PMH/PCH in the Kootenay Boundary Dr David Merry,

PMH/PCH in the Kootenay Boundary Dr David Merry,

PMH/PCH in the Kootenay Boundary Dr David Merry, Board Chair Andrew Earnshaw, Executive Director

Our PMH/PCH Journey Spring 2015 MoH Policy Papers opportunity recognition* promotion Fall 2015 CSC Leadership Commitment Division AGM & Northern

Health road show Winter 2016 QI Discussion Paper Spring 2016 Engagements Fall 2016 Proof of Concept designation & subsequent funding

Feb 2016 CSC Retreat Working ?s 1.What do we want from this stakeholder, long term? 2.Based on 1., what initial engagement (next 3 months) does this stakeholder need? 1.Whats the existing level of

awareness of this group? 2.What are the key messages? 3.What pitfalls must be avoided (fears, concerns, expectations to be managed) 4.What Champions (/Key Informants) should be engaged first?

41.5% 2016 Source: BC Auditor General report: 201 PCH Risks and Pitfalls for Community 1. Big Change, reduction in overall service Managing the ongoing needs in Acute

& ED & Complex MHSU 2. The train not stopping in your community running on by 3. Downloading - Change in the Social Contract between Community and Citizens Community now held accountable for Health? ETC PCH Risks and Pitfalls for Physicians 4. Team relationship / role clarification

5. Big Change, Small Improvement negative R.O.I. 6. Physician Liability & responsibility in Team Based Care ETC PCH Risks and Pitfalls for IH Staff 7. Developing additional skills and expanded scope of practice 8. Recognizing need for change (they have gotten best outcomes to date -? Feelings of loss or lack of appreciation)

9. Requirement to change (again!) change fatigue within IH staff ETC Benefits of the Patients Medical

Home A summary of 73 Articles (70 Peer Reviewed) Outcomes of the Work: 1. Broad Physician interest across KB 2. Clinic re-organization conversations in

three communities 3. Focused and cohesive CSC 4. Strong Community Leader interest 5. Proof of Concept status at GPSC 6. Proof of Concept funding by IHA: $500K for new nursing & allied

Concept: High Skill Rural Generalism In rural communities, where economies of scale for specialised services are absent, highly skilled and highly integrated generalist teams are

the most effective approach to affect the core system challenges... Process The CSC will facilitate a collaborative, consensusbased planning process with Boundary GPs & IH staff, CSC leaders, and (if desired) IHA senior

representatives, to reach agreement by all parties re.: 1. Outcome Targets 2. Framework for QI & Team Development processes 3. Incremental Staffing Complement 4. Governance of New Staffing

(DRAFT!) Outcomes 1. Decrease the CTAS 4 & 5 ED visits by 30% over 12 months and 50% over 3 years 2. Reduction of MHSU clients and service days to KB levels of 48/1000 pop and 576 service days/1000 pop over 12 months and further

reduction to IH levels (32/1000 and 376/1000, resp.) by year 3 3. Decreased hospitalization for 75+ patients of 20% over 12 months, and a further reduction of 20% by year 3. 4. Etc

Summary: Embrace the opportunity for something bigger.

Apply rigorous change and engagement theory. Be political, strategic and maximize relationships. Local & Provincial. Think complex system:

Nobody is in charge.

Demand local governance. Assuage insecurity with story. Utilize experienced Physician voice. Focus on the BIG problems. Lead with risks and pitfalls. So others dont. Sing the single aim, Per Capita Cost

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