supporting specialist physicians and the health system to innovate and improve patient care
DESCRIPTION
This presentation was delivered in session G4 of Quality Forum 2014 by: Kelly McQuillen Executive Director, Primary Health Care and Specialist Services Branch, Medical Services and Health Human Resources Co-Chair Specialist Services Committee Sean Virani Co-Chair Specialist Services CommitteeTRANSCRIPT
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?