CMHO Workshop Presentation: Boards and Dashboards A framework for Boards to drive quality through strategy CMHO Workshop Presentation: Boards and Dashboards Presenters: Kim Ciavarella, CEO Glenys Currie, Director of Quality & Risk Management

Boards and Dashboards was created based on the Institute for Healthcare Improvement (IHI) quality framework, a U.S.-based model that has been widely adopted by the Ministry of Health & Long-Term Care (MOHLTC), the Local Health Integration Network (LHIN), the Ontario Hospital Association (OHA) and the Ontario Community Support Association (OCSA).

About Us BANYAN is a not-for-profit organization serving youth in conflict with the law, children and seniors/adults with disabilities.  Since 1976, an integral part of our service portfolio has been Youth Justice.  The organization has two secure-custody, residential detention programs: Arrell Youth Centre (AYC) and Peninsula Youth Centre (PYC) and an open-custody residential program, George R. Force (GRF) Group Home. 

About Us BANYAN has developed a strong infrastructure to support high-risk youth who have been placed by the court into our secure and open programs. Specialized programs and services offer youth new learning opportunities to increase their skills and abilities, improve and change negative behaviour, increase youth engagement with supports and decrease re-offending to ensure public safety.  BANYAN promotes the successful reintegration of youth back into their communities.  The program staff, including a team of clinicians, work closely with the youth; mentoring and caring for them with the utmost respect and dignity. 

Objectives of Session After this presentation participants will be able to: Understand the framework and drivers of board leadership in quality; Set a high quality standard with deliverables; Learn about and describe three (3) best practices for the use of Board quality and safety dashboards; Understand what questions Boards should be asking about quality performance data.

Why Do Boards Exist? To represent the owners = COMMUNITY

Boards oversee, on the community’s behalf: Mission Strategy Executive Leadership Financial Stewardship Quality of Care and Service

Some Truths About Boards Boards think quality is a lot better than the administrators and staff do. “But you never told us in a way we could understand it” “We’re above average” “Understand the gap” However, Boards can make an enormous difference. The CEO is held accountable for quality and safety goals. The Board Quality committee reviews client satisfaction results. The Board sets the board agenda for quality. Management and staff are involved in setting the agenda for the board’s discussion surrounding quality.

The Best Boards… Aim High “Our aim is to reduce peer-on-peer incidents by 10%...” Aim Broad “…for the entire organization, across all programs and services…” Take Dead Aim “…by December 31, 2019.”

Framework: Board Leadership for Quality 1. Set Direction: 100% or Zero PULL Make the future attractive PUSH Make the status quo uncomfortable 3. Build Will Involve clients and families Understand the gap between your current performance, the best in class and the theoretical ideal Use stories and data Go transparent Show courage 4. Execute Change Establish accountability for results Establish good oversight process on “are we achieving our aims?” Watch your own dots monthly or quarterly data 25% Board time on quality Generate Ideas Elaborate on each section in the following slides. 2. Establish the Foundation Establish Quality Committee Bring knowledgeable quality leaders onto the board Quality education standards for board Build a board culture of healthy conversations with administration and staff

1. Set Direction: Promises and Aims We will offer all of what we know will help you. The aim is 100% We will do nothing that will harm you. The aim is zero. We will provide children and youth services that are safe. Programs and services that work and leave no one behind. Our promise and aim…REDUCE PEER-ON-PEER INCIDENTS BY 20% BY DECEMBER 2019.

2. Establish the Foundation Establish a Quality Committee of the Board Bring quality expertise onto the Board Set / Achieve educational standards for the Board Build a culture of real conversations, at board and committee meetings with leaders with staff Allocate adequate resources for all staff training.

3. Build Will Establish a policy of full data transparency. Insist on data and stories. Help / let clients and families tell their stories. Set the expectation. Communication, disclosure, support, resolution, learning Understand the gap between current performance and ideal/best in class. Give quality and safety 25% of the Board’s time. Show courage: don’t flinch.

4. Execute Change Establish accountability for achievement of aims. Establish an effective oversight process. 25% of board time on quality and safety Watch your own dots Monthly or quarterly data Ask hard questions. Are we on track to achieve the aim If not, why not? Strategy? Execution?

murky aims CAUSE…murky dashboards Not-So-Specific Aims “Our organization strives to achieve the highest levels of quality.” “LaSalle Group Homes aims to be the top residential program for children and youth in Ontario for quality and safety.” As measured by…? By when…? murky aims CAUSE…murky dashboards

Your strategic theory drives the creation of the board “strategic quality dashboard” Big Dots (Pillars, Balanced Score Card) Drivers (Core theory of Strategy) Projects (Operational Plans) What are your key strategic aims? How good must we be, by when? What are the organizational-level measures of those aims? Down deep, what really has to be changed, or put in place, in order to achieve each of these goals? What are you tracking to know whether these drivers are changing? What set of projects will move the drivers far enough, fast enough to achieve your aims? How will we know if the projects are being executed?

