Report to Rapport au: Ottawa Board of Health Conseil de santé d Ottawa. March 17, mars 2014

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1 Report to Rapport au: Ottawa Board of Health Conseil de santé d Ottawa March 17, mars 2014 Submitted by Soumis par: Dr./ D r Isra Levy, Medical Officer of Health/Médecin chef en santé publique Contact Person Personne ressource: Esther Moghadam, Manager/Gestionnaire Integration, Quality and Standards Direction de l intégration, de la qualité et des normes Ottawa Public Health / Santé publique Ottawa , ext./poste esther.moghadam@ottawa.ca Ward: CITY WIDE / À L'ÉCHELLE DE LA VILLE SUBJECT: QUALITY IMPROVEMENT PLAN File Number: ACS2014-OPH-IQS-0002 OBJET: PLAN D'AMÉLIORATION DE LA QUALITÉ REPORT RECOMMENDATIONS That the Board of Health for the City of Ottawa Health Unit receive this report for information. RECOMMANDATIONS DU RAPPORT Que le Conseil de santé de la circonscription sanitaire de la ville d Ottawa prenne connaissance du présent rapport à titre d information.

2 BACKGROUND The purpose of this report is to inform the Board of Health on the development and implementation of Ottawa Public Health s (OPH s) Quality Improvement Plan (QIP). Continuous quality improvement in public health is the use of a deliberate and defined improvement process, which is focused on activities that respond to community needs and improve population health: an effort to achieve measurable improvements in efficiency, effectiveness, performance, accountability and quality outcomes in services and processes. 1 Through the Strategic Plan, the Board of Health identified continuous quality improvement as a focus. Additionally, the Ontario Public Health Organizational Standard requires public health units to provide policy direction on performance management and quality improvement. OPH is committed to quality improvement through evidenced-informed practice, health status reports, surveillance and Public Health Accountability Agreements. For several years, quality improvement within OPH has been supported by branch program reviews, program evaluations, client satisfaction and employee engagement surveys, and quarterly organizational performance reviews. Global movement towards formal quality improvement plans Although quality improvement research studies are fairly new within the public health field, studies have demonstrated that applying quality improvement methods have positive effects on public health outcomes, such as immunization rates and breastfeeding initiation rates, while also reducing operational costs and adverse client safety events, and improving working conditions and client satisfaction Across the healthcare and public health sectors, there has been significant movement towards formalizing quality improvement processes. This movement has been taking place at the international, national, provincial and local levels, as health organizations increasingly recognize that the efficient provision of high quality public health services is fundamental to population health outcomes and contributes to enhancing public trust and confidence. Within Canada, many healthcare organizations have pursued voluntary accreditation of quality improvement processes. Among national accrediting bodies, Accreditation Canada (AC) is now recognized as a national leader and has recently introduced public health service standards to focus on client and community safety as well as operational excellence. Among the 36 Ontario public health units, 14 are currently accredited.

3 OPH Quality Improvement Plan Work on the Quality Improvement Plan was initiated in June 2012, beginning with a selfassessment on quality and client safety completed by frontline and management staff, which revealed several opportunities for improvement. To ensure the success of these quality improvement efforts, the Quality Improvement Plan was formalised and quality work teams were established. The operational Quality Improvement Plan (held on file with the Board of Health Secretary) is guided by the following ten dimensions of quality: 1. Safety keep client/community safe 2. Effectiveness do the right thing to achieve the best possible results 3. Efficiency optimize the use of resources and ensure financial and operational sustainability 4. Accountability meet Ministry of Health and Long-Term Care and Ministry of Children and Youth Services reporting requirements and be financially responsible 5. Responsiveness take prompt and appropriate steps to remediate unplanned events 6. Population approach match the right level of resources to meet the needs of communities 7. Client-centered services enhance client satisfaction and experience 8. Work life promote wellness in the workplace 9. Continuity of services offer coordinated, uninterrupted services with community support 10. Equity offer timely, culturally-acceptable, accessible and equitable services DISCUSSION OPH s Quality Improvement Plan supports improvement activities that provide an integrated approach to client and community safety as well as quality services. Key quality improvement activities have been chosen based on several criteria, including: addressing opportunities identified through the OPH self-assessment; addressing gaps with the Ontario Public Health Standards; and enabling achievement of Public Health Funding and Accountability Agreement (PHFAA) Indicator targets.

