Presentation Transcript

1. Welcome!
2. Our Partner Sponsors Health Quality Ontario (HQO) Residents First Ontario Long Term Care Association (OLTCA) Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) Ontario Association of Community Care Access Centres (OACCAC) Canadian Patient Safety Institute (CPSI) Canadian Health Services Research Foundation (CHSRF)
3. Overview of the Day Presentation Questions/Discussion Case Study Capability Assessment Action Plan at the end of the day
4. Why Are We Here? Common desire to provide the best and safest care possible to residents, patients and clients. Quality Improvement Plan: Required for CCAC in 2014 and LTC in 2015 Increasing role of the governing body in supporting quality Increasing need for data and performance measurement to support quality in Long Term Care and Community Care Thus, Governance training for qualityand patient safety.
5. Customized sessions Active Working Group LTC/CCAC Multiple Governance structures Licensees, boards, committees, municipal councils Governing body = Board Patient, resident, client Good blend of participants – Administrators, governors, senior leaders
6. Our Commitment To You A framework for Effective Governance for Quality and Patient Safety Experienced peer facilitators Opportunity to share
7. Our Expectation of You PARTICIPATION!
8. WhERE ARE WE ON THE Quality & Patient safety agenda
9. Objectives Importance of governing body in leading the quality agenda Review the evolution of quality and patient safety journey across the healthcare sectors Set context for LTC and Community Care Discuss alignment with current quality requirements
10. Recent Wake-Up Call for Board Involvement Canadian Adverse Event Study Corporate failures and public expectations Ministries of Health initiatives Board specific education (IHI, GCE, CPSI/CHSRF) Public Inquiries Accreditation requirements ECFAA and its related regulations Media and public interest
11. Institute of Medicine Report 2000 44,000–89,000 patients die yearly from adverse events Equivalent to 1 jumbo jet going down every 2 days 25–50% are preventable
12. Milestones of the Modern Era 2000-01Conferences on Medical Error – UK, US 2001 Crossing the Quality Chasm – A New Health System for the 21st Century 2001-10 Canadian Healthcare Safety Symposium (Halifax Series) RCPSC Report: Building a Safer System Canadian Patient Safety Institute 2004 Canadian Adverse Events Study 2010 Long Term Care Homes Act 2007 2010 Excellent Care for All Act 2012 Long Term Care Task Force on Resident Care & Safety 2013 Safety At Home: A Pan-Canadian Home Care Study
13. Canadian Adverse Event Study 2004 Findings: 3,745 charts reviewed ~7.5% of hospital admissions involve adverse event; 37% of adverse events considered preventable Extrapolation: Of ~ 2.5 million hospital admissions in Canada in 2000 185,000 experienced 1 or more adverse events 70,000 of the 185,000 were determined to be preventable between 9,000 and 24,000 deaths due to adverse events could have been prevented Baker, G. Ross, et al. “The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.” Canadian Medical Association Journal 170, no. 11 (2004): 1678-86.
14. Long Term Care Homes Act 2007 Fundamental principle – ….a Home is primarily the home of its residents and is to be operated so that it is a place where its residents may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.
15. Long-Term Care Task Force on Resident Care and Safety 2012 “MAKE RESIDENT CARE AND SAFETY THE NUMBER ONE PRIORITY IN LONG-TERM CARE HOMES OVER THE NEXT YEAR AND A TOP PRIORITY IN YEARS TO FOLLOW “
16. Safety At Home: A Pan-Canadian Home Care Study 2013 Rate of Adverse Events: 10 -13% over 1 year period Over half deemed preventable Most common events: falls, infections & medication related incidents
17. Ontario’s Action Plan for Health Care Sets the Course for Transformation Keeping Ontarians Healthy Ontario’s Action Plan for Health Care Sets the Course for Transformation Person- Centred Faster Access to Family Care Right Care, Right Place, Right Time
