1 excellent care for all strategy breakfast with the chiefs adalsteinn brown ministry of health and...
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Excellent Care for All StrategyBreakfast with the Chiefs
Adalsteinn BrownMinistry of Health and Long-Term Care
13/5/2010
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While health care costs in Ontario have been rapidly increasing, it is unclear whether the quality of care delivered to patients has been enhanced
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Source: CIHI data 2009. In current dollars.
Recession begins
Government announces 18% reduction on hospital funding over 3 years
Health Services Restructuring Commission begins hospital bed closures and restructuring
Social Contract
Caps and clawbacks on physician compensation
Barer-Stoddart report – reductions to medical school spaces Steeper rate
of growth than pre-recession
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$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
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f20
09f
$ p
er
ca
pit
a g
ov
ern
me
nt
ex
pe
nd
itu
re o
n h
ea
lth
, O
nta
rio
Source: CIHI data 2009. In current dollars.
Recession begins
Government announces 18% reduction on hospital funding over 3 years
Health Services Restructuring Commission begins hospital bed closures and restructuring
Social Contract
Caps and clawbacks on physician compensation
Barer-Stoddart report – reductions to medical school spaces Steeper rate
of growth than pre-recession
Source: CIHI data 2009. In current dollars.
Recession begins
Government announces 18% reduction on hospital funding over 3 years
Health Services Restructuring Commission begins hospital bed closures and restructuring
Social Contract
Caps and clawbacks on physician compensation
Barer-Stoddart report – reductions to medical school spaces Steeper rate
of growth than pre-recession
Source: Canadian Institute for Health Information
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We know that adoption of evidence can have a significant effect on enhancing quality through reducing clinical variation…
OHTAC Recommendations (FY 2005): Arthroscopic debridement of the knee has thus far only
been found to be effective for medical compartmental osteoarthritis. All other indications should be reviewed with a view to reducing the use of arthroscopic debridement as an effective therapy
Arthroscopic lavage of the knee alone is not recommended for any stage of osteoarthritis
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OHTAC recommendation
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…and at the same time, reducing cost while simultaneously improving the patient experience
Providing patients with written discharge instructions has been shown to decrease readmission, particularly in CHF
Sault Ste Marie Group Health Centre demonstrated that sustained reduction of CHF readmission of over 40% is possible through targeted quality improvement efforts
Enhanced Feedback for Effective Cardiac Treatment (EFFECT) demonstrated that public report cards on hospital performance can be an effective method for improving the quality of cardiac care
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Top 10% of readmission types responsible for 60% of cost = $415M
Top 20% of readmission types responsible for 80% of cost = $536M
All readmissions = $705M [upper end costs and excluding physician fee component]
CHF
COPD
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Tillsonburg District Memorial Hospital reducing readmissions and and hospital days
Mississauga Halton CCAC/LHIN redesigning criteria and processes to change culture while creating better outcomes for seniors and reducing ALC numbers.
Humber River Regional Hospital and North York General Hospital established a mobile Nurse Led Outreach Team that has prevented unnecessary ED visits
Ottawa Heart Institute supports ~ 1,200 patients from B.C. to N.L. with 13 hospital satellite sites and decreased heart failure 30-day readmission rate from 54% to14.8%.
Sault Ste. Marie Group Health Centre’s congestive heart failure discharge program reduced the number of readmissions by 43%.
Bluewater Health, St. Joseph’s Health Centre, Trillium Health Centre and Markham Stouffville Hospitals are piloting a lean/quality improvement program that aims to free up clinicians’ time on acute medical units in order to provide more direct patient care.
Hamilton Health Sciences used a lean process redesign to improve patient, information, and work flow in outpatient clinics.
Thunder Bay has reduced Bed Empty Time by 25% (four hours to three), by implementing lean process redesign.
Orillia Soldiers Memorial’s ED patients waiting time for initial physician assessment has decreased by 50%, and the number of people who leave without being seen has been reduced to 0.
Scarborough Hospital implemented a new discharge planning process and use unit whiteboards to increase the number of patients discharged before 11 am, and reduce overall length of stay.
