The Population Health Approach in Canadian Healthcare: Looking to Leaders and Champions Jean Harvey, Director, Canadian Population Health Initiative (CPHI) Canadian Institute for Health Information (CIHI) 2014 National Health Leadership Conference June 2, 2014 1
Canadian Institute for Health Information (CIHI) 2
Canadian Population Health Initiative (CPHI) Mission To support policy-makers and health system managers in Canada in their efforts to improve population health and reduce health inequalities through research and analysis, evidence synthesis and performance measurement. Strategic Directions 1. Build knowledge and understanding of factors that influence population health, health system outcomes and health inequalities 2. Stimulate policy responses and enhance the capacity of decision-makers and health system managers to act on population health and health system outcomes 3
Exploring Population Health in Health System Planning and Decision-Making Project A collaborative research project between CPHI, University of Toronto and University of Saskatchewan Research Question: How can population health information be meaningfully used in the planning and decision-making activities of health system leaders? What is the population health approach and what is it s perceived value? Attributes of successful adopters Enablers and barriers Population health information needs what are they and where are the gaps? Examples of the population health approach in action 4
How did we do it? Project unfolded in two phases: Phase 1 (November 2012 February 2013) Interviews with health system leaders Phase 2 (March 2013) Two workshops that engaged lead users of population health information (Vancouver and Toronto; March 26 and 28, 2013 respectively) Considered feedback from the interview process and explored opportunities and mechanisms for using the population health approach 5
Phase 1 Interviews The Study Sample: Health System Leaders (n=21) (response rate 21/29) Geographical coverage Roles Organization Types BC Alberta Saskatchewan Manitoba Ontario Quebec Nova Scotia Northwest Territories Canada/National Deputy Minister Assistant Deputy Minister CEO Executive Director Chief of Staff/VP Dean of Medicine Regional /District Health Authorities LHINS Provincial Ministry of Health Chief Medical Officer of Health Teaching Hospitals Community Health Centres * urban and rural viewpoints were represented ** Interviews ran approximately one hour 6
Project Findings While not the norm, we learned that there are champions from within health care who are using the population health approach in their work Application of Approaches: In the design and delivery of programs Through partnership and collaboration As a part of organizational learning and behaviour 7
Attributes of Successful Adopters of the Population Health Approach Leadership Serve as role models; establish buy-in at the most senior levels Population health IQ Have a strong understanding of population health concepts Creative Problem Solving Are willing to think outside of the box or to work under the radar to make things happen Accountability and incentive alignment Recognize the importance of population health information in helping to reduce avoidable health care utilization 8
Attributes of Successful Adopters of Population Health Information cont d Information to support decisions Recognize the impact of narratives and other alternative means of communicating information Recognize the need for population health indicators Understand the importance of, and need for, more evaluation of interventions 9
Perceived Value of the Population Health Approach Planning To understand the health of the population and sub-populations Resource Allocation To be able to provide support for the business case for investing in population health Performance and Evaluation To track and demonstrate progress to defend programs against budget cuts Advocacy To compel others to take action; to build the case for intersectoral action 10
Enablers for Using the Population Health Approach Health system leaders recognize the contribution of the population health approach in helping to avoid costly healthcare interventions and improving financial sustainability A clear focus and compelling vision for improving population health Have senior mgmt/governing body buy-in as well as champions (e.g., Chief Medical Officer of health at senior mgmt tables) Leveraging community actions in a context-appropriate manner 11
Enablers for Using the Population Health Approach cont d Information and evidence to support the case for action AND information and evidence on the effectiveness of actions taken to ensure that they can be sustained Sufficient latitude within the command-andcontrol systems of the health care environment (e.g. legislation, regulations, accountability requirements) to enable creative approaches 12
