Innovative Learning Collaboratives

Innovative Learning Collaboratives: E i t M iEngaging teams, Measuring progress,

Changing cultureAlberta’s Strategic Clinical

Networks

Presenter:Tracy Wasylak

Senior Program Officer St t i Cli i l N t kStrategic Clinical Networks Alberta Health Services

September 28-29, 2015

OutlineB k d• Background

• ChallengeT• Teams

• Approach & Objectives• Components• Results• Questions

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Healthcare in Alberta: The Need for Balance

Quality all dimensions

Patients

S t i bilitAccess Sustainability value for money

Access appropriate and

equitable

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What are Strategic Clinical Networks?Collaborative provincial clinical groups• Collaborative provincial clinical groups– Alberta Health Services = Stewards on behalf of Alberta

Health Eco-System• Focused on stages of life diseases/conditions areas of care• Focused on stages of life, diseases/conditions, areas of care

in order to– Improve patient outcomes and experience– Increase access and quality– Increase access and quality– Build a health care system that is sustainable

2012: Addictions & Mental Health, Bone & Joint, Cancer, Cardiovascular Health & Stroke Diabetes Obesity & Nutrition Seniors HealthHealth & Stroke, Diabetes Obesity & Nutrition, Seniors Health

2013: Critical Care, Emergency, Surgery2014: Respiratory Health2015: Maternal Newborn Child & Youth

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Pending: Kidney Health, Primary Health Care, Pop / Aboriginal Health

Strategic Clinical Networks in AlbertaGoalTo achieve a sustainable health care

t th t t thsystem that creates the healthiest population and best health outcomes in Canadaoutcomes in Canada

Target100% of Albertans are100% of Albertans are impacted positively by SCN priorities and plans – with evidence

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Scope of SCNsBeyond AHS to involve the wholeBeyond AHS to involve the whole healthcare system…• Patients & families• Physicians, nurses, allied healthy , ,• Researchers, institutions,

foundations • Primary care/PCNs• Operational areas, administrators• Government• Not-for-profit and community

groups

Strategic Clinical NetworksP i i l M d l f C ll b tiProvincial Model of Collaboration• Put Patients at the Centre

• Support Primary Care

• Optimize all Resourcesp

• Evidence-informed, Context Specific

• Share + Link Information to Improve

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‘t t b tt ’ li t i tti i iti‘top to bottom’ alignment in setting priorities to balance needs and perspectives

Administrators

Patients Providers

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Patients

Policy Makers/Payers

SCN IMPACTSStroke Action Plan 14 sites

Hip & Knee Plan – 12 sites

Insulin Pump Program – 12 centers

Vascular Risk Reduction

Fragility & Stability – 12 Sites

Appropriate Use of Antipsychotics

Empathy – All Schools in Red Deer

E-Referral – Lung / Hip & Knee

Safe Surgery Checklist - 59 sites

Enhanced Recovery After Surgery – 6 SiSites

Collaborative Learning

The most intensive front-line improvement work happens in Collaboratives. These 12-month programs are d i d f i ti itt d t hi idesigned for organizations committed to achieving sustainable change within a specific topic area. Through shared learning, teams from a variety of organizations g y gwork with each other and faculty to rapidly test and implement changes that lead to lasting improvement.

(From Institute of Healthcare Improvement)(From Institute of Healthcare Improvement)

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Learning Collaborative Teams

• Clinician-lead site teams – Physicians– Nurses– Allied health professionals– Administration– Administration

• Work collaboratively – over a period of time – on local improvements – toward system-wide outcomes.

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Build and Support Improvement Teams Inside + Outside AHS

@ front line: eg. across hospitals + clinics + community@ front line: eg. across hospitals clinics community

ChinookTeam One of the Edmonton Teams

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- Misericordia -

Innovative Approach

Engaging learning sessions + A ti i d f l l i t+ Action periods of local improvement+ Balanced score card

– introduce new provincial practices at the local level– drive sustainable change owned by the frontline staff

and site leadershipand site leadership– link improvements to teamwork, data and a balanced

scorecard

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Model for ImprovementWhat are we trying to

accomplish?

How will we know that aHow will we know that achange is an improvement?

What change can we make thatwill result in improvement?will result in improvement?

