Towards a Learning Health Care SystemExperiences in Kootenay Boundary

Jennifer Ellis, QI Manager, Kootenay Boundary Division of Family PracticeMarch 6, 2020

Kootenay Boundary

78,000 people93 GPs and 6 NPs in family practice49  ED physicians, hospitalists,locums, GPs/NPs in focused practice50 specialists26 primary care clinics3 hospitals with inpatient beds3 health care centres with EDs open indaytime only

“science, informatics, incentives, and

culture are aligned for continuous

improvement and innovation, with best

practices seamlessly embedded in the

delivery process and new knowledge

captured as an integral by-product of the

delivery experience.”

Institute of Medicine, 2015

A Learning HealthcareSystem

QI not QAThe data is a conversation starter.Establish a blame-free culture that

allows falling forward.

Data literacy basedTalk about the data. Explain whatthings mean and how they weremeasured. Discuss uncertainty.

Voluntary but value-addBring people along by helping them to seethe value of the work and information. Get

feedback on approaches.

Principles of a Learning System in KB

Data and tool democracyShare data openly with safeguards.Build and share a library of  tools to

enable shared language and commonapproaches.

Su�cient resourcingData collection, analysis and

sharing takes time and money.This cannot be done off the side

of a desk.

Imperfection is expectedAnd accepted. The data is messy.

The tools are imperfect. Somethings seem unmeasurable. Butthere is a need to move forward.

Outcomes focusUnderstand what you are trying to

achieve and how you will know changeis an improvement. Logic models!

Measure twice (or more)Use a diverse set of measures to to triangulate, tell a robust storyand account for the unexpected.

Ground in the literatureYou're probably not the �rst to try todo something. Learn what you can

from the experiences of others.

Principles of a Learning System in KB

Relationships enableTrust is integral to data sharing, data

collection and discussions aboutoutcomes, progress and mistakes.

Disaggregate dataThe data must be as disaggregateas possible enabling people to see

themselves within it while stillpreserving trust and privacy.

Decentralization andSelf-management

A learning system cannot be top down.Ideas must �ow up and down and local

people must be empowered to self-manage.

Embedded evaluators and QI coordinatorsBuilds relationships and trust Keeps the focus on data, outcomes and learningEnables formative evaluation and regular feedback loops

01

Protected budgets for QI and evaluationCreates buffer and allows for experimentationEnsures evaluation always happensEvaluation, QI and data sharing becomes an organizational norm

02

Evaluation and QI roles separate from project managementProject managers do not plan or execute evaluations and evaluators/QIcoordinators do not project manage 

03

Physician leaders in data sharing and literacy"I'll show you mine, if you show me yours" - normalizes resultsSessional supported

04

Structures of a Learning System: People 

Regular data and QI "events" part of all initiativesLearning labs and Regional QI meetings establish regular re�ectionFacilitate data sharing, data democracy and data literacyAllow for a refocusing of action around outcomes and data

05

Regular "Report on Outcomes" with 20 indicatorsKeeps focus on outcome indicators vs. process or output indicatorsOpportunity to review what we know, and explore what if any utility that provides

06

Evaluation and QI tools and frameworksToolkit of frameworks, surveys, consent forms, reports, logic models, infosharing agreements and indicators developed collaboratively  

07

Routine data collection using standardized toolsAnnual member survey, patient surveys, project check-insMakes data collection just a part of doing businessMoving towards more automated EMR data analytics 

08

Structures of a Learning System: Tools 

Commitment to and funding for sharing learningsCommitment to sharing �ndings, tools developed, approaches andexperiences to multiple audiences

09

10Establishing partnerships to access data, share data and collect dataCommunities of practice enable learning and sharing of tools 

11

Data relationships and communities of practice

12

Structures of a Learning System: Partners 

Partnerships with research organizationsExpand our reach, bring in new expertise and enable innovative projects

Provincial working groups and pilotsAbility to engage in provincial discussionsOpportunity trial new tools and approaches

Culture enablesstructures 

andStructures create

culture

Embedded QICoordinators and

Evaluators

PhysicianLeaders

Protected andSufficientBudgets

Voluntary butValue Add

QI not QA

OutcomeFocus

Self-Management

Regular Data andQI Events

Robust Toolbox

Reports onOutcomes

Regular andAutomated Data

Collection

Data Partnershipsand Communities

of Practice

SharingLearnings

Partnershipswith research

organizations

Pilots

Culture of LearningKootenay Boundary Learning System 

QI Coordinatorsand Coaches for

each clinic

Clinic QI Leads

0.8 FTEfor QI Eval for

12 clinics

Voluntary, butValue Add

QI not QA

OutcomeFocus

Self-Management

QI and EvaluationFramework

12 outcomes and 37indicators

PatientExperience Survey

n=1500

PCN Learning Lab

CPCSSN for EMRanalytics

IH DataRelationship

IH PCN EvaluationCommunity of

Practice

Researchprojects with

UBC and UVic

MoH Data

Linking Pilot

Culture of LearningKootenay Boundary Vignette: PCN  

Tools for measuringaccess, team &

PROMS

PCN Clinic Leads

Establishenablingframeworks

Make dataeasilyaccessible

Fund internaland externaldata analysts

Support learningnetworks andcommunities ofpractice

Establish keyindicatorscollaboratively

Building a Learning Health Care System Provincially

Create a toolkit withstandardizedmeasures

Enable topdown and bottom uplearning

Incentivize datacollection andre�ection

Establishmechanismsfor knowledgesuccession

Allow forlocalinnovation

Include allstakeholders

Eliminate datasilos andenable datalinking