Version 2.0

Version Date: June 2015

Bone and Joint Health

Strategic Clinical Network

2015-2018

Transformational Roadmap

TABLE OF CONTENTS

Letter from the Leadership Team 1

Introduction 2

More Research and Faster Transfer of Knowledge 2 A Framework for Transforming Musculoskeletal Care 3 Musculoskeletal Program Expansion 4 The Best in Providing Evidence-based Care 5

The Drivers of Transformation 7 The Musculoskeletal Landscape 7 Team-based Care 7 Quality Improvement 8

Transforming Musculoskeletal Care in Alberta 10 Development of the BJH SCN’s Transformational Roadmap 10 Inclusive Models of Care 10 Six Common Themes of Transformation 11 Health Promotion and Injury Prevention 11 Centralized Intake and Triage 12 Musculoskeletal Multidisciplinary Assessment and Treatment Clinics 12 Evidence-based Clinical Pathways and Frameworks for Measuring Performance 12 Provider Support and Education 12 Patient Engagement and Education 13 Seven Essential Enablers of Transformation 13 Engagement 13 Communication 14 Quality Improvement 14 Technology 15 Research, Innovation and Knowledge Translation 15 Funding Models 16 Human Resources 17

Musculoskeletal Care transformation Initiatives 2015-2018 18 Signature Projects are High-Profile 18 Hip and Knee Arthroplasty Program 18 Fragility and Stability Program 19 Priority Projects Demonstrate Musculoskeletal Transformation 20 Knee Soft Tissue Injury 20 Inflammatory Arthritis 21 Research Projects 22 SpineAccess Alberta 22 Optimizing Central Intake to Improve Arthritis Care 22 Pan-SCN Activities 23

Appendix A – Bone and Joint Health Strategic Clinical Network Core Committee 24

1

Letter from the Leadership Team

INCREASING THE BREADTH, SCOPE AND IMPACT OF PREVENTION AND CARE

As Alberta’s population grows, so grows its need for musculoskeletal (MSK) health care. And as

Albertans know, the population growth here has been sharp and fast, eclipsing other jurisdictions in

Canada.

The correlation between population growth and MSK health care need is simple. There are more than

200 MSK conditions affecting the body’s numerous bones, joints, tendons, ligaments and muscles. Every

Albertan will develop at least one MSK-related condition in his or her lifetime. These conditions are

extraordinary for their breadth and scope. They encompass those of acute onset, such as trauma, pain

and cancer, to those of chronic long-term illness, such as osteoarthritis, rheumatoid arthritis, and low

back pain. They are the most common cause of severe long-term pain and physical disability, and they

affect hundreds of thousands of Albertans at any one time.

Population aging (including workforce aging) and rising rates of obesity in Alberta add a level of

complexity and urgency. Many MSK conditions are more prevalent in the later stages of life and some,

such as osteoarthritis and low back pain, are directly associated with excess body weight.

We are compelled by this challenging demographic reality and the growing economic burden of health

care to take a critical look at how we are managing MSK health and health care in Alberta. Can we

reduce the burden of demand on the public health care system by doing more to prevent MSK injury

and illness? Can we improve the outcomes of patients and use our resources more efficiently by using

more effective, evidence-based ways to deliver services when MSK illness strikes? Can we be more

innovative in managing MSK conditions in their early stages to avoid surgery?

These were the questions the Bone and Joint Health Strategic Clinical Network (BJH SCN) put to

stakeholders in Alberta’s clinical, administrative, policy and patient communities. The positive feedback

we received was used to develop a three-year plan that will serve as a roadmap for transforming MSK

care to meet the challenges Alberta faces. We call it our Transformational Roadmap.

On the pages that follow you will learn about the initiatives we will undertake, and the objectives and

strategies we will use as we test-run our Transformational Roadmap over the 2015-to-2018 period. We

welcome views and ideas that may lead to further improvement. Please take the time to share your

thoughts and suggestions with us at Violet.Hejnar@albertahealthservices.ca.

Sincerely,

DON DICK SENIOR MEDICAL DIRECTOR

LYNNE MANSELL SENIOR PROVINCIAL DIRECTOR

LINDA WOODHOUSE SCIENTIFIC DIRECTOR

MEL SLOMP EXECUTIVE DIRECTOR

2

INTRODUCTION

More Research and Faster Transfer of Knowledge

Population growth, population aging and rapidly rising rates of obesity are the major drivers of demand

for musculoskeletal (MSK) health care. Rising demand together with the long-term chronic nature of

most MSK conditions has brought a sense of urgency to improving prevention and treatment. These

factors have also exerted considerable pressure for more research and faster transfer of knowledge

from the research bench to the hospital bedside. However, health care is a fragmented industry. Each

party within the industry – physicians and other health care professionals, researchers, patients, public

health agencies, policy makers, and private industry – has its own unique set of guiding principles,

pressure points and measures of success. Fragmentation

slows the practical application of knowledge.

The Bone and Joint Health Strategic Clinical Network (BJH

SCN) draws together individuals from all of these parties to

collaborate on bringing the best in clinical practices and

innovation to everyday prevention and clinical care. In

doing so, it creates an environment that favours alignment

among the service delivery, research, policy and planning

areas of MSK health care, and puts patients and their

families at the centre of health service delivery.

The BJH SCN was established by Alberta Health Services in 2012 to promote MSK disease prevention and

improve the way care is planned and delivered when disease strikes. Its work since then has focused

primarily on:

Hip and Knee Joint Arthroplasty: Embedding in clinical practice across Alberta an evidence-based

clinical pathway for hip and knee replacement patients, and measuring and reporting the quality of

care delivered under the pathway as part of a comprehensive continuous quality improvement

initiative.

Fragility and Stability: Designing and implementing an evidence-based clinical pathway for hip

fracture patients, including innovative prevention programs to reduce the risk of a subsequent

fracture related to osteoporosis.

Frameworks have been built to measure the quality of care for hip and knee joint replacement and hip

fracture patients in six dimensions: accessibility, safety, effectiveness, efficiency, appropriateness and

acceptability. These dimensions were identified by the Health Quality Council of Alberta as the most

effective when evaluating health care quality.

The BJH SCN has been assisted in this work by Alberta Bone and Joint Health Institute (ABJHI), an

independent not-for-profit organization with expertise in project management, clinical pathway design,

knowledge translation, and performance measurement and analysis.

THE BJH SCN DRAWS TOGETHER

INDIVIDUALS TO COLLABORATE

ON BRINGING THE BEST IN

CLINICAL PRACTICES AND

INNOVATION TO EVERYDAY

PREVENTION AND CLINICAL CARE.

