RX: Innovate

Focused on patients

Realized through collaboration

Over the last decade, BC doctors, government, health authorities, allied health professionals and the communities we serve have been working together to meet the changing demands on our health care system. We’ve stepped into an era of partnership-led, patient-focused advances in treatment, and a culture of open dialogue, changing the way we provide, and think about, patient care.

Physicians in Front Experience leads the way

Who better understands how well our health care system meets patient needs than the doctors who treat them? The JCC’s work starts with doctors who see opportunity for improvement and system change. We bring together doctors and administrators as a team whose goal is to find solutions and make them a reality. Where there’s experience there’s an idea, where there’s a team there’s a way.

BC Inherited Arrhythmia Program When knowing is preventing

Mark was a healthy and active 11-year old. He was outside playing with his twin brother near his family’s Vancouver Island home when he suddenly collapsed, his life cut short by sudden cardiac arrest. Only afterwards was he diagnosed with inherited arrhythmia, a genetic condition with manageable but often undetected symptoms, and with the potential for catastrophic consequences, if left untreated. In the wake of the tragedy, Mark’s entire family was referred to the BC Inherited Arrhythmia Program (BCIAP) for diagnosis. Three family members tested positive and are today receiving integrated BCIAP care and counselling from a specialized team.

Mark was one of roughly 7,000 British Columbians who are today affected by inherited arrhythmia. His family was unaware of his condition.
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About 1 in 500 people in BC carry A Gene in their family that puts them at risk of heart arrhythmias.
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Every year, sudden cardiac arrest kills over 30,000 Canadians of all ages and fitness levels.
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EPILEPSY
Some 10% of patients diagnosed with epilepsy may have inherited arrhythmias.
Northern Health origins

It’s 2004 and Dr. Laura Arbour is on her way to the Northern Health authority, where high occurrences of inherited arrhythmia are the community’s greatest health care priority. Doctors have just acquired the technology to test genetic indicators of inherited arrhythmia on a molecular level, and Dr. Arbour is going north to research and diagnose the condition’s hereditary reach. What begins as a research program, however, evolves into a rapidly expanding system of care involving cardiologists, genetic counsellors and genetics specialists, where at-risk individuals are proactively diagnosed, educated and treated. It is the beginning of a new perspective on inherited arrhythmia treatment.

“As physicians we have the opportunity, through the SSC, to consider innovative programs. It made sense that the multidisciplinary care we were delivering in northern BC should be offered to the whole province.”

— Dr. Laura Arbour, Co-Director, BCIAP
DR. LAURA ARBOUR, Clinical Geneticist
The British Columbia Inherited Arrhythmia Program evolved from an innovative model of integrated care that originated in the Northern Health Authority, in 2004.
Expanding the network, increasing diagnoses, growing knowledge

The BC Inherited Arrhythmia Program began in April 2013, with funding from the Specialist Services Committee and Cardiac Services BC. Now five BCIAP clinics are active across the province, with the capacity to diagnose entire families when one member suffers a suspect cardiac event. While proactive diagnoses and preventive treatment are central to BCIAP’s operations, the program’s approach is a model of medical innovation. Multiple disciplines collaborate with the common understanding that continued research and education of patients, as well as physicians, is as important as diagnoses and treatment.

Patient + Their Family
Research Nurses +
Technologists
Data Collection
Databases
Physicians Cardiologist
Pediatrician
Geneticist
Trainees
Genetics Counselors
Educators
Physicians
Diagnostic
Testing
Imaging, Monitoring,
Invasive Genetic
Testing, Other
Education Physicians
Nursing
Genetics
Supports Secretarial
Device Managment
Social Work
Maternal Fetal
Medicine
The BC Inherited Arrhythmia Program envelops the patient within a collaborative network of health care disciplines.
DR. ANDREW KRAHN, CARDIOLOGIST
Challenges born from success

BCIAP has improved care of inherited arrhythmia patients immeasurably, and continued diagnoses of inherited arrhythmia in previously unidentified gene mutations are contributing to a very rapidly expanding body of knowledge. In fact, BCIAP’s success is its greatest challenge. As BCIAP referrals continue to grow, the program requires more resources and new tools. Common data collection and integration, increased use of digital resources, such as web teaching, videoconferencing care and patient portals will allow greater collaboration between teams across health authorities and greater access for patients and families. These are all challenges in the coming years, but they are the right sort of challenges - challenges born from progress.

