Mississauga Halton LHIN

Governance to Governance Session:

Governing for Quality

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On November 20, Health Quality Ontario will host Canada's largest annual conference on quality in health care. Health Quality Transformation 2014 is open to everyone committed to improving the quality of our health

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Agenda

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Welcome and Introductions

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Community Governance

Consultation

Group (CGCG)

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CGCG – New Membership

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September 24th

Governance Resource Centre • Established a Governance Resource Centre section on the new

Mississauga Halton LHIN website - located on our new

website under the Tab – for HSPs

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Governance Resource Library

• Sponsored by the CGCG with funding provided by the

Mississauga Halton LHIN

• In the Governance Resource Centre section on the new

Mississauga Halton LHIN website.

• Includes articles, reports, templates, tools and frameworks

• Materials reflect current best practices

• You are free to download materials, edit and add to them

for use within your funded HSP.

• Disclaimer: The resources provided are only suggestions for your

consideration and use. Every board should make sure all of the

content is relevant to and works for their organization and to adapt

as necessary.

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Mississauga Halton CCAC Board of Directors Role for Quality:

The Quality, Safety & Risk Desk Aid Date: September 17,2014

MH LHIN G2G Session

Dieter Pagani, Chair Mississauga Halton

CCAC Board of Directors

Agenda

1.Overview of Mississauga Halton CCAC Board role in quality

2.Quality, Safety and Risk Framework

• Sharing the Desk Aid as one sample tool

3.Collaborating with health system partners for system improvement

Board Role in Quality

For the Mississauga Halton CCAC Board:

• Board decision-making is guided by accountability statements, for example

• To patients/families for quality services and best practices

• To health system partners, for cooperation and collaboration

• To the LHIN, for performance of M-SAA*; participation in LHIN led initiatives; fiscal management; communicating gaps between needs of community and scope of services provided

• To the Ministry of Health and Long Term Care, for compliance with

policies and regulations

• Board roles and responsibilities include • Quality oversight

• Risk identification and oversight

• The Board’s Patient Care Quality Committee • Assists the Board in overseeing/monitoring the quality of patient

care and assessing related opportunities and risks

• *Multi-sectoral Service Accountability Agreement

Quality Journey

CPSI: Canadian Patient Safety Institute; CQN: Community Quality Network

Quality, Safety and Risk Journey

To summarize organizational quality, safety and risk practices, we created our Quality, Safety and Risk Framework

The Desk Aid

To help everyone see how they contribute to quality care, and how their role aligns with others, we created a Desk Aid for each group

Customized Desk Aid

The Desk Aid for Board of Directors draws on the Board’s accountability and role statements

Collaboration for System Improvement

To illustrate how the Board acts on the roles articulated in the Desk Aid, here the example of “Collaborate with Health System Partners for system improvement”:

As a Board, we collaborate through:

• Governance 2 Governance (G2G) participation • Community Quality Network, part of Synergy West GTA • Regular dialogue with acute care and LHIN Board Chairs • Formal partnership with Trillium Health Partners

• Seamless Transitions: Hospital to Home

Questions/Discussion

We’d like to hear from you:

1. What questions do you have?

2. How can we help?

3. What examples of Board leadership for Quality do you want to share with us?

Ray Applebaum, CEO, Peel Seniorlink

Caroline Brereton, CEO, Mississauga Halton CCAC

Cathy Hecimovich, CEO, Central West CCAC

The Community Quality Network

September 17, 2014

An Update for the Mississauga Halton LHIN G-2-G Session

Kumee Rao, CQN Co-chair Jutta Schafler Argao, CQN Secretariat

1. The Structure for Collaboration

2. CQN Mandate

3. Current Priority: Shared Scorecard

4. Lessons Learned

5. Dialogue

Appendix:

1. Overview of Synergy West GTA

Agenda

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THE STRUCTURE FOR COLLABORATION

Successful Collaboration requires Structures for Engagement and Communication

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Structure Enables Focused Collaboration

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COMMUNITY QUALITY NETWORK MANDATE

