B11 equip your organization for a cqip

AOHC Conference 2018 June 13, 2018 “How to Equip your organization to participate in a C-QIP”

Presenter Disclosure Presenters: Langs Bill Davidson, Executive Director Kerry-Lynn Wilkie, Health Link Director Cambridge and North Dumfries

Health Quality Ontario Julie Nichols, Regional Quality Improvement Specialist Southern Ontario, Kerri Bennett, Quality Improvement Specialist, Quality Improvement Plans

Relationships to commercial interests: Grants/Research Support: none Speakers Bureau/Honoraria: none Consulting Fees: MD+A Health Solutions Other: none

Disclosure of Commercial Support

This project has not received financial support This project has not received in-kind support

Agenda • Overview of the Presenting Organizations – the “people” resource • Overview of the Pilot Project • How one Sub-Region implemented the C-QIP • Resources, Tools and Approaches to “equip” your work • Summary of Learning and Tips to Bring C-QIPs to your subregion • Considerations for Future • Questions

Langs - Mission and Vision MISSION • Every person in our neighbourhoods will have a place to call home for health, wellness and community support.

VISION • Changed Lives, Healthy Communities

LANGS CORE SERVICES:

6 LOCATIONS:

Who is Health Quality Ontario?

Our mandate: Provide system level leadership so that all parts of the system can improve.

Quality Improvement Plans QIP PLANS BY THE NUMBERS

2018/19

• Annual, transparent articulation of commitment to quality improvement • Organizational engagement from board to bedside • Progress over 6+ years of quality improvement plans

1025 QIPs With submissions from:

Acute Care 137

Long-Term Care 623 Home Care 14

Primary Care 291

Why Undertake Collaborative QI? • Collaborative improvement efforts can be supported with a mechanism and tool: – That focusses on a cross sector issue – Allows different partners to develop together, and then highlight their collective efforts towards improvement – Allows for measurement at a LHIN or sub-region level where possible and where appropriate – Allows all sectors to play a role in quality improvement – Requires a focus on improvement activities and not just scorecards or data

Evolving QIPs for Different Purposes

Multi-sector QIP (Collaborative QIP)

Organization-Level QIP

Program-Level QIP

Multi-organizational, cross-sector QIP e.g. LHIN, or LHIN sub-region

Continue and expand to other sectors / types Advance specific and focussed quality issues e.g. Standards, NSQIP/Surgical quality

Note a program-level, or collaborative-QIP does not replace the organizational QIP.

www.HQOntario.ca

C-QIP Components: Workplan

Example: C-QIP Pilot in Waterloo Wellington LHIN • Cambridge-North Dumfries – CHF – Psychiatry in primary care

• Guelph-Puslinch – COPD – Rapid access clinic

• Kitchener-Waterloo-WellesleyWilmot-Woolwich (KW4) – Palliative

• Wellington – The rural way plan

Aug

• HQO/LHIN meetings to discuss possible idea.

2016

Sep 2016

Nov 2016

Jan-Feb 2016

• LHIN-hosted 4 sub-region meetings with Governors • LHIN – brought data, invited participants, facilitated event • HQO – presented on quality landscape in Ontario, Governor’s role in quality, background on C-QIPs • LHIN-hosted follow-up sessions in the other 3 sub-regions with Governors and QI leads for further guidance/information • HQO – main facilitator, C-QIP worksheet with action plan, timeline, key governance questions, as well as sign-off commitment for each participating organization • Workshops held for 2 sub-regions to develop C-QIPs with the QI leads from each sub-region.

• Identify in each sub-region a key contact HSP – main facilitator

• Board review process.

• Board sign-off MarchMay 2016 • Submission to the LHIN and HQO

Governor Engagement

http://www.waterloowellingtonlhin.on.ca/boardandgovernance/governance_engagement.aspx

Cambridge and North Dumfries Sub-Region • Readiness for C-QIP • Each sub-region has a different focus for their C-QIP • Foundation for collaborative work with working groups of Health Link (now subregion) • “work didn’t change; structure of work plan and reporting did change”

Collaborative Quality Improvement Plan Development and Approval Process WWLHIN Governor’s Session September 2016

Board discussions/updates on CQIP development and participation February-May 2017

WWLHIN and HQO host Sub-Region CQIP Meeting January 2017

Briefing Note for Boards for review/approval

Approve C-QIP May - June 2017

May 2017

C-QIP Development January – May 2017

Work Streams identified; Work Plan and Dashboard Established

August 2017

Board Approval • Tools to aid Board communication and approval • Briefing Note – customized to each agency • Id sub-regional leadership model for delivering mental health and addiction services to patients in Cambridge North-Dumfries Change Idea

Process Measure

Process Target

Other Participating Organizations

1.