18. The principles of the Excellent Care for All Act apply to all health care organizations The people of Ontario and their Government: … Believe that the patient experience and the support of patients and their caregivers to realize their best health is a critical element of ensuring the future of our health care system … Share a vision for a Province where excellent health care services are available to all Ontarians, where professions work together, and where patients are confident that their health care system is providing them with excellent health care … Recognize that a high quality health care system is one that is accessible, appropriate, effective, efficient, equitable, integrated, patient centred, population health focussed, and safe … Believe that quality is the goal of everyone involved in delivering health care in Ontario
19. Leading Board Practice Research Team, led by Ross Baker: Synthesized the published and gray literature Conducted key informant interviews Prepared illustrative case studies
20. The Drivers of Effective Governance for Quality and Patient Safety
21. Barriers to Progress Increasing system complexity Paradox: scientific progress brings more risk to manage Creates specialization but demands cooperation Lingering culture of autonomy Effective management of change challenging Leadership- competing priorities
22. Summary Currently, the models of governance and practice are highly variable Capability-building, practice change and policy reform are required to support this agenda The health care system is on a transformational journey
23. Boards Influencing Quality and Patient Safety Dr. Ross BakerProfessor, Department of Health Policy, Management and Evaluation, University of Toronto
24. Where Are You With Quality and Patient Safety?
25. Objectives To explore the challenges and changes in the healthcare environment and its impact on the board’s role in quality. Discuss your needs, desires and expectations of the Effective Governance for Quality and Patient Safety.
26. Reflection/Discussion What is happening in your context that has an impact on your role as a board? What do you hope to achieve from this learning session?
27. Governor’s Story
28. Botched tests cast doubts on cancer screening Beverly is one of the first patients lined up to testify at the inquiry. She found a small lump in her breasts in early 2001. At the time, she was told she tested negative for a hormonal treatment that can drastically reduce chances of cancer's reoccurrence in eligible patients. By the time she learned her test results were wrong - six years later -- it was too late for the treatment.
29. KNOWLEDGE OF QUALITY Skills and roles . .
30. Objectives To clearly understand how the roles, responsibilities and obligations of the governing body and the skill level of each of its members has an impact on quality improvement To develop strategies to assess and build the governing body’s knowledge, skills and experiences related to effective governance practices for improving quality
31. Role Governing Body Responsibilities* Vision, Mission and Values Organizational key goals Strategic Plan Focus on quality and patient safety clearly stated within strategic plan Senior Leader recruitment, performance management, and succession Succession planning for members of governing body *In workbook.
32. Governance Standards Examples: Accreditation Canada Standard 2.0 The governing body has the appropriate membership to fulfill its role Standard 2.1 The governing body identifies the mix of background, experience, and competencies needed in its membership to govern effectively Commission on Accreditation of Rehabilitation Facilities (CARF) Section 1 – Governance 1.B.2. Governance policies address: b. Board member orientation. f. Board structure, including: Board composition. g. Board performance, including 3) Annual self-assessment of the entire board. 4) Periodic self-assessment of individual members.
33. Role Policy Formulation, Decision Making and Oversight The governing body will delegate to service leaders whose role it is to operationalize policies. Quality Performance “The Board has the ultimate responsibility for the organization's quality of care and patient safety” IHI - Boards on Board “Boards that set strategic quality goals, and spend 25% more time on Q&S issues have better outcomes” (Jiang) Assess impact of resource allocation decisions on quality!
34. Alignment of strategic priorities Organization’s mission and overall vision Organization’s Strategic Plan Quality improvement initiatives are driven by and aligned with the priorities of the organization expressed in the strategic plan Quality Improvement Plan Dashboard showcasing performance results Indicators and metrics tracked Quality improvement program/ initiative Source: Ministry of Health and Long Term Care