3

Themes

Health promotion and injury

prevention

Centralized intake and triage

Multidisciplinary clinics and teams

Clinical pathway and measurement

Provider support and education

Patient engagement and education

Enablers

Engagement

Communication

Technology, data and measurement

Quality improvement

Research, innovation and knowledge

translation

Funding models for multidisciplinary teams

Human resources

A Framework for Transforming Musculoskeletal Care

Now in the third year of its mandate, the BJH SCN is expanding its work and employing a strategic

framework under which innovation in MSK health care will be truly transformative. This framework

(Figure 1) will serve as the foundation on which the transformation of care will be carried out. The

framework, which can be applied in any area of MSK care, will have common underlying themes and

enablers, including:

Once tested and proven effective in practice, these themes and enablers will be applied to every

initiative the BJH SCN undertakes.

Transformation will be guided by seven firm principles:

1. Services are patient-centric.

2. Services are available across the province.

3. Services are comprehensive.

4. Access to services is improved.

5. A multidisciplinary/interprofessional team approach to care is encouraged.

6. Services are comprehensive across the continuum of care, including chronic care, acute care,

surgery, and non-surgical care.

7. Outcomes are measured and analyzed.

In a transformational shift in strategy, the BJH SCN’s main focus in all its initiatives will swing upstream

from surgery to prevention, early detection and conservative (non-surgical) management of MSK

conditions using evidence-based models of multidisciplinary team-based care. Evidence-based surgical

treatment will continue to be an important part of the BJH SCN’s scope of work under its

Transformational Roadmap, but will no longer be the primary focus.

4

Figure 1: The BJH SCN’s transformational roadmap will have common themes and enablers that apply to all initiatives.

Services will span multidisciplinary triage, assessment and care, patient engagement in treatment

decisions, performance measurement and reporting, and better information flow among providers,

researchers and stakeholders. A knowledge translation strategy will ensure results of the BJH SCN’s

transformational projects are understood and shared broadly

for maximal benefit.

The greater emphasis on services upstream of surgery

recognizes that most chronic diseases of the MSK system can

be prevented, or their progress halted or slowed significantly,

by making the right personal choices in daily activities and in

health and dietary habits. It also recognizes that 80% of

people who develop an MSK condition do not require surgery

to treat it.

Musculoskeletal Program Expansion

The BJH SCN’s current programs – Hip and Knee Arthroplasty, and Fragility and Stability – will continue

under the Transformational Roadmap banner. But there will be new emphasis on improving the

upstream services in these programs, reflecting the progress that has been made in the surgical

component of the continuum of care. There will also be new initiatives launched in three high-need

areas of MSK care:

1) Spine-related Disorders. The initial work in this area will involve developing and piloting an

innovative model for assessing and triaging people with spine conditions and low back pain. The

BJH SCN will then design a set of evidence-informed clinical pathways that will set out the

protocols and procedures for non-surgical and surgical treatment of spine conditions and low

back pain.

2) Knee Care (other than knee replacement). The BJH SCN will develop a comprehensive evidence-

informed approach to preventing and treating acute and chronic knee conditions.

A KNOWLEDGE TRANSLATION

STRATEGY WILL BE CARRIED OUT

TO ENSURE RESULTS OF THE

TRANSFORMATIONAL PROJECTS

ARE UNDERSTOOD AND SHARED

BROADLY FOR MAXIMAL BENEFIT

5

Patients

Within a transformed MSK care

system, Albertans will be

supported across the full

continuum of care from prevention

to independence. The support and

care they receive will be

coordinated and integrated. The

health care system will provide

early meaningful diagnosis and

interventions, personalized care

plans, and optimized navigation

across the continuum. Patients will

be engaged in collaborative and

shared decision making, and will

be partners in their care.

Providers

Within a transformed MSK care

system, clinicians will be part of

collaborative, integrated care

teams providing patients with

education, diagnosis, triage,

treatment and rehabilitation

support based on best practices

and evidence-based guidelines.

Each team member will work to

the full scope of practice, and will

be knowledgeable and respectful

of other team members’ roles in

the flow and care of patients.

The Health Care System

Within a transformed MSK care

system, patient care will be

coordinated and integrated across

the continuum. The process of care

will be clear and transparent to

patients and their providers.

Patients will have access to all of

their medical records and clinicians

will have access to the medical

records of their patients.

Algorithms and pathway flows will

be built to ensure all patients have

timely access to integrated care

that is consistently of high quality

and that optimizes their outcomes.

3) Rheumatoid Arthritis. The BJH SCN will increase the capacity of the health system to provide

care for patients across the continuum by maximizing the scope of practice and using the

appropriate health care professional in the most favourable setting at the most advantageous

time.

These new initiatives were selected as transformational projects by the BJH SCN’s Core Committee,

which provides leadership and oversight of projects undertaken by the BJH SCN. In making the selection,

its members engaged with stakeholders in the clinical, administrative, policy and patient communities to

determine the relevance of the proposed work and the readiness to accept change while also weighing

the ability to leverage progress made on earlier work in these areas.

These initiatives together with the Hip and Knee Arthroplasty and the Fragility and Stability projects will

provide the opportunity for the BJH SCN to test its transformational framework for proof of concept

over the 2015-to-2018 period. Once the concept has been proven effective, the transformation

framework will become the foundation for all subsequent BJH SCN initiatives.

The Best in Providing Evidence-based Care

The Bone and Joint Health Strategic Clinical Network was established by Alberta Health Services in 2012.

It was one of six initial areas of high-need clinical care assigned a dedicated Strategic Clinical Network.

The BJH SCN is committed to six principles, which guide its day-to-day operations:

1) Ensuring public health care is sustainable

2) Using evidence to inform decisions

3) Supporting research and encouraging innovation

4) Making health and health care patient- and family-centred

5) Improving the patient experience with health care services

6) Achieving the best possible health outcomes

The BJH SCN’s vision is to become the best bone and joint system in providing evidence-based care. Its

mission is to improve bone and joint health care by addressing the needs of patients, providers and the

health care system as follows:

6

In transforming the MSK care system, the BJH SCN will:

Build capacity by training and establishing multidisciplinary teams and alternate care providers

to leverage for patients the full scope of practice of each relevant medical discipline.

Operationalize evidence-based guidelines and criteria for referral, diagnostic imaging,

treatment and other aspects of care.

Standardize clinical pathways and embed in them performance feedback and outcome

measurement mechanisms.

Build sustainability through innovative models of care delivered by

multidisciplinary/interprofessional teams and funded using approaches that incent team-based

care.

Provide comprehensive team-based care to optimize patient outcomes.

Invest in services at the front end of the continuum of care, including health promotion, injury

prevention, early identification of illness, and conservative (non-surgical) management of

conditions as a means of avoiding or delaying more costly specialist care.

Standardize care and reduce variation in care practices and protocols in urban, rural and

remote areas.

Endeavour to prevent the development of osteoarthritis brought on by trauma, and to slow the

progression of disability through innovative primary and secondary prevention strategies.

