evidence based approach to provincial urology services presentation.pdf · provincial urology...
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Evidence Based Approach to Provincial Urology Services
Philip Belitsky MD
Peter MacKinnon MHSA CHE
Rachelle O’Sullivan MBA
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Today’s Presentation
1. Urology Care Today
2. Urology in Nova Scotia 2006
3. New Delivery Concept
4. From Concept to Actuality
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Yesterday’s Urology
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Today’s Urology
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Criteria for Quality Care
1. Contemporary Standard of Care• Including technology and skill sets
2. Readily Accessible
3. Fiscally Responsible
4. Positive Environment • Recruitment and Retention
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60,50063,000
82,500
73,500
32,50047,000 46,000
404,000
130,000
DHA PopulationsProvincial Total 939,000
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60,500
63,000
82,500
73,500
32,50047,000 46,000
404,000
130,000
Where are our hospitals ?
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60,500
63,000
82,500
73,500
32,500
47,00046,000
404,000
130,000
Are all hospitals the same ?
Sydney
AntigonishNew GlasgowTruro
Amherst
Bridgewater
Yarmouth
Kentville
Halifax
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60,500
63,000
82,500
73,500
32,500
47,00046,000
404,000
130,000
Where are the Urologists ?
Sydney
AntigonishNew Glasgow
Truro
Amherst
Bridgewater
Yarmouth
Kentville
Halifax
13
3
0.2 0.5
2
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Where do patients receive Urologic Care ?
Sydney
Antigonish
Bridgewater
Yarmouth
Kentville
Halifax
13
3
2
0.2 0.5
9%
55%
Truro
New Glasgow
Amherst
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Is it easy/quick to get urology care ?
Sydney
Antigonish
Bridgewater
Yarmouth
Kentville
Halifax
TruroNew Glasgow
Amherst
2.75 h
rs
2.1
hrs
1.2
hrs
2.6
hrs
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Do We Have Quality Urology Care In Northern NS?
1. Contemporary Standard of Care• Including technology and skill sets
2. Readily Accessible
3. Fiscally Responsible
4. Positive Environment • Recruitment and Retention
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Western
Region
206,000
Capital
Region
404,000+
Tertiary Care
Cape
Breton
Region
161,000
Northern Region
183,000
New Concept Step 1 Change Geography
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Western
Region
Capital Region
Cape
Breton
Region
New Concept, Step 2 – Determine Urology Centres
Sydney
Truro
Kentville
Halifax
Northern Region
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New Concept Step 3 - Create Functionality
Antigonish
Truro
New
Glasgow
Amherst
Major Centre
• Clinics
• Diagnostics
• Minor Surgery
• Major Surgery
• Major Technology & Infrastructure
Satellite Centres
• Clinics
• Diagnostics
• Minor Surgery
• Supporting Infrastructure
Halifax
3-4 Urologists
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Does Concept Fit Definition of Quality Care?
1. Contemporary Standard of Care• Including technology and skill sets
2. Readily Accessible
3. Fiscally Responsible
4. Positive Environment • Recruitment and Retention
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Building the Model - History
• DoH initiated surgical services plan for the Northern Region
• Critical meeting in Northern Area– Summit of multiple stakeholders
– Visioning exercise for northern region
– Created buy in for concept of a shared service for urology
– Siting for inpatient unit determined by DoH
• Planning for shared service in northern region indicates the need for a broader, more provincial focus
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Building the Model – Buy In
• Established project team led by DoH
• Engaged consultants with credibility for physician engagement in development of model
• Developed Steering Committee Structure
– Government
– DHA representation• senior leadership
• management
• health disciplines
– Academia
– Urologists – community and academic
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Building the Model – Project Objectives
• Develop a provincial multiple-site shared service model for urology with implementation plan for Northern Area
• Identify the role of CDHA both as the academic and tertiary/quaternary care centre
• Identify service requirements, including HHR and equipment needs
• Identify processes that will enable provision of consistent standards of care throughout the province
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Building the Model – Engagement
• Consultation with stakeholders– During the development of the model
– Validating the model
• Steering Committee– Effective Sounding Board
– Inclusive/Open/Participatory
– Mutual Benefits understood
– Patient focus +++
– Document Creation & Sign – Off
• Senior leaders – government and DHA’s– Approval of model/report
– Support for moving forward with next steps
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Building The Model - Physician Champion
• Wide consultation throughout process
• Demonstration of improved access and care to family physicians, hospital administration, staff, stakeholders of better access
• Patient focus/better care for referring physicians
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Building the Model -Where are we now• Patient Focus – majority access, i.e. travel
– < 30 minutes • Consult with specialist• Workup• Minor surgery
– <1 – 1.25 hours for major surgery and care
• Implementation Starting at CRH – Recruitment– Connection with CDHA– Renovations– Equipment– New Facility Planning– Work in Progress
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Summary
• Complex initiative
• Several years to come to fruition
• Starts next month
• Next Steps
– Determine additional costs and get through funding approval process
– Staged for full program implementation
– Evaluation Framework