35. Role Governing body role in Improving Quality Governing body has developed a precise view of Quality and understands where resident/client safety fits Governing body works with management to develop and prioritizes quality and resident/client safety indicators – set targets – choose comparators Focus on monitoring – measurement and indicators Governing body delegates responsibilities to senior leadership to implement and operationalize.
36. Role Governing body role in Improving Quality “Boards with a Quality Committee can significantly enhance the Board’s oversight function” (Jiang 2008) Governing body ensures organizational/board structures in place to achieve quality and safety goals * Support of initiatives for the development of quality and safety culture – (resources) Quality Improvement Plan *In workbook.
37. Role Critical Questions on Governing Body Role to Support Quality What should the Quality Committee do? * Who should be on the Quality Committee? What information does the Quality Committee need? How will the Quality Committee support the senior leader in operationalizing the organization's quality decisions? Who are the stakeholders? * In workbook.
38. Skills Governance Essentials Strong governing bodies can live with the tension between governance and operations “Two types of questions How good is our care? How do we compare to others? Who is the “Best” Is our care getting better? Are we on track to achieve our key quality and safety objectives? If not, why not? Is strategy wrong , or is it not being executed effectively?” (J LReinertsen)
39. Skills Governance Essentials Composition and Recruitment Environmental Scan Skills/ Competency Matrix Robust Orientation (build “governance maturity”) “Buddy” – mentor new members Leadership and succession Assess/manage capability and effectiveness* * in workbook
40. Modes of Governance Governance as Leadership Fiduciary Strategic Generative * Content based on Governance as Leadership by Chait, R., Ryan, W., Taylor, B.
41. Knowledge Knowledge of Quality and Safety Determine what specific education/knowledge is needed in the area of quality and safety Targeted recruitment How can a governing body recruit members who are experts in this area? (similar to other key strategic areas – lawyers, accountants)
42. Knowledge Knowledge of Quality and Safety Continuing education Build “experts” in targeted areas – (Quality and Safety) Encourage “respectful dissent” within all governing body /committee discussions
43. The 8 Indisputable Behaviours of Successful Boards1 Successful Boards… Act on behalf of their communities. They define their community, and seek their views and values to use in decision making. Know their job, they know the business of the organization, their duties under law, and they continually educate and orient themselves. Set targets and priorities for the organization to accomplish and consider it in quality improvements. Identify the risks and liability issues that the organization must manage and avoid. Know their job Act on behalf 2 1 8 7 Practice discipline Report back 5 6 Assess Performance Delegate the work 4 3 Identify risk Set targets 5. Delegate the work of the operations clearly to one staff person. Assess performance by rigorously monitoring to see if the organization has achieved the targets and avoided the risks, by fairly and only comparing performance to board-stated policies/ expectations. Practice governancediscipline, including orientation, meeting attendance, preparedness, participation, discussion, use of board policies, and the avoidance of conflicts of interest. Report back to the community on the progress toward “hitting the target”. 1Adapted from “The OnTarget Board Member: 8 Indisputable Behaviors” (C. Raso, M. Conduff, and C. Gabanna; 2007)
44. Final Thoughts “Governance should be the engine that pulls the train of change. Instead it is often the caboose dragging along behind – with the brakes on.” James Orlikoff “It is not the strongest of the species that survives, nor the most intelligent, but rather the one most responsive to change” Charles Darwin “Thinking is the hardest work there is, which is probably the reason why so few engage in it.” Henry Ford
45. THANK YOU QUESTIONS?
46. CAPABILITY ASSESSMENT
47. CASE STUDY:Transitions in Care