Now in the third year of its mandate, the BJH SCN has 10 sister Strategic Clinical Networks, including:

Seniors Health; Surgery; Addiction and Mental Health; Cancer; Cardiovascular Health and Stroke; Critical

Care; Emergency; Diabetes, Obesity and Nutrition; Maternal, Newborn, Child and Youth; and Respiratory

Health. The Strategic Clinical Networks collaborate on projects, with one seeking the expertise of

another when needed. For example, the risk of developing osteoporosis and suffering hip fracture in a

fall are higher among the elderly. In this area, the Seniors Health Strategic Clinical Network has provided

valuable support to the BJH SCN in developing and carrying out its Fragility and Stability program.

The Strategic Clinical Networks are founded on the Institute of Healthcare Improvement’s (IHI) Triple

Aim, which is to simultaneously:

1) Improve the health of the population;

2) Enhance the experience and outcomes of patients; and

3) Reduce the per-capita cost of care for the benefit of communities.

Triple Aim serves as the foundation for organizations and communities to optimize health for individuals

and populations. The BJH SCN applies the IHI’s Plan, Do, Study, Act model, an action-oriented method of

change that involves planning change, trying it, observing the results, and acting on what is observed.

7

THE DRIVERS OF TRANSFORMATION

Three powerful forces are driving the BJH SCN’s efforts to transform MSK care: 1) the MSK landscape; 2)

team-based care; and 3) quality improvement.

The Musculoskeletal Landscape

Many MSK conditions are chronic, characterized by long-term pain and disability. Chronic MSK

conditions, such as osteoarthritis, rheumatoid arthritis and back pain, are often challenging to treat.

They require a system of care that can focus on not only treating the MSK conditions but also on

managing the comorbidities that are commonly associated

with them, such as diabetes, depression and obesity.

This complexity serves as a catalyst for health care system

transformation recognizing that patients often require

many different services to treat their disease and

comorbidities for long periods of time.

Escalating health care costs, rising numbers of patients,

long waiting times for some services, and an aging work

force are issues that have converged to bring urgency to

transforming the way MSK care is delivered in Alberta.

MSK conditions are the leading cause of severe long-term pain and physical disability. They are costly to

the Canadian economy. The Arthritis Alliance of Canada estimated the combined annual economic

burden of osteoarthritis, the most prevalent form of arthritis, and rheumatoid arthritis, a crippling

autoimmune disease, was approximately $33 billion in 2010. This suggests the annual economic burden

was about $4.6 billion in Alberta. This burden, which is growing annually, requires alternative models of

care with innovative approaches across the continuum.

Team-based Care

Service delivery is fragmented and medical care practices and protocols are highly variable in MSK

medicine.

Funding methods oriented toward reimbursing individual practitioners for services rendered are a major

contributor to fragmented service delivery in Alberta. For example, Alberta’s fee-for-service funding

structure does not allow for widespread collaborative models of care, especially the long-term and

multidisciplinary care associated with chronic disease. Team-based funding is a desirable alternative

method. It would incent coordination of services across assessment, triage, treatment and rehabilitation

with common goal setting and outcome tracking by providers.

Access to the appropriate provider at the point in time most advantageous to the patient is a major

challenge when managing chronic diseases that require a collaborative, multidisciplinary model of care.

Inter-professional collaboration could improve by providing more information about the scope of

practice and the roles that can be played by the different clinicians involved in delivering care to MSK

patients. It is essential in a multidisciplinary care environment for individual roles and responsibilities to

be transparent to all and for communication among providers to be fluid and unambiguous.

ESCALATING HEALTH CARE COSTS,

RISING NUMBERS OF PATIENTS,

LONG WAITING TIMES FOR SOME

SERVICES, AND AN AGING WORK

FORCE ARE ISSUES THAT HAVE

CONVERGED TO BRING URGENCY

TO TRANSFORMING THE WAY MSK

CARE IS DELIVERED IN ALBERTA.

8

Continuous

Quality

Improvement

Quality Improvement

The BJH SCN views quality improvement as a process of putting in place proven tools and strategies that

reveal for frontline health professionals how they are doing and encourage them to continuously

challenge themselves to do better.

Figure 2: Initiated bottom-up and supported top down.

Bottom-up pressure from the front lines is

a pivotal feature of the BJH SCN’s

continuous quality improvement strategy.

It reflects the BJH SCN’s belief that

improvement driven by those on the front

lines who deliver and manage services is

more meaningful, effective and

sustainable than improvement driven by

top-down directive alone (Figure 2).

This strategy uses the Quality Matrix for

Health, Measurement Framework,

Balanced Scorecard, and Learning

Collaborative as highly effective tools.

Quality Matrix for Health (Figure 3): The

Health Quality Council of Alberta’s Quality Matrix provides a common language, understanding and

approach to quality so that everyone is working toward well understood goals. The Matrix was

developed to avoid the confusion that arises when quality is interpreted differently by health care users,

providers and organizations. It captures the patient experience in six dimensions of quality and four

distinct but related areas of service need. Using key performance indicators (KPI) in the six dimensions,

the quality of service can be measured, tracked and reported to encourage continuous quality

improvement in a standardized, systematic way.

Figure 3: The

Health Quality

Council of

Alberta’s

Quality Matrix

for Health.

9

Measurement Framework: The BJH SCN uses Measurement Frameworks to evaluate the performance of

clinical pathways in a way that is consistent, standardized and transparent for all involved in delivering

care along the pathway. A Measurement Framework is made up KPIs in the Quality Matrix’s six

dimensions, the data needed to measure performance in each of the indicators, and performance

benchmarks. Regularly collecting data and measuring performance makes it possible to quickly flag

areas of the clinical pathway where performance levels are not meeting benchmarks and need to be

addressed.

Balanced Scorecard (Figure 4): The BJH SCN uses Balanced Scorecards together with team dynamics as a

highly effective tool for quality improvement in hip and knee replacements. Multidisciplinary teams of

frontline health professionals, including surgeons, nurses, therapists, unit managers and case managers,

are formed in hospitals that provide hip and knee replacements. Each team develops a Balanced

Scorecard with targets for KPIs in the Quality Matrix’s six dimensions. The teams monitor their

performance, adjusting practices and strategies to meet the targets, which may be local or provincial.

Once the targets are met and sustained, the teams adopt new KPIs with targets. The Balanced Scorecard

approach maintains a constant province-wide drive for quality improvement in hip and knee

replacements, and can be adopted in other areas of bone and joint care.

Figure 4: Sample

Balanced Scorecard

used by

multidisciplinary

teams to improve

the quality of care.

Learning Collaborative: The BJH SCN uses the Learning Collaborative to help frontline teams develop the

necessary competency to use the Balanced Scorecard methodology to maximal benefit. Developed by

ABJHI, the Learning Collaborative serves as a model for creating the conditions for bottom-up change

and achieving breakthrough improvement in performance. The Learning Collaborative uses Six Sigma

process improvement and the Institute for Healthcare Improvement’s Breakthrough Methodology for

accelerating progress toward team targets.

