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Page 1: PQI Themes in Interior Health - PQI Summit Website... · 2018-12-17 · project charter start 2019 Jan:Cohort 3 intake May:Notification of acceptance cohort 3 May:Cohort 2 projects

PQI Themes in Interior Health

Page 2: PQI Themes in Interior Health - PQI Summit Website... · 2018-12-17 · project charter start 2019 Jan:Cohort 3 intake May:Notification of acceptance cohort 3 May:Cohort 2 projects

Disclosures

• No disclosures• No conflict of interest

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Geographical and Clinical Diversity

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ENABLE

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Online Training Resources

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Co-Creation

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Dyads

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PQI meets MSA

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Overview of Physician QualityImprovement (PQI)at Northern Health

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Disclosure

I have no conflicts or disclosures

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Our Vision

κ Physician champions: Physicianengagement, empowerment andleadership.

κ Patient and family centeredκ QI Infrastructure/support synergizing with

existing HA framework/programκ Weaving QI at every level to create

culture of QI

“To deliver exceptional care for Northerners”

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Our Journey

First SteeringCommitteeMeeting –November

2016

Staff Hired –February

2017

Educationfirst session –

June 2017

Seed GrantProcess

launched–September

2017

May 2018 -First

physicians tocomplete

intermediateQI

Ongoing for22 months

now –

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Organization# ofReps

Perspectives Members

Patient Representative 3 Patient Partners Edwina NearhoodKD TaylorMillie Percival

Practicing Physicians &Physicians Groups

9 Rural GP or Nurse Practitioner

Operational Chief of Staff

Quality Program Lead Physician

Medical Staff Association

Division of Family Practice

Practicing GP & SP; Varying geographic/regionalperspectives

Physician Mentors

VACANT

Dr. Dawid van RensburgDr. Shyr Chui and Dr. Singh

Dr. Amin Lakhani

Dr. Bill Clifford

Dr. Denise Jaworsky NW,NE VACANTNI Dr. Shyr Chui

Dr. Jamil Akhtar, Dr. Laura Brough

Specialist ServicesCommittee

3 Physician RepresentativeSenior Staff Representative

Dr. Kathy LeeAman HundalVACANT

Northern Health 5 Medical Director or NHMAC

Executive team and/or Operational

HA PQI Sponsor

Quality & Innovation

Primary Care Clinical Quality Program Co-Lead

Dr. Anurag Singh

Penny Anguish

Candice Manahan

Tanis Hampe

Dr. Paul Murray, Pam Mulroy

Steering Committee

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StaffNH PQI Staff Photo: Summer, 2018

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We love our patient partners

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NH PQI Education Photos

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Our Achievements

κ Integration with HA Quality infrastructureleadership and program

κ Region-wide impactκ Increasing physician participation and

interest in QI education and projectsκ PQI Steering Committee and Staff

subscribe to a common visionκ Highly motivated and engaged PQI support

staff

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Our Opportunities

κ Physicians leading large scale transformativeQI projects – Physician Mentors

κ Expansion of PQI network and collaboratingwith other HA- PQI

κ Role clarity between PQI support staff andphysicians

κ Utilize patient partners in individualprojects

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What’s Next for our PQI Program?

κ Recognition: NH Research and QI Conference Nov 6-8, 2018κ Education: Implement this year’s PQI education workshop series

(including new brief skill building workshops)κ Staff: Continue our staff learning plan; Monitor staff resource

capacity challengesκ Collaborate: UNBC, UBC, PHSA, Doctors of BC.κ Program Improvements: Further develop the PQI learning journey

from beginner to intermediate, to advanced training, embedmilestones for physician recognition

κ Evaluation: Embedding provincial and local evaluationrecommendations into team planning/steering committee

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Questions?

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Island Health PQI experience:Dr. Jason Wale

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I have no conflicts of interest to declare.

I receive no honorariums or finance.

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Fraser Health Set a pretty high standard…

“We’re #2!”

Island Health

Fraser HealthHAL Smechner

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Island Health PQIexperience:

3rd year and growing up fast!

2016

Now

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First challenge is weare a long and skinnygeography

In person meeting ischallenging.