4 Progress on quality improvement priorities is monitored through the quality work teams. In addition, a centralized decision support function has been established and dashboard reports are reviewed on a quarterly basis. The dashboard report provides pertinent indicator information driving frontline staff, supervisors and management accountability, and key decisions related to quality improvement. The six key quality improvement priorities for include: 1. Managing medication The goal of this activity is to further enhance client safety by reviewing and improving current processes related to medication management: avoiding the use of abbreviations that can lead to errors, proactively maintaining equipment used to provide direct client services, and managing the supply chain of medications and medical equipment necessary to provide optimal service to OPH clients. In addition to client safety this will support client satisfaction and further enhance public trust and confidence. This initiative will be most directly pertinent to clinical settings, such as OPH dental, sexual health and immunization clinics, but will also provide benefits for non-clinical services. 2. Administrative policy framework The goal of this QI activity is to further enhance organizational effectiveness and client safety by ensuring that staff proactively engages in the development, review and records management of policies, procedures and medical directives. This will have organization-wide benefits in mitigating client safety risks associated with the absence of effective and up-to-date documentation. Mobile, office- and clinic-based staff will benefit from having a direct and quicker access to all policies for delivering programs and services. 3. Infection prevention and control The goal of this activity is to enhance client and staff safety by coordinating, planning, implementing and evaluating infection prevention and control procedures and inspections. The focus will be to protect clients, staff, students and volunteers from exposure to infections, including a hand hygiene program as well as immunization policies. 4. Fulfillment of PHFAA Indicator Targets Through the PHFAA, Ottawa Public Health investigates and takes corrective action when indicator targets are not reached (negative performance variant reports).

5 Proactively, staff also undertakes ongoing risk analyses regarding indicator targets that require 100% compliance. While there continue to be several population-level health promotion measures included within the PFHAA, which are influenced by complex interactions of many factors often beyond the direct control of the Board of Health, there are several indicator targets which stand to benefit more directly from strengthened quality improvement processes. 5. Client Satisfaction OPH is committed to service excellence and recognizes the substantial impact that client satisfaction can have, in combination with employee engagement and organizational excellence, on public trust and confidence. Collecting client input will allow OPH to continually improve services and ensure services are meeting clients needs in an efficient and effective manner, support program-level decision-making and service optimization. 6. Information technology (IT) OPH is committed to leveraging technology to extend services and make better connections with clients. In 2014, pending the provincial project running as planned, the first two modules of PANORAMA, a provincial communicable disease surveillance management system, will be implemented by OPH. This system will improve quality, efficiency and client safety through integrated client, workflow, knowledge, records and data management, as well as improved information security and interoperability. It will also ensure that there is integrated work processes and information across organizational units and functions. OPH will also continue to be an active participant in the City of Ottawa s Mobile Workforce Initiative and will have a total of 110 mobile field workers from three program areas fully deployed by the second quarter of Next steps Significant progress has been made towards enhancing a culture of quality improvement. In June 2014, OPH quality improvement results will be evaluated against Accreditation Canada s standard of excellence. The evaluation will further guide OPH in identifying opportunities to improve quality, reduce risk, and strengthen accountability into programs, policies and practices. Additionally, this evaluation by Accreditation Canada will require the involvement of two Board of Health members. OPH staff will

6 send a call of interest regarding participation in the accreditation process to Board members in the coming weeks. RURAL IMPLICATIONS There are no rural implications to this information report. CONSULTATION The purpose of this report is administrative in nature and therefore no public consultation is required. LEGAL IMPLICATIONS There are no legal impediments to receiving the information in this report. RISK MANAGEMENT IMPLICATIONS There are no risk management implications associated with this information report. FINANCIAL IMPLICATIONS There are no financial implications associated with this report. ACCESSIBILITY IMPACTS There are no accessibility implications to receiving this report. TECHNOLOGY IMPLICATIONS There are no technology implications associated with this report. BOARD OF HEALTH PRIORITIES The recommendations in this report support the Board of Health Strategic Priority: Maximize resources through continuous improvement, program adjustments, partnerships and technological efficiencies (F3). TERM OF COUNCIL PRIORITIES This report supports the Term of Council Priority: Healthy and Caring Communities.

7 DISPOSITION This report is provided for information and staff will continue to implement the Quality Improvement Plan. 1 Riley, W., Moran, J., Corso, L., Beitsch, L., Bialek, R. & Cofsky, A. (2010). Defining quality improvement in public health. Journal of Public Health Management and Practice, 16 (1): Smith, G., Poteat-Godwin, A., Harrison, L.& Randolph, G. (2012). Applying LEAN principles and kaizen rapid improvement events in public health practice. Journal of Public Health Management and Practice, 18 (1): Randolph, G. (2013). The CQI Movement in the US. Presented at the meeting to advance CQI in Ontario Public Health. Toronto, ON. September 20, Wright, S., Lea, C., Holloman, R., Cornett, A., Harrison, L. & Randolph, G. (2012). Using quality improvement to promote breast-feeding in a local health department. Journal of Public Health Management Practice, 18 (10); Livingwood, W., sabbgh, R., Spizfaden, S., Hicks, A., Wells, L. et al (2013). A quality improvement evaluation case study: impact on public health outcomes and agency culture. American Journal of Preventive Medicine, 44 (5): Public Health Quality Improvement Exchange (2013). Case studies retrieved from