Barrie Community Health Centre Barrie, Ontario, Canada Carla Palmer B'Sc, M'Sc'

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Barrie Community Health CentreBarrie, Ontario,
CanadaCarla Palmer B.Sc, M.Sc.

• Diabetes A preventable epidemic
• An integrated prevention and care pathway
• using
• Strategy Mapping/Balanced Scorecard Methodology

The Future of Primary Care in Europe Utrecht, The
Netherlands October 12, 2006
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Overview

• Community Health Centre model in Ontario
• Diabetes management in Canada
• BCHCs goal to improve client health outcomes
  through improved integration
• Strategy map and balanced scorecard methodology
  
• Preliminary results after the first year of 3
  year plan
• Discussion of integration best practices and
  challenges

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CHCs in Ontario

• Provincially funded
• Community governed
• Primary health care
• Salaried staff

Interdisciplinary team includes Physicians,
Nurse Practitioners, Nurses, Physiotherapists,
Dietitians, Social Workers, Health Promoters
Community Health Workers
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Diabetes Prevalence in Canada

• 25 increase in prevalence in Ontario in 7
  years
• 1994 3 of population
• 2001 4.2 of population
• 2006 6 of population (estimated)
• With the trend of increasing obesity, the
  prevalence of diabetes is expected to continue to
  climb

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Diabetes Morbidity
www.healthandage.com/html/res/primer/hormones.htm
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Providers functioning like islands

• Providers working to full capacity, as
  individuals, not as a team
• No mechanisms to ensure clients were accessing
  the right care in the Centre or in the community
• No linkage between prevention and care

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Integration and Accountability

• Imagine a primary care centre that has organised
  its professionals in a network, but where
  communication and exchange of information between
  professionals is poor. Though this centre may
  appear integrated from the provider perspective,
  for the user, navigating the system has not been
  made any easier. From his perspective, care is
  still fragmented.
• (Wait, European Social Network Conference,
  Edinburgh 2005)
• Cited in Integrated Care A Guide for
  Policy-makers (James Lloyd and Suzanne Wait)

Barrie Community Health Centre
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BCHC Vision Statement

• Barrie Community Health Centre is recognized as
  an innovative, responsive and relevant health
  care partner along the health care continuum
  advancing the health of individuals and the
  community through integrated prevention and care
  pathways.

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BCHCKey Strategic Result

• Advance and balance prevention and primary care
  for the individual and the community to
• improve health outcomes,
• reduce avoidable use of healthcare services, and
• build on our communities strengths

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Enabling the Goal for Integrating Prevention and
Care

• Measurable description of the future
• Consensus about targets
• Approved strategic framework
• Highest priority for focus
• Staff supported to implement and measure their
  strategy for integration
• Bengt Ahgren and Runo Axelsson, Evaluating
  Integrated Health Care A system of measurement,
  Internation Journal of Integration Care, 31
  August 2005

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Enabling the Goal for Integrating Prevention and
Care

• Structure follows strategy
• Guus Schrijvers, Editorial, International Journal
  of Integrated Care, November 2005

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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
Healthy Eating and fitness Less overweight and
obesity
Help you help yourself
Access to care you need when you need it
Client Perspective
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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
Healthy Eating and fitness Less overweight and
obesity
Help you help yourself
Access to care you need when you need it
Client Perspective
Interdisciplinary team best practices
BCHC working in collaboration
Volunteer led programs
Internal Processes Perspective
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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
Healthy Eating and fitness Less overweight and
obesity
Help you help yourself
Access to care you need when you need it
Client Perspective
Interdisciplinary team best practices
BCHC working in collaboration
Volunteer led programs
Internal Processes Perspective
Staff with new knowledge and skills
Volunteers trained as leaders
Learning and Growth Perspective
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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
Healthy Eating and fitness Less overweight and
obesity
Help you help yourself
Access to care you need when you need it
Client Perspective
Interdisciplinary team best practices
BCHC working in collaboration
Volunteer led programs
Internal Processes Perspective
Staff with new knowledge and skills
Volunteers trained as leaders
Learning and Growth Perspective
Financial Perspective
Commitment of resources for training
Shift of Staff Role
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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
Healthy Eating and fitness Less overweight and
obesity
Help you help yourself
Access to care you need when you need it
Client Perspective
Interdisciplinary team best practices
BCHC working in collaboration
Volunteer led programs
Internal Processes Perspective
Staff with new knowledge and skills
Volunteers trained as leaders
Learning and Growth Perspective
Financial Perspective
Commitment of resources for training
Shift of Staff Role
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Diabetes A Preventable Epidemic
Less diabetes
Fewer complications
System Outcomes
Healthy Eating and fitness Less overweight and
obesity
Help you help yourself
Access to care you need when you need it
Client Perspective
Interdisciplinary team best practices
BCHC working in collaboration
Volunteer led programs
Internal Processes Perspective
Staff with new knowledge and skills
Volunteers trained as leaders
Learning and Growth Perspective
Financial Perspective
Commitment of resources for training
Shift of Staff Role
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Results Financial

