12/9/2018 3:38 PM Quality Improvement Plans (QIPs): Aligning the Content to the QIP Guidelines

Components of the QIP The Quality Improvement Plans required under the Excellent Care for All Act follow a template and guidelines available through Health Quality Ontario. The Quality Improvement Plan (QIP) includes two components: The Short Form The Long Form (which is in spreadsheet format but is now entered into a portal at Health Quality Ontario). The Long Form can be conceptualized as having 2 sections: Left side: Includes Quality Dimensions, Outcome Measures, Baseline Data and Targets Right Side: Includes Change Ideas, Process Measures and Targets

ECFAA Short Form Quality Aims/Priorities Overview (Objectives, Alignment with other organizational & jurisdictional planning) Integration and Continuity of Care Challenges, Risks, Mitigation Strategies Information Management Systems Engagement of Clients, Staff & Broader Leadership Accountability Management

QIP: Long Form (Left Side) Maintain/ Improve Directional Statement re: Indicator Target Rationale Baseline Performance Indicator Target Dimensions Outcome Indicators Aim Measure Quality Dimension Objective Indicator Unit/Pop Source/ Period Current Performance Target Target Justification Maintain/Improve  

Objectives and Indicators – Left Side Outcome indicators Reflect the voice of the client Directly measure areas that would be of concern to clients related to: Safety of service Effectiveness of service Access to service Extent to which service is Client-Centred Extent to which service is well Integrated within and across agencies/organizations

Your Turn…assess the content of these columns in relation to the expected content Objective Indicator Improve client experience with Admission to our facility % of Clients who have an “Excellent Experience” with Admission and Orientation to our Facility Indicate the extent to which you believe the Objective and Indicator are aligned to HQO/ECFAA requirements (ie content in each column is appropriate): Response Options Very aligned to ECFAA guidelines Somewhat aligned to ECFAA guidelines Not very aligned to ECFAA guidelines Objective – good to see directionality with the word INCREASE and it links with the indicator in the next column Indicator – it is an outcome measure which is good, and the wording frames it as a measure; note that it also includes the fact that the measure will reflect those who check off only “very satisfied”; this specificity is important for outcome indicators that relate to survey data Note however, that often an outcome measure on client experience would reflect the answers to a few questions, not one (this might but it could just as easily be the response to one survey question); often, it is a dimension of client experience that is reflected, that might aggregate responses to a few survey questions that focus on a particular area of service delivery

Let’s try another one… Objective Indicator Increase client & family input into goals of care based on changing client needs % of clients who have reviewed/renewed care plans Indicate the extent to which you believe the Objective and Indicator are aligned to HQO/ECFAA requirements (ie content in each column is appropriate): Response Options Very aligned to ECFAA guidelines Somewhat aligned to ECFAA guidelines Not very aligned to ECFAA guidelines Objective: this one is focused more on a process that reflecting an outcome. While clients/families care about input into care goals, a different way of describing this might be: Increase client and family experience in decision-making about care; Indicator: it is framed as a metric, but in keeping with the previous comment, it is more of a process than an outcome indicator. The other challenge identified here is that it focuses on ensuring that care plans get reviewed and revised as needs change, but it doesn’t really speak to the issue of involvement in decision-making. An even better outcome might be: % clients/families who are “very satisfied” with their level of involvement in decisions about their care This information would lend itself well to two Change Ideas and Process Measures on the right side/green side of the template. For example: Change ideas about: Ensure that care plans get reviewed and revised every with change in client condition. With a process measure such as % of care plans that are reviewed each time there is a change in client condition. Engage clients/families in setting care plan goals, with a process measure such as % of care plans that include client-specified goals.

QIP: Long Form (Left Side) Maintain/ Improve Directional Statement re: Indicator Target Rationale Baseline Performance Outcome Indicators Indicator Target Dimensions Aim Measure Quality Dimension Objective Indicator Unit/Pop Source/ Period Current Performance Target Target Justification Maintain/Improve  

QIP: Long Form (Left Side) Maintain/ Improve Directional Statement re: Indicator Target Rationale Baseline Performance Dimensions Outcome Indicators Indicator Target Aim Measure Quality Dimension Objective Indicator Unit/Pop Source/ Period Current Performance Target Target Justification Maintain/Improve  

Targets & Justification for Outcome Measures Expected to be aspirational – high enough to inspire and motivate, yet not so much of a stretch that it isn’t at all possible to achieve within a year If the indicator is linked to one of your organizational quality priorities, and the Aim for that priority includes a 3 year goal, this annual target should take you a third of the way toward achieving that stretch, 3 year goal. Target Justification: Generally reflects either a benchmark established by comparisons within the sector, or theoretical best, or moving toward theoretical best, or even, stretch based on organizational historical experience

