Follow us @nccmt Suivez-nous @ccnmo
Funded by the Public Health Agency of Canada | Affiliated with McMaster UniversityProduction of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The
views expressed here do not necessarily reflect the views of the Public Health Agency of Canada..
Peer-to-Peer Webinar: Success Stories in EIDM
Webinar 2 - Featuring:
Establishing a Community of Practice to Build Knowledge
and Skills in EIDM
Zsuzsi Rety, Amanda Harvey and Faye Parascandalo, City of Hamilton
Public Health Services
Applying the Access Improvement Measure Process
for Well-child Immunization
Sandy Phillips and Wendy Timmermans, Alberta Health Services
October 19, 2017 1:00 – 2:30 PM ET
Follow us @nccmt Suivez-nous @ccnmo2
Housekeeping
Use Chat to post comments and/or
questions during the webinar
• ‘Send’ questions to All (not
privately to ‘Host’)
Connection issues
• Recommend using a wired
Internet connection (vs.
wireless),
• WebEx 24/7 help line
• 1-866-229-3239
Participant Side
Panel in WebEx
Chat
Follow us @nccmt Suivez-nous @ccnmo3
After Today
Presentation slides (in English and French) and a
video recording (in English) will be posted.
These resources will be available at:
http://www.nccmt.ca/capacity-development/webinars/previous-webinars
Surveys will be conducted immediately following
webinar and in 2-3 months.
Follow us @nccmt Suivez-nous @ccnmo4
How many people are watching
today’s session with you?
Poll Question #1
a. Just me
b. 1-3
c. 4-5
d. 6-10
e. >10
Follow us @nccmt Suivez-nous @ccnmo5
NCC
Infectious
DiseasesWinnipeg, MB
NCC
Methods
and ToolsHamilton, ON
NCC Healthy
Public PolicyMontreal, QC
NCC
Determinants
of HealthAntigonish, NS
NCC
Aboriginal
HealthPrince George, BC
NCC
Environmental
HealthVancouver, BC
6
Registry of Methods and Tools
Online Learning
Opportunities
WorkshopsVideo Series
Public Health+
Networking and
Outreach
NCCMT Products and Services
7
Follow us @nccmt Suivez-nous @ccnmo
The EIDM Casebook
• Collection of success
stories in public health
• Available at
www.nccmt.ca/impact/
eidm-casebook
8
Presented by:
ESTABLISHING A COMMUNITY OF PRACTICE TO BUILD KNOWLEDGE AND SKILLS IN
EVIDENCE-INFORMED DECISION MAKING WITHIN A PUBLIC HEALTH SETTING
City of Hamilton Public Health Services
October 19, 2017
Zsuzsi Rety
Public Health Nurse
Amanda Harvey
Competency Development Specialist
Suzanne Neumann
Public Health Nutritionist
Vicki Edwards
Public Health Nutritionist
Michelle Wawrzyniak
Public Health Nurse
Faye Parascandalo
Public Health Nurse
OBJECTIVES
• Illustrate how the City of Hamilton Public Health
Services is implementing Evidence-Informed
Decision-Making (EIDM)
• Discuss barriers to implementing EIDM initiatives
and how we overcame them
• Entice webinar participants to start or enhance their
EIDM strategy
BACKGROUND
• Participated in KB Mentoring Program at NCCMT
• Needed a way to build and practice new skills
• Started a Community of Practice (CoP)
• Established shared goals and objectives
• Supported by NCCMT mentor
• Participation grew over time
TERMS OF REFERENCE OBJECTIVES
1. To develop staff capacity to appraise relevant
public health research.
2. To develop staff capacity to apply validated EIDM
tools in practice.
3. To support program teams in their efforts to
appraise research and use EIDM.
