1. The Mental Health and Addictions Quality Initiative A Multi-facility Collaboration
Presentation to the Association of General Hospital Psychiatric Services’ 6th Leadership Summit
November 24-25, 2016
Dr. Pamela Prince, Director, Strategic Planning & Evaluation, The Royal
Debra Wicks, Director, Decision Support, Waypoint Centre for Mental Health Care
Robyn Griff, Strategic Planning Project Coordinator, The Royal

2. The Mental Health & Addictions Quality Initiative (MHAQI)
Began in 2011 as a “peer comparison” project among four specialty mental health hospitals in Ontario. It is a unique example of mental health and addictions hospitals coming together to define quality indicators and share results in order to develop common processes and quality improvement initiatives.
CAMH (Centre for Addiction & Mental Health): Toronto
529 Inpatient Beds, 4,000 IP admissions
Ontario Shores: Whitby
339 beds,  595 IP admissions
The Royal: Ottawa
2 sites, 439 beds, 1790 IP admissions
Waypoint: Penetanguishene
2 sites (1 forensic), 312 inpatient beds,1,079 IP admissions

3. Objectives
Develop a standardized approach to measuring performance in mental health care in key domains of:
Client experience
Complexity
Access
Outcomes
Client & Staff Safety
Human Resources
Fiscal Responsibility
Compare performance among facilities
Publically demonstrate accountability and transparency
Share best practices among hospitals and across departments
Highlight the work of specialty mental health facilities

4. Indicator Selection Criteria
Alignment with provincial and national initiatives
Impact on health system
Understandable - must be meaningful from a public perspective
Standardization: common and clear definitions across organizations
Valid and reliable
Timely
Actionable
Availability of data 4 4

5. The Role of The Resident Assessment Instrument
for Mental Health (RAI-MH)
Implementing a standard set of indicators that includes the RAI-MH has been instrumental in facilitating consistency in quality measurement:
Offered an existing data system
Offered standardized definitions for a number of indicators
Offered opportunity the develop new indicators from existing data elements
Data quality – collective resolution over time 5 5

6. MHAQI Indicators (2016-17) Domain Indicator Rationale
Client Complexity
# of reasons for admission
Assumption that clients with more than one reason for admission are more complex. Similarly with # of psychiatric and medical diagnoses; the discharge assessment was chosen because the diagnostic information was thought to be more complete and reliable than at admission. Source: RAI-MH, CIHI
# of psychiatric diagnoses at discharge
# of medical diagnoses at discharge
Outcomes
Change Self-Care Index and Overall Change in Care Needs between admission and discharge
Two measures of the effectiveness of care. Self-Care Index and Overall Change in Care Needs were chosen because of their applicability across diverse diagnostic groups.
Source: RAI-MH, CIHI
Readmission rate within 30 days of discharge to Same facility and Any Facility
A standard proxy indicator of outcomes in many hospital settings, to ensure that clients are not being discharged too early.
Source: Internal data and CIHI
Client Access
% of ALC days
Access to services is a major issue in mental health, where it is common to have clients who have been hospitalized for many years because of the lack of appropriate supportive housing. Inability to discharge patients to appropriate levels of care has a negative impact on the number of beds available for new admissions.
Source: Internal data
Wait Times
In Progress

7. Fiscal Responsibility
Domain
Indicator
Rationale
Client Safety
Prevalence of physical restraint, acute control medication use and seclusion at admission
Restraint of clients is a safety issue in both physical and emotional terms. All four hospitals have restraint reduction initiatives.
Source: RAI-MH, CIHI
% ULOA days
Unauthorized leave of absence (ULOA) is a risk to client safety, as well as, to a lesser degree, to the public.
Source: Internal data
% of admissions with completed medication reconciliation
Reconciliation of patient medication on admission is a requirement of Accreditation Canada, and a key performance measure across hospitals of all types.
Medication Incidents
Medication incidents are errors or potential errors with medication that may cause or could lead to inappropriate medication use or patient harm.
Source: Internal data
HR Indicator
Absenteeism rate
Can be a reflection of employee engagement.
Employee Engagement
% positive score on the Employee Engagement Survey "Engagement" subscale
Employee Engagement Survey
Source: NRC Picker Canada
Fiscal Responsibility
# of Balanced Budgets in last 5 years
Fiscal responsibility is an area of increasing concern for hospitals. This indicator was chosen over a financial ratio as more relevant and understandable to the public.

8. Results -5 Year Peer Comparisons

9. Expansion and Growth
Over the past five years, a number of facilities have joined the MHAQI at the suggestion of their LHINs. This enables comparisons across organization and LHINs using the same Mental Health measures.
2012:
Contracted with CIHI to facilitate central data collection and generate quarterly scorecards
13 Facilities on-boarded :
Publication, The Mental Health and Addictions Quality Initiative: Collaboration in Public Reporting and Quality Improvement (Prince & Willett)
Standardized reporting for Medication Reconciliation and Incidents
Joint Partner with the Mental Health Commission in the International Initiative for Mental Health Leadership Indicator Project (IIMHL)
18 facilities on-boarded

10. Expansion and Growth (cont…)
2015 – present:
2-year Quality improvement initiative – Restraint reduction and prevention
Access to Care Initiative (Ontario’s Mental Health and Addictions Strategy Funding)
MHAQI scorecard - Basis for a current provincial initiative to implement MHA indicators across the sector
20 facilities on-boarded

12. How Member Facilities are Sharing the Scorecard (excerpt of MHAQI Member Survey, October, 2015):
42% present the MHAQI Scorecard to their Board
83% review the MHAQI Scorecard at the Senior Management Team Level
33% review the MHAQI Scorecard at the Program Level
Practice Changes:
Enhanced networking amongst peer facilities across Ontario in multiple departments (e.g., staff and client safety, finance, Human Resources, etc.)
Improved data quality and understanding/interpretation of indicators
Internal quality improvement initiatives resulting from sharing results and quarterly meetings

13. Where are we now?
Collaboration Across Care Settings
Canadian Mental Health Association Ontario/ Addictions and Mental Health Ontario
Health Quality Ontario - Quality Standards (Depression, Schizophrenia, Dementia)
Client Experience and Outcomes
Adoption of Ontario Perception of Care for Mental Health, (OPOC-MH) by community services and 4 specialty hospitals provides opportunity for evaluation across the MHA sector
Multi-facility validation of the Waypoint Index of Clinical Improvement (WICI) - RAI-MH based outcome measure developed by Dr. H. Barbaree et al.
Access to Care
The MHAQI has partnered with the Ontario Ministry of Health and Long Term Care to develop and pilot access and wait time indicators (Access to Clinician within 7 days of Discharge; Youth access to psychiatry with 14 days of referral; Access to CBT) z

14. Thank You Contact: Robyn Griff, MHAQI Coordinator
Pamela N. Prince, PhD
Dreba Wicks