Bone and Joint Health
Strategic Clinical Network
2015-2018
Transformational Roadmap
Version 2.0
Version Date:
June 2015
TABLE OF CONTENTS
Letter from the Leadership Team
1
Introduction
2
More Research and Faster Transfer of Knowledge
A Framework for Transforming Musculoskeletal Care
Musculoskeletal Program Expansion
The Best in Providing Evidence-based Care
2
3
4
5
The Drivers of Transformation
The Musculoskeletal Landscape
Team-based Care
Quality Improvement
7
7
7
8
Transforming Musculoskeletal Care in Alberta
Development of the BJH SCN’s Transformational Roadmap
Inclusive Models of Care
Six Common Themes of Transformation
Health Promotion and Injury Prevention
Centralized Intake and Triage
Musculoskeletal Multidisciplinary Assessment and Treatment Clinics
Evidence-based Clinical Pathways and Frameworks for Measuring Performance
Provider Support and Education
Patient Engagement and Education
Seven Essential Enablers of Transformation
Engagement
Communication
Quality Improvement
Technology
Research, Innovation and Knowledge Translation
Funding Models
Human Resources
10
10
10
11
11
12
12
12
12
13
13
13
14
14
15
15
16
17
Musculoskeletal Care transformation Initiatives 2015-2018
Signature Projects are High-Profile
Hip and Knee Arthroplasty Program
Fragility and Stability Program
Priority Projects Demonstrate Musculoskeletal Transformation
Knee Soft Tissue Injury
Inflammatory Arthritis
Research Projects
SpineAccess Alberta
Optimizing Central Intake to Improve Arthritis Care
Pan-SCN Activities
18
18
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19
20
20
21
22
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Appendix A – Bone and Joint Health Strategic Clinical Network Core Committee
24
Letter from the Leadership Team
INCREASING THE BREADTH, SCOPE AND IMPACT OF PREVENTION AND CARE
As Alberta’s population grows, so grows its need for musculoskeletal (MSK) health care. And as
Albertans know, the population growth here has been sharp and fast, eclipsing other jurisdictions in
Canada.
The correlation between population growth and MSK health care need is simple. There are more than
200 MSK conditions affecting the body’s numerous bones, joints, tendons, ligaments and muscles. Every
Albertan will develop at least one MSK-related condition in his or her lifetime. These conditions are
extraordinary for their breadth and scope. They encompass those of acute onset, such as trauma, pain
and cancer, to those of chronic long-term illness, such as osteoarthritis, rheumatoid arthritis, and low
back pain. They are the most common cause of severe long-term pain and physical disability, and they
affect hundreds of thousands of Albertans at any one time.
Population aging (including workforce aging) and rising rates of obesity in Alberta add a level of
complexity and urgency. Many MSK conditions are more prevalent in the later stages of life and some,
such as osteoarthritis and low back pain, are directly associated with excess body weight.
We are compelled by this challenging demographic reality and the growing economic burden of health
care to take a critical look at how we are managing MSK health and health care in Alberta. Can we
reduce the burden of demand on the public health care system by doing more to prevent MSK injury
and illness? Can we improve the outcomes of patients and use our resources more efficiently by using
more effective, evidence-based ways to deliver services when MSK illness strikes? Can we be more
innovative in managing MSK conditions in their early stages to avoid surgery?
These were the questions the Bone and Joint Health Strategic Clinical Network (BJH SCN) put to
stakeholders in Alberta’s clinical, administrative, policy and patient communities. The positive feedback
we received was used to develop a three-year plan that will serve as a roadmap for transforming MSK
care to meet the challenges Alberta faces. We call it our Transformational Roadmap.
On the pages that follow you will learn about the initiatives we will undertake, and the objectives and
strategies we will use as we test-run our Transformational Roadmap over the 2015-to-2018 period. We
welcome views and ideas that may lead to further improvement. Please take the time to share your
thoughts and suggestions with us at [email protected].
Sincerely,
DON DICK
SENIOR MEDICAL DIRECTOR
LYNNE MANSELL
LINDA WOODHOUSE
SENIOR PROVINCIAL DIRECTOR
SCIENTIFIC DIRECTOR
1
MEL SLOMP
EXECUTIVE DIRECTOR
INTRODUCTION
More Research and Faster Transfer of Knowledge
Population growth, population aging and rapidly rising rates of obesity are the major drivers of demand
for musculoskeletal (MSK) health care. Rising demand together with the long-term chronic nature of
most MSK conditions has brought a sense of urgency to improving prevention and treatment. These
factors have also exerted considerable pressure for more research and faster transfer of knowledge
from the research bench to the hospital bedside. However, health care is a fragmented industry. Each
party within the industry – physicians and other health care professionals, researchers, patients, public
health agencies, policy makers, and private industry – has its own unique set of guiding principles,
pressure points and measures of success. Fragmentation
slows the practical application of knowledge.
THE BJH SCN DRAWS TOGETHER
INDIVIDUALS TO COLLABORATE
ON BRINGING THE BEST IN
CLINICAL PRACTICES AND
INNOVATION TO EVERYDAY
PREVENTION AND CLINICAL CARE.
The Bone and Joint Health Strategic Clinical Network (BJH
SCN) draws together individuals from all of these parties to
collaborate on bringing the best in clinical practices and
innovation to everyday prevention and clinical care. In
doing so, it creates an environment that favours alignment
among the service delivery, research, policy and planning
areas of MSK health care, and puts patients and their
families at the centre of health service delivery.
The BJH SCN was established by Alberta Health Services in 2012 to promote MSK disease prevention and
improve the way care is planned and delivered when disease strikes. Its work since then has focused
primarily on:
 Hip and Knee Joint Arthroplasty: Embedding in clinical practice across Alberta an evidence-based
clinical pathway for hip and knee replacement patients, and measuring and reporting the quality of
care delivered under the pathway as part of a comprehensive continuous quality improvement
initiative.
 Fragility and Stability: Designing and implementing an evidence-based clinical pathway for hip
fracture patients, including innovative prevention programs to reduce the risk of a subsequent
fracture related to osteoporosis.
Frameworks have been built to measure the quality of care for hip and knee joint replacement and hip
fracture patients in six dimensions: accessibility, safety, effectiveness, efficiency, appropriateness and
acceptability. These dimensions were identified by the Health Quality Council of Alberta as the most
effective when evaluating health care quality.
The BJH SCN has been assisted in this work by Alberta Bone and Joint Health Institute (ABJHI), an
independent not-for-profit organization with expertise in project management, clinical pathway design,
knowledge translation, and performance measurement and analysis.
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A Framework for Transforming Musculoskeletal Care
Now in the third year of its mandate, the BJH SCN is expanding its work and employing a strategic
framework under which innovation in MSK health care will be truly transformative. This framework
(Figure 1) will serve as the foundation on which the transformation of care will be carried out. The
framework, which can be applied in any area of MSK care, will have common underlying themes and
enablers, including:
 Themes
 Health promotion and injury
prevention
 Centralized intake and triage
 Multidisciplinary clinics and teams
 Clinical pathway and measurement
 Provider support and education
 Patient engagement and education
 Enablers
 Engagement
 Communication
 Technology, data and measurement
 Quality improvement
 Research, innovation and knowledge
translation
 Funding models for multidisciplinary teams
 Human resources
Once tested and proven effective in practice, these themes and enablers will be applied to every
initiative the BJH SCN undertakes.
Transformation will be guided by seven firm principles:
1.
2.
3.
4.
5.
6.
Services are patient-centric.
Services are available across the province.
Services are comprehensive.
Access to services is improved.
A multidisciplinary/interprofessional team approach to care is encouraged.
Services are comprehensive across the continuum of care, including chronic care, acute care,
surgery, and non-surgical care.
7. Outcomes are measured and analyzed.
In a transformational shift in strategy, the BJH SCN’s main focus in all its initiatives will swing upstream
from surgery to prevention, early detection and conservative (non-surgical) management of MSK
conditions using evidence-based models of multidisciplinary team-based care. Evidence-based surgical
treatment will continue to be an important part of the BJH SCN’s scope of work under its
Transformational Roadmap, but will no longer be the primary focus.
3
Figure 1: The BJH SCN’s transformational roadmap will have common themes and enablers that apply to all initiatives.
Services will span multidisciplinary triage, assessment and care, patient engagement in treatment
decisions, performance measurement and reporting, and better information flow among providers,
researchers and stakeholders. A knowledge translation strategy will ensure results of the BJH SCN’s
transformational projects are understood and shared broadly
for maximal benefit.
A KNOWLEDGE TRANSLATION
STRATEGY WILL BE CARRIED OUT
TO ENSURE RESULTS OF THE
TRANSFORMATIONAL PROJECTS
ARE UNDERSTOOD AND SHARED
BROADLY FOR MAXIMAL BENEFIT
The greater emphasis on services upstream of surgery
recognizes that most chronic diseases of the MSK system can
be prevented, or their progress halted or slowed significantly,
by making the right personal choices in daily activities and in
health and dietary habits. It also recognizes that 80% of
people who develop an MSK condition do not require surgery
to treat it.
Musculoskeletal Program Expansion
The BJH SCN’s current programs – Hip and Knee Arthroplasty, and Fragility and Stability – will continue
under the Transformational Roadmap banner. But there will be new emphasis on improving the
upstream services in these programs, reflecting the progress that has been made in the surgical
component of the continuum of care. There will also be new initiatives launched in three high-need
areas of MSK care:
1) Spine-related Disorders. The initial work in this area will involve developing and piloting an
innovative model for assessing and triaging people with spine conditions and low back pain. The
BJH SCN will then design a set of evidence-informed clinical pathways that will set out the
protocols and procedures for non-surgical and surgical treatment of spine conditions and low
back pain.
2) Knee Care (other than knee replacement). The BJH SCN will develop a comprehensive evidenceinformed approach to preventing and treating acute and chronic knee conditions.
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3) Rheumatoid Arthritis. The BJH SCN will increase the capacity of the health system to provide
care for patients across the continuum by maximizing the scope of practice and using the
appropriate health care professional in the most favourable setting at the most advantageous
time.
These new initiatives were selected as transformational projects by the BJH SCN’s Core Committee,
which provides leadership and oversight of projects undertaken by the BJH SCN. In making the selection,
its members engaged with stakeholders in the clinical, administrative, policy and patient communities to
determine the relevance of the proposed work and the readiness to accept change while also weighing
the ability to leverage progress made on earlier work in these areas.
These initiatives together with the Hip and Knee Arthroplasty and the Fragility and Stability projects will
provide the opportunity for the BJH SCN to test its transformational framework for proof of concept
over the 2015-to-2018 period. Once the concept has been proven effective, the transformation
framework will become the foundation for all subsequent BJH SCN initiatives.
The Best in Providing Evidence-based Care
The Bone and Joint Health Strategic Clinical Network was established by Alberta Health Services in 2012.
It was one of six initial areas of high-need clinical care assigned a dedicated Strategic Clinical Network.
The BJH SCN is committed to six principles, which guide its day-to-day operations:
1)
2)
3)
4)
5)
6)
Ensuring public health care is sustainable
Using evidence to inform decisions
Supporting research and encouraging innovation
Making health and health care patient- and family-centred
Improving the patient experience with health care services
Achieving the best possible health outcomes
The BJH SCN’s vision is to become the best bone and joint system in providing evidence-based care. Its
mission is to improve bone and joint health care by addressing the needs of patients, providers and the
health care system as follows:
Patients
Within a transformed MSK care
system, Albertans will be
supported across the full
continuum of care from prevention
to independence. The support and
care they receive will be
coordinated and integrated. The
health care system will provide
early meaningful diagnosis and
interventions, personalized care
plans, and optimized navigation
across the continuum. Patients will
be engaged in collaborative and
shared decision making, and will
be partners in their care.
Providers
Within a transformed MSK care
system, clinicians will be part of
collaborative, integrated care
teams providing patients with
education, diagnosis, triage,
treatment and rehabilitation
support based on best practices
and evidence-based guidelines.
Each team member will work to
the full scope of practice, and will
be knowledgeable and respectful
of other team members’ roles in
the flow and care of patients.
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The Health Care System
Within a transformed MSK care
system, patient care will be
coordinated and integrated across
the continuum. The process of care
will be clear and transparent to
patients and their providers.
Patients will have access to all of
their medical records and clinicians
will have access to the medical
records of their patients.
Algorithms and pathway flows will
be built to ensure all patients have
timely access to integrated care
that is consistently of high quality
and that optimizes their outcomes.
In transforming the MSK care system, the BJH SCN will:








Build capacity by training and establishing multidisciplinary teams and alternate care providers
to leverage for patients the full scope of practice of each relevant medical discipline.
Operationalize evidence-based guidelines and criteria for referral, diagnostic imaging,
treatment and other aspects of care.
Standardize clinical pathways and embed in them performance feedback and outcome
measurement mechanisms.
Build sustainability through innovative models of care delivered by
multidisciplinary/interprofessional teams and funded using approaches that incent team-based
care.
Provide comprehensive team-based care to optimize patient outcomes.
Invest in services at the front end of the continuum of care, including health promotion, injury
prevention, early identification of illness, and conservative (non-surgical) management of
conditions as a means of avoiding or delaying more costly specialist care.
Standardize care and reduce variation in care practices and protocols in urban, rural and
remote areas.
Endeavour to prevent the development of osteoarthritis brought on by trauma, and to slow the
progression of disability through innovative primary and secondary prevention strategies.
Now in the third year of its mandate, the BJH SCN has 10 sister Strategic Clinical Networks, including:
Seniors Health; Surgery; Addiction and Mental Health; Cancer; Cardiovascular Health and Stroke; Critical
Care; Emergency; Diabetes, Obesity and Nutrition; Maternal, Newborn, Child and Youth; and Respiratory
Health. The Strategic Clinical Networks collaborate on projects, with one seeking the expertise of
another when needed. For example, the risk of developing osteoporosis and suffering hip fracture in a
fall are higher among the elderly. In this area, the Seniors Health Strategic Clinical Network has provided
valuable support to the BJH SCN in developing and carrying out its Fragility and Stability program.
The Strategic Clinical Networks are founded on the Institute of Healthcare Improvement’s (IHI) Triple
Aim, which is to simultaneously:
1) Improve the health of the population;
2) Enhance the experience and outcomes of patients; and
3) Reduce the per-capita cost of care for the benefit of communities.
Triple Aim serves as the foundation for organizations and communities to optimize health for individuals
and populations. The BJH SCN applies the IHI’s Plan, Do, Study, Act model, an action-oriented method of
change that involves planning change, trying it, observing the results, and acting on what is observed.
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THE DRIVERS OF TRANSFORMATION
Three powerful forces are driving the BJH SCN’s efforts to transform MSK care: 1) the MSK landscape; 2)
team-based care; and 3) quality improvement.
The Musculoskeletal Landscape
Many MSK conditions are chronic, characterized by long-term pain and disability. Chronic MSK
conditions, such as osteoarthritis, rheumatoid arthritis and back pain, are often challenging to treat.
They require a system of care that can focus on not only treating the MSK conditions but also on
managing the comorbidities that are commonly associated
with them, such as diabetes, depression and obesity.
This complexity serves as a catalyst for health care system
transformation recognizing that patients often require
many different services to treat their disease and
comorbidities for long periods of time.
Escalating health care costs, rising numbers of patients,
long waiting times for some services, and an aging work
force are issues that have converged to bring urgency to
transforming the way MSK care is delivered in Alberta.
ESCALATING HEALTH CARE COSTS,
RISING NUMBERS OF PATIENTS,
LONG WAITING TIMES FOR SOME
SERVICES, AND AN AGING WORK
FORCE ARE ISSUES THAT HAVE
CONVERGED TO BRING URGENCY
TO TRANSFORMING THE WAY MSK
CARE IS DELIVERED IN ALBERTA.
MSK conditions are the leading cause of severe long-term pain and physical disability. They are costly to
the Canadian economy. The Arthritis Alliance of Canada estimated the combined annual economic
burden of osteoarthritis, the most prevalent form of arthritis, and rheumatoid arthritis, a crippling
autoimmune disease, was approximately $33 billion in 2010. This suggests the annual economic burden
was about $4.6 billion in Alberta. This burden, which is growing annually, requires alternative models of
care with innovative approaches across the continuum.
Team-based Care
Service delivery is fragmented and medical care practices and protocols are highly variable in MSK
medicine.
Funding methods oriented toward reimbursing individual practitioners for services rendered are a major
contributor to fragmented service delivery in Alberta. For example, Alberta’s fee-for-service funding
structure does not allow for widespread collaborative models of care, especially the long-term and
multidisciplinary care associated with chronic disease. Team-based funding is a desirable alternative
method. It would incent coordination of services across assessment, triage, treatment and rehabilitation
with common goal setting and outcome tracking by providers.
Access to the appropriate provider at the point in time most advantageous to the patient is a major
challenge when managing chronic diseases that require a collaborative, multidisciplinary model of care.
Inter-professional collaboration could improve by providing more information about the scope of
practice and the roles that can be played by the different clinicians involved in delivering care to MSK
patients. It is essential in a multidisciplinary care environment for individual roles and responsibilities to
be transparent to all and for communication among providers to be fluid and unambiguous.
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Quality Improvement
The BJH SCN views quality improvement as a process of putting in place proven tools and strategies that
reveal for frontline health professionals how they are doing and encourage them to continuously
challenge themselves to do better.
Figure 2: Initiated bottom-up and supported top down.
Bottom-up pressure from the front lines is
a pivotal feature of the BJH SCN’s
continuous quality improvement strategy.
It reflects the BJH SCN’s belief that
improvement driven by those on the front
lines who deliver and manage services is
more meaningful, effective and
sustainable than improvement driven by
top-down directive alone (Figure 2).
Continuous
Quality
Improvement
This strategy uses the Quality Matrix for
Health, Measurement Framework,
Balanced Scorecard, and Learning
Collaborative as highly effective tools.
Quality Matrix for Health (Figure 3): The
Health Quality Council of Alberta’s Quality Matrix provides a common language, understanding and
approach to quality so that everyone is working toward well understood goals. The Matrix was
developed to avoid the confusion that arises when quality is interpreted differently by health care users,
providers and organizations. It captures the patient experience in six dimensions of quality and four
distinct but related areas of service need. Using key performance indicators (KPI) in the six dimensions,
the quality of service can be measured, tracked and reported to encourage continuous quality
improvement in a standardized, systematic way.
Figure 3: The
Health Quality
Council of
Alberta’s
Quality Matrix
for Health.
8
Measurement Framework: The BJH SCN uses Measurement Frameworks to evaluate the performance of
clinical pathways in a way that is consistent, standardized and transparent for all involved in delivering
care along the pathway. A Measurement Framework is made up KPIs in the Quality Matrix’s six
dimensions, the data needed to measure performance in each of the indicators, and performance
benchmarks. Regularly collecting data and measuring performance makes it possible to quickly flag
areas of the clinical pathway where performance levels are not meeting benchmarks and need to be
addressed.
Balanced Scorecard (Figure 4): The BJH SCN uses Balanced Scorecards together with team dynamics as a
highly effective tool for quality improvement in hip and knee replacements. Multidisciplinary teams of
frontline health professionals, including surgeons, nurses, therapists, unit managers and case managers,
are formed in hospitals that provide hip and knee replacements. Each team develops a Balanced
Scorecard with targets for KPIs in the Quality Matrix’s six dimensions. The teams monitor their
performance, adjusting practices and strategies to meet the targets, which may be local or provincial.
Once the targets are met and sustained, the teams adopt new KPIs with targets. The Balanced Scorecard
approach maintains a constant province-wide drive for quality improvement in hip and knee
replacements, and can be adopted in other areas of bone and joint care.
Figure 4: Sample
Balanced Scorecard
used by
multidisciplinary
teams to improve
the quality of care.
Learning Collaborative: The BJH SCN uses the Learning Collaborative to help frontline teams develop the
necessary competency to use the Balanced Scorecard methodology to maximal benefit. Developed by
ABJHI, the Learning Collaborative serves as a model for creating the conditions for bottom-up change
and achieving breakthrough improvement in performance. The Learning Collaborative uses Six Sigma
process improvement and the Institute for Healthcare Improvement’s Breakthrough Methodology for
accelerating progress toward team targets.
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TRANSFORMING MUSCULOSKELETAL CARE IN ALBERTA
Development of the BJH SCN’s Transformational Roadmap
The BJH SCN’s Transformational Roadmap was developed through a year-long stakeholder engagement
effort. Factors emerged that weighed heavily in the decision to make spine-related disorders, knee care,
and rheumatoid arthritis the lead-off projects for transforming MSK care, including:





Need at the local and provincial level.
Impact on the six dimensions of quality and the evidence to support change in the way care is
delivered.
Opportunity to build on previous work, such as clinical pathways that have been developed but
not implemented.
Readiness and ability to implement change across the province.
Local champions to lead Working Groups in carrying out the projects.
Demonstrating Musculoskeletal Transformation
MSK transformation will have two project phases. Phase 1
projects – Knee Care, Rheumatoid Arthritis, and Spine-related
Disorders – are under way in select locations. The BJH SCN’s six
principles (page 6) and the benefits of MSK transformation will
be clearly exhibited as the three Phase 1 projects are carried
out. In Phase 2, the BJH SCN will expand these projects and the
best practices developed with them to all areas of the province.
It will also expand the scope of its work to other MSK
conditions, as noted in the table to the right.
The BJH SCN’s Transformational Roadmap will be reviewed
annually to ensure it remains relevant and feasible.
Progress on the Transformational Roadmap will be
measured regularly to identify opportunities for
improvement and to take corrective action early.
Phase I
Knee
Arthritis
Spine
Phase II
Foot and ankle
Shoulder
Other conditions and
specialty areas, such as
juvenile arthritis
PROGRESS WILL BE MEASURED
REGULARLY TO IDENTIFY
OPPORTUNITIES FOR IMPROVEMENT.
Inclusive Models of Care
Patients and primary care providers have, through an iterative consultation process, made clear to the
BJH SCN their view that Albertans need innovative MSK care that does not rely exclusively on specialists,
such as surgeons and sports medicine physicians. They have suggested that inclusive models of care
making optimal use of appropriate clinicians will improve access to comprehensive care while reducing
duplication of services, referrals to the wrong clinician or wrong discipline, and service fragmentation.
Furthermore, patients and primary care providers have said they support improved and expanded
primary prevention, public and patient education, and personal health management strategies. This is,
in part, because these efforts reduce injuries, increase the ability of individuals to manage their
condition at home, and provide patients with access to a range of services that allow them to minimize
the likelihood they will need surgery or other intensive, specialized care.
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Six Common Themes of Transformation
The Transformational Roadmap sets out six common themes considered by the BJH SCN to be essential
to transforming MSK care.
1. Health Promotion and Injury Prevention
The BJH SCN will launch primary and secondary injury and disease prevention programs. These
programs will slow and, where possible, reverse the growing demand for bone and joint care in
hospitals and in the community.
Primary prevention seeks to avert injury or the onset of disease by employing risk reduction
strategies. Secondary prevention occurs following an injury or the start of disease. It is intended to
avoid re-injury or to halt or slow the progress of disease in its earliest stages, averting further
damage.
Prevention programs will target at-risk populations,
such as youth in schools, sport and recreation, and
the frail elderly.
IN THE AREA OF HEALTH
PROMOTION, PROGRAMS WILL BE
DEVELOPED IN PARTNERSHIP WITH
A BROAD GROUP OF COMMUNITY
STAKEHOLDERS, SUCH AS SCHOOLS,
INDUSTRIES, RESEARCHERS AND
CLINICIANS.
Knee soft tissue injuries are among the most common
sports injuries. The BJH SCN will implement an
evidence-informed primary prevention program
developed and proven effective by the Sport Injury
Prevention Research Centre at the University of
Calgary. The BJH SCN will collaborate with the
Research Centre and other stakeholders to identify
and implement sport-specific neuromusculoskeletal training aimed at reducing injury in other
extremities once the knee injury prevention program is well established across Alberta.
Falls are the leading cause of injury in Canada. The BJH SCN will support Alberta Health Services’
Risk Management Group and Injury Prevention Group in developing primary prevention programs
to decrease the fall rate and injury from a fall in the adult population.
Secondary prevention programs will be developed as part of the three projects under way in Phase
1 of MSK transformation: Spine-related Disorders, Knee Care, and Arthritis.
A secondary prevention program called Catch a Break, launched in 2014 as part of the BJH SCN’s
Fragility and Stability program, has been rolled into the Transformational Roadmap. Catch a Break
searches databases to identify bone fracture patients suspected of having osteoporosis, a thinning
of the bones that leaves them susceptible to fracture. These patients are advised to be tested for
osteoporosis. They and their family physician are sent information about treatment and fracture
prevention strategies.
In the area of health promotion, programs will be developed in partnership with a broad group of
community stakeholders, such as schools, industries, researchers and clinicians. This work has
begun on a limited scale with programs promoting exercise and recommendations on vitamin D
and calcium intake. These programs will become part of a comprehensive, strategic approach to
promoting good bone and joint health.
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2. Centralized Intake and Triage
The BJH SCN is advancing centralized intake as a triaging strategy that will improve access to MSK
care across the province, particularly for rural populations. Centralized intake in hip and knee
replacement clinics is well established in Alberta. The BJH SCN will make centralized intake standard
practice for all MSK conditions. This will capitalize on existing information and referral mechanisms,
such as Health Link Alberta, the round-the-clock provincial telephone service, and eReferral, the
new information systems solution for end-to-end tracking and management of patient referrals.
eReferral has been introduced by Alberta Health Services initially for hip and knee replacement,
lung cancer and breast cancer referrals with plans to quickly expand to other areas of care. The BJH
SCN is promoting eReferral to referring physicians as the optimal replacement for the variety of
incompatible electronic and paper-based systems that are being used to refer hip and knee patients
to specialists in Alberta. Having a single electronic referral system for the province will reduce the
rate of incomplete and inappropriate referrals and eliminate duplicate referrals.
3. Musculoskeletal Multidisciplinary Assessment and Treatment Clinics
The BJH SCN is advocating Musculoskeletal Specialty Care Clinics across Alberta. These clinics would
provide comprehensive services including MSK assessment, triaging, diagnosis and treatment
planning in a single location. They would be linked closely with primary care providers, such as
family doctors and therapists, at the early stage of service, and with specialists, such as orthopaedic
surgeons and rheumatologists, at the treatment stage.
These linkages would make the clinics pivotal in
MSK SPECIALTY CARE CLINICS
ensuring access and continuity of care across the
continuum.
WOULD OFFER AN INTERMusculoskeletal Specialty Care Clinics would also help
coordinate efforts to improve and expand public,
patient and provider education about maintaining good
health and preventing injury. The inter-disciplinary
professional nature of the clinics would create an
environment in which providers would have quick onsite peer advice and consultation.
DISCIPLINARY PROFESSIONAL
ENVIRONMENT WHEREIN
PROVIDERS WOULD BE ABLE TO
BENEFIT FROM ON-SITE PEER
ADVICE AND CONSULTATION.
4. Evidence-based Clinical Pathways and Frameworks for Measuring Performance
The BJH SCN will lead a robust and comprehensive continuous quality improvement (CQI) effort in
MSK care across Alberta. CQI will span the six dimensions of quality (Figure 3). Establishing and
implementing evidence-based clinical standards and pathways will be pivotal to this work. Having
provincial standards and measuring results tied to evidence-based benchmarks in the six quality
dimensions would reduce the variation in clinical practice that results in uneven care across the
province.
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5. Provider Support and Education
The BJH SCN will help design and produce clinical decision support tools and educational materials
and events, such as newsletters, webinars and workshops, to inform practitioners about research,
innovation and evidence-based clinical practice related to MSK conditions.
6.
Patient Engagement and Education
The BJH SCN will open up a valuable and informative line of communication between patients and
providers.
The BJH SCN is committed to a continued strong linkage with Patient and Community Engagement
Research (PACER), a ground-breaking program initiated at the University of Calgary’s Cumming
School of Medicine to train patients as researchers. It will also continue to work with Health Link
Alberta in making health information available around the clock.
Seven Essential Enablers of Transformation
The following essential enablers of transformation will come into play in each of the six themes of
transformation described above.
1. Engagement
The BJH SCN has a collaborative membership model ensuring patients and their families, health
professionals, researchers and educators, policy makers, and the general public are engaged in
ways that give them meaningful participation in decisions and programs.
a. Patient and family engagement
Patient and family engagement will embody the following principles:
 Diverse perspectives are sought purposefully, including those of Albertans from a wide
range of cultures, Albertans who are part of vulnerable populations, and Albertans who
live in remote, rural and urban areas.
 Patients are involved directly as advisors in developing strategies and programs that
have an impact on them at every point along the continuum of care.
 Patient engagement research is integrated into all key initiatives.
A range of methods is required to ensure the experiences of patients and those who support
them, including their families, friends and others, are heard and reflected in the BJH SCN’s
programs.
The BJH SCN is a strong proponent of patient engagement research and will leverage the
PACER.
b. Community engagement
The BJH SCN will engage with the general public and community groups across Alberta to
derive maximal value from their health care experiences and views as initiatives are planned
and carried out under the Transformational Roadmap. The following principles will be
applied in engaging the community:
13
 Communities include residential areas, not-for-profit and for-profit organizations whose
work has a bearing on bone and joint health or health care, local and national policy
bodies, advocacy groups, and government.
 Community engagement recognizes cultural, geographic and economic diversity.
 Community engagement activities include sharing information, seeking input and
providing feedback on an ongoing basis.
The BJH SCN will participate in public education events to engage with community groups.
c. Clinician and researcher engagement
The BJH SCN believes improvement in MSK care will be most successful when it is led by the
people on the front lines of health care and research, and when care providers and managers
from Alberta Health Services’ five zones are engaged in the effort. Accordingly, the BJH SCN
will engage frontline care providers, private-practice clinicians such as physical and
occupational therapists, zone managers and researchers in all areas of activity, from
identifying and spreading leading practices to setting priorities and channelling evidence into
improved prevention and treatment. The following principles will be applied:
 Care at all points along the continuum reflects the evidence-based consensus of
clinicians.
 Care providers and managers from each of the zones are engaged in all programs under
the Transformational Roadmap.
 Alberta has a productive MSK research network.
 Health care providers from a broad range of disciplines and researchers and educators
from a broad range of faculties and educational institutions are involved in the BJH
SCN’s initiatives.
2. Communication
Strategic communications form an essential element of the BJH SCN’s Transformational
Roadmap. The BJH SCN will:



Engage in timely communication with its internal and external stakeholders.
Integrate into its initiatives the views of stakeholders.
Use a wide range of communications materials and services to reach Albertans,
recognizing the diversity of Alberta’s population.
3. Quality Improvement
The BJH SCN has been expanding its data and analytics capabilities as quality improvement
programs are launched. For example, in hip and knee replacement, data in a broad range of KPIs
are collected through ABJHI. The data are analyzed and interpreted by ABJHI to identify areas of
opportunity for improving the quality of care at the provider, site, zone and provincial levels.
The KPIs span the six quality dimensions that comprise the Quality Matrix for Health (Figure 3).
In another BJH SCN program, data are being collected and analyzed to identify Albertans who
have had a low-impact bone fracture suggesting osteoporosis. The program is intended to get
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patients into treatment that will stop their osteoporosis from progressing and avert a
catastrophic fracture of the hip.
4. Technology
The BJH SCN is participating in the Health Data
Partnership, a collaborative project to establish
and operate Alberta’s first electronic platform for
standardizing, collecting, storing and sharing MSK
health care information. It would be built and
managed by government, Alberta Health Services
and the research community.
THE HEALTH DATA PARTNERSHIP
WOULD CAPTURE, STORE AND
SHARE CRITICAL PATIENT HEALTH
INFORMATION AVERTING GAPS IN
TREATMENT ALONG THE
CONTINUUM OF CARE.
The Health Data Partnership would enable
clinicians to capture, store and share critical
patient health information, ensuring continuity of care, avoiding duplication of services, and
averting gaps in treatment along the continuum (Figure 5). Patients would have access to all of
their personal medical information in a single location. Researchers would have access to a rich
field of comprehensive and reliable data to support studies leading to better clinical practice,
patient outcomes and public policy. Service planners would have access to data they need for
measuring and reporting health system performance, modelling service need and demand, and
planning resources to meet demand.
Figure 5: The Health Data Partnership would capture, store and share critical patient health information.
HDP HUB
Having information in a single location would enhance the ability of health care administrators
to safeguard the privacy of patient data. Access to information in the Health Data Partnership
would be subject to a governance model setting out strict practices and protocols for handling
data safely and securely.
The BJH SCN will look for other, related collaborative opportunities to advance the use of
technology.
5. Research, Innovation and Knowledge Translation
The BJH SCN seeks opportunities to spread the knowledge generated by its work and that of the
research community.
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As a knowledge broker, the BJH SCN’s Scientific Director is well positioned to provide assistance
to investigators in the critical areas of knowledge management and knowledge translation,
helping to ensure their work is understood and shared broadly for maximal benefit.
Alberta has a highly respected and successful bone and joint health research network. The BJH
SCN’s Scientific Director and Assistant Scientific Director partner with members of this network
to increase collaboration among established research groups and emerging investigators. The
BJH SCN and its sister Strategic Clinical Networks have the common goals of:






Identifying and cultivating research opportunities in Alberta.
Generating evidence to inform best practices and influence decision making.
Helping to manage knowledge generated by research.
Supporting efforts to translate research knowledge.
Facilitating connections to research resources.
Leveraging research funding to evaluate innovative approaches to care.
The BJH SCN is working with members of the research community to facilitate interdisciplinary
research and the exchange of research innovations. By assisting in these areas, BJH SCN hopes to
accelerate the pace at which innovations move from the bench to bedside to community.
The BJH SCN’s Provincial Research Advisory Committee (PRAC) provides guidance in setting
research priorities and identifies research innovations with the potential to improve bone and
joint health and health care. PRAC also informs university-based researchers in Alberta of
opportunities to collaborate with the BJH SCN in areas of mutual interest.
PRAC has developed strategic plans outlining the areas in which the BJH SCN should focus its
research efforts over three-year and five-year periods. It recommends three priority areas:
1) Health system management, including waiting times for services, referral and central
intake systems, multidisciplinary team care, innovative technologies in surgery,
operational management, and economic evaluation.
2) Prevention of osteoarthritis, osteoporosis, pain, acute and chronic knee problems, low
back pain, and rheumatoid arthritis.
3) Knowledge translation and education related to bone and joint health, including the
appropriateness of treatments and services.
The BJH SCN is committed to integrating patient engagement research into its programs. This
will be achieved by collaborating with the PACER program.
6. Funding Models
The BJH SCN plans to initiate and lead reform of the methods used to fund the treatment of MSK
conditions in Alberta. The first step will be to introduce a funding model that incents providers
to work in teams. A team-based funding model is an effective approach for treating MSK
conditions, the majority of which are chronic and require the coordinated intervention of
multiple disciplines over a long period.
Current funding models in Alberta do not incent providers to function as a team coordinating
care across the full spectrum of services with the patient at the centre and working collectively
16
toward common treatment goals. Instead, there is a patchwork of misaligned funding methods.
For example, the majority of physicians in Alberta are paid a fee for service for treating their
patients. Hospitals have a global operating budget from which the cost of providing acute care
to patients is paid. Long-term care for patients is
funded on a case base.
This patchwork comes with contradictory
incentives. For example, hospitals aim to stay
within their global budgets and one method of
doing so is to ration care by limiting the number of
patients treated. Meanwhile, fee-for-service
compensation incents physicians to treat more
patients.
MISALIGNMENT OF FUNDING MAY
LEAD TO INEFFICIENCIES THAT
INCREASE COSTS AND REDUCE THE
QUALITY OF CARE PATIENTS
RECEIVE.
The BJH SCN’s plan for reform is supported by an analysis of the potential for improving the
methods used to fund the treatment of MSK conditions in Alberta. Commissioned in 2014, the
analysis examined the strengths and weaknesses of different funding options, identified the
most promising methods, examined the potential barriers to reform, and recommended
strategies for removing the barriers.
7. Human Resources
The BJH SCN will develop models of the current and future needs of local communities for MSK
health and health care. These models will identify the number of health professionals from
different disciplines required to promote good health, prevent injury and illness, and provide
non-surgical and surgical services. Health professionals will work in multidisciplinary teams that
leverage the knowledge and skills of individual team members. Using its models, the BJH SCN
will work with Alberta Health Services’ Human Resources department to plan appropriate
staffing levels to meet requirements in urban and rural areas and in high-need populations, such
as first nations and the frail elderly.
The collaborative practices principles of respect, accountability, transparency, engagement,
safety, learning and performance will be applied to maximize the effectiveness of the
multidisciplinary teams.
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MUSCULOSKELETAL CARE TRANSFORMATION INITIATIVES 2015-2018
Signature Projects Are High-Profile
Each Strategic Clinical Network is obligated to undertake signature projects, so named for their high
profile with the public and inside the health system, and for their potential to have a significant impact
on health care services in Alberta.
The BJH SCN has two signature projects: the Hip and Knee Arthroplasty Program and the Fragility and
Stability Program.
1. Hip and Knee Arthroplasty Program
The Hip and Knee Arthroplasty Program is a suite of initiatives whose common objectives are to
encourage adherence to Alberta’s standardized care path for hip and knee replacement patients
and to improve the quality of care these patients receive. The program is being managed by ABJHI,
which has expertise in areas that are critical to its success, including performance measurement
and analysis, knowledge translation, frontline team strategies, and the use of improvement
methodologies, such as Learning Collaboratives and Balanced Scorecards. The program’s suite of
initiatives includes:
Frontline Quality Improvement Teams
Multidisciplinary arthroplasty teams are established in the 12 hospitals at which hip and knee
replacements are performed. Team members are selected from across the continuum of care,
including acute care units, rehabilitation, operating rooms and hip and knee central intake clinics.
They include the surgeons, nurses, therapists and managers whose day-to-day decisions directly
affect the quality of care patients receive.
Each team develops a strategic plan for improving its
performance and uses a Balanced Scorecard to
measure and track the results in a range of KPIs.
TEAMS USE A BALANCED
SCORECARD TO MEASURE AND
TRACK RESULTS IN A RANGE OF
KEY PERFORMANCE INDICATORS.
Across the province, the frontline teams have saved
approximately 43,000 hospital bed-days by reducing
patient length of stay. The bed-days have a cumulative value exceeding $42 million. Shorter
hospital stays are freeing up bed space for more patients. In 2014, there were 9,600 elective
primary hip and knee replacements, compared with just 6,000 a decade earlier – an increase of
73% with just 5% more acute care bed-days. Patient readmissions to hospital, already low and a
good measure of patient safety, have declined 20% over the past decade. This also saves money.
Each readmission avoided saves on average a 10-day hospital stay at a cost of $11,500.
Continuous Improvement Reporting to Surgeons
ABJHI produces semi-annually a confidential Continuous Improvement (CI) Report for each of 67
hip and knee replacement surgeons in Alberta. The reports are based on ABJHI’s analysis of
patient data gathered from the surgeons and administrative data from hospitals across Alberta.
The reports cover a 12-month period and show results in 17 KPIs across the six quality
dimensions.
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Continuous Improvement Reporting to Zones
ABJHI aggregates and de-identifies the information in the surgeon reports to produce a CI
Report for each of the five health zones in Alberta. These reports provide results for each
hospital within the zone using aggregated patient data from the surgeons who practice at the
hospitals as well as administrative data.
Program Lead

