• Canada’s Investment in Health Innovation: The Need for a Balanced Portfolio

    Innovation is considered a crucial enabler to enhance healthcare performance and quality for Canadians while supporting health system sustainability and driving economic growth. Canada has many assets that can be leveraged to advance the innovation agenda in health systems, including a highly educated population and being a top knowledge producer worldwide. Yet, Canada ranks in the bottom quartile of developed countries for adopting innovation to support health system performance and economic growth compared to other OECD countries. Accelerating the adoption and scale of Canadian products, technologies, and innovations hold the potential to not only strengthen healthcare delivery, but also spur economic growth through job creation, as product sales increase and companies expand into global markets. Highly successful Canadian companies in the health sector drive wealth creation that supports publicly funded health systems, and positively positions the Canadian economy in global health system markets worldwide. So how is it possible that Canada is a top knowledge and innovation producer, yet our companies remain challenged to get their innovations adopted by Canadian health systems to achieve market growth?

    This project reviewed Canadian investments in innovation to better understand Canada’s lack of progress in commercializing and bringing health innovations to domestic and global markets. The project team reviewed all programs and organizations, with online presence, identified as supporting health innovation through various mechanisms such as funding, research, capacity building, relationship brokering, and policy analysis. This study analyzed the mandate and distribution of innovation programs and investments across provincial and federal jurisdictions in Canada. The analysis strategy was to review all publicly available information on innovation organizations in the country to determine what innovation organizations exist, where and how they are funded, and what the innovation mandate is for each organization. The data was then mapped along the Innovation Adoption Journey (Ontario Health Innovation Council, 2016) to examine where investments are being made along this continuum from early discovery to dissemination and scalability of innovation across health systems. Each organization identified was placed on the continuum based on the best alignment of the organization’s mandate to the specific phases of the innovation journey. For example, organizations that invested in discovering new knowledge were placed at the earliest part of the innovation journey – discovery of new ideas and identifying health system needs and priorities, which includes discovery-focused initiatives to solve or address health system priorities and needs.

    The following key findings can be used to inform and support future investments to accelerate health innovation in Canada. A review of federally funded programs revealed that less than 20% ($1.32B) of total federal innovation program funding identified through public sources was focused on health sector innovation. Federal funding across all innovation programs and all sectors totalled approximately $6.75B. Approximately 95% ($1.3 billion) of this funding was allocated to programs supporting research and development focused on the discovery phase of innovation, such as new therapies, new treatments or new technologies, and while only ~3% ($42 million) was focused on pilot testing, commercialization and early adoption of new innovations. Approximately two percent of federal funding was allocated to programs focused on partnership and capacity building to stimulate adoption of innovative products. There were no federal programs identified that focused on diffusing, scaling, and widespread adoption of innovation.

    From a provincial and territorial funding perspective, British Columbia and Ontario demonstrated the highest level of investment into the research and development phase of the innovation journey. In Ontario, the majority of programs identified were focused on research and development, followed by pilot testing and commercialization and significantly less funding was allocated to other phases of the innovation adoption journey. Saskatchewan and the Northwest Territories were the only two jurisdictions identified with a funding focus on dissemination and scalability of innovations. Innovation programs and organizations in smaller provinces and territories (Newfoundland, Prince Edward Island, New Brunswick, Nunavut, and Yukon) tended to have a more dominant focus on programs that funded capacity building and strategic partnerships in health system innovation.

    These findings offer insights into where Canada is investing in innovation – primarily the discovery and development of new technologies, new products and new approaches to managing disease. There are significant gaps in funding to get innovative products adopted and scaled across health systems. These findings also provide information and evidence to decision-makers and program leaders who are making investment decisions. A more “balanced portfolio” of investment by Canadian government’s focussed on supporting implementation, adoption and scaling of innovative products and technologies emerging from the programs funding development and commercialization would support Canadian companies to accelerate their market growth strategies and more rapidly achieve economic value. A balanced investment of funding throughout the continuum of innovation from idea to adoption and scalability across health systems could overcome the Canadian challenge of getting innovative products to market and improve economic growth.

  • Creating Visibility to Strengthen Quality and Performance in Healthcare

    Health systems in Canada, and worldwide, have been very slow to adopt information infrastructure and technologies that seamlessly track the processes, products, and progress of patient care services to create visibility, improve efficiency and strengthen capacity of health systems to deliver care. Proficiency in patient flow management is a key strategy to enhance delivery of services when and where needed. Advanced information technologies hold great promise as key enablers to achieve a more integrated and highly productive health system.