KEY RECOMMENDATIONS
1. Secure management support at the outset
2. Identify mentors for involvement
3. Encourage volunteer over mandated participation
4. Determine participant needs to drive the focus and goals for the CoP
5. Establish and adapt a Terms of Reference to continually meet
participant needs
6. Track participation
7. Empower staff to take turns leading the meetings
8. Encourage knowledge transfer to non-participants where relevant.
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
SECURE MANAGEMENT SUPPORT AT
THE OUTSET
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
IDENTIFY MENTORS FOR INVOLVEMENT
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
ENCOURAGE VOLUNTEER OVER
MANDATED PARTICIPATION
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
DETERMINE PARTICIPANT NEEDS TO DRIVE
THE FOCUS AND GOALS FOR THE CoP
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
ESTABLISH AND ADAPT A TERMS OF
REFERENCE TO CONTINUALLY MEET
PARTICIPANT NEEDS
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
TRACK PARTICIPATION
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
EMPOWER STAFF TO TAKE TURNS
LEADING THE MEETINGS
Lack of management
support
Lack of
mentors/expertise
Low participation rates Lack of visibility
Culture (learning culture) Resources (time) Staff buy-in Silos
Lack of ownership Not an organizational
priority
Lack of direction/
expectations
Burden on key staff
An add-on to typical workload of staff
ENCOURAGE KNOWLEDGE TRANSFER TO
NON-PARTICIPANTS WHERE RELEVANT
SINCE THE CASEBOOK
• CoP ongoing
• Organizational priority
• Trained 20 more people
• EIDM being embedded in processes
NEXT STEPS
• Training
• Evaluation
• Culture change
OBJECTIVES
• Illustrate how the City of Hamilton Public Health
Services is implementing EIDM
• Discuss barriers to implementing EIDM initiatives
and how we overcame them
• Entice participants to start or enhance their EIDM
strategy
COMMITMENT TO CHANGE
In the chat pod please tell us:
• What are your next steps?
• What will you bring back to your organization?
QUESTIONS AND DISCUSSION
Follow us @nccmt Suivez-nous @ccnmo28
Your Comments/Questions
• Use Chat to post comments
and/or questions
• ‘Send’ questions to All (not
privately to ‘Host’)
Chat
Participant Side
Panel in WebEx
Follow us @nccmt Suivez-nous @ccnmo29
Presenters
Wendy Timmermans, RN,
BScN, CCHN(c)
Alberta Health Services
Sandy Phillips, RN, BN, MN,
CCHN(c)
Alberta Health Services
ALBERTA AIMACCESS * IMPROVEMENT * MEASURES
THORNHILL COMMUNITY HEALTH CENTER
Well Child Immunization
October 19, 2017
The only person who likes
CHANGE is a baby in a wet
diaper! Anonymous
AIM helps healthcare teams to assess their process to improve client access
A collaborative model of learning for achieving high quality, team–based clinical care. The model was guided by expert facilitators but implemented at our local WC clinic (Thornhill)
Following processes were applied:
Team:Improvement teams represented all key roles in the clinic - "those who do the work must change the work.“ The team (a nurse, clerk and managers) met every 1-2 weeks in addition to 5 X 1 ½ day learning sessions.
Aim:Set specific, measurable goals for client access, office efficiency and clinical care.
Map:Built a flow map to understand all the elements of a client's visit through the clinic, and identified where challenges and constraints exist.
An All-Inclusive Resort…
Process Maps
Client phones into
CHC
Client selects from
phone tree options
(55 secs long)
Client presses
Option #3
Client greeted by
clerk on phone
Client Addressed
by Clerk
immediately
(Not placed on
Hold)
Client placed on
Hold
Client taken off
Hold and greeted
by Clerk
Client advised to
come to office to
complete New
Client Form and
bring Vaccination
History
Client arrives at
CHC Reception to
make Appointment
or Register
New Client Phones into CHC (From Outside Calgary Zone)
New Client Arrives at CHC (From Outside Calgary Zone)
Client arrives at or
calls into CHC
New Client To Thornhill CHC (From Within Calgary or Rural Area)
Clerk looks up
Vaccination History
in Phantim Reports
Clerk enters
Vaccination
History in
Phantim
Clerical
verifies
clerical data
entry
Determine if
client has an
AB PHN / ULI
#
Clerk requests AB
PHN (ULI #) from
client
Within
Calgary
and
Airdrie &
Cochrane
Urban +
Rural Area
excludes
Airdrie,
Cochrane
Rural
No
Yes
Existing Client in Phantim (Urban Calgary/Airdrie/Cochane)
Client
phones into
CHC
Client selects from
phone tree options
(55 secs long)
Client
presses
Option #3
Client greeted
by Clerk on
phone
Client taken off
hold and
greeted by
Clerk
Clerk looks
up client’s
info in
Phantim
Clerk verifies
client
vaccination
due /
demographics,
etc
Clerk goes
into Phantim
& changes
demographics
for baby
Clerk offers
appointment to
ClientYes
No
Clerk goes into
Phantim and
changes
demographics
for parents
Client specified
preference: am/
pm/evening clinic
& day of week
Clerk searches
for next available
appointment
Client
phones
into clinic
Client
enters
Phone
Tree
Client greeted by
Clerk on phone
(may be placed on
hold)
Clerk looks
up Client in
Phantim
Clerk verifies
Client
Vaccinations
due
Clerk verifies
Client
demographics and
contact
information
Client completes
New Client
Registration form
Clerk contacts
client to schedule
appointment
Clerk contacts
client to schedule
appointment
Client is then
treated as a new
client (see above)
Client provides
vaccination history
to clerk or faxes to
CHC
Yes
Vaccination History
received at CHC &
entered into PhantimClerk/Client completes and faxes
“Request for Vaccination History Form
to applicable site
Clerk photocopies
Vaccination History
and adds to client
chart
No
For clients without an
AB PHN (ULI#)
See Page 2
Go to “Making
Appointment” Map
Thornhill Community Health Center (Feb/Mar 2014)
Are Changes
Required
Is Client’s
Vaccination
History
available?
