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Andrew Neuner, Chief Executive Officer (CEO), HQCA
Andrew has served at the HQCA as CEO since 2014 and as he departs from the HQCA, has offered some parting thoughts and reflections.

I was approached back in 2014 about the CEO position at the HQCA. At the time, I was an executive at Interior Health in British Columbia. I didn’t see how I could possibly fit in. I’m an operations guy. To be perfectly honest, I didn’t think it was something that would be a good fit for me. I didn’t appreciate the place the HQCA held in the system.

I was intrigued, though, and took the leap. The HQCA’s culture of collaboration and legislated mandate to improve healthcare with and on behalf of Albertans resonated with my core values and professional interests.

Then, once I steeped myself in the work, it didn’t take me long to “get it.” The team at the HQCA quickly showed me the power of information, how to maximize its benefits, and how this work is profoundly relevant. I have especially appreciated how the HQCA does this work and makes sense of things. The value here is immense. If Alberta’s healthcare system acted more consistently on the HQCA’s objective, evidence-, and experience-based information when pursuing quality improvement work, I believe that front line workers, patients, and their loved ones would not need to demonstrate such herculean levels of resilience.

From my experience, this is a common admission from leaders in healthcare. Healthcare quality and safety improvement can, at surface glance, seem burdensome. Costly. Overly meticulous and methodical. Work that can and often does fall low on the list of priorities.

However, when you:

• really stop and immerse yourself in the science of improvement,
• see an initiative through an improvement cycle (or two….or three),
• conduct a robust evaluation to really capture the return on investment, and
• develop a strategy to spread the improvement throughout the entire system,

the value of devoting the time and resources required to do this kind of work right becomes crystal clear.

Because there is gold to be found here, both literally and figuratively. A relentless focus on quality improves lives and reduces cost. Period.

Under the current circumstances and pressures of the pandemic response, our time and resources are increasingly precious commodities. Keeping healthcare quality top of mind in all decisions and improvement efforts is more important than ever. As I said before, the Alberta Quality Matrix for Health dimensions of quality: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety should always be our compass or ‘North Star.’

We need to make common sense, common practice.

More than ever, we must identify, understand, and act on the opportunities raised or supported by Alberta’s bright minds. I believe the capable minds and those with lived experience here in Alberta, including patients and frontline workers, are our most underused resource. Yes, meaningful engagement takes time, however working inclusively and bringing these voices together into the same space—often virtually right now, of course—to come up with creative solutions to very real problems is the key.

There are days when things in the health system can be really complicated. But for the most part, it’s not as complicated as we make it. Sometimes, we seem to go out of our way to make it more complicated through a series of endless meetings and processes that delay making good, timely decisions.

When we get into those academic, technical, or logistical weeds, or get completely side-swiped by something unexpected (e.g., COVID-19), stop ask yourself and those at your decision-making table, these questions:

• Where is there someone with a health need?
• Where is there someone who can help?
• How do you bring those two things together?

And, to the decision makers and those who are responsible for the direction and performance of the whole system, you must make a reliable map for those at your decision-making table. Make sure there is a clear vision of what needs to be achieved. Help identify and communicate the priorities and strategy so that leaders are asking and answering these questions about the most critical areas to improve. Then, let the evidence guide you as you consider solutions to address the questions above.

It has been a pleasure serving Albertans for the past six years and I know the HQCA will continue to find buried treasure in search of quality healthcare for all. I remain hopeful that, when the HQCA reveals these treasures, the system will be open and willing to act appropriately on the spoils so everyone can benefit.

HQCAMatters presents perspectives on topics or issues relevant to healthcare in Alberta the HQCA considers valuable.

Andrew Neuner, Chief Executive Officer, HQCA 

There’s no shortage of things to think about these days if you are a family physician in Alberta.

Your practice is busy. The COVID-19 pandemic has added serious new patient questions. And in the background, we know the ongoing discussions with the Alberta government about the physician funding framework are likely on your mind.