10

TRANSFORMING MUSCULOSKELETAL CARE IN ALBERTA

Development of the BJH SCN’s Transformational Roadmap

The BJH SCN’s Transformational Roadmap was developed through a year-long stakeholder engagement

effort. Factors emerged that weighed heavily in the decision to make spine-related disorders, knee care,

and rheumatoid arthritis the lead-off projects for transforming MSK care, including:

Need at the local and provincial level.

Impact on the six dimensions of quality and the evidence to support change in the way care is

delivered.

Opportunity to build on previous work, such as clinical pathways that have been developed but

not implemented.

Readiness and ability to implement change across the province.

Local champions to lead Working Groups in carrying out the projects.

Demonstrating Musculoskeletal Transformation

MSK transformation will have two project phases. Phase 1

projects – Knee Care, Rheumatoid Arthritis, and Spine-related

Disorders – are under way in select locations. The BJH SCN’s six

principles (page 6) and the benefits of MSK transformation will

be clearly exhibited as the three Phase 1 projects are carried

out. In Phase 2, the BJH SCN will expand these projects and the

best practices developed with them to all areas of the province.

It will also expand the scope of its work to other MSK

conditions, as noted in the table to the right.

The BJH SCN’s Transformational Roadmap will be reviewed

annually to ensure it remains relevant and feasible.

Progress on the Transformational Roadmap will be

measured regularly to identify opportunities for

improvement and to take corrective action early.

Inclusive Models of Care

Patients and primary care providers have, through an iterative consultation process, made clear to the

BJH SCN their view that Albertans need innovative MSK care that does not rely exclusively on specialists,

such as surgeons and sports medicine physicians. They have suggested that inclusive models of care

making optimal use of appropriate clinicians will improve access to comprehensive care while reducing

duplication of services, referrals to the wrong clinician or wrong discipline, and service fragmentation.

Furthermore, patients and primary care providers have said they support improved and expanded

primary prevention, public and patient education, and personal health management strategies. This is,

in part, because these efforts reduce injuries, increase the ability of individuals to manage their

condition at home, and provide patients with access to a range of services that allow them to minimize

the likelihood they will need surgery or other intensive, specialized care.

Phase I Phase II

Knee Foot and ankle

Arthritis Shoulder

Spine Other conditions and specialty areas, such as juvenile arthritis

PROGRESS WILL BE MEASURED

REGULARLY TO IDENTIFY

OPPORTUNITIES FOR IMPROVEMENT.

11

Six Common Themes of Transformation

The Transformational Roadmap sets out six common themes considered by the BJH SCN to be essential

to transforming MSK care.

1. Health Promotion and Injury Prevention

The BJH SCN will launch primary and secondary injury and disease prevention programs. These

programs will slow and, where possible, reverse the growing demand for bone and joint care in

hospitals and in the community.

Primary prevention seeks to avert injury or the onset of disease by employing risk reduction

strategies. Secondary prevention occurs following an injury or the start of disease. It is intended to

avoid re-injury or to halt or slow the progress of disease in its earliest stages, averting further

damage.

Prevention programs will target at-risk populations,

such as youth in schools, sport and recreation, and

the frail elderly.

Knee soft tissue injuries are among the most common

sports injuries. The BJH SCN will implement an

evidence-informed primary prevention program

developed and proven effective by the Sport Injury

Prevention Research Centre at the University of

Calgary. The BJH SCN will collaborate with the

Research Centre and other stakeholders to identify

and implement sport-specific neuromusculoskeletal training aimed at reducing injury in other

extremities once the knee injury prevention program is well established across Alberta.

Falls are the leading cause of injury in Canada. The BJH SCN will support Alberta Health Services’

Risk Management Group and Injury Prevention Group in developing primary prevention programs

to decrease the fall rate and injury from a fall in the adult population.

Secondary prevention programs will be developed as part of the three projects under way in Phase

1 of MSK transformation: Spine-related Disorders, Knee Care, and Arthritis.

A secondary prevention program called Catch a Break, launched in 2014 as part of the BJH SCN’s

Fragility and Stability program, has been rolled into the Transformational Roadmap. Catch a Break

searches databases to identify bone fracture patients suspected of having osteoporosis, a thinning

of the bones that leaves them susceptible to fracture. These patients are advised to be tested for

osteoporosis. They and their family physician are sent information about treatment and fracture

prevention strategies.

In the area of health promotion, programs will be developed in partnership with a broad group of

community stakeholders, such as schools, industries, researchers and clinicians. This work has

begun on a limited scale with programs promoting exercise and recommendations on vitamin D

and calcium intake. These programs will become part of a comprehensive, strategic approach to

promoting good bone and joint health.

IN THE AREA OF HEALTH

PROMOTION, PROGRAMS WILL BE

DEVELOPED IN PARTNERSHIP WITH

A BROAD GROUP OF COMMUNITY

STAKEHOLDERS, SUCH AS SCHOOLS,

INDUSTRIES, RESEARCHERS AND

CLINICIANS.

12

2. Centralized Intake and Triage

The BJH SCN is advancing centralized intake as a triaging strategy that will improve access to MSK

care across the province, particularly for rural populations. Centralized intake in hip and knee

replacement clinics is well established in Alberta. The BJH SCN will make centralized intake standard

practice for all MSK conditions. This will capitalize on existing information and referral mechanisms,

such as Health Link Alberta, the round-the-clock provincial telephone service, and eReferral, the

new information systems solution for end-to-end tracking and management of patient referrals.

eReferral has been introduced by Alberta Health Services initially for hip and knee replacement,

lung cancer and breast cancer referrals with plans to quickly expand to other areas of care. The BJH

SCN is promoting eReferral to referring physicians as the optimal replacement for the variety of

incompatible electronic and paper-based systems that are being used to refer hip and knee patients

to specialists in Alberta. Having a single electronic referral system for the province will reduce the

rate of incomplete and inappropriate referrals and eliminate duplicate referrals.

3. Musculoskeletal Multidisciplinary Assessment and Treatment Clinics

The BJH SCN is advocating Musculoskeletal Specialty Care Clinics across Alberta. These clinics would

provide comprehensive services including MSK assessment, triaging, diagnosis and treatment

planning in a single location. They would be linked closely with primary care providers, such as

family doctors and therapists, at the early stage of service, and with specialists, such as orthopaedic

surgeons and rheumatologists, at the treatment stage.

These linkages would make the clinics pivotal in

ensuring access and continuity of care across the

continuum.

Musculoskeletal Specialty Care Clinics would also help

coordinate efforts to improve and expand public,

patient and provider education about maintaining good

health and preventing injury. The inter-disciplinary

professional nature of the clinics would create an

environment in which providers would have quick on-

site peer advice and consultation.