48. Case Study Objectives

    Engage in a client/resident story that reflects the very real complexities of the community sector and long term care service delivery. Reflect upon the issues, challenges and accountabilities within the case from a governance perspective. Identify and consider safety, quality, client and family experience and transitions in care issues throughout the case. Appreciate the challenges and complexity of board driven quality and safety leadership in the relationship with the operational leadership team. Start to apply concepts and tools from the Effective Governance for Quality and Client Safety driver framework to a complex client case.

49. Case Study

    You are a member of the Carlton CCAC or the Happy Dale Long Term Care Home Board Mr Strong’s son has submitted a letter of complaint to both Board’s, the executive directors (administrators) of these organizations, as well as local politicians and media You are now meeting as a Board to discuss the letter and the case to determine Board action on this issue. The media has been calling and the Associate Deputy Minister of Health has requested a meeting with the board chairs of both organizations *Read letter

50. Case Study

    The following narrative has been provided to you by your executive director or administrator of the organizaiton.

51. One Family’s Story

    Mr Strong, an 87 year old retired bank manager with a history of cardiac, breathing problems, diabetes, urinary incontinence and depression was discharged from hospital back to his home. He spent 45 days in hospital after receiving treatment to stabilize his congestive heart disease. During his hospitalization MrStong’s medication regime was adjusted to more aggressively manage his heart failure. His wife is 83 years old and had a hip replacement 12 months ago. His son and daughter work full time.

52. Case Study

    Discharge planning and the meeting with the CCAC and hospital team was done two days before his discharge. It was determined Mr Strong could go home for a period of time with home care in place as he waited for a long term care placement. Mr Strong was looking forward to returning home through ‘Home First’. But unfortunately through the discharge planning assessment it was determined that Mr Strong would need long term care due to his condition and his wife’s health.

53. Case Study

    Home care services, which included nursing care, personal support care, meals on wheels for Mr and Mrs Strong were activated by the CCAC within 24 hours of discharge from hospital. The personal support workers and nurses who had known Mr Strong prior to his hospital admission were not available to the family over the initial days he spent back at home due to scheduling conflicts. Within 7 days Mr Strong was admitted to Happy Dale Long Term Care Home

54. Case Study

    Unfortunately on the first family visit, Mrs. Strong and her son and daughter arrived to find Mr. Strong in bed and unresponsive, the nursing staff had just called 911 for assistance as Mr. Strong's vital signs showed an unstable cardiac status and low level of consciousness.

55. Case Study

    During the incident investigation and analysis it was discovered that Mr Strong had been receiving half his usual dose of heart medication (digoxin) in the seven days he spent at home post hospital stay Through an incident investigation by the quality manager at the LTC home, it was understood that Mr Strong had a medication reconciliation done pre hospital discharge, that the dose of heart medication was incorrectly noted on the med rec document and that the discharging physician followed this incorrect notation.

56. Case Study

    Further findings in the analysis: Medication reconciliation incorrect pre hospital discharge the CCAC admitting case manager followed the incorrect hospital discharge medication order on his admission to home care, rather than initiating a full medication review on admission to CCAC Due to scheduling challenges, the Strong's didn’t have access to their usual home care provider team, missing the opportunity for a known team to detect early deterioration in Mr. Strong Mr. Strong was admitted to the LTC home on a Saturday late afternoon, when staff ratios are reduced

57. Case Study Discussion A Governance Perspective

    What are the operational issues that the governing body should be delegating to the senior leadership team? What are some of the system level governance issues in this case that should be dealt with from a governance perspective?

