Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in...

Establishing A Model to Sustain Improvement in Clinical Care

February 28, 2014

Establishing A Model to Sustain Improvement in Clinical Care

Successes Challenges

Critical Factors

North Shore High Needs Unattached Population

Estimated 2,870-6,270 Mental Challenges

Homeless Frail Elderly

Access to Health Care

Emergency Department Homeless Shelter Home Health Care

Development of a Multidisciplinary Clinic With Vancouver Coastal Health

Integrated Practice Support Initiative

NS Division of Family Practice Physician Information

Technology Office Practice Support Program

Align & Integrate Physician Practice Support

Change Management Quality Improvement Technology Adoption

Framework of Integrated Support

North Shore

Division

PSP PITO

HealthConnection Clinic • Customized a Systematic Decision Matrix tool

for selecting an Electronic Medical Record • Developed an Access Intake Process • Created a Complexity Scoring Tool

Key Learnings

• Collaboration is critical • Collaboration promoted engagement of other

key stakeholders (Shared Care, IPCC) • Organization support and team willingness led

to outcomes that might not have been achieved otherwise

Challenges of IPSI

• Difficulty moving from “siloed” processes • Encouraging collaborative creative thinking • Lack of awareness of the culture within

partner organizations • Lack of clarity about broad IPSI goals,

expectations and deliverables

Successes of IPSI • Built and strengthened relationships • Successfully supported HealthConnection

Clinic • Gained an understanding of roles & expertise • Developed a Collaborative Model that can be

used to help integrate teams in future initiatives.

Next Steps

• Implement EMR at HealthConnection Clinic • Inform Physicians/MOAs of IPSI support • Introduce VCH team to the IPSI team & model • Broaden collaborative table to larger

community including VCH, IPCC, etc

Critical Factors for Success of IPSI

• Collaborative table with decision making • Division Leadership & project support • Clear mandate supported by on-line

collaborative technology • Evaluation implemented at outset of project • Knowledge sharing & open communication

We wish to thank the GPSC for the

tremendous opportunity to engage PSP, PITO and the Division in support of physicians and

their patients