Excellent Care for All Quality Improvement Plans (QIP): Progress Report for 2014/15 QIP The Progress Report is a tool that will help organizations make linkages between change ideas and improvement, and gain insight into how their change ideas 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 ideas, and inform robust curriculum for future educational sessions. ID Measure/Indicator from 2014/ Current Performance as stated on QIP14/15 Target as stated on QIP 14/15 Current Performance 1 Falls for Long-Stay Clients: Percentage of adult long-stay home care patients who record a fall on their follow-up RAI-HC assessment. Adult long stay home care clients BLANK HCD, RAI-HC via LSAS 33.80 32.50 37.20 Change Ideas from Last Years QIP (QIP 2014/15) Review leading practice comprehensive falls prevention program research to identify the key program elements, and initiate a Central East CCAC plan that incorporates these elements - initial focus will include rehabilitation and home safety assessments. Was this change idea implemented as intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? A comprehensive review of leading practice was completed in the Fall of 2014. The review demonstrated that leading practice tends to consist of four main components; 1) Home safety assessments, 2) Medication reconciliation, 3) Rehab/Activation & 4) Education. The review also points to considering the fact that CCAC s are caring for more patients with higher and more complex needs. At quality improvement team meetings, gaps were identified for the Central East CCAC. Some of the gaps included: providing patients with more and consistent education on preventing falls,
Audit the charts of patients who have indicated a fall to develop profile of patients that fall most frequently and explore common causes and other patterns, to inform the development of the Central East CCAC falls prevention plan and optimize the efforts for the highest risk population. Develop a focused treatment pathway/approach and evaluate it's impact to reduce falls for a subpopulation of patients within the newly developed Central East CCAC Restorative Physiotherapy stream. linking the patient through the continuum to falls programs in the community, identifying the falls programs available in the community; and educating service providers and care coordinators to identify patients who would benefit from a home safety assessment. The /16 Central East CCAC QIP identifies next steps for improvement. Charts were audited and various commonalities identified opportunity for quality improvement initiatives with regards to Falls Prevention. Common themes arising from these audits were; Seniors unstable gait and patient transfer often lead to a fall. Falls also increased by 80 for those over 75 years of age. In addition, the Central East CCAC Rapid Response Nurses (RRN) Program did undertake a pilot initiative focusing on medication reconciliation for patients at high risk for a fall. Focused service Occupational Therapy pathways have been developed and implemented in the Central East CCAC (Late 2014). The pathways are specifically related to home assessment of safety and equipment. Additional Physiotherapy pathways focusing on functional improvements (eg. Gait training) were implemented late in the year with no impact or outcomes yet understood.
ID Measure/Indicator from 2014/ 2 Five-Day Wait Time for Home Care Nursing Services - Percentage of patients who received the first nursing visit within 5 days of the service authorization date Home Care Clients BLANK Ministry of Health Portal Current Performance as stated on QIP14/15 Target as stated on QIP 14/15 95.00 95.70 95.80 Current Performance Change Ideas from Last Years QIP (QIP 2014/15) Central East CCAC will explore contributing factors for patients who are waiting 4 or 5 days for nursing services and then establish appropriate improvement initiatives to decrease wait time. Was this change idea implemented as intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? An enhancement was made in the patient electronic health information system which allows for improved data quality in calculating the wait time for nursing services in November 2014. The strength of our Home First Program has continued to promote early service engagement.
ID Measure/Indicator from 2014/ 3 Five-Day Wait Time for Home Care - Personal Support Services - Percentage of complex patients who received the first personal support visit within 5 days of the service authorization date Home Care Clients BLANK Ministry of Health Portal Current Performance as stated on QIP14/15 Target as stated on QIP 14/15 88.30 88.50 86.60 Current Performance Change Ideas from Last Years QIP (QIP 2014/15) Central East CCAC will explore root causes that are impacting complex patients who are waiting 4 or 5 days for Personal Support services and then establish appropriate improvement initiatives to decrease wait time. Was this change idea implemented as intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? An enhancement was made in the patient electronic health information system which allows for improved data quality in calculating the wait time for personal support services in November 2014.
Measure/Indicator from ID 2014/ 4 Client Experience Home Care Clients FY 2012/13 OACCAC Current Performance as stated on Target as stated on Current Performance QIP14/15 QIP 14/15 92.00 95.00 91.70 Change Ideas from Last Years QIP (QIP 2014/15) Investigate the root causes of those who are scoring the CECCAC as low (poor) on overall satisfaction and implement a plan to address this rating. Implement an action plan to increase the number of patients who score the CECCAC as very good or excellent. Introduce and implement in phases, the NOD (name, occupation and duty) technique to be utilized by the Central East CCAC Care Coordinators, Team Assistants and Service Providers. Implement in phases across the Central East CCAC and with all Service Providers the Changing the Conversation project:o What is the most important thing I can help you with today? o Before Was this change idea implemented as intended? (Y/N button) No No Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Patient experience satisfaction survey results were analyzed. Key top themes included transitions of care (eg. from hospital-to-community) and consistency/continuity of service provider staff; consistency of scheduling appointments and providing a clear outline of the service expectations. The resulting plan of action includes the facilitation of patient focus groups or learning circles. It is anticipated that this form of patient level engagement will provide a better understanding of the root causes and the requirements patient expect when receiving services from the Central East CCAC. The education for both Name, Occupation, Duty (NOD) and Changing the Conversation improvement initiatives are underway with the plan for implementation (in-house and Service Providers) by March/April (delayed initially by the number of initiatives rolled out to staff and then by the recent CCAC labor disruption). Rollout will be promoted through an e-learning module as well as the Patient Welcome Booklet. The education for both the Name, Occupation, Duty (NOD) and Changing the Conversation improvement initiatives are underway with the plan for implementation (in-house and Service Providers) by March/April (delayed
leaving... is there something I can help you with before I go?o Is there anything you would like me to tell the agency initially by the number of initiatives rolled out to staff and then by the recent CCAC labor disruption). Rollout will be promoted through an e-learning module as well as the Patient Welcome Booklet.