58. Client Safety

    What is the quality and patient safety culture in your organization, do your care providers feel comfortable speaking up when the quality of care is compromised? Do your care providers know when to speak up, are there processes in place to support a reporting and learning culture in your organization? Does your organization have governance policies in place regarding disclosure of harm or compromised care to your clients and family and are staff trained and knowledgeable in disclosure skills?
59. Assess and Improve Quality and Client/Resident Safety Culture
60. Objectives Understand the importance of leadership by the governing body to assess and improve an organizational culture focused on quality and client/resident safety Identify broad principles and levers that influence organizational culture towards an enhanced client/resident experience
61. Principle: Culture Every health organization must aspire to a culture of quality and client/resident safety The governing body has a key leadership role to play in fostering and supporting such a culture
62. Culture: A Definition Shared basic assumptions that are: Invented, discovered or developed by the group as it… Learns to cope with the problems of internal integration and external adaptation in ways that… Have worked well enough to be considered valid, therefore… Can be taught to new members… As correct ways to perceive, think and feel in relation to these problems. Schein in Weick and Sutcliffe (2001, page 21)
63. Culture: A Definition (2) Culture is a combination of: An organization’s structure, control systems, rules, regulations and practices designed to enhance quality and client/resident safety The values it professes Its values in practice ‘the way we do things around here’ ‘the way people behave when no one is looking’ ‘behaviours that are condoned/rewarded’ Physical structures Language Symbols, rituals and ceremonies Stories, myths and legends Values & Norms Beliefs Assumptions
64. Governing Body: Overall Culture Playing a Leadership Role in the Pursuit of Excellence: A robust engagement of members of the governing body demonstrated by: High enthusiasm Constructive deliberations and respectful dissent Mutual trust and willingness to take action with a commitment to the organization’s: Vision, mission values Openness to discussing performance issues (financial and quality) Taking action when necessary A commitment to high standards and the pursuit of excellence in all endeavors
65. Culture of Quality and Client/Resident Safety GENERATIVE Safety is how we do business around here Increasingly Informed PROACTIVE We work on the problems that we still find CALCULATIVE We have systems in place to manage all hazards REACTIVE Safety is important, we do a lot every time we have an accident Increasing Trust PATHOLOGIC Who cares as long as we do not get caught
66. Culture- Key Building Blocks Governing body-driven Quality Plan Body owns definition of quality and client/resident safety, quality framework, quality plan, quality improvement initiatives, monitoring and reporting on performance Governing body Commitment to transparency and accountability Public access to materials (agendas, minutes, policies, quality plan) Public reporting on performance in various ways Active involvement of governing body in quality and client/resident safety events
67. Key Building Blocks Involving clients/residents and their families Hearing client/resident stories at governing body meetings Involving client/resident and family in quality improvement initiatives Managing Client/Resident Safety Issues Building a fair and just culture (learning vs. blame, system vs. individual failure) Monitoring and reporting on adverse events and near misses Disclosure policy and practices Corrective action
68. Key Building Blocks Embrace a culture of transparency and disclosure Disclosure Working Group. Canadian Disclosure Guidelines. Edmonton, AB: Canadian Patient Safety Institute; 2008
69. Key Building Blocks Involving residents, patients, clients and their families Resident councils - OARC Family councils Use of resident/ patient stories* *in workbook
70. Key Building Blocks Learning from resident/patient safety incidents Learning from adverse events: Fostering a just culture of safety in Canadian hospitals and health care institutions. Ottawa, ON: Canadian Medical Protective Association; 2009.
71. Aligning Quality Improvement and Client/Resident Safety from the Governing Body to the Front-line staff Quality Councils Inspections Organizations Regulatory Bodies/Accreditation Others Ministries /Legislation  Agencies  Associations  Public  Others  Key Building Blocks GOVERNING BODY BOARD OF DIRECTORS Senior Leaders THE DELIVERY SYSTEM
72. Levers for Quality and Client/Resident Safety Culture Legislation ECFAA; LTCHA Accreditation requirements
73. Levers for Quality and Client Safety Culture Governance standards within the service accountability agreements with LHIN’s MSSAA and L-SAA
74. Linking Quality and Client Safety to All Governance Processes Some examples: selection of new members to governing body & committee, appointment of chairs new member orientation developing vision, mission and values quality component of the strategic plan governance-driven quality definition, framework, plan and review process Senior leader performance objectives, review and assessment board performance assessment Safety Quality
