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Show, lift, wink, hold, push, pull, nudge, nod Connaissances et leviers de changement pour l’amélioration des systèmes de santé Jean-Frédéric Levesque, MD PhD Chief Executive Agency for Clinical Innovation Conjoint Professor Centre for Primary Health Care and Equity, UNSW Séminaires Pole Santé HEC Montréal Automne 2017, Montréal, 3 Octobre 2017

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Page 1: Show, lift, wink, hold, push, pull, nudge, nodpolesante.hec.ca/wp-content/uploads/2017/09/Présentation-Pôle-sant... · Show, lift, wink, hold, push, pull, nudge, nod Connaissances

Show, lift, wink, hold, push, pull, nudge, nodConnaissances et leviers de changement pour l’amélioration des systèmes de santé

Jean-Frédéric Levesque, MD PhD

Chief Executive – Agency for Clinical Innovation

Conjoint Professor – Centre for Primary Health Care and Equity, UNSW

Séminaires Pole Santé HEC Montréal Automne 2017, Montréal, 3 Octobre 2017

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Reconnaissance

“J’aimerais reconnaitre les populations

autochtones dont les territoires ancestraux

se situent sur les lieux ou nous nous

rencontrons aujourd’ui et payer mes

respects à leurs ancetres et leurs ainés.”

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De la connaissance au

changement:

un intéret nouveau?

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Agency for Clinical

Innovation

Independent Hospital Pricing

Authority

The King’s FundThe Nuffield Trust

Dr Foster

Centres for Medicare and

Medicaid Services (CMS)

Hospital Quality

Alliance (HQA)

National Committee for Quality Assurance

(NCQA)

National Quality Forum

(NQF)

Bureau of

Health Information

USA Accountable

Care Organisation

Canadian Institute of

Health Information

Australian Commission for Safety and

Quality in Healthcare

UK Care Quality Commission

RAND Corporation

Agency for Healthcare

Research and Quality

(AHRQ)

USA Institute for Health

Improvement

Ambulatory Care Quality

Alliance (AQA)

Joint Commission on Accreditation of

Healthcare Organizations (JCAHO)

Physician Consortium for

Performance Improvement

(AMA)

Leapfrog Group

Commissaire à

la santé et au

bien-être La haute autorité

de santé France

Healthcare Quality

Ontario

Canadian Foundation for

Healthcare Improvement

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Balises conceptuelles1

Fondements organisationnels2

Applications operationnelles3

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Balises conceptuelles1

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Connaissance

Information

Données

Action

Changement

Source: Bureau of Health Information, NSW

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Données

Les données sont une

codification de phénomenes

réels sous une forme pouvant

être analysé

Source: Bureau of Health Information, NSW

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Census data

PathologyPopulation

Health

Electronic

medical

records

Prescribing

Information

Survey data

Diagnostic

Imaging

Social justice and

education data

Ambulance

recordsHospital

records

Community

care records

Emergency

department

records

Workforce

Specialist

disease

registries

Vital

records

Primary care

records

Costs

Health

Information

Exchange

HealthStats

NSW

Information

for Mental

Health

Activity Based

Management

Portal

Secure

Analytics for

Population

Health

Research and

Intelligence

CHeReL –

Master

Linkage Key

Source: Bureau of Health Information, NSW

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Source: Bureau of Health Information, NSW

Information

Les données deviennent de

l’information par l’application

de méthodes analytiques et

par la codification qui soutien

l’interprétation

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AccessibilitéPrévalence

Mortalitéévitables

Besoins non-comblés Evénements

indésirables

Qualité de vie

Grands utilisateurs

Duplications

Risquessanitaires

Climatorganisationnel

Litératie de santé

Incapacité

Mortalitéhospitaliere

Coûts

Securité

RessourcesSatisfaction

Coordination

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Source: Bureau of Health Information, NSW

Connaissance

La connaissance signifie la

compréhension des choses

réelles ou des concepts abstraits

que les données et informations

ont permis de décrypter,

d'analyser et d’internaliser

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Productivity

Impact

Healthcare performance

assessment framework

Resources,

structures and

organisation

Patient

needs and

expectations

Patient

health and

wellbeing

Services

delivered

Source: Bureau of Health Information, NSW

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Source: Bureau of Health Information, NSW

Unwarranted clinical variation

Technically

proficient?

Proportionate to

needs &

expectations?

No

Right care

Yes

Contraindicated care,

not evidence-based

No

YesRight way

Misdiagnosis, errors or

misuse Appropriate

patient care

Right amountYes

Sub-therapeutic or

excessive care

No

Indicated?

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Source: Bureau of Health Information, NSW

Action

La connaissance peut soutenir

l'action grâce à son effet sur

de multiples comportements

et décisions

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Peer learning

Hug

Training

BenchmarkingRegulation

Continuous education

Pay for outcomes

Pay for performance

Quality improvement

Awareness

Self-regulation

Peer-pressure

Monitoring

Incentive

Judge

Provider feedback

Cross-fertilisation

Nudge

Contract management

Monitoring

Shove

Push

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Source: Levesque & Sutherland, BMJ Open

planned

emergent

internal external

supportive

formative

coercive

normative

structural

competitive

cognitive

mimetic

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Source: Bureau of Health Information, NSW

Changement

Le changement dans la

performance provient de

modifications durables de

structures, des procéssus et des

comportements cliniques

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Plusieurs definitions du terme ‘innovation’ existent. Le thème

sous-jacents consiste en une transposition de nouvelles

connaissances et idées dans la practique, pour des bénéfices

tangibles aux organisations et aux utilisateurs de services.

“Implementing new ideas that create value”

- Innovation Network, U.S.A

“The intersection of invention and insight, leading to the creation of social and

economic value”

-U.S National Innovation Initiative

Gordan Graham, 2008 (www.slideshare.net/Brokenbulbs/understand-innovation-in-5-minutes)

Changement ou innovation?

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Fondements organisationnels2

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Processus d’amélioration

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Programmes d’amélioration

Redesign

et evaluation

Support a

l’implantation

Avis specialises sur

l’innovation clinique

Guides de pratiques

& models de soins

Developpement

des capacites

Echange de

connaissances

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Nos réseaux et services cliniques

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2016-2017 en un coup d’oeil

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Approche au re-design clinique

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Applications operationnelles3

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Alignement des mesures et des

incitatifs

L'exemple de mesures de rendement hospitalier

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Alignement des mesures avec les

programmes d'évaluation de la

qualité

Les exemples de la mortalité et des réadmissions

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Alignement des mesures avec les

lignes directrices cliniques

L'exemple de mesures de variations cliniques

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Connaissance

Information

Données

Action

Changement

Source: Bureau of Health Information, NSW

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Source: Levesque & Sutherland, BMJ Open

planned

emergent

internal external

supportive

formative

coercive

normative

structural

competitive

cognitive

mimetic

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Thank you and questions

Jean-Frédéric Levesque, MD PhD

Chief Executive

NSW Agency for Clinical Innovation

[email protected]