Jane Squire Howden, Executive Director, Edmonton Musculoskeletal Centre.
2. Fragility and Stability Program
Fragility and Stability is a multifaceted program launched by the BJH SCN to prevent bone fracture
associated with osteoporosis and to introduce standardized care that is more patient-centred,
streamlined and evidence-based when a fracture occurs. The program is managed by ABJHI.
Fragility and Stability currently comprises three major components:
a. Develop and implement innovative programs to prevent osteoporotic fracture.
b. Implement across the province a standardized evidence-based acute care path for hip
fracture.
c. Design and implement evidence-based restorative care paths for hip fracture.
I.
Prevention
The Prevention Working Group is developing a comprehensive strategy for identifying and
treating osteoporosis in the early stage of disease. A provincial campaign, called Catch a
Break, was launched in 2014 to reduce by up to half the 2,400 hip fractures experienced by
Albertans every year. Under the program, Health Link Alberta staff review bone fracture
patient charts to identify Albertans suspected of having had an osteoporotic fracture. These
patients and their family doctor are contacted and provided with information about
osteoporosis and strategies to stop it from progressing.
In Catch a Break’s first nine months, approximately 10,600 fracture patients were identified
as potential osteoporosis patients. About 7,000 were screened for osteoporosis and of these,
approximately 5,000 were identified as likely to have the disease and require treatment.
Project Lead

