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.

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Who is who?

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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

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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 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:

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Discuss in pairs: HV(CC)C at your institution

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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?

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• 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?

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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

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CanBetter: social accountability

Care for the elderly

Train residents

in:

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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

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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

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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

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

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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

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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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

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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

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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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