Transcript Slide 1

WELCOME!
Our Partner Sponsors
•
•
•
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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)
Overview of the Day
•Presentation
•Questions/Discussion
•Case Study
•Capability Assessment
•Action Plan at the end of the day
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 quality and patient safety.
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
Our Commitment To You
• A framework for Effective Governance for
Quality and Patient Safety
• Experienced peer facilitators
• Opportunity to share
Our Expectation of You
PARTICIPATION!
WHERE ARE WE ON THE
QUALITY & PATIENT
SAFETY AGENDA
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
Recent Wake-Up Call for Board
Involvement
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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
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
Milestones of the Modern Era
2000-01
Conferences 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)
2002
RCPSC Report: Building a Safer System
2003
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
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.
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.
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 “
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
Keeping Ontarians Healthy
Ontario’s Action
Ontario’s Plan
Action Plan
for
Health
Care Sets
the
for
Health
Care
Course for Transformation
Sets the Course for
Transformation
Cancer Risk
Profile
Healthy Kids
Smoke-Free
Ontario
PersonCentred
Quality
Regime
Integration
Efforts
Increased Access
Faster Access to Family Care
Redefine
LTCH
Senior’s
Strategy
Home &
Self-Managed
Care
Specialized
Clinics
Right Care, Right Place, Right Time
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
Leading Board Practice
• Research Team, led by Ross
Baker:
– Synthesized the published
and gray literature
– Conducted key informant
interviews
– Prepared illustrative case
studies
The Drivers of Effective Governance
for Quality and Patient Safety
Barriers to Progress
•
Increasing system complexity
•
•
Paradox: scientific progress brings more risk to
manage
Creates specialization but demands
cooperation
•
Lingering culture of autonomy
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Effective management of change challenging
•
Leadership- competing priorities
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
Boards Influencing Quality and
Patient Safety
Dr. Ross Baker
Professor, Department of Health Policy,
Management and Evaluation,
University of Toronto
Where Are You With Quality and
Patient Safety?
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.
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?
GOVERNOR’S
STORY
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.
.
KNOWLEDGE OF
QUALITY
.
SKILLS AND ROLES
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
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.
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.
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!
Alignment of strategic priorities
Organization’s mission and overall vision
Quality improvement initiatives are driven by and aligned
with the priorities of the organization expressed in the
strategic plan
Organization’s 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
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.
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.
Role
Critical Questions on Governing Body
Role to Support Quality
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What should the Quality Committee do? *
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Who should be on the Quality Committee?
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What information does the Quality Committee need?
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How will the Quality Committee support the senior leader in
operationalizing the organization's quality decisions?
•
Who are the stakeholders?
* In workbook.
Skills
Governance Essentials
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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)
Skills
Governance Essentials
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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
Modes of Governance
Governance
as
Leadership
Generative
* Content based on Governance as Leadership by Chait, R., Ryan, W., Taylor, B.
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)
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
The 8 Indisputable Behaviours of Successful Boards1
Successful Boards…
Act on
behalf
1
Report
back
Delegate the
work
4
Know
their job
8 7
5 6
Identify
risk
2
Practice
discipline
Assess
Performance
Set
targets
3
1.
Act on behalf of their communities. They define
their community, and seek their views and values
to use in decision making.
2.
Know their job, they know the business of the
organization, their duties under law, and they
continually educate and orient themselves.
3.
Set targets and priorities for the organization to
accomplish and consider it in quality
improvements.
4.
Identify the risks and liability issues that the
organization must manage and avoid.
5.
Delegate the work of the operations clearly to one staff person.
6.
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.
7.
Practice governance discipline, including orientation, meeting attendance, preparedness,
participation, discussion, use of board policies, and the avoidance of conflicts of interest.
8.
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)
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
THANK YOU
QUESTIONS?
CAPABILITY ASSESSMENT
CASE STUDY:
TRANSITIONS IN CARE
Case Study Objectives
1. Engage in a client/resident story that reflects the very real
complexities of the community sector and long term care
service delivery.
