Supporting rapid learning and improvement in a health-system transformation: A qualitative description of implementation supports

Article type
Authors
Waddell K1, Lavis J2, Bulloch H1, Grimshaw J3
1Rapid Improvement Support and Exchange
2McMaster University
3Ottawa Hospital Research Institute
Abstract
Background: Rapid-Improvement Support and Exchange (RISE) was created to support consumer-and evidence-driven rapid learning and improvement cycles among newly created Ontario Health Teams. As Ontario Health Teams mature, they will become clinically and fiscally accountable for delivering a full and coordinated continuum of care.

Objectives: To describe how rapid learning and improvement is being used to support health-system transformation, namely the creation of Ontario Health Teams

Methods: We use qualitative description to describe the use of transformational design to develop supports for Ontario Health Teams. Transformational design emphasizes the use of distributed resources (knowledge, tools, and expertise) and participation of users, beyond the public including management and front-line staff, to develop solutions to system-level challenges. We use five data sources including literature reviews, documentary analysis, one-on-one key informant interviews, focus groups, evaluations of a two-day event, and the experiences of the authors participating in the work of RISE to inform this description.

Results: RISE is being iteratively designed in a manner that matches the principles of transformative design by employing participatory methods to engage stakeholders in the process of designing and providing supports. This includes the development of two communities of practice, with 269 members, the mobilization of knowledge in 13 RISE briefs and 3 rapid syntheses to date, and through the insights of two focus groups to debrief an event held for over 200 stakeholders. A description of designing RISE and the supports that it provides will be presented according to ten early lessons learned about implementation supports, which among others, include: ‘roll with the punches;’ emphasize learning from each other rather than from experts; and have coaches and other ‘on-the-ground’ supports play to their comparative advantages and commit to ‘warm handoffs.’

Conclusions: To date RISE has aimed to leverage expertise within the health system and fill gaps by synthesizing local and global evidence to be used in the implementation of Ontario Health Teams. However, just as in the rapid learning and improvement framework, work to collaboratively design and develop supports is constantly in need of adjustment to ensure they are tailored to support teams. This description documents the iterative design and development of RISE and provides one example of how to operationalize rapid learning and improvement to support health-system reforms.

Healthcare consumer involvement: Citizens, patients, families and caregivers are engaged as key partners in our network of experts as well as on the the RISE advisory council. Further, patient and caregiver partners recently participated in a citizen panel to codesign guidance for Ontario Health Teams on how to engage citizens, patients, families and caregivers in the process of reform.