4. Evidence-based Clinical Pathways and Frameworks for Measuring Performance

The BJH SCN will lead a robust and comprehensive continuous quality improvement (CQI) effort in

MSK care across Alberta. CQI will span the six dimensions of quality (Figure 3). Establishing and

implementing evidence-based clinical standards and pathways will be pivotal to this work. Having

provincial standards and measuring results tied to evidence-based benchmarks in the six quality

dimensions would reduce the variation in clinical practice that results in uneven care across the

province.

MSK SPECIALTY CARE CLINICS

WOULD OFFER AN INTER-

DISCIPLINARY PROFESSIONAL

ENVIRONMENT WHEREIN

PROVIDERS WOULD BE ABLE TO

BENEFIT FROM ON-SITE PEER

ADVICE AND CONSULTATION.

13

5. Provider Support and Education

The BJH SCN will help design and produce clinical decision support tools and educational materials

and events, such as newsletters, webinars and workshops, to inform practitioners about research,

innovation and evidence-based clinical practice related to MSK conditions.

6. Patient Engagement and Education

The BJH SCN will open up a valuable and informative line of communication between patients and

providers.

The BJH SCN is committed to a continued strong linkage with Patient and Community Engagement

Research (PACER), a ground-breaking program initiated at the University of Calgary’s Cumming

School of Medicine to train patients as researchers. It will also continue to work with Health Link

Alberta in making health information available around the clock.

Seven Essential Enablers of Transformation

The following essential enablers of transformation will come into play in each of the six themes of

transformation described above.

1. Engagement

The BJH SCN has a collaborative membership model ensuring patients and their families, health

professionals, researchers and educators, policy makers, and the general public are engaged in

ways that give them meaningful participation in decisions and programs.

a. Patient and family engagement

Patient and family engagement will embody the following principles:

Diverse perspectives are sought purposefully, including those of Albertans from a wide

range of cultures, Albertans who are part of vulnerable populations, and Albertans who

live in remote, rural and urban areas.

Patients are involved directly as advisors in developing strategies and programs that

have an impact on them at every point along the continuum of care.

Patient engagement research is integrated into all key initiatives.

A range of methods is required to ensure the experiences of patients and those who support

them, including their families, friends and others, are heard and reflected in the BJH SCN’s

programs.

The BJH SCN is a strong proponent of patient engagement research and will leverage the

PACER.

b. Community engagement

The BJH SCN will engage with the general public and community groups across Alberta to

derive maximal value from their health care experiences and views as initiatives are planned

and carried out under the Transformational Roadmap. The following principles will be

applied in engaging the community:

14

Communities include residential areas, not-for-profit and for-profit organizations whose

work has a bearing on bone and joint health or health care, local and national policy

bodies, advocacy groups, and government.

Community engagement recognizes cultural, geographic and economic diversity.

Community engagement activities include sharing information, seeking input and

providing feedback on an ongoing basis.

The BJH SCN will participate in public education events to engage with community groups.

c. Clinician and researcher engagement

The BJH SCN believes improvement in MSK care will be most successful when it is led by the

people on the front lines of health care and research, and when care providers and managers

from Alberta Health Services’ five zones are engaged in the effort. Accordingly, the BJH SCN

will engage frontline care providers, private-practice clinicians such as physical and

occupational therapists, zone managers and researchers in all areas of activity, from

identifying and spreading leading practices to setting priorities and channelling evidence into

improved prevention and treatment. The following principles will be applied:

Care at all points along the continuum reflects the evidence-based consensus of

clinicians.

Care providers and managers from each of the zones are engaged in all programs under

the Transformational Roadmap.

Alberta has a productive MSK research network.

Health care providers from a broad range of disciplines and researchers and educators

from a broad range of faculties and educational institutions are involved in the BJH

SCN’s initiatives.

2. Communication

Strategic communications form an essential element of the BJH SCN’s Transformational

Roadmap. The BJH SCN will:

Engage in timely communication with its internal and external stakeholders.

Integrate into its initiatives the views of stakeholders.

Use a wide range of communications materials and services to reach Albertans,

recognizing the diversity of Alberta’s population.

3. Quality Improvement

The BJH SCN has been expanding its data and analytics capabilities as quality improvement

programs are launched. For example, in hip and knee replacement, data in a broad range of KPIs

are collected through ABJHI. The data are analyzed and interpreted by ABJHI to identify areas of

opportunity for improving the quality of care at the provider, site, zone and provincial levels.

The KPIs span the six quality dimensions that comprise the Quality Matrix for Health (Figure 3).

In another BJH SCN program, data are being collected and analyzed to identify Albertans who

have had a low-impact bone fracture suggesting osteoporosis. The program is intended to get

15

patients into treatment that will stop their osteoporosis from progressing and avert a

catastrophic fracture of the hip.

4. Technology

The BJH SCN is participating in the Health Data

Partnership, a collaborative project to establish

and operate Alberta’s first electronic platform for

standardizing, collecting, storing and sharing MSK

health care information. It would be built and

managed by government, Alberta Health Services

and the research community.

The Health Data Partnership would enable

clinicians to capture, store and share critical

patient health information, ensuring continuity of care, avoiding duplication of services, and

averting gaps in treatment along the continuum (Figure 5). Patients would have access to all of

their personal medical information in a single location. Researchers would have access to a rich

field of comprehensive and reliable data to support studies leading to better clinical practice,

patient outcomes and public policy. Service planners would have access to data they need for

measuring and reporting health system performance, modelling service need and demand, and

planning resources to meet demand.

Figure 5: The Health Data Partnership would capture, store and share critical patient health information.

Having information in a single location would enhance the ability of health care administrators

to safeguard the privacy of patient data. Access to information in the Health Data Partnership

would be subject to a governance model setting out strict practices and protocols for handling

data safely and securely.

The BJH SCN will look for other, related collaborative opportunities to advance the use of

technology.

5. Research, Innovation and Knowledge Translation

The BJH SCN seeks opportunities to spread the knowledge generated by its work and that of the

research community.

THE HEALTH DATA PARTNERSHIP

WOULD CAPTURE, STORE AND

SHARE CRITICAL PATIENT HEALTH

INFORMATION AVERTING GAPS IN

TREATMENT ALONG THE

CONTINUUM OF CARE.

HDP HUB

16

As a knowledge broker, the BJH SCN’s Scientific Director is well positioned to provide assistance

to investigators in the critical areas of knowledge management and knowledge translation,

helping to ensure their work is understood and shared broadly for maximal benefit.

Alberta has a highly respected and successful bone and joint health research network. The BJH

SCN’s Scientific Director and Assistant Scientific Director partner with members of this network

to increase collaboration among established research groups and emerging investigators. The

BJH SCN and its sister Strategic Clinical Networks have the common goals of:

Identifying and cultivating research opportunities in Alberta.

Generating evidence to inform best practices and influence decision making.

Helping to manage knowledge generated by research.

Supporting efforts to translate research knowledge.

Facilitating connections to research resources.

Leveraging research funding to evaluate innovative approaches to care.