Indicator Current Performance Target Target Justification % clients who report a fall after receiving falls screener and intervention 31% referred for falls assessment 20% assessed by professional 17% had environmental assessment 4% received intervention 31% 90% 30% 20% Falls analysis for 2014/15 provides baseline data Let’s try one…. Indicator – not the focus, but this is an outcome indicator appropriate to this column Current performance. These data are relevant to process measures that would be (and indeed are) replicated on the green/action plan side of the template. All we need in the Current Performance column is the baseline number of falls after receiving the screener and intervention (or the percentage of clients who received those interventions who sustained a fall) Target: Assuming that the target related to an outcome measure, all but one of these would be appropriate. The first one is equal to baseline, and if the intent is to maintain then one would expect to see Sustain in the Target Justification column. I suspect that would not be the case however, given the baseline performance on this process measure. Target Justification: The information included here indicates where the organization has sourced the data; that could be included under the Source column (assuming it is also the source for actual Falls that have occurred). The information intended to go under Target Justification is, as noted previously, some type of Benchmark, moving toward theoretical best, etc. Indicate the extent to which you believe the above Current Performance, Target, & Target Justification are aligned to HQO/ECFAA requirements: Response Options Very aligned to ECFAA guidelines Somewhat aligned to ECFAA guidelines Not very aligned to ECFAA guidelines

One more… Indicator Current Performance Target Target Justification # Client/Family Complaints about Service Delivery 25 10 Moving toward Theoretical Best Indicate the extent to which you believe the above Current Performance, Target, & Target Justification are aligned to HQO/ECFAA requirements: Response Options Very aligned to ECFAA guidelines Somewhat aligned to ECFAA guidelines Not very aligned to ECFAA guidelines

QIP: Long Form (Right Side) Create an Action Plan: Change Ideas as part of a project Targets for Process Measures Outcome Indicators From Scorecard Process Measures Projects CHANGE   Planned improvement initiatives (Change Ideas) Methods Process Measures Goal for change ideas Comments 1) 2) … N) Indicator 1 Indicator 2 Indicator 3

Change Ideas & Associated Process Measures Changes to service delivery at the front line that are hypothesized to help the organization impact the associated outcome measure (on the left of the template) They should be specific enough that someone can pick up the plan and understand what changes front line staff will be testing and implementing Process Measures: Assess the extent to which the change ideas are being implemented Targets for these measures need to be 90-100% in order to impact the associated outcome measures

Let’s look at one…. Change Idea Process Measure Target Re-educate front line staff on Changing the Conversation % Staff Trained on Changing the Conversation % Staff Demonstrating Competency on Changing the Conversation 90% Create a Client Council Council composition reflective of client population Created by Q3 All teams to test and implement an Always Event responding to client comments by service % Teams That Have Implemented an Always Event Indicate the extent to which you believe the above Change Ideas, Process Measures and Targets are aligned to HQO/ECFAA requirements: Response Options Very aligned to ECFAA guidelines Somewhat aligned to ECFAA guidelines Not very aligned to ECFAA guidelines

One more example… Change Idea Process Measure Target Effective person –centred planning Bi-annual reports and bi-monthly interviews 50% Safe service delivery across the organization Safety compliance checklist Indicate the extent to which you believe the above Change Ideas, Process Measures and Targets are aligned to HQO/ECFAA requirements: Response Options Very aligned to ECFAA guidelines Somewhat aligned to ECFAA guidelines Not very aligned to ECFAA guidelines Change Ideas: Not sufficiently specific to understand what staff at the front line will actually be doing. A more specific Change Idea might be: Provide and review information to clients about internal and external programs to increase community engagement Process Measures: These provide a method for measurement, but actually relate more to methods for collecting outcome measure data, not data that would reflect the extent to which a change idea has been fully implemented. If the suggested Change Idea were included, a relevant Process Measure would be: % of clients who have a meeting with their Care Coordinator to discuss participation in internal and external community activities Targets: These need to be 90-100% for process measures but none are included here. If the team is not likely to achieve that level within the year, a lower target can be included with a note in the Comments section about how far into the next fiscal year it will take to achieve 90-100%.

To Summarize….. The QIP template is comprised of a Short Form (narrative) and a Long Form (indicators and action plan). Short Form: should be only 2-3 pages, and should include the organization’s Quality Priorities which will form the foundation for the QIPs over a time horizon that is longer than 1 year (typically about 3 years) Long Form: Left side is focused on Quality Dimensions and Outcome Indicators; Right side is focused on Change Ideas and Process Measures The QIP is assumed to cover a one year time horizon from April 1st to March 31st The template follows a logic model from left to right that is similar in sequence to a Driver Diagram