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Early Years Health and Development - Improvement Science Works in Populati…

Early Years Health and Development - Improvement Science Works in Populati…



Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. ...

Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.

Population and Public Health Branch of Saskatoon Health Region deployed improvement methods to develop a comprehensive strategy to improve outcomes for small children ages 0 to 5. The Early Years Health and Development Strategy (EYHDS) team comprised of 5 front line staff and an improvement consultant worked intensively over three months (Feb, Mar, and April, 2012) to Define, Measure and Analyze the opportunity for improvement and generated 25 recommendations. The result was a set of related recommendations for health planners, governments and community organizations. The presentation will demonstrate how improvement methods can be used effectively in community based health promotion areas of health care.
Better Health

Mary Smillie; Dr. Julie Kryzanowski, Saskatoon Health Region



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    Early Years Health and Development - Improvement Science Works in Populati… Early Years Health and Development - Improvement Science Works in Populati… Presentation Transcript

    • Early Years Health and Development -Improvement Science works in Population andPublic HealthMary SmillieThis Session is sponsored by:
    • Early Years Health and DevelopmentImprovement Science in Population and Public HealthPresentation and Discussion at Inspire Conference, April 10, 2013Dr. Julie Kryzanowski, Saskatoon Health Region & Mary Smillie, Improvement Advisor
    • Needed to define a path forwardNeed: Improveoutcomes for 0 -5year olds.Challenge: TimeOpportunity:Child HealthReportInterest:ImprovementScience
    • Went looking for helpHealth PromotionManager Tanya Dunn-Pierce called Mary Smillie.• Public Health• Health Promotion• Improvement Science
    • How couldimprovementscience help?• Leadership team• Project team• Content ConsultantsEngaged LeadershipFive Dedicated Staff plusMary3 Month Focus and FinishDMAIC – define, measureand analyse
    • The Early Years Health and Development Project Team
    • Weekly MeetingsAs needed andtwice as a groupEvery two weeksThrough PDSAs,focus groups,one to onemeetings
    • http://www.youtube.com/watch?v=GbSp88PBe9E&feature=related
    • Video – Change the First Five Years andYou Change Everything
    • Neighbour Discussion• What do you think needs to be done toimprove health and development outcomesfor small children?(5 minutes)
    • Health Inequities Exist Among Children• Saskatoon Health Regionchildren generally healthy,but• Many indicators revealedhealth inequities byneighbourhood andRegistered Indian Status– Almost 25% of the children inSaskatoon lived in areas ofhighest deprivationEarly Years Report
    • Early Years ReportSocioeconomic Status
    • Ethnicity• Birth rates of the RISpopulation is up to threetimes higher than the non-RIS population (33.4compared to 12.3 in 2009)• Higher rates of:– Preterm births (10.5% vs.7.1%)– Low and high birth weights– Teen pregnancy (160.5 vs.23.5 per 1,000)– Vulnerable IHBQ score (70.3vs. 27.7%)Early Years Report
    • Readiness to LearnBased on Early DevelopmentInstrument (EDI)scores acrossthe five key domain areas:• Physical health & well-being• Social competence• Emotional maturity• Language & cognitivedevelopment• Communication skills &general knowledgeEarly Years Report
    • What we learned through the project:
    • A life course perspectiveHealth trajectories are thepathways that individualsfollow from a healthperspective.These pathways evolve overtime, and the directions takendepend on individual actions,as well as the circumstancesand conditions experiencedthroughout life.Impacts of Poverty on Marginalized GroupsMCH Life Course Toolbox: www.citymatch.org/lifecoursetoolbox
    • Adverse experiences in childhood
    • Parents view of help available
    • Parents and CBOs
    • Many agencies with mandate for children
    • What we learned about Canadians• So many programs existto reduce isolation –single family dwellings• Parents connect witheach other throughscheduledappointments – playdates• Ideal community size iswalkable, services andbasic householdcommodities available
    • Dr. James Heckman• Economist• Nobel Laureate• University ofChicagohttp://www.heckmanequation.org/content/resource/why-early-investment-matters
    • Video – Why Early Investment Matters
    • The Heckman Equation“One dollar spent inthe early years isestimated to savebetween $3 and $9in future spendingon health, social andjustice services.”Grunewald, R. & Rolnick, A.(2006), from The Chief PublicHealth Officer’s Report on TheState of Public Health inCanada 2009
    • Neighbour discussion• What to do?• 5 min
    • Aim, Measures and Strategies• Less than 18% EDI by 2018• Measurement infrastructure• 25 Recommendations– Support parents– Invest in early years– Act as one system
    • Measures for Early ChildhoodIn-HospitalBirthQuestionnaireEarlyDevelopmentInstrumentBookends of Early ChildhoodCommunity Risk IndicatorsWhat is the community like where children are growing up?% teenmothers% lowbirthweights% SocialAssistanceProgramrecipients% of housingin need ofmajor repair% of adultswith loweducation% loneparentsPrenatal Birth Age 1 Age 3Age 2 Age 4 Age 5 Age 6Grade 1 –MandatedschoolattendanceKindergartenEntry
    • RECOMMENDATIONSEncourage andSupport HealthSector ActionDevelop and Implement aProvincial Early Childhood Healthand Development Strategy1. Agreement on a key goal = “18 by 18”2. A focus on family needs4. Commitment of targeted investments5. Robust monitoring tools1. Deliver family-centred,accessible, integratedservices.2. Bolster health promotionand protection, illness andinjury prevention efforts3. A holistic approach for improving thehealth and development of First Nationsand Métis children3. Work with partners to betterprotect children fromenvironmental health risks
    • Learning from Quality Improvement
    • What worked well:• Engaged leadershipwith questions• Dedicated staff anddedicated time• Focus and Finish• Plan Do Study Act cycles• Engaged parents andcommunity agencies• Mapping• Compelling data• Elegant design forlearning
    • Even better if:• More time prior togetting started• More time to developtrust and relationshipswith First Nations andNew Canadian parents
    • Much better when:We achieve EDI scores less than 18% by 2018When we set a new aim for EDI less than 10% and achieve it.A child born to any family anywhere in Saskatchewan has thesame opportunity for success as the next child born.
    • Thank you!For more informationcontact:Dr. Julie Kryzanowskijulie.kryzanowski@saskatoonhealthregion.caOr Mary Smilliemsmillie@sasktel.net