2. Reflect upon the issues, challenges and accountabilities within
the case from a governance perspective.
3. Identify and consider safety, quality, client and family
experience and transitions in care issues throughout the case.
4. Appreciate the challenges and complexity of board driven
quality and safety leadership in the relationship with the
operational leadership team.
5. Start to apply concepts and tools from the Effective Governance
for Quality and Client Safety driver framework to a complex
client case.
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
Case Study
The following narrative has been provided to you by your
executive director or administrator of the organizaiton.
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 Mr Stong’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.
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.
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
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.
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.
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
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?
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?
Assess and
Improve Quality
and
Client/Resident
Safety Culture
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
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
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)
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
Physical structures
Language
Symbols, rituals and
ceremonies
Stories, myths and legends
Values & Norms
‘the way we do things around here’
‘the way people behave when no one is looking’
‘behaviours that are condoned/rewarded’
Beliefs
Assumptions
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
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
PATHOLOGIC
Who cares as long as we do
not get caught
Increasing Trust
CultureKey Building Blocks
1) 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
2) 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
Key Building Blocks
3) Involving clients/residents and their families
• Hearing client/resident stories at governing body
meetings
• Involving client/resident and family in quality
improvement initiatives
4) 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
Key Building Blocks
Embrace a culture
of transparency
and disclosure
Disclosure Working Group. Canadian
Disclosure Guidelines. Edmonton, AB:
Canadian Patient Safety Institute; 2008
Key Building Blocks
Involving residents, patients, clients
and their families
•Resident councils - OARC
•Family councils
•Use of resident/ patient stories*
*in workbook
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.
Key Building Blocks
• Aligning Quality Improvement and Client/Resident Safety
from the Governing Body to the Front-line staff
GOVERNING BODY
BOARD OF DIRECTORS
Ministries /Legislation
Agencies
Associations
Public
Others




Senior Leaders






THE DELIVERY SYSTEM
Quality Councils
Inspections
Organizations
Regulatory
Bodies/Accreditation
Others
Levers for Quality and
Client/Resident Safety Culture
• Legislation
–ECFAA; LTCHA
• Accreditation requirements
Levers for Quality and Client
Safety Culture
• Governance standards within the service
accountability agreements with LHIN’s
– MSSAA and L-SAA
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
Measuring Culture and Improving
Performance: A Ten-Step Process
1.
Build Capacity
• Build internal capacity to undertake survey and follow-up
2. Select an appropriate survey instrument
• Number of surveys available including one used by Accreditation Canada
3. Obtain informal leadership support
• Understanding of the complete process by senior leadership team
4. Involve healthcare staff
• Involve key groups in implementing the survey
5. Survey distribution and collection
• Design strategy to obtain highest possible response rates
Healthcare Quarterly, 8(Sp) 2005: 14-19
Patient Safety Culture Measurement and Improvement: A "How To" Guide
Mark Fleming
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: 14-19
Patient Safety Culture Measurement and Improvement: A "How To"
Guide
Mark Fleming
Culture Stories
Source: Leisureworld presentation July 2013
THANK YOU
QUESTIONS?
Capability
Assessment
Relationships
between the
governing body
and Senior
Leaders,
Clients/Residents
and their Families,
External
Organizations
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.
Current Reality
• 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.
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.
Relationship with Clients/Residents and
their Families
• 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.
Relationships – Volunteers
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
Dr. Jack Kitts
Chief Executive Officer
The Ottawa Hospital
Relationships Governing bodies and Senior leadership
• 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.
Governance Standards
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:
a) Delegation of authority and responsibility to executive
leadership;
b) Access to management and staff as appropriate.
c) Support of governance by the organization.
External Relationships
External Relationships
• Health Service Partners
•Ministry
•LHIN
•HQO
•Accrediting bodies
•Media / Public
•Community engagement
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)
CCAC Relationship with Contracted
Service Providers
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.
