Developing evidence-based clinical initiatives that will truly transform healthcare requires a pipeline approach to healthcare innovation. Dr Jean-Frédéric Levesque reveals why this will be the change-maker for healthcare in NSW.
In my interactions with clinicians and health leaders, there is general agreement that adopting an 'innovation pipeline’ approach will enable us to affect the most significant change for the community, health workers and the system.
Previously at the ACI, we have spent a lot of time in the ‘refine’ space of the pipeline – reviewing current practices to ensure the delivery of best-practice, evidence-based care, within existing models. Refining also means looking at new ways to optimise resources; for example, collaborating with colleagues interstate to develop a shared framework that leverages existing best practice -guidance that can be adapted to suit our local context.
'Refine' activities will continue to be important. However to effect real change, we need to strike a balance with initiatives that can move towards evolving and transforming healthcare. This requires us to take a different approach in how we work.
Evolving healthcare is about making incremental change. To achieve this, the first step is to ask whether we should ‘stop, swap or strengthen’ current delivery models. This means:
- reducing low-value care
- changing where, what, when and by whom care is delivered, to provide less resource-intensive care (so long as it is non-inferior)
- in certain cases, increasing investment – where the marginal benefit far outweighs the marginal cost of additional services.
We are now working in partnership with clinicians, consumers and system leaders to identify alternate models and to assess suitability for adoption across the system to achieve this.
Progressing through the pipeline
To ensure initiatives progress through the pipeline, we need to develop a purposeful approach to identifying, testing and scaling high-potential models of care. The ACI is currently engaging with clinicians to modernise our approach on how to develop a model of care that has innovation potential (rather than sitting in the continuous improvement and refine space).
Our Evidence directorate is now seeking expressions of interest from clinicians to participate in rapid scans of key journals and our weekly Evidence Digest to identify ‘game changers’. Game changers are clinical innovations that have the potential to deliver a step change in patient outcomes or healthcare delivery. We know if we’re going to reap the benefits of game-changers, we often have to prepare as a system and we need your help to get ready for them! To express your interest, please complete this form by Tuesday 5 September 2023.
We need to ensure pilots are well run and vigorously evaluated so we can progress high-potential pilots towards spread and scale across the system. A good example is the same-day joint replacement surgery – an alternative care pathway for patients to access joint replacement surgery and being discharged within 24 hours. ACI worked with partners across the system to adapt an evidence-based model and implement with local sites across NSW, specifically targeting sites with long waiting lists for joint replacement surgery.
The Yellow Gum Healing ACE Pilot Program, featured in this edition, reveals how we have adapted an established drug and alcohol treatment program to pilot a new approach that is culturally appropriate for Aboriginal populations.
In this issue, we also share a new initiative developed to support neonatal services staff to enhance communication with families and carers; in particular, through virtual care. This is the first of its kind and has the potential to enhance the way care is delivered and improve the experience for families with a newborn in intensive care.
Spread and scale
Transforming healthcare is about disrupting the way care is delivered. It requires fundamental changes to how care is organised, managed, funded or regulated. This is often done at scale across multiple care settings.
One example is the NSW Health Patient Reported Measures Program, which is being embedded into routine care throughout health services and clinical areas in NSW. The program enables patients to provide direct and timely feedback on their healthcare experiences and outcomes to ensure care continues to meet patients’ needs and drive health system improvements.
The program will further expand as it becomes integrated into the NSW Health Electronic Medical Record (eMR), providing efficiency, transparency and consistency in a patient’s care. Kate Norman, Patient Reported Measures Program Lead in Nepean Blue Mountains Local Health District, outlines the transformational benefits of this milestone in our guest editorial.
I hope you enjoy reading more about these initiatives in this issue, as well as updates from our clinical networks.
I'll leave you with this valuable feedback on the PRMs program recently shared by Mark Spittal, Chief Executive of Western NSW Local Health District, which echoes that being received from across the state from consumers, clinicians and health leaders.
Western NSW LHD has become the first in NSW to implement patient reported outcome measures (PROMs) for older people receiving transitional aged care support (TACP). The feedback directly from those older individuals can now be found in the eMR as part of the person’s clinical record. Those older people are now helping us learn what their post discharge experience is like.
Already, for example, most older people discharged from our facilities into TACP are telling us that their pain is poorly managed. We didn’t expect to hear that, but now we know we can work together to do something about it. This is just one of the ways that we show respect to those who come to us for care. Listening to them, walking in their shoes, and taking steps to improve their health journey when we can.