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2014-2015
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Patient visits to BCIAP clinics have been rising steadily since the program’s implementation.
BCIAP’s methods of diagnosis and treatment have greatly improved the lives of inherited arrhythmia patients.
Transitioning Responsibly to Adult Care (ON TRAC) A doctor and a camp counsellor

Dr. Sandy Whitehouse was a resident of pediatrics when she experienced first-hand the perils of the gap between pediatric and adult care. She was serving as a Diabetes Camp physician in northern Ontario when one of the camp’s popular counsellors, a capable and cool 23 year-old nursing student who enjoyed widespread admiration, walked into her clinic having lost vision in one eye. “This young woman had not sought any care since she had turned 18,” says Dr. Whitehouse, “was unable to identify a family doctor or specialist, and had been managing diabetes on her own.” Five-years of unmonitored insulin injections had dire consequences. “If she had kept going the way she was,” Dr. Whitehouse says,” she likely would not have survived another five years.

“This young woman had not sought any care since she had turned 18, was unable to identify a family doctor or specialist, and had been managing diabetes on her own.”

— Dr. Sandy Whitehouse
Bridging canyons

Adolescence can pose all sorts of challenges, but for teenagers who have received consistent care for chronic conditions through much of their young lives, the transition between childhood and the adult world is especially fraught. It entails nothing less than bridging the canyon between pediatric and adult care, two very different worlds of treatment. “It’s a transition marked by a complete shift in the culture of care,” Dr. Whitehouse says, “from pediatrics, which has a more holistic focus on growth and development, to adult care, which is essentially compartmentalized around risk-reduction.” Dr. Whitehouse’s mission has centered on bridging these two cultures by empowering young patients and challenging traditional practice.

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Each year 1,700 youth with chronic health conditions "graduate" from the pediatric care system.
Mike Klinkhamer’s story illustrates the challenges faced by pediatric patients transitioning to adult care.
Shifting focus from silos to systems

In April 2011, the Youth & Young Adults in Transition workshop marked a major turning point in the way BC doctors began to think about patients in transition. Once the conversation began it felt like systemic change was an evolution just waiting to happen. The Joint Collaborative Committees funded the Youth Transition Initiative and helped to support Transitioning Responsibility to Adult Care (ON TRAC). The expertise was obviously there, but channels of communication needed to be opened to manage the transition between pediatrics and adult care. “Communication and cultural shift were among the essential problems the system had to tackle,” Dr. Whitehouse says, “so much of ON TRAC’s early work was on communication products developed to educate patients and physicians. We aimed at shifting the thinking from concentrated silos of medical practice to wider systems of care.”

2011 Youth & Young Adults in Transition workshop summary Download the document | PDF 120kb
ON TRAC has focused on developing communications products that empower young patients to take ownership of their health and confidently engage physicians.
New territories for improvement

There’s been a marked increase in the general awareness of youth transition issues in the health care community since ON TRAC was launched. More than ever doctors, counsellors and nurses are mindful of transition issues, especially in the pediatric setting. The resulting cross-disciplinary conversations about the patient experience are fueling a cultural shift in health care. This new climate is fertile ground for new innovations that empower and support young patients in transition.

Develop clinical guidelines and documentation tools to smooth transfer between pediatric and adult systems.

Work with youth and families to ensure their voices are heard in developing transition support toolkits.

Hold workshops and presentations for patients and health care providers exploring transition issues.

Publish our reserach on transition practices and evaluate transition efforts.

ON TRAC’s four areas of focus
Just TRAC it! is a communications innovation that encourages youth to use technology to take ownership of their health.
Outcomes of Collaboration The greater the diversity, the better the outcome

It's our experience that collaboration drives innovation. Collaboration works best when it includes a wide spectrum of perspectives, from clinicians to health authorities to patients and families. The greater the diversity of voices, the more inclusive the community, the more considered the solution, the better the outcome.