Where does
Client Live
Is Client in
Medipatient
System?
Is client placed
on hold?
Yes
No
Measure:
Collect and analyze data to understand performance and assess
the impact of changes (positive or negative improvements).
Ongoing measurement is essential to improve and maintain top
system performance.
Change:
Tests of change are applied using The Model for Improvement
PDSA (Plan-Do-Study-Act) cycles.
Sustain/Spread:
Sustain the gains, celebrate success and spread a culture of
improvement throughout the clinic and larger team or system.
AIM for Thornhill CHC
Reduce wait times from 65 days (Jan 2014) to 42
days by November 1/2014 With 2.0 FTE Augmentation and 100% Backfill, wait
times were at 6 days by May 26th, 2014.
Augmentation and full Backfill were discontinued
September 30th and wait times were back to 67 days
on October 13t, 2014 (as of Mar 13/15 - 72 days).
Office Efficiency Aim To increase process efficiency - amount of time that
the client can spend with the nurse in clinic is
maximized.
Decrease/address bottlenecks in the clinic process
from the time the client checks in.
Patient Survey Analysis
A total of 202 surveys were returned
Rated length of time spent with the nurse during the visit =
“Just Right”- 96% of time.
Rated the amount of information shared with them during their
appointment = “Correct Amount” – 95%.
Rated their visit = “Very Satisfactory” - 83%.
Areas for Improvement
Waited too long for an appointment.
Difficulty getting through on the phone to book an appointment.
Waited too long on hold on the phone.
Waited too long in the waiting room to see the nurse.
ENGAGE STAFF IN AIM BY:
Idea Parking Lot for staff to document their suggestions for
improvement/efficiencies with ongoing input of staff ideas.
PDSA Board in the staff room with up to date information on
planned/completed PDSAs with accompanying data.
Health Care Team Effectiveness Analysis completed by all staff
Designed to develop excellence in teamwork and collaboration.
Goal is to improve healthcare delivery through enhanced efficiency of
interdisciplinary teams.
Share AIM information at staff meetings.
All staff are involved in implementing the PDSAs and provide feedback.
Storyboard was created with up to date information (available in clinic and
presented at AIM Learning Sessions).
IDEAL SITUATION:
Demand matches Supply and matches Activity
D = S = A
DEMAND
Demand is the measure of “workload” generated (appointment demand)
Multiple ways to measure demand: yearly; daily basis; by panel size (number of clients in a practice); new appointments (new demand – 2 month visit); return appointments (return demand).
Demand is counted on the day it is generated - appointment requested on October 15th for November 20th. The Demand is counted on October 15th. (Done manually by the clerical when the client requests an appointment (phone and in person).
DEMAND – Anticipated Demand Outweighs Current Supply
Example #1
Birthrate of approximately 257/month with 2 monthers = 2 X 30 minute appointments 4, 6,12,18 monthers = 1 X 30 minute appointments REQUIRE: 4626 X 30 minute appointments/12 weeks
Staffing with NO augmentation provides 4302 appointments/12 weeks , therefore the clinic is short 324 appointments/12 weeks This doesn’t include vaccinating Preschoolers, Adults or In-Migration.
Further, Preschoolers = 2628 children (upcoming year)= 606 appts/12 weeks. We are short 930 appts without considering Adults (10 minute appts)
or In-Migration. This is based on Preschoolers coming throughout the year versus our reality = a surge before the start of the school year.
Note: Birthrate has now increased to approx 275/month. Calgary Zone Population increase of 38,000 from 2013 to 2014.
SUPPLY
Is a measure of what could be done (in a perfect scenario).
Reflects the total number of minutes the provider can provide for appointments (captured in 10 minute increments with AIM).
It’s the number of available appointments and captures the planned work, not the actual work completed (e.g. clinic nurse away due to vacation/education etc. and not replaced).
Appointment length has an effect on the available appointments per day (10 minute, 30 minute and 60 minute appointments).
ACTIVITY
Activity is also called the “supply used” and is the actual
number of appointments seen.
It measures the time (in minutes) that the provider actually
spends with the client (those clients that show for their
appointments).
