Overview of the HQCA and the R i f Q lit A iReview of Quality Assurance in

Continuing Care Health Services gin Alberta

Charlene McBrien-MorrisonC ll St i kCarmella Steinke

October 23, 2014

Outline

Overview of the HQCAWho we areWho we areHow we get engaged and engage othersH d kHow we do our work

Review of Quality Assurance in Continuing Care Health Services in Alberta

ScopeFindings & recommendations

Who we are

Health Quality Council of AlbertaQ yAn independent corporation legislated under the Health Quality Council of Alberta Act with ya mandate to promote and improve patient safety and health service quality on a

i id b iprovince-wide basis.

How we get engagedLegislated mandate:

Measure, monitor and assess patient safety and health service qualityservice quality. Identify effective practices and make recommendations for the improvement of patient safety and health service quality. Assist in the implementation and evaluation of activities, strategies and mechanisms designed to improve patient g g p psafety and health service quality. Survey Albertans on their experience and satisfaction with patient safety and health service qualitywith patient safety and health service quality. Assess or study matters respecting patient safety and health service quality.Appoint a panel and provide administrative support for health inquiries, as directed by the Lieutenant Governor in Council.

How we engage others

Section 13The Council shall network … for the purposes of • sharing information on patient safety and

health service quality issues,• identifying and assessing patient safety and

h lth i lit i dhealth service quality issues, and• developing and recommending effective

ti i ti t f t d h lth ipractices in patient safety and health service quality

How we do our workSection 12 - reasonable access to information held by health authorities• Provincial custodian under HIA• Administrative health databases – e.g., IP,

Ambulatory Physician claims Vital statisticsAmbulatory, Physician claims, Vital statistics

Section 16 - enter and inspect any place under th j i di ti f i l h lth th itthe jurisdiction of a regional health authority, community health council or subsidiary health corporation; require the production of anycorporation; require the production of any documents or records

Survey Albertans on their experience and satisfaction

Continuing care surveys:• LTC Resident and Family 2007/08; Family 2010/11;

Family 2014Family 2014• Supportive Living (3, 4, 4D) Resident and Family 2014• Home Care development and pilot 2014

Review of Quality Assurance in Continuing y gCare Health Services in Alberta

Review of Quality Assurance in Continuing Care Health Services in Alberta

• In accordance with s.15(1) of the Health Quality Council Act, a review was requested by the Minister of Health inMinister of Health in September 2013

• In December 2013, the Minister expanded the scope of the review

ScopeHQCA examined the adequacy and monitoring of quality assurance and quality management processes in

fpublicly funded continuing care health services.

Out of scope - examination of:privately funded continuing care services

access to continuing care services

th t f i id dthe type or scope of services provided

the funding of continuing care services

the individual providers of continuing care servicesthe individual providers of continuing care services

Accommodation Standards (or quality assurance activities related to the Accommodation Standards)

aspects of contract management beyond quality management

Overview

The HQCA learned that there are tools and mechanisms in place for managing quality and safety in continuing care across Alberta’s healthcare system, however they can be strengthened, and applied more consistently.

Issue: Contracts

Due to variability in the continuing care contracts across the province, as well as lack of clarity for contract oversight, the contracts cannot be fully utilized as a tool to support AHS oversight of quality and safety management of contracted providers.

Recommendation 1AHS develop a plan, with timeframes, to move all legacy continuing care contracts over to thelegacy continuing care contracts over to the standardized master services agreement.

Recommendation 2AHS make explicit where the responsibility and accountability for continuing care contract accou tab ty o co t u g ca e co t actcompliance monitoring and oversight resides.

Issue: Auditing processes

The current auditing processes in continuing care result in redundancies and inefficiencies at the provider, health authority, and ministry levels.

Recommendation 3The Ministry of Health and AHS improve auditing processes in continuing care including Continuing C H lth S i St d d (CCHSS)Care Health Service Standards (CCHSS), Accommodation Standards, and accreditation with a goal to remove redundancy and improve efficiency.goal to remove redundancy and improve efficiency. When redesigning the audit processes, some general principles should be considered:

Consistent application across the province and across the three continuing care streams.

Auditing to be done by a group that is removed fromAuditing to be done by a group that is removed from frontline or zone operations.

Separation of the auditing process from the process thatSeparation of the auditing process from the process that provides quality improvement support and coaching.

Recommendation 4

The Ministry of Health and AHS provide clarity on th l d i t f dit ti ithe role and requirement for accreditation in quality and safety management for continuing carecare.

Issue: Quality monitoringThe information available from the interRAIassessment tool is being underused forassessment tool is being underused for quality monitoring and evaluation at all levels of the continuing care systemlevels of the continuing care system.

Recommendation 5

The Ministry of Health and AHS complete y pthe implementation and support the full use of the interRAI assessment instruments and the Alberta Continuing Care Information System (ACCIS).y ( )

Issue: Experience surveysContinuing care lacks a standardized, consistent and province wide approach toconsistent, and province-wide approach to administering client and family experience surveyssurveys.

Recommendation 6The HQCA continue to build on the work completed to date to establish validcompleted to date to establish valid, reliable, and consistent province-wide client and family survey tools and processes forand family survey tools and processes for long-term care, supportive living, and home care that support and facilitate qualitycare that support and facilitate quality improvement efforts throughout the continuing care systemcontinuing care system.

Issue: Safety informationNo single repository exists of continuing care safety information from across thecare safety information from across the province.

Recommendation 7AHS develop a plan for incorporating all continuing care safety information (e gcontinuing care safety information (e.g., reportable incidents, hazards/hazardous situations close calls patient harm eventssituations, close calls, patient harm events, concerns, and PPC reports) from AHS staff, physicians and contracted servicephysicians, and contracted service providers to effectively identify and analyze safety issues share safety informationsafety issues, share safety information across the continuing care system, and inform system improvementinform system improvement.

Issue: Roles and responsibilitiesQuality and safety management in continuing care lacks clarity in rolescontinuing care lacks clarity in roles, responsibilities, and accountabilities among the Ministry of Health AHS and contractedthe Ministry of Health, AHS, and contracted providers. Within AHS alone there is a similar lack of clarity regarding roles andsimilar lack of clarity regarding roles and responsibilities for quality and safety management in continuing caremanagement in continuing care.

Recommendation 8Recommendation 8The Ministry of Health and AHS develop an accountability matrix for continuing care thataccountability matrix for continuing care that clearly delineates the lines of responsibility and accountability for quality and safety managementaccountability for quality and safety management from the Ministry to AHS, and from AHS to contracted service providers.

Recommendation 9AHS ensure clear lines of accountability and responsibility for quality and safety management in continuing care.

Questionshqca.ca

Promoting and improving patient safety and health service quality across Alberta