Session D: Sharing success spreading to sustain Partnering to - PowerPoint PPT Presentation

Session D: Sharing success – spreading to sustain Partnering to accelerate best care, best health, best value Des partenariats pour offrir de meilleurs soins, être en meilleure santé, optimiser les ressources

Session D: Sharing success – spreading to sustain Moderator: • Dr. Nick Kates , Professor and Acting Chair, Dept. of Psychiatry and Behavioural Neurosciences, McMaster University; Senior Advisor, Health Quality Ontario Panelists: • Bernie Blais , President and CEO, Bruyère Continuing Care • Ru Taggar , Vice President Quality and Patient Safety, Chief Nursing and Health Professions Executive, Sunnybrook Health Sciences Centre • Terry McCarthy , Executive Director, Hamilton Family Health Team • Dr. Bruce Baskerville , Senior Scientist, Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo • Josie d’Avernas , Vice President, Schlegel-UW Research Institute for Aging www.HQOntario.ca 1

Disclosures Moderator and panelists have nothing to disclose • Dr. Nick Kates • Bernie Blais • Ru Taggar • Terry McCarthy • Dr. Bruce Baskerville • Josie d’Avernas www.HQOntario.ca 2

Session format Moderated panel format Panelists will present their message utilizing a few slides to illustrate the key strategies and or tactics needed to move towards a common quality agenda. The audience will have an opportunity to participate by asking question in two ways: • Use the microphones located throughout the space • Use the cards found on your table and staff will pick them up www.HQOntario.ca 3

Moderator presentation Nick Kates Professor and Acting Chair, Dept. of Psychiatry and Behavioural Neurosciences, McMaster University; Senior Advisor, Health Quality Ontario www.HQOntario.ca 4

Spread ... not used to encourage this concept ... www.HQOntario.ca 5

What is spread? The degree to which learning, best practice or improvement is adopted across an organization/system/region by those who would benefit from the change. www.HQOntario.ca 6

Laying the groundwork for spread www.HQOntario.ca 7

For spread to succeed there needs to be • A recognised need that something requires improving • A proven and sustainable idea • A connection to an organisation’s strategic directions or priorities • Leadership www.HQOntario.ca 8

And the idea should be … • An improvement on the current situation • Compatible with the system adopting it • Simple (relatively) • Testable/adaptable • Able to produce visible benefits www.HQOntario.ca 9

Key enabling factors • For the spread of new ideas to happen in a timely way, the process needs to be managed • Communication, to raise awareness, attract early adopters, and share the technical aspects of the change itself • Leadership to support the spread effort and allocate sufficient time to succeed • Measurement – is it really better? Leads to evidence • Influencers or opinion leaders in the social system serve as the best messengers • Making the success of early adopters visible makes it easier for the later adopters Source: Langley, G., Moen, R., Nolan, K., Nolan, T., Norman, C. & Provost, L. “The Improvement Guide.” Jossey-Bass: San Francisco, 2009. www.HQOntario.ca 10

Questions to ponder • How do we transfer improvements and learnings across organizations, practices, Spread and the system? • How do we sustain the improvements over time? Sustainability • How do we use the learnings and skills Continuous improvement developed during a QI initiative to infrastructure continuously improve? www.HQOntario.ca 11

Panelist presentation Bernie Blais President and CEO, Bruyère Continuing Care www.HQOntario.ca 12

Behavioural Supports Ontario (BSO) is a catalyst for large-scale change The BSO vision Make a plan, then lead the way Pillar 1: System Coordination Pillar 3: Pillar 2: • QI training and techniques Capacity Interdisciplinary • Consult and empower the front-line Building Service Delivery • Integrate across sectors • HQO coaching Province-wide, within a LHIN, and at the bedside, BSO knits together clinical best practices that already exist and embeds them into care for every client, every time. www.HQOntario.ca 13

Smiling is infectious and so is BSO! 14

Panelist presentation Ru Taggar Vice President, Quality and Patient Safety, Sunnybrook Health Sciences Centre Catalyzing Spread at Sunnybrook ... www.HQOntario.ca 15

