Evaluating Innovation in Practice: A GP for Me - Canadian Government Executive
DevelopmentInnovations
April 3, 2018

Evaluating Innovation in Practice: A GP for Me

Throughout Canada, healthcare systems are challenged by population growth, aging, and physician retirement and relocation. These, among other factors, have added demands to and limited the capacity of the healthcare system.

Such challenges require a combination of initiatives, including community-driven efforts to first understand and then respond to local and regional needs. In British Columbia, the Ministry of Health and Doctors of BC worked in partnership through the General Practice Services Committee (GPSC), to foster community action of this sort, through a three-year initiative named A GP for Me. Launched in 2013, A GP for Me had three goals:

  • Confirm and strengthen the continuous doctor and patient relationship, including better support for the needs of vulnerable patients.
  • Increase the capacity of the primary health care system.
  • Enable patients who want a family doctor to find one.

Funding for A GP for Me was provided in two ways: the creation of incentive fees to facilitate practice-level change with physicians; and investments in projects delivered by more than thirty Divisions of Family Practice, groups of family physicians in over 230 communities across British Columbia.

At the heart of it, A GP for Me was truly a community-driven, broad undertaking to foster innovation, quality and continuity in patient access and care.

The Task: Undertaking a Provincial Evaluation of A GP for Me 

Evaluating an initiative like that of A GP for Me is complicated. A few of the twists and turns of this endeavour centred on the following.

Relating Results: A GP for Me was one of many efforts in British Columbia to further health care system transformation. Additionally, divisions of family practice had been formed around the province, providing an alternative way for family physicians to collaborate with health authorities and other partners to identify and address local healthcare challenges. Over the course of A GP for Me, about 150 projects were started by divisions, each furthering its own form of innovation. This made the direct attribution and summary of results to A GP for Me challenging.

Harnessing Efforts: The purpose of the provincial evaluation was to not only gain an understanding of the effectiveness of A GP for Me from the experiences of those involved but also to share lessons learned from innovations that seek to enhance the quality of care.

In addition to the provincial evaluation, divisions were also completing assessments of the effectiveness of supported projects, to inform their own learning and innovation. The provincial evaluation had to harness these local efforts to allow for an integration of findings, while also not obstructing the unique work that was proceeding.

Dealing with Unknowns:  In 2015, a substantial Provincial Evaluation Plan was prepared for A GP for Me with the involvement of staff from the Doctors of BC and the Ministry of Health, a GPSC Evaluation Working Group, contracted specialists, a Divisions Reference Group, and evaluators hired by various divisions.

Following the completion of this Provincial Evaluation Plan, and by the time the provincial evaluation commenced, it became apparent that the awareness of stated outcomes and indicators of performance for A GP for Me had since diminished such that partners were challenging concepts, describing intentions and using measures in a variety of disparate ways. This complicated the ability to draw comparisons and roll-up findings across the province. In addition, as the provincial evaluation progressed, it became clear that baseline data was not always available for some of the indicators and planned data sources (e.g. a Core Provincial Patient Survey) would not be obtained in time.

The Answer: A Collaborative and Adaptive Approach to the Evaluation

The success of the provincial evaluation of A GP for Me was founded on the following key principles that guided the work of what was a hybrid evaluation team, made up of staff from the Doctors of BC as the contracting authority and MNPLLP as the contracted evaluator.

Collaboration: Members of the Doctors of BC team and the MNP team worked closely together, such that the provincial evaluation was a truly collaborative undertaking.  This extended beyond frequent, joint check-in meetings to include the co-facilitation of consultations as well as the assigning of work across the combined teams. It was also critical to coordinate with the work of other evaluators, be it the ones engaged by divisions or those working on components of the Provincial Evaluation Plan.

Integration: The provincial evaluation had to integrate the foundational work of the Divisions of Family Practice and that of several other external evaluators, as well as administrative data from the Ministry of Health.  With the divisions, a tiered, thematic analysis was carried out of thirty “Final Evaluation and Project Implementation Close-Out Reports” in the form of a high-level summary, division highlights, and direct report extracts.

