“Health systems are starting to realize that the way we’ve done things in the past is not necessarily the most efficient nor does it provide the best patient experience. We want to change that.”
Those are the words of surgical oncologist and head of VGH’s Division of General Surgery, Dr. Heather Stuart. She chairs VPSA’s newest committee, the Integrated Practice Unit (IPU) Implementation Focus Group.
“We’ve been focusing on the patient: live or die, but we haven’t been focusing on how that patient moves through the system and experiences it,” she said. “In an era of multidisciplinary care, we need to arrange things so the system is a bit more streamlined.”
Around 2018, the former head of the Division of General Surgery, Dr. Morad Hameed, collaborated with VCH Regional Strategy and Quality Manager, Quality and Patient Safety, Arianna Cruz to introduce the concept of IPUs at VGH. The idea is based on research by Michael Porter, who has published on health systems and innovative strategies. He describes building health groups around patient problems. Patients can access whoever they need to address that specific problem.
“It’s a one-stop shop leading to a solidified plan,” said Dr. Stuart.
VGH’s Division of General Surgery redesigned its surgical system, dividing it into three groups: oncology care, transplant care, and acute care. Each group has subsets with assigned leaders working with multidisciplinary teams. Working with the Arianna Cruz, who has her MBA from UBC, each group is developing flow charts to map patients’ journeys and note their experiences.
“We started to look at where in those processes patients were either slowing down or not getting the care we felt should be standard,” explained Dr. Stuart. “From that information and looking at the flow charts we developed OKRs—objectives and key results. There are specific questions that have a quantitative answer that we can collect data on.”
VPSA’s role
“Engagement,” said Dr. Stuart, “is hard. Trying to convince someone outside your specialty that they should spend their time doing something that you want rather than what they want even though it is for the greater good has been difficult.”
Knowing that funding was available from VPSA for such engagement, Dr. Stuart and Patricia Balmes approached the association to request assistance. The result: the IPU Implementation Focus Group was formed. It has three objectives:
- Formalize the structure and multidisciplinary membership of the IPUs.
- Create actionable recommendations/deliverables for IPUs to pursue.
- Establish a process/SOP for IPUs to pursue quality improvement initiatives and practice changes in the future.
“The funding from VPSA is really helpful as it allows us to compensate VGH physicians who come and participate,” added Dr. Stuart. “Also, knowing that people care and that they’re interested is a true motivation in having us continue to move forward. It tells us that our hospital is invested in us and wants to support us in this. It makes a huge difference.”
Next steps
The Division of General Surgery is funding meetings between the IPU leaders and Innovation UBC, which specializes in facilitation.
“They’re helping us brainstorm, while making sure our OKRs are things that are actually measurable,” said Dr. Stuart. “It’s something we’ve struggled with. We don’t have formal training in transformative health-care systems. A lot of this is new and takes a lot of thinking. This group has worked extensively with the Department of Family Practice to redo or modify clinics to make them more efficient in the community.”
At the same time, the IPU leaders are working with Learning Health Systems, which is helping the IPU leaders to develop a longitudinal plan.
“We want to develop a process map for how IPUs work over time,” added Dr. Stuart. “We’re asking things like what’s the next step after implementation. Is it just repeating the same process? How long do we collect metrics for? Do we need to meet at regular intervals? What would it look like if we were to apply it at other hospitals?”
Dr. Stuart is grateful to everyone who has contributed their ideas and their time to the project.
“Clinicians, the quality of patient safety group, the data analytics group, administrative assistants, UBC…. we wouldn’t be here without them,” she said. “It’s truly everyone working together to try and make this happen.”
Photo: IPU members speaking at a value-based health-care symposium.