The BJH SCN is working with members of the research community to facilitate interdisciplinary

research and the exchange of research innovations. By assisting in these areas, BJH SCN hopes to

accelerate the pace at which innovations move from the bench to bedside to community.

The BJH SCN’s Provincial Research Advisory Committee (PRAC) provides guidance in setting

research priorities and identifies research innovations with the potential to improve bone and

joint health and health care. PRAC also informs university-based researchers in Alberta of

opportunities to collaborate with the BJH SCN in areas of mutual interest.

PRAC has developed strategic plans outlining the areas in which the BJH SCN should focus its

research efforts over three-year and five-year periods. It recommends three priority areas:

1) Health system management, including waiting times for services, referral and central

intake systems, multidisciplinary team care, innovative technologies in surgery,

operational management, and economic evaluation.

2) Prevention of osteoarthritis, osteoporosis, pain, acute and chronic knee problems, low

back pain, and rheumatoid arthritis.

3) Knowledge translation and education related to bone and joint health, including the

appropriateness of treatments and services.

The BJH SCN is committed to integrating patient engagement research into its programs. This

will be achieved by collaborating with the PACER program.

6. Funding Models

The BJH SCN plans to initiate and lead reform of the methods used to fund the treatment of MSK

conditions in Alberta. The first step will be to introduce a funding model that incents providers

to work in teams. A team-based funding model is an effective approach for treating MSK

conditions, the majority of which are chronic and require the coordinated intervention of

multiple disciplines over a long period.

Current funding models in Alberta do not incent providers to function as a team coordinating

care across the full spectrum of services with the patient at the centre and working collectively

17

toward common treatment goals. Instead, there is a patchwork of misaligned funding methods.

For example, the majority of physicians in Alberta are paid a fee for service for treating their

patients. Hospitals have a global operating budget from which the cost of providing acute care

to patients is paid. Long-term care for patients is

funded on a case base.

This patchwork comes with contradictory

incentives. For example, hospitals aim to stay

within their global budgets and one method of

doing so is to ration care by limiting the number of

patients treated. Meanwhile, fee-for-service

compensation incents physicians to treat more

patients.

The BJH SCN’s plan for reform is supported by an analysis of the potential for improving the

methods used to fund the treatment of MSK conditions in Alberta. Commissioned in 2014, the

analysis examined the strengths and weaknesses of different funding options, identified the

most promising methods, examined the potential barriers to reform, and recommended

strategies for removing the barriers.

7. Human Resources

The BJH SCN will develop models of the current and future needs of local communities for MSK

health and health care. These models will identify the number of health professionals from

different disciplines required to promote good health, prevent injury and illness, and provide

non-surgical and surgical services. Health professionals will work in multidisciplinary teams that

leverage the knowledge and skills of individual team members. Using its models, the BJH SCN

will work with Alberta Health Services’ Human Resources department to plan appropriate

staffing levels to meet requirements in urban and rural areas and in high-need populations, such

as first nations and the frail elderly.

The collaborative practices principles of respect, accountability, transparency, engagement,

safety, learning and performance will be applied to maximize the effectiveness of the

multidisciplinary teams.

MISALIGNMENT OF FUNDING MAY

LEAD TO INEFFICIENCIES THAT

INCREASE COSTS AND REDUCE THE

QUALITY OF CARE PATIENTS

RECEIVE.

18

MUSCULOSKELETAL CARE TRANSFORMATION INITIATIVES 2015-2018

Signature Projects Are High-Profile

Each Strategic Clinical Network is obligated to undertake signature projects, so named for their high

profile with the public and inside the health system, and for their potential to have a significant impact

on health care services in Alberta.

The BJH SCN has two signature projects: the Hip and Knee Arthroplasty Program and the Fragility and

Stability Program.

1. Hip and Knee Arthroplasty Program

The Hip and Knee Arthroplasty Program is a suite of initiatives whose common objectives are to

encourage adherence to Alberta’s standardized care path for hip and knee replacement patients

and to improve the quality of care these patients receive. The program is being managed by ABJHI,

which has expertise in areas that are critical to its success, including performance measurement

and analysis, knowledge translation, frontline team strategies, and the use of improvement

methodologies, such as Learning Collaboratives and Balanced Scorecards. The program’s suite of

initiatives includes:

Frontline Quality Improvement Teams

Multidisciplinary arthroplasty teams are established in the 12 hospitals at which hip and knee

replacements are performed. Team members are selected from across the continuum of care,

including acute care units, rehabilitation, operating rooms and hip and knee central intake clinics.

They include the surgeons, nurses, therapists and managers whose day-to-day decisions directly

affect the quality of care patients receive.

Each team develops a strategic plan for improving its

performance and uses a Balanced Scorecard to

measure and track the results in a range of KPIs.

Across the province, the frontline teams have saved

approximately 43,000 hospital bed-days by reducing

patient length of stay. The bed-days have a cumulative value exceeding $42 million. Shorter

hospital stays are freeing up bed space for more patients. In 2014, there were 9,600 elective

primary hip and knee replacements, compared with just 6,000 a decade earlier – an increase of

73% with just 5% more acute care bed-days. Patient readmissions to hospital, already low and a

good measure of patient safety, have declined 20% over the past decade. This also saves money.

Each readmission avoided saves on average a 10-day hospital stay at a cost of $11,500.

Continuous Improvement Reporting to Surgeons

ABJHI produces semi-annually a confidential Continuous Improvement (CI) Report for each of 67

hip and knee replacement surgeons in Alberta. The reports are based on ABJHI’s analysis of

patient data gathered from the surgeons and administrative data from hospitals across Alberta.

The reports cover a 12-month period and show results in 17 KPIs across the six quality

dimensions.

TEAMS USE A BALANCED

SCORECARD TO MEASURE AND

TRACK RESULTS IN A RANGE OF

KEY PERFORMANCE INDICATORS.

19

Continuous Improvement Reporting to Zones

ABJHI aggregates and de-identifies the information in the surgeon reports to produce a CI

Report for each of the five health zones in Alberta. These reports provide results for each

hospital within the zone using aggregated patient data from the surgeons who practice at the

hospitals as well as administrative data.

Program Lead

Jane Squire Howden, Executive Director, Edmonton Musculoskeletal Centre.

2. Fragility and Stability Program

Fragility and Stability is a multifaceted program launched by the BJH SCN to prevent bone fracture

associated with osteoporosis and to introduce standardized care that is more patient-centred,

streamlined and evidence-based when a fracture occurs. The program is managed by ABJHI.

Fragility and Stability currently comprises three major components:

a. Develop and implement innovative programs to prevent osteoporotic fracture.

b. Implement across the province a standardized evidence-based acute care path for hip

fracture.

c. Design and implement evidence-based restorative care paths for hip fracture.

