Canadian perspectives on spread and scale of healthcare improvement: Presentation at @ALASSOrg Congress in Montreal, August 2019

1. cfhi-fcass.ca | @cfhi_fcass.ca
Accelerating Health System
Improvement
Jennifer Zelmer
Association latine pour l’analyse des systems de santé
August 22-24, 2019, Montreal

3. Is it always a problem?
Where is it better?

4. cfhi-fcass.ca | @cfhi_fcass.ca 4
Global Child MortalityShare of the world’s population dying and surviving the first 5 years of life
0%
40%
100%
1800 2017
Survivors
Deaths
Source: GapMinder & World Bank via OurWorldInData

5. Changes at Scale: Canadian Examples
Smoking Day Surgery
Heart attack mortality EMR use

6. Sustain It’s still happening
Spread It’s happening elsewhere
Scale It’s happening everywhere

7. 7

8. 11
Our spread and scale
collaboratives
Bring together interprofessional teams
Focus on proven innovations that tackle a
common healthcare issue
Are team-based & ‘all teach-all learn’
Provide the support to kick-start sustainable
improvement at the service delivery level, e.g.:
 Seed funding
 Evidence-informed program
 Coaching to support implementation
 Mutual support from a community of innovators

9. 9

10. cfhi-fcass.ca | @cfhi_fcass.ca 10
Towards Person-Centred Dementia Care
In 2012-13, 1 in 3 LTC residents in Canada
was on an antipsychotic.
In 2016-17, 1 in 5 LTC residents in Canada
was on an antipsychotic.

11. 11
“What a difference! …. Of course, the
dementia hasn’t gone away, but the
deprescribing [of antipsychotics] has
completely changed his life, not to mention
the lives of his caregivers and family
members.”
- Georgette Bertin, daughter of Adelbert
Bertin, Paquetville, NB

12. cfhi-fcass.ca | @cfhi_fcass.ca 12

13. What are we learning?

14. cfhi-fcass.ca | @cfhi_fcass.ca 14
Lessons Learned (1)
› Even the best ideas and
practices don’t implement and
spread themselves
› Change takes time, capacity,
dedicated and resources and
leadership … and ultimately
depends on a willing team
working with patients and
families
› Money alone cannot buy change
… but seed funding can help free
up existing resources to focus on
improvement
› Specificity matters – in
intervention design (what?) and
implementation planning (how?)

15. cfhi-fcass.ca | @cfhi_fcass.ca 15
Lessons Learned (2)
› Context matters
› Building capacity for
improvement in tandem with
doing improvement creates
lasting skills
› Measure change in real time to
build momentum and propel
change farther
› Large-scale change depends on
action at multiple levels

17. Source: Baker & Denis, 2011.

18. cfhi-fcass.ca | @cfhi_fcass.ca 18
Thank you

19. The Canadian Foundation for Healthcare Improvement is a not-for-profit
organization funded by Health Canada. The views expressed herein do not
necessarily represent the views of Health Canada.
La Fondation canadienne pour l’amélioration des services de santé est un
organisme sans but lucratif financé par Santé Canada. Les opinions
exprimées dans cette publication ne reflètent pas nécessairement celles de
Santé Canada.cfhi-fcass.ca | @cfhi_fcass.ca
REFERENCES:
Baker R, Denis JL. (2011). A comparative study of 3 transformative health systems: Lessons for Canada. Available: https://www.cfhi-
fcass.ca/publicationsandresources/researchreports/ArticleView/11-10-26/0d3e9041-a834-4511-9f95-7c37ba287a79.aspx
Canadian Foundation for Healthcare Improvement. (2019). Appropriate use of antipsychotics. Available: https://www.cfhi-
fcass.ca/WhatWeDo/appropriate-use-of-antipsychotics
Canadian Foundation for Healthcare Improvement. (2019). More improvement, for more people, that lasts. Available
https://www.cfhi-fcass.ca/sf-docs/default-source/documents/strategy-2019-2021-e.pdf?sfvrsn=c43dad44_2
Ferguson N. (2017). The square and the tower: Networks and power from the Freemasons to Facebook. London: Allen Lane.
Roser M. (2018). The world is much better. The world is awful. The world could be much better. Available:
https://ourworldindata.org/much-better-awful-can-be-better
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https://www.who.int/immunization/hpv/deliver/scalingup_health_service_delivery_who_2007.pdf
World Health Organization & Global Health Workforce Alliance. (2008). Scaling Up, Saving Lives
Task Force for Scaling Up Education and Training for Health Workers. Available:
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