Shared System of Care COPD HF Prototype Session 4

1. Shared System of Care COPD HF Prototype Session 4 February 28, 2013 Wireless: Westin-Meeting Wireless Code: bcma2013

2. Session Opening Dr. Gordon Hoag

3. Brian Deakin The Good The Bad The Ugly

5. My Health • COPD • Heart Failure • Ischemic Heart Disease • Diabetes • Renal Problems • Hypertension • Barretts Esophagus • Sleep Apnea • Former Smoker • Reformed Alcoholic

6. How Many Health Professionals Share My Care? • 2007 • Uncoordinated • Sporadic • Loosely Structured • 2012 • Coordinated • Continuous • Comprehensive & proactive

7. Comparing My Care … Then and Now • Now • Shared Coordinated • Continuous • Comprehensive • Complex Then • As I saw fit • Loosely structured • Sporadic • Incomplete • Easy

8. My experience with COPD & HF My care has really developed over the past few years • COORDINATED • I know where things are leading to • COMPREHENSIVE • I know that someone is going to look after my heart, and that someone is going to check my lungs • CONTINUOUS • I don’t need to chase the health professionals because they are following up with me on a regular basis.

9. This WAS my Experience THEN • “A growing number of sub-specialties and … physician teams … have contributed to care that is comprehensive… often disjointed, especially for the most complex patient populations.” https://www.bcma.org/files/SharedCare_Backgrounder.pdf This IS my Experience NOW ! • Shared Care initiatives foster mutual trust, respect, and knowledge of each physician’s expertise, skills, and responsibilities… • It’s not just mutual trust between physicians, it’s mutual trust between them and the PATIENT!

10. My Self Management… Now • Communication • Education • Resources • Active interest • in my life • in my health • Then • Invincible • Self-Denial • Smoked • Drank • Medications? • Huh?

11. What Has Happened? • I have taken charge of my health • Group medical visits • I learned how to communicate • I ask questions, and I record answers • My GP and I have mutual trust & respect for each other. • That has absolutely has an impact on my experience with specialists COMMUNICATION LEADERSHIP PARTNERSHIP

12. Shared Care

13. Break Out Sessions – Part 1 • Predictive Modelling and PROOF - Ella Young, Dr. Bruce McManus and Janet McManus Steveston • Updated HF and Co-morbid materials - Drs. Sean Virani and Mark FitzGeraldBridgeport • Partners in Care - Aman Hundal, Clay Barber Lulu Island • Brief Action Planning - Connie DavisGulf of Georgia

14. Break

15. Break Out Sessions – Part 2

16. Creating Shared Care in a Northern Health Practice

17. Shared Care – Heart Failure Prototyping in Maple RidgeJuly – December 2012

18. Our Team • Dr. Ken Burns – Family Physician Champion • Dr. Winston Tsui – Cardiologist • Carol Galte – Nurse Practitioner, Co-Lead Regional Health Failure Strategy, Fraser Health • Marleen Ouellette – Clinical Nurse Specialist, Heart Function Clinic, Fraser Health • Patti Scott – Practice Automation Coach, PITO • Dr. Christopher Rauscher – PSP Specialist Lead, Fraser Health • Kathy Riyazi/Jennifer Montgomery – PSP Project Coordinator, Fraser Health

19. Our Goals • Focus on clinical pearls • Build the Network • Connect with resources

20. What We Did • 2 team meetings to plan learning sessions • 2-2 hour learning sessions • Optional Practice/Support visits

21. Content of Learning Sessions • Clinical Review • Case Studies • Registry Building • Boardwalk Activity

22. Content of the Learning Sessions • Patient Self Management • Local Community Resources • Heart Failure Zones • Smoking Cessation

23. Support Visits • Registry building • Smoking Cessation • Case Finding • Resource Access

24. The Future • Shared Care COPD Module to begin in April

25. For more information Jennifer Montgomery Jennifer.montgomery@fraserhealth.ca Sophia Tanaka Sophia.tanaka@fraserhealth.ca

26. Lunch

27. Idea BONANZA! Christina Southey

28. Pa, I think these folks have some ideas in ‘em.

29. If you were 10 times bolder, what would you test to improve shared care for HF/COPD in your community.

30. Step 1 Write 1 idea on the cue card provided. Do not put your name on it 1 cue card for each person. Each person must write one idea.

31. Step 2 Walk around the space trading cards with everyone you pass

32. Step 3 When asked to stop, read the idea on the cue card you hold and rate it from 1-5, on the back of the card. 1 = This idea is not for me 5 = I love this idea and want to try it!

33. Step 4 Repeat 4 more times

34. Step 5 After 5 rounds tally up the numbers on the back of the 5th cue card. Give a score out of 25.

35. Planning for Sustainabilityaka Holding the Gains Connie Davis

36. Objectives • Define sustainability • Describe what ‘sustainability actions’ to take during testing and implementation • Create a sustainability plan

37. What is Sustainability?

38. What is Sustainability? • The ability to be maintained at a certain rate or level. • The ability to be upheld. - Oxford English Dictionary • Maintaining the process - National Health Service Modernization Agency, 2002

39. The challenge is not starting, but continuing after the initial enthusiasm is goneOvretveit, 2003

40. Act Plan Study Do Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Langley et al, The Improvement Guide, 2009

41. Testing vs Implementation vs Spread • Testing: Trying and adapting existing knowledge on a small scale. Learning what works in your system. • Implementing: Making a change a part of the day-to-day operation of the system in your pilot population. Holding the gains. • Spreading: adapting change to areas or populations other than your pilot populations

42. Act Plan Study Do The Sequence for Improvement and Spread Spreading to other locations/processes Make part of routine operations Implementing a change (HTG) Test under a variety of conditions Testing a change Theory and Prediction Robert Lloyd Developing a change

43. Creating a New System Improvement Hold Gains Spread BETTER Improvement Hold Gains Design Spread Spread Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. San Francisco: Jossey-Bass; 2009

44. During Testing— Before We Even Implement! • Purposefully test the changes under a wide range of conditions (robust design) • Regular staff/temp, experienced/ inexperienced staff • Foolproof the new process/procedure • Look for ways to use constraints, affordances, reminders, differentiation • Use technology where appropriate • Look for opportunities to use computers/EMR, bar coding ,etc. • Think about reliability and change concepts related to reliability

45. Think of a Time • When an improvement was implemented • Are the gains still there? • If yes, what was done to make that happen? • If no, why weren’t they sustained? What got in the way?

46. During Implementation • Use multiple PDSA cycles to implement the change • Testing is not de-facto implementation! • Collect data over time when conditions are expected to change • Continue use of run chart • Redesign support processes for new process • Training, getting forms, etc. • Address the social aspects of change • WIFM, appreciation, publicity, resistance

47. Collect Data Over Time When Conditions are Expected to Change Baseline Begin implementation on pilot unit Testing Successful Testing Evidence of improvement during implementation

48. Implementation Cycle Source: Improvement Guide, Pg 185 Project Name:       Project Manager:      

49. Key Factors for Holding the Gains • Clarify what you are sustaining • Engage leaders • Involve and support front-line staff • Communicate the benefits of the improved process • Ensure the change is ready to be implemented and sustained • Embed the improved process in your electronic and human processes. • Build ongoing measurement Health Quality Ontario

50. What are You Sustaining?