Successful Collaboration requires Clarity of Accountabilities and Roles

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CQN works in the “grey space” between organizations

and helps to build capacity and capability for agencies

and the sector

HSP Board

• Corporate mandate and authority

• Accountable to the LHIN through accountability agreements

• Bound by specified legislation

• Expectations set by external organizations (MOHLTC, LHIN, etc)

• Role is direction and oversight

• Fiduciary, Strategic & Generative roles

Community Quality Network

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• Voluntary membership

• Accountable through shared commitment to work together

• Expectations established and agreed upon by the membership

• Role is steering and advisory

• Strategic and Generative roles

CQN will make a positive impact at the

Governance and Operations Levels

Governance Explore common and

consistent governance practices that enable HSP Boards to effectively guide and monitor the quality of client transition points among the community sector

Focus on preparing the community sector for compliance with the Excellent Care for All Act (ECFAA) and ensuring appropriate monitoring and evaluation of quality within and across the community sector

Operations

• Explore opportunities to

reduce process/program and

practice variation and enable

consistently high quality

outcomes for target

populations who are

frequently served, or have the

potential to be served, by

multiple agencies – through

quality improvement or process/program innovation

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Learning about the drivers for effective

Governance for Quality first, helped to create a

Network with shared focus and language – we

are now focusing on “Measurement”

CURRENT PRIORITY: SHARED SCORECARD

Successful Collaboration requires Shared Focus

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Stages of Shared Scorecard Development

• Stage I - Level Setting / Learning (min. 6 months)

o Agreement on the attributes (Health Quality Ontario)

o Gathering existing definitions

o Agencies are sharing their results with each other

o Begin to analyze collective data for emerging trends or patterns

• Stage II - Explore Standardization (min. 6 months)

o Work towards consistent indicator, definition and algorithm where indicated

o Validate the menu of Indicators

o Where indicated, arrive at:

• Common definitions for each indicator

• Common consistent data collection processes

• Common understanding of meaningful system wide analysis

• Common CQN wide QIP?

• Stage III - Production of Evolved Sector Scorecard (tbd - 2015)

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Shared Scorecard Dimensions

In 7 of the 10 attributes*, member organizations are already monitoring a number of indicators; this was our agreed-upon starting point

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* Source: Health Quality Ontario (HQO) website, ** Accreditation Canada http://www.hqontario.ca/public-reporting/home-care/attributes-of-quality

Accessible

Accessible

Effective

Safe

Patient / Client Centred

Integrated

Efficient

Work Life** Equitable

Focus on Population Health

For Future:

Appropriately Resourced

Indicators for Sharing

• Client satisfaction measures (14) ranked #1 in “Patient/Client Centred”

• # of individuals using the service (12)

• % M-SAA financial indicators meeting or exceeding target (12) ranked #1 in “Efficient”

• % of Administration (11)

• #/% Employee Turnover (11) ranked #1 in “Work Life”

• #/% discharges (11) ranked #1 in “Integrated”

• Avg wait time from assessment to service initiation (10) ranked #1 in “Accessible”

• # Clients with at least one hospitalization (9) ranked #1 in “Effective”

• # Complaints (9)

• # Compliments (9)

• % Falls rate for Long Stay clients (8)

• # incidents (8) top ranked in “Safe”

• # Client serious occurrences (8)

We started with a menu of indicators that were already being collected, and from that menu (see Appendix), member agencies identified the following we could start with:

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Indicators for Sharing (2)

A Working Group is in the process of fine-tuning the list–

here a glimpse of the draft

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Quality Dimension Measure(s)

Accessible Length from referral to assessment

Accessible Length from assessment to service initiation

Effective # of clients with at least one hospitalization

Effective unplanned ED visits

Effective % patients with unplanned hospital readmissions

Safe # of incidents or risk events

Safe # of incidents or risk events that are adverse events

Patient/Client Centred Overall satisfaction

Patient/Client Centred Quality Care

Patient/Client Centred Loyalty

Integrated Adoption of Integrated Assessment Record

Efficient % M-SAA financial indicators meeting or exceeding

targets

Worklife Employee satisfaction

Worklife Employee Turnover

LESSONS LEARNED

Collaboration is as successful as partners’ willingness to learn from successes and failures