In addition to these close-out reports and what was referenced above, there were the results of surveys (e.g. of family physicians, with the GPSC, and the Canadian Community Health Survey), interviews with health authorities and the BC Ministry of Health, and facilitated focus group sessions.

Adaptation: Allowances had to be made for adaptations to the Provincial Evaluation Plan to address gained insight, respond to any gaps in information, and ensure key perspectives were accounted for.

It was also critical to follow an iterative approach to validating early findings and interpretations. This took the form of a staged confirmation of the findings with a variety of stakeholders, covering the various components of the analyses (e.g., interpretations of the administrative data).

The Takeaways: Reflecting on the Experiences of the Evaluation

Just as A GP for Me has illustrated that there is not one solution to address the complex challenges of BC’s health care system, the provincial evaluation highlighted opportunities for future practice.

There are clear benefits to be gained from adopting hybrid evaluation teams, bringing together experienced staff and third-party contractors.  Yet, it is important to also keep in mind the maintenance of harmony and balance in teams, be it with respect to size, well-defined and agreed upon roles, and contributed areas expertise.

Having a well-thought-out plan, or framework, for an evaluation is another factor of success.  The value of this planning though is nicely summed up by Voltaire, “don’t let the perfect be the enemy of the good.” Ongoing socialization of an evaluation plan and allowing for moments for adaptation along the way should be embraced.

With initiatives that serve to foster innovation, especially across geographic and other communities of interest, there can be a concern of imposing structure, which can come in the form of evaluation.  Just as innovation depends on some arrangement for implementation, evaluators need to consider how findings will be combined in a coherent way.

Finally, the pursuit of an all-inclusive, retrospective evaluation may be better replaced with an iterative strategy that allows for the staging of evaluative studies over the course of a major long-term initiative like A GP for Me.  In this way, the evaluation approach will naturally evolve with the initiative, and the latter stages of evaluation will yield findings that are informed by refined priorities, strategic direction and focus.

During the final stages of the A GP for Me evaluation, the GPSC was looking forward and updating its strategic direction to include the patient medical home as the foundation of an integrated system of care. The provincial evaluation informed the evolution of the primary health care system in British Columbia, by providing important insights into local healthcare challenges; raising awareness of community-driven innovations that build on the important work of physicians, divisions of family practice, and health authorities; and furthering an environment for conversation on how to continue to improve patient access and care.

 

Bill Reid, Partner, Advisory Services, MNP and Past President, BC and Yukon Chapter, Canadian Evaluation Society, bill.reid@mnp.ca

Jasmina Fatic, Manager, Advisory Services, MNP, and Past Vice President, BC and Yukon Chapter, Canadian Evaluation Society, jasmina.fatic@mnp.ca

Petra Lolic, Executive Coordinator, GPSC, Doctors of BC, plolic@doctorsofbc.ca

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At first glance, the title may seem counterintuitive. By their very nature, high potentials (HiPos) are assumed to be, or even defined as, very engaged. Yet, when we look at the evidence, this is not necessarily the case. A 2009 study by the Corporate Leadership Council (CLC) discovered that 25% of HiPos were planning to...
 
The Liberal government’s first federal budget laid out $11.9 billion over five years for new infrastructure spending and the move was met with approval from some mayors of the country’s largest cities. Ottawa plans to spend $29.4 billion this year, $29 billion in 2017, $22.8 billion the following year and $17.7 billion in 2019-2020. The...
 
The Liberal government is expected to announce on Tuesday a new federal budget with a deficit in the area of about $30 billion. There’s been a lot of concern about that huge deficit but a number of economists calculate that Canada could actually absorb a much larger deficit and that it may not be even...
 
A leader’s credibility begins with personal success. It ends with helping others achieve personal success. – John Maxwell In 1966, U.S. Senator Robert Kennedy made an influential visit to South Africa. He offered words of hope to opponents of apartheid in his famous “Ripple of Hope” speech at the University of Cape Town: Related posts: From memes to social media, the technology that matters most to the public...
 