I. Prevention

The Prevention Working Group is developing a comprehensive strategy for identifying and

treating osteoporosis in the early stage of disease. A provincial campaign, called Catch a

Break, was launched in 2014 to reduce by up to half the 2,400 hip fractures experienced by

Albertans every year. Under the program, Health Link Alberta staff review bone fracture

patient charts to identify Albertans suspected of having had an osteoporotic fracture. These

patients and their family doctor are contacted and provided with information about

osteoporosis and strategies to stop it from progressing.

In Catch a Break’s first nine months, approximately 10,600 fracture patients were identified

as potential osteoporosis patients. About 7,000 were screened for osteoporosis and of these,

approximately 5,000 were identified as likely to have the disease and require treatment.

Project Lead

Dr. Angela Juby, Geriatrician, University of Alberta.

II. Acute Hip Fracture

The Quality Review Working Group is leading efforts to promote adherence across the

province to the evidence-based practices and protocols set out in a national acute care path

for hip fracture. It is currently focusing on three critical areas of the care path: 1) getting

patients into the operating room within 48 hours of their arrival at a hospital or clinic with a

hip fracture; 2) getting patients up and moving the day following their surgery; and 3)

transferring patients out of acute care and into the post-acute environment within seven

days of first presenting with a hip fracture at a hospital or clinic.

20

Project Leads

Dr. Rob Stiegelmar, Orthopaedic Surgeon and Facility Chief, Division of Orthopaedic Surgery,

University of Alberta Hospital.

Kyle Lang, Manager, Surgery and Women’s Health, Peter Lougheed Hospital.

III. Restorative Care

The Restorative Care Working Group is designing and implementing evidence-based care

paths for osteoporotic fracture of the hip joint. The new care paths will include putting

adequate resources in the community to meet patient needs following discharge from acute

care.

Project Leads

Allison Hermanns, Program Manager, Congregate Sites, Supportive Living, Continuing

Education, Edmonton Zone.

Dr. Douglas Faulder, Medical Director, Continuing Care, Edmonton Zone.

Priority Projects Demonstrate Musculoskeletal Transformation

Each Strategic Clinical Network undertakes priority projects that demonstrate transformation of

prevention and treatment services in high-need clinical areas. The BJH SCN has two priority projects:

Knee Soft Tissue Injury and Inflammatory Arthritis.

1. Knee Soft Tissue Injury

The Knee Soft Tissue Injury Working Group plans to implement a medical home model that will

introduce innovative primary (prevent injury) and secondary (prevent progression of disease)

prevention programs, and will make early assessment and triage, multidisciplinary team care, and

evidence-based guidelines and protocols standard across Alberta. It will provide patients with

education about their condition and treatment, and will give them the support they need along the

continuum of care. Performance related to benchmarks for service delivery and patient outcomes

will be measured and the results fed back to individual providers and to multidisciplinary teams to

promote continuous quality improvement.

Injuries to the soft tissue of the knee are among the most

common and clinically challenging MSK disorders in

emergency rooms and clinics.

Accurate and timely diagnosis and treatment increase the

likelihood of restoring fully the normal and pain-free use

of the injured knee and avoiding long-term disability.

However, delays and inappropriate treatment can lead to

chronic degenerative joint disease and loss of function.

The Knee Soft Tissue Injury Working Group will design and implement evidence-based clinical

pathways for both acute and chronic conditions arising from injury to the soft tissue of the knee. It

will also develop primary and secondary prevention programs.

INJURIES TO THE SOFT TISSUE OF

THE KNEE ARE AMONG THE MOST

COMMON AND CLINICALLY

CHALLENGING MSK DISORDERS IN

EMERGENCY ROOMS AND CLINICS.

21

Project Leads

Dr. Gordon Arnett, Orthopaedic Surgeon, Edmonton.

Dr. David Magee, Professor, Faculty of Rehabilitation Medicine, University of Alberta.

Prevention Subcommittee Leads

Dr. Carolyn Emery, Associate Dean, Research, Faculty of Kinesiology, University of Calgary.

Dr. Jackie Whittaker, Assistant Professor and Research Director, Glen Sather Sport Medicine

Clinic, Faculty of Rehabilitation Medicine, University of Alberta.

Acute Care Subcommittee Leads

Dr. Preston Wiley, Sport Medicine Physician and Associate Professor, Faculty of Kinesiology

and Department of Family Medicine, University of Calgary.

Dr. Catherine Hui, Orthopaedic Surgeon, Edmonton.

Non-acute Care Subcommittee Lead

Dr. Randy Gregg, Primary Care Physician, Edmonton.

2. Inflammatory Arthritis

The Inflammatory Arthritis Working Group will develop and manage several initiatives to meet the

biggest challenge in rheumatological care: getting patients accurately diagnosed and into

appropriate treatment before the inflammation in their joints causes irreversible joint damage and

disability. Among these is a plan to train a cadre of Advanced Care Practitioners (ACP).

ACP training will be available to health professionals including physicians, physiotherapists, nurses,

occupational therapists and other medical professionals. The Working Group is examining the

option of training ACPs through Advanced Clinician Practitioners in Arthritis Care (ACPAC), a 10-

month academic and clinical training program in rheumatological care initiated in Ontario. The

program was developed to facilitate the interprofessional, patient-centred collaborative approach

to patient care desired by the Working Group.

Working in a team setting and located around the province, ACPs will reduce the need for patients

in rural and remote areas to travel to Edmonton or Calgary, where nearly all of Alberta’s

rheumatologists are located. Working collaboratively with rheumatologists, they will improve the

capacity to care for patients at every point along the continuum. Together, these teams will assess

new cases, monitor and provide maintenance -level care of patients with inflammatory arthritis,

manage existing patients who experience a painful disease flare up, and free up additional

rheumatologist time to focus on the diagnosis and treatment of complex cases.

In addition to developing the plan to use ACPs, the Working Group has designed an evidence-based

provincial care path for RA patients. The care path is being implemented across Alberta. ABJHI

managed the new care path’s design on behalf of the BJH SCN.

Project Leads

Dr. Joanne Homik, Rheumatologist and Assistant Professor, Division of Rheumatology,

Department of Medicine, University of Alberta.

22

Project Status

Pilot triage centres are expected to be

operating in Edmonton and Calgary in 2015.

They will be evaluated by the SpineAccess

Alberta research team over an 18-month

period.

Project Status

Objectives for access to specialists and patient

outcomes have been established and a

framework for measuring performance against

objectives has been developed. Different central

intake models are being analyzed to find the

features best suited to meeting Alberta’s

objectives.

Dr. Dianne Mosher, Rheumatologist and Professor, Chief, Division of Rheumatology,

Department of Medicine, University of Calgary.

Research Projects

The BJH SCN is conducting two research projects: SpineAccess Alberta and Optimizing Central Intake to

Improve Arthritis Care.

1. SpineAccess Alberta

SpineAccess Alberta researchers will design a model that provides the right care to the right patient

at the right time. Two pilot triage centres will be set up for multidisciplinary teams with special

training in spine conditions to assess, triage and recommend treatment plans for patients. These

knowledgeable teams will reduce inappropriate referrals to specialists and unnecessary diagnostic

imaging, which are creating patient backlogs and

adding to long waiting times for consultation and

magnetic resonance imaging.

