1. Welcome to Cancer Care Ontario September 11, 2013 Garth Matheson CAPCA - COO Roundtable

2. We do more than Cancer now Performance Management and Management Cycle Standards and Guidelines Public Reporting and Transparency IM/IT Health System Policy Expertise Clinical Engagement and Alignment Regional Partnerships Cancer As mandated by the Cancer Act; Ontario Cancer Plan III Access to Care Building on Ontario’s Wait Time Strategy Chronic Kidney Disease Ontario Renal Network launched June 2009; Driving performance and quality Core Competencies 2

3. Our new Mission Together, we will improve the performance of our health systems by driving quality, accountability, innovation, and value Our new Vision Working together to create the best health systems in the world Vision and Mission 3

4. New Corporate-wide Areas of Focus Patient-Centred Care Prevention of Chronic Disease Integrated CareValue for Money Knowledge Sharing & Support 4

5. Organizational Structure Audit and Finance Committee Vice President, CIO Vice President, Ontario Renal Network Vice President, Clinical Programs and Quality Initiatives Vice President, Planning and Regional Programs Vice President, Planning and Regional Programs Vice President, Chief Financial Officer Vice President, Prevention and Cancer Control Vice President, Communications Board of Directors President and CEO Vice President, Corporate Services, General Counsel and Chief Privacy Officer 5 14 Regional Vice Presidents

6. 14 Local Health Integration Networks = 14 Regional Cancer Programs 6 Population = 13.5M ~ 65,000 new cases ~ 25,000 deaths 17 facilities delivering radiation (103 Linacs) 77 facilities delivering chemo

7. Cancer Survival in Ontario 7

8. The System Strategic Plan S I X STRATEGIC PRIORITIES The Ontario Cancer Plan III (2011 – 2015) 1 Develop and implement a focused approach to cancer risk reduction 2 Implement integrated cancer screening 3 Continue to improve patient outcomes through accessible, safe, high quality care 4 Continue to asses and improve the patient experience 5 Develop and Implement innovative models of care delivery 6 Expand our efforts in personalized medicine www.cancercare.on.ca 8 8

9. CCO does not operate facilities or deliver care Principle advisor to govt. Plan the system Oversight of the system Pay for volume / purchase service ($1.6B) Establish quality and access targets Monitor and drive performance 9

10. The Performance Structures 10

11. Provincial and regional leadership accountability Ministry of Health and Long-Term Care Cancer Care Ontario Cancer Quality Council of Ontario Other regional cancer providers (e.g., home care, hospice, etc.) Provincial Clinical Programs with Clinical Leads Regional Cancer Programs led by Regional Vice Presidents Clinical Accountability Prevention Family Medicine Screening Cancer Imaging Pathology and Laboratory Medicine Surgical Oncology Systemic Treatment Radiation Therapy Psychosocial Oncology Patient Education Survivorship Palliative Care 11 Provincial Leadership CouncilClinical Council

12. The performance improvement cycle Using key levers to improve the system Horizon-scanning and championing innovation Identifying quality improvement opportunities Standardizing development and guidelines Developing and implementing improvement strategies Monitoring performance 12

13. Setting the performance priorities Meant to drive performance in the cancer system in areas that need improvement Priorities are determined annually  Access/Wait times  Evidence-based clinical priorities (e.g.: thoracic surgery guidelines, pathology reporting)  Provincial priorities (e.g.: colorectal cancer screening program) Proposed/approved by:  clinical expert panels  programs at CCO  Regional Cancer Programs 13

14. Indicator selection and target setting Indicators must be:  in alignment with OCPIII and accountability agreements  actionable for the Regional Cancer Programs  areas requiring significant improvement provincially and/or in at least 5 regions  capable of data updates quarterly/annually and lag of 3 months or less 14 Targets: Expert panels recommend targets designed to improve quality Program areas set provincial targets using evidence and consensus Programs determine “ultimate or maximum” target first then set annual targets Annual target must be achievable by at least 50% of the regions by year end Targets approved by Clinical Council and Provincial Leadership Council

