Western Health (Newfoundland) invests in better self-management support for people living with diabetes


This story is part of a collection featuring improvements from the Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC).

The Challenge

Newfoundland and Labrador has one of the highest rates of Type 2 Diabetes in the country. According to the Canadian Diabetes Association (CDA), in 2010, 47,000 Newfoundlanders – or 9 percent of the province’s population – had Type 2 Diabetes. The province has several risk factors for Type 2 Diabetes, including an older population and the highest rates of overweight and obesity in Canada. These factors suggest that the number of Newfoundlanders living with Diabetes will increase substantially in coming years. In fact, CDA forecasts that by 2020, an estimated 73,000 people in the province will have Diabetes, or 14 percent of the population – the highest in the country. This increase could overwhelm local healthcare systems if not properly managed.

Provincially, the Department of Health and Community Services recognized the importance of self-management in healthcare and introduced a program called “Improving Health: My Way.” Western Health, in turn, examined ways health professionals could support client self-management. To determine the best approach to supporting self-management for patients with Diabetes, the regional health authority used the Assessment of Primary Care Resources and Supports (PCRS) tool, which helped identify existing strengths and weaknesses in supporting chronic disease self-management. This PCRS tool targets front-line providers who deliver care to assess delivery of self-management support services and organizational infrastructure from their perspectives.

“According to the Canadian Diabetes Association, in 2010, 47,000 Newfoundlanders – or 9 percent of the province’s population – had Type 2 Diabetes – among the highest rates in Canada.”

The Solution

Working with the Canadian Foundation for Healthcare Improvement through the AHC, Western Health developed a new approach to Diabetes care with self-management as its cornerstone. Focusing on each patient’s emotional health, patient input and staff training, the new approach incorporated many changes, including types of services offered, how services were delivered, referral mechanisms, and more. Particular emphasis was placed on improving emotional health as clients who are experiencing depression may not have the motivation to self-manage their health. The health authority adopted the use of the Personal Health Questionnaire (PHQ) to screen new clients for depression and also developed a treatment algorithm, reporting 100 percent compliance of completion. A poster campaign encouraged clients to provide compliments or complaints on the healthcare services they receive, and a new client survey focusing on Diabetes patient satisfaction and outcomes was developed.

In addition, Western Health initiated several strategies to improve providers’ skills and knowledge around self-management. This included a two-day workshop in partnership with Dalhousie University’s Behaviour Change Institute and the development of a community of practice (COP) for Diabetes team members. The community of practice uses a web-based forum for collaborating and sharing information, as well as quarterly meetings to discuss successes and barriers to implementing Diabetes self-management.

The Results

The PCRS tool, containing 18 self-management support domains, was readministered after the program changes were implemented. Scores in all 18 domains improved, with the greatest improvement seen in the three domains previously identified in the pre-PCRS assessment:

  • Patient emotional health
  • Patient input
  • Staff training

While improvement in the three target areas was expected, the degree of improvement in other domains (for example, ongoing quality improvement, goal setting, link to community resources, and coordination of referrals) was unanticipated.

The team members also completed self-assessments to rate their skills and attitudes toward self-management on three different occasions – initial, immediately before and after the advanced training. By the time training was completed, team members’ scores had increased. The self-assessments showed that team members’ attitudes toward self-management changed during the initiative, with team members placing greater importance on self-management support.

Furthemore, a tool administered during the initiative called the Patient Assessment of Chronic Illness Care (PACIC) measured the extent to which the care provided is patient-centred, proactive and planned. The results showed that this was, indeed, the case. and includes collaborative goal setting; problem solving and follow-up support.

Overall, the implementation of the self-management support strategies has strengthened the team approach and led to positive feedback from staff and patients. Changes in the team membership throughout the initiative posed difficulties in both training and evaluation. Development of the COP has proved invaluable in maintaining momentum and integration of the new strategies. However, staffing changes caused delays with formalizing the training modules to promote spread to newer team members.

The Spread

Western Health is working to sustain the positive momentum generated by this initiative. The PCRS tool will be used as an ongoing quality improvement tool and to identify other priority areas within the organization. Additionally, a COP has been established for Diabetes providers, a self-management support working group and a behavioural psychologist have been brought in to assist with the ongoing implementation of self-management support strategies within practice. The COP also has a website that contains resources, educational tools (such as videos and articles) and a blog for providers to stay connected and discuss opportunities and challenges with these self-management strategies.

Other health authorities within Newfoundland and Labrador have expressed interest in this initiative and the team has shared their resources and tools. The self-management coordinator will continue to assist these regions as they implement changes that support Diabetes self-management.

The Western Health team shared their results at the National Health Leadership Conference (NHLC) held in June 2015 and intends to publish the results in a peer-reviewed journal article.

Jennifer-Hennebury-125Jennifer Hennebury
Regional Chronic Disease Prevention & Management Manager
Diabetes Services
Western Health




Darla-King-125Darla King
Regional Director, Medical Services
Western Health