Health Quality Ontario The provincial advisor on the quality of health care in Ontario Waterloo Wellington LHIN Quality Session Lee Fairclough, VP Quality Improvement February 1 st, 2015

3 Quality Matters… Link to video Link to video

5 Recent launch: HQO Strategic Plan Vision: Better Health for Every Ontario. Excellent quality care. Mission: Together, we work to bring about meaningful improvement in health care. Values: Collaboration Respect Integrity Excellence

WHAT ARE WE DOING TO SUPPORT IMPROVEMENT?

Health of the Population

Measures of system integration Timely follow up post discharge Post-discharge follow up (CHF or COPD) Post-discharge follow up (mental illness or addiction)

LHIN results: Follow up within 7 days for mental health

Anti-psychotic medication use in Ontario Long Term Care Homes

Equity: Differences based on language spoken, income status

QBP SURVEY

Use of Evidence, Quality Standards HQO to ‘promote health care that is supported by the best available scientific evidence’ Addressing unwarranted variations in practice Quality standards - filling a gap in Ontario’s existing health care quality infrastructure Providing an evidence-based platform for prioritized quality improvement and offer a means to measure success across the continuum of care Concise sets of 5-15 strong (“should do”), measurable, evidence-based statements guiding care in a topic area

How Quality Standards Can Be Used Patients, caregivers and the public can use Quality Standards to understand what excellent care looks like and what they should expect from their health care providers Health care professionals can use Quality Standards to evaluate their practice, identify areas for personal and organizational quality improvement and incorporate them into professional education Provider organizations can use Quality Standards to audit their quality of care, identify gaps, guide organizational improvement strategies and inform clinical program investments LHINs and disease agencies can use Quality Standards to inform regional improvement strategies and monitor the care provided by health service providers Government can use Quality Standards to identify provincial priority areas, inform new data collection and reporting initiatives, and design performance indicators and funding incentives

Involving Patients & Families

Quality Improvement Annual public commitment to quality improvement goals through Quality Improvement Plans –1076 Organizations – Acute, LTC, CCAC, and Primary Care –Increased emphasis on involving patients –Act on the plans, more about progress Large scale efforts to improve quality Building capacity and support for improvement –Organizations making investments in teams, structures and process to support QI –Training in QI through programs such as –Connecting the community Leadership

What is a Quality Improvement Plan (QIP) All health care organizations are required to submit a quality improvement plan to HQO every year (April 1) “All” means: –Hospitals –Long term care homes –Organized primary care (i.e. Family Health Teams) –Community Care Access Centres

Intent of Quality Improvement Plan An organization’s annual articulation of their goals to improve quality in the coming fiscal year. –1076 Organizations – Acute, LTC, CCAC, and Primary Care –Increased emphasis on involving patients –Act on the plans, more about progress Includes: –Report on progress from the previous year (2014/15) –Identification of priorities, targets, and change ideas that will be pursued –Narrative description –Plan is posted publicly on organization’s website, and also on HQO website Board approves plan, and provides oversight on progress throughout the year Ideally, links well with the SAA’s that LHINs utilize to hold organizations accountable Important opportunity to address system quality challenges from a cross sector perspective. i.e. ED visits for LTC patients and ED Wait Times (hospitals), integration of care

Provincial integration and collaboration (as cited in QIP narratives) Collaboration within each sector

Transparency: All QIPs are publicly accessible

QIP 15/16 query ALC improvement plans in WW QIPs We have chosen not to include it on our QIP and are working within our LHIN. Pilot and implement a standard tool and visual tracking by patient, daily discharge monitoring process in all units; extend discharge planning resources from 5 days a week to 7 days a week - improve involvement of CCAC in discharge planning. Update policies regarding bed utilization. Standardize workflows. Educate staff on information management principles and importance of correct data entry. Track volume and work effort for manual wait time information system corrections. Sustain expedited discharge processes and reviews within clinical programs. Sustain weekly alternate level of care rounds. Sustain senior leadership and management collaborative meetings. Using the Plan-Do-Check-Act (PDCA) process through a LEAN approach, discharge planning processes will be reviewed in conjuction with CCAC and the Family Health Teams. Changes will be implemented based on project findings.

Functionally Integrated QIPs: Cross-Sector Collaboration HospitalPrimary CareCCACLTC 30-Day Readmission for Select HIGs 30-Day Readmission for one of CHF/COPD or Stroke ALC Rate Primary Care Visits Post- Discharge Hospital Readmission for Primary Care Patient Population (A) Hospital Readmissions Unplanned ED Visits Potentially Avoidable ED Visits Patient SatisfactionPatient ExperienceClient ExperienceResident Experience Appropriate Prescribing ED Length of Stay (90 th percentile, admitted) Timely Access ED Visits for Conditions BME (A) Five-Day Wait Time for Home Care Med Rec (at admission) CDI Hand Hygiene before patient contact (A) Pressure Ulcers (A) Falls (A) Med Rec (at discharge) (A) VAP (A) CLI (A) Physical restraints in mental health (A) Surgical Safety Checklist (A) % of patients with diabetes with two or more HBA1C tests within the past 12 months Colorectal and Cervical Cancer Screening Influenza Immunization (A) Falls for Long-Stay ClientsPressure Ulcers Falls Restraints Incontinence (A) % of palliative care patients discharged home with supports (A) Dying in Place of Choice (A) NEW (A): additional indicator NEW Green=sector specific Quality Improvement Plans in ON Priorities for 2016/17

ALC requires cross collaboration Organizations that reported progress in percent of alternate level of care (ALC) days included the following change ideas: –Following best practice rehabilitation care pathways, especially for hip and knee replacements, hip fractures and stroke –Using prediction models to estimate time of discharge, improving timing of decision making, and putting services in place to reduce the risk of functional decline that can lead to a patient being designated as ALC

Engagement activities reported in 2015/16 Quality Improvement Plans

Primary Care Practice Report Long Term Care Practice Report Confidential reporting: HQO Practice Reports (Audit and Feedback)

Coordinated Care Plans By September 2015, 11,302 complex patients were provided with coordinated care plans through Health Links Access to Primary Care By September 2015, 23,643 patients were provided with regular and timely access to Primary Care through Health Links *Data collection supported by HQO Quality Improvement Reporting & Analysis Platform (QI-RAP) tool Care for Patients with Complex Conditions and Circumstances Through Health Links

SPREAD VS. SCALE 6 SPREAD SCALE Horizontal diffusion System-wide structural change One team at a time Policy levers Requires champions Requires political commitment Acknowledgement: Dr. Danielle Martin

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37 Some Final Thoughts Understand experience, engage patient and public in designing the improvements in areas that matter to them Shift our focus from silos to systems –Keep the momentum going on your common areas of focus for QIP by Sub-LHIN area Support development of knowledge and capacity for QI –QI the new epi? Need the space to innovate and engage teams creatively in improvement AND..celebrate success