75. Measuring Culture and Improving Performance: A Ten-Step Process Build Capacity Build internal capacity to undertake survey and follow-up Select an appropriate survey instrument Number of surveys available including one used by Accreditation Canada Obtain informal leadership support Understanding of the complete process by senior leadership team Involve healthcare staff Involve key groups in implementing the survey Survey distribution and collection Design strategy to obtain highest possible response rates Healthcare Quarterly, 8(Sp) 2005: 14-19Patient Safety Culture Measurement and Improvement: A "How To" GuideMark Fleming
76. Measuring Culture and Improving Performance: A Ten Step Process 6. Data analysis and interpretation Comparing results and determining areas of strength and weakness 7. Feedback of results Timely feedback is critical to maintaining momentum and support 8. Determining interventions through consultation Involve staff in prioritizing interventions 9. Implement interventions Determine specific interventions 10.Track change Assess changes in culture Healthcare Quarterly, 8(Sp) 2005: 14-19Patient Safety Culture Measurement and Improvement: A "How To" GuideMark Fleming
77. Culture Stories Source: Leisureworld presentation July 2013
78. THANK YOU QUESTIONS?
79. Capability Assessment
80. Relationships between the governing body and Senior Leaders, Clients/Residents and their Families, External Organizations
81. Objectives Establish the importance of the alignment of the entire organization around the quality and client/resident safety, Establish the importance of creating an effective and positive relationship with client/resident and their families, volunteers, the Ministry of Health and Long-Term Care, the LHIN, Health Quality Ontario, other health service partners, accrediting bodies, the media and the public.
82. Too often governing bodies defer quality and safety oversight to the administration and organizational staff, who are seen to be responsible for quality and client /resident safety The governing body has the ultimate responsibility for the performance of the organization, hence for quality and safety. It must play a leadership role, working closely with the Administrators and organizational leadership. Current Reality
83. Relationships Formal, written documentation or terms of reference should be developed for the governing body including its responsibility for quality and safety. The capability of the governing body to function effectively and to move appropriately between fiduciary, strategic and generative modes relies on trust, candor and inquiry as well as skills.
84. Supporting informed decisions, the organization provides clients and their families with: timely, complete and accurate information about services they will be receiving; education related to their service needs. Actively engage clients/residents and their families in care and service design and delivery. Relationship with Clients/Residents and their Families
85. Ensure the services to clients/ residents and caregivers are being provided in a safe manner : screening of volunteers informing them of their roles and limitations ongoing education, training and support optimizing match between client / caregiver and volunteers. Relationships – Volunteers
86. RelationshipsDr. Jack KittsChief Executive Officer The Ottawa Hospital
87. Governing bodies and senior leadership need to develop a clear understanding of each other’s roles and create a strong collaborative relationship to achieve organizational goals. Position descriptions and performance expectations for senior leaders should be clear, and outline their expectations for promoting quality and client safety. Relationships - Governing bodies and Senior leadership
88. AC Standard 11.0 The governing body works with the CEO to reduce risks to the organization and promote ongoing quality improvement. CARF Standard 3 The Board’s relationship with executive leadership includes: Delegation of authority and responsibility to executive leadership; Access to management and staff as appropriate. Support of governance by the organization. Governance Standards
89. External Relationships
90. Health Service Partners Ministry LHIN HQO Accrediting bodies Media / Public Community engagement External Relationships
91. Relationship – Health Service Partners When different health care providers work as a team to care for a patient, they can better coordinate the full patient journey through the health system, leading to better care for patients. (MOHLTC – Health Link Website)
92. Provincial Contract Performance Framework Developed in 2013 to provide guidance to CCACs and Service Provider organizations to incent the provision of safe, high quality patient-centred care and continuous quality improvement and to increase the consistency in quality of care so that patients can expect to have similar experiences regardless of where patients live in the province. CCAC Relationship with Contracted Service Providers