LHIN Regions
1. Erie St. Clair
2. South West
3. Waterloo Wellington
4. Hamilton Niagara Haldimand Brant
5. Central West
6. Mississauga Halton
7. Toronto Central
8. Central
9. Central East
10. South East
11. Champlain
12. North Simcoe Muskoka
13. North East
14. North West
While there are many examples of quality improvement success stories across Ontario, our challenge is to have a more systematic approach
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Leadership Quality and system design is a
core strategy Focus on patient first Engaged staff workforce and
physicians Strategic alignment of aims,
measures and activities Incentives and accountability Innovation, design and redesign of
services Capability for improvement Incentives and accountability Information technology and
meaningful measurement
A range of factors contribute to the design of a sustained systematic approach to quality
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The Excellent Care for All Strategy is designed to build the foundation for a high performing health system
Where We Are Excellent Care for All Strategy
Leadership
Quality as Core Strategy
Focus on Patient First
Engaged Workforce
Aligned Aims & Measures
Incentives & Accountabilities
Capability for Improvement
Quality Committee of the Board
Annual QI Plans
Compensation Linked to Quality
Critical Incident Reporting
Patient Surveys
Statement of Values
Patient Based Payment
Evidence Based Funding
Support for QI Initiatives
Public Reporting of Quality Indicators
Staff Surveys
Quality Committee of the Board (Some Hospitals)
Annual QI Plans (Some Hospital)
Compensation Linked to Quality (Some Hospitals)
Patient Surveys (Most Hospitals)
Patient Based Payment (e.g. Incremental Wait Times )
Evidence Based Funding (e.g. PET Scans)
Support for QI Initiatives (e.g. QIIP, ED-PIP, Flo Collaborative)
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The strategy will help ensure that care is centered around the person and enhances the patient experience
Recovery, Rehabilitating and Managing
Monitoring and Preventing
Diagnosing Intervening
Patient Satisfaction Surveys
Statement of Values
Evidence Based Clinical Practice Guidelines and Continuous Quality Improvement
Patient Education
Evidence Based Diagnostic Testing
Public Reporting Hub: Quality, Patient Safety, Wait Times
Evidence Based Practices to Reduce Avoidable Hospitalization
Patient Relations Process
Evidence Based Practices to Reduce Readmissions
Measures to Prevent Duplicate Diagnostic Tests
Money follows the patient
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The Excellent Care for All Strategy will also help create a culture focused on continuous quality improvement throughout the system
Strong CQI Culture at the Organization Level
Quality Committees of the Board, Publicly available annual quality
improvement plans Executive compensation linked to quality Patient relations process Patient/client/caregiver surveys Staff surveys to assess Declarations of values Critical incident reporting
Supported at the System Level
Proposed expanded mandate of OHQC: Provide recommendations to the
health system on clinical practice guidelines and protocol
Provide recommendations in consultation with the public, to the Minister concerning the Government of Ontario's provision of funding for health care services and medical devices
Patient based Payment Support from Quality Improvement
organizations
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Ontario’s patient-based payment approach will draw from over 25 years of international funding policy evolution
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1993 Australia
1983 United States
Sweden
1995 Italy
1997 NorwaySpain
1998 JapanFinland
2000 Denmark
2003 England
2004 France
2005 Germany
An emerging focus on quality and evidence-based care
United States: 14.1% decrease in cost per admission, 2.4% reduction in overall system costs over 4 years; 6.7% decrease in average LOS)
Australia (Victoria): Up to 25% reduction in cost per admission over 5 years Sweden (Stockholm): 1% reduction in total costs
United States: 14.1% decrease in cost per admission, 2.4% reduction in overall system costs over 4 years; 6.7% decrease in average LOS)
Australia (Victoria): Up to 25% reduction in cost per admission over 5 years Sweden (Stockholm): 1% reduction in total costs
Norway: 40% reduction in wait times over 2 years
Denmark: 17% reduction in wait times one year after implementation
Ontario (Wait Time Strategy): Reduced 90th percentile wait times for hip replacement from 351 to 153 days, knee replacement from 440 to 184 days
Norway: 40% reduction in wait times over 2 years
Denmark: 17% reduction in wait times one year after implementation
Ontario (Wait Time Strategy): Reduced 90th percentile wait times for hip replacement from 351 to 153 days, knee replacement from 440 to 184 days
Australia: 3% reduction in adverse events among complex patients
England: Introduction of ‘Best Practice Tariffs’ based on costs of clinical best practice treatment for a patient condition
United States: Associated with decreases in mortality; non-payment policies for never events
Australia: 3% reduction in adverse events among complex patients
England: Introduction of ‘Best Practice Tariffs’ based on costs of clinical best practice treatment for a patient condition
United States: Associated with decreases in mortality; non-payment policies for never events
Emphasis on cost containment
Improving access and reducing wait times
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We have only begun the journey to a truly sustainable, patient-centered and quality-focused health system
Weeks Months Years
Excellent Care for All Act
Patient-based Payment Simulations
Recommendations from OHQC
Further Recommendations on Evidence-Informed Funding
Strengthened Critical Incident Reporting
Patient-Centered Care Across Continuum
Sustained Culture ChangeInter-Professional
Collaboration
Fully Engaged Patient
Innovation Tournament
Engaged Workforce and Physicians
Focus on Patients First
Quality as a Core Strategy
Capability for Improvement
Incentives and Accountability
Patient Based Payment
Strategic Alignment of Aims, Measures and Activities
Sustainable Healthcare SystemInnovation, design and
redesign of services
Meaningful Measurement
Act
ions
/Mile
ston
esR
esul
ts
Evaluations of Pilot QI Initiatives
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Thank you.