Quality Imprvement Plan (QIP) Narrative fr Health Care Organizatins in Ontari 2/7/2016 This dcument is intended t prvide health care rganizatins in Ontari with guidance as t hw they can develp a Quality Imprvement Plan. While much effrt and care has gne int preparing this dcument, this dcument shuld nt be relied n as legal advice and rganizatins shuld cnsult with their legal, gvernance and ther relevant advisrs as apprpriate in preparing their quality imprvement plans. Furthermre, rganizatins are free t design their wn public quality imprvement plans using alternative frmats and cntents, prvided that they submit a versin f their quality imprvement plan t Health Quality Ontari (if required) in the frmat described herein. 1
Overview The 2016-2017 Annual Quality Imprvement Plan (QIP) is part f ur nging cmmitment t patients, caregivers, cmmunity and funders t prvide the best quality care in a fiscally respnsible manner. Building n the learnings frm Central CCAC s tw previus QIPs, the 2016-2017 QIP fcuses n further integrating quality within ur strategic planning prcess. Guided by ur Visin, Outstanding care every patient, every day, the pririties identified in this QIP are supprted by a slid strategic fundatin that fcuses the rganizatin n: Quality thrugh Integrated Care Quality thrugh Access t Care and Services Quality thrugh Optimizing Patient Outcmes In additin t capitalizing n pprtunities fr nging imprvement, we have aligned ur QIP t a key gvernment strategy that utlines the future f health care in Ontari - Patients First: Prpsal t Strengthen Patient-Centred Health Care in Ontari. As part f ur cmmitment t quality, safety and excellence in quality imprvement, Central CCAC participates in a rigrus Qmentum accreditatin prgram thrugh Accreditatin Canada. The accreditatin prcess measures and assesses ur prgrams and services against a natinal set f standards n a fur-year cycle. In December 2015, Central CCAC was Accredited with Exemplary Standing, the highest level f accreditatin available t health care rganizatins, fr ging beynd the requirements f Accreditatin Canada and demnstrating excellence in quality imprvement. We utilize accreditatin standards and best practices in the develpment f quality imprvement initiatives, quality imprvement plans and strategic initiatives. The six cmmn areas f fcus fr CCACs are: Maintaining the percentage f patients wh experienced a fall in the hme Reducing Emergency Department visits by Central CCAC patients within 30 days f hspital discharge Reducing hspital readmissin by Central CCAC patients within 30 days f hspital discharge Increasing the percentage f cmplex patients wh receive nursing and persnal supprt services within five days f being admitted t CCAC services Imprving the verall patient experience Imprving the experience f palliative/end-f-life patients by supprting them in their preferred place f death We engaged a brad range f stakehlders t help infrm ur QIP and used Health Quality Ontari s Appendix A: Appraches t Setting Targets fr Quality Imprvement Plans t determine ur targets fr 2016-17. We als incrprated learnings frm ur tw previus QIPs t streamline the prcess fr sliciting change ideas and priritizing imprvements. As we cntinue ur quality imprvement jurney, we anticipate challenges in the cming year. With mre than half f ur patients nw cming directly frm hspital, we are crdinating care fr an increasingly cmplex grup f patients. We have the highest number f patients with high and very high needs f any CCAC. We als prvide services in ne f the mst diverse and fastest-grwing regins in the prvince. Sme f the anticipated challenges include: Falls: Given the aging ppulatin in the Central regin and the highest number f cmplex patients in the prvince, we anticipate the number f patients wh experience a fall in the hme t increase significantly. Hwever, with the falls preventin strategies that we are implementing, we expect t minimize the upward trend and maintain ur current falls rate at 31.4%. Data availability: We understand that data fr three f ur QIP measures - Patient satisfactin, ED visits and hspital readmissins - may nt be easily accessible. Central CCAC will cntinue t explre ther lcal measures that may give us a better indicatin f ur perfrmance in a timelier manner. Budget: A rapidly aging ppulatin, cmbined with the increasing cmplexity f patients care needs, places pressure n existing resurces. Central CCAC s strategic pririties supprt equity and cnsistency f service fr patients with similar needs and help us make the best use f resurces available t prvide quality, patient-centred care. 2