No Shows and Cancellations are NOT ACTIVITY – they count as
Demand but do not materialize as Activity
Activity can be greater or less than either Supply or Demand
HOW TO MEASURE Demand, Supply and Activity
This is performed daily
Supply: Took the number of nurses assigned to clinic in Phantim
to determine our Supply (each AM clinic, a nurse does 1x10, 1x60
and 4x30 min appointments).
Demand is measured by the number of requests that the clerical
receive for specific appointments. Demand is measured at the
time of the call, not the actual appointment date.
Variance – clerks may be busy and may not accurately track
the appointments.
Activity is measured/entered daily by Secretary through Phantim.
0
10
20
30
40
50
60
70
80
12-M
ay-1
4
19-M
ay-1
4
26-M
ay-1
4
2-J
un-1
4
9-J
un-1
4
16-J
un-1
4
23-J
un-1
4
30-J
un-1
4
7-J
ul-1
4
14-J
ul-1
4
21-J
ul-1
4
28-J
ul-1
4
4-A
ug
-14
11-A
ug-1
4
18-A
ug-1
4
25-A
ug-1
4
1-S
ep
-14
8-S
ep
-14
15-S
ep-1
4
22-S
ep-1
4
29-S
ep-1
4
6-O
ct-
14
13-O
ct-
14
20-O
ct-
14
Da
ys
Timeline
100% Clinic Backfilling for
vacation/sick time/leaves
ended Sept 30/14.
School nurses assigned
to clinic July 7 – Aug 15/14 = ↑Supply
Staggered Start
Times began
Oct 1/14
Augmented 570
extra appts May 12-
June 30/14
THIRD NEXT AVAILABLE APPOINTMENT
PDSA: New Phone Tree Message
Old Phone Tree
Takes 49 seconds to be transferred to a person
New Phone Tree
Takes 20 seconds to be transferred to a person
PDSA: Chart Verification
PDSA: Check In and Check Out Process
75%
0%
25%
0%
Not Working Well
Neutral
Working OK
Working Great
Pre PDSA: Clerk Satisfaction with Check
In Process
N 4
17%
33%
50%
0%
Not Working Well
Neutral
Working OK
Working Great
Post PDSA: Clerk Satisfaction with Check In
Process
N = 6
PDSA: Wait List Management
PDSA: Another Nurse Weighs Infant
PDSA: Undress Baby Before Appointment
PDSA: Bookmarks for each Age Group
www.jdennissn.wix.com/hphc
PDSA: Posting Cost of No Shows in Waiting Room
PDSA: No Shows
What do we want to put here?????
0%
2%
4%
6%
8%
10%
12%
12-M
ay-1
4
19-M
ay-1
4
26-M
ay-1
4
2-J
un-1
4
9-J
un-1
4
16-J
un
-14
23-J
un
-14
30-J
un
-14
7-J
ul-1
4
14-J
ul-
14
21-J
ul-
14
28-J
ul-
14
4-A
ug
-14
11-A
ug
-14
18-A
ug
-14
25-A
ug
-14
1-S
ep
-14
8-S
ep
-14
15-S
ep
-14
22-S
ep
-14
29-S
ep
-14
6-O
ct-
14
13-O
ct-
14
20-O
ct-
14
No
Sh
ow
Pe
rce
nta
ge
Timeline
No Show Chart
Clinic Average None None None
Weather aberation
affects attendance.
Calgary Stampede
Proposed schedule will ↓ the underutilized 10 min
appts and gain a 30 min appt for each nurse –
M,W,F (if you have 5 AM clinics each (M,W,F) = 15
additional 30 min appt per week. Will have 10 min
appt in Evenings and Tuesday & Thursday all clinics
PDSA: Increasing Supply with Appointment Schedule
May 23 - June 27th, 2014
Supply = 496 appts
Demand = 384 appts (77% used)
Activity = 343 appts (89% of the Demand)
Activity (69% of the Supply)
No Show = 39 appts (10.1%) 112 appts not booked
115 +39/496 appts were not used = 30.4%
September 02 – October 04, 2014Supply = 435 appts
Demand = 310 appts (77.42% used)
Activity = 277 appts (89% of the Demand)
Activity (64% of the Supply)
No Show = 32 appts (10.3%)157 appts not booked
157+32/435 appts were not used = 43.4%
Thinking
or
Stinking!
