Post on 22-Jan-2018
Rural Surgical and Obstetrical Networks Improving Rural Access, Sustainability and Satisfaction
Dr. Nancy Humber, MD, FPESS Lillooet| Jude Kornelsen, PhD CRHR
on behalf of the RSON Team (Kim Williams, PSBC, Dr. Ray Markham, RCCbc, Dr. Victoria Vogt, MD, FPESS Revelstoke, Dr. Bob Woollard, DFP UBC, Dr. Kirstie Overhill, UBC CPD, Dr. Kirk McCarroll, FPA, Revelstoke)
Quality Forum 2017 | Vancouver, March 1
Disclosure
Dr. Nancy Humber does not have any conflicts of interest to disclose.
Jude Kornelsen, PhD, does not have any conflicts of interest to disclose.
Management of Potential Bias Strong commitment to sustainable rural services that meet the needs of rural residents (including providers)
Have both led and been involved in primary research projects yielding evidence to inform rural health service modeling and planning
Have approached the development of RSON from an expanded and triangulated definition of evidence including ◦ Individuals‟ knowledge
◦ Community-based knowledge
◦ Scientific and expert knowledge
◦ Policy and planning knowledge
Objectives 1) Introduce the context of rural surgical and maternity care in
BC and illustrate with 2 patient journeys
2) Discuss Networks as a mechanism to meeting the needs of rural residents and describe component parts
3) What networks can deliver
4) „We don‟t know what we don‟t know‟: learning through a research and evaluation lens
THE RURAL REALITY
WHAT NETWORKS CAN DO
WHAT A NETWORK IS NOT
PULL NOT PUSH
RIGHT CARE, RIGHT TIME
Minimize geography Relationships Sustainable Adaptable Cross boundaries Professional satisfaction
Rural Surgical & Obstetrical Networks: A Rural Health Services Imperative
“Whereas the formalization of interprofessional service networks between small surgical programs and those in regional and tertiary settings through network models of rural surgical care is the optimal health human resources solution to meet the surgical needs of rural residents, we recommend that network models of integrated rural surgical services be established and maintained by all key professions in rural Canada.”
Royal College of Physicians and Surgeons of Canada The Future of General Surgery (2014) …strong support for generalism, for the “rural imperative”, and for training suited to anticipated practice needs
College of Family Physicians of Canada creation of a Community of Practice (CoP) section of Enhanced Surgical Skills with a promise of credentialling (CAC).
Canadian Association of General Surgeons
Component Parts Increased Scope and Volume for local services (necessary for sustainability)
Clinical Coaching and Training (for rural teams at smaller volume rural sites to maintain and improve their skills sets through collaboration with specialists at regional sites; enhances CQI)
Remote Presence Technology (enables teams, separated by distance and by training, to stand shoulder to shoulder and operate together/clinical coaching/CQI/benefit for ER, Critical Care & trauma)
Continuous Quality Improvement
Evaluation (network development, process/surgical outcomes)
INCREASED SCOPE AND VOLUME
INTEGRATIVE NETWORKED CLINICAL COACHING TEAMS
REMOTE PRESENCE TECHNOLOGY
CQI
RURAL NESTED IN REGIONAL ROUNDS MORE OB JOURNAL CLUB CURRENCY TEAM EXPERIENTIAL LEARNING SIMULATIONS
Anticipated Outcomes 1) Increased access to health care choices for BC‟s rural communities;
2) Increased „closer to home‟ access to surgery and obstetrical services for patients in rural communities;
3) Increased sustainability of rural health care programs particularly those with smaller volume surgical and obstetrical services;
4) Increased ability to recruit and retain health care providers for BC‟s rural communities;
5) Increased provider satisfaction;
6) Increased access to screening procedures for BC‟s rural communities;
7) A greater understanding of the holistic/comprehensive cost-efficiencies of rural surgical networks in meeting surgical demand;
8) A greater understanding of the efficacy of networks on rural health care outcomes and their ability to reduce wait times throughout the province;
9) Enhanced quality of rural health services for rural citizens through the development of a multi-professional CQI system appropriate to the privileging of rural smaller volume generalist, surgical and perinatal services;
Facilities
Population Health
Outcomes
Qualitative Data on Network
Function
Shared Measures
Comprehensive Costing
Potential (additional) areas of system transformation Surgical wait times
Increased uptake of rural screening?
Other?
Moving forward How do we engage with regional (HA) planning to actualize the networks?
What would this look link in your Health Authority?
Network Infrastructure and Relationships
Remote Presence CQI Increased Scope and Volume Clinical Coaching
Provincial Funding Sources
Rural Surgical and Obstetrical Networks
Receiving Organization RSON Committee
Project Manager
Increased Operational Capacity
Anesthetists
Surgeons
OR Nurses
NSQIP Nurse
CME
Regional Departmental CQI
Virtual visits
Elective Intraoperative
Emergency Triage
IT/HA
NSQIP RN
First Nation Health Council
Maternity
Anesthesiologists
Surgeons
OBGYN
UBC CPD
Community Specific Working Group
GP, Maternity provider/ESS HA, network coordinator
Specialist Surgeon, nurse, first nations patient advocate
Patient advocate
Network Evaluation
HA
Perinatal BC Representative
Physician Vacancies Physician Vacancies If everyone is moving forward together, then
success takes care of itself