Some of you may wonder why the HQCA chose now to release the 2020 Primary Healthcare Panel Reports.

The answer is we wanted to get this information – the most current and comprehensive data about patient panels – in your hands as soon as possible. And, frankly, some of you have been asking for it. Delaying the release runs the risk of making data less relevant.

I know all of you won’t have capacity to reflect on your panel data at this time. And that’s ok. It’s available for you to review whenever you’re ready.

With everyone focused on the COVID-19 response, the HQCA has put on hold – until further notice – our planned activities to promote these reports with physician and other healthcare audiences. That means we won’t offer webinars or pro-actively communicate about the reports in the near-term. There will also be delays in generating reports for new requestors.

There’s information on the HQCA website about what’s new with the 2020 data, and if you have any questions, please reach out to our team at primaryhealthcarereports@hqca-main-branding-nexcess.dev.developmentwebsite.ca.

Thanks again for all you do to support patient safety and health service quality in Alberta.

Andrew Neuner, Chief Executive Officer, HQCA

My parents live in Penticton, British Columbia. My mother has been facing increasingly challenging health issues in recent years. She has always managed the details for my family. Now, my father is learning to look after her. Our family provides additional supports in a variety of ways. I find it difficult to feel like I am doing enough from a province away.

I have no doubt that many of you are in similar situations, looking after loved ones and wondering if you are doing enough and doing it well. We take it one day at a time, and some are better than others.

We talk regularly and, as you can imagine, I always ask about my mom’s recent healthcare appointments. I am met with half-answers. My dad remembers some details, my mom fills in some blanks. There are still gaps. Gaps that make me worry. I know my mom’s providers are giving her sound advice and carefully considering her care, based on their discussions. However, much of the direction and recommendations shared in those increasingly critical appointments is lost after the interaction is over. Those gaps create risk that our family won’t be able to support my mom to the best of our ability.

This year, as part of our Patient Experience Awards selection process, I was particularly struck by one initiative: the My Care Conversations smartphone recording app. While this initiative was not selected, I felt a connection to this work because it immediately made me think of my parents. I know that tools like this have been used in other jurisdictions for some time, however the true value of a tool like this really resonated, given my mom’s and family’s current circumstances.

Then, the healthcare leader switch in me flipped and jumped to questions about privacy and confidentiality, specifically around consent to record a consult. In reaching out to the My Care Conversations project team to learn more, they addressed my questions about privacy and my focus moved on to scale and spread. What would it take to get more widespread acceptance and adoption of using this technology?

At this point in my thought process, doubt starts to creep in. In 2011, Dr. Ross Baker and Dr. Jean-Louis Denis released a report that concluded healthcare systems in Canada have experienced difficulties in creating and sustaining large-scale improvements; local initiatives are difficult to replicate and spread, and improvement efforts are often limited in scale.

Eight years after the release of this report, I see the pattern here in Alberta: excellent pilot or proof of concept at a local or sector-specific level that fails to gain traction elsewhere. So, how can we work together, to make sure that meaningful work like that done by the My Care Conversations team realizes its full potential? Because I feel, from personal experience and observations as a healthcare leader, this tool has applicability well beyond cancer care.

There are many great resources that offer evidence-based suggestions about how to overcome barriers to achieving scale and spread. A few that come to mind are:

• NHS Scotland Quality Improvement Hub’s The Spread and Sustainability of Quality Improvement in Healthcare
• East London NHS Foundation Trust’s Scale-up and Spread resources
• Health Quality Ontario’s Spread Primer
• (Behind a paywall, however worth seeking out if you can access) From pilot project to system solution: innovation, spread and scale for health system leaders review.

If you have others that readers should be accessing, please pop over to my Twitter feed and add your suggested resources to this thread. Because patients and family members deserve to reap the benefits of these leading practices that support information continuity and overall continuity of care.

HQCAMatters is published monthly and presents perspectives on topics or issues relevant to healthcare in Alberta the HQCA considers valuable.