There is clear and growing evidence that medical engagement makes a critical contribution to achieving innovation and improvement for patient care. Throughout the past four years, the Cowichan leadership team and their physician partners have recognized this and have worked together to create a culture within the Valley that meets this challenge. This journey of engagement and shift in culture has been supported by investment not only in quality improvement, engagement events, leadership development, education and training, but also by governance arrangements which have led to the desired state.
Effectively integrating the clinical and administrative components of physician engagement has called for strong physician leadership and participation in governance roles, which has been enhanced through the dyad leadership model across the area where Island Health administrative leaders are often paired with medical leaders.
By focusing on joint decision making and aligning strategy between physicians and administrators, Cowichan has demonstrated a unified model of care delivery with clinical integration that also provides a vehicle for bringing physicians and administrators together and underpinning the argument that medical engagement should not be an optional extra, but rather an integral element of the culture of any health organization and system.
This commitment to improving collaboration has been facilitated in many ways including ensuring that all physicians working in the area have forums to be heard and that they are informed as to how to navigate the system to allow them to contribute to the planning and decision making within the area. These contributions have been provided through a variety of channels including the Collaborative Services Committee (CSC), the CDH Quality and Operations Committee, the Cowichan Valley Quality and Operations Council, the development of the Physician Human Resource Planning Committee, the Local Medical Advisory Council and the Health Authority Medical Advisory Council.
Identified quality improvement physician champions across Cowichan have worked diligently to advance the quality improvement vision with key developments such as the Rapid Access & Discharge Unit (RADU), Critical Care Outreach Team (CCOT), Rapid Response Physician in the community, and the Residential Care Initiative (RCI) establishment and evolution of palliative care services.
Other improvements have included:
- implementation of the electronic Best Possible Medication History (eBPMH) in the CDH Emergency Department
- implementation of the MORE OB program
- same day discharge for select major joint replacement patients
- successful implementation of a stroke protocol in the emergency department
- unprecedented efficiency within the operating room and surgical services
These practical examples of improvement provide evidence of the work underway to provide high value performance and consequently improve operational excellence, reducing variation, maximizing reliability and delivering maximum value to stakeholders.
At a shared care engagement event recently held in Cowichan, these examples were outlined by Dr. Graham Blackburn as part of his presentation to highlight how the area can adapt the principles of highly reliable organisations to drive operating cost reductions and higher output, while maintaining the high safety environment demanded by healthcare environments. Together with Brenda Aguiar, Quality and Safety Lead for Geography 3, Dr. Blackburn explained that the key to a highly reliable organization’s performance is to conduct consistent, sustainable and low error operations based on informed, high quality decision making and controls and that collaboration and engagement between physicians and administrators is necessary for this to be executed successfully. As Dr. Graham Blackburn put it, "Getting to know each other and understanding how we can best work together will help us provide reliable, high quality health care."
Following the event, Dr. Bob Anderson said, "I hope we all can have more events like this one in the future. I think we all work so well together that we lose sight of the full service features that have evolved here at CDH. What a team!!"
Further, while Dr. Jan Malherbe would be the first to admit that he is not one to gush, he also found the engagement sessions to be highly enjoyable.
"The sessions were unique in that we had various levels of care providers in one place, sitting together shoulder to shoulder, all speaking to the same topic of how we can improve patient care. There’s a great deal of value in the perspectives of so many people with vastly different experiences," says Dr. Malherbe. "Every day on the wards, I see these same people and witness their commitment to our patients, but there isn’t time for deep engagement. After brainstorming with them at the sessions there is now a recognition that we were all part of the same process. It’s absolutely brilliant."
Throughout the four-year journey to improve collaboration and build relationships based on trust, the Cowichan Valley has recognized that a key principle in alignment has been "separate togetherness" in which physicians and administrators have maintained their own autonomy as separate groups but simultaneously united around a common purpose of driving up standards of quality care and provision of service delivery. This shared vision, common purpose and trust is what is hoped will lead the Cowichan Valley to continue its pursuit of operational excellence, and a coveted spot as one of the best places to work on Vancouver Island for both physicians and administrators alike.
Emma James, Area Director and Dr. Michelle Weizel, Area Medical Director both acknowledged, "The Cowichan area is fortunate to have a group of committed and engaged physicians who approach the work of aligning operational strategy with energy and enthusiasm and are truly committed to the improvement of the organization and overall achieving our area goals."