Strategic & Operational Clinical Networks. Campus Alberta April 24 th, 2012 Tracy Wasylak & Tom Noseworthy

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1 Strategic & Operational Clinical Networks Campus Alberta April 24 th, 2012 Tracy Wasylak & Tom Noseworthy 1

2 Non-sustainable healthcare cost increases in Canada: Alberta is above average 23.4M people 34.2 M people 1975 to 2010 Expenditure increases = 3.5 fold Population increases = 1.5 fold 2

3 In 1996, Alberta spent less than the average of other Provinces, with spending (in current dollars) diverging over the period 1 Source: Canadian Institute for Health Information, National Health Expenditure Trends, (Ottawa, Ont.: CIHI, 2008). 3

4 In 2008 Alberta had the second highest per capita spending of all Canadian Provinces 1 Source: Canadian Institute for Health Information, National Health Expenditure Trends, (Ottawa, Ont.: CIHI, 2008). 4

5 Alberta s actual waits are longer in recent years 1 Source: The Fraser Institute's national waiting list surveys,

6 Children Receiving Community Mental Health Treatment Within 30 Days 100% 90% 80% 70% 60% % 50% 40% 30% 20% 97% 99% 91% 91% 93% 80% 80% 76% 72% 72% 96% 95% 90% 85% 85% 72% 65% 54% 45% 36% 85% 79% 76% 77% 79% 82% 78% 79% 74% 73% 10% 0% South Calgary Central Edmonton North Alberta 2010/11 Q1 2010/11 Q2 2010/11 Q3 2010/11 Q4 2011/12 Q1 Source: Alberta Health Services - Data Integration, Measurement and Reporting 'Alberta Health Services Performance Report September 2011' 6

7 Effectiveness Stroke 30 Day Mortality Rates (2007/08 to 2009/10) % Alberta South Zone Calgary Zone Central Zone* Edmonton Zone North Zone* *Significantly different than Calgary and Edmonton zones. Edmonton and Calgary zones are not significantly different from each other Note: Risk adjusted and in-hospital mortality only. 'Stroke' includes both haemorrhagic and infarction. Source: Canadian Institute for Health Information, Health Indicators 2011 (Ottawa, Ont.: CIHI, 2011) 7

8 In Alberta the Health Adjusted Life Expectancy (HALE) at birth is lower than the average for all of Canada 1 Source: Statistics Canada. Table Health-adjusted life expectancy, at birth, by sex, for all income groups, Canada and provinces, 2001, CANSIM. * Excludes the territories. 8

9 In Alberta the Health Adjusted Life Expectancy (HALE) at birth is lower than the average for all of Canada 1 Source: Statistics Canada. Table Health-adjusted life expectancy, at birth, by sex, for all income groups, Canada and provinces, 2001, CANSIM. * Excludes the territories. 9

10 10

11 Top 20 characteristics of high performing health systems 1. Success is defined and terminology is clear for all stakeholders. Quality is defined. 2. Physicians are engaged at all levels. 3. Innovation is defined and embraced: people, processes, and systems. Not just devices/drugs. 4. People in teams and networks - that lead a culture of innovation across boundaries (people, processes, systems, services). 5. People test innovation; it s OK to fail. 6. Champions of change (and leaders) are identified, developed and supported. 7. There is an engaged and empowered public (the public is actively involved). 8. Evidence-based treatments and approaches are used wherever possible and/or are pursued through research. 9. There is fusion of health, environment and education in a planned way: the health system addresses broader determinants. 10. The system improves value (and value for money) for all as a major goal. 11. Good information for decisions is essential: real time evidence is key. 12. Prevention is part of doing business (it is somebody s job). 13. The system invests to buy positive changes. 14. There is a good human resource system. 15. Careful (avoid perverse) incentives are used to incent all stakeholders. 16. Careful (avoid perverse) on-line measurement with feedback to those who need it. Measure for goals and beware of what is not measured. 17. Strong and engaged primary care and strong community care. 18. Planning models with embedded research. 19. Be patient but always keep the patient in mind. Meet or exceed patient expectations as a top priority. 20. Top down meets bottom up in all ways (structures, programs, goals). 11

