Excellent Care for All Quality Improvement Plans (QIP): Progress Report for 2016/17 QIP

Transcription

1 Excellent Care for All Quality Improvement Plans (QIP): Progress Report for QIP The Progress Report is a tool that will help organizations make linkages between change ide and improvement, and gain insight into how their change ide might be refined in the future. The new Progress Report is mostly automated, so very little data entry is required, freeing up time for reflection and quality improvement activities. Health Quality Ontario (HQO) will use the updated Progress Reports to share effective change initiatives, spread successful change ide, and inform robust curriculum for future educational sessions. ID Meure/Indicator from 1 5 Day Wait Time - Nursing Visits: % of patients who received their first nursing visit within 5 days of the service authorization date. ( %; Home Care Clients; Oct 2014 Sep 2015; OACCAC CHRIS, OACCAC DAD) QIP on QIP In, NSM CCAC continued to focus on improvement and sustainability of our cycle time from service authorization to service offer. Though wait time results for nursing showed slight variation month over month, the gains achieved in 2015/16 were sustained from Q1 through Q3 and our target of 95.0% w met in the month of May. We continue to work with our service providers to track towards our target throughout the remainder of. This indicator will continue to be closely monitored into /18. Change Ide from Lt Year s QIP (QIP ) Business process redesign to ensure consistent use of Patient Availability Date(PAD) in patient databe (CHRIS). W this change idea implemented intended? (Y/N button) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? ed education w completed with Team Assistants and Care Coordinators on the correct use of the patient available date and service scheduling reons in CHRIS (our patient information system) and on the electronic service authorization form. In Q4, NSM in partnership with one service provider organization (SPO) is completing a PDSA cycle (Plan, Do, Study, Act) to test a standard process for provider notification of a change in first visit date due to patient/family choice.

2 Change Ide from Lt Year s QIP (QIP ) Business process redesign of service offer process for community referrals. Communication of 5 day wait time monthly results to contracted service provider organizations and internal staff. *5 Day Wait Time Nursing Change Ide Cont d W this change idea implemented intended? (Y/N button) No What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? NSM completed a PDSA cycle on a new service offer process for community nursing and complex personal support (PS) referrals with a goal of reducing cycle time. This process change shifted the responsibility for service offers from one team to another. During this testing it w learned that there were a number of undocumented scenarios that required further investigation. After hearing feedback from both teams, the process w reverted back to the original process until further education and documentation is completed and a second PDSA cycle can be tested. Service providers receive their organization s 5 day wait time results monthly through communication from our contracts team. In addition, at quarterly all provider meetings, overall results are shared. Internally wait time results are shared at quarterly meetings between senior leadership and staff, successes celebrated in our internal weekly newsletter and on the NSM internal SharePoint page.

3 ID Meure/Indicator from 2 5 Day Wait Time - Personal Support for Complex Patients: % of complex patients who received their first personal support service within 5 days of the service authorization date. ( %; Home Care Clients; Oct Sep 2015; OACCAC CHRIS, OACCAC DAD) QIP In, NSM CCAC continued to focus on improvement and sustainability of our cycle time from service authorization to service offer. Significant improvements were made throughout for complex personal support. NSM reached their target of 85.0% of complex PS patients being seen within 5 days or less by the end of Q2, and by the end of Q3 exceeded this target. We continue to track toward sustaining this performance throughout the remainder of. This indicator will continue to be closely monitored into /18 with new stretch targets set for continued improvement. Change Ide from Lt Year s QIP (QIP ) Business process redesign to ensure consistent use of Patient Availability Date (PAD) in patient databe (CHRIS). W this change idea implemented intended? (Y/N button) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? ed education w completed with Team Assistants and Care Coordinators on the correct use of the patient available date and service scheduling reons in CHRIS (our patient information system) and on the electronic service authorization form. In Q4, NSM in partnership with one service provider organization is completing a PDSA cycle (Plan, Do, Study, Act) to test a standard process for provider notification of a change in first visit date due to patient/family choice.

4 Change Ide from Lt Year s QIP (QIP ) Business process redesign of service offer process for community and hospital referrals. Communication of 5 day wait time monthly results to contracted service provider organizations and internal staff. *5 Day Wait Time Personal Support Change Ide Cont d W this change idea implemented intended? (Y/N button) No What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? NSM completed a PDSA cycle on a new service offer process for community nursing and complex PS referrals with a goal of reducing cycle time. This process change shifted the responsibility for service offers from one team to another. During this testing it w learned that there were a number of undocumented scenarios that required further investigation. After hearing feedback from both teams, the process w reverted back to the original process until further education and documentation is completed and a second PDSA cycle can be tested. Service providers receive their organization s 5 day wait time results monthly through communication from our contracts team. In addition, at quarterly all provider meetings, overall results are shared. Internally wait time results are shared at quarterly meetings between senior leadership and staff, successes celebrated in our internal weekly newsletter, and on the NSM internal SharePoint page.