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To quote our members…

• “There is a lot more common ground than I imagined; we all are interested in quality; the same indicator and/or outcome can mean different things depending upon the setting; the CQN provides an incredibly rich learning environment”

• “We have appreciated the training opportunities with (CPSI), the exchange of ideas and being part of a draft of a LHIN wide scorecard”

• “I’m taking the lessons learned about building a foundation for quality and sharing them at the Board and Leadership levels in my organization”

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• Join us at our next meeting:

– Tuesday, October 7th

– 6-8 p.m.

– Mississauga Halton CCAC

– 2655 North Sheridan Way, Suite 140, Meeting Room #1

• Contact the Secretariat:

– Jutta Schafler Argao

– 416-780-7878

– jutta.schaflerargao@mh.ccac-ont.ca

• Visit our Website – http://synergygtawest.com

If you’d like to join us, or if you have questions

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Dialogue

• What questions do you have?

• How else can the CQN help to advance Quality in the system?

• How can the CQN support the governance practices for Quality in this LHIN?

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Break

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APPENDIX: OVERVIEW OF SYNERGY WEST GTA

Successful Collaboration requires Clear Purpose

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Better Care through Community Collaboration

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Vision

Together, the agencies seek out opportunities to leverage and

find innovative ways to build on strategic planning activities

undertaken by all three organizations in the best interest of

improving the quality of care in the community.

Guiding Principles for Collaboration

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• Work related to this collaboration will be linked to and will build on local

system development work to date.

• Where possible, existing structures/forums will be used for planning and

implementation.

• Early and consistent stakeholder engagement will be a key element of all

projects.

• Planning and implementation will be collaborative and will engage

representatives from all impacted stakeholder groups.

• Each area of work will be informed by intelligence from both local and

other jurisdictional work.

The Journey Thus Far

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Nov/11 CPSI Workshop

Nov/12 Hiring of Paula Blackstein-Hirsh With LHIN Funding Support

Strategy Session Confirmation of Quality, Diversity & IT/Back Office as Priorities

Feb/13 Governance Workshop

March/13 Inaugural CQN Meeting

Established Planning Team (Working Group)

Aug/13 Confirmation of Priorities for Quality

Feb /14 Election of CQN Co-Chairs

Jun/14 Shared Indicators Identified

Current CQN Terms of Reference

• To improve the care provided to clients through a collaborative and shared focus on quality

• Will develop, plan and implement a variety of projects to support the quality agenda of member organizations – create efficiencies by developing joint templates that can be customized

locally – partner on improvement initiatives that require the seamless integration of

more than one agency – partner on the resourcing of decision support, quality improvement training,

and other supports – organize forums for sharing governance and operational successes achieved

and failures/challenges experienced by individual organizations.

• All community-based health service providers in the two LHINs are encouraged to join the Community Quality Network – currently there are 23 member agencies

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CQN Members

• Acclaim Health

• Balance for Blind Adults

• Canadian Mental Health Association – Halton Region Branch

• Canadian Mental Health Association – Peel Branch

• Canadian Red Cross

• CANES Community Care

• Central West CCAC

• Halton Region Services for Seniors

• Heart House Hospice

• Hope Place Centres

• Hospice Dufferin

• Mississauga Halton CCAC

• Nucleus Independent Living

• Ontario March of Dimes

• Peace Ranch

• Peel Addiction Assessment & Referral Centre

• Peel Senior Link

• Richview Community Care Services

• S.E.N.A.C.A. Seniors Day Program

• Seniors Life Enhancement Centres

• Summit Housing & Outreach Programs

• SHIP – Supportive Housing in Peel

• Victoria Order of Nurses

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A summary of proposed collaborative

work, as identified in February 2013

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Initiative Rank Order

Balanced Scorecard 28 Votes

Template for organizational Quality Improvement Plan 24 Votes

Joint Strategies to Build Organizational Capability for Quality Improvement (eg Jointly sponsored training program, shared staff, etc)