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Some of our First Cohort: 2016/17

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Some of our First Cohort: 2016/17

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Balance

Physician InterestLocal cultureNovel ideas

Physician EducationHA Priorities

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Challenges:

• Role clarity• Education versus commitment ( especially surgeons)• Balance HA needs with physician interests• New admin structures• What admin endorsement means• What to do with grads after cohort

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PQI SummitPhysician Quality Improvement VCH/PH

Vinay Dhingra MDChair PLQI VCH/PH

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Disclosure

Presenter Dr Vinay Dhingra

Relationships with commercial interests:

Grants / Research Support None

Speakers Bureau/ Honoraria None

Consulting Fees None

Other None

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Goals of Physician Led QI VCH/PH

To create the capacity andcapability for physicians toengage and lead qualityimprovement

To engage the VCH andPHC physician medicalstaff to further a culture ofquality improvement

To support the local needsof physicians withimproving the quality ofpatient care

Primary Goals

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PLQI JointSteering

Committee

MedicalAdministration

SpecialistServices

CommitteeMedical

Staff

QualityPatientSafety

PatientsAdvisors

Alignment

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VCH/PHC Physician Led Quality Improvement

• Collaboration between VCH, PHC, and the Specialist Services Committee (SSC)

1 Day QI Training

• Offered 4 times per year• 130+ VCH PHC physicians since Jun 2018• Next dates:

• Nov 27, 2018• Feb 6, 2019• Mar 6, 2019

• Funded PLQI Cohort Projects• Cohort 1 (17/18FY): 24• Cohort 2 (18/19FY): 38

Funding for projects, trainingand sessionals

QI Support and PhysicianAdvisors for mentorship &coaching

Physician-Led QI Initiative – Advanced Training

Tech support Including dataanalysis

Steering Committee providesoversight

Online Module – Intro to QI

• In development – target 2019

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1-day QI TrainingObjectives:• Develop a culture of engagement in QI among physicians in PHC/VCH• Enhance QI understanding for physicians in PHC/VCH• To provide fundamental skills, tools and resources for QI

134Total physicians trained

7One day 1-day QI training sessionsheld between Mar 2017 – Jun 2018

Spread the word! Upcoming dates:• Nov 27, 2018• Feb 6, 2019• Mar 6, 2019

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PLQI Cohort Timeline

Aug: PLQI Launch Cohort1

24 projects

2017

2018

June: Cohort 1Graduation

July/Aug:project charter start

2019

Jan: Cohort 3 intakeMay: Notification ofacceptance cohort 3

May: Cohort 2 projects chosen

(14 continuation +22 new= 36 total projects)

Sept – May 2019: Cohort 2Ongoing advanced training and project support

Apr-May: Cohort 2Project Presentations

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PLQI Project SpecialtiesGeneral Practice Critical Care Medicine

PsychiatryEmergency Medicine

Physical Medicine and Rehabilitation

Anesthesiology

Cardiology

Internal Medicine

Laboratory Medicine

Neurology

Infectious Diseases

Radiology

Palliative Medicine

Dermatology

Pediatrics

Community and Rural

Obstetrics and Gynecology Thoracic Surgery

OrthopedicsOtolaryngology

20specialties

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September October November December January February March April May June

Cohort Training – 2018/19 Training Schedule

#1Sept 12

#2Sept 19

#3Sept 26

#4Oct 30

#5Nov 29

#6Jan 16

#7Mar 5

#8Apr 3

#9May 16 Graduation

TBD

One DayTraining

Nov 29

One DayTraining

Feb 6

One DayTraining

Mar 6

One DayTraining

Aug 23

One DayTraining

Jun 12

Cohort Training

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Cohort Training - PLQI Team

PLQI SupportStaff

PLQI PhysicianCoaches

PLQI PhysicianCohort Alumni

• Model for Improvement• Overview of DMAIC• Project Charters• Ethics in QI• Project management• Considering Cause and Effect: Driver Diagrams, Ishikawa,

5Whys• Human Side of Change - Stakeholder Engagement, Patients,

Colleagues, Administration, Leadership, Public• Data planning• Testing Changes

• QI Communications• Overcoming early barriers and road-blocks• Variation – The measurement and clinical perspective• Team Work & Communication• Sustaining and Spreading Improvement• Identifying Change Ideas – moving forward post-project

Teaching Topics Covered Include:

AND MORE!!!!