93. Service Accountability Agreements Purpose: to provide funding for the provision of services, to support collaborative relationships to engage communities to improve the health of Ontarians through better access to high quality health services to coordinate health services to manage the health system at the local level effectively and efficiently to identify performance standards Relationships - Governing Body and LHIN
94. Ministry Quality agenda Policy Regulatory agenda Strategy Licensing and inspection
95. To support ECFAA, the role of HQO was expanded to include: Public reporting on the quality of Ontario’s health system- Residents First Supporting continuous quality improvement, Promoting health care that is based on best available evidence, Receiving and reporting on the annual quality improvement plans of health care organizations Relationships -Governing Body and Health Quality Ontario
96. Accrediting bodies Accreditation Canada and CARF set standards to help organizations foster relationships related to: Clients / Residents / Families Leadership team Other providers and programs Public
97. “Guidelines For Informing The Media After An Adverse Event” – Canadian Patient Safety Institute (CPSI) Sharing Information on Adverse Events Communication Plan Media / Public Relations
98. THANK YOU QUESTIONS?
99. Capability Assessment
100. Quality and Safety Plan
101. Objective Provide overview of intent of quality improvement plan Identify important areas for consideration when developing a quality improvement plan
102. The Quality Improvement Plan A documented set of commitments and actions that assist an organization meet its quality objectives and recognize the importance of integration and continuity of care; A powerful lever to publicly demonstrate commitment to quality and safety; Is directed and approved by the governing body; Is aligned with the vision and mission; Is embedded into the Strategic Plan;
103. The Quality Improvement Plan Has specific measures, timelines and targets; Is action oriented and outcome driven; Is clear, easy to understand and interpret; Is monitored and evaluated by the governing body; Is communicated effectively both internally and externally.
104. The Quality Improvement Plan Is aligned with the principles of ECFAA, organizations: Develop an annual quality improvement plan (by April 1 of every year), Focus on system, regional, local and organizational priorities Submit that plan to Health Quality Ontario Organizations that are not currently required/mandated to develop and submit a QIP may still voluntarily submit to HQO
105. Why is a QIP important Ensures oversight on quality issues affecting the organization and demonstrates accountability to clients/residents/public and government Formalizes dialogue around the improvement of quality of care Makes quality improvement a priority for the Governing Body/ Senior Leadership and used to focus the Governing Body’s agenda Provides direction to the leadership and staff Meets/prepares for legislative/ contractual requirements Plan execution drives measurable improvement to patient/client/resident experience
106. QIP Strategic Implementation: A codified process explore Assess sector readiness and determine appropriate policy lever design Engage with sector representatives; establish requirements and timeframes; determine priority themes and indicators implement initial implementation ongoing evolution Implement policy and communicate requirements to sector; provide supports to the sector in collaboration with HQO explore design implement standardize improve performance achieve thresholds monitor performance standardize Move from organization-specific methods of indicator measurement to standardized, system-wide approaches Improve performance Drive performance using ongoing feedback and evidence-informed targets and benchmarks achieve thresholds Reach high-performing ‘steady state’ monitor performance Monitor and sustain performance Source: MOHLTC - Health Quality Branch
107. The principles of the Excellent Care for All Act apply to all health care organizations The people of Ontario and their Government: … Believe that the patient experience and the support of patients and their caregivers to realize their best health is a critical element of ensuring the future of our health care system … Share a vision for a Province where excellent health care services are available to all Ontarians, where professions work together, and where patients are confident that their health care system is providing them with excellent health care … Recognize that a high quality health care system is one that is accessible, appropriate, effective, efficient, equitable, integrated, patient centred, population health focussed, and safe … Believe that quality is the goal of everyone involved in delivering health care in Ontario
108. System-wide quality improvement: using the QIP as a lever for change Source: Ministry of Health and Long Term Care
109. The QIP Today: Lessons Learned Leverage relationships with sector representatives to achieve successful strategic direction and policy implementation. Avoid contributing to indicator burden. No data is no excuse! Insisting on indicator or data perfection can hinder improvement. QIP is a multi-purpose tool. One size won’t necessarily fit all – balancing between flexibility and standardization.
