National Quality Collaborative Quality is Job 1: How do we get there? Blair J. O’Neill MD FRCPC Chair, Quality Collaborative, Specialist Forum CMA Associate Chief Medical Officer, Strategic Clinical Networks, Alberta Health Services Past President and Chair of DDQI Initiative, Canadian Cardiovascular Society Conflicts of Interest Disclosur Conflicts of Inter est Disclosure: None e: None 1 Leadership. Knowledge. Community.
EXHIBIT ES-1. OVERALL RANKING O O Canada….. anada….. COUNTRY RANKINGS Top 2* Middle Bottom 2* AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US 4 10 9 5 5 7 7 3 2 1 11 OVERALL RANKING (2013) 2 9 8 7 5 4 11 10 3 1 5 Quality Care 4 7 9 6 5 2 11 10 8 1 3 Effective Care 3 10 2 6 7 9 11 5 4 1 7 Safe Care 4 8 9 10 5 2 7 11 3 1 6 Coordinated Care Patient-Centered Care 5 8 10 7 3 6 11 9 2 1 4 8 9 11 2 4 7 6 4 2 1 9 Access Cost-Related Problem 9 5 10 4 8 6 3 1 7 1 11 6 11 10 4 2 7 8 9 1 3 5 Timeliness of Care 4 10 8 9 7 3 4 2 6 1 11 Ef f ciency 5 9 7 4 8 10 6 1 2 2 11 Equity Healthy Lives 4 8 1 7 5 9 6 2 3 10 11 $3,800 $4,522 $4,118 $4,495 $5,099 $3,182 $5,669 $3,925 $5,643 $3,405 $8,508 Health Expenditures/Capita, 2011** Notes: * Includes ties. ** Expenditures shown in $US PPP (purchasing power parity); Australian $ data are from 2010. 2 Leadership. Knowledge. Community. Source: Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization; and Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, Nov. 2013).
Non-sustainable healthcare cost increases in Canada 34.2 M people 23.4M people 1975 to 2010 • ‰ Expenditure increases = 3.5 fold • ‰ Population increases = 1.5 fold 3 Leadership. Knowledge. Community.
Objectives • ‰ To discuss the opportunity of quality improvement • ‰ To describe progress to date of the National Quality Collaborative (CMA/ Specialist Forum) • ‰ What can you do to improve quality? 4 Leadership. Knowledge. Community.
What is Quality? 5 Leadership. Knowledge. Community.
Intermountain Health Care 6 Leadership. Knowledge. Community.
Intermountain Health Care Dr Brent James 7 Leadership. Knowledge. Community.
The he Int nter ermount mountain ain Healt Healthcar hcare e Way Way • ‰ Apply the rigorous measurement tools developed for clinical research to routinely measure clinical variation in routine care performance • ‰ Examine quality, utilization and efficiency • ‰ Learning Approach ; not a judgmental approach • ‰ Focus on the process ; not on the persons 8 Leadership. Knowledge. Community.
The he Oppor Opportunit unity • ‰ Care often falls short of its theoretical potential • ‰ Well documented massive variation in practices • ‰ High rates of inappropriate care • ‰ Unacceptable rates of preventable care-related patient injury and death • ‰ A striking inability to do “what we know works” • ‰ Huge amounts of waste leading to spiraling costs that limits access to care – 50% of resource expenditures in hospitals is quality-associated “waste” 9 Leadership. Knowledge. Community.
Intermountain Health care approach to protocols • ‰ Build evidence-based best practice protocols results (memory-based medicine gets it right 50% of the time!) • ‰ Incorporate them into clinical workflow • ‰ Embed data systems to track protocol variations and short- and long- term • ‰ Demand that clinicians vary care based upon patient need • ‰ Feed the data back in a “Learning Loop” • ‰ Consistently update and improve protocols 10 Leadership. Knowledge. Community.
National Quality Collaborative National Specialist Forum Canadian Medical Association 11 Leadership. Knowledge. Community.