Enhanced Recovery When beliefs collide

It was something of an uneasy discovery for Dr. Ahmer Karimuddin. He was serving as a surgical resident at the University of Saskatchewan when he came across European studies that listed specific routine pre and post-operative practices which significantly improved patient care – practices that were not included in his training. “It was 2003 at that time and when I approached my peers about these practices the idea was met with a certain degree of skepticism,” Dr. Karimuddin says today. “There was a general certainty in the community that we were doing the right thing for our patients, or else we wouldn’t be doing it.” Dr. Karimuddin conceded the residency program was not the place to challenge the beliefs of his field. His findings were filed away, but not forgotten.

“There was a general certainty in the community that we were doing the right thing for our patients, or else we wouldn’t be doing it.”

— Dr. Ahmer Karimuddin
A more receptive audience

What was perceived as a non-starter when Dr. Karimuddin was a resident in 2003 became a conversation starter when he arrived in Victoria in 2008. While establishing a practice as a colorectal surgeon, he began to talk with the Chief of General Surgery and, most notably, a dietician. Extending the conversation beyond his surgery was key in initiating a program that, in essence, would be a deeply collaborative undertaking. The team developed a colon care map spotlighting the colorectal surgery patient experience, and had a pilot project up and running within six months.

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Enhanced
Recovery
Without
Enhanced
Recovery
4 days AFTER pilot program
9 days BEFORE pilot program
Implementation of the pilot enhanced recovery program almost immediately reduced the days for inpatient recovery after surgery.
Improvement is contagious

Soon after the pilot program in Victoria, Dr. Ron Collins independently initiated an enhanced recovery program with similar results in Kelowna. By the time Dr. Karimuddin moved to St. Paul’s in 2012, the hospital was keen on adopting enhanced recovery. “There was an overall snowballing effect happening with the program,” Dr. Karimuddin says. “Because the program was clearly working in a few sites, it was natural that others wanted to adopt the program as well.” At that point, through JCC’s Specialist Services Committee, the Enhanced Recovery Collaborative was born to standardize adoption and execution of the program, and provide a set of guidelines and tools so that each new facility didn’t have to reinvent the wheel.

Facilities across the province are adopting the enhanced recovery program.
Patient + Their Family
Dieticians
Surgeons
Anesthesiologists
Pharmacists
Physicians
Nurses
A multidisciplinary approach to care, enhanced recovery requires participation from a wide range of health care providers, as well as the patient.
Patient participation is key to the Enhanced Recovery program. This video was developed by Enhanced Recovery to prepare patients for surgery, providing a narrative that illustrates what patients should expect, and the steps they should take for a positive recovery.
Enhanced recovery is improved care

The Enhanced Recovery approach includes putting in place some 20 processes of care before, during and after surgery. These new processes get patients healing better and faster, while reducing surgical complications and shortening hospital stays. It also helps that the program has been shown to reduce the average cost of colorectal surgery by over 30%. Because multidisciplinary collaboration lies at the heart of Enhanced Recovery, the program goes beyond a mere checklist of procedures. It prescribes a supportive infrastructure that provides communications products to all participants, and forums for continued opportunities to share lessons, evaluate results, test new methods and plan for growth.

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cost
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enhanced recovery
WITHOUT
enhanced recovery
The average cost for colorectal surgery is significantly reduced with enhanced recovery.
Proactive engagement with the patient enhanced recovery has improved the patient experience immeasurably.
Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative Mapping a new perspective

The Collaborative started with a story. Val Tregillus was there, along with doctors and health authority reps. A boy’s patient journey map told how a family waited 10 years to receive adequate care for their son. “He was diagnosed with a mental health issue when he was four, but it wasn’t until he had encounters with criminal justice at 14 that he received the care he needed,” says Val. It was this story, from the patient’s perspective, which motivated the founding of the CYMHSU Collaborative. Its goal - to increase access to timely integrated mental health and substance use services and supports for children, youth and families in BC.

Click to open David's patient journey map A patient journey map, like this one of an anonymous patient named “David,” made it clear that change was necessary in child and youth mental health and substance use services.

