1. Quality and Governance

2. Purpose Explore the relationship between Governance and Quality Examine Quality Improvement Roles and Responsibilities

3. Why Focus on Quality? In Canada… ~7.5% of hospital admissions involve an adverse event 37% of adverse events considered preventable Extrapolate to all Canadian admissions: 9,000 – 24,000 preventable deaths due to adverse events Patient’s deserve quality care, not just care. Because it is codified in legislation (and MSAA)

4. The Excellent Care for All Act Royal Assent: June 8, 2010 Implemented in hospitals first Implemented in Primary Care April 1 2013

5. 1. The client is at the centre of the health care system 2. Decisions about client care are based on the best evidence and standards 3. The health care system is focused on the quality of care and the best use of resources 4. The main goal of the health care system is to get better and better at what it does The Excellent Care for All Act

6. ECFAA requires that all health care providers: Annual quality improvement plans (QIPs) Link executive compensation to the achievement of targets set out in the QI plan Client / care provider satisfaction surveys Conduct staff surveys Develop a declaration of values Establish a patient relations process

7. What does quality mean to you?

8. Quality Efficient Pop Health Effective Accessible Equitable Resourced Integrated Client Centred Safe

9. Quality Improvement is… A management philosophy and system which involves management, staff and health professionals in the continuous improvement of work processes to achieve better outcomes of patient/client/resident care. (Health Canada, 2000)

10. Quality Improvement Plans Required by ECFAA (April 1, 2013) Oversight by the board Embedded in the strategic plan Has specific measures, timelines and targets Action oriented, outcome driven Staff involved in execution

11. Quality Efficient Pop Health Effective Accessible Equitable Resourced Integrated Client Centred Safe

12. The QIP Template AIM Quality Dimension Objective Measure Measure/ Indicator Current Perform ance Target for 2015/16 Target Justification Change Planned Improvement Ideas (Change Ideas) Methods and process measures Goals for change ideas (2015/16) Comments

13. The QIP Indicators - Access AIMMEASURE Quality dimensionObjectiveIndicator AccessTimely Access to Primary Care when needed Percent of clients able to see a doctor or nurse practitioner on the same day or next day, when needed Change Ideas 1)Reduce unused appt. 2)Train medical secretary on triage. 3)Educate clients on appt. types. 4)Reduce late cancelations and no-shows.

14. The QIP Indicators – Client Experience AIMMeasure Quality DimensionObjectiveIndicator Client ExperienceReceiving and utilizing feedback regarding patient/client experience with the primary health care organization. When you see your doctor/NP how often do they or someone else in the office give you and opportunity to ask questions about recommended treatment? Change Ideas 1)Update client survey to reflect HQO measure. 2)Build/enhance awareness of client-centred measures among clinical team.

15. The QIP Indicators - Integration AimMeasures Quality DimensionObjectiveMeasure/indicator IntegrationTimely access to primary care appointments post ‐ discharge through coordination with hospital(s). Percent of clients who see their primary care provider within 7 days after discharge from hospital for selected conditions. Change Ideas 1)Educate clients about importance of informing the CHC of their admission/discharge to hospital, and in booking follow-up visits with primary care provide.

16. Toronto Central LHIN (go to pdf)