II.
Dr. Angela Juby, Geriatrician, University of Alberta.
Acute Hip Fracture
The Quality Review Working Group is leading efforts to promote adherence across the
province to the evidence-based practices and protocols set out in a national acute care path
for hip fracture. It is currently focusing on three critical areas of the care path: 1) getting
patients into the operating room within 48 hours of their arrival at a hospital or clinic with a
hip fracture; 2) getting patients up and moving the day following their surgery; and 3)
transferring patients out of acute care and into the post-acute environment within seven
days of first presenting with a hip fracture at a hospital or clinic.
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Project Leads


III.
Dr. Rob Stiegelmar, Orthopaedic Surgeon and Facility Chief, Division of Orthopaedic Surgery,
University of Alberta Hospital.
Kyle Lang, Manager, Surgery and Women’s Health, Peter Lougheed Hospital.
Restorative Care
The Restorative Care Working Group is designing and implementing evidence-based care
paths for osteoporotic fracture of the hip joint. The new care paths will include putting
adequate resources in the community to meet patient needs following discharge from acute
care.
Project Leads


Allison Hermanns, Program Manager, Congregate Sites, Supportive Living, Continuing
Education, Edmonton Zone.
Dr. Douglas Faulder, Medical Director, Continuing Care, Edmonton Zone.
Priority Projects Demonstrate Musculoskeletal Transformation
Each Strategic Clinical Network undertakes priority projects that demonstrate transformation of
prevention and treatment services in high-need clinical areas. The BJH SCN has two priority projects:
Knee Soft Tissue Injury and Inflammatory Arthritis.
1. Knee Soft Tissue Injury
The Knee Soft Tissue Injury Working Group plans to implement a medical home model that will
introduce innovative primary (prevent injury) and secondary (prevent progression of disease)
prevention programs, and will make early assessment and triage, multidisciplinary team care, and
evidence-based guidelines and protocols standard across Alberta. It will provide patients with
education about their condition and treatment, and will give them the support they need along the
continuum of care. Performance related to benchmarks for service delivery and patient outcomes
will be measured and the results fed back to individual providers and to multidisciplinary teams to
promote continuous quality improvement.
INJURIES TO THE SOFT TISSUE OF
THE KNEE ARE AMONG THE MOST
COMMON AND CLINICALLY
CHALLENGING MSK DISORDERS IN
EMERGENCY ROOMS AND CLINICS.
Injuries to the soft tissue of the knee are among the most
common and clinically challenging MSK disorders in
emergency rooms and clinics.
Accurate and timely diagnosis and treatment increase the
likelihood of restoring fully the normal and pain-free use
of the injured knee and avoiding long-term disability.
However, delays and inappropriate treatment can lead to
chronic degenerative joint disease and loss of function.
The Knee Soft Tissue Injury Working Group will design and implement evidence-based clinical
pathways for both acute and chronic conditions arising from injury to the soft tissue of the knee. It
will also develop primary and secondary prevention programs.
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Project Leads


Dr. Gordon Arnett, Orthopaedic Surgeon, Edmonton.
Dr. David Magee, Professor, Faculty of Rehabilitation Medicine, University of Alberta.
Prevention Subcommittee Leads


Dr. Carolyn Emery, Associate Dean, Research, Faculty of Kinesiology, University of Calgary.
Dr. Jackie Whittaker, Assistant Professor and Research Director, Glen Sather Sport Medicine
Clinic, Faculty of Rehabilitation Medicine, University of Alberta.
Acute Care Subcommittee Leads


Dr. Preston Wiley, Sport Medicine Physician and Associate Professor, Faculty of Kinesiology
and Department of Family Medicine, University of Calgary.
Dr. Catherine Hui, Orthopaedic Surgeon, Edmonton.
Non-acute Care Subcommittee Lead

Dr. Randy Gregg, Primary Care Physician, Edmonton.
2. Inflammatory Arthritis
The Inflammatory Arthritis Working Group will develop and manage several initiatives to meet the
biggest challenge in rheumatological care: getting patients accurately diagnosed and into
appropriate treatment before the inflammation in their joints causes irreversible joint damage and
disability. Among these is a plan to train a cadre of Advanced Care Practitioners (ACP).
ACP training will be available to health professionals including physicians, physiotherapists, nurses,
occupational therapists and other medical professionals. The Working Group is examining the
option of training ACPs through Advanced Clinician Practitioners in Arthritis Care (ACPAC), a 10month academic and clinical training program in rheumatological care initiated in Ontario. The
program was developed to facilitate the interprofessional, patient-centred collaborative approach
to patient care desired by the Working Group.
Working in a team setting and located around the province, ACPs will reduce the need for patients
in rural and remote areas to travel to Edmonton or Calgary, where nearly all of Alberta’s
rheumatologists are located. Working collaboratively with rheumatologists, they will improve the
capacity to care for patients at every point along the continuum. Together, these teams will assess
new cases, monitor and provide maintenance -level care of patients with inflammatory arthritis,
manage existing patients who experience a painful disease flare up, and free up additional
rheumatologist time to focus on the diagnosis and treatment of complex cases.
In addition to developing the plan to use ACPs, the Working Group has designed an evidence-based
provincial care path for RA patients. The care path is being implemented across Alberta. ABJHI
managed the new care path’s design on behalf of the BJH SCN.
Project Leads

Dr. Joanne Homik, Rheumatologist and Assistant Professor, Division of Rheumatology,
Department of Medicine, University of Alberta.
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
Dr. Dianne Mosher, Rheumatologist and Professor, Chief, Division of Rheumatology,
Department of Medicine, University of Calgary.
Research Projects
The BJH SCN is conducting two research projects: SpineAccess Alberta and Optimizing Central Intake to
Improve Arthritis Care.
1. SpineAccess Alberta
SpineAccess Alberta researchers will design a model that provides the right care to the right patient
at the right time. Two pilot triage centres will be set up for multidisciplinary teams with special
training in spine conditions to assess, triage and recommend treatment plans for patients. These
knowledgeable teams will reduce inappropriate referrals to specialists and unnecessary diagnostic
imaging, which are creating patient backlogs and
Project Status
adding to long waiting times for consultation and
magnetic resonance imaging.
Pilot triage centres are expected to be
operating in Edmonton and Calgary in 2015.
They will be evaluated by the SpineAccess
Alberta research team over an 18-month
period.
The pilot triage centres will be evaluated against
evidence-based benchmarks in key indicators of
performance. Expansion of the triage model across
the province will depend on the results of the pilot.
Principal Investigators



