Strategic Clinical Networks

KEY POINTS

• Since 2012, Alberta’s Strategic Clinical Networks (SCNs) have catalyzed health system improvement across the province, through effective partnerships, leadership and careful priority setting.

• The experience of the clinical networks offers valuable lessons for other health systems.

• Strategic Clinical Networks create capacity within health systems to rapidly and rigorously test health innovations, implement those that benefit patients, improve utilization of health services or contribute cost savings, and scale and sustain them.

• Alberta’s networks have developed a 5-year plan that identifies areas of focus and actions to accelerate progress on priority health issues (e.g., integrated care, prevention, surgical access and sustainability of the provincial health system).

• The 5-year plan reflects stakeholder feedback and highlights the importance of leadership support, multilevel engagement, alignment and coordination with clinical, research and community partners, and robust measurement and reporting as key enablers for improvement in the health system.

Alberta first piloted Strategic Clinical Networks (SCNs) in 2012 and has leveraged them as a way to get evidence into care, rapidly test and scale proven health innovations, and bring stakeholders and health partners together to achieve common goals. For 7 years, SCNs have catalyzed health system improvement and innovation in Alberta, along the continuum of health care.^1,2 As noted in the introductory article, a recent analysis of cumulative costs, benefits and value of the SCNs showed substantial return on investment and cost savings.³ The SCNs have also delivered substantial value by improving patient outcomes, safety, satisfaction and quality of life, and supporting clinical pathway development and health research that has brought more than $65 million in grants from outside the province.³ Equally important returns include network contributions to system learning, change management experience, and enhanced physician, staff and public engagement.

As outlined in the articles in this supplement, the SCNs are working together with operational leaders and front-line clinicians to get evidence into practice, address pressing challenges that cross multiple health disciplines (e.g., transitions in care, surgical access and chronic disease), and operationalize systemwide improvements. The articles highlight the many successes of the SCNs, reflect on challenges the networks have encountered, and discuss strategies they used to overcome barriers, advance projects and implement changes in clinical practice on a provincial scale. Not all projects lead to measurable improvements in the health system, and several articles discuss the importance of rigorous evaluation and processes that enable teams to fail fast and adapt rather than sustain activities that do not provide value for patients or the health system.

Qualitative reviews of clinical networks in Scotland, the United Kingdom and Australia have shown that they evolved substantially over time in terms of network structure, processes and capabilities.⁴ Alberta’s experience reflects a similar evolution and strengthening of network capabilities.^4,5 This process of maturation is important because networks do not typically deliver improvements in health outcomes or savings to the health system in their first 2 to 3 years. However, as the networks build partnerships, identify strategic priorities and implement strategies, their ability to get evidence into care increases. Tools and processes that support idea generation, collaboration and co-design, and rapid, rigorous evaluation help advance improvements and innovations in the health system that provide high value.⁶

Since 2015, about 20 projects that showed a positive and substantial effect for patients and the health system have been implemented on a provincial scale.⁷ Ten of these are profiled in a 2019 report that described the effect of SCNs on health outcomes, ² and all involved evidence-informed changes in clinical practice. The SCNs have helped to improve the use of appropriate antipsychotics in patients with dementia, supported the implementation of enhanced recovery after surgery protocols and the safe surgery checklist, improved access to diagnosis for patients with breast cancer and supported the implementation of a provincial stroke action plan (Stroke Care Alberta).² Developing integrated care pathways, improving access and patient experiences, and reducing unwarranted variation continue to be priorities for the networks.

In 2018, Alberta Health Services (Alberta’s provincial health authority; AHS) asked the SCNs to develop a 5-year plan that would enable them to align their efforts, address key health challenges and maximize their collective impact. The intent was to identify strategic areas of focus that would build on the work SCNs had done to date, advance progress on system-wide priorities and continue to drive performance and innovation in the health system.⁸ To ensure the plan reflected the needs and perspectives of all network stakeholders, the SCNs began a comprehensive consultation and engagement process involving focus groups, meetings with SCN leaders and health administrators, input from core committees and patient and family advisors, and interviews with a range of stakeholders in administrative and clinical roles.⁸

Feedback shared during the consultation process reinforced known success factors for clinical networks (e.g., effective leadership, partnerships and communication, adequate resources and strategic alignment with partners⁷). The SCNs’ commitment to patient engagement was identified as an area of strength as was their ability to connect stakeholders and work together to address health challenges that are difficult to resolve independently. Participants expressed confidence in the networks as a valued resource to get evidence into practice. Leadership support at an organizational level was identified as a critical enabler to support a change culture and evidence-informed decision-making. The SCNs’ relationships with provincial and national organizations, operational units across all health zones and clinical champions at local sites were also recognized as important enablers for effective collaboration, project execution and implementation.

