0. Engaging Patients to Improve Care 1:15 pm – 2:30 pm
Making Practice Improvements Through Involving Patients and Using Patient Experience Information
Association of Family Health Teams of Ontario – Health Quality Ontario Collaboration
Reference AFHTO in introductory remarks. Hence, this story about engaging patients to improve care will talk about primary care.
Health Quality Ontario
The provincial advisor on the quality of health care in Ontario

1. Presenter Disclosure Name of Presenter(s): Dave Zago
Relationships with Commercial Interests:
Grants/Research Support: None
Speakers Bureau/Honoraria: None
Consulting Fees: None
Other: None
No plan to mitigate potential bias as none are known

2. Background Access (2014) Involved in Decisions (2014)
Measuring Up
Access (2014)
Involved in Decisions (2014)
Having a Primary Care Provider
Ontario 94%
LHIN range from 87.3% %
Same Day/Next Day when sick
Ontario 44.3%
LHIN range from 28.4% %
After-hours care
Ontario 52%
LHIN range from 45.3% %
Patients involved in decisions about their care
Ontario 86%
no LHIN level in Measuring Up; comparisons to other provinces and internationally
System-level data being reported about patient experiences

3. BACKGROUND Quality Improvement Plan Indicators
Timely access to a Primary Care Provider
Patients’ Experiences: Patient Involvement in Decisions about Care
Patients’ Experiences: Primary Care Providers Spending Enough Time
Patients’ Experiences: Opportunity to Ask Questions
Primary care organizations who submit an annual Quality Improvement Plan asked to reflect on these ideas in their submission.

4. Background Simple math - right? Primary care patient experience data
+ Quality Improvement Plan indicators
= Improvement
Maybe not…maybe folks that support quality improvement in primary care could use some help
Maybe there’s a bit of a mystery of how to use this information and how to involve patients in improving quality

5. What we did
AFHTO-HQO invited Quality Improvement and Decision Support Specialists (QIDSS) to come together to talk about this AND we asked QIDSS to bring a patient(s) with them.
Review patient experience data (existing)
Refresh and apply QI tools to consider change ideas to improve patient experience
Evaluate immediately and 2-3 weeks post workshop
Attendance: 28 QIDSS, 11 patients and 6 other staff

6. Engaging for Improvement
Conversation between QIDSS and Patients
Review patient experience data
Anything surprising?
Why is this important?
Problem Statement
Why is this happening?
Brainstorm ideas together
Cluster ideas
Some main root causes
Attendance: 28 QIDSS, 11 patients and 6 other staff
You use tools to analyze patient experience data. Why not use tools to involve patients in understanding your areas for improvement? Some Quality Improvement approaches can help guide this conversation.
Some QI approaches and tools to help with the conversation:
Problem statement – thinking about what you could do to make that worse!
Getting a picture of how things work now – from patient’s perspective. Adds another perspective to what might be an incoherent process.
Affinity processes for grouping…some data to inform what are some of the main root causes (Pareto)…
Generating ideas for improvement. Ranking them for Impact/Effort.
What could we do differently (test)?
Brainstorm ideas together
Rank
test ideas
Start some tests for improvement

7. Reflections
“I would like more information on how to get my feet wet with patient engagement”
“We lost out by not bringing a patient”
“Having a patient from outside helps you to question what is important and avoid wasted effort”.
“Surprised there [is] a group focussed on QI … doesn’t seem usual for a government organization – If we (patients) know you’re (QIDSS) there, it helps us know what’s available to help us”.
“Decision-makers need to be part of the next session”
Carol Talking points:
“I would like more information on how to get my feet wet with patient engagement” – and the person saying this was among the minority of qidss who DID bring a patient!!
“We lost out by not bringing a patient” – they would never would know that if we hadn’t tried to this (ie failure is just as good as success to encourage learning/change)
“Having a patient from outside helps you to question what is important and avoid wasted effort”.
“Surprised there [is] a group focussed on QI … doesn’t seem usual for a government organization – If we (patients) know you’re (QIDSS) there, it helps us know what’s available to help us”.
“Decision-makers need to be part of the next session” – patient engagement can NOT be delegated to the “pat engagement person”

8. Written evaluation (44 of 45 participants)
Evaluation statement
% agree
Comments (representative)
The program met my expectations
83%
Was frankly surprised by the program!
The program was credible & non-biased
95%
Continue with these seminars and you will change our medical [system] for the better.
The program was well organized
As a patient representative, I was impressed with the organization & caring of the people organizing.
I can use the content from today to improve patient experience at the practice
Saw that it was possible to include patients to improve patient experience – not just a “tick box”
Carol 44 out of 45 – that already says something

9. Impact after the workshop
Many QIDSS took action within 2-3 weeks of the workshops
carol

10. Conclusions
Inviting even just a small number of patients to collaborate on QI worked to both engage patients in QI and learn how to make that easier.
Helps you get patient input
[Patients] “prevented us all from making incorrect assumptions about what patients want and thus avoid wasted effort”.
Helps you get better at getting patient input  
“After sharing with my team how this day went, I feel a patient would attend the next one”.
“I feel motivated to go back and just start”
Dave