Privacy: With increased cllabratin cmes the need fr sharing f patient infrmatin and data acrss sectrs and prviders. Central CCAC will take apprpriate measures t ensure mechanisms are in place t mnitr and mitigate privacy breaches. Transfrmatinal year: In this year f health system transfrmatin, which may result in a new structure fr the hme and cmmunity sectr, Central CCAC will need t be diligent and fcused in rder t achieve ur QIP targets. QI Achievements frm the Past Year One f Central CCAC s pririties in 2015-16 was t increase utilizatin at ur seven cmmunity nursing clinics. CCAC nursing clinics are a cnvenient, cst-effective mdel f care that allws us t maximize health care funding and ensure that we can cntinue t prvide health services t as many peple as pssible in the cmmunity. There are several benefits frm bth the patients and rganizatin s perspective, including: Patients benefit scially and physically when they are able t get ut f their hme and attend a cmmunity clinic Clinics prvide scheduled appintment times n waiting at hme r in ER Clinics are pen 7 days/week frm 8:00 a.m. t 8:00 p.m. and ffer a variety f appintment times Clinics are cnveniently lcated t minimize required travel time Supplies are available n site n risk f supplies nt arriving r running ut at hme, needing t be at hme fr supply delivery, r finding a place t stre supplies Frm an rganizatinal perspective, Central CCAC has realized a savings f $32 per visit when cmpared t in-hme nursing. These savings have been reinvested int patient care, allwing Central CCAC t prvide persnal supprt service t mre high needs patients. Data played an integral rle in ensuring the right prcess were being addressed and sustained imprvements were being made. At the early nset f this initiative, the rganizatin cnducted an audit at the pint f intake t better understand where imprvement effrts shuld be fcused. Based n these findings, strategies were develped t address areas f pprtunities, including: Establishing targets fr each team Redesigning the intake prcess frm the hspital Increasing awareness f CCAC clinics as an alternative t visiting the emergency department fr treatments In additin, the weekly mnitring f clinic utilizatin (in-hme nursing referrals versus clinic referrals) allwed the prject team t drive imprvement and adjust strategies accrdingly. Patient input was als included in the imprvement prcess thrugh feedback cllected thrugh patient satisfactin surveys. As with any successful imprvement initiative, the senir leadership team played an integral rle in its success. Frm designating this initiative as a strategic pririty fr the rganizatin t taking n the rle as executive spnsr, their invlvement and nging supprt helped remve barriers and allwed the initiative t gain tractin. Central CCAC s nursing prviders als played a key rle in the success f this initiative. Wrking tgether as ne integrated team, bth CCAC care crdinatrs and nursing prviders cnsistently cmmunicated the benefits f receiving nursing care at a CCAC cmmunity clinic. Given the shared understanding f the benefits f this initiative by patients, CCAC staff and service prviders, Central CCAC was able t achieve significant utcmes. Having increased clinic utilizatin by 40%, frm 55% in April 2015 t 82% in February 2016, we believe this initiative was Central CCAC s greatest quality imprvement achievement this past year. Our gal is t sustain the mmentum and cnsistently maintain an average clinic utilizatin f 80%. 3
Integratin and Cntinuity f Care As a key partner in the health care system, we wrk cllabratively with hspitals, primary care prviders and cmmunity supprt agencies t develp and implement quality imprvement initiatives t imprve integratin and cntinuity f care fr patients. These prgrams are cntinually evaluated and imprved based n patient and stakehlder feedback. Belw are sme key stakehlders that we wrk with t supprt transitins in care and ultimately help achieve ur QIP gals: Hspitals Wrk clsely with Central LHIN hspitals t develp and test a predictive tl t trigger interdisciplinary case cnferences during transitins. Our gal is t increase the number f case cnferences triggered by the use f this predictive tl resulting in integrated care fr patients acrss the health system. Imprve cmmunicatin with hspitals: Thrugh the E-ntificatin initiative, Central LHIN hspitals will ntify Central CCAC every time a CCAC patient visits the Emergency Department r is re-admitted t hspital. Our gal is t have E-ntificatin rlled ut and in use at all seven Central LHIN hspitals by March 31, 2017. Cllabrating with hspitals n the Integrated Funding Mdel t develp and test innvative mdels f care. Service Prviders Enhance service delivery and patient experience by engaging Central CCAC staff and service prviders Wrk cllabratively with service prviders t adpt and implement best practice in falls preventin screening tls. The gal is t have all Central CCAC cntracted service prviders utilize best practice in their wn falls preventin screening tls by September 2016. Patients and Caregivers Actively engage patients and families in Central CCAC quality imprvement initiatives. Our gal is t engage 30 patients/caregivers in 2016-17. Cntinue t supprt patient and caregiver vice in service planning and delivery. Fr example, patients and caregivers can chse when they want CCAC services t cmmence. Staff Engage staff in the develpment f standard rdering practices t supprt patients in receiving safe, quality care in a timely manner. Develp and execute an HR plan t supprt staff during this year f health system transfrmatin. Central LHIN Partner with the Central LHIN t develp a reginal hub mdel fr palliative care. The gal is t imprve the experience f palliative/end-f-life patients by supprting them in their preferred place f death. Central CCAC will cntinue t actively seek ut pprtunities t cllabrate with health system partners and stakehlders t ensure residents in ur cmmunity have access t timely, safe and high quality care and services. 4