(Core Theory of Strategy) Example: a strategic theory for the aim “reduce peer on peer incidents” Big Dot Aim Drivers (Core Theory of Strategy) Projects (Operational Plans) Provide a safe environment: Understand the root cause of peer-on-peer incidents and work to reduce 20% of their occurrences by December 31, 2019. % of peer-on-peer incidents have reduced by 10% to date. High risk aggressive behavioural youth are likely to have altercations with other YPs while in care Rewarding youth for less aggressive behaviour will result in less altercations Youth satisfaction surveys at discharge Perform a root cause analysis on factors related to peer-on-peer incidents to prove theory Develop and implement a risk management system which flags high risk aggressive behavioural youth to all staff Enhance existing recognition program that provides incentives to youth demonstrating less aggressive behaviours

The Ideal Strategic Dashboard Parallels the Strategic Theory

The Ideal Strategic Dashboard Parallels the Strategic Theory At this point would you advise training? Because this is new youth satisfaction is down because it’s a new structure. Level system and aggressive behaviour seems to be correlated correctly. Monitor youth satisfaction to see if youth satisfaction to see if it is related to peer-on-peer incidents. Look into youth satisfaction tool; what drivers are pulling down youth satisfaction. Is safety concerns of youth addressed. As a board member I would stay the course. It looks like the theory is working. Q: Are we on track to hit our target of reducing peer-on-peer data by 20%? A: Maybe, maybe not Q: Are we executing our strategy? A: For youth satisfaction; No For aggressive behaviour and level system; Yes

It’s not enough to have a dashboard that tracks your organizational-level aims and drivers. If you are to achieve your goals, the board and senior management must review the key data on big dots and drivers, and respond if needed with changes in strategy or improvements in execution, quickly.

Summary Strategic dashboards answers questions… are we on track to achieve our aims? …and is our strategy working? To answer these questions… The board dashboard should parallel the organization’s aims and strategic theory. The measures should be monthly or quarterly, real time and displayed in run charts. Management and the Board should review the key organizational-level measures at every meeting.

What about the other important type of quality question? How does our quality measure up… To other similar programs and services? To standards and regulatory requirements? To industry “benchmarks”? …etc.

Recommendations for Board Use of “how we compare to other” Dashboards Do not use comparative reports to oversee and guide improvement at each meeting. Do ask for an “exception report” for any measures that are “off” the regulatory and compliance targets. Compare to the best, not the 50th percentile. Always make sure you know how “green” is determined.

Summary: Good Board Practices for Dashboards

Summary: Good Board Practices for Dashboards Separate the “comparison” and “strategic” questions into two (2) dashboards. Use the “comparison” dashboard to take stock from time to time, not to steer by. Set a FEW organizational-level, specific aims, and develop a Strategic dashboard with timely, “good enough” data that is based on your theory of what needs to happen to achieve the aims. Spend time on your strategic dashboard: If you’re not on track to achieve your aims, start asking hard questions.

Separate the “comparison” and “strategic” questions into two (2) dashboards. Use the “comparison” dashboard to take stock from time to time, not to steer by.

Set a FEW organizational-level, specific aims, and develop a Strategic dashboard with timely, “good enough” data that is based on your theory of what needs to happen to achieve the aims. Spend time on your strategic dashboard: If you’re not on track to achieve your aims, start asking hard questions.

Oversight: Questions that all Boards should ask regularly about the data Are we on track to achieve our aim? Are we executing our strategy to achieve our aim? Does this set of strategies/aims fully support our mission, vision and values? How many clients is that? Who is the best in the province? Were clients and families involved?

Dashboard Workshop (time permitting) Assess your organization’s strategic goals. Are the major aims crystal clear? Which measures belong on the “how do we compare” dashboard and which belong on the “are we on track to achieve our aims” dashboard? How timely are the measures? How could you improve the time delay in getting feedback on performance? For harm (risk) related measures, does the dashboard answer the question “How many clients was that?” List three specific improvements you intend to make in your board’s oversight and monitoring of strategic plan and quality outcomes.

Thank you for your time. Questions?