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Collaborating Through Quality Improvement

It is estimated that it takes an average of 17 years for research evidence to reach clinical practice. Changing ingrained habits, practices and behaviours in health care systems is challenging and difficult. Yet, there are growing numbers of clinicians and leaders who are embracing this challenge and finding ways to introduce evidence-based changes and processes to drive improvement in health systems. Saskatchewan is an example of where individuals are supported by a health care system that has embraced quality improvement to introduce evidence-based changes and improvements in the province.

Choosing Wisely Saskatchewan, launched in 2017, is led by the Saskatchewan Health Quality Council (HQC), which coordinates provincial efforts through collaboration with the Appropriateness of Care Program, the Saskatchewan Medical Association, the University of Saskatchewan’s College of Medicine, patient and family advisors, and other health system partners. Those supporting the provincial campaign all share a common goal – ensure patients receive appropriate care.

A key component of appropriateness is avoiding overuse, which can cause harm to patients and wastes health system resources. Quality improvement tools and strategies offer evidence-based implementation approaches to reduce unnecessary tests and treatments.

Recently, Saskatchewan’s Clinical Quality Improvement Program (CQIP) has provided a new outlet for clinicians to align Choosing Wisely recommendations into quality improvement initiatives.  Offered in partnership between the Ministry of Health and the Saskatchewan Medical Association (SMA) and delivered by the Health Quality Council (HQC), the program provides in-depth training and a space for clinicians to share, learn, and seek feedback from colleagues practicing quality improvement at the clinical level from across the province. This type of environment lends itself well to Choosing Wisely, which supports grassroots initiatives and collaboration with health care professionals to change practices that will reduce overuse and lead to better patient care.

Dr. Jeffrey Betcher, a critical care physician in Regina currently enrolled in the program’s second cohort, is working on antimicrobial stewardship in the intensive care unit (ICU) for his quality improvement project. “The program brings clinicians together from across the province and really allows you to see the work being done beyond your own area,” says Dr. Betcher. “You have the opportunity to network with colleagues who share the same interest in quality improvement in a well-working environment.”

Dr. Rabia Shahid, a graduate from the program’s first cohort, focused her project on reducing unnecessary pre-operative testing for patients. Using the Choosing Wisely recommendation on pre-operative testing and Drop the Pre-Op toolkit as guidelines, her project focused on developing a protocol that will guide in selecting appropriate investigations based on a patient’s health status, comorbid illness, and risk of surgical procedures.

Dr. Shahid believes working in a program that supports building capacity across the province has had a positive effect in implementing change. “The health care system is complex and needs a collaborative approach to change. We need to focus on how we practice, work together, and utilize resources in the most appropriate way for our patients” says Dr. Shahid.

Through quality improvement initiatives such as CQIP, Choosing Wisely Saskatchewan and its affiliated partners are thriving in a collaborative environment where there is a shared commitment towards improving the health care system.

“I strongly believe that Saskatchewan’s commitment to implementing a culture of continuous quality improvement will support clinicians and patients to choose wisely” says Jennifer Wright, Choosing Wisely Saskatchewan Coordinator. “In Saskatchewan, I don’t see Choosing Wisely as a separate program—rather its recommendations, campaigns and resources are being embedded within current QI strategies and initiatives such as CQIP. They support and align with what we, at the Health Quality Council, hope to accomplish which is the highest quality of health care for everyone, every time.”

Although it has been only a year since Choosing Wisely Saskatchewan launched, their efforts have already established ways to help spread knowledge, support innovative skills, and has created a network of clinicians working on quality improvement initiatives. We look forward to furthering alignment of Choosing Wisely recommendations into quality improvement initiatives and the evidence demonstrating improvements to patient care led by dedicated clinicians across the province.

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