Alberta is introducing Strategic Clinical Networks in areas such as mental health and addictions, cancer care, diabetes, obesity and nutrition.

These networks are meant to lead clinical practices province-wide, and improve the quality of care, outcomes and costs of health care services.

This is an ambitious undertaking which may contain some lessons for Ontario.

Alberta’s new Strategic Clinical Networks

Health care in Alberta is set to embark on another major restructuring with the introduction of Strategic Clinical Networks (SCN).  The person leading the effort is Tom Noseworthy, an intensive care doctor and Associate Chief Medical Officer at Alberta Health Services (AHS). He says the mandate of SCNs is to “focus on provincial strategy and clinical performance with the intention to produce high quality health care outcomes at a reasonable cost.” The SCNs will have a broader mandate, a wider scope, and will be better resourced than the clinical networks they will replace.  SCNs will have a voice in resource allocation and expenditure priorities, but will not themselves control budgets or commission services. AHS has yet to announce the exact amount of resources being allocated to the SCNs.

Each SCN will be clinically co-led by a senior medical director and a business manager, and will develop best practices that are intended to be implemented across the province.  AHS wishes to create a strong leadership role for clinicians, because its leaders believe clinicians are most aware of opportunities for quality improvement and inefficiencies on the front lines.

By engaging clinicians at the leadership level, Alberta hopes they will be able to drive change amongst their colleagues across the province.  Cy Frank, an orthopedic surgeon and executive director of the Alberta Bone and Joint Health Institute, describes SCNs as creating “a bottom-up structure, which will help administrators develop top-down policies.”

The SCNs will be organized around key strategic areas that cut across patient groups.  Noseworthy describes these as “areas where we think there is the greatest need and disease burden, and where there is a need to improve clinical practice.”  These areas will include mental health and addictions, cancer care, diabetes, obesity and nutrition.  The first six SCNs are tentatively scheduled to launch in May 2012.

SCNs face considerable challenges.  Noseworthy explains “The big risk that SCNs face is the inability to be successful in clinician and physician engagement.”  For SCNs to be successful, “you must have clinicians engage and feel that they are in the driver’s seat.”  He notes “we may stumble, but we believe that we have the right strategy and will invite other provinces to learn from what we are trying to do.”

Clinical leadership in Ontario’s quality of care agenda

Ross Baker, a professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation, says “the issue Alberta has recognized as really important is that we have to build up the leadership and quality improvement skills of people who are already great clinicians.  We have to give them the resources and structures they need to drive change.  Bringing clinical leadership front and center in the healthcare system is the best way to drive system wide improvement.”  Baker points to Cancer Care Ontario as an example of where Ontario has succeeded in supporting clinical leadership, with good results.

Cancer Care Ontario has developed Communities of Practice, based around clinical groupings, such as surgical oncology.  Jonathan Irish, head of Cancer Care Ontario’s surgical oncology program, explains “each Community of Practice has ‘champions’ in each region.  When a community develops new guidelines, these regional champions provide the leadership to put them into practice.”

Communities of Practice are also able to share data on outcomes, so clinicians can monitor their own performance next to colleagues in other parts of the province.  Irish identifies both prostate cancer and colon cancer as examples of where communities of practice have had success in bringing surgical and pathology practice in line with provincial guidelines.

Irish attributes much of Cancer Care Ontario’s success to its willingness to effectively support clinical leadership.  Each Community of Practice receives project management and implementation support.  Irish believes that “ Cancer Care Ontario’s approach could provide a useful template for supporting clinical leadership in other areas of health care.”

An important part of Cancer Care Ontario’s success, in addition to its clinical leadership, has been that it controls an envelope of funding that it can use to drive quality improvement in cancer prevention, diagnosis and treatment.  However, the government of Ontario has yet to create and resource similar networks in other clinical areas, although it did recently give Cancer Care Ontario responsibility for the management of the Ontario Renal Network, which produced the first profile of clinical and performance measures in renal disease in Ontario.

The Cardiac Care Network was formed in 1995, and has played an important role in advocating for cardiac care in Ontario, as well as monitoring and reporting on the outcomes of selected cardiac procedures. However, it does not allocate any funding for cardiac disease.

There are other clinical networks in Ontario, such as the Ontario Stroke Network and the Ontario Diabetes Strategy, and while these have had some success in improving quality of care, none of them have Cancer Care Ontario’s provincial reach, clinical influence or ability to commission services directly.

A tale of two provinces?

There is no guarantee that Alberta’s SCNs will be successful. However, they do appear to be a serious attempt at developing a province-wide, clinician co-led approach to quality improvement that is currently largely lacking in Ontario.

Note: Andreas Laupacis currently sits on the Board of Directors of Cancer Care Ontario.