    This project reports on the integration of innovative information technology designed to overcome gaps in information, barriers to patient flow, to streamline patient care processes at a community hospital. The McKesson Performance Visibility (MPV) information system is a patient flow tracking system that integrates information from every patient data source, and displays the progress of patient care processes on interactive  screens in the hospital. Strategically placing the screens throughout the hospital enabled all staff to have complete visibility of every care process for each patient from admission, to diagnosis, and discharge. Enhanced visibility of information that captures the progress of every care process using streamlined communication for staff members, and clinical teams, enables and supports informed decisions in “real time” and care to be delivered as efficiently as possible for each patient.

    This project studied the impact of this MPV technology on: the quality of work-life for staff, the impact on decision-making processes, impact on hospital capacity (wait times), and staff experiences with adopting the new technology.

    The study found that visibility of accurate, and real time information on the progress of patient care had a significant and positive impact on how teams work together, how decisions are made and how hospital capacity can be enhanced. Employee communication and teamwork was more coordinated and streamlined to support completion of tasks more efficiently. Staff collaboration was also strengthened across clinical units in the hospital as a result of access to the same information about which patient was waiting for care, and who was ready for discharge. The new information system contributed to significant, positive shifts in staff perceptions about workload, fairness of workload distribution, and job satisfaction. Hospital leader’s decision-making was better informed by visibility to patient care progress in real time, and efficiency was achieved by reducing the number of phone calls required to gather information vital for evidence based decision-making. The information technology system resulted in improved hospital performance indicators including: increased capacity (reduced patient waiting time in the emergency department and increased patient volumes), decreased length of stay in key programs such as Mental Health which demonstrated a 50% reduction in wait times, and improved quality outcomes such as decreased patient falls and a 25% increase in the number of patients with discharge plans 48 hours prior to their anticipated discharge. Evidence emerging from project findings demonstrated that innovation adoption is a dynamic, iterative process that evolves over time, when the innovation is integrated and “translated” into the day to day work processes of staff focused on achieving key outcomes that deliver value for patients and families.

     

     

  • The Impact of an Integrated Model of Care for the Frequent User Population in Ontario

     ‘Frequent users’ of the healthcare system are patients who experience multiple hospital admissions and emergency department visits. An Ontario study (Wodchis, Austin, & Henry, 2016) documented that 5% of Ontario citizens consume 67% of health system resources due to high prevalence of hospitalizations and emergency services utilization. Yet, health organizations have no current way to identify patients who are frequent users as they seek services and care. Consequently, if frequent users cannot be identified as they enter Ontario hospitals, clinician teams are unable to design clinical care approaches to better support these patients to remain healthy in the community and reduce their frequent need for hospital services.

    To overcome this substantial challenge, a community hospital adopted a new technology. The software application was connected to the hospital information system to cross reference patient information to identify patients accessing the hospital system more than three times in the previous year. Once a frequent user was identified, the community hospital team worked with each patient to create an individualized and integrated model of care. Case managers and the primary care team were mobilized to partner with the patient and their family to co-create care plans that focused on personal goals for wellness and quality of life. Key features of the individualized, integrated model of care in the community included the following: high level of patient and family engagement in setting goals and planning care focusing on the whole person with quality of life as a central goal of care; leveraging existing strengths of clinical care in the community; and engagement of primary care physicians as the lead coordinator of care with the support of intensive case management.

    This study created the evidence of impact of the community hospital’s innovative approach to identify and care for frequent users of the health system. Use of the individualized, integrated model of case management and the impact the model achieved on patient outcomes was documented including patient admissions to hospital, and frequency of visits to emergency departments for care. The study involved interviews with primary care teams, hospital case managers, and patients to examine the effectiveness of the software and the individualized, integrated case management model on patient outcomes and quality of work-life for clinical teams.

    The software identified that frequent user patients change over time: each month there were new frequent patients approached to participate in the integrated care model, and patients whose integrated care resulted no further need to access emergency care or hospitalization at the community hospital. The software tool identified the frequent user status of a patient, providing information to better understand the dynamic and changing needs of the frequent user population. Frequent user patient profiles were characterized by multiple chronic conditions, low income (< $20,000/year), mental health challenges in over 50% of cases, and high school education or less in the majority of these patients. The individualized, integrated model of care focused on ensuring the right care provider was offering services when needed, and care decisions were led by the primary care physician. 

    The early outcomes of the integrated care model documented statistically significant reductions in hospital days by 40%, and reduced ED visits by these patients by 40%. The model enabled networking and communication among clinicians across primary care, community care, and hospital settings. The integrated model of care focused on helping patients to achieve their personal health goals. The clinician teams partnered with patients to help them self-manage their health conditions to achieve greater health and wellness, and reduce their reliance on emergency care services.