The pilot triage centres will be evaluated against

evidence-based benchmarks in key indicators of

performance. Expansion of the triage model across

the province will depend on the results of the pilot.

Principal Investigators

Dr. Linda Woodhouse, BJH SCN Scientific Director and Associate Professor , David Magee

Endowed Chair in Musculoskeletal Clinical Research, Department of Physical Therapy,

Faculty of Rehabilitation Medicine, University of Alberta.

Dr. Leah Phillips Adjunct Professor, Faculty of Rehabilitation Medicine, University of Alberta.

Dr. Greg Kawchuk, Professor and Canada Research Chair in Spinal Function, Faculty of

Rehabilitation Medicine, University of Alberta. – until June 2015

2. Optimizing Central Intake to Improve Arthritis Care

The research team is designing a centralized intake system that will reduce the waiting time for

consultation and treatment, and ensure patients are referred initially to the right specialist. The

team will set objectives for access and patient outcomes and analyze different central intake

models, selecting from them the features best

suited to meeting the objectives. The new

intake system will also be designed to

accommodate the projected increase in the

rates of disease and to expand to other MSK

conditions.

A measurement framework for evaluating the

centralized intake system’s performance is also

being developed by the research team.

23

Principal Investigators

Dr. Deborah Marshall, Advisor, Health technology Assessment and Research, ABJHI; Arthur

J.E. Child Chair of Rheumatology Outcomes Research; Canada Research Chair of Health

Services and Systems Research; and Associate Professor, Community Health Sciences,

University of Calgary.

Dr. Linda Woodhouse, BJH SCN Scientific Director and Associate Professor , David Magee

Endowed Chair in Musculoskeletal Clinical Research, Department of Physical Therapy,

Faculty of Rehabilitation Medicine, University of Alberta.

Pan-SCN Activities

The prevalence and pervasiveness of MSK conditions create opportunities for the BJH SCN to collaborate

with other Strategic Clinical Networks serving the same at-risk patient populations or those with related

disorders. For example, the prevalence of many MSK conditions increases markedly with age, surgery is

frequently required to repair MSK damage, and many MSK conditions are associated with lifestyle

factors, such as obesity. These risk factors may present opportunities for the BJH SCN to collaborate

with the Seniors Health SCN, the Surgery SCN, and the Diabetes, Obesity and Nutrition SCN.

Indeed, collaboration is already well under way. The BJH SCN is working with the Seniors Health SCN to

perform a cost-effectiveness analysis of services associated with surgery for osteoporotic hip fracture.

The work is associated with the BJH SCN’s Fragility and Stability program.

The BJH SCN is also collaborating with the Surgery SCN to move patients quickly into surgery following

hip fracture. The objective is to perform surgery within 48 hours of the patient first presenting at a

hospital or clinic. This work is also associated with the Fragility and Stability program.

These collaborative initiatives, known as cross-cutting projects within the Strategic Clinical Network

community, illustrate the SCNs’ flexibility in pooling knowledge, skills and resources to maximize results.

24

Appendix A – Bone and Joint Health Strategic Clinical Network Core Committee The BJH SCN’s leadership and Core Committee membership comprise individuals from different

disciplines and from Alberta Health Services and external organizations. Membership on the BJH SCN’s

Core Committee changes periodically. The BJH SCN deeply appreciates the contributions of all past and

current members of the Core Committee. The following were active members as of June 2015:

Alex Charlton, Clinical Practice Lead, Rockyview General Hospital

Allan Ryan, Executive Director, Priorities and Performance, Alberta Health Services

Christopher Smith, Chief Operating Officer, Alberta Bone and Joint Health Institute

Clayne Steed, Primary Care Physician, South Zone

Dave Hanley, Metabolic Bone Specialist, University of Calgary

Dave Hart, Professor of Microbiology, Immunology & Infectious Diseases, University of Calgary

Dianne Mosher, Internal Medicine, Rheumatology, Calgary Zone

Don Dick, Senior Medical Director, Bone and Joint Health SCN

Geoff Schneider, Physiotherapist, Researcher, Calgary

Gordon Arnett, Orthopedic Surgeon, Edmonton

Jane Squire Howden, Executive Director, Edmonton MSK Centre

Jean Miller, Patient Engagement Researcher

Joanna Homik, Associate Professor, Rheumatology, University of Alberta

Joanna Oda, Medical Officer of Health, Edmonton

June Norris, Senior Practice Lead, Physiotherapy, Interprofessional Practice Team, Allied Health

Kelley De Souza, Medical Director, Rockyview General Hospital

Kelly Martial, Program Manager, Inpatient Orthopedics/Surgical Float Pool, Covenant Health, Edmonton

Kyle Lang, Manager, Peter Lougheed Centre, Calgary Zone

Linda Woodhouse, Scientific Director, Bone and Joint Health SCN

Lynne Mansell, Senior Provincial Director, Bone and Joint Health SCN

Lynne Malmquist, Senior Knowledge Management Consultant, Alberta Health Services

Marie Lyle, Acting Executive Director, Acute Care, Alberta Health

Marty Landrie, Senior Manager, Aboriginal Health Program, Central/Edmonton Zone

Mel Slomp, Executive Director, Bone and Joint Health SCN

Nav Rattan, Podiatric Surgeon, Family and Sports Medicine, Red Deer

Nick Antonopoulos, IT Manager, Edmonton Zone

Noorshina Virani, Physical Medicine Specialist, Calgary Zone

Pam Gossmann, Nurse Practitioner, Rockyview General Hospital

Rob Stiegelmar, Orthopedic Surgeon, Edmonton MSK Centre

Robert Swanson, Director, Medical Surgical Inpatient Services, Red Deer

Sheila Kelly, Manager, Bone and Joint Health SCN

Stephen Aaron, Internal Medicine, Rheumatology, Heritage Medical Research Centre

Stephen Weiss, Executive Director, Alberta Bone and Joint Health Institute

25

Steve Chambers, Primary Care Physician, Allin Clinic, Edmonton

Susan Reader, Executive Director, Surgery SCN, Calgary

Tanya Christiansen, Administrative Manager, Alberta Hip and Knee Clinic, Calgary

Ted Pfister, Assessment Analyst, Health Technology Assessment & Adoption, Alberta Health Services

Terri May, Business and Operations Manager, McCaig Institute for Bone and Joint Health

Tim Pearce, Orthopedic Surgeon, Red Deer

Tim Takahashi, Certified Athletic Therapist, Rebound Health Centre, Lethbridge

Tracey Geyer, Senior Health Planner, Planning and Performance, Alberta Health Services

Wynand Wessels, Orthopedic Surgeon, North Zone

Yolanda Lackie, Senior Director, Operations, Covenant Health