Dr. Linda Woodhouse, BJH SCN Scientific Director and Associate Professor , David Magee
Endowed Chair in Musculoskeletal Clinical Research, Department of Physical Therapy,
Faculty of Rehabilitation Medicine, University of Alberta.
Dr. Leah Phillips Adjunct Professor, Faculty of Rehabilitation Medicine, University of Alberta.
Dr. Greg Kawchuk, Professor and Canada Research Chair in Spinal Function, Faculty of
Rehabilitation Medicine, University of Alberta. – until June 2015
2. Optimizing Central Intake to Improve Arthritis Care
The research team is designing a centralized intake system that will reduce the waiting time for
consultation and treatment, and ensure patients are referred initially to the right specialist. The
team will set objectives for access and patient outcomes and analyze different central intake
models, selecting from them the features best
Project Status
suited to meeting the objectives. The new
intake system will also be designed to
Objectives for access to specialists and patient
accommodate the projected increase in the
outcomes have been established and a
framework for measuring performance against
rates of disease and to expand to other MSK
objectives has been developed. Different central
conditions.
A measurement framework for evaluating the
centralized intake system’s performance is also
being developed by the research team.
22
intake models are being analyzed to find the
features best suited to meeting Alberta’s
objectives.
Principal Investigators


Dr. Deborah Marshall, Advisor, Health technology Assessment and Research, ABJHI; Arthur
J.E. Child Chair of Rheumatology Outcomes Research; Canada Research Chair of Health
Services and Systems Research; and Associate Professor, Community Health Sciences,
University of Calgary.
Dr. Linda Woodhouse, BJH SCN Scientific Director and Associate Professor , David Magee
Endowed Chair in Musculoskeletal Clinical Research, Department of Physical Therapy,
Faculty of Rehabilitation Medicine, University of Alberta.
Pan-SCN Activities
The prevalence and pervasiveness of MSK conditions create opportunities for the BJH SCN to collaborate
with other Strategic Clinical Networks serving the same at-risk patient populations or those with related
disorders. For example, the prevalence of many MSK conditions increases markedly with age, surgery is
frequently required to repair MSK damage, and many MSK conditions are associated with lifestyle
factors, such as obesity. These risk factors may present opportunities for the BJH SCN to collaborate
with the Seniors Health SCN, the Surgery SCN, and the Diabetes, Obesity and Nutrition SCN.
Indeed, collaboration is already well under way. The BJH SCN is working with the Seniors Health SCN to
perform a cost-effectiveness analysis of services associated with surgery for osteoporotic hip fracture.
The work is associated with the BJH SCN’s Fragility and Stability program.
The BJH SCN is also collaborating with the Surgery SCN to move patients quickly into surgery following
hip fracture. The objective is to perform surgery within 48 hours of the patient first presenting at a
hospital or clinic. This work is also associated with the Fragility and Stability program.
These collaborative initiatives, known as cross-cutting projects within the Strategic Clinical Network
community, illustrate the SCNs’ flexibility in pooling knowledge, skills and resources to maximize results.
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Appendix A – Bone and Joint Health Strategic Clinical Network Core Committee
The BJH SCN’s leadership and Core Committee membership comprise individuals from different
disciplines and from Alberta Health Services and external organizations. Membership on the BJH SCN’s
Core Committee changes periodically. The BJH SCN deeply appreciates the contributions of all past and
current members of the Core Committee. The following were active members as of June 2015:
Alex Charlton, Clinical Practice Lead, Rockyview General Hospital
Allan Ryan, Executive Director, Priorities and Performance, Alberta Health Services
Christopher Smith, Chief Operating Officer, Alberta Bone and Joint Health Institute
Clayne Steed, Primary Care Physician, South Zone
Dave Hanley, Metabolic Bone Specialist, University of Calgary
Dave Hart, Professor of Microbiology, Immunology & Infectious Diseases, University of Calgary
Dianne Mosher, Internal Medicine, Rheumatology, Calgary Zone
Don Dick, Senior Medical Director, Bone and Joint Health SCN
Geoff Schneider, Physiotherapist, Researcher, Calgary
Gordon Arnett, Orthopedic Surgeon, Edmonton
Jane Squire Howden, Executive Director, Edmonton MSK Centre
Jean Miller, Patient Engagement Researcher
Joanna Homik, Associate Professor, Rheumatology, University of Alberta
Joanna Oda, Medical Officer of Health, Edmonton
June Norris, Senior Practice Lead, Physiotherapy, Interprofessional Practice Team, Allied Health
Kelley De Souza, Medical Director, Rockyview General Hospital
Kelly Martial, Program Manager, Inpatient Orthopedics/Surgical Float Pool, Covenant Health, Edmonton
Kyle Lang, Manager, Peter Lougheed Centre, Calgary Zone
Linda Woodhouse, Scientific Director, Bone and Joint Health SCN
Lynne Mansell, Senior Provincial Director, Bone and Joint Health SCN
Lynne Malmquist, Senior Knowledge Management Consultant, Alberta Health Services
Marie Lyle, Acting Executive Director, Acute Care, Alberta Health
Marty Landrie, Senior Manager, Aboriginal Health Program, Central/Edmonton Zone
Mel Slomp, Executive Director, Bone and Joint Health SCN
Nav Rattan, Podiatric Surgeon, Family and Sports Medicine, Red Deer
Nick Antonopoulos, IT Manager, Edmonton Zone
Noorshina Virani, Physical Medicine Specialist, Calgary Zone
Pam Gossmann, Nurse Practitioner, Rockyview General Hospital
Rob Stiegelmar, Orthopedic Surgeon, Edmonton MSK Centre
Robert Swanson, Director, Medical Surgical Inpatient Services, Red Deer
Sheila Kelly, Manager, Bone and Joint Health SCN
Stephen Aaron, Internal Medicine, Rheumatology, Heritage Medical Research Centre
Stephen Weiss, Executive Director, Alberta Bone and Joint Health Institute
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Steve Chambers, Primary Care Physician, Allin Clinic, Edmonton
Susan Reader, Executive Director, Surgery SCN, Calgary
Tanya Christiansen, Administrative Manager, Alberta Hip and Knee Clinic, Calgary
Ted Pfister, Assessment Analyst, Health Technology Assessment & Adoption, Alberta Health Services
Terri May, Business and Operations Manager, McCaig Institute for Bone and Joint Health
Tim Pearce, Orthopedic Surgeon, Red Deer
Tim Takahashi, Certified Athletic Therapist, Rebound Health Centre, Lethbridge
Tracey Geyer, Senior Health Planner, Planning and Performance, Alberta Health Services
Wynand Wessels, Orthopedic Surgeon, North Zone
Yolanda Lackie, Senior Director, Operations, Covenant Health
25