Monday was the final day for Canadians to donate money to overseas relief efforts for Syrian refugees in order for the funds to be matched by the federal government. But the money donated by Canadians fell short of the maximum $100 million which the government promised to match. Related posts: Mandatory insurance for federally regulated railways raised to $1-B Salvaging Shared Services Canada Strategic Procurement in the Age of Deliverology...
 
Huawei is bringing back to Canada and expanding its information communication technology-focused student exchange program. Seeds for the Future will once more provide 20 third-year engineering students from Canada, the opportunity to visit Beijing and work in the communication technology provider’s headquarters in Shenzhen, China. This is only the second year of the program in Canada. Huawei Canada is now receiving...
 
Many women entrepreneurs in Canada struggle to access capital, technology, networks and training. Cisco Canada has launched a program called the Cisco Women Entrepreneur’s Circle which aims to bridge this gap. Cisco is working with Women of Influence , a community dedicated to the advancing women professionals; Completely Managed , a managed services provider; the Business Development Bank of Canada ; and Communitech , and industry-led innovation centre based in...
 
Written by Tim Wacker Almost a quarter century ago, when most municipalities were rummaging through file cabinets and sifting through folders for specific documents, and the internet was still in the future (to say nothing of “cloud computing”), the District of Mission in British Columbia became an early adopter of an electronic document management system...
 
Written by  Brady G. Wilson You may not realize it, but your organization is home to an incredibly powerful operating system (O/S). Think outside the realm of technology. What has the potential to engage and energize your employees, bring teams closer together, and create a high-performing workforce? It’s conversation. Conversation is the common denominator behind...
 
Continuous, life-long learning is the future of the public service. Building the capacity of our workforce to meet new expectations and new ways of doing business is key to public service renewal. Large scale organizational learning efforts must be supported to make the leap from current to future state. Related posts: The benefits of an executive coach Connecting with the skills for public service leadership Survey: Professional development...
 
Mega-ConnEX is an annual speed networking event organized by the Health Canada Young Professionals Network which connects young professionals and public sector senior executives. This event, loosely modelled on the ‘speed dating’ process, allows participants to network with senior executives in rapid succession. Related posts: The benefits of an executive coach Infinite development pathway Survey: Professional development...
 
Canada’s contribution to development and humanitarian assistance is recognized around the world. Its official development aid is $5 billion annually. Related posts: APEX Symposium: Making change happen The policy analyst's political world From Procurement to the Commissioning of Public Services...
 
Deliberations and negotiations in the United Nations are intensifying on what the successor framework to the Millennium Development Goals should be as the MDG end date – 2015 – approaches. There is broad consensus that the post-2015 framework should include goals, targets and indicators, as is the case with the MDGs. Related posts: Millennium Development Goals: A sprint to 2015 and the way forward Post-2015 MDG framework: The world we want...
 
The UN consultations on the post-2015 development framework are focused on what the UN Millennium campaign aptly calls, “The World We Want.” What do we want to achieve in a generation? What do we want to achieve in our lifetime? Related posts: Millennium Development Goals: A sprint to 2015 and the way forward Canada post-2015: Confronting our own development challenges...
 
At the turn of the millennium, the international community made a major commitment to address pressing development challenges and combat poverty. The United Nations (UN) Summit in 2000 saw leaders from 189 nations endorse the Millennium Declaration, which led to the establishment of eight Millennium Development Goals (MDGs). Related posts: It's good for what ails your organization Post-2015 MDG framework: The world we want Canadian Governments Lagging in Online Service Delivery...
 
Budgets are statements of political will and power. They are performance agreements that give expression to government’s priorities and expected outcomes....
 
Decades of reform in developing countries point to four enduring dilemmas: Reforms focus on changing rules and behaviour by design rather than on changing practices during implementation;… Related posts: From past to future: Contrasting perspectives on public sector management...
 
The Lough Erne Accountability Report states that the G8 has played a constructive role in promoting better governance in the developing world. It cites the G8’s 70 percent funding of the Africa Peer Review Mechanism to promote democratic processes, citizen rights, and the rule of law. Related posts: Spanning boundaries … Globalization...
 
