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Applying high-value health care in postgraduate education: a Dutch perspective
Prof.dr. Frank Smeenk Corry den Rooyen, Msc
Awareness project
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The image part with relationship ID rId3 was not found in the file.
We don’t have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.
Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication.
4
Who is who?
ICRE workshop 5
Learning objectives
At the end of this session, participants will be able to… 1 To endorse a practice-informed approach to reduce waste and
increase value in healthcare 2 To learn what already is implicit available at their own workplace
which can be addressed for HVCCC (from implicit to explicit) 3 To translate the methods provided to their own training program
ICRE workshop 6
Workshop Outline
1 Welcome, Aim & Outline 2 What do you know or already do? 3 Short Structured Presentations What is our definition of HVCCC, introduction in awareness project
4 Introduction in base of pyramid 5 Workshop in small groups Quick scan Sharing outcomes
6 Introduction in second level: doing an HVCCC project 7 Workshop in small groups Small HVCCC projects Sharing workshop outcomes
8 Deepening: just a preview 9 Take home message 7
Discuss in pairs:
ICRE workshop 8
Discuss in pairs: HV(CC)C at your institution
ICRE workshop 9
What’s your definition
What’s already present
Workshop Outline
1 Welcome, Aim & Outline 2 What do you know or already do? 3 Short Structured Presentations What is our definition of HVCCC, introduction in awareness project
4 Introduction in base of pyramid 5 Workshop in small groups Quickscan Sharing outcomes
6 Introduction in second level: doing an HVCCC project 7 Workshop in small groups Small HVCCC projects Sharing workshop outcomes
8 Deepening: just a preview 9 Take home message 10
High Value Care? (High Value Cost-Conscious Care - HVCCC)
Delivering same quality for less costs AND/OR Increase quality for same costs
Young EAP 11 26-11-2018
And also about?
Young EAP 12
• It’s about much more than costs • It’s also about: improving processes, organisation,
quality, medication; … • And Quality is also in: patient satisfaction, shared
decision making, quality at end-of-life; …
26-11-2018
• 2002 CanMEDS • 2010 Implementing CBE in the “softer”
competencies: HOW?
13 ICRE workshop
How is delivery of high-value care embedded into the new general directives for medical specialist training: NL
maandag 26 november 2018 Workshop introductie doelmatigheid 14
“CanBetter”: social accountability
maandag 26 november 2018 Workshop introductie doelmatigheid 15
CanBetter: social accountability
Care for the elderly
Train residents
in:
maandag 26 november 2018 Workshop introductie doelmatigheid 16
Care for the elderly
Patient safety
Train residents
in:
CanBetter: social accountability
maandag 26 november 2018 Workshop introductie doelmatigheid 17
Care for the elderly
Patient safety
Train residents
in:
Medical leadership
CanBetter: social accountability
maandag 26 november 2018 Workshop introductie doelmatigheid 18
Care for the elderly
Patient safety
High Value CC Care
Train residents
in:
Medical leadership
CanBetter: social accountability
ICRE workshop 20
N ENGL J MED 373;26 NEJM.ORG DECEMBER 24, 2015
N ENGL J MED 373;26 NEJM.ORG DECEMBER 24, 2015
BMJ 2015;350:h1163
N ENGL J MED 374;10 NEJM.ORG MARCH 10, 2016
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JAMA May 15, 2018 Volume 319, Number 19
JAMA May 15, 2018 Volume 319, Number 19
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JAMA December 8, 2015 Volume 314, Number 2
N Engl J Med 375;18 nejm.org November 3, 2016
Journal of Graduate Medical Education, December 2015
Training in HVCCC in The Netherlands
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Characteristics 1. Specific training in HVCCC 2. As part of all postgraduate medical training 3. Obligatory 4. Sponsored by Dutch Government 5. Executed by Central Council of Medical Specialties
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Goal: residents use a HVCCC perspective in daily practice This adds to: 1. Improved training of residents Better education Developing their CanMEDS competencies Building a CV in management/leadership
2. Better health care Improving the quality of care Improving sustainability of the healthcare system
Training in HVCCC
HVCCC and teaching opportunities
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INCREASIN
G FO
CUS
Daily team meetings Case based discussions
etcetera
PROJECTS
MODULAR EDUCATION
Trainee-ship
“What do you want to improve?” Motivated residents
Teaching HVC Master Modules
Motivated residents