    Reference

    Wodchis, W.P., Austin, P.C., & Henry, D.A. (2016). A 3-year study of high-cost users of health care. CMAJ. doi: 10.1503/cmaj.150064

     

     

  • Defining an Innovative Model for Renal Care

    This project collaborated with clinical teams across the Ontario health system to examine the experience of patients and their families managing chronic renal disease, and to identify opportunities for innovative models of care for this population that both strengthen health outcomes for patients and offer value for the health system. The research engaged clinical teams working with this population in specialized centres across the province to define opportunities for innovation in renal care. Clinical teams identified key priorities for renal care across the province and identified where there may be opportunities to strengthen services to improve patient outcomes and reduce the incidence of “crash starts” of dialysis care, a priority identified by experts in renal care.

    Health system leaders defined key priorities for innovation in care approaches for this population, particularly given the significant impact of chronic renal failure on health services utilization across the province. Patients and their families identified the complex challenges of navigating the multiple care pathways associated with renal care, involving several specialists, primary care givers, health educators, and many others. Family caregivers described the significant challenge of coordinating services and managing prescribed treatments and interventions. 

    A key finding was the burden of care coordination that was described often as confusing, chaotic, and difficult to fully understand and manage. The perspective of patients, families and their caregivers, as well as the experiences of clinician experts informed the development of an innovative model of renal care. This innovative model is patient-family centric and partners with clinical teams by leveraging mobile digital technologies that connects patients and families to their clinical teams to support and strengthen self-management of their health, wellness and renal care more specifically. The proposed model engages a personalized approach to care for this highly complex patient population that achieves value for patients and families first and foremost, while at the same time achieving value for health providers and health systems more broadly. This project has resulted in an improved understanding of the systemic gaps in care for individuals with chronic kidney disease or those at risk in order to build a scalable, tactical plan to improve current practices.

     

     

  • Provincial Innovation Strategy: Assessing the Impact of the Innovation and Change Agenda

    In 2010, the B.C. Ministry of Health implemented the “Innovation and Change Agenda”, a three-year provincial strategy designed to provide networks of services in communities, ensure high quality care for those who need it, and assist in achieving and maintaining healthy lifestyles. Through addressing 16 key performance areas of focus, the strategy was designed to bring about system-level change in the way healthcare is delivered, and how health is promoted/maintained.

    This research was a collaboration between the B.C. Ministry of Health, the Institute for Health System Transformation and Sustainability and the WIN research team under the leadership of Dr. Anne Snowdon. The research examined the impact this policy agenda has had on the provincial health system. British Columbia is experiencing numerous health and healthcare challenges, similar to every Canadian health system. However, through the implementation of the Innovation and Change Agenda, this research clearly demonstrated that the province is achieving success by addressing those challenges across many areas. Results revealed that the Agenda has been widely viewed as having made a number of very impressive gains, in particular, the rapid adoption of electronic medical records (EMRs) technologies across the province. With the substantial uptake of EMRs among physicians, B.C. is well positioned to support citizens to strengthen self-management of health and wellness by expanding the use of mobile and digital technologies that strengthen connectivity between providers and patients/families. These key conditions of successful innovation can further strengthen population health and wellness by connecting people with their provider teams when and where needed, and by enabling the timely and secure sharing of health information.

    An important next step in the transformation of the B.C. healthcare system has been to expand the engagement of community-based providers to achieve the key priorities of the Innovation and Change Agenda. The truly transformative nature of the B.C. policy agenda is unprecedented in Canada, which has achieved a coordinated provincial, system-wide shift in how health and care are conceptualized and measured. As the province continues to make this transformative shift from a hospital-centric, disease focused health care system toward one that prioritizes health, wellness, and self-management in a community-centric approach, population health outcomes will continue to be strengthened.

     

     

     

     

  • Exploring Home Care Services for Persons with Alzheimer’s Disease

    Global health systems are experiencing an unprecedented demand for health services due to a major demographic shift towards aging populations and the increasing prevalence of cognitive dementias, such as Alzheimer’s disease (AD). The treatment options available for AD remain very limited, with likely few opportunities for prevention or cure of dementia to be available in the near future. As the number of individuals diagnosed with AD increases, there is a growing shortage of beds in long-term care facilities, and very few alternatives to caring for these patients in the community.

    This study examined the experiences of formal caregivers (community nursing) and families caring for loved ones with AD who need help in providing their loved ones with the necessary support to maintain quality of life. Allowing a person with AD to remain at home is often viewed as a more desirable course of action to institutionalization, however the availability of community resources to support families to care for loved ones at home is often very limited. Dr. Snowdon partnered with a leading international pharmaceutical company to explore the scope, impact, adequacy and cost of home care services for patients with AD and their families in the province of Ontario. This study examined the rate and type of service utilization in the community, the frequency and type of home care services, the experiences of both formal and informal caregivers in providing support and care to patients, and the gaps in services experienced by these families.