15. 15 Prevention Family doctor/ health centre Routine screening Hosp or SMRCC to undergo tests Cancer not diagnosed Diagnosis of cancer Radiation Systemic End of treatment CureSurvivorship Palliative/Supportive care Terminal care Death Relapse Continuing treatment Goes to Referred to Long-term monitoring and follow up Surgery Considers the full Cancer continuum

16. Example of a priority indicator Systemic Treatment – Referral to Consult (RCC) 16 - one target for all - Confidence intervals - Rank order Shows relative position against target and change from previous period

17. From indicators to motivating performance in the Field How do we do it without line authority? 17

18. Motivate through passion for the cause - a growing demand for care It is estimated that will develop cancer in their lifetime 45% of males 40% of females and Incidence + Prevalence Chronic Disease 18

19. Motivate with credibility - clinical engagement throughout 19

20. 20 Motivate through formal structures for accountability Administrative and Clinical Leadership

21. Motivate with money - Contracts/Agreements 21 Purpose is to clearly lay out the roles and obligations of all parties: Volume Funding Performance requirements Management of performance  Quarterly reviews  Reconciliation  Funding adjustments (volume re-allocations)  Quality and reporting requirements

22. 22 Motivate through regional participation - the RCP Working together to ensure that every patient, regardless of where they live, can rely on high quality cancer care – as close to home as possible. An alliance is formed. patients & clients Cancer Centre Hospital PHUs Other Health Care Providers Physicians Academic Centres CCACs Palliative Care ResearchPrevention Screening Acute Care Supportive Care

23. 23 Motivate with data - comparative reporting

24. Motivate through healthy competition - overall ranking of RCPs 24 Z Score Ranking: relative distance between the centres

25. Critical Success Factors 25

26. Strong policy and planning capacity 26

27. “As RVP … I am responsible for the quality and performance of the Program.” – Dr. Craig McFadyen, RVP Central West / Mississauga Halton Regional Cancer Program 27 Regional Vice Presidents (RVP) are key to leading the Regional effort

28. A must… a strong IT/IM backbone Information Strategy Framework 28  Innovation  Informatics  Instrument the System  Infrastructure

29. Monitoring tools 29 Regional Cancer Scorecard

30. 30 Quarterly Performance Reviews (text, data, voice)  dialogue  key process in driving accountability and improving performance  provides a focus for accountability  designed to be efficient for CCO and regions to administer  reinforces need for continuous attention  attended by RCP partners (Alliance)  embeds “how can CCO help”  tool for the RVP  clearly identified follow-up

31. Culture of public reporting on performance 31 MOHLTC Wait Times site Cancer System Quality Index (CSQI) CCO Web site

32. A watch-dog - CSQI 2012 summary Cancer Quality Council of Ontario 32

33. A must…many partnerships 33 Health care providers

34. A must…infrastructure/capacity 34

35. A must…good leaders who are:  Passionate  Creative  Change agents  Influencers  Motivators  Thinkers  Etc. 35  dissatisfied with current performance  performance managers, not performance reporters

36. There is always variation in performance? Hospital/ Program size - too big and complex or too small and lack the infrastructure Competing mandates - consumed with major capital developments, issues in other non-cancer portfolios or academic pursuits Host Hospital Issues- experiencing major financial difficulties, is under review, or can’t allocate appropriate supporting resources Infrastructure – lack of treatment and/or clinic space, equipment needs replacement, information management systems are too old Health Human Resources – short staffed and/or face physician shortages Seasonal variation – Q2 includes the summer months / Q3 includes Christmas when operations slow down or shut down in some cases Information – stakeholders don’t trust the data Leadership – performance / style 36

37. 37 What’s next?  Expanding funding levers through Health System Funding Reform  Pay for performance  Sustainability metrics  More quality indicators tied to volume contracts  Dealing with project/initiative related indicators that need qualitative scoring

38. So Much More to do