Health Transformation: A View From the Front Lines
On February 10, 2015, members of the Telfer Health Transformation Exchange (THTEX) took part in a panel discussion at the Telfer School of Management. “Transforming Healthcare: Realities and Opportunities, A Clinical Perspective” featured Dr. James W.T. Chan, Dr. Michael Fung-Kee-Fung, and Dr. Mark Walker, all from the Ottawa Hospital (TOH) and the University of Ottawa Faculty of Medicine. Approximately 30 students from the Master of Science in Health Systems and Master of Health Administration graduate programs and other interested participants were in attendance.
Dr. Mark Walker, of the Department of Obstetrics, Gynecology and Newborn Care at TOH, began the discussion by referring to the large variation in caesarian section rates that existed across Ontario a few years ago. He launched a province-wide initiative of collecting data on newborns and mothers, which prepared the ground for the Better Outcomes Registry & Network, or BORN. Dr. Walker presented a dashboard and metrics that showed how voluntary improvement was achieved across the province, not only in c-section rates but in a wide variety of maternal and newborn quality metrics made available through big data. He emphasized the need to “manage change proactively” and underscored the importance of workplace culture in bringing about this transformation.
Dr. Michael Fung-Kee-Fung, of the Surgical Oncology Program at TOH, discussed the work he initiated at the regional level (Champlain LHIN) related to lung cancer transformation. The data had shown that the waiting period between an abnormal x-ray and the decision to treat the result as potentially cancerous was often lengthy. The time interval severely impacted the ability to manage lung cancer effectively. Dr. Fung-Kee-Fung explained that managing cancer is a complicated process involving many specialties and clinical silos, as patients move from suspicion to diagnosis, treatment and palliation. Recognition of these challenges by clinicians and administrators led to the launch of the cancer transformation program. The new program incorporated the elements of process redesign, collaborative methodologies and enabling technology. This clinician-led change employed the Ottawa-community-of-practice model that helped to revamp processes, streamline activities and reduce the wait time by 45% to date, with a further 10% reduction anticipated. This result is welcome news for patients with this aggressive form of cancer and a good example of the medical community (clinical and administrative) working together to effect transformation of health practices.
The third panelist, Dr. James W.T. Chan of the Division of General Internal Medicine at TOH, focused on local innovations. He spoke to the need of clinicians to document their practices and activities for the Ministry in order to be accountable, safe and professional. Physicians currently use “hospital blue cards” to capture patient identification as part of paper charting for orders, consults and documentation for verification. While the system is well-established, improvements in terms of convenience, accuracy and increased security are being explored, Dr. Chan explained. His department approached a 3rd-party mobile app developer to create an iPad application capable of achieving the same as the blue card system while also providing enhancements. In the end, organizational hurdles proved more difficult than expected, and a pilot study that was to involve 6 physicians was prematurely halted. Dr. Chan shared a number of lessons learned, including the need for communication and greater coordination between frontline innovations and organizational priorities. He also made the case that while physicians and other health providers seeks ways to innovate and stay ahead of the curve in healthcare delivery, these efforts need support from the top as well as a change in mindset in order to be successful.
The common theme from the panel was the importance of harnessing the incredible innovative potential among frontline healthcare professionals in order for healthcare transformation to be achieved. The crucial elements in this process include organizational change management, effective use of data and communication strategies.
There was excellent audience engagement and participation, with many insightful questions and comments relating to healthcare transformation and the shifts in workplace culture that can support it.
A very special thank you to James, Mark, and Michael for preparing and delivering the panel. This was a very successful event for the THTEX and we look forward to many more in the near future!