From independence to today: Elevating quality, speed and reach every step of the way

When I started at the Centre for Effective Practice, which was at the time part of the University of Toronto’s Department of Family and Community Medicine, I never imagined it would be where it is today. At the time, our focus was trying to do small projects and finding the experts to help us do it. We had very few resources and frankly could only work on one thing at a time.

Today, we are a very different organization. Now, CEP works on many topics simultaneously, with the goal of system-level impact, and that shift required us to change. Today, it’s not only about improving in a particular area but about the overall quality, speed and reach of our work. We’ve grown but have also become more agile. For example, if a solution that once seemed suitable for a care gap doesn’t work, we aren’t afraid to pivot and find one that does. Here are some examples of how our work has evolved over the years:

Quality

As the largest reviewer of clinical practice guidelines in Canada, we now assess significant volumes of evidence. As a result, we have established and continue to refine processes that allow us to assess evidence while also taking providers’ needs into consideration (a key success factor for the demand of our work). Our tool development process today builds on that work, and now employs leading design science and behavioural economics for both EMR and paper-based tools.

From an academic detailing lens, our delivery framework and processes are now more refined, and reflect our own experience plus support from leading programs in this area across Canada and internationally. As an organization, we’ve moved from “program evidence” to implementing high quality training and support systems for over 18 detailers across Ontario. The result is a far higher caliber of structure to support the program.

Speed

Being faster without sacrificing quality remains a strategic priority for the CEP. We need to be responsive to shifting system needs, demand for topics and get results sooner. Having an ethos of getting things done well and soon is a core part of what we are trying to achieve as an organization. Speed also involves a mindset of efficiency, which is critical for reducing costs and delivering value.

Whether it’s quickly finishing and updating tools on topics such H1N1, Cannabis, or MAiD, we now can produce effective tools and resources in far less time than it used to. We can now release a tool once every two months. Whereas, in the past, it took six months. Another example: we were able to recruit, hire, train and deploy academic detailers, along with supporting materials, across the province in less than six months — that has allowed us to exceed our targets, and more importantly demonstrate impact sooner.

Reach

In short, more people are using our resources now than ever before. Our tools are now disseminated and used broadly across the province, and we’ve expanded our audience to not just family physicians but also nurse practitioners and other professionals. Our website is currently the most popular destination for family physicians and nurse practitioners in Ontario, with over 50% of all family physicians downloading our CORE Back Tool (as one such example). By July, around 1,000 family physicians will have received an interactive one-on-one academic detailing visit, addressing opioids and chronic pain.

Our reach involves more than direct contact with front line providers. Over the past 10 years, CEP has strengthened relationships with many networks, stakeholders and healthcare system organizations to align or work with, and extend our impact. From provider organizations to medical schools to regional groups, we continue to work with organizations who share our objective of improving care by supporting front line providers.

Last, we’ve strengthened our reach by evolving our products and services to reflect changing user needs and technologies. Now, we develop more EMR modules and leverage the use of tablets and other platforms. We’ve worked year after year to build trust and add value to our work for providers. Through the quality and relevance of the work we’ve done, we’ve gained a loyal following of providers.

Looking back, it’s been a long, hard journey. It wasn’t easy or fast but there is satisfaction in knowing how we have evolved and grown. But some things haven’t changed: having an idea, creating something tangible and getting it into providers’ hands to make a difference is just as rewarding today as it was when we began.