In this Q&A conducted recently by phone with HDC, Dr. Sze discusses her views on family practice, lifelong learning and the role of HDC in advancing continuous quality improvement.
About Dr. Shirley Sze
Dr. Shirley Sze graduated from medicine at the University of Alberta in 1976, completed a family medicine residency at Queen’s University, and started work in Kamloops, BC in 1979. For the next 30 years, she divided her time among three activities: providing full-service family practice care to her patients, raising her family, and supporting her medical community through her role in continuing professional development.
After transitioning out of full-service family practice in 2009, she was able to devote more time to health care transformation at the systems level. She was elected as District 10 Delegate to the Doctors of BC Board of Directors. This was soon followed by founding and leading the Thompson Region Division of Family Practice. The premise of Divisions was developed on having good working relationships with the health authorities to co-create and facilitate sustainable change that would improve patient care. This led to the creation of the Collaborative Service Committees (CSCs) and Shirley was co-chair of the Thompson Region CSC. She has been and continues to be a physician champion for the Practice Support Program and has participated at the steering committee level for development of the adult mental health and chronic pain modules.
Not one to let technology evade her, in 2008 she developed and chaired the PITO Community of Practice for Kamloops. That resulted in many of the physicians in Kamloops adopting the same EMR, which facilitated better information exchange. She was a founding Board member of the Physician Data Collaborative and is presently Secretary of the Board of Directors for the Health Data Coalition, a nonprofit that looks at the collaborative use of clinical data to improve patient care. (These excerpts on Dr. Sze’s life and work originally appeared in an article called The Good Doctor. To learn more about Dr. Sze, please read the full profile in the BC Medical Journal.)
Tell me more about your passion for lifelong learning?
Doctors are curious by nature, and open to learning something new every day. That’s why we chose the medical profession. Curiosity is built into our profession. I also believe that improving the quality of patient health outcomes comes through the application of continuous lifelong learning, with self-reflection which is better guided through use of clinical data. It’s a virtuous circle. A continuous learning process needs to include the ability to reflect on one’s practice and work, and in order to reflect we need to document what we do, learn about best practices, implement them and watch the changes that occur over time.
What’s changed in the profession from when you first started to practice?
When I started in practice, I chose full-service family practice because it offered a variety of challenges and allowed me to provide longitudinal care to the whole family. I was able to follow and help my patients through the entire continuum of care. Another advantage of working in family practice was the opportunity to have good relationships with a variety of medical professionals, allowing for coordination of care. What I see more now is a fragmentation of care where, due to a variety of reasons, a number of family physicians are not able to deliver care in hospitals, deliver babies or work in emergency as we did previously. This leads to lesser contact between family physicians and specialists which can decrease the opportunity to communicate for effective handover of care. But I remain hopeful. The work we’re doing at HDC with our partners is one way I believe we can bring back a bit of that circle or community of care for our patients.
What was your “aha” moment for you in seeing the immense potential of EMRs and CQI?
The HDC approach was partly inspired by the success of Pegasus Health (an independent practitioners’ association in Christchurch, New Zealand) in collaboratively using clinical data to improve patient care. At first I was reticent to join a local group of physicians heading to New Zealand on a fact-finding mission. I remember saying to myself, “Do I really have to go? It’s so far.” But the trip and the learnings that came from it were one of the most transformative moments in my life. Here was an organization very similar to the Divisions of Family Practice in BC doing amazing work way on the other side of the world. Pegasus combined a team-based care approach, with sophisticated use of EMRs and small group peer learning to not only measure progress and improve health outcomes, but also to create and sustain a supportive medical community and in doing so, also save their health care system tens of millions of dollars which they committed back to their community for healthcare improvements. What they also achieved was publishable, trackable patient and population outcomes based on continuing education intervention, which is totally amazing. On return, I found that some of the physicians in Prince George had very similar ideas and were developing these concepts through their organization AMCARE (which has now become HDC).
Why is Continuous Quality Improvement important for the average physician?
Medicine is a self-regulating profession. We’re responsible for keeping up to date to deliver the best care to patients. With great responsibility comes accountability. Continuous Quality Improvement (CQI) is the accountability piece of the equation. We have to own that.
The reality is that there is also significant scrutiny of healthcare spending due to the constant escalating costs and governments and health authorities have to be fiscally responsible Everyone is asking: what are we getting back in terms of return on investment in our physicians and healthcare system. I get that. Doctors are doing great work, but it doesn’t always appear so. We need to have the data to demonstrate we’re making a difference in terms of health outcomes. Otherwise, external forces will dictate terms for quality assurance that may lead to unintended consequences, for individuals as well as our profession.
What’s next for the HDC?
There is momentum to drive a new approach to health data use, analytics and data-driven decision making, and BC is creating unique solutions. Consensus is that the key ingredients are in place (data, funding, stakeholders, etc.). But the “how” has yet to be determined to ensure physicians are able to take best advantage of this tool and supporting structures to enable effective CQI.
HDC is first and foremost a grassroots organization, physician driven and governed. We have a real sense of ownership and are fully invested in making this succeed on a provincial and national scale. Our technology solution is open source and our specific technical approach hasn’t been done before across EMR agnostic platforms. We also offer a collaborative effort across all levels of the system.
It’s complicated work, but I believe HDC can lead the way to help tie all the disparate pieces together for the common good.