Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. Population and Public Health Branch of Saskatoon Health Region deployed improvement methods to develop a comprehensive strategy to improve outcomes for small children ages 0 to 5. The Early Years Health and Development Strategy (EYHDS) team comprised of 5 front line staff and an improvement consultant worked intensively over three months (Feb, Mar, and April, 2012) to Define, Measure and Analyze the opportunity for improvement and generated 25 recommendations. The result was a set of related recommendations for health planners, governments and community organizations. The presentation will demonstrate how improvement methods can be used effectively in community based health promotion areas of health care. Better Health Mary Smillie; Dr. Julie Kryzanowski, Saskatoon Health Region

1. Early Years Health and Development -
Improvement Science works in Population and
Public Health
Mary Smillie
This Session is sponsored by:

2. Early Years Health and Development
Improvement Science in Population and Public Health
Presentation and Discussion at Inspire Conference, April 10, 2013
Dr. Julie Kryzanowski, Saskatoon Health Region & Mary Smillie, Improvement Advisor

3. Needed to define a path forward
Need: Improve
outcomes for 0 -5
year olds.
Challenge: Time
Opportunity:
Child Health
Report
Interest:
Improvement
Science

4. Went looking for help
Health Promotion
Manager Tanya Dunn-
Pierce called Mary Smillie.
• Public Health
• Health Promotion
• Improvement Science

5. How could
improvement
science help?
• Leadership team
• Project team
• Content Consultants
Engaged Leadership
Five Dedicated Staff plus
Mary
3 Month Focus and Finish
DMAIC – define, measure
and analyse

6. The Early Years Health and Development Project Team

7. Weekly Meetings
As needed and
twice as a group
Every two weeks
Through PDSAs,
focus groups,
one to one
meetings

8. http://www.youtube.com/watch?v=GbSp88PBe9E&feature=related

9. Video – Change the First Five Years and
You Change Everything

10. Neighbour Discussion
• What do you think needs to be done to
improve health and development outcomes
for small children?
(5 minutes)

11. Health Inequities Exist Among Children
• Saskatoon Health Region
children generally healthy,
but
• Many indicators revealed
health inequities by
neighbourhood and
Registered Indian Status
– Almost 25% of the children in
Saskatoon lived in areas of
highest deprivation
Early Years Report

12. Early Years Report
Socioeconomic Status

13. Ethnicity
• Birth rates of the RIS
population is up to three
times higher than the non-
RIS population (33.4
compared to 12.3 in 2009)
• Higher rates of:
– Preterm births (10.5% vs.
7.1%)
– Low and high birth weights
– Teen pregnancy (160.5 vs.
23.5 per 1,000)
– Vulnerable IHBQ score (70.3
vs. 27.7%)
Early Years Report

14. Readiness to Learn
Based on Early Development
Instrument (EDI)scores across
the five key domain areas:
• Physical health & well-being
• Social competence
• Emotional maturity
• Language & cognitive
development
• Communication skills &
general knowledge
Early Years Report

15. What we learned through the project:

16. A life course perspective
Health trajectories are the
pathways that individuals
follow from a health
perspective.
These pathways evolve over
time, and the directions taken
depend on individual actions,
as well as the circumstances
and conditions experienced
throughout life.
Impacts of Poverty on Marginalized Groups
MCH Life Course Toolbox: www.citymatch.org/lifecoursetoolbox

17. Adverse experiences in childhood

18. Parents view of help available

19. Parents and CBOs

20. Many agencies with mandate for children

21. What we learned about Canadians
• So many programs exist
to reduce isolation –
single family dwellings
• Parents connect with
each other through
scheduled
appointments – play
dates
• Ideal community size is
walkable, services and
basic household
commodities available

22. Dr. James Heckman
• Economist
• Nobel Laureate
• University of
Chicago
http://www.heckmanequation.org/content/resource/
why-early-investment-matters

23. Video – Why Early Investment Matters

24. The Heckman Equation
“One dollar spent in
the early years is
estimated to save
between $3 and $9
in future spending
on health, social and
justice services.”
Grunewald, R. & Rolnick, A.
(2006), from The Chief Public
Health Officer’s Report on The
State of Public Health in
Canada 2009

25. Neighbour discussion
• What to do?
• 5 min

26. Aim, Measures and Strategies
• Less than 18% EDI by 2018
• Measurement infrastructure
• 25 Recommendations
– Support parents
– Invest in early years
– Act as one system

27. Measures for Early Childhood
In-Hospital
Birth
Questionnaire
Early
Development
Instrument
Bookends of Early Childhood
Community Risk Indicators
What is the community like where children are growing up?
% teen
mothers
% low
birth
weights
% Social
Assistance
Program
recipients
% of housing
in need of
major repair
% of adults
with low
education
% lone
parents
Prenatal Birth Age 1 Age 3Age 2 Age 4 Age 5 Age 6
Grade 1 –
Mandated
school
attendance
Kindergarten
Entry

28. RECOMMENDATIONS
Encourage and
Support Health
Sector Action
Develop and Implement a
Provincial Early Childhood Health
and Development Strategy
1. Agreement on a key goal = “18 by 18”
2. A focus on family needs
4. Commitment of targeted investments
5. Robust monitoring tools
1. Deliver family-centred,
accessible, integrated
services.
2. Bolster health promotion
and protection, illness and
injury prevention efforts
3. A holistic approach for improving the
health and development of First Nations
and Métis children
3. Work with partners to better
protect children from
environmental health risks

29. Learning from Quality Improvement

30. What worked well:
• Engaged leadership
with questions
• Dedicated staff and
dedicated time
• Focus and Finish
• Plan Do Study Act cycles
• Engaged parents and
community agencies
• Mapping
• Compelling data
• Elegant design for
learning

31. Even better if:
• More time prior to
getting started
• More time to develop
trust and relationships
with First Nations and
New Canadian parents

32. Much better when:
We achieve EDI scores less than 18% by 2018
When we set a new aim for EDI less than 10% and achieve it.
A child born to any family anywhere in Saskatchewan has the
same opportunity for success as the next child born.

33. Thank you!
For more information
contact:
Dr. Julie Kryzanowski
julie.kryzanowski@saskatoon
healthregion.ca
Or Mary Smillie
msmillie@sasktel.net