While there can be no singular solution for good governance, building common strategies that can be locally adapted is important in achieving development outcomes....
 
it’s not the most original saying...
 
With the demographics of an aging workforce and a significant number of pending executive retirements facing most organizations, are governments prepared to manage the transition and invest in the right type of leadership development?...
 
Shakespeare’s “dark comedy,” Measure for Measure, deals with the issues of mercy, justice and truth....
 
Reform is almost always about developing the capacity of government to manage, deliver and renew public services. The capacity deficit is pronounced in developing countries, where basic services are just beyond reach....
 
CGE Vol.13 No.3 March 2007 Assembly of First Nations National Chief Phil Fontaine is promoting a vision for eliminating poverty i...
 
CGE Vol. 14 No.5 May 2008 Before dawn on Monday, 18 February 2008, just as an international conference was about to commence on the We...
 
CGE Vol. 14 No.4 April 2008 “What is a Foreign Service for? Where should it focus its energies?” Prime Minister Gordon Brown asked las...
 
CGE Vol.14 No.3 March 2008 Most observers expect more than 40 percent of the executive cadre of the public service to retire in th...
 
CGE Vol.14 No.3 March 2008 The Commonwealth Secretariat convened the first Commonwealth forum of ministers responsible for public...
 
If you want to understand someone else’s position, walk a mile in their shoes, so the saying goes. To better prepare its future leaders, the Alberta public service has put that chestnut to the test. In 2005, Alberta c...
 
What makes a perfect mentor? Is it age and seniority? Perhaps it is years of education and experience?...
 
Often, decisions about how to recruit are made based on habit – doing what the organization has always done without much consideration of unique job requirements or labor market conditions....
 
It has been said that if everything is important, nothing is important. As a leader, what are the two or three things that are most important to you? What are your passions? What legacy do you wish to leave?...
 
The Mosaic Index, by Professor Richard Florida, which measures the percentage of population who are immigrants, indicates that Canada outperforms the United States, just as Ontario outperforms its peer jurisdictions on diversity. Canada has 20 percent imm...
 
Government policy agendas have long been fraught with complexity....
 
Looking at all the engineering diagrams overlaid on maps on the wall at the band office, I see a hand-drawn picture of a berm, a smiling moose cartoon on the pipeline, and an arrow beside it. "What does that represent?" I asked the engineeri...
 
Gérés efficacement, les conflits peuvent favoriser la résolution conjointe des problèmes, améliorer la communication, rehausser le moral et accroître la connecti...
 
Popular wisdom holds that the public service will need to recruit a large number of young professionals, mostly recent grads, to replace soon-to-retire baby boomers. Of course, there is nothing wrong with following an unoriginal renewal strategy, as lo...
 
CGE Vol.14 No.2 February 2008 As I mentioned previously, one cannot underestimate the importance of educating program executives,...
 
CGE Vol.13 No.9 November 2007 What is the toughest job in government? Try head of the public service in Iraq – mediating between three factions with t...
 
CGE Vol.13 No.9 November 2007 Growth can mean opportunity. Significant increases in population can lead to a stronger workforce, a...
 
The subtitle of this report, prepared by the U.S. National Governors Association (NGA) Centre for Best Practices, is called “Using Arts and Culture to Stimulate State Economic Development.” The report puts to bed the argument that arts are...
 
We can learn from archetypes. They can help us lead, if they are clear and practical enough...
 
Improving leadership development is widely recognized by HR leaders and senior managers as a key priority for any high performing, modern organization....
 
Natural Resources Canada is accustomed to nurturing, protecting and growing Canada’s most precious resources. Now it is also able to nurture and grow its young policymakers....
 
In an increasingly competitive and complex global marketplace, both employers and employees who display creativity, knowledge and imagination are at a premium....
 
The transition from the private sector into an executive role in the federal public service is not easy....
 
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Canada’s international reputation for welcoming and integrating newcomers is unparalleled. At a time when much of the world seems intent on pulling itself apart over disputes around immigration and placing formidable barriers in the path of newcomers, Canada is raising its immigration levels. In November 2017, Ahmed D. Hussen, the Minister of Immigration, Refugees and...