Case Studies

SPIDER (Structured Process Informed by Data, Evidence, and Research)

SPIDER, a research and QI project, uses a comprehensive approach to enhance healthcare for individuals with complex medical needs. The primary objective of the study is to evaluate the effectiveness of SPIDER in fostering collaborative and informed discussions between patients and physicians regarding prescribed medications. The term "polypharmacy" is used to describe the challenges associated with managing numerous medications, and the aim is to identify and discontinue unnecessary medications. By reducing polypharmacy, there is an anticipation of improvements in overall patient care and health outcomes, contributing to heightened satisfaction among physicians and other healthcare professionals involved in the treatment of complex patients.

Achieving the Triple Aim on the COPD Journey

Although chronic obstructive pulmonary disease (COPD) is the leading cause of hospitalization of the elderly and a leading cause of death worldwide, it is commonly under-diagnosed in patients with mild to moderate conditions. The result is increased suffering and missed opportunities to ease its impact. The Credit Family Health Team used the Institute for Healthcare Improvement’s triple aim—better health, better care, better cost—as its guiding principle in a project to improve its early diagnosis, treatment, and care processes for COPD.

Reduction in ED Admissions in Long Term Care

The Leisureworld Etobicoke Residents First QI project was chosen for presentation at the Institute for Healthcare Improvement annual conference in Florida in December 2011. “It was very exciting to be there,” said Leisureworld Etobicoke Administrator Lora Monaco, who attended the prestigious international conference with some of her staff. “We were the only LTC home presenting at the conference, and it gave us a real sense of achievement.” Residents First QI coach Faten Mitchell was invited to present the results of the successful project she supported, which significantly reduced emergency department transfers from the home in 2011.

Using System Maps to Gain a System Perspective to Improve Outcomes

Throughout the world, people are living longer, and chronic and degenerative diseases are on the rise (Bloom et al. 2011; National Institute on Aging and WHO 2011; Yach et al. 2004). These factors place great demands on healthcare systems and threaten sustainability. Fundamental changes are needed to improve health outcomes and reduce costs. Changes that affect desired outcomes include aligning and understanding stakeholders’ motivations and behaviours as well as gaps in key processes. Through that understanding, when desired outcomes are not achieved, we can answer why. A system perspective provides insight into what changes to make, and system maps are critical tools to help gain that system perspective.

Case Study: West End Quality Improvement Collaboration

The West End Quality Improvement Collaboration is a partnership of six community health centres in Toronto that was established with the goal of increasing the efficiency and effectiveness of service delivery by working alongside one another on quality indicators. Community health centres are funded to serve the most marginalized populations, which include people living in poverty, homeless people, street-involved people, newcomers, and lesbian, gay, bisexual, transgender, or queer (or questioning) people. In Year 1 of the initiative, we chose to focus on cancer screening rates. After the results were analyzed and we had started to see improvement in these rates, we overlaid an equity analysis to ensure that our marginalized populations were screened at similar rates. This case study will examine the steps taken to get to these outcomes and the lessons learned for collaborative practice for quality improvement. This includes understanding the importance of collaboration, including group dynamics and a culture of learning from each other, investing time, and the role of expertise, all with the ultimate result of improved client care.