2014 QC Re-cap • ‰ Winter 2014 - Support from SPF and CMA Board • ‰ Ad hoc Steering Committee confirmed direction • ‰ Summer - Discovery Conversations to inform QC options/partnerships • ‰ SK HQC, HQC AB, BCPSQC, HQO, ON’s IDEAS, Cancer Care Ontario, Canada Health Infoway, RCPSC, CMPA, Accreditation Canada, CFHI, CPSI, CPAC, CIHI • ‰ Fall – Advisory Committee and CFHI ramping up 12 Leadership. Knowledge. Community.
General Themes From Discovery Calls • ‰ All around support • ‰ Niche : physicians as leaders of change , peer-to-peer champions • ‰ NSS involvement - core asset • ‰ Spreading and scaling crucial • ‰ Physician-level and synoptic (template-style) reporting • ‰ Role of education, IT & KT • ‰ Early patient involvement • ‰ Suggested Focus : Unwarranted Clinical Practice Variation 13 Leadership. Knowledge. Community.
Unwarranted/Unexplained CPV 14 Leadership. Knowledge. Community.
Distribution of Ontario hospitals by ratio of PCI:CABG procedures Tu, J et al. CMAJ 2012. DOI:10.1503/cmaj.111072 15 Leadership. Knowledge. Community.
PCI/CABG ratio by cardiologist 16 Leadership. Knowledge. Community. Tu, J et al. CMAJ 2012. DOI:10.1503/cmaj.111072
Next Steps • ‰ What comes next depends on: • ‰ What role CMA wants to play in the Quality Agenda • ‰ Whether CFHI gets funding in Federal Budget, allowing for National Quality Focused Learning Collaborative • ‰ Most importantly, CFHI and CMA are committing to advance work in this area 17 Leadership. Knowledge. Community.
Role of Participating NSS/ Physicians if CFHI gets Federal Funds • ‰ Identify physicians to lead CFHI applications • ‰ Operationalizing the QI Collaborative - ‰ Designing improvement plans - ‰ Creating indicators - ‰ Developing stakeholder engagement strategy - ‰ Implementation - ‰ Evaluation and measurement - ‰ Preparing for spread • ‰ Need for supportive participating institution • ‰ Team members attend face-to-face learning sessions & webinars 18 Leadership. Knowledge. Community.
Regardless of CFHI funding, we propose that all QC organizations • ‰ Identify 1-3 CPV areas • ‰ Outline why these are patient care issues • ‰ Encourage ≥ 1 MD-level CPV report • ‰ Base priorities on member input • ‰ Follow-up phase - creation of action plans 19 Leadership. Knowledge. Community.
What will it take? • ‰ Standardized order sets • ‰ Clinical Pathways • ‰ Ultimately, eMR with POC clinical decision support prompts • ‰ Measurement, KPI’s, Audit and Feedback • ‰ NSS’ set targets in areas with wide clinical practice variation • ‰ Constant Quality Improvement Efforts 20 Leadership. Knowledge. Community.
Quality is Job 1 21 Leadership. Knowledge. Community. Lucy Savitz 2015
Your Role in Quality 22 Leadership. Knowledge. Community. Lucy Savitz 2015
Team Sport: Plan, Do, Study, Act 23 Leadership. Knowledge. Community.
Hunches can lead to improvement Innovations 24 Leadership. Knowledge. Community.
Leading with Quality • ‰ Measure success in lives • ‰ Higher quality drives lower costs • ‰ Better Care is the least expensive care • ‰ Focus on those work processes (<10%) that drive 95% of costs 25 Leadership. Knowledge. Community.
Better has no limit … . Old Yiddish Proverb 26 Leadership. Knowledge. Community.
Conclusions • ‰ Quality is key element of physician leadership in the Healthcare System • ‰ National Specialty Societies have a major role to play in improving quality • ‰ Advocate for tools • ‰ Education/culture change of all members in quality improvement, identification and intervention in key areas of CPV 27 Leadership. Knowledge. Community.
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