Engagement f Leadership, Clinicians and Staff At Central CCAC, we strngly believe in engaging the rganizatin in ur quality imprvement effrts t help drive changes that are meaningful t ur patients. This was ne f ur guiding principles thrughut the develpment f this year s QIP, alng with incrprating patient/caregiver feedback. We began ur QIP prcess by benchmarking ur perfrmance against the ther 13 CCACs and using Health Quality Ontari s dmains fr target setting. We held five fcus grups, each fcusing n ne f the quality dimensins f the QIP effectiveness, patient centered, safety, timeliness and palliative care. The fcus grup participants included frntline staff, managers, senir leadership and cntracted service prviders. Each fcus grup had an pprtunity t prpse a target alng with the assciated change ideas. The grup priritized these ideas and drafted a prpsed wrk plan. A separate fcus grup was held with patients and caregivers t help understand what changes they wuld like t see incrprated int ur wrk plan. This feedback was incrprated int a draft wrk plan and shared with ur hspital partners wh prvided additinal feedback. The additinal changes were incrprated int a revised wrk plan and presented t ur senir leadership team. Once apprved, it was shared with the Central CCAC Bard f Directrs. Similar t last year, each f the change ideas will have assigned leads wh wrk clsely in the area f fcus t ensure the changes are being implemented. Oversight fr this wrk will be prvided by the quality and safety cmmittee, including mnitring the implementatin f each change idea and hw these changes are cntributing t the verall measure. This prcess wrked well last year and supprts accuntability. One f the challenges that Central CCAC faced in the develpment f the QIP was the priritizatin f the change ideas. Given that 2016-17 is expected t be a year f transfrmatinal change fr the health system, it was difficult t determine which change ideas wuld be feasible. Anther challenge that was presented was the inability t benchmark perfrmance fr three f the indicatrs - hspital admissin, unplanned emergency department visits and patient experience. At the time the fcus grups were held, the data was nt available fr these indicatrs and, therefre, it was difficult t use Health Quality Ontari s Appendix A: Appraches t Setting Targets fr Quality Imprvement Plans t establish ur targets fr 2016-17. Client, Patient, Resident Engagement A prven way t enhance care quality is t engage directly with patients and family and embed their vice int everything we d. We see patients and families as an integral part f the care team and wrk hard t listen and respnd t their preferences and persnal gals. Last year, Central CCAC made prgress n ur multi-year strategy t increase patient and caregiver invlvement in key decisins, fr example thrugh participatin in fcus grups and steering cmmittees. In 2015-16, Central CCAC held 16 quality events with ver 200 patients, caregivers, staff and health and cmmunity partners t find better ways f wrking tgether t meet patient needs. In additin, five patients/caregivers participated n a cmmittee t infrm hw best t engage patients and caregivers in ur planning and decisin-making. As well, three patients/caregivers participated in fcus grups t help develp Central CCAC s 2016-17 quality imprvement wrk plan. We cntinue t use patient stries t start each cmmittee meeting t help fcus us n what is really imprtant The Patient. T supprt cntinuus quality imprvement, Central CCAC has a cmprehensive, mandatry reprting system that is used by ur emplyees and cntracted service prviders t track and mnitr risks and cmplaints. We systematically analyze this infrmatin and thrugh investigate issues, using what we learn t drive quality imprvements in cllabratin with everyne invlved in the patient s care. We als track cmpliments, giving us a better understanding f what we need t d mre f in ur day-t-day wrk. Patient satisfactin surveys are als analyzed t understand hw t better deliver services in clinics and thrugh ur direct nursing prgrams rapid respnse nursing, Telehmecare and nurse practitiners. These surveys ultimately infrm actin plans and quality imprvement initiatives. 5
Over the cming year we will cntinue t fcus n patient and caregiver engagement thrugh fcus grups, interviews, quality imprvement events and surveys. We als plan t enhance the active rster f patients and caregivers wh will be called upn t prvide input and guidance t help Central CCAC imprve the care experience fr all patients and families. Sign-ff It is recmmended that the fllwing individuals review and sign-ff n yur rganizatin s Quality Imprvement Plan (where applicable): I have reviewed and apprved ur rganizatin s Quality Imprvement Plan Bard Chair Je Parker (Name) Original signed by (Signature) Quality Cmmittee C-Chair Al Luciani (Name) Original signed by (Signature) Quality Cmmittee C-Chair Charles Schade (Name) Original signed by (Signature) CEO Megan Allen-Lamb (Name) Original signed by (Signature) Vice-President, Patient Services & Care Crdinatin Tini Le (Name) Original signed by (Signature) Vice President, OHPI Jacqueline Mckler (Name) Original signed by (Signature) 6