1. Introducing ARECCI Project Ethics Tools for the Development of Ethically Sound Quality Improvement and Evaluation Projects in Interior Health 2012-present Background “Respecting and protecting people should be integrated and incorporated into everything we do. It is a way to operate and function both as a person and a professional.” Birgitta Larson Embedding ethics into our Quality Improvement and Evaluation work makes sense. The challenge is in identifying risks, managing the risk to a level acceptable to the organization and doing so in an efficient, standard and consistent manner. Interior Health has adopted the ARECCI Project Ethics Tools to support the ethical development of all QI and Evaluation Projects involving people and their information. Project Goals To identify and manage ethical risks in non-research projects To increase awareness of the ethical risks inherent in QI and Evaluation Projects To provide a structured framework that allows for a consistent process which supports project development, ethics screening and ethics review in QI and Evaluation projects which involve people or their information To create a shared need, where project leads and teams value the use of the ARECCI tools and the protection of people and their information, and where this becomes integrated into our day to day work To build capacity within the organization to support ongoing use of the ARECCI tools and provide appropriate reviews based on identified risk To foster relationships external the health authority and support our desire to ‘pay it forward’ by helping to increase capacity across BC To develop policy to support the process Steps taken to Incorporate the ARECCI Process into IH Identified a working group who had passion for the work and who could keep the energy high Developed a close working relationship with Alberta Innovates Health Solutions who have created the ARECCI program and generously supported our journey The IH team of 3 were trained in Level One use of the tools, Train the Trainer and Second Opinion Reviews Developed in-house capacity to train and mentor Second Opinion Reviewers Built capacity within IH for Level One competency by training staff across the Health Authority Built capacity for IH to complete Second Opinion Reviews by Increasing the number of Second Opinion Reviewers within IH from 3 to 12. Created a ‘Project Ethics’ email address to receive inquiries and requests for Second Opinion Reviews Created a Frequently Asked Questions document to support staff new to the process and those needing additional support Created a Decision Support Tool to aid users in clarifying which work would require screening using the ARECCI process Presented information sessions to leadership teams across the Health Authority, as well as other groups across the province Developed expertise in the logistics of setting up and delivering course content Welcomed 4 non-IH participants in our training sessions Developed and received approval for The IH Project Ethics Policy Project Team and Contact Information Jody Pistak, Quality Improvement Consultant, IH East, KB jody.pistak@interiorhealth.ca Nicole Elliot, Manager, Physician Recruitment nicole.elliot@interiorhealth.ca Heather Engram Administrative Assistant, IH Quality and Patient Safety Linda Comazzetto (Sponsor) Corporate Director, Quality, Risk & Accreditation For information contact us at projectethics@interiorhealth.ca Results We have seen growing interest in the use of the ARECCI tools to ensure the ethical development of Quality Improvement and Evaluation Projects This interest continues in pockets and those who have adopted the use of the tools continue to champion and spread the word Changes have been made in individual projects related to methodology, data collection and storage, and reporting of results of projects based on recommendations made during Second Opinion Reviews Testimonials “The evaluation we were looking at was complex. There were a number of IH leaders involved with the initiative who had concerns regarding the structure of the evaluation. ARECCI allowed us to be very objective regarding our concerns. When we presented the concerns, they didn’t come across as critical or personal. That was utterly and completely invaluable. I often come to the table as the one expressing concerns. This ARECCI process fully supported my concerns, and the tool even highlighted things I wouldn’t have picked up on, on my own. I like that we may get to a place in the organization where everything will be evaluated with the same parameters. The challenge will be how to embed that across the whole health region.” Lori Seeley Practice Lead, Community Integration (Chronic Disease, Community Allied Health) “As Chair of the Interior Health Clinical Ethics Committee and a Regional Practice Leader in the Professional Practice Office, I found the level one ARECCI course to be very exciting in many ways. As we strive to advance the ethics culture in Interior Health and create a more integrated ethics model, tools like those presented in the course are extremely helpful. These tools serve to bring the organizational values and key ethical principles to life and make them more real. Consistently using the language of ethics promotes respect and understanding across the organization and the ARECCI tools help us to spread those messages.” Linda Sawchenko Past Chair, Interior Health Clinical Ethics Committee and Regional Practice Leader, Professional Practice Office ARECCI Project Ethics Framework Linda Barrett-Smith Jody Pistak Nicole Elliot Birgitta Larson Geoff Schierbeck Pictured in Kelowna Main Beliefs in Project Ethics Ethics Screening ought to be done for all projects that involve people or their data to identify ethical risks and determine review requirements Ethics Review for quality and evaluation projects is needed but the process must be flexible and integrated in the organization (or practice or service) in a way that encourages (not impedes) worthwhile projects When I first saw a presentation of the ARECCI tools I thought WOW – just what we need to reduce the workload on staff and students who did not have a quick and simple way of deciding if their project was research, evaluation or quality improvement. It has proven invaluable in reducing the workload for the research ethics board and evaluation team and at the same time has increased our collective knowledge about the ethical use of personal information in our health authority. Special thanks to Jody and Nicole for their enthusiasm in moving this forward and also special thanks to the staff in the Research, Evaluation departments and the Office of Privacy and Security for their support. Linda Comazzetto Corporate Director, Quality, Risk & Accreditation Interior Health