Every improvement – big or small – matters

February 10, 2017

Twice a year, 3sHealth, eHealth and the Ministry of Health get together to share continuous improvement successes and to learn from one another. On Feb. 1, 3sHealth hosted the event.

“It’s a great way to celebrate our successes and learn from one another,” says Jill Forrester, director of 3sHealth’s Continuous Improvement office. “As a province we are working to improve our approach to system-wide improvements, and it’s great to see the results unfold.”

At the event, the Ministry presented on the provincial Emergency Room wait times initiative and two Appropriateness of Care projects, and eHealth shared information on its Citizen Health Information Portal, their 100 Challenge, and provider identity management. 3sHealth presented on work flow improvements within the Employee Benefits Program (EBP), and how Lean concepts and strategies were used to support the Smart Pump implementation project and are now being used within Transcription.

In her presentation, 3sHealth Director of Employee Benefits Alana Shearer-Kleefeld showed how her team is looking for opportunities to improve how they care for the caregiver. By isolating specific pieces of work, the team is finding ways to eliminate waste and save time.

Calculations shared by Shearer-Kleefeld proved that in order to meet demand within the employee benefits service line, they needed 33 per cent more benefit officers.

“My CEO looked at me when we did that calculation – and we did the calculation three different ways – and said ‘Alana, how are you going to improve your efficiency to get this work done?’ He challenged me to find a way to do our work with our current resources.”

The first step for the team was to tackle one piece of work – processing benefit changes for new retirees.

“At the end of every month, we get a flood of retirements,” she says. “And each retirement was taking us at least 25 minutes to process. My CEO challenged me to get that down to 10 minutes, and I said I was going to get it down to seven minutes.”

In the end, through a series of plan, do, check, act (PDCA) cycles, the EBP team is now completing each individual retirement package within five minutes – an 80 per cent improvement.

What used to take the team up to four days a month now is done by a single person in less than one day, so the impact on the team is significant. Rather than having to make up a 33 per cent increase in resources, the gap has shrunk to 15 per cent.And Shearer-Kleefeld and the team are not done. They have other work they are targeting for improvement.

“There is definitely a benefit to our customer but there is also a benefit for the team,” she says. “They are working full-out – they’re not getting breaks and they feel like they’re always behind. There is great satisfaction in doing today’s work today.”

In the Appropriateness of Care initiatives, the Ministry of Health has seen some real gains in terms of the number of MRIs being ordered through implementation of the MRI Lumbar Spine Checklist, and the number of blood glucose strips being covered for people with diabetes.

Tami Denomie, an Executive Director with the Strategic Priorities Branch, said there are 5,000 MRIs ordered annually in Saskatchewan related to the lumbar spine. A group of clinicians, including orthopedic surgeons and other experts, developed a checklist that will help physicians to determine when this type of testing is appropriate for the patient.

Denomie says they’re already seeing good compliance with the checklist, and it brought the team to another question about how many CT exams are also being ordered for the same diagnosis.

“When we unpacked that data, we found that in Regina and Saskatoon, there were a number of patients that were getting both a CT and an MRI for lumbar spine exams.” The same group of clinicians developed a checklist for lumbar spine CTs, based on best practices, and is now trialing the checklist in Saskatoon, Regina Qu’Appelle, Prairie North and Five Hills Health Regions, with the intent to implement the checklist provincially. The intent of this project is to reduce duplicate testing, ensuring patients receive the most appropriate imaging test for low back pain.”

Nick Doulias, Director, Pharmaceutical Policy and Appropriateness with the Drug Plan and Extended Benefits Branch, shared a success on the appropriate use of blood glucose strips. He said the province provides about $9 million annually to cover this single piece of technology used in the management of diabetes.

They worked closely with the provincial branch of the Canadian Diabetes Association (CDA) and considered best practice in terms of the number of times a person with diabetes usually needs to test their blood glucose levels.

Initially, he says, there was reluctance to the concept of reducing the use of the strips but recently several guidelines and national reviews have been changing that point of view.

“A person who is insulin-dependent would typically need to test more frequently than an individual with Type 2 diabetes who is managing well with diet and exercise.”

In 2016, as a result of this work, the province has seen significant savings related to blood glucose strips.

“The rate has been constantly increasing since 1996, so this is the first drop we’ve seen, and that’s significant,” said Doulias. “Our unique approach involved partnership with the CDA, which hosted webinars for patients and healthcare professionals and included information in their newsletters. The assistance of the CDA with this initiative was valuable and much appreciated.”

People living with diabetes are among patients using the eHealth Citizen Health Information Portal (CHIP) to keep track of their personal health information, said Lillian Ly, program lead for the project. Ly presented with eHealth Communication Director Lisa Adam.

CHIP, which is set to roll out province-wide sometime in 2017, is an interactive tool that gives participants quick and easy access to their personal health information, said Ly. Information might include prescription history, immunization records, visits to acute care facilities and lab results.

The pilot project involved significant stakeholder engagement, said Adam. A citizen advisory panel of 21 people helped to gather more than 600 people to pilot the portal and provide feedback to the project team on what they liked and what could be improved. Within weeks of announcing the pilot, they had added to that group – building the pilot project to about 1,000 participants, with even more on a waiting list.

Participants shared their experience talking about the value that it had provided to them, their families and, most importantly, to their health and health outcomes.

“This project has improved patient care by reducing waste,” said Adam. “Participants told us they spent less time waiting and needed to see their doctors less frequently because they had the information they needed to manage their own condition.”

The next bi-annual review will be hosted by the Ministry of Health.


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