Act Plan

Study Do

From: Associates inProcessImprovement

Collaborative Process

SCORE CARD

Learning Workshop 1

SCAction Periods

BASELINE

SC

BASELINE

PlanPADS BASE

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SCORE CARDPAAction Period 1

SCORE CARD

PA PA PA PDS

A PDS

A

PA PDS

A PDS

ADS DS

DS BASELINEDS

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SCORE CARDLearningW k h

SCORE CARDPA

PDS

APDS

A

Workshop 2

PAPDS

APDS

A DSDS

DS BASELINE

DS

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SCORE CARDSCORE CARDLearningWorkshop PA

PDS

APDS

A

Workshop 2

PAPDS

APDS

A DSDS

DS BASELINE

DS

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Sustained Continuous

LearningWorkshop

Continuous Improvement

Workshop 3 PA

DS

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Balanced Scorecard: Step 1

• STEP 1: Identify an improvement indicator under each quality dimension

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Scorecard Overview

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• STEP 2: Determine the degree of importance of each improvement indictor

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Scorecard: Weighting

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• STEP 2: Determine the degree of importance of each improvement indictorSTEP 3 C ll t b li d t t l t “ i ”• STEP 3: Collect baseline data to populate “as-is” state

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Scorecard: Baseline Data

60 45 60 30 45 60 Total Score = 300

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300



• STEP 2: Determine the degree of importance of each improvement indictorSTEP 3 C ll t b li d t t l t “ i ” t t• STEP 3: Collect baseline data to populate “as-is” state

• STEP 4: Identify measurement tools and strategies (to determine to what extent indictor selected has(to determine to what extent indictor selected has improved, using a scale of 1-10)

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Quality Dimension Measures• STEP 4: Identify measurement measures and strategies (to determine to whatSTEP 4: Identify measurement measures and strategies (to determine to what

extent indictor selected has improved, using a scale of 1-10)– Acceptability: Patient Satisfaction

• Measure: HCAPS’ Pain Control ResponsesAccessibility: Time to Surgery– Accessibility: Time to Surgery

• Measure: T0-T2– Appropriateness: Patient Mobilized Day 0

• Measure: % of Patients Mobilized Day 0– Effectiveness: Date of Discharge versus Predicted Date of Discharge

• Measure: Number of Days from Predicted Date of Discharge to Actual Date of Discharge

– Efficiency: Length of Stay• Measure: Time from Patient arrival at the hospital to Actual Time of

Discharge– Safety: OR “Time Out”

• Measure: % of Surgeries preformed that completed an OR “Time Out”

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Scorecard: Incremental Changes

160 135 90 45 Total Score = 590

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= 590



• STEP 2: Determine the degree of importance of each improvement indictorSTEP 3 C ll t b li d t t l t “ i ” t t• STEP 3: Collect baseline data to populate “as-is” state

• STEP 4: Identify measurement tools and strategies (to determine to what extent indictor selected hasdetermine to what extent indictor selected has improved, using a scale of 1-10)

• STEP 5: Develop strategies to meet each goal

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Action Plan OverviewBenefit (What you

Quality Dimension Proposed Strategy

Benefit (What you expect to be the result) Cost (Time, Dollars, FTE's, other) By Whom By When

1.0 Standardize pain assessment documentation on white board including time of last analgesic, patient pain score and discharge date

A higher quality patient experience and satisfaction because of the significantly better

Nurse: nominal time to keep whiteboard current so all can see. No new $ or other costs.

JOINT (Sheila/Becky) & Unit 81 Staff, PCM/APCM, Nurse

Prep - April 30, 2009. Implement – May 1, 2009. Evaluate - May 15, 2009 and adjust if necessary

control of their pain. Educator

2.0 Meet with H-CAHPS to customize patient survey to include additional probing questions

More accurate determination of reasons why pain control is suboptimal, leading to better strategies to address

d i i

JOINT: 2-3 hours to establish strategy with H-CAHPS, e.g. desired Probing questions/info wanted. H-CAHPS Surveyor: Nominal time to ask probing questions No new $ or other costs

JOINT (Sheila/Becky)

Implement – May 29, 2009

Acceptability

and improve pain control.