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Hold joint board education sessions on mental health and addictions

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Number of education sessions Number of attendees

1 education session attended by a minimum of 20 board members in FY17/18

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CMHA Langs WRNPLC Two Rivers FHT Grandview Medical Centre Heritage FHO WWLHIN (Home & Community Care) Stonehenge Therapeutic Community Cambridge Memorial Hospital

Discharge Planning C-QIP • Led by Cambridge Memorial Hospital • Langs, NP Led Clinic, Two Rivers FHT, Grandview FHT, Community Support connections, Cambridge Memorial Hospital , WWLHIN • Focus on CHF patients and discharge post admission • Patient education; materials patients take home from hospital • Medication reconciliation Small changes = big impact

Mental Health and Addiction Services Integration with Primary Care • Membership • Division of project work and leadership – work streams • Meeting scheduling • Engagement of CEO’s/Executive Directors • Progress and completion of work Small changes = big impact + builds momentum

Langs House of Friendship

St. Mary’s Counselling Services

Threshold Homes and Supports

Heritage FHO

Two Rivers Family Health Team

Grandview FHT

Waterloo Region Nurse PractitionerLed Clinic

CMHA

Cambridge Memorial Hospital

Stonehenge Therapeutic Community

29 Individuals engaged in the CQIP

Waterloo Wellington LHIN

Mental Health and Addiction Services Integration with Primary Care Working Group of Cambridge and North Dumfries Health Link

C-QIP Implementation in Action

Project Implementation and tracking • Tools developed for tracking work plan progress: - Dashboard report - Annual progress summary • Engagement of Board/Governors

Dashboard – Work Stream 1 StrategicObjective (Change Concept)

Activity

PerformanceIndicator

Target #

Target Date

Q1

Q2

Q3

Q4

Status Updates

Work Stream 1: Communication with Primary Care Increase transparency regarding access to services

Expand access to standardized MH&A resources and services

1.

1.

Launch means such as HRM to provide additional transparency to patients and primary care regarding Here 24/7 referral status, wait-times, service availability etc.

Primary care providers are aware of HRM access.

Education sessions/information sent to primary care providers to increase awareness of HRM access.

Increase awareness of the web-based CBT services (Big White Wall) with primary care providers.

Education sessions and written communication with primary care providers on the web-based CBT service.

70% of providers aware of HRM access to Here 24/7 referral status.

Dec-17

100% of providers receive information regarding access to HRM for updates on Here 24/7 referrals.

2 education sessions held with providers.

100% of requests for educations sessions met.

Written communication sent to providers.

Mar-17

CMHA presentation at Family Practice Rounds and letter sent to providers on October 17.

HRM access will go live as a pilot with one psychiatrist in Wellington in March 2018.

Spread to Cambridge and North Dumfries in 2018/2019 Two session held Jan. 18; 50 attendees from health and social service organizations.

One additional session to be held March 28 at Two Rivers FHT. CMHA to manage requests for educations sessions.

Media release sent September 2017.

Highlights of Actions Implemented to Date:  Consultation with Working Group on CMHA workplan and implementation  CMHA launches Big White Wall and HRM for updates on referrals to Here 24/7

Dashboard – Work Stream 2

Highlights of Actions Implemented to Date:  Joint Board orientation /education session planned for November 2017 for 30+ organization -Agenda to include orientation to cQIP and overview of mental health and addiction services in Cambridge and North Dumfries  Visioning session held with Working Group for mental health and addiction services

Dashboard – Work Stream 3

Highlights of Actions Implemented to Date:  Inventory completed of mental health and addiction group programs offered in Cambridge and North Dumfries  Readiness assessed of these groups to be offered in a primary care setting

Governor Education Sessions

Reporting on C-QIP Standard and Created Tools • Quarterly dashboard report • Annual HQO report • Annual report to Governors

How a partner agency links their organization’s QIP to the C-QIP

Summary of the Findings Area

Findings

Confusion about the pilot

• The nature of a pilot process, and release of Patient’s First mid-way through planning resulted in a lack of clarity of roles, and mixed messaging

What’s changed?

• Collaboration • Change in service delivery • Better understanding of issues and change ideas

What was achieved?

• Considerable progress made in relationship building and planning • Some sub-regions have made concrete strides in moving their ‘big dot’ metrics forward

What was learned?

• Local collaboration on quality improvement is worth pursuing. Don’t wait until everything is perfect; start with a group of the willing.

• The QIP is one tool. You will require other tools to translate your quality improvement initiatives into useful information for other stakeholders • Collaborative governance is a challenging, but valuable endeavor • The focus of collaborative efforts should not be just the ‘mandatory’ indicators, rather the impact on the patient experience.

Considerations • Collaborative work takes considerable time and effort

– Keep your expectations realistic, and focus on one or two priorities – Take advantage of opportunities that emerge

• Consider stakeholder inclusion

– How when and in what capacity stakeholders may be involved in the collaboration – Begin by building open communication & trusting relationships – Maintain a client focus rather than provider focus

• A formal structure for decision-making and oversight

– Whether or not there is a ‘lead’ organization and where issues of accountability lie – Take advantage of pre-existing cross-sector tables. Efforts with other regional planning will need to be discussed to reduce redundancies and leverage synergies

Thank You Questions

Appendix: Tools • • • •

Contacts Workplan Board briefing note template Stakeholder analysis form