Green Shield Canada Foundation Health Innovation Collaborative
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Green Shield Canada Foundation Health Innovation Collaborative
GSC Foundation Mission To create innovative solutions that improve access to better health
Agenda for today
• Introduce the Green Shield Canada
Foundation (GSCF) Health
Innovative Collaborative (HIC)
• Introduce our panel & their projects
• Audience interaction
• Re-group
• Closing thoughts
The Story
of Bob
Smith
Before and after
the GSCF
Health
Innovation
Collaborative
(HIC)
http://www.rgbstock.com/photo/mhBLDMW/Old+Wise+Man
Bob Smith: Before the HIC • 80 years of age, living alone, with diabetes, arthritis and a colostomy from colon cancer • He is becoming increasingly forgetful • Has trouble getting an appointment with his family physician (increasingly confused) • Jane, his daughter, who lives far away, tries to make appointments whenever she is in town
A preventable and costly admission • Mr. Smith trips on a rug and breaks his wrist • A neighbour finds him the next day, agitated • He spends 36 hours on a gurney in the Emergency Department of a nearby hospital • He is given antipsychotics • While on the ward, he gets a C. difficile infection and is isolated
• He is unable to return home and
A sad waits eight weeks to get a bed in a
ending nursing home
• Over the next two years, he makes
six trips to the ER for infections and
dehydration, with three admissions,
each lasting between 3 and 5 days
• Despite his original wish to die at
home, he develops infected bed
sores at the Long Term Care Facility
and requires another hospital
admission
• He dies in a hospital ward, alone, at
age 82
The GSCF HIC Enter the GSCF Health Innovation Collaborative (HIC). Each member organization was chosen for their unique and innovative approach to improving health care. The organizations and their respective projects funded by GSCF include: • Bridgepoint Active Healthcare, Bridge2Health: a website of recommended health information resources for people living with complex conditions and disabilities, and their families. • Centre for Global eHealth Innovation, Health eConcierge: an online ecosystem that makes it easier for the public to find health and social services that meet their needs. • Alzheimer Society of Toronto, Dementia Care Training Program: an online training program for Personal Support Workers and primary caregivers in dementia care excellence. • SPRINT Senior Care, HouseCalls: an interdisciplinary, home-based, primary healthcare program for frail and homebound seniors. • St. Michael's Hospital, Virtual Ward: a program designed to improve health outcomes for patients who have been recently discharged from the hospital by improving access to home-based interdisciplinary team-based care.
Bob Smith & the HIC • When Mr. Smith is 79, Jane learns about the Health eConcierge and links to Bridge2Health where she finds information on home safety and peer support for her father, and caregiving information and support for herself • The Health eConcierge connects them with counsellors at 211 who identify agencies that help Mr. Smith with bathing, meals, grocery shopping, social interaction, and the installation of an alarm system • The rug is removed, preventing Mr. Smith’s fall
Coordinated Support • The Alzheimer Society instructs Mr. Smith’s Personal Support Worker and trains Jane as a caregiver, through counsellors and its eLearning resources • Jane uses Bridge2Health again to access legal and financial-related resources she will need in the years ahead, such as powers of attorney and advance care plans • When Mr. Smith is 81, he develops severe diarrhea and needs to be admitted to hospital for several days for dehydration • He is identified as being at high risk for post-discharge complications and is therefore "admitted" to the Virtual Ward on the day he goes home
Coordinated Support
• The Virtual Ward case manager assesses Mr. Smith at
home the day after he is discharged. She notes that he is
still dizzy when he stands up and that he is not sure what
medications he is supposed to be taking. She asks the
Virtual Ward pharmacist to see him. He sees him the next
day, and notes that Mr. Smith is stillSt.taking a diuretic
Mikes Virtual Ward that
was discontinued in hospital. He calls Mr. Smith's pharmacy
and arranges for the medications to be "blister packed" to
avoid medication errors.
• The Virtual Ward team also discovers, in speaking with
Jane, that Mr. Smith no longer sees his family doctor
because of mobility problems. Mr. Smith is referred for
ongoing interdisciplinary care by the House Calls teamA Peaceful Death at Home • Over two years, the House Calls team treats pneumonia and dehydration at home, preventing re-admissions • One day the House Calls team is called in due to abdominal pain. Tests reveal that the cancer has spread to the liver and is incurable • The House Calls team uses Bridge2Health to refer Jane to the Canadian Virtual Hospice and the Community Care Access Centres to support her at this difficult time • The team mobilizes additional services identified through the Health eConcierge and is trained by the Alzheimer Society on how to support patients and families affected by dementia • Mr. Smith dies at home, peacefully, with Jane by his side
GSFC HIC Proposed Impact Measures
• Improve quality and accessibility of care for seniors in the GTA region,
aged 65+ with multiple complex chronic health issues.