PROPOSED SCHEDULE (3 mornings/week)
↓Underutilized 10 minute appts = ↑30 min appts
TIME APPOINTMENT LENGTH
0820 – 0850 30 minutes
0850 – 0920 30 minutes
0920 – 0950 30 minutes
0950 – 1005 Coffee Break (15 mins)
Are 2 X 30 mins combined
1005 – 1105 60 minutes
1105 – 1135 30 minutes
1135 – 1205 30 minutes
1205 – 1220 Stocking Rooms
PDSA: Preschool Appointment Recall
Mail out monthly reminders to parents re: Preschooler’s
Vaccinations
@ 200 reminders/month to balance the Demand stream.
37% of 162 No Shows for July, 2014 were Preschoolers.
Re-evaluate this PDSA as there are plans to use the automated dialing
system to do this.
GOING FORWARD
Rolled out to Calgary Zone Community Health Centres:
Undress your baby poster
Bookmarks for HPHC Resource
Modification of the phone tree at various sites
Measurement of Demand, Supply & Activity
Wait list management process
At Thornhill we now have a QI committee (Clinic rooms,
Student anxiety, etc.)
Resources to Share
Resources to Share
How would you rate this wait?
Not Acceptable
At All
Not Very
Acceptable
Moderately
Acceptable Acceptable Very Acceptable
How would you rate the usual wait for an appointment when you (the patient) are sick
and call your medical clinic for an appointment?
Not Acceptable
At All
Not Very
Acceptable
Moderately
Acceptable Acceptable Very Acceptable
How would you rate getting this medical appointment fitting in with your schedule?
Very Easy Fairly Easy Neutral Not Very Easy Not At All Easy
How long did you wait for your appointment to start after you arrived?
Less than 5 minutes
5 to 10 minutes
11 to 20 minutes
21 to 30 minutes
More than 30 minutes
There was no set time for my appointment
How would you rate this wait?
Not Acceptable
At All
Not Very
Acceptable
Moderately
Acceptable Acceptable Very Acceptable
How would you rate the length of time spent with the healthcare provider you (the
patient) saw today?
Much too short Too short Just right Too long Much Too Long
How often do you leave the doctor’s office with unanswered questions?
Never Sometimes Often Always
THORNHILL CLERK SATISFACTION WITH NEW CHECK IN PROCESS (Pre PDSA)
Not Working Well Neutral Working OK Working Great
“Oh Geez” “Meh” “Yah Baby” “Awesome Dude”
Please check off which box applies.
Thank you!
QUESTIONS
For more information:
Sandy Phillips – [email protected]
Wendy Timmermans - [email protected]
Follow us @nccmt Suivez-nous @ccnmo59
Your Comments/Questions
• Use Chat to post comments
and/or questions
• ‘Send’ questions to All (not
privately to ‘Host’)
Chat
Participant Side
Panel in WebEx
Follow us @nccmt Suivez-nous @ccnmo
Share your story!
• Are you using EIDM in your practice? We want
to hear about it!
• Email us: [email protected]
• Need support for EIDM? Contact us for help!
• Email us: [email protected]
• We typically respond within 24 business hours
60
Follow us @nccmt Suivez-nous @ccnmo61
Your Feedback is Important
Please take a few minutes to share your thoughts
on today’s webinar.
Your comments and suggestions help to improve
the resources we offer and plan future webinars.
The short survey is available at:
https://nccmt.co1.qualtrics.com/jfe/form/SV_7QKry4LCPFju
B4F
Follow us @nccmt Suivez-nous @ccnmo62
Join us for our next webinar
Webinar 3 - Featuring:
Effective Psychological and Psychosocial Interventions to Prevent
Perinatal Depression and Anxiety Disorders: A Rapid Review and
Applicability Assessment
Becky Blair, Louise Azzara, John Barbaro, and Amy Faulkner, Simcoe-
Muskoka District Health Unit
Building a Best Practice Tool to Address the Needs of Clients with
Hepatitis C Mary Guyton and Heidi Parker, Sherbourne Health Centre Site
Date: November 15, 2017
Time: 1:00 – 2:30pm EST
Register at: https://health-evidence.webex.com/health-
evidence/onstage/g.php?MTID=ef084d07d25268ba09bde5c40330205b2
Follow us @nccmt Suivez-nous @ccnmo
Webinar Series from NCCMT
www.nccmt.ca/webinar-series
• Spotlight on Methods and Tools
• Topic-Specific Methods and Tools
• Online Journal Club
• Peer-to-peer Webinars
63
Follow us @nccmt Suivez-nous @ccnmo
Funded by the Public Health Agency of Canada | Affiliated with McMaster UniversityProduction of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The
views expressed here do not necessarily reflect the views of the Public Health Agency of Canada..
For more information about the National Collaborating Centre for Methods and Tools:NCCMT website www.nccmt.ca
Contact: [email protected]
Top Related