Grant: Partnerships for Health System Improvement (PHSI)

Alberta Health Services; Alberta Innovates (Edmonton); Manitoba Health Research Council; Winnipeg Regional Health Authority; Michael Smith Health Research BC; Saskatoon Health Region (Saskatchewan); Saskatchewan Health Research Foundation; Vancouver Coastal Health Authority; Vancouver Island Health Authority

<html> <body> <p>Patient flow &ndash; ensuring that patients receive the care they need, when and where they need it &ndash; is one of the greatest challenges facing healthcare today. While emergency department (ED) overcrowding is its most recognizable symptom, stagnant flow is widely recognized to be a <i>system</i> problem. Yet little is known about what flow-improvement strategies, especially system-level strategies, are truly effective. This research, developed in collaboration with the Western Healthcare CEO forum, its associated Patient Flow Collaborative and all of its member regions, provincial stakeholders and Accreditation Canada, will meet healthcare leaders&rsquo; need for guidance on this crucial, complex issue.<br> <br> <b>Goal</b>: To determine how health regions can achieve maximal improvement in patient flow.<br> <br> <b>Research Questions</b> <br> </p> <ul> <li>What works to improve flow?</li> <li>What explains inter-regional differences in flow performance?</li> <li>What can regions learn from each other's successes and challenges?</li> </ul> <p> <b>Approach</b>: Mixed-methods comparative case study of Western Canada's 10 urban health regions/zones (R/Z).<br> <br> <b><i>Objective 1</i></b>: Establish performance differences.<br> <i><b>Methods</b>:</i> Inter-R/Z (hierarchical linear modeling) and time series (statistical process control) analysis of ED and inpatient length of stay.<br> <br> <i><b>Objective 2</b>:</i> Deeply understand R/Zs' flow strategies (across the continuum of care), systems, and context.<br> <i><b>Methods</b>:</i> Our conceptual framework unites an original theoretical model of organizational change in complex systems with an empirical taxonomy of four levels of explanation for flow performance (specific flow strategies, system design, selection process, social context). <i>Realist</i> analysis will compare common flow strategies across R/Zs to identify intervention mechanisms and key contextual factors required for their operation. Qualitative inquiry (in-depth interviews, document review, participant observation) will probe system design (are the parts arranged to work in harmony or at cross purposes?), selection (decision-making) process, and social context (culture, leadership, intergroup relations).<br> <br> <b><i>Objective 3</i></b>: Explain performance differences.<br> <i><b>Methods</b>:</i> Pattern recognition and explanation-building to identify factors that <i>differentiate</i> between R/Zs with higher/lower flow performance and improvement.<br> <br> <b>Team</b>: The 10 exceptionally system-engaged researchers possess a wealth of expertise in relevant content (patient flow, social/organizational theories, system integration, etc.) and methodology (quantitative analysis of large administrative datasets, qualitative research and synthesis, comparative case studies, etc.). Knowledge users (1 Project Leader per province, 1 point person per R/Z, and others in a concentric structure) include middle managers with primary responsibility for flow, CEOs and VPs, clinician leaders, and stakeholders from health ministries and Accreditation Canada.<br> <br> <b>Outputs &amp; Contributions</b>: Through its unprecedented breadth and depth, this study will furnish clear understanding of the most important drivers of regional flow performance &ndash; yielding concrete recommendations for the design and implementation of flow strategies and broader system change. Reports, products and workshops will guide decision-makers in diagnosing and overcoming the key barriers to flow improvement within their unique context. Findings will inform 10 R/Zs' system-transformation efforts and Accreditation Canada standards and guidelines. The ultimate contribution will be better access for patients, in Western Canada and beyond.</p> </body> </html>