24 NSQIP sites! Majority started in April – Aug year funding arrangement Procedure Targeted – General Vascular1 Procedure Targeted – Multispecialty4 Classic – Multispecialty16 Small & Rural2 Pediatric1 Total24

Program NSQIP Sites in BC

Call to Action – Data Challenge! Use your non risk adjusted data to identify areas of improvement. Aim for improved care in targeted areas by November [gulp]

Surgeon Anesthesia SCR BC Working Group (SCRs/QI) SCR (QI) Admin Leads

Set Up ACS Contract Signed Start of data submission to ACS Data Cleaning Plan (post ramp-up) Number of Charts Reviewed (by Feb 2012) Current Month - Chart Abstraction Analysis and Dissemination Problem Area (ie., SSI) Data sharingData Review and Analysis (SPC charts) Action Team Charter/Aim Statement Action Teams Milestones

Where are we?! ACTION TEAMS Problem Areas [from non risk adjusted] No. of sites identified problem area No. of SITES with Action teams* UTIs1712 SSIs (colorectal/cardiac/other) 102 Pneumonia41 VTE2- Total14 * Information based on March 2012

10 Awareness Iceberg 4% known to top leaders 9% known to middle managers 74% known to supervisors 100% known to the front line & patients/families Adapted from study conducted by Sidney Yoshida, initially presented at the International Quality Symposium LS unleash action on the front line

Key Elements

Martin Makary, MD American College of Surgeons 2006

Surgery: Teamwork & Communication 14 hospitals (9 NSQIP) Over 70 units 2334 health care professionals Unit Level Response Rate over 60% Fraser Health AuthorityVancouver Island Health Authority Burnaby HospitalCampbell River Hospital Royal Columbian HospitalCowichan District Hospital Surrey Memorial HospitalNanaimo Regional General Hospital Providence Health CareRoyal Jubilee Hospital Mount St. Joseph HospitalSaanich Peninsula Hospital St. Paul's HospitalSt. Joseph's General Hospital Vancouver Coastal Health Authority Victoria General Hospital Richmond HospitalWest Coast General Hospital

BC Findings

Where BC does well! I am less effective at work when fatiqued

Disagreements in this work setting are resolved appropriately

Why is change so hard? Reluctant to alter habits Legacy of distrust Effective engagement campaign Communication strategy

Engagement and Communication Build social movement thinking into quality Engage at a wide scale Using Engagement Storytelling Digital strategy

Tools & Products 1. Blasts 2.Sharing presentations 3.Videos 4.Photos 5.Unique website 6.Twitter

Download it now from Follow

Local Risk Adjustment Engagement! Surgeons and others Second Cohort for SAQ (early 2013) Link with Canadian sites Now! Economic Impact Evaluation What’s Next for SQAN?

Facilitators for Doug Cochrane, MD, Surgery co-lead, SQAN and Chair of BC Patient Safety and Quality Council Peter Doris, MD, Surgery co-lead, Surgical Quality Action Network NSQIP Craig Bosenberg, MD, Anesthesia, Surgical Quality Action Network Checklist Kimberly McKinley, RN MN candidate Data Analyst and SCR liaison Rebecca Brooke, Quality Leader, Surgical Quality Action Network Marlies van Dijk, Director, Surgical Quality Action Network