Quality improvement, Indigenous Health, and an address from the new DoBC president

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Over 100 medical staff attended the February 13 VMDAS quarterly meeting in person and online. They had the opportunity to learn about the Physician Quality Improvement initiative, the efforts being undertaken by VCH’s Indigenous Health team, as well as to hear from Doctors of BC President Dr. Joshua Greggain.

Physician Quality Improvement Overview

Physician QI Chair Dr. Kelly Mayson provided a summary of quality improvement opportunities for medical staff at VCH. Physician Quality Improvement is an SSC initiative to address gaps in quality structures relating to physician participation in QI activities. It ensures those physicians have adequate dedicated technical supports such as data analysts and QI advisors.

When launched in 2007, the initiative had a triple aim: improved patient experience; better outcomes; and lower costs. A fourth goal was added in 2014: clinician well-being. A fifth aim was identified in 2021: health equity.

There are many reasons for VMDAS members to take PQI training. QI allows for a systematic method to solve complex problems through testing and learning. It empowers those closest to the improvement opportunity to identify and test ideas. Perhaps most importantly, with the current health-care crisis, we cannot just continue with the way we are doing things now.

Dr. Mayson used the example of the Surgical Patient Optimization Collaborative initiative to demonstrate how identifying the goal of optimizing patient prehabilitation has led to improved health of patients pre-op in 86 per cent of cases.

PQI alumni note that the initiative has helped them work on passion projects, find a renewed sense of purpose, and to connect with team members and other like-minded physicians. Participating in PQI training has also accelerated their career development.

The PQI initiative offers funding for QI training and projects as well as opportunities to participate in quality initiatives. At VCH, this means QI coaching: a new ad-hoc, on-demand opportunity with sessional funding for coaching time. Level 1 of VCH QI training is five hours of sessional funding for sessions at the Institute for Healthcare Improvement where you learn online at your own pace. More than 500 physicians and nurse practitioners have already graduated from Level 2, which is two half days of learning in an interactive Zoom class. Seven hours of sessional funding is offered for this with the next sessions coming up May 11 and 12 and again July 13 and 14. Level 3 includes 10 months of cohort training from August to May each year. There are interactive training days with full project support from the QI team and data support. More than 200 physicians have received Level 3 training, with sessional funding available for between 100 to 150 hours.

To find out more about PQI, check out this website, email medicalquality@vch.ca, or call Allison Chiu at 604-970-1479.

Regional Medical Director of Indigenous Health

Dr. Don Wilson joined the meeting virtually from the unceded territory of the K’ómoks First Nation on Vancouver Island. Technical difficulties meant Dr. Wilson was not able to complete his presentation on the work of VCH’s Indigenous Health team but he has shared his slides and they are available here.

VCH Indigenous Health works closely with several partners including the First Nations Health Authority and the 14 First Nations that are part of VCH’s geographic area. Its scope of work is influenced by the In Plain Sight report as well as the 94 calls to action regarding health care that emerged from the Truth and Reconciliation Commission. VCH Indigenous Health is also guided by the Urban Aboriginal Health Strategy, the United Nations Declaration on the Rights of Indigenous People, recommendations from the Missing and Murdered Indigenous Women and Girls report, and other strategies and reports including VCH’s mandate letter and service plan.

The goal of the Indigenous Health team is to improve cultural safety when Indigenous patients have contact with the health-care system. To help achieve this, the group’s priorities are to empower Indigenous communities to lead solutions, uphold reconciliation in health, embed Indigenous cultural safety and humility, advance health equity, and encourage health innovation and evolution.

To date, Indigenous Health has established an Elders-in-Residence program, created an Indigenous Patient Experience Team (IPET) that includes registered nurses and Indigenous patient navigators, expanded and evaluated Indigenous cultural safety training, established an Office of Indigenous Women and Family Health, developed recommendations for Indigenous pandemic response plans, and conducted research into reproductive and sexual health access.

Dr. Wilson noted the great work being done by IPET to mitigate any negative experiences Indigenous patients may experience in the moment. Indigenous patient navigators (IPNs), who are part of IPET, meet with patients and families at the point of care to act as a bridge between providers, the patient, systems, and the community. Five IPNs work in VCH’s urban locations providing coverage seven days a week, while four work in rural locations five days a week. Referrals have skyrocketed, from about 200 in 2020 to over 1,600 in 2022. Complaints from Indigenous patients have decreased substantially; the impact of the IPNs has been tremendous.

Dr. Wilson expressed his gratitude to the commitment from VCH senior leadership, physicians and nurses to improve how we provide care to Indigenous people and he hopes to see this momentum continue.

Doctors of BC President

The last guest of the evening was Dr. Joshua Greggain, who assumed the presidency of Doctors of BC on January 1. Dr. Greggain provided a quick overview of his background. He shared his belief that there are no powerful people, but there are powerful positions and the importance therefore of how physicians use their influence.

In his view, this is a time for refreshment, renewal, reformation, transformation, and possibly revolution. Dr. Greggain noted that the new Physician Master Agreement had a 92 per cent approval rate and that there is a new Longitudinal Family Physician Payment Model. There are opportunities now to transform the health-care system and create new ideas.

Dr. Greggain acknowledged the impact of burnout and reminded members that the Physician Health Program is available 24/7. He encouraged us to care for and about our patients and colleagues and to create new spaces for dialogue.

Next meeting

The next VMDAS quarterly meeting is set for Monday, April 17.

Members are reminded that dues for active and provisional staff are due March 31. More information is available here.

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