5 ID Meure/Indicator from 3 Dying in preferred place of death: % of palliative/end of life patients who died in their preferred place of death. ( %; Palliative patients; N/A; CHRIS) QIP CB CB 51.4 Throughout NSM CCAC focused on improving data quality for the tracking of patients preferred place of death for the purpose of establishing a beline and the setting of improvement targets for /18. Change Ide from Lt Year s QIP (QIP ) Standard process for utilization of discharge dispositions related to patient preferred place of death. Capture initial and follow up conversations regarding preferred place of death in Client Health and Related Information System (CHRIS). W this change idea implemented intended? (Y/N button) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? A standard business process and documentation standards were developed for correct utilization of discharge dispositions related to patient s preferred place of death. Education w provided to the palliative team on this process. An auditing process h been implemented to ensure proper use and improvement in coding month over month. In Q3 a standard process for palliative care coordinators to document their initial conversation with the patient/family concerning preferred place of death at both initial and resessment w implemented. This ensures that this information is being consistently and accurately documented in CHRIS in preparation for the new preferred place of death coding to be releed in CHRIS in /18.

6 ID Meure/Indicator from 4 Percent of home care clients who responded "Good", "Very Good", or "Excellent" on a fivepoint scale to any of the client experience survey (CCEE) questions: i) Overall rating of CCAC services ii) Overall rating of management/handling of care by Care Coordinator iii) Overall rating of service provided by service provider ( %; Home Care Clients; April 2014 March 2015; OACCAC CCEE Survey) QIP As evidence suggests that there is a correlation between staff satisfaction and positive patient outcomes, NSM CCAC continued to seek opportunities in to improve both patient and staff experience. Building on the outcome of patient engagements completed in 2015/16, patients and caregivers were engaged in several quality improvement initiatives including a process for informing patients/ caregivers of a change in their care coordinator and in the expansion of our nursing care clinics. The Patient and Staff Experience Team gained momentum and implemented various initiatives with goal of improving the overall culture of the organization and staff satisfaction. This work w informed by results from the Work-Life Pulse Tool through Accreditation Canada. Through these initiatives we were able to sustain our results within 1.0% and continue to be equivalent to the provincial average.

7 Change Ide from Lt Year s QIP (QIP ) Identify and implement two quality improvement initiatives that will improve overall patient experience. Identify and implement two quality improvement initiatives that will improve overall staff experience. Implement patient experience survey for patients attending nursing clinics and for patients transitioning from hospital to home. *Patient Experience Change Ide W this change idea implemented intended? (Y/N button) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? With the expansion of nursing clinics in the NSM region patients were engaged to determine what factors impacted both positively and negatively on their clinic experience. This information informed improvements in our clinics and provided the opportunity to address concerns specific to transportation needs of our patients. As a result, NSMhealthline added a transportation link for patients and caregivers to improve clinic access. NSM Patients/caregivers were also engaged in developing a standard communication process for informing patients/families of a change in their care coordinator. This new process is currently being implemented. Quarterly meetings with staff and senior leadership were rein a result of survey results that reflected staff s need for increed communication from senior leaders. From staff focus group results, a peer to peer recognition program w launched in Q3 starting with a gratitude tree during the holiday seon. Overall staff work-life and organizational culture will be an ongoing focus at NSM CCAC for remainder of Q4 and for /18 the organization transitions to the renewed LHIN. Through NRCC NSM began surveying patients who received their nursing care at clinics. These results will be included in our analysis of overall patient experience. The Transition survey which focuses on the patient s experience in transitioning from hospital to home will be launched for patients who were discharged from hospital during Q4. In addition, NSM implemented the Caregiver Voice survey in Q2 which surveys caregivers and focuses on their experience with the end of life care received by their family member. These surveys will be continued into the /18 fiscal year.

8 ID Meure/Indicator from 5 Percentage of adult long-stay home care clients who have a fall on their follow-up of the international research network s Resident Assessment Instrument (interrai) for home care. ( %; Home Care Clients; Oct Sep 2015; OACCAC HCD) QIP Through the implementation of a number of improvement initiatives, CCAC continues to be a collaborative partner with the Integrated Regional Falls Program (IRFP), our contracted service providers and with other community agencies and together have exceeded the NSM QIP target by reducing the percentage of falls among long stay home care patients. Change Ide from Lt Year s QIP (QIP ) Support utilization of standard process for falls risk reporting. Standard referral process to the Integrated Regional Falls program for patients identified a falls safety risk. W this change idea implemented intended? (Y/N button) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? Staff were educated by the NSM CCAC Falls Committee and ongoing audits of the reporting process are completed. In Q2 a new process w initiated where falls risk issues were also reported by the Information and Referral (I&R) team which increed the number of falls risk issues being entered for new patients. Our target of 50% improvement from beline w met and exceeded for the % of occurrences when a falls risk w identified in the RAI-HC sessment and a falls issue w entered in CHRIS. In Q4, referrals to the IRFP transitioned from a manual to an electronic process. This change ensures a more efficient referral process, allows the care team to see that a referral h been made and allows for NSM to track the # of referrals made to the program. This improvement will move forward into /18 we ensure that all eligible patients are referred.

