cadth_2014_e6_cadth_panel_discussion_policy_confirmed__now what__phillip morehouse
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Policy Confirmed: Now What?TRANSCRIPT
Panel Discussion- CADTH "Policy Confirmed. Now What?”
Phillip Morehouse, Director, Performance Excellence
Cape Breton District Health Authority
2014 CADTH Symposium
April 6-8, 2014
Hilton Lac-Leamy, Gatineau, Quebec
Gap Between Evidence & Practice
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
Why does the Gap Exist?
Failure to acknowledge the value of Customers and Stakeholders
Complacency
Lack of Management Support
Lack of Resources
Work Life Issues
Benchmarking
Poor Planning = Negative Impact
Barriers to Change
Complexity
Fit with process
Open to adaption
Trialibility
Observation
Factors Influencing the Adoption of
Change
Factors Contributing to Change
Predisposing factors
◦ Individual knowledge, attitude, behaviour, beliefs and values that affect willingness to change
Enabling factors
◦ Factors in the environment or community- facilitate or present obstacles to change
Reinforcing factors
◦ Positive or negative effects of adopting the behaviour
Human Factors Approach to
Improvement
Information
Education
Rules and policies
Reminders, checklists, double checks
Simplification/standardization
Automation/computerization
Forcing functions and constraints
Less Effective
More Effective
Shewart and Deming
Systems thinking- process driven
Starts with a concept of improvement
Testing and learning cycles
Feedback driven
Variation exists
Knowledge of Improvement &
Decision Support
Decision Support Framework
CBDHA Experience
Diagnostic Utilization:
◦ Test ordering guideline, peer comparisons, cost of testing
◦ 30 lab tests & DI exams- 3 years
71,892 reduction in test/exams or 14.4% change
Diabetes Quality Collaborative
◦ 10 physicians, 1100 IDDM, 10 indicators
2-45% improvement from baseline
Clean Hands, Save Hands:
◦ HH auditing & Front line empowerment over an 8 month period
◦ 2 medical units with 7% and 4% improvement
Reference:
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
Released: September 6, 2012
Systematic Approach to Care
Improvement
Evidence Learning
Family Health Care Provider Patient
Policy
Practice
Dat
a &
Feedbac
k
Process
Impro
vem
ent R
eso
urce
s Process
Technology
Incentives
Incentives Technology
How Can Evidence Producers Help?
Work with providers, patients and families to understand
the evidence requirement
More research into improvement methodologies
Facilitate improvement ideas and strategies
Document and discuss success stories