23 Votes

Tools to Support Completion/Execution of a Quality Plan 22 Votes

Quality Improvement Collaborative focused on a Shared Aim (eg Transition of Clients from Hospital to Community)

21 Votes

Online Repository of Evidence-based Practices for QI

18 Votes

Declaration of Client Values 13 Votes

Support Governance Practices for Quality and Client Safety (sharing successes and challenges, buddy system for Accreditation and Quality, developing a Board Quality Committee, etc)

11 Votes

Enterprise-wide Risk Management Framework 10 Votes

QI Readiness Assessment/QI Capability Inventory 5 Votes

Forum to Celebrate Successes 2 Votes

For each attribute, we have agreed to

shared goals and asked organizations

which of the menu of indicators they had

available and wanted to share:

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Attribute Definition* Shared Goal Shared Indicators Accessible People should be able

to get timely and appropriate healthcare services to achieve the best possible health outcomes

Minimize Wait Times ☐Avg wait length from referral to assessment

☐Avg wait length from assessment to service initiation

☐Hospital discharge to service initiation time

☐# days waiting for service

☐# patients on the wait list

☐Wait time (LHIN metric requirement)

Effective People should receive care that works and is based on the best available scientific information

Minimize avoidable Hospital Readmissions and or ED Visits

☐# Clients with at least 1 hospitalization

☐ED Readmit Rates

*Health Quality Ontario

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Safe People should not be harmed by an accident or mistakes when they receive care

Promote a culture of safety

☐# Client serious occurrences

☐# Adverse events

☐# Incidents

☐#/% Incidents that are medication errors

☐#/% Client files with a completed medication reconciliation at intake/admission

☐% Falls rate for Long Stay clients

☐% Long Stay clients with medication review in last 90 days

Patient/Client Centred Healthcare providers should offer services in a way that is sensitive to an individual’s needs and preferences

Individual clients services are sensitive to their needs and preferences

☐Client satisfaction measures

☐Caregiver satisfaction measures

☐# Complaints

☐# Compliments

☐# of individuals using the service

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Attribute Definition* Shared Goal Menu Measures/Indicators

Integrated All parts of the community care system should be organized, connected and work with all healthcare providers to provide high quality care

Collaborate to serve clients

☒#/% Of Transferred clients who receive followup

☐#/% of staff accessing integrated assessment record

☐#/% service refusals

☐#/% of discharges

☐System Partner Satisfaction measures

Efficient Healthcare providers should look for ways to achieve the highest possible client outcomes using the most efficient services*

Leverage resources to optimize capacity*

☐% MSAA financial indicators meeting or exceeding targets

☐Efficiency targets achieved to support maximum investment in client care

☐% of Administration

☐Forecast/Actual Variance ($)

☐Unit cost of service

*Health Quality Ontario

Facilitated Consultation

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Quality Improvement Plans

• Hospital QIPs – implemented

• Primary Care QIPs – implemented

• CCAC QIPs – first year 2014-15

• LTC Homes QIPs – first year 2015-16

• CSS and MH&A QIPs - TBD

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Community Care Access Centre Quality Improvement Plan WorkplanThis worksheet has 3 major categories across row 5. Aim is the first category and it has 2 sub-categories under it. Measure is the second category and it has 4 sub-categories under it. Change is the third category and it has 4 sub-categories under it. All of the sub-categories are in row 6. There are links to the 3 main categories and to the major elements under each category found in column A. The links go horizontally across the worksheet beginning in cell B2. The data to enter in cell G7 and moving downward is numbered so press F2 to edit the contents of the cell and then type your information. There is a decorative image border at the bottom of this data table and it does have Alt text.aim measure change safety effectiveness access client-centred

Quality dimension Objective Measure/Indicator

Current

performance

Target for

2014/15

Target

justification

Planned improvement initiatives

(Change Ideas)