“He was diagnosed with a mental health issue when he was four, but it wasn’t until he had encounters with criminal justice at 14 that he received the care he needed.”

— Val Tregillus, Project Director, CYMHSU Collaborative
Breaking barriers, integrating care

The lack of communication between child and youth professionals essentially isolated the patient from the health care system and health care professionals from one another, creating silos of care. A school counsellor seeing a troubled child Monday morning might not have known that the same student was admitted to the hospital for treatment that weekend. The CYMHSU Collaborative’ s challenge was to break down these silos so that the whole community was effectively working together within a holistic model of care. Early local action team meetings, which focused on building relationships between providers across systems, revealed how necessary change was. “I saw many providers cry during those early meetings,” Val says, “because they had felt so isolated and unsupported in their work.”

SILOED CARE

The traditional fragmented model isolates families from the system and providers from one another.

Patient
Care Providers

INTEGRATED CARE

The Collaborative model brings together a network of providers to wrap the family in a collaborative and coordinated system of care.

“I saw many providers cry during those early meetings, because they had felt so isolated and unsupported in their work.”

— Val Tregillus, Project Director, CYMHSU Collaborative
Collaborating for change
Family Physicians
Substance Use Teams
CYMH Teams
Aboriginal Partners
Police
Schools
Youth & Families
Specialists
Community Organizations
The CYMHSU collaborative model of care depends on inputs from multiple disciplines and community members.
Local action, provincial collaboration

The CYMHSU Collaborative is a change mechanism that operates on local and provincial levels. On the ground level, Local Action Teams of youth and families, doctors, clinicians, school counsellors, community agencies, Aboriginal services, police and other stakeholders, meet to build relationships and discuss integrated solutions to child and youth mental health and substance use issues specific to their communities. On the provincial level, eleven Working Groups tackle wider clinical and system issues which are then tested by Local Action Teams, for eventual expansion to all communities across the province.

Tyler and Kirby share their journeys with mental health and substance use issues, and their challenges in getting help. Both joined the Kootenay Boundary Local Action Team early in the Collaborative to help improve the system for youth like them. The video is available here.
Since 2013, the Collaborative has grown from just 120 participants in the Interior to 2,000 people providing integrated care across BC today.
Tipping point, where practice becomes policy

The spread of CYMHSU Collaborative Local Action Teams across the province speaks volumes of the need for the Collaborative’s integrated approach. Eight overarching ‘tipping points’ have been identified to move the Collaborative from a vast change mechanism to an integrated sustainable system of care. The Collaborative’s 2,000 members have committed to achieving these tipping points and making this a reality – it is only a matter of time.

The CYMHSU Collaborative has grown rapidly since 2013, going from 8 Local Action Teams in the Interior, to 64 across the province today.
Reflecting on Success, Preparing for Opportunity Showcase for a culture of change

On February 24, 2016, the Joint Collaborative Committees held their first collective forum since the committees were established over a decade ago. The JCC Showcase was a venue to discuss the diverse projects initiated by the collaborative committees. At the same time, it was an acknowledgement of the era of cooperation, a celebration of a culture open to dialogue and change.

Some of the JCC Co-Chairs discuss their work.
Lessons learned, opportunities for exploration

The JCC’s first Showcase was an open forum for dialogue about what the JCC had achieved and how we might continue to drive change. The themes of the day focused on the importance of collaboration and the crucial role of doctors in leading systemic innovations. The conversation involved nearly 400 general practitioners, specialists, allied staff, patient representatives and health care authorities. While BC health care practitioners have been hard at work driving change for over a decade, the Showcase was the JCC’s opportunity to take stock of what we’ve learned and where we’re going.

What did the Joint Collaborative Committees Showcase mean to you?

Additional Information JCC Showcase Report
Download showcase report | PDF 6.6MB

JCCs Backgrounder
Download a summary report | PDF 197kb

JCC Showcase Program Guide PDF
Download program guide | PDF 2.6mb

Photo gallery from JCC Showcase 2016
Photo Gallery |

Joint Collaborative Committees
visit Doctors of BC website |

Get involved Please email for more information:
JCCShowcase@doctorsofbc.ca |