3.0 Standardize practice to include patient's pain score on discharge note (change form).

Patient will be able to better manage their pain control after discharge. More staff satisfaction and pride in caring for the

JOINT: 1 – 2 hours to revise Discharge Sheet to include pain assessment score and indicate pain management for home was reviewed. This work will beaccomplished with the established group revising the Discharge Sheet that has

JOINT (Sheila/Becky) & workgroup from inpatient staff and Central Intake.

Prep – May 11, 2009. Implement – May 15, 2009. Evaluate – June 15, 2009 and adjust if necessary

in caring for the patient.

revising the Discharge Sheet that has reps from inpatient staff and Central Intake. JOINT: 3-4 hours to design education sessions (material developed would be integrated into the education sessions planned for 'Efficiency' strategy 3). JOINT and Unit 81 staff: Nominal time to implement and monitor. Under $50 for creation of a visual poster

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Under $50 for creation of a visual poster For teaching

Three Fs

Frontline engagementFocus on qualityFinishFinish

Exemplar system-wide clinicalExemplar system wide clinical pathway and guidelines implementation projects

Engaging front line site teamsMeasuring progress

Changing complex culture

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g g p

Appropriate Use of Antipsychotics (AUA) in LTC

AUA G id li & b b d T lkitAUA Guideline & web-based Toolkit

Trialed approach with 11 Early Adopter Sites

50% reduction in number of50% reduction in number of residents on meds over 9 months

170 LTC sites in AlbertaSeries of 7 Collaboratives offeredSeries of 7 Collaboratives offered across province for over 100 sites with ‘higher’ antipsychotic use

Key processes: monthly medication reviews, staff education, family engagement; data submitted to Practice Leads

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CIHI public reporting AUA QI

Enhanced Recovery After Surgery

• Evidence-based clinical pathwaysp y

• Data driven quality improvement

• Local site implementation and change management

International network of leadership from

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Hip and knee arthroplasty

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Stroke Action Plan I l t d t k• Implemented stroke best practice in 14 rural centresrural centres

• Success driven by collaborative – learning sessions– scorecards

front line– front-line engagement and excitement

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Questions?

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Additional Resources & References• www albertahealthservices ca/scn asp• www.albertahealthservices.ca/scn.asp

• AUA: www.albertahealthservices.ca/auatoolkit.asp

• Stroke Action Plan: www.albertahealthservices.ca/7678.asp

Hi & K A h l• Hip & Knee Arthroplasty:www.albertahealthservices.ca/10780.asp

• ERAS:www.albertahealthservices.ca/10318.asp

• www.ihi.org/engage/collaboratives/

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Acknowledgements• Mollie Cole, Manager, Seniors Health SCN, Alberta Health Services• Agnes Joyce, Manager, Cardiovascular Health & Stroke SCN, Alberta Health Services• Sheila Kelly, Manager, Bone & Joint Health SCN, Alberta Health Services• Stacy Kozak, Manager, Surgery SCN, Alberta Health Services

Glenda Moore Manager Diabetes Obesity & Nutrition SCN Alberta Health Services• Glenda Moore, Manager, Diabetes Obesity & Nutrition SCN, Alberta Health Services• Alison Nelson, Senior Consultant, SCNs, Alberta Health Services

• Dennis Cleaver, Executive Director, Seniors Health SCN, Alberta Health ServicesL M ll S i P i i l Di t B & J i t H lth d S i H lth SCN Alb t H lth• Lynn Mansell, Senior Provincial Director, Bone & Joint Health and Seniors Health SCN, Alberta Health Services

• Louise Morrin, Executive Director, Cardiovascular Health & Stroke SCN, Alberta Health Services• Petra O’Connell, Executive Director, Diabetes Obesity & Nutrition SCN, Alberta Health Services• Jill Robert, Acting Senior Provincial Director, Surgery SCN, Alberta Health Services• Shelley Vallaire Senior Provincial Director Cardiovascular Health & Stroke SCN Alberta Health• Shelley Vallaire, Senior Provincial Director, Cardiovascular Health & Stroke SCN, Alberta Health

Services• Michelle Salesse, Acting Executive Director, Surgery SCN, Alberta Health Services• Mel Slomp, Executive Director, Bone & Joint Health SCN, Alberta Health Services

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Innovative Learning Collaboratives