110. Important Lessons Learned Challenges & Opportunities Engagement (Generative Governance) Commitment Education (Quality is complex) Direction for the Quality Improvement Plan Approval, Monitoring and Evaluation of the Quality Improvement Plan Changing culture is a long-term process
111. What Does a Good Plan Look Like? Champlain CCAC Quality Plan* North East CCAC Quality Framework* North East CCAC QIP Part B* *In workbook
112. THANK YOU QUESTIONS?
113. Capability Assessment
114. Measurement of Quality and Client/Resident Safety Information on Quality and Client/Resident Safety
115. Objective Review the importance of meaningful information and measurement to inform governance decisions for quality and client/resident safety.
116. Governors need access to informative andrelevant measures of client/patient safety and quality that they can use to assesscurrentperformance and targetimprovement strategies But........ In a sea of information and indicators, how are governors/leaders supposed to keep track?
117. Alignment of strategic priorities Organization’s mission and overall vision Organization’s Strategic Plan Quality improvement initiatives are driven by and aligned with the priorities of the organization expressed in the strategic plan Quality Improvement Plan Dashboard showcasing performance results Indicators and metrics tracked Quality improvement program/ initiative Improved outcomes
118. Informative and Relevant Measures Are aligned with strategic priorities for quality and client/resident safety Start with a baseline, valid and reliable, evidence based - where we are now ? Are sensitive to the changes we seek to make Are timely, allowing us to observe changes close to when they happen Can be trended to show improvements over time
119. Informative and Relevant Measures Can be benchmarkedexternally against other relevant organizations (Who is the best?) or trended internally against past performance or established targets Can be a composite of interrelated information (a big dot) Can also include a basic actual count of the most direct measures that personify performance Deaths, complications, infections, complaints
120. Examples of Quality and Safety Measures prevalence of falls pressure ulcers medication safety ED visits Hospital re-admissions Patient Experience
121. Accreditation Canada Qmentum Program 2013 Governance Standards 9.2 The governing body monitors organizational-level measures of client safety. 9.3 The governing body addresses recommendations made in the organization’s quarterly client safety reports. 9.4 The governing body regularly reviews the frequency and severity of adverse events and near misses and uses this information to understand trends, client and staff safety issues in the organization, and opportunities for improvement.
122. Accreditation Canada Qmentum Program 2013 Governance Standards 12.0 The governing body regularly monitors and evaluates the organization’s performance against agreed-upon goals and objectives. 12.1 The governing body identifies the data and information it needs to monitor the organization’s performance. 12.2 The governing body monitors data to assess the organization’s performance and the achievement of the strategic plan. 12.3 The governing body identifies opportunities for improvement and monitors the actions taken to address them.
123. CARF Standards M. Information Measurement & Management Data are collected and information is used to manage and improve service delivery 1. Data are collected that: Provide information on; The needs of the person served The needs of other stakeholders The business needs of the organization b. Allow for comparative analysis.
124. Reporting and the Person Actual accounts of high-impact personal experiences convey strong messages. Personal stories add significant context to understanding quality and client safety goals and measures.* The public needs to be considered in how public reports of the board convey goals and measures. *In workbook.
125. Dashboards/Scorecards for governors/leaders Snapshot of organization - wide, outcome driven measures associated with strategic areas Should be clear, easy to read / interpret and timely / updated on regular basis Governors should monitor indicators of quality & client / resident safety performance as they do financial performance.
126. Monitoring Reports Examples of Dashboards / Scorecards Union Villa LTC Home* Mississauga Halton CCAC* Saskatoon Health Region* Central East CCAC* *In workbook.
127. Summary From: Many disparate measures Retrospective reports Abstract rates Ad hoc isolated updates Measuring what is available To: Meaningful, summative measures associated with strategic plan Up-to-date or real-time reports Real-life stories and absolute counts Continuous monitoring of change Measuring what matters
128. THANK YOU QUESTIONS??
129. Capability Assessment
130. The Quality Journey in Action
131. Objectives Prioritize quality journey action steps Introduce Effective Governance for Quality and Patient Safety Toolkit
132. Adapting the Evidence: The Toolkit
133. The Drivers of Effective Governance for Quality and Patient Safety
134. Action Steps