Methods and process

measures

Goal for change

ideas (2014/15) Comments

1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

Effectiveness To reduce the

number of

unplanned ED visits

among home care

clients

Unplanned Emergency Department Visits: Percentage of home care

clients with an unplanned, less-urgent ED visit within the first 30

days of discharge from hospital

To reduce avoidable

hospital admissions

among home care

clients

Hospital Readmissions: Percentage of home care clients who

experienced an unplanned readmission to hospital within 30 days of

discharge from hospital

Client-centred

To reduce service

wait times

Five-Day Wait Time for Home Care:

Client Experience: Percent of home care clients who responded

“Good”, “Very Good”, or “Excellent” on a five-point scale to any of

the following client experience survey questions

• Overall rating of CCAC services

• Overall rating of management/handling of care by Care

Coordinator

• Overall rating of service provided by service provider

To improve client

experience

Access

2014/15

Safety To reduce falls

among long-stay

home care clients

Falls for Long-Stay Clients: Percentage of adult long-stay home care

clients who record a fall on their follow-up RAI-HC assessment

AIM MEASURE CHANGE

Space for additional indicators

Space for additional indicators

Space for additional indicators

Space for additional indicators

Attributes of a High Performing Healthcare System

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Performance Measure

“A performance measure is a comparison that provides

objective evidence of the degree to which a performance

result is occurring over time.”*

• measures of performance must satisfy this definition if

they’re going to drive performance improvement*

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*Stacey Barr - PuMP

Common Measures

• The Mississauga Halton LHIN Quality Committee is

looking for:

• measures that are standardized across programs/sectors

• that can be used in QIPs and

• that track to our initial focus on the attributes of Safe,

Accessible, Effective and Patient Centred.

• In light of QIPs which are organizational quality

improvement plans, we hope to develop at least one

common indicator per program/sector in each of these

attributes.

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Common Measures

• Standardized definition and methodology for

calculation

• Clear enough definition for repeatability and

reproducibility

• Comparable for benchmarking with other

organizations

• Measures can stand in at both the system and HSP

level.

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Common Measures

• These measures can stand in at both the system and HSP

level…as an example…

System Level Ministry LHIN Performance Agreement

(MLPA):

• Repeat ED visits for Mental Health

• 15.2% for Q4 2013/14

• Repeat ED visits for Substance Abuse

• 24.9% for Q4 2013/14

• If you are MH&A HSP, you can measure these rates at

your organization level.

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Table Exercises

• You have been purposely placed at each of your tables

• We have tried to segment attendees by placing “like” with

“like” as best we could:

• Adult Day Services providers

• Supports for Daily Living

• LTC Homes

• MH&A HSPs

• Etc…

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Table Exercise

• Choose a scribe

• Blank Paper and Pens are on your tables

• Prior G2G start on indicators provided at your table

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EXERCISE:

Attributes of a High Performing HSP “Sector”

Part 1

• For your healthcare program/sector how would you define

what is:

• Safe?

• Accessible?

• Effective?

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Example – HQO Attributes for Home Care

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EXERCISE:

Indicators to Measure HSP “Sector” Attributes

Part 2

• For your healthcare program/sector how would you

measure:

• Safe?

• Accessible?

• Effective?

• Be specific!

• Clear consistent definition, define the numerator

and/or denominator

• How would it be measured?

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Goals for this exercise

1. What is your “program or sector” high level definition for

the attributes:

• safe,

• accessible and

• effective.

2. What one indicator can you agree should be considered by

your HSP and “sector” to measure:

• safe,

• accessible and

• effective.

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Exercise Debrief

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Reminders

• For those Executive Directors and Board members who

attended the Board Education Sessions, Session #3 is

happening on September 24th at 5:30 pm – 8:00 pm.

Please register (link found on LHIN website under G2G)

• HOLD THE DATE: Next Governance to Governance

Session will be: Wednesday, December 3, 2014

• Your feedback on this event is important! A survey link

will be emailed to you in the next few days

• Contact us at GovernanceGroup@lhins.on.ca

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Closing Remarks

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Thank you for attending

tonight’s session

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