Profile, extra curricular Residents with specific interest in HVCCC
Daily practice
All residents
Knowledge Role model
Reflection Support CULTURE
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Training in HVCCC The Needs Stammen et al. JAMA 2015. 314(22): 2384-400
Workshop Outline
1 Welcome, Aim & Outline 2 What do you know or already do? 3 Short Structured Presentations What is our definition of HVCCC, introduction in awareness project
4 Introduction in base of pyramid 5 Workshop in small groups Quickscan Sharing outcomes
6 Introduction in second level: doing an HVCCC project 7 Workshop in small groups Small HVCCC projects Sharing workshop outcomes
8 Deepening: just a preview 9 Take home message 27
HVCCC and teaching opportunities
ICRE workshop 28
INCREASIN
G FO
CUS
Daily team meetings Case based discussions
etcetera
PROJECTS
MODULAR EDUCATION
Trainee-ship
“What do you want to improve?” Motivated residents
Teaching HVC Master Modules
Motivated residents
Profile, extra curricular Residents with specific interest in HVCCC
Daily practice
All residents
The Quickscan An exercise in self-reflection
1 Read Quickscan 2 Try to fill in whats appropriate for
your situation 3 Share outcome in small group 4 15 minutes
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Workshop Outline
1 Welcome, Aim & Outline 2 What do you know or already do? 3 Short Structured Presentations What is our definition of HVCCC, introduction in awareness project
4 Introduction in base of pyramid 5 Workshop in small groups Quickscan Sharing outcomes
6 Introduction in second level: doing an HVCCC project 7 Workshop in small groups Small HVCCC projects Sharing workshop outcomes
8 Deepening: just a preview 9 Take home message 30
HVCCC and teaching opportunities
ICRE workshop 31
INCREASIN
G FO
CUS
Daily team meetings Case based discussions
etcetera
PROJECTS
MODULAR EDUCATION
Trainee-ship
“What do you want to improve?” Motivated residents
Teaching HVC Master Modules
Motivated residents
Profile, extra curricular Residents with specific interest in HVCCC
Daily practice
All residents
HVCCC Projects
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Format and roadmap for projects
Core questions 1. How does the initiative
contribute to HVCCC 2. Which CanMEDS
competencies the residents acquire
3. How is long term operation and implementation guaranteed
Roadmap 1. Problem statement 2. Action plan 3. Description of intended
results 4. Implementation 5. Achieved results? 6. Evaluation 7. Long term operation 8. Description role resident
and lessons learned
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How to support residents doing a project
1 What kind of projects? 2 How to facilitate? 3 15 minutes
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35
Workshop Outline
1 Welcome, Aim & Outline 2 What do you know or already do? 3 Short Structured Presentations What is our definition of HVCCC, introduction in awareness project
4 Introduction in base of pyramid 5 Workshop in small groups Quickscan Sharing outcomes
6 Introduction in second level: doing an HVCCC project 7 Workshop in small groups Small HVCCC projects Sharing workshop outcomes
8 Deepening: just a preview 9 Take home message 36
HVCCC and teaching opportunities
ICRE workshop 37
INCREASIN
G FO
CUS
Daily team meetings Case based discussions
etcetera
PROJECTS
MODULAR EDUCATION
Trainee-ship
“What do you want to improve?” Motivated residents
Teaching HVC Master Modules
Motivated residents
Profile, extra curricular Residents with specific interest in HVCCC
Daily practice
All residents
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Example
Our deliverables
1. A learning community (website) 2. Different tools for teaching and learning HVCCC
(toolbox) 3. ‘Dissemination and mainstreaming’ of the results
(invitational, articles, workshops, website) 4. Regulations : ‘HVCCC’ in training curricula of all
medical specialties 5. ‘HVCCC’ as an item in the accreditation of training
centers 6. Disseminating the Dutch experience / results in
training residents in HVCCC internationally ICRE workshop 39
Toolkit
1 Toolkit for residents: Workshop HVCCC: what is it, how to do a project Online courses (about costs and about change management
and VBHC) E-learning “how to do a project” with different tools Flyers/stickers to promote HVCCC, costs of medicine/etc Examples of projects (also video’s) Serious game: Doctor Flow Modules: costs in healthcare/IC
2 Toolkit for program directors: Same as for residents: online courses, workshops, modules Quickscan and checklist local program Examples of projects (also video’s)
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Take home message
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