12 Why Networks? Networks have proven to be an effective mechanism to ensure collaboration, joint decision-making and shared learning. Networks are a proven model to promote the use/uptake of clinical experience, knowledge and research to reduce variation and improve care. Networks are a positive way for all partners along a broad continuum to be involved in planning and improving healthcare service delivery. 12

13 What are Strategic Clinical Networks (SCNs)? Collaborative clinical teams (with a strategic mandate) Led by clinicians and driven by clinical needs Comprised of: Front-line physicians and clinicians from all professions (including primary care and community-based providers) Zone and Clinical Operations / Clinical Support Service leaders Researchers Content experts Public/ patients AHW & other external partners 13

14 What is the Provincial Mandate of AHS/SCNs? Improve population health Ensure continuous quality improvement Incorporate research that impacts patients Focus on patient outcomes Design more accessible care Develop & implement appropriate clinical practices Make patient safety a priority Ensure value for money 14

15 A Proposed Provincial Model Link Primary Care with Provincial Networks to Support Optimal Prevention and Chronic Disease A Patient-Centred Model Health is the target while managing all diseases Optimizes All Resources Leverages human resources Leverages private - if relevant Evidence-informed but Context Sensitive Case management Accountable for A, Q + C Care + Prevention integrated System pays for what works Model that Supports Primary Care Access to specialty networks A common approach to all chronic diseases all 6 quality dimensions One Database - Linked by Information (IT) EHR and CDRs integrated Management Pharmacy Alberta Health and Wellness Chinook Palliser David Thompson Chinook Calgary Provincial Bone and Joint Advisory Committee Physician Steering Committee Alberta Cancer Bone and Joint Health Institute Universities Physician Steering Alberta Committee Alberta Health and Bone and Wellness Joint Mental Health Institute Palliser Universities and Addiction David Thompson Calgary Peace Provincial Bone and Joint Advisory Committee Peace Alberta Health and Wellness Northern Lights International Advisory Board Foundations, Institutes, Networks Chinook Palliser East Central Northern Lights International Advisory Board Foundations, Institutes, Networks Aspen David Thompson Physicians and Other Providers Capital Alberta East Central Health and Wellness Calgary Aspen Chinook Palliser Physicians and Other Providers Capital Peace David Thompson Calgary Provincial Bone and Joint Advisory Committee Alberta Health and Wellness East Central Peace Chinook Palliser Northern Lights International Advisory Board Physician Steering Committee Alberta Bone and Joint Health Diabetes Institute Universities Northern Lights Provincial Bone and Joint International Advisory Advisory Board Committee Bone and Physician Steering Committee Alberta Bone and Health Joint Institute Universities Foundations, Institutes, Networks Educated Healthy Population Aspen Physicians and Other Providers Capital Alberta Health and Wellness David Thompson Calgary Provincial Bone and Joint Advisory Committee Physician Steering Committee Chinook Palliser East Central Universities Aspen Foundations, Obesity and Institutes, Networks Nutrition David Thompson Physicians and Other Providers Capital Alberta Bone and Joint Health Institute Calgary Provincial Bone and Joint Advisory Committee Physician Steering Committee Universities Peace Clinics + Urgent Care Centres Peace Northern Lights Alberta Bone and Joint Health Institute International Advisory Board Foundations, Institutes, Networks East Central Northern Lights International Advisory Board Foundations, Institutes, Networks Aspen Cardiovascular Physicians and Other Providers and Stroke Capital East Central Aspen Seniors KEY = Collaborative use of all resources and infrastructure with same accountability Physicians and Other Providers Capital Dietary Support services

16 How will SCNs be Different from Former Clinical Networks? Broader mandate: Specific populations, i.e. seniors Diseases with high impact, i.e. vascular disease Research infrastructure and mandate Scope encompasses entire continuum of care From population health to prevention to primary care to acute care to chronic disease management to seniors to palliation Activities better aligned with AHS and AHW priorities Integrated with and into organizational priority-setting and decision-making Better resourced and supported to achieve improved clinical outcomes and for research and K2A 16

