar Spine X-Ray

Chest X-Ray

Portable Chest X-Ray

Abdominal Ultrasound (No change)

Pelvic Ultrasound

CT Head

Thyroid Ultrasound

CT Lumbar Spine

CT Chest

Barium Swallow

Barium Enema

OBS Ultrasound-Early

Rib X-Ray

0-5% No Change

5-10%

10-20%

> 20%

• Reduced direct costs

• Reduced follow up testing/consultation

• Increased capacity

• Reduced wait times

• Reduced radiation exposure

Test/Exam Analysis Time= <15 hours

Since March 2010- $1,197,374

# of Tests

Test/Exam Variance

% Variance

Annualized Value

Lab Tests

17 (57,612) 16.7% $151,125

DI Exams

13 (14,280) 9.5% $215,013

Total

30 (71,892) 14.4% $366,138

Utilization Project Analysis (March 2010 – April 2013)

10 family practices participated, MOU’s signed Over 1100 patients with Type 2 Diabetes, over the age of 18 and not

living in a nursing home. Monthly data submissions and feedback reports; Quarterly workshops; Incentives: ◦ Office support; ◦ GPs eligible for 25 Mainpro C credits, and 24 M1 credits; ◦ $1000 every 3 months (compensate for time collecting data); and ◦ Compensation for time spent at workshops.

Governance: Quality Collaborative Executive Leadership Team, monthly meetings; Advisory Committee, quarterly meetings

Quality Collaborative: Diabetes

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Pe

rce

nt

of

T2D

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op

ula

tio

n

Comparison of baseline to final clinical and process measures for the CBDHA Quality Collaborative

Baseline, N=1119 Final, N=1065

Sept 2012

2011 ◦ 91 C-difficile cases ◦ 15 deaths

2012 ◦ NS Auditor General/Public Health Agency of Canada/ Infection Prevention & Control NS

2013 ◦ Hand Hygiene Program & Database ◦ Pilot on 2 Medical Units

Hand Hygiene auditing at the unit level Front line empowerment- individual pins and trophies

Pre-Intervention Post-Intervention % Difference

Unit 1 86.25% 93.00% 6.75%

Unit 2 86.50% 90.75% 4.25%

DHA 82.50% 82.25% -0.25%

0

10

20

30

40

50

60

70

80

90

100

Hand Hygiene Compliance Rates Monthly

%

June 2012 – Feb 2014

Reference: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Released: September 6, 2012

Evidence Learning

Family Health Care Provider Patient

Policy

Practice

Dat

a &

Fee

db

ack

Process

Imp

rovem

ent R

esou

rces Process Technology Incentives

Incentives Technology

morehousep@cbdha.nshealth.ca