BC NSQIP SITE ASSESSMENT SUMMARY FINDINGS SURGICAL QUALITY ACTION NETWORK MEETING FEBRUARY 18 TH 2015

AGENDA 1.Poll 2.Introduction 3.Methodology 4.Findings 5.Next Steps

POLL Use your phones to respond to questions Text to: To vote in multiple Choice: Enter “number” and message

POLL Use your phones to respond to questions Text to: To vote in free text: Enter “number” then message

INTRODUCTION  NSQIP is currently in place in 25 hospitals in B.C.  The majority of sites have been participating in NSQIP for nearly 4 years  Consideration is being given to expanding NSQIP to additional sites across the province  The BCPSQC commissioned an assessment of 5 existing sites to review their experiences with NSQIP and inform potential roll out to new sites

METHODOLOGY  Sample of 5 sites interviewed across 4 health authorities  Conducted 18 phone interviews with 19 participants  Roles included:  SCRs  Surgeon Champions  Anesthesia Leads  Quality Improvement Specialists  Administrative Leads  Areas discussed included team structure, data dissemination and characteristics of NSQIP at each site.  Data qualitatively analyzed  Summary Report created

FINDINGS Implementation Team Environment & Stability Surgeon Champion Engagement All sites reported issues during NSQIP set up: Lack of clear roles & responsibilities Staffing mix Difficulty accessing mentors All sites reported issues during NSQIP set up: Lack of clear roles & responsibilities Staffing mix Difficulty accessing mentors Majority of sites reported that their teams worked well together. Turnover of core team, particularly SCRs and SC impacted success of site Majority of sites reported that their teams worked well together. Turnover of core team, particularly SCRs and SC impacted success of site Surgeon Champion engagement described as: Attending meetings Responding to s Discussing NSQIP data with colleagues Engaging in QI Surgeon Champion engagement described as: Attending meetings Responding to s Discussing NSQIP data with colleagues Engaging in QI

FINDINGS (CONT.) Clinician Engagement Frontline Manager Support Leadership Support Varying levels of clinician engagement at sites. Engagement affected by: Competing priorities Remuneration Time Skepticism about data Varying levels of clinician engagement at sites. Engagement affected by: Competing priorities Remuneration Time Skepticism about data Important for QI and SC to meet with managers and present/discuss data Surgical Nursing Managers key to accessing frontline staff for QI Important for QI and SC to meet with managers and present/discuss data Surgical Nursing Managers key to accessing frontline staff for QI Positive feedback about support from Admin leads Financial support from Senior Exec Operational support from Senior Exec lacking at some sites Positive feedback about support from Admin leads Financial support from Senior Exec Operational support from Senior Exec lacking at some sites

FINDINGS (CONT.) Timeliness of Data Majority of sites used non risk adjusted NSQIP data for trending Use of other data sources (Discharge Abstract Database, Infection Control data) Introduction of real time risk adjusted NSQIP data positive Majority of sites used non risk adjusted NSQIP data for trending Use of other data sources (Discharge Abstract Database, Infection Control data) Introduction of real time risk adjusted NSQIP data positive Must Have Characteristics for Success  Strong leadership  Engaged and enthusiastic core team to drive change  Good communication with team and frontline  Strong QI and data support  Committed and engaged Surgeon Champion  Sustained commitment from leadership for QI  Supportive Administrative lead to break down barriers, and  Remuneration of Surgeon Champions

FINDINGS (CONT.) Advice for New Sites Starting NSQIP in B.C 1.Board & Senior Executive demonstrates leadership and importance of QI 2.Leverage the current B.C sites for advice (Mentoring) 3.Provide QI training for core team members 4.Tailor data reports to respective audiences (e.g. surgeons, nurses, Senior Exec, Board) 5.Surgeon Champion, QI and SCRs need to understand NSQIP data and how it’s collected before presenting to an audience 6.Have a dedicated QI specialist 7.Recruit a strong Surgeon Champion who has credibility and passion for data and QI 8.Understand that improvement takes time 9.Encourage core team members to attend ACS NSQIP Conference 10.Ensure appropriate space and technology for SCRs

NEXT STEPS Review feedback from this session Post Summary Report on BCPSQC site Review opportunities to publish findings

Any questions or comments about the project contact Anna Needs or Kimberly McKinley at