1. 12/9/2018 3:38 PM
Quality Improvement Plans (QIPs): Aligning the Content to the QIP Guidelines

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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 % in order to impact the associated outcome measures

15. 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

16. 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 % 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 %.

17. 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