    The findings revealed that families receive, on average, three hours of formal home care services per week. The availability of programs to engage, support and socialize people living with AD are very limited, which results in isolation from community engagement for people with AD, and very high levels of burden for families who must provide care and supervision 24 hours per day, 7 days a week. Families described the devastating impact of this caregiving burden on their quality of life, their financial burden in paying for privatized services to offer respite from caregiving, and the negative impact on their employment opportunities. At the health system level, the economic burden for the provincial health system is growing, and supporting the AD population in the community may exceed the entire home care budget within the next decade. Novel therapies for AD that prolong the ability of individuals with AD to live independently with greater quality of life are urgently needed to offset the substantial burden of caregiving for families and the growing costs of home care services for health systems.

     

     

  • Leveraging International Best Practices to Achieve an Innovative Youth Mental Health Strategy in Canada

    Innovative approaches to enhancing mental health and wellness services are a major priority in jurisdictions across Canada and globally. Youth, in particular, are a key population that experience high rates of mental health challenges, yet struggle to access services when and where they are most needed. Youth mental health is a pervasive and highly significant challenge for global health systems. 70% of all mental illnesses begin during childhood and youth.

    This project represents a major opportunity for game changing innovations that offer accessible youth mental health services that integrate health, education, social services, justice to identify youth at risk, intervene early to prevent more severe outcomes that continue into adulthood, and offer services which are supportive of youth and their families. Integrated services that engage youth directly, offer support and empowerment, and are available and easily accessed can strengthen the capacity for health systems to more effectively meet the needs of youth, Canada’s next generation.

    This project is working collaboratively with a national consortium of mental health experts, organizations and private sector partners to advance the development and implementation of integrated youth mental health services across Canada.

  • Establishing a Health Innovation Ecosystem

    Innovation is a key priority for health systems as they are challenged to meet growing demands for services while working with limited fiscal resources to do so. The WIN team has designed and implemented a health innovation ecosystem in a specific region in Canada. The focus of this project is to build capacity for innovation adoption that is scaled across the entire health care continuum in a defined region.

    The project includes an innovation leadership program, specially designed to build capacity for leading innovation across the ecosystem, a research methodology to create the evidence for the impact of innovation within the ecosystem, and a strategy to design models for scalability of innovations, that have demonstrated value for provincial health systems. The project activities include leadership development, health system capacity building for scalable innovation solutions, and a series of innovation demonstration projects that engage health organizations, industry partners, policy makers, and academic research teams in a collaborative partnership.

    The ecosystem strategy will identify the key conditions for supporting innovation across the continuum of health care, and the strategy for scaling innovations across the ecosystem to achieve economic value for Canada.

  • Building Capacity for Supply Chain Innovation to Achieve Economic Value for Canadian Companies

    The healthcare industry has become a global business whose future sustainability will rely on advanced manufacturing of devices and pharmaceutical products that can achieve disruption to the current labour intensive service delivery systems. In order for adoption of advanced technologies to be successful, supply chains, distribution networks and business processes will need to be transformed in health systems to allow Canadian companies to access health markets previously inaccessible to them.

    The goal of this initiative is to create capacity for supply chain innovations in Canadian health systems through partnerships and collaborative research across sectors.  Key outcomes include:

    • Collaboration across an established, national, inter-sectorial network of supply chain and logistics partners across seven Canadian provinces.
    • Knowledge synthesis of current empirical evidence for supply chain strategies and use of global standards in health systems, in Canada and globally

    A multi-sector network with capacity to design, implement, and evaluate global supply chain innovation and economic impact for Canadian companies and policy makers

  • Expanding Health and Wellness Approaches in the Retail Pharmacy Environment

    Dr. Snowdon partnered with a leading international retail chain and a Canadian insurance company to investigate innovative approaches to building capacity for health and wellness services in the retail pharmacy environment. This study examined how retail pharmacy settings engage consumers in health and wellness services to explore the potential for retail pharmacy to build capacity for health care services in communities.

    Health care systems are struggling to meet demands for quality services that are accessible to consumers in their own community. The role of pharmacists in retail settings was found to be one of “trusted advisor” where consumers build long term relationships with their pharmacists to seek advice and validate whether they are receiving quality care that meets their needs.

    Over 1000 consumers participated in this study and described their experiences and perceptions regarding pharmacy services in retail settings. Findings indicate there are unique population segments that rely on pharmacists as a resource and clinician they engage for health and wellness care to support quality of life. Pharmacist and dietician roles in retail settings were investigated for the potential to strengthen quality and access to health care services in communities through patient engagement with a focus on health and wellness.

    This demonstration project created evidence for the emerging role of pharmacists in the retail environment which demonstrated opportunity for access to care in a setting that is part of the day to day lives of consumers in their communities to build capacity for health and wellness care in communities.