CFHI Interview with Erin Christian, Project Lead, Primary Healthcare Nova Scotia Health Authority

July 2016

Interview with Erin Christian

Left to right : Dr. Crystal Todd, Cheryl Tschupruk, Jo-Anne Wentzell, Erin Christian, Rachel Bard (CFHI Coach)

In an occasional feature, we interview leads of CFHI-supported projects. This month we profile the Nova Scotia Health Authority and their involvement in CFHI's EXTRA cohort 12.

Please describe your involvement with CFHI and its programs?

The Nova Scotia Health Authority (NSHA) is participating in the 2016-17 Canadian Foundation for Healthcare Improvement (CFHI) EXTRA Executive Training Program. Our work is the first improvement project from the NSHA to be accepted by the EXTRA program since the formation of the NSHA on April 1, 2015.

What improvement project is your team undertaking?

The Nova Scotia Health Authority is developing and implementing an operational framework to integrate a palliative approach into primary healthcare settings. Specifically, collaborative primary healthcare teams in Nova Scotia will demonstrate the successful implementation of a palliative approach to care in a home setting by 2017, resulting in a validated operational framework that includes building capacity for primary healthcare providers and increasing access to quality palliative care, demonstrating a shift in the model of palliative care from a specialized program to a person- and family-centred approach that can be delivered in a home environment. Anticipated outcomes include enhancing access to appropriate care; building capacity in primary care; optimizing existing resources; role clarity in palliative care; and improving patient/family experience, ultimately resulting in quality palliative care for Nova Scotians.

What key challenge will your innovation solve?

In 2014, the Nova Scotia Department of Health and Wellness released a provincial palliative care strategy to guide the health system toward an integrated model of palliative care rooted in primary healthcare and aligned with Canada’s national palliative care strategy. Early access to palliative care is shown to improve patient and family outcomes. Primary care providers are often the first and most consistent points of contact in the health system. Their role in palliative care is essential as we move toward collaborative team-based care in the primary healthcare system in Nova Scotia.

As palliative care evolved into a specialty, lack of role clarity for primary care providers has resulted in some providers having limited involvement in palliative care; therefore, competency and confidence in primary healthcare has decreased. Specialty services are designed to offer expertise to compliment comprehensive and continuous care provided in the health home and is not intended to sustain comprehensive care or address individuals’ needs over time. With all team members working together (primary care, specialties, and community resources) no one person is overburdened and individuals requiring palliative care remain in familiar surroundings.

How does your innovation improve care for patients, families and caregivers?

Our goal is to help facilitate seamless, coordinated, high quality palliative and end-of-life care for patients that is person- and family-centred and can be delivered in a familiar setting close to home.

To ensure that all patients, families and caregivers benefit from a quality palliative approach, training through Pallium Canada’s accredited education platform (LEAP – Learning Essential Approaches to Palliative and End of Life Care) will be provided to primary healthcare / collaborative teams participating in the project. Training covers topics ranging from decision-making and planning, useful tools and symptom management. In turn, we will monitor measures related to provider confidence and competence in delivering a palliative approach, along with patient and family experience and other key measures.

We plan to work with patient and family advisors throughout the development and implementation of the improvement project to ensure the patient and family perspective is accurately reflected and integrated from the outset through to evaluation.

Are there any cost savings that can be realized from your project? If yes, please describe.

Given our project is in the development phase, we have not had the opportunity to see any cost savings realized. However, one of the aims associated with implementing this approach is to see a more sustainable approach to palliative care delivery, which over time, is anticipated to reduce healthcare costs. We are currently looking at the literature and consulting with our coach and other advisors to determine an appropriate indicator to measure this change.

What has your experience been like working with CFHI?

Our experience working with CFHI through the EXTRA program has been very positive. Webinars with leading faculty have been informative and directly related to the development of our improvement project; and an onsite visit early in the project directly established our relationship with the CFHI team and our improvement project coach. We look forward to continuing to work with CFHI staff, faculty and coaches as we continue to progress through the EXTRA fellowship and prepare for the August residency session.

What feedback have you received concerning your project?

To date, we have received positive feedback on the project proposal from key strategic stakeholders, and we look forward to conducting further stakeholder engagement to gather broader feedback from patients and families, as well as providers, partners and leaders in our organization.

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