• Expand opportunities for care at home, improving the quality of life of
seniors and their informal caregivers.
• Reduce Emergency Department visits, hospital admissions/re‐
admissions, and admissions to Long‐Term Care (LTC) facilities by
improving community or at‐home services and support.
• Increase the skills of Personal Support Workers (PSWs) who work
directly with seniors in their homes.
• Increase the availability of online and mobile resources which offer
practical tools to connect seniors and their informal caregivers to local
health care providers.
13Bridgepoint Bridge2Health
UHN Health eConcierge
SPRINT Senior Care House Calls
What is SPRINT Senior Care?
SPRINT Senior Care (formerly known as
Senior Peoples’ Resources in North
Toronto) was established in 1983.
We are a not for profit, community
support service (CSS) agency comprised
of just over 225 staff and just over 450
volunteers.
Main funding sources: the Ministry of
Health and Long Term Care (via the
Toronto Central LHIN, the City of
Toronto, and the United Way)
21What We Do
• Provide a basket of practical, low-cost programs and
services that help clients stay safe, connected, and live
as independently as possible
• Prevent premature or inappropriate institutionalization
• Supply programs and services regardless of race,
religion, ethnic origin, citizenship, marital status, or
gender identity
• Practice senior-centred care
22Overview of Our Services
• Caregiver education and support • Dementia care residence
• Counselling and support groups • In‐home care
• Footcare • Supportive housing
• Health and wellness programs • Primary care (House Calls)
• Programs for seniors with dementia, other
cognitive impairments and/or physical
challenges
• Security checks
• Community dining • Transportation
• Farmers’ markets
• Meals on WheelsWhat is House Calls? • Interdisciplinary primary healthcare program providing ongoing comprehensive geriatric home-based primary care since 2009. • Unique collaborative led by Dr. Mark Nowaczynski, Clinical Director, and SPRINT Senior Care, Lead Administrative Agency, House Calls provides comprehensive primary medical care, as well as occupational therapy, physiotherapy and social work. • House Calls also facilitates connections to community support services for homebound seniors with physical, cognitive and social frailties. • House Calls and its partners work closely with hospitals and other health care providers to foster client-centred care, especially during transitions between care providers.
House Calls Team House Calls team members include: • Physicians (3 FTE) • Nurse Practitioner (1 FTE) • Occupational Therapist (1.5 FTE) • Social Worker (1 FTE) • Physio Therapist (0.5 FTE) • Team Coordinator (1 FTE) • Rehab Assistant (0.7 FTE) • Community Paramedic
House Calls Key Partners /
Supporters
Our key partners are:
• VHA Home Healthcare
• Mt. Sinai Hospital
• University of Toronto
• Toronto Paramedic Services (formerly EMS)
We are supported by:
• TC LHIN
• Green Shield Canada FoundationAlzheimer Society Toronto Online Dementia Care Training
St. Mike’s Hospital Virtual Ward / Gemini
Bob Smith
In Hospital
Delirium
C. difficile
Pressure sore
Recurrent
infections
http://www.rgbstock.com/photo/mhBLDMW/Old+Wise+ManVirtual Wards
Method of providing care to people in the community
“Ward” – Borrows elements of hospital care (team-based, shared notes, single
point of contact)
“Virtual” - Patients remain at home (nothing “high-tech” about it)GEMINI: Understanding how
hospitals care for Bob Smith
Delirium
C. difficile
Pressure sore
Recurrent infections
http://www.rgbstock.com/photo/mhBLDMW/Old+Wise+ManGeneral Internal Medicine Wards • 75% of elderly have at least 2 chronic medical conditions • Care of multi-morbid patients: ~80% of healthcare costs in Ontario in 2009 ($21b) • General Internal Medicine patients represent 35-50% of emergency room admissions
General Internal Medicine Wards
University Health Network
8,376
Common Diagnoses 8,000 7,827
7,317
Heart Failure 6,831
7,000
Lung Disease 6,022
GIM Patients
Pneumonia 6,000
Urinary Tract Infection 5,000
Skin Infections 4,000
GI Bleeding
3,000
Diabetes
Kidney Failure 2,000
Cirrhosis 1,000
Stroke 0
FY2009-10 FY2010-11 FY2011-12 FY2012-13 FY2013-14General Internal Medicine Wards
University Health Network 40%
8,376
Common Diagnoses 8,000 7,827
7,317
Heart Failure 6,831
7,000
Lung Disease 6,022
GIM Patients
Pneumonia 6,000
Urinary Tract Infection 5,000
Skin Infections 4,000
GI Bleeding
3,000
Diabetes
Kidney Failure 2,000
Cirrhosis 1,000
Stroke 0
FY2009-10 FY2010-11 FY2011-12 FY2012-13 FY2013-14A GENERAL MEDICINE INPATIENT CLINICAL REGISTRY Build infrastructure to measure the quality of hospital care so that we can Identify opportunities for quality improvement so that we can Improve care for GIM patients Reduce cost of health care Improve patient experience
GEMINI: Understanding how
hospitals care for Bob Smith
Improve quality and accessibility
of care for seniors in the GTA
region, aged 65+ with multiple
complex chronic health issues
http://www.rgbstock.com/photo/mhBLDMW/Old+Wise+ManSRDC
SRDC ROLE
What is SRDC?
