The joy of showing your team the results of their efforts
As Medical Directors for HDC, Dr. Oona Hayes and I (Dr. Cole Stanley) have been keen to speak with our family physician peers across the province to hear how others have been working to improve care for their patients and using HDC Discover to track progress.
For our first Bright Spots entry, I want to share two short vignettes that both happen to focus on cervical cancer screening. Besides this commonality, they both were initiated organically by the frontline physician and their team, and they both ended up with data showing improvements. But the similarities pretty much end there; one was on a rural island, the other in the Lower Mainland. They each had their own reason for choosing this clinical topic, and the changes they implemented fit well with their local context. This, I think, is the secret sauce for collective impact: the combination of intrinsic motivation and tailoring to local context at the frontline, with shared broader system goals.
First, I spoke with Dr. Stephen Hughes. Originally from the UK, he’s now practicing rural family medicine at the Quadra Island Medical Clinic, after a stint of a few years in Mission, BC. Working with his PSP coordinator, Meg, he reviewed his HDC data and noted that rates of Pap screening for cervical cancer were lower than what he would like. He worried that some folks requiring a Pap in his rural community were being missed, and the potentially dire consequences of this.
With the help of his wife, he tried something different. They prepared personalized letters for eligible patients who were overdue for a Pap test (and FIT test for colon cancer screening). This took considerable work preparing letters and mailing envelopes, and they were initially a little disappointed when the Pap response rate seemed low (they estimated that around 10% acted on the letter). It wasn’t until our HDC team member Kent was reviewing the data with Dr Hughes a few months later that there came a pleasant surprise. His screening measure shot up dramatically in 2022, following their letter initiative, and is trending upward (see below graph). He jumped up to go find his wife to share these results, and they both ended up with a renewed sense of motivation. He next plans to hone in on patients at highest risk without a previous Pap. I’m grateful that Dr. Hughes offered to share his story with us.
Next, I chatted with a physician, who I consider a superstar, from a more urban practice in the Lower Mainland. In her modesty, she didn’t want to share her identity here, but I can say that she’s done a lot of great work over the years for us as longitudinal primary care physicians. She told me she was feeling overwhelmed by the deluge of incoming cancer screening reminders and results. Amid the pandemic, she noted her screening measure gradually dropping. True to her style though, she didn’t let this get her down. She engaged with PSP to do some facilitation cycles to take back control of her inbox.
From this, she learned that taking just 2 hours a week of MOA time could make an outsized difference. The “clinical workflow associate” function was born. During these 2 hours of focused work, the MOA ensures that all incoming results and reminders are correctly coded in the EMR. Once this is done, accurate reports are run regularly, and recalls are done when needed. Within a few months, her screening measure on HDC Discover showed dramatic improvement, where her screening rates are now among the highest in the province (see last dark grey bar on the distribution plot below).
She credits this entirely to the work of her MOA, a team member whose work is vital to our success but often goes unrecognized. Here, HDC data was used to celebrate success and served to motivate her team. She also noted that this work can be done remotely, giving a flexibility that came in handy when her MOA fell ill and needed time out-of-office but still wanted to help. With this experience and the evidence to back it up, she is now thinking of how to spread and fund this new function across the system. I thank her for sharing this story, for testing out something new, figuring out what works, and now wanting to spread her success to the rest of us.
Aren’t those great Bright Spots to share! Stay tuned as we continue to share more peer Bright Spot stories in the coming months.