Driving Patient-Centered Innovations throughout the Ontario Cancer System Helen Angus Esther Green Cancer Care Ontario June 2007
CCO Mission We will improve the performance of the cancer system by driving quality, accountability and innovation in all cancer-related services 2
Outline 1. CCO definition of innovation? 2. Overview of CCO’s innovation strategy 1. Provincial Palliative Care Integration Project 2. Implementing a new role: Nurse Endoscopy 3. Lessons Learned 3
CCO’s Definition of Innovation H3. Nurture options for breakthrough H2 . Build & test opportunities new ideas that have potential to H1. Improve - Cancer research program transform care quality and performance of existing activities - CCO’s Innovation Strategy -Local CQI activities -Provincial programs Adapted from McKinsey & Co. “Three horizons model of business competitiveness” 4
CCO Innovation Strategy • A dedicated innovation directorate • Focus on pushing out successful innovations • Palliative Care Integration Project (Kingston) • RN endoscopists • Focus on building capacity in process reengineering – new skills to reach wait time targets in radiation and systemic therapy • Sustainability factors • Recognition program 5
Palliative Care Integration Project • Standardize use of Common tools – Edmonton symptom assessment system – Palliative performance scale – Collaborative care plans – Symptom management guidelines • Formal Evaluation Framework – Capturing process and outcome information • Quality Improvement Methodology 6
Local Project to Province Wide Initiative and Back Again Provincial initiative built on this regional solution to produce a project with 3 Expectation is Proof of concept lofty aims for the RICs to incubated translate this locally in back into their Kingston regions Adapted from McKinsey & Co. “Three horizons model of business competitiveness” 7
Nurse Endoscopy Project • Goal – To increase screening capacity for colorectal cancer through clinics that provide flexible sigmoidoscopy procedures. • Project – Model after existing international program design – Core course to develop knowledge and clinical expertise for nurses – Establish nurse-led clinics providing flexible sigmoidoscopy procedures in 6 locations across Ontario. – Evaluate the program with recommendations for improvement and sustainability. 8
Learning : Overview • A balance of pull and push projects increases the yield from scarce innovation funding • Achieving system-wide impact requires a significant scale of effort and appropriate level of funding. Be entrepreneurial in looking for funding. • Expect and plan for important differences between the initial site and provincial scale effort – Different work processes – Evaluation and measurement requirements – Expect the unexpected 9
Learning 1: Aim for a Balanced Portfolio of Innovation Initial Site Provincial Project • A proposal call was • More focused process issued and applications • Project parameters were were reviewed by a panel defined provincially and with priority placed on organizations were proposals with high offered the opportunity to likelihood of impacting implement locally wait times in the short • Projects selected on the term basis of a readiness assessment re: organizational commitment and implementation strategies 10
CCO Cycle of Innovation “PULL” “PUSH” Implementation & evaluation Review & recommendations : Review & Select initiatives recommendations for broader diffusion Implementation Best Practice recommendations & evaluation Full funding Further R & D development funding 11
Learning 2: Be Entrepreneurial in Looking for Funding Initial Site Provincial Project • Small amounts of seed • Small amounts of funding funding was enough to have been enough to stimulate local interest stimulate local interest • $100K from the Change • Appeal to the priorities of Foundation for RN others Endoscopy – PPCIP re-profiled as a QI project • $200K from the – RN endoscopy profiled as Innovation Fund for an HR innovation to Palliative Care increasing screening • MOHLTC funding critical capacity 12
Learning 3: Adapt Work Processes Initial Site Provincial Project • Local leadership key • Structured approach to success to work required – Clinicians – Clarify roles and responsibilities – Senior Administrators • Additional skills, tools – Organizations – Project management • Work processes can be less systematic – Structured collaboration – Rapid cycle quality improvement 13
Palliative Care: Central Support Structure • Project Planning • Expert Coaching and Guidance – Learning Improvement Sessions – Provincial improvement coordinator – Quality Improvement advisor – Kingston coaches including the provincial palliative care program lead 14
�� RN Endoscopists: Project Structure Steering Committee Stakeholder Advisory Group Helen Angus/, Joshua Tepperp/Linda Rabeneck* �������� ����������� Nursing Clinical Adviser Project Sponsors ���� CCO Erin Hughes Esther Green Annette Ellenor Program Manager/ Site Leads Project Implementation Coordinator Site Implementation Catherine Montgomery Teams Administrative Support or project coordinator TBC �������� �������� Communication Service Provider Funding Payment Education Team Evaluation Team ����� Support Team 15
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Palliative Care: Model for Improvement What are we trying Aim to accomplish? How will we know a Measures change is an improvement ? What change can we make Change that will result in improvement? CYCLES for Act Plan Testing and Implementing Change Study Do Langley, Nolan, Nolan, Norman, Provost; Improvement Guide , 1996 16
Learning 4: Invest in Measurement and Evaluation • Initial Site • Provincial Project – Focus of – Central evaluation measurement defined framework centrally, e.g. wait – Metrics defined times provincially – Metrics defined locally – Data collection tools – Performance reported provided provincially through progress – Scheduled data status reports submission requirements – Provincial and local analysis of outcomes 17
Palliative Care: Quantifiable Improvement Aims To improve care for palliative patients WHY? HOW? 1. 90% target 2. 90% target symptoms 3. 90% functional status is population are controlled. (SMGs) assessed (PPS) screened for and coordinated support symptom provided (CCPs). severity (ESAS) 18
Final Thoughts • Expect that local business relationships may not be able to grow with the project • Pay attention to and address intellectual property issues from the outset • Knowledge transfer and sustainability need equal attention and effort • Acknowledge local leaders and find ways to keep them engaged • Both success and failure are important ways to learn 19
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