• Social Research and Demonstration Corporation
• A non-profit research organization
• Created specifically to learn what works - to
develop, field test, and rigorously evaluate new
programs and policy initiatives
• The evaluation partner for the Health Innovation
Collaborative
46SRDC ROLE
HIC Evaluation questions
1. Impact - How did the projects and HIC impact
families/caregivers/patients/partners and the
healthcare system?
2. Integration – How did the HIC work together?
3. Lessons learned - What did the HIC and its partners
learn from working together, can it be replicated, and is
it scalable?
47SRDC ROLE
HIC Evaluation framework
• Early years of development = developmental
approach
• Evaluation has to consider not only the internal
workings of the HIC, but also the influence of the
macro context regarding health care*
• SRDC will assess its potential to achieve collective
impact, insofar as it meets the following pre-
conditions: a common agenda, shared measurement,
mutually reinforcing activities, continuous
communication and backbone support**
*Handler, Issel, and Turnock (2001). A conceptual framework to measure performance of the public health system.
**Hanleybrown, Kania, and Kramer (2012). Channeling change: making collective impact work.
48SRDC ROLE
Why Collective Impact?
49SRDC ROLE
Common features
• Focus on people with complex chronic health
conditions
• Focus on innovation in healthcare service delivery
and organization
• Focus on system-level change, but within relatively
short timeframes
• Collaborative/collective organizational structure
• Clients wanted an evaluation with a high degree of
stakeholder engagement
50SRDC ROLE
Evaluation design
• Multi-level approach – focuses primarily on the HIC, but we developed
case studies of the individual projects to understand how these affect
the HIC’s functioning.
• The collective case study design allows SRDC to capture information
about implementation and short-term outcomes of the HIC, and its
potential to achieve broader, systems-level impacts.
Health System Outcomes:
Equity, Efficiency, Effectiveness
System System
Changes in:
Projects Projects
Learning
Networking
Collaboration
HIC HIC
9-12 months
POST
PRE
51Collaboration Exercise 25 minutes Q: What makes a good funder? Q: What makes a good grantee? Q: What does good collaboration look like?
Collaboration Exercise Feedback Q: What makes a good funder? • A commitment or policy to be collaborative • Clearly defined mandate • Targeted dissemination of collaborative interests • Measurement • Being open to the new • Being a connector • Share learnings • Being effective internally from review to evaluation • Holding yourself as an organization / foundation to be accountable • Having diversity: skills, resources, geography • Being strategic within funding parameters and decisions
Collaboration Exercise Feedback
Q: What makes a good grantee?
• Full disclosure
• Transparency
• Clarity of mission
• Governance – same end goal
• Willingness to be challenged
• Learning expert
• Track record of success and failure
• Stability (avoid fund into crisis or fund into transition / frustration, action for
change)
• Energy
• Leadership
• Are they networking / collaborating?Collaboration Exercise Feedback Q: What does good collaboration look like? • Outreach • Listening • Different expertise – recognized by different funders • Backbone organization needs to be determined • If collaboration works, what’s next? • Trust between partners • History of the partners involved • Shared goal and vision • Measure outcomes • Shared attribution of success and failure • Shared resources – what can I do vs. with what you can do? • Accountability and trust balance • Common / streamlined reporting • Start with good vision as to what you want to accomplish
Collaboration Exercise Feedback Q: What makes an effective grantee relationship? • Courage to speak openly about failure or unexpected outcomes • People motivated to make change happen • Trust in process • Communication of results so that everyone can understand • Willingness to collaborate • Clarity of vision (or not, during times of ambiguity) • Us vs. I mentality
Collaboration for the
GSCF HIC
How we did it
What we learned
Challenges
Success outside this collaborativeClosing thoughts on collective impact and project collaboration Q: What this means to you? Q: What this means to your organizations? Q: What this means to the future of your organizations?
Thank You! http://www.rgbstock.com/photo/mhBLDMW/Old+Wise+Man
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