Combining the right “what” with the right “how”
Spreading successful health care innovation is critical to the success of transforming health care systems.
But this is no easy task, especially in today’s complex health care environment. Funding constraints, slow-moving organizations and siloed care responsibilities can combine to create challenges to implementing new initiatives and it currently takes an average of 12 years for a health care innovation to be adopted into practice.
So, it is fitting that we should celebrate a program which over the past 5 years overcame these hurdles and helped introduce 8 proven health care initiatives to all parts of the province, in the process improving care for an estimated 300,000 patients. These interventions continue to be sustained and spread further across the province to this day.
As we review the work of the Adopting Research to Improve Care (ARTIC) program and the 5-year partnership between the Council of Academic Hospitals of Ontario and Health Quality Ontario, it is clear there are lessons that will benefit the transformation in the healthcare system currently underway in Ontario
When we discussed the progress of the program in an earlier blog midway through the partnership, we noted that it countered the well-known propensity of Canadians to fail to capitalize on and spread proven health care interventions – a viewpoint reiterated in August at a national summit on innovation hosted by the Canadian Medical Association in Toronto.
The gist of the program, which began in 2010, was taking a health care intervention that was well-researched and evidence-based and using a focused approach to promote broader adoption within a 2-year period, thereby dramatically accelerating the pace of spreading proven innovations in care.
The projects selected for support were wide-ranging; from supporting antimicrobial stewardship in intensive care units in community hospitals to rapid access addiction medicine clinics and client-friendly discharge summaries for patients leaving hospital (known as PODS).
Earlier projects focused on spreading an evidence-based intervention to a select number of academic hospitals in the province. In the later stages, the program was involved in taking proven initiatives, such as rapid access clinics for musculoskeletal conditions, to help the Ministry of Health and Long-Term Care scale them for the entire province.
Each project saw unique successes and challenges in implementing the initiatives at sites across Ontario. Those lessons were then applied to guiding subsequent projects.
What can the experience with the program tell us? One revelation is the impact far beyond the introduction of a specific intervention. We found the process of spreading a promising intervention not only deepened the relationships among the partners involved, but fostered a culture of quality, creating an even stronger foundation for a continuous focus on quality improvement.
Those involved in leading the implementation of the initiatives found the following to be critical enablers of success:
- Having strong leadership from credible clinicians that have implemented the model before and local clinical champions
- Ensuring the intervention itself was evidence-based and the implementation approach taken was known to effectively address the key drivers for change – combining the right “what” with the right “how”. Interventions selected were judged to be mature models that warranted further spread and the implementation methods for each were tailored to the intervention and the intended mechanism of change.
- Being linked to provincial priorities and being important and relevant to those involved
- Making sure interventions are redirecting existing resources or replacing existing tasks and not adding to existing workloads
- Setting a time limit for investing in and implementing the project that is short enough to accelerate the intervention and maintain momentum and interest but long enough to allow the project targets to be met. In the case of these projects this was two years.
- Facilitation of an effective community of practice to share knowledge and other implementation supports
- Having a strong evaluation framework with ongoing measurement and evaluation.
Over the past five years, those involved with the ARTIC program have gained these and other unique insights. This knowledge is particularly relevant during the current period of transformation and should prove useful when it comes to connecting the dots between where health care innovation is well advanced and where there may be more capacity for adoption.
(The authors would like to acknowledge the pioneering work done to develop this program by Karen Hurlburt, formerly Executive Director of the Council of Academic Hospitals of Ontario)
Anthony Dale is President and CEO, Ontario Hospital Association and also serves as Lead Executive of CAHO. Lee Fairclough is VP, Quality Improvement for Health Quality Ontario