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The Evolution of Change Agents Supporting PMH and HN Transformation in Alberta

​The change agent role and its support is not a new concept in Alberta.  Near the turn of the millennium small pockets of physician innovators began the work of changing how primary and community specialty care is delivered.  Many were looking at new ways that they could approach care delivery in their practices, a few also worked with system partners to enhance care where it intersects with the broader health care system.  They looked at what other health care systems across the world were doing then adopted and adapted promising practices to fit their context.  It was these innovators who drove both the early quality improvement initiatives and set the vision for the new structures to drive change, including the development of the PCNs (Primary Care Networks).  In addition to the physician champions, over time, small numbers of other change agent roles evolved, such as the practice facilitator (PFF.  The PF role developed in organizations like Toward Optimized Practice (TOP), Alberta Health Service (AHS) and in PCNs to support community-based quality improvement (QI) initiatives such as Alberta AIM[1], Health Screen in Action[2], TRACII[3], and pcnACT[4].  The data collected from these projects demonstrated that the interventions were successful, however, the initiatives did not spread beyond a few innovators and early adopter practices, eluding impact at the system level. 

In 2013, Alberta Screening & Prevention (ASaP) initiative launched.  This initiative was purposefully designed to engage several hundred physicians across the province.  What set this initiative apart from previous ones (i.e., that had not gone to scale) was the strategic investment by PCNs in change agents, beginning with physician champions and practice facilitators.  Other roles supporting change at the practice level emerged as the initiative ramped up; the panel manager supporting panel identification, maintenance, and management; and the EMR specialist role, experts who support other change agents or the clinic directly with their EMR expertise for clinical care improvements.  Within the first two years, ASaP delivered on demonstrating impact at the provincial level, both in physician uptake and statistically significant improvements in screening rates. 

Through the same period as the ASaP initiative was in full swing, Alberta adopted the College of Family Physicians Canada (CFPC) A Vision for Canada:  Family Practice - The Patient's Medical Home as the provincial vision and adapted the Safety Net Medical Home Initiative Implementation Elements (2011) as the Alberta roadmap to achieve the vision.  (This document has since been updated:  A New Vision for Canada – Family Practice – The Patient's Medical Home 2019.)  The first goal set forth with this work was to support primary care physicians to work on panel processes. Once again change agents were central and engaged physicians and their teams in the work and to successfully scale the uptake of panel processes across the province to almost 70% in under four years. These change agents have been critical in the ability for practices to engage in other improvement initiatives such as Choosing Wisely Alberta and other PCN-level PMH initiatives. 

Guided by both the international evidence for change agents in primary care system transformation and the Alberta experience of reaching scale with improvement initiatives, supports for change agents were built to help change agents to connect, share, and learn from one another.  These supports include, but are not limited to: 

The change agent roles are continuing to evolve internationally and within Alberta.  Through this Blueprint, the AMA is organizing its plan to support change agents through their journey of helping clinics implement PMH and HN, as well as other PCN priorities as they arise. 

Diagram:  The Evolution of Change Agents Supporting Primary Care Transformation in Alberta:


                                                     

[1] Alberta AIM

[2] Health Screen in Action

[3] TRACII

[4] pcnACT