Barriers to Using the Population Health Approach Lack of clarity in terms of what is meant by the term, population health Ownership of the population health agenda Budget pressures that force organizations to retreat from efforts not considered core to mandate Tyranny of the acute the urgency of health care issues dominates the agenda; persistent public focus of health care services Lack of permanency in approaches; pervasiveness of pilot funding; initiatives are champion-driven but not institutionalized Difficulty finding common ground among multiple partners 13
Types of Population Health Information Quantitative and qualitative research and analysis Recognized the value of the narrative for communicating information Need to expand definition of information to include that which is derived from the human experience Complex health determinants can be more easily articulated through the lens of human experience which can help to illuminate issues for which data is not available/could not be collected 14
Analytical Capacity Where Are the Gaps? Substantial variations across organizations in terms of capacity to conduct data analysis Lack of interaction between analytical staff and the public health and health services arms of the organization Hospitals and Local Health Integration Networks (LHINs) may rely on external resources Rural communities have limited resources; challenges recruiting and retaining qualified staff 15
Information Needs Where are the Gaps? Need to collect better data Data that illuminates differences at the community level often unavailable and/or costly to collect Data collected at the national level, such as the CCHS often not granular enough to guide on-the-ground efforts 16
Information Needs Where are the Gaps cont d Population Health Indicators Relatively few performance indicators about population health are included in scorecards, report cards and dashboards Corporate-level indicators are dominated by measures of access, efficiency, safety, patient satisfaction and financial performance 17
Empowering Examples of the Population Health Approach in Action Establishing score cards and an accountability wall where senior management report on and assume responsibility for progress in key areas of patient and population health Using neighborhood level data to map high risk diabetes populations and food deserts to generate evidence for inter-sectoral action among community members and grocery stores 18
Part II Case Studies: Population Health in Healthcare Case study research to showcase examples of the population health approach in action within the context of the healthcare system Inspired by success stories that emerged over the course of the project First case study completed: The Ottawa Hospital and Ottawa Inner City Health (OICH) A partnership between a large teaching hospital and an Inner City Mission to provide acute and long-term care beds in the community for the homeless population Findings presented in written and video format 19
Ottawa Inner City Health (OICH) A not for-profit that grew out of the concerns about a sub-group within the population of chronically homeless shelter users High-users with complex health needs The main function of OICH is to coordinate and integrate health care services so that homeless individuals can receive the same quality of care as other Canadians 20
The Ottawa Hospital and Ottawa Inner City Health (OICH): A Case Study VIDEO LINK 21
Evolving Program of Work: Population Health and Canada s Health System Population Health and Healthcare: Exploring a Population Health Approach in Health System Planning and Decision-Making - Report of Study Findings available at www.cihi.ca Journal Articles The population health approach: A qualitative study of conceptual and operational definitions for leaders in Canadian healthcare (published in SAGE Open Medicine) Innovators and Early Adopters of Population Health in Healthcare: Real and Present Opportunities for Healthcare Public Health Collaboration (HealthCare Papers, Vol. 13 No. 3 2013 - Is Public Health Ready to Participate in the Transformation of the Healthcare System) 22
Evolving Program of Work: Population Health and Canada s Health System cont d Presentations at conferences and other events The Ottawa Hospital and Ottawa Inner City Health: A Case Study Written case study is available; findings also reflected in 10- minute video and a 3-minute video snapshot of the case study (available at www.cihi.ca ) Potential Next Steps Exploring options for 2-3 additional case studies A national collaborative Patient-level socio-demographic data collection 23
Questions and Comments Do you have suggestions on the role that CIHI could play in continuing to bring the population health approach to health care planning and decision-making? Are you aware of any partnership opportunities that CIHI could consider that might help to move this agenda forward Are there other stakeholders who should be involved moving forward? 24
Final Thought Until we all collectively assume accountability for the health of the population, they (the people that we serve) will just keep bumping up and turning up in health care later - CEO of a Health Region jharvey@cihi.ca www.cihi.ca/factorsinfluencinghealth 25