• Refocusing continuing education budget
• Re-allocating staff from relocating
• 5 physiotherapy-led exercise
• classes to resources within the community

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Results Learning and Growth

• Selection of and training in use of
  evidence-based interdisciplinary best practice
  tool
• Two staff and one volunteer have received
  training in the Stanford model of Chronic Disease
  Self Management at Stanford University in
  California

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Results Internal Processes

• it has been audited that all team staff members
  are using the best practice tool
• staff sit on new organization teams related to
  the integrated prevention and care pathways of
  which diabetes is one
• the Centres Health Service Manager sits as
  Chairman on the inter-agency Diabetes
  Collaborative

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Results Client Outcomes

• Increase healthy nutrition and activity levels
• improvement of eating habits and activity levels
  reported by 50 of BCHC playgroup participants
  50 of clinical clients
• breastfeeding initiated by 90 of new mothers who
  use BCHC clinical services or Teen Parent and
  Young Parent programs
• 60 will breastfeed exclusively for 6 months
• Improve clinical status
• 5 7 reduction in weight within 1 year by 50
  of BCHC clinical clients with a high BMI ( 27)
  or an at risk waist circumference
• improvement in diabetic clinical status by 50 of
  BCHC clinical clients
• Increase self-management skills and strategies
• passing score on a Diabetes Self-care Assessment
  an acceptable score on the Diabetes Quality of
  Life scale achieved by 70 of BCHC clients
  attending the BCHC Diabetes Management Centre
  program

Barrie Community Health Centre
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Client Story

• L.G is a 67 yr old retired man referred by a
  physician outside the centre to the BCHC Diabetes
  Management Centre
• One-on-one consultation with nurse and dietitian
• Diabetes education program re nutrition, fitness
  and self management re blood glucose levels
• Regular monitoring of A1c levels by his physician
• 3 mo results 28 pounds weight loss, 3 decrease
  in the A1c level

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Conclusion

• Enablers of Success we believe we have achieved
  through Strategy Mapping and Balanced Scorecard
  Methodology
• Structure follows strategy
• Consensus about integration targets
• Targets in a strategic framework
• Evaluation data guide managers and providers
• Change management priority, linked by
  accountabilities, with the achievement of one
  objective driving the other
• Ongoing Challenges
• Information system
• Interagency collaboration process to define new
  roles, and bridge between organizational cultures

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References

• Integrated Prevention and Care
• Lloyd, James and Wait, Suzanne, Integrated Care
  A Guide for Policymakers, Report from the
  European Social Network Conference, Edinburgh,
  2005
• Ahgren, Bengt and Axelsson, Runo, Evaluating
  Integrated Health Care a model for measurement,
  International Journal of Integrated Care, 31
  August 2005
• Schrijvers, Guus, Prevention and Cure should be
  integrated (editorial). International Journal of
  Integrated Care, 2 November 2005
• Chronic Disease Prevention and Care
• Haydon, Emma, et al, Chronic Disease in Ontario
  and Canada Determinants, Risk Factors and
  Prevention Priorities, Prepared for the Ontario
  Chronic Disease Prevention Alliance and the
  Ontario Public Health Association, March 2006
• WHO, Innovative Care for Chronic Conditions
  Building Blocks for Action, 2002
• Hurtubise, Michelle and Harvey, Betty,
  Presentation Diabetes Care at the London
  InterCommunity Health Centre (Ontario), May 2006
• Strategy Mapping and Balanced Scorecard
• Kaplan, Robert S. and Norton, David P., Having
  Trouble with Your Strategy? Then Map It, Harvard
  Business Review, September-October 2000
  (www.hbr.org Product 5165)
• Kaplan, Robert S. and Norton, David P., Strategy
  Maps, Harvard Business School Publishing
  Corporation, 2004
• Niven, Paul R., Balanced Scorecard Step-by-Step
  for Government and Nonprofit Agencies, John Wiley
  and Sons, Inc, 2003

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Stretch Targets
A target which is currently out of reach, but not
out of sight.
It may require the breaking of previous
boundaries and constraints
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Thank you

• Acknowledgements
• Barrie Community Health Centre Board of Directors
  for their leadership, Christine Colcy (Health
  Services Manager) for her operational expertise
  to bring life to the Balanced Scorecard and BCHC
  staff for their perseverance to implement it, and
  the Southwest Ontario CHC Executive Directors
  Group for their support of my work and the
  expense of registration for this conference.