Full Report

RENAL
Forging alliances
for better care
Staff believe the improvement project was an
important factor in the drafting of a service
agreement between NWT and the Northern
Alberta Renal Program (NARP). The project’s
standardized guidelines and referral process
helped ensure the territory’s practices were
similar to those in Alberta. The agreement,
currently being finalized, will provide
assurance of sustainable nephrology services
to NWT communities and improve continuity
of services for patients transferred to Alberta
for specialized care.
What we found
As in any endeavour, leadership played a significant role
in either facilitating or impeding improvement. Although
a few staff expressed minor concerns about leadership,
most agreed that suitable leadership was available for
the pilot project. Staff qualified this endorsement by
indicating that the ongoing development of strong local
and system-level leadership will be crucial if CPGs are to
be used for renal and other chronic diseases. “You need
a champion,” reported one interviewee, “someone in
the middle of the system who sees a lot of people and
can speak both up and down; someone who is aware of
what is going on at a local level and at a high level.”
The support of GPs and specialized physicians is
equally important. Staff noted that physicians were
open to using the guidelines and that the leadership
of the internist at STHA proved essential to drive the
work forward. 84
Figure 8
Referrals by Clinician Type
2 2
6
Nurse practitioner
General practitioner
28
10
Registered nurse
Community health nurse
Diabetic educator
Internal medecine
Nurse in charge
1 1
Anecdotal evidence suggests that most referrals were made by GPs prior to the renal improvement project; however, the project clarified the referral
process and instilled confidence in other practitioners to screen, refer and manage patients. Of the 52 new referrals during the project, more than
three-quarters came from practitioners other than GPs—an indication that many staff may now be practicing at the full extent of their ability to refer.
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Making the Case for Change