BSO’s design supports visible leaders at all levels LHIN 6 LHIN 7 LHIN 1 LHIN 2 LHIN 3 LHIN 5 LHIN 8 LHIN 11 LHIN 13 LHIN 14 Buddy LHINs Early Adopter LHIN 10 Early Adopter LHIN 9 Early Adopter LHIN 4 Early Adopter LHIN 12 LHIN Project Lead LHIN Project Lead LHIN Project Lead LHIN Project Lead LHIN Steering Committee LHIN Steering Committee LHIN Steering Committee LHIN Steering Committee Project Working Group Project Working Group Project Working Group Project Working Group Quality Improvement Teams Provincial Resource Team (PRT) Health Quality Ontario (HQO) BSO * Resource and Advisory * Quality Improvement Guidance supports * Coordination between BSS and other related local QI initiatives 4 LHIN Early Adopter Steering * System alignment Alzheimer Knowledge Committee (SC) * QI Evaluation/ measurement Exchange (AKE) Communication and Knowledge Dissemination project Coordination and Reporting Office (CRO) manager Project Management (NSM LHIN) Quality Improvement techniques + issues management + empower front-line staff + physician engagement + buddy system coaching + acknowledgment & recognition = better care, spread, sustainability www.HQOntario.ca 16

Broad dissemination ... Quality Improvement Plan www.HQOntario.ca 17

Broad dissemination ... www.HQOntario.ca 18

Panelist presentation Terry McCarthy Executive Director, Hamilton Family Health Team www.HQOntario.ca 19

Building the culture and the capacity for quality improvement • What is your compelling vision? • Pursuit of perfection is the enemy of the good • Pull – don’t push • Partner to create leadership and infrastructure • Invest in dedicated change management • See one, do one, teach one • QI Plan – keep it simple www.HQOntario.ca 20

A simple QIP Quality Aim Process Goal Outcome Goal Obtain patient feedback on Based on feedback, Patient-Centred there they receive introduce two Care -Town hall, focus group improvements to the care survey received by patients Timely Access to Measure Improve patient Care supply and demand access to care Population-Focused Identify patient populations Use a registry to intervene Care within the panel earlier with patients www.HQOntario.ca 21

Panelist presentation Dr. Bruce Baskerville Senior Scientist, Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo www.HQOntario.ca 22

Effective spread of innovations in primary care – practice facilitation Primary care practices Performance feedback Academic Strategies detailing & IT Practice (literature & exemplar support facilitators/ methods) coaches Local consensus building Learning collaboratives www.HQOntario.ca 23

Practice facilitation impact Results Spread • Meta-analysis of 23 high quality practice In the last 10 years: facilitation studies with 1,398 • IMPACT BC, AIM Alberta, MPAN (MB), participating practices BETTER Project & IDOCC (Ont), • Overall effect - facilitated practices are TRANSIT (Que), Building a Better 2.97 times more likely to adopt evidence- Tomorrow (NB & NS) based guidelines to improve quality • Multiple facilitation projects in the U.S. • Evidence that the effect is sustained (e.g. California, Oregon, Oklahoma, etc.) • Adaptation is key – facilitation tailored to • Patient-centered Medical Home models the context had greater impact high-quality primary care using Medical Home Facilitators • Intensity is key - the more facilitation the • greater the impact Agency for Healthcare Research and Quality is anticipating a national primary care extension program, making facilitation available to practices across the U.S. Baskerville NB , Liddy C , Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Annals of Family Medicine, 10 (1), 63-73 . Liddy, C., Laferriere, D., Baskerville, B. et al. An overview of outreach facilitation programs in Canada: Current perspectives and future directions. Healthcare Policy . (In Press). www.HQOntario.ca 24

Panelist presentation Josie d’Avernas Vice President, Schlegel-UW Research Institute for Aging www.HQOntario.ca 25

From data to information www.HQOntario.ca 26

From information to dialogue • Annual Indicators Report • Pick 5 things your neighbourhood does really well • Pick 5 things your neighbourhood really needs to improve • Root cause analysis • Consult with teams doing it well • PDSA cycles for QI www.HQOntario.ca 27

From dialogue to action What we now know, is opening up exciting new avenues e.g. Java Music Club % responding “most of the time” or “always” to “staff ask for my help or advice” 28 17 14 Schlegel 2011 Schlegel 2012 Canada www.HQOntario.ca 28