Relationships - Governing Body and LHIN
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
Ministry
•
•
•
•
•
Quality agenda
Policy
Regulatory agenda
Strategy
Licensing and inspection
Relationships Governing Body and Health Quality Ontario
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
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
Media / Public Relations
“Guidelines For Informing The Media After An
Adverse Event” – Canadian Patient Safety
Institute (CPSI)
- Sharing Information on Adverse Events
- Communication Plan
THANK YOU
QUESTIONS?
Capability
Assessment
QUALITY AND
SAFETY PLAN
Objective
• Provide overview of intent of quality
improvement plan
• Identify important areas for
consideration when developing a quality
improvement plan
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;
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.
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
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
QIP Strategic Implementation: A codified process
initial implementation
explore
explore
design
implement
standardize
Improve performance
achieve thresholds
monitor performance
design
ongoing evolution
implement
standardize
improve
performance
achieve thresholds
monitor performance
•
Assess sector readiness and determine appropriate policy lever
•
Engage with sector representatives; establish requirements and timeframes; determine priority themes and indicators
•
Implement policy and communicate requirements to sector; provide supports to the sector in collaboration with HQO
•
Move from organization-specific methods of indicator measurement to standardized, system-wide approaches
•
Drive performance using ongoing feedback and evidence-informed targets and benchmarks
•
Reach high-performing ‘steady state’
•
Monitor and sustain performance
Source: MOHLTC - Health Quality Branch
113
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
System-wide quality improvement:
using the QIP as a lever for change
Source: Ministry of Health and Long Term Care
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.
116
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
What Does a Good Plan Look Like?
• Champlain CCAC Quality Plan*
• North East CCAC Quality Framework*
• North East CCAC QIP Part B*
*In workbook
THANK YOU
QUESTIONS?
Capability
Assessment
Information on Quality
and Client/Resident
Safety
Measurement of
Quality and
Client/Resident Safety
Objective
• Review the importance of meaningful
information and measurement to inform
governance decisions for quality and
client/resident safety.
Governors need access to informative
and relevant measures of client/patient
safety and quality that they can use to
assess current performance and
target improvement strategies
But........
In a sea of information and indicators,
how are governors/leaders supposed to
keep track?
Alignment of strategic priorities
Organization’s mission and overall vision
Organization’s Strategic
Quality improvement initiatives are driven by and aligned
Plan
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
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
Informative and Relevant Measures
• Can be benchmarked externally 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
Examples of
Quality and Safety Measures
• prevalence of falls
• pressure ulcers
• medication safety
• ED visits
• Hospital re-admissions
• Patient Experience
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.
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.
CARF Standards
M. Information Measurement & Management
Data are collected and information is used to manage
and improve service delivery
1. Data are collected that:
a. Provide information on;
i. The needs of the person served
ii. The needs of other stakeholders
iii. The business needs of the organization
b. Allow for comparative analysis.
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.
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.
Monitoring Reports
Examples of Dashboards / Scorecards
• Union Villa LTC Home*
• Mississauga Halton CCAC*
• Saskatoon Health Region*
• Central East CCAC*
*In workbook.
Summary
From:
To:
 Many disparate
measures
 Meaningful, summative measures
associated with strategic plan
 Retrospective reports
 Up-to-date or real-time reports
 Abstract rates
 Real-life stories and absolute
counts
 Ad hoc isolated updates
 Measuring what is
available
 Continuous monitoring of change
 Measuring what matters
THANK YOU
QUESTIONS??
Capability
Assessment
THE QUALITY JOURNEY IN
ACTION
OBJECTIVES
• Prioritize quality journey action steps
• Introduce Effective Governance for
Quality and Patient Safety Toolkit
Adapting the Evidence:
The Toolkit
The Drivers of Effective Governance
for Quality and Patient Safety
Action Steps