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CADTH_2014_E6_CADTH_Panel_Discussion_Policy_Confirmed__Now What__Phillip Morehouse

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Policy Confirmed: Now What?

Policy Confirmed: Now What?

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  • 1. Panel Discussion- CADTH "Policy Confirmed. Now What?” Phillip Morehouse, Director, Performance Excellence Cape Breton District Health Authority 2014 CADTH Symposium April 6-8, 2014 Hilton Lac-Leamy, Gatineau, Quebec
  • 2. Gap Between Evidence & Practice  Volume of evidence, information & technology  15 - 20 years to reach routine clinical practice  Systematic reviews vs. single studies  Few have resources to find or use evidence  Knowledge or policy on its own will not change practice
  • 3. Why does the Gap Exist?  Failure to acknowledge the value of Customers and Stakeholders  Complacency  Lack of Management Support  Lack of Resources  Work Life Issues  Benchmarking  Poor Planning = Negative Impact Barriers to Change
  • 4.  Complexity  Fit with process  Open to adaption  Trialibility  Observation Factors Influencing the Adoption of Change
  • 5. Factors Contributing to Change  Predisposing factors ◦ Individual knowledge, attitude, behaviour, beliefs and values that affect willingness to change  Enabling factors ◦ Factors in the environment or community- facilitate or present obstacles to change  Reinforcing factors ◦ Positive or negative effects of adopting the behaviour
  • 6. Human Factors Approach to Improvement  Information  Education  Rules and policies  Reminders, checklists, double checks  Simplification/standardization  Automation/computerization  Forcing functions and constraints Less Effective More Effective
  • 7.  Shewart and Deming  Systems thinking- process driven  Starts with a concept of improvement  Testing and learning cycles  Feedback driven  Variation exists Knowledge of Improvement & Decision Support
  • 8. Decision Support Framework
  • 9. CBDHA Experience  Diagnostic Utilization: ◦ Test ordering guideline, peer comparisons, cost of testing ◦ 30 lab tests & DI exams- 3 years  71,892 reduction in test/exams or 14.4% change  Diabetes Quality Collaborative ◦ 10 physicians, 1100 IDDM, 10 indicators  2-45% improvement from baseline  Clean Hands, Save Hands: ◦ HH auditing & Front line empowerment over an 8 month period ◦ 2 medical units with 7% and 4% improvement
  • 10. Reference: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America Released: September 6, 2012 Systematic Approach to Care Improvement Evidence Learning FamilyHealth Care Provider Patient Policy Practice Data&Feedback Process ImprovementResources Process Technology Incentives IncentivesTechnology
  • 11. How Can Evidence Producers Help?  Work with providers, patients and families to understand the evidence requirement  More research into improvement methodologies  Facilitate improvement ideas and strategies  Document and discuss success stories
  • 12. Questions? morehousep@cbdha.nshealth.ca