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Presentation on theme: "Thank you for joining CHSRF on Call! Please turn on your computer speakers to connect to the audio for this session. (If you do not have computer speakers."— Presentation transcript:

1 Thank you for joining CHSRF on Call! Please turn on your computer speakers to connect to the audio for this session. (If you do not have computer speakers you can dial to connect via telephone) If you need assistance at any time please choose a tech support option below. 1 1

2 Gina BrowneStephen SamisScott Robertson 2 Optimizing the Roles of Nurses to Improve Efficiencies

3 OPTIMIZING THE ROLES OF NURSES TO IMPROVE EFFICIENCIES Gina Browne Professor of Nursing McMaster University Presentation Prepared for the CHSRF on Call Webinar Series Optimizing the Roles of Nurses to Improve Efficiencies, June 27,

4 Transforming? 4 “… we must depart from habits of mind that have characterized our usual thinking.” - Clyde Hertzman

5 WICKED PROBLEMS Wicked questions are used to expose the assumptions held about an issue or situation by members of a group -Zimmerman … to make the “undiscussable”, discussable -Rusch It is “wicked” if there is an embedded paradox or tension in the question Wicked questions do not have obvious answers “How to control health costs and make the health care system sustainable?” 5

6 General Assumptions About Causation of Costs: Aging? Chronic Disease? Baby Boomer? Technological Advances? 6

7 CONTEXT and Behaviour re-examined 7 Ontario population 13 million 1% of population 130,000 use 49% of hospital/home care services 5% of population 650,000 use 84% of hospital/home care services

8 Winnipeg ED Frequent Use Category (Doupe et al., 2012) 8 Less Frequent 1-6 visits/year Frequent 1-17 visits/year Very Frequent > 18 + visits Number of People103,2872, Primary Care Visits >733.2%66.7%71.3% Primary Care Physicians Visited >3 22.7%46.8%62.3% Specialists Physician Visits >3 22.3%48.7%38.1% Hospital Admissions >21.7%5.0%3.6% E.D. Visits Previous Year >7 0.5%17.8%70% Calls to Health Links >2.7%13.0%20.2%

9 9 Less Frequent FrequentVery Frequent Lowest Income Quintile 27.0%46.5%57.9% Physical Disease Arthritis Asthma Diabetes Heart Disease Ischemic Stroke 39.7% 17.8% 12.7% 14.5% 8.2% 60.1% 37.6% 28.4% 31.3% 17.4% 78.0% 40.4% 25.1% 14.8% 10.3% - Winnipeg, Doupe et al., 2012

10 10 Less Frequent FrequentVery Frequent Mental Illness Anxiety Depression Dementia Personality Disorder Schizophrenia Substance Abuse 12.6% 30.4% 6.1% 2.2% 1.9% 9.9% 34.3% 60.3% 21.6% 13.3% 8.0% 35.9% 57.0% 79.4% 43.9% 31.4% 22.9% 67.3% - Winnipeg, Doupe et al., 2012

11 11 Principles of causation in Social Epidemics “Tipping Point” The “boiling” point of massive modern change” by Malcolm Gladwell “Biographies of Mysterious change” 1. Contagious Behaviour or ideas: … unexpected properties of things … “sticks”, makes an impact … because of reading, hearing, seeing, thinking e.g… virus, fashion, crime, technologies, use of health resources 2. Law of the few: … little causes having big effects … geometric progression and out-of-proportion, not … proportional or gradual 3. Both contagion and the few happens in a hurry! Dramatic change – “baby boomers” - “The power of context” Drummond Report Deterioration of Ontario’s Financial Rating

12 Different Ways of Tipping 12 Growth (stimuli): aging, technology Growth (transformation) of disease: from acute to chronic Growth and loss in context – Health care consumes 50% of provincial budgets – Financial down grading

13 How can we create positive social epidemics? 13 Contagious message of social justice sticks Suddenly “man set himself on fire” Youth rebels Arab Spread Arab Spring?

14 New Contagious Messages About Patient Needs and Health Care: A few people use most expensive health resources Acute, episodic, on-demand medical care: – A poor match for some chronically ill – Does not prevent emergency hospital use Proactive nurses providing continuity needed for better care of chronically ill and vulnerable 5% 14

15 Transforming Models of Care 15 Recurrent Problem Citizen Resolved Problem Citizen Resistant Problem or Unreached No problem resourceful citizen “Low Access” “Hi Access” 5% 95% Hi Vulnerability 84% of hospital home care budget 16% of hospital home care budget Low Vulnerability

16 Comparative effects and costs of models of care for chronic disease Expert Commission 2012 CHSRF/CNA “Better Health, Better Care” 16

17 17 - Birch & Gafni, 1996 IncreasedSameReduced Increased Same Reduced Costs for Resources Consumed Effects Produced

18 Promising Models of Chronic Care? 18 Professionally-led Targeted Proactive (outreach and aimed at determinants of health) For chronically ill or circumstances Supplement areas of vulnerability Comprehensive – Interdisciplinary Team Use of phone or alerts (case finding) Nurse-led Natural settings-schools Primary Care Community Home Care

19 Priority Chronically Ill? 19 Hospitalized past year recently discharged ER use past year recently discharged Lives alone Cognitive impairment (Dementia) Mental (Anxiety, Depression, Substance Abuse) Living in a long-term care facility Poor

20 Steps for Large Scale Transformations -John Kotter 20 1.Increase the urgency for change 2.Build the powerful guiding team 3.Get the vision right 4.Communicate for buy-in e.g. MD Model okay for 95% (remove fear), Nurse led model for 5% 5.Empower action 6.Create short term wins 7.Don’t let up 8.Make change stick… contagious messages

21 Closing Comment: 21 Changing behaviour is less a matter of giving people analysis to influence their thoughts and more about helping people see a truth to influence feelings – The Heart of Change - John Kotter

22 The Northern reality of advanced nursing practice Scott Robertson Chief Nursing Officer, Government of the Northwest Territories 22

23 23

24 24 NURSING PROFESSION ACT S.N.W.T. 2003,C.15 In force January 1, 2004; SI NURSING PROFESSION ACT S.N.W.T. 2003,C.15 In force January 1, 2004; SI

25 25

26 26

27 27 A Tale of Two Hospitals

28 28

29 29 Now what?

30 Questions? Please submit your questions electronically using the “Questions box” on the bottom left of your screen. Alternatively, English questions can be asked verbally by pressing *1 on your telephone. 30

31 For more information on past and future sessions please visit us at Thank you! 31 To connect directly with our presenters….


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