PLQIChairs

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Cohort Training – Additional Facilitators

Capturing andUnderstanding the

Patient voicePatient Advisor

How to be aneffective change

agentChange Specialist

PHC – Leadership andOrganizational Change

What Matters to YouEngagement Leader

BCPSQC

Patient-CentredMeasurement in BC

(PROMs/PREMs)VCH QI, Patient Centred

Measurement Working Group

Communicating Change(Knowledge Translation)

Director, Health Services andClinical research and Knowledge

TranslationPHC

PLQI Support StaffPLQI Physician

ChairPLQI PhysicianCohort Alumni

Teamwork andCommunication

Leader, Health SystemImprovement

BCPSQC

PLQI PhysicianCoaches

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Cohort 1 Graduation & Awards

PLQI Project:• to provide early access to food

and water in the ED at St.Paul's Hospital in an effort toreduce aggressive behaviour.

Dr. David Agulnik, Emergency Physician, St. Paul’s Hospital

2018 BC Health Care Hero Award

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Steering Committee MembersVCH/PHCDr. Brenda WagnerDr. Janet KowAllison MuniakCamille CiarnielloVivian Chan (HA Sponsor)

SSCDr. Ken HughesAman Hundal (SSC Sponsor)

Clinically Active PhysiciansDr. Vinay Dhingra (Chair)Dr. Kelly MaysonDr. Julie BaxterDr. Karen Dallas

Patient PartnersLori PedersonHamid Ghanbari

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PQI Summit Session: PHSA Rapid Fire

Dr. Montgomery Martin

Ms. Georgene Miller, VP Quality PHSA

Ms. Bethina Abrahams, Dr. Celine Kim

November 19, 2018

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Disclosure

2

Presenter / Faculty Dr. Montgomery Martin

Relationships with commercial interests:

Grants / Research Support

Speakers Bureau/ Honoraria

Consulting Fees

Other

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PHSA PQI Journey:

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Lessons Learned:

3

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Impact:

3

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Cohort #2; 2018-2019:

3

20 PhysiciansIN

Five Programs /Agencies:

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3Collaboration Education

Future Plans:

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Thank You

3

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PQI Across the ProvinceFraser Health

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Dr Chris BozekChairman Fraser Health PQI Steering Committee

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Conflicts

• I have no commercial conflicts in the presenting of this talk

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FH PQI Journey

• had 2 “champions” in Fraser Health

• the late Dr Jan Kornder, had initial job of QA/QI 2013

• Dr Curt Smecher, QI since 80’s before medicine, did IHI training in Boston in2013

• May 2014, meeting of SSC and FH, decided Curt would lead the change tostart PQI in FH

• Apr 2015 first cohort of FH Physicians, trained entirely by Curt, 9 docs

• “ on the run” setting of terms of reference and steering committee

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FH PQI Journey

• the budget of 1 million 2015 grew to 2 million 2016

• forged multiple partnerships with privacy office, IT, QA early on

• setting up of formal Steering Committee after cohort 1 underDayan Muthayan, EMD at FH

• 2016, cohort 2 had 13 docs, hiring of Crystal Sun and AngelaTecson to assist Curt and the cohort

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FH PQI Journey

• we've grown!

• currently cohort 4 has 26 students

• we've accepted community docs,medical administrators

• our support staff has grown to 24,teaching is increasingly being doneby cohort graduates

• we have 2 patient representatives

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FH PQI Journey

• and we've had results!

• over 100 projects are being managed

• several workshops have been done to promote spread of QI

• a QI network has been established to support ongoing work, collaborationand spread of successful projects

• through FE, a growing engagement with site administrators already focusedon QI is clearly occurring, with trained QI doctors sharing the lead

• over 50 percent of our graduates are assuming leadership roles in FH

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FH PQI Journey

• but theres more to be done…

• we are reaching a “tipping point” where a culture of QI is getting embedded

• we are increasingly moving to a project management focus

• change from a cohort training model which is based in one site, to bringing thetraining to hospitals in modules, easier access

• steering committee to work mainly on steering our PQI, not operations

• and this is all physician led!

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STAY TUNED!