Partners in Care - Proposal (Radiology) January 14, 2013 Prepared for: Shared Care - January 29, 2013 Ridge Meadows Division of Family Practice Page 1 of 5
Project Summary Initiative Type Name of Project Division Partners in Care Referral Radiology Ridge Meadows Term of project 18 months (March 15, 2013 to October 15, 2014) Funding Requested $140,000 Location of Initiative Contact (role, tel, email) A: Project Description and Management Ridge Meadows Area Treena Innes - Executive Director (778) 885 5750 tinnes@divisionsbc.ca The Ridge Meadows Hospital located in Maple Ridge BC provides high quality health services to the community. Over the last few years there has been an increasing trend towards patients traveling outside of the community to receive radiology services. Specifically, patients are receiving services in Private Clinics in Abbotsford and Coquitlam, some even traveling as far as New Westminster. Based on initial conversations with family practitioners (FP) and specialists (SP), the following list identifies areas for improvement and potential causes for patients traveling to neighboring communities: Delay in communication turnaround of information back to FP. o Private Clinic 2-3 days faxes. o RM Hospital 7-8 days POI only available to FP on EMR, non urgent reports 12-14 days. Urgency appropriately communicated, thus too many urgent request from FP s. Some FP s feel that they spend too much time lobbying for patients to get access to local hospital imaging resources, thus not appropriate use of time and resources. Information technology Electronic Medical Record issues. Overall communication issues with FP and SP. Over time with introduction of hospitalist, less FP visit the hospitals and fewer opportunities to develop relationships with SP. Shortage of technicians in the province and community, which results in a lot of downtime, especially after long weekends. The intended outcomes of this project include: Increase care within the community, thus reducing the need for patients to travel. Increase job satisfaction for FP and SP. Educate FP s on appropriate level of urgency and appropriate investigation. Enhance communication among FP and SP. Reduce waste and more efficiently use hospital resources. o For instance many FP believed that an x-ray of the lower back was required before getting a CT. SP advised that when CT s were initially introduced that was the case and no longer valid. Note: the above list will be expanded/changed as the project moves forward and input is received from the advisory committee. The intended benefits of this project are for: 80 FP and 4 SP. 100,000 residents of Maple Ridge and Pitt Meadows. Fraser Health Authority (Ridge Meadows Hospital). Overall environment (less travel outside of community). Note: the above list will be expanded/changed as the project moves forward and input is received from the advisory committee. Page 2 of 5
Budget Request To achieve the desired outcomes for this project, the RM Shared Care Project is requesting a budget of $140,000. The term of the project is eighteen month with an end date of October 15, 2014. The SP s have agreed to the division s quest to hold these funds in a separate account within the division and provide the accounting resources. Any surplus funds will be used for future Shared Care projects; moreover, if there is a shortfall of funds a briefing note will be sent to SCC for additional funds. Please see below table for a breakdown of funding request. A more detailed breakdown has been provided in Appendix A. Category Amount SP & FP Sessional $41,532 Project Manager $37,500 Facilitator $7,920 Evaluation $11,900 DoFP Admin Assistant $6,880 DoFP Director $7,345 Food Cost $6,720 Room Cost $3,700 Travel $2,000 Booking $1,000 Grand Total $126,497 Including 10% Contingency $139,147 SCC Budget Request (FTA) $140,000 Project Governance & Oversight A steering committee will provide oversight and direction for the project. They will be responsible for managing the scope, timelines, risks along with the budget and resources. The steering committee will be comprised of: Medical FP Lead Dr. Ward Tinney Medical SP Lead Dr. Andrew Mason Division Executive Lead Treena Innes Project Lead To be determined Fraser Health Authority (senior) - To be determined Shared Care Aman Hundal In addition to the steering committee there will be an advisory committee. This committee will aim to meet monthly to move the initiative forward. Membership will include: Steering Maple Ridge FP and up to three Radiology SP Fraser Health Authority (local) Christiane McLeod (RM Hospital, Imaging Department) Patient Voice To be determined Project Facilitator To be determined For specific workload and assignments working groups may be developed. These working groups membership s will be small and will only meet a few times to help move forward with workload and detailed activities. Please refer to Appendix B for a graphical diagram of these committees and how they align with the broader structure as developed by the Physician Master Agreement. Page 3 of 5
Potential Risks Set too high of goals that are not achievable or specific. The change management is not successful or sustainable. Capacity at hospital for repatriation from Abbotsford and Coquitlam. Inability to implement any IT solution or other communication challenges. Scope creep and loose focus of approved scope and funding by Shared Care. Physician engagement (SP and FP) in the Ridge Meadows community. Evaluation The evaluation of the project will be conducted by an external evaluator. The evaluation will follow the Institute of Healthcare Improvement s Triple Aim approach and will align with the PDSA cycles of the project in order to provide feedback to inform the development of the project. Due to the nature of the project and its continual evolution throughout the evaluation, each phase informs the evaluation phase of the next one. The overall evaluation process includes: Stage 1 - Framework Development Ideally this is a collaborative effort between the evaluator and a staff person. The evaluator brings knowledge of evaluation and related methodologies and the staff person has specific program knowledge. Framework development includes identifying the objectives of the evaluation as well as evaluation questions, indicators, data collection methods and sources as well as timelines. Stage 2 - Data Collection Typically data collection involves a number of steps, can include several methods, and be an ongoing process-depending upon program length and resources. Most, or all of the following data collection methods may be deemed relevant depending on your project: File and document review - this may be an on-going process and could include data that is collected as part of the program s operation. Development of data collection tools this also may be an on-going process depending upon the length of the project (for example it might be deemed necessary to conduct interviews at differing intervals). Tools may include interview guides, surveys, focus group questions etc. Implementation of data collection tools - again, this may be an on-going process depending upon the length of the program and the resources allocated to the evaluation. Stage 3 - Data Analysis Depending on the length of the program, and data collection timelines, data analysis can be an on-going process. Data analysis relates the data collection directly back to the program s objectives. Stage 4 - Reporting Reporting can be done at more than one time during the lifecycle of an evaluation and typically depends upon length of the program as well as resources. The final report typically synthesises all of the information that the evaluation has collected and presents it in a way that identifies key strengths, outcomes, weaknesses, developmental opportunities as well as threats. Reports can also identify key lessons that the program provides and in some cases, a discussion of how what has been learned could be transferable. The following are potential indicators or areas that need to be evaluated: Wait times for patient access. Wait times for FP to receive reports regarding imaging results. Capacity in the community (number of patients served). increased understanding for FP s on level of urgency. increased understanding for FP s on appropriate testing. increased FP perception of communication with SPs. increased SP perception of communication with FP s. Page 4 of 5
Overall Structure Ministry of Health BCMA Physician Master Agreement General Practice Services Shared Care Specialist Services Divisions of Family Practice Ridge Meadows Shared Care Steering (PiC) Fraser Health Authority Collaborative Services RM DoFP Advisory Working Group 1 Working Group 2 Page 5 of 5