9 ID Meure/Indicator from 6 Percentage of home care clients who experienced an unplanned readmission to hospital within 30 days of discharge from hospital ( %; Home care clients discharged from hospital; July 2014 June 2015; OACCAC HCD, CIHI DAD, CIHI NACRS) QIP In NSM CCAC continued to focus on strategies to reduce unplanned hospital readmissions through small tests of change and sustaining cross organizational partnerships. Though we have not seen an improvement in our results, we are on par with the province and continue to focus on reducing readmissions for specific populations including COPD and CHF in partnership with Primary Care, Health Links and our Hospitals. Change Ide from Lt Year s QIP (QIP ) Ongoing partnership in the Health Link approach to care to support the completion of Coordinated Care Plans for identified Health Link patients. Provide access to patient information via the Community Health Portal (CHP) for all Family Health Teams within the NSM region. Incree the number of patients (COPD and CHF) enrolled in the Telehomecare monitoring program. W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? NSM is actively engaged with all Health Link partners at the steering committee level, and actively participates in the completion of Coordinated Care Plans for complex patients in multiple are within the region. NSM continues to work with Primary Care organizations who express readiness to access patient information through access to the shared Community Health Portal (CHP). Access to the health portal is currently underway with two Family Health Teams and will continue into /18. Engagement with community stakeholders w ongoing throughout including hospitals and family health teams. By the end of Q3 the monitoring program exceeded the annual enrolment target by 10%.

10 ID Meure/Indicator from 7 Percentage of home care clients with an unplanned, less-urgent ED visit within the first 30 days of discharge from hospital. ( %; Home care clients discharged from hospital; July 2014 June 2015; OACCAC HCD, CIHI DAD, CIHI NACRS) Change Ide from Lt Year s QIP (QIP ) Incree the number of patients (COPD and CHF) enrolled in the Telehomecare coaching program. Expand e-notification process currently used at Royal Victoria Regional Health Centre to all hospitals within NSM. Implement redesign of intravenous (IV) medication referral process within all NSM hospital emergency departments and spread to inpatient referrals. QIP In NSM CCAC continued to focus on strategies to reduce unplanned, less-urgent ED visits through small tests of change and sustaining cross organizational partnerships. Though we have not seen an improvement in our results we are on par with the province and continue to focus on reducing unplanned ED visits for specific populations including COPD and CHF in partnership with Primary Care, Health Links and our Hospitals. W this change idea implemented intended? (Y/N button) No Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? Engagement with community stakeholders w ongoing throughout including hospitals and Family Health Teams. Referrals to the Telehomecare program have shown an incree in over 2015/16. E-notification w successfully implemented at Royal Victoria Regional Health Centre. With a shift in priority within our LHIN area to the implementation of the e-referral between acute care and CCAC, the expansion of this functionality w put on hold though will be a focus for implementation in /18. In, NSM improved the medication referral process with the rollout of a new medication referral form for both ER and inpatient referrals. Revisions to existing documents used by staff provide consistent reminders of standard cut off times for same day medication orders to avoid missed doses and the requirement for a contingency plan.

11 Change Ide from Lt Year s QIP (QIP ) Ensure equitable access to nursing services through the implementation of nursing ambulatory clinics in all subregions within NSM. *Unplanned ED Visits- Change Ide Cont d W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? NSM h successfully launched nursing clinics in 4 of our 5 sub regions. Planning is in progress for the 5 th sub region with implementation expected in early /18. ID Meure/Indicator from 8 Safety: Percent of home care patients who responded "" to the following patient experience survey questions: Ce Manager discussed Safety Issues Told how to move around home safely ( %; Home Care Clients; April 2014 to March 2015; NRC Picker) QIP NA current performance on this indicator is not comparable the questions have changed. Safety h been an ongoing focus at NSM CCAC and is reflected in our improvement on this indicator year over year since 2012/13. Patients, caregivers well internal and external stakeholders have been engaged in a number of patient safety initiatives including: the ongoing development of our Safe at Home webpage; a workshop with our service provider organization s to strategize on ide to improve patient safety and an interactive patient safety fair for NSM staff during patient safety month in November. Change Ide from Lt Year s QIP (QIP ) Evolve the "Safe At Home" webpage on the North Simcoe Muskoka (NSM) CCAC website through feedback from patients, families and other stakeholders. W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? A sample of patients and caregivers were contacted with direction on reviewing the safe at home website well completion of an online survey to provide feedback. In addition, a small subgroup of the Patient Safety Committee with staff and service providers met and reviewed the

12 *Safety - Change Ide (Cont d) content of the safe at home website and provided recommendations, which were implemented in Q4. Change Ide from Lt Year s QIP (QIP ) Identify key are for improving patient safety in the home through collaboration with contracted service provider organizations (SPOs). W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? NSM hosted a workshop focusing on falls and patient safety with our SPOs. Two change ide for inclusion on SPO QIPs were identified. All SPO QIPs were submitted in July and included change ide to support patient safety in the home.