17 What about Existing Clinical Networks? Accountability transferred to ACMO SCN/CCP and VP SCN/CCP Continue current work and initiatives Some will evolve into SCNs or OCNs Three will become Operational Clinical Networks (OCNs) Equally as important but different: Critical Care Emergency Medicine Surgical Services There may be others added in the future. 17

18 Proposed Support & Resources: SCNs/OCNs Combination of dedicated business intelligence staff (i.e. Project Management, Analytics, Costing) and Clinical Design / initiative-based staff (quality improvement, pathway development, patient safety, knowledge management, etc.) Embedded research capability and expertise Capacity and Capability Building (skill development) Funding including: Seed money for innovation, initiatives, and research Remuneration of clinical team members Opportunities to retain savings that are realized 18

19 First Six SCNs to be Launched Diabetes, Obesity and Nutrition Bone and Joint Health Cardiovascular Health and Stroke Seniors Health Addiction and Mental Health Cancer Care 19

20 The Next Six SCNs Population Health and Health Promotion Primary Care Maternal Health Newborn, Child, and Youth Health Neurological Disease, ENT, and Vision Complex Medicine (including the current Respiratory Clinical Network) 20

21 Core Committee Members 1. Senior Medical Director & Strategy VP 2. Strategic Clinical Network Executive Director 3. Patient/Family Lead 4. Communities/Public Lead 5. Research and innovation 6. Physicians Primary Care, specialty care and others 7. Clinicians from all professions (Nurses, Physiotherapists, Psychology, OT, etc.) 8. Zone and other Clinical Operational/Clinical Support Services Leaders 9. Alberta Health & Wellness Policy Lead 10.Strategic Partners (e.g. Alberta Heart & Stroke Foundation, Alberta Bone & Joint institute, etc. SCN dependent). 21

22 ACMO SCN & CCP Dyad Leadership VP SCN & CCP Drawn from Centers of Expertise, Dedicated Support for 6 SCNs & 3 OCNs Dyad Leadership Senior Medical VP, Strategy Director Senior Comms Advisor HR Lead Admin Executive Director Scientific Director IT Lead Project Coordination Sr. Planning QHI Lead Finance & Business Management Business Intelligence Research Evaluation HTA DIMR Health Professions Lead Clinical Informatics Engagement & Comms Health Professions Clinical Design, Work Lead Flow, Engagement Project Management Care Path Design Knowledge Management DI Provincial Lead Pharmacy Lead Dedicated Support for each single SCN Laboratory Lead

23 Next Steps Launch the first six SCNs Visioning - Co-Directors to identify goals and priorities Assemble resource and support team for each SCN Identify the core and broader membership of each SCN Develop plans for each SCN SCNs beginning the process to build and strengthen provincial level research networks Discussions underway about recruiting and supporting research leaders (Scientific Directors) for each SCN Transition current Clinical Networks into OCNs - Surgery, Critical Care, Emergency 24

24 Physiology of the Strategic Clinical Networks Evidence informed Population Data Zone disparity Strategic Clinical Networks WHAT HOW WHEN 3 priorities 1-3 YR Horizon 1-2 YR Horizon Negotiations Negotiations Provincial Transformation Forum - business intelligence Workforce / CPSM / IT / Finance Zone Transformation council Consultation Consultation Consultation SCN Members Clinicians (Physicians & Non- Physicians) 50% Research / Scientific Director Patient / Family lead Community lead AHW policy lead Zone leads Strategy Partners Clinical Network Manager Strategy Co-Lead Clinical Co-Lead KEY PRINCIPLES: SCN: ZONE: Evidence informed Change Patient Care Delivery Best Practice Implementation Idea Generation Participate in planning Participant in planning Performance Metrics Performance Metrics Evaluation Evaluation

25 QUESTIONS? 26

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