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Establishing A Model to Sustain Improvement in Clinical Care February 28, 2014

Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

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This was presented in session E2 at the Quality Forum 2014 by: Margaret English Executive Director North Shore Division of Family Practice Josefa Kontogiannis Acting Manager Vancouver Coastal Health Practice Support Program

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Page 1: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Establishing A Model to Sustain Improvement in Clinical Care

February 28, 2014

Page 2: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Establishing A Model to Sustain Improvement in Clinical Care

Successes Challenges

Critical Factors

Page 3: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

North Shore High Needs Unattached Population

Estimated 2,870-6,270 Mental Challenges

Homeless Frail Elderly

Page 4: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Access to Health Care

Emergency Department Homeless Shelter Home Health Care

Page 5: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Development of a Multidisciplinary Clinic With Vancouver Coastal Health

Page 6: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Integrated Practice Support Initiative

NS Division of Family Practice Physician Information

Technology Office Practice Support Program

Page 7: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Align & Integrate Physician Practice Support

Change Management Quality Improvement Technology Adoption

Page 8: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Framework of Integrated Support

North Shore

Division

PSP PITO

Page 9: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

HealthConnection Clinic • Customized a Systematic Decision Matrix tool

for selecting an Electronic Medical Record • Developed an Access Intake Process • Created a Complexity Scoring Tool

Page 10: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Key Learnings

• Collaboration is critical • Collaboration promoted engagement of other

key stakeholders (Shared Care, IPCC) • Organization support and team willingness led

to outcomes that might not have been achieved otherwise

Page 11: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Challenges of IPSI

• Difficulty moving from “siloed” processes • Encouraging collaborative creative thinking • Lack of awareness of the culture within

partner organizations • Lack of clarity about broad IPSI goals,

expectations and deliverables

Page 12: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Successes of IPSI • Built and strengthened relationships • Successfully supported HealthConnection

Clinic • Gained an understanding of roles & expertise • Developed a Collaborative Model that can be

used to help integrate teams in future initiatives.

Page 13: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Next Steps

• Implement EMR at HealthConnection Clinic • Inform Physicians/MOAs of IPSI support • Introduce VCH team to the IPSI team & model • Broaden collaborative table to larger

community including VCH, IPCC, etc

Page 14: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

Critical Factors for Success of IPSI

• Collaborative table with decision making • Division Leadership & project support • Clear mandate supported by on-line

collaborative technology • Evaluation implemented at outset of project • Knowledge sharing & open communication

Page 15: Establishing a High Needs Outreach Clinic in North Vancouver: A Model to Sustain Improvements in Clinical Care

We wish to thank the GPSC for the

tremendous opportunity to engage PSP, PITO and the Division in support of physicians and

their patients