Areas of focus in the 2019–2024 Strategic Clinical Network Roadmap⁸

Area of focus	Description	Success factors, enablers and priorities*
Engage the people of Alberta	The SCNs commit to strengthening relationships with Patient and Family Advisors, engaging them as equal partners in decisionmaking and prioritizing work that improves health outcomes and patient and family experiences.	Patient engagement Collaboration Patient- and family-centred care
Strengthen our connections	The Roadmap identifies opportunities to expand and strengthen partnerships (across the province and with national and international organizations), improve communication, align planning processes and reduce fragmentation across the system.	Multilevel engagement Collaboration Communication Leadership support Alignment
Support integrated care across the patient journey	The SCNs will support integrated care models, development of clinical pathways and practice change that focus on patients, not diseases, and improves continuity of care, patient transitions, communication among providers and access to specialty care.	Patient- and family-centred care Multilevel engagement Collaboration
Promote wellness, prevention and population health	The SCNs will work together to support health promotion and prevention, track population health indicators, and partner with provincial agencies and First Nation, Métis and Inuit communities to improve population health and health equity.	Prevention Equity Quality indicators Collaboration
Improve value and sustainability	The SCNs commit to identifying and eliminating low-value practices, supporting clinical appropriateness and developing indicators, accountability structures and incentives that support high-value care.	Physician audit and feedback Robust evaluation, measurement and reporting Quality indicators
Advance health research and innovation	The SCNs will work to embed research into daily clinical practice and build capacity to rapidly identify, evaluate and implement proven health innovations (i.e., programs, care pathways and guidelines) that improve health outcomes and value.	Multilevel engagement Collaboration Robust evaluation, measurement and reporting
Support of our people and processes	The SCNs will embed ongoing evaluation into our work, share best practices and continue to refine and strengthen our tools, structures and processes (e.g., quality indicators and reporting).	Sharing best practices Robust evaluation, measurement and reporting Quality indicators Communication

Note: SCN = Strategic Clincal Network.

^*Based on stakeholder feedback, recommendations and lessons learned.

The consultation also revealed opportunities for improvement. Participants acknowledged the need for greater coordination across networks and multilevel engagement strategies that reach leadership in Alberta’s health zones, local sites, front-line providers, and patients and their families. They emphasized the importance of communication and coordination across networks, and the need to expand relationships with primary health care and community partners, research institutes and other health organizations.⁷ Stakeholders acknowledged the inherent tension that exists between SCNs and local operational priorities. Participants also suggested that shared planning and participation in quality, safety and operational committees would provide opportunities to align resources, clinical objectives and efforts for quality improvement. Finally, participants stressed the importance of robust measurement for all SCN initiatives, including quality indicators and reporting of clinical outcomes, savings to the health system and return on investment. Rigorous evaluation and robust data were considered essential to secure buy-in from health system administrators, successfully implement and spread changes in clinical practice and build momentum for future innovation in the health system.

The 2019–2024 SCN Roadmap identifies 7 areas of focus that will inform the actions of Alberta’s SCNs over the next 5 years (see table). These areas of focus build on the strengths and existing work of the networks and reflect the input, priorities and recommendations of network stakeholders. Within each area of focus, the SCN Roadmap identifies specific objectives and actions.⁸ The SCN leadership is currently working with each network to develop an implementation plan that will define accountabilities, milestones and deliverables to ensure that the SCNs are able to track their progress. It is important to recognize that the SCN Roadmap reflects collective areas of focus that complement, but do not replace, the work each SCN is doing to support its Transformational Roadmap, which identifies priorities specific to each network.

Funding partnerships provide critical resources that support the work of the SCNs as they move from idea to pilot to full-scale practice change. In Alberta, the Partnership for Research and Innovation in the Health System with Alberta Innovates funds high-impact, evidence-informed projects that test the effect of interventions or strategies to close gaps in health or health care. Likewise, the Health Innovation Implementation and Spread Fund, a partnership with Alberta Health, supports provincial implementation of projects that have been shown to improve health outcomes and provide high value. This pipeline of funding and health research provides the critical support that is needed to advance health innovations beyond the pilot stage and achieve full-scale implementation.²

The SCNs’ impact on clinical care and patient outcomes is evident across the health spectrum and is documented in recent evaluations,^2,3 which show a positive return on investment for Alberta’s health system. However, other health care systems considering networks should be aware that these benefits are not realized immediately, as networks typically require 2 to 3 years to deliver a positive return.

The work of Alberta’s SCNs is enabled by a single province-wide health system. However, the tools and approaches they use are applicable to other provinces and health jurisdictions. Patient and stakeholder engagement, leadership support, strategic alignment, funding partnerships and rigorous evaluation are important enablers, and provinces should evaluate the unique opportunities and barriers that exist within their local context.⁴

The SCNs will continue to build and strengthen relationships with patients and community, academic, health and industry partners, locally and outside the province, having identified areas of focus for the next 5 years that reflect lessons learned, stakeholder feedback, shared priorities and current opportunities to advance improvement and transformation in the health system.⁸ Improving coordination and alignment across SCNs and among network stakeholders, sharing best practices, and ensuring rigorous measurement and reporting are expected to be pivotal in further increasing the networks’ effect and progress in supporting a learning, high-performing health system.