COMMITTEE REPORTS TO THE BOARD

Item # 9 F i COMMITTEE REPORTS TO THE BOARD To From South East LHIN Board Members Quality Committee Reviewed by Quality Committee Committee Members of the Committee were given the opportunity to review the report before submission to the Board. Date February 26, 2018 Report Summary for February 6, 2018 Quality Committee Meeting Topics of Discussion: Patient Story Complexity of Care Reports: Proposed Priorities & Targets 2018/19 Draft 2017/18 Progress Report Q3 Home and Community Care Report Client & Caregiver Experience Q1 Evaluation Survey (CCEE) BN Accreditation Opting Out Committee Progress and Highlights: Reports Received by Committee: QIP Priorities and Target 2018/19/QIP Progress Report 2017/18: Noted that Extending Care Coordination was no longer a focus. HCC working across regions with partners on enhancing coordination. Plan to continue what is being done through co-design projects. Need for a different approach to address team capacity. LHINs are not yet ready for an HSP collaborative QIP approach. Need for local indicator re strengthening care coordination, equity, and system perspective. Will be included in Narrative and will incorporate a review of these parameters into the Quarterly QIP review. A Briefing Note will be provided to the Board as a separate item for approval. 2018-19 Submission documents will include: QIP In Progress report (last fiscal year progress report) QIP Narrative (provides context to the workplan) QIP Workplan (outline of change ideas, targets for improvements and monitoring status) Page 1 of 2

Item # 9 F i Q3 Home and Community Care Quality Report: No new risks identified at this time. (attached as Appendix 1) Mid-Year Client Caregiver Experience Evaluation Survey Results: Mid-year report. Numbers continue to look good, but still recognize staff concerns regarding lack of resources. Team is working on examples of tests of change to manage challenges.(attached as Appendix 2) MAID: Discussion from a quality perspective. There is no reporting mechanism or requirement at this time. From a Home & Community Care perspective, we can look at (current or past) Home and Community Care patient stats if needed. Policy Review: To be tabled at the May meeting for further review if required. Accreditation: Decision to defer due to new organizational entity and the need to reflect on current practices to enable achievement of the LHIN s new mandate. Will maintain practices that earned H&CC exemplary standing in 2012. LHIN will maintain access to Accreditation Canada s supporting materials and standards to enable ongoing improvement. There is no provincial requirement for accreditation. Committee Workplans Completed review of first draft of Priorities for 2018/19. Given timing of submission will go directly to the Board in February without further review by this Committee. Policy review to be tabled at May meeting. Workplan Deliverables NA Committee Engagement Risks Appendices NA High level of quality of care and service throughout SE LHIN key responsibility. Oversight essential to monitor achievement of quality accountabilities and avoid risk. Appendix 1: Q 3 Home and Community Care Quality Report Appendix 2: Mid-Year Client and Caregiver Experience Evaluation Report NOTES: This report is to provide a brief update on committee activities between meetings. Committee minutes will still be distributed to the Board after committee approval This report is NOT to replace Briefing Notes for Board Approvals and Decision making Page 2 of 2

Home & Community Care Quality Committee Report Prepared by: Gina Miller, Senior Manager, Quality and Performance Kelly Ostrander, Quality Coordinator 2017/18 Q3 report

Overview Purpose: The purpose of this report is to support effective governance of quality of Home and Community Care by providing: A summary of performance indicators related to the quality of home and community care services Information related to risks associated with home and community care services Progress on the Quality Improvement initiatives An update on adverse events Target Audiences: The Quality Committee of the Board, the South East LHIN Executive Team and the Home and Community Care Senior Leadership Team Alignment: The performance indicators contained in this report align with the South East LHIN Quality Improvement Plan Frequency: This report will be provided quarterly. 2

Home and Community Care Quality Indicators Quality Dimension Aim/Issue Indicator Target Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Trend Safety of patients in the % of adult long stay HC patients who record a fall on their follow up RAI HC 35.0% 36.4% 34.4% 31.2% 29.5% 32.3% 35.4% 32.7% 37.0% 36.7% 37.1% 31.9% 34.2% community assessment Patients with ERL codes 1 and 2 with contingency plan 55.4% 56.9% 61.2% 67.2% 73.9% 76.7% 85.9% 86.1% 87.5% 88.7% 95.8% 97.3% Safe % of patients who responded Agree to I was satisfied with the support received 92.5% 89.3% 91.5% from the care coordinator/agency to address safety concerns at home Healthcare associated harm Adverse events 0 0 0 1 1 2 0 0 0 1 0 0 Effective Effective Transitions Overall Emergency Department visits % of HC patients with an unplanned, less urgent ED visit within the first 30 days 7.0% 8.4% of discharge from hospital % of HC patients presenting to ED within 30 days of discharge from hospital 30.0% 30.8% 29.5% 26.6% 31.9% 28.9% 30.1% 31.8% 32.5% 34.1% 25.8% 28.0% 30.0% % of HC patients who experienced an unplanned readmission to hospital within 30 days of hospital D/C 17.3% 16.8% % of HC patients presenting to ED 15.0% 18.7% 17.7% 18.5% 19.2% 18.9% 18.2% 19.2% 19.6% 19.3% 17.6% 18.5% 16.9% See Appendix for indicator definitions 3

Home and Community Care Quality Indicators Quality Dimension Aim/Issue Indicator Target Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Trend Timely access to % of patients who received their first nursing visit within 5 days of the service 95.0% 94.3% 94.8% 94.6% 93.7% 95.4% 95.3% 94.8% 94.1% 94.6% 94.9% 94.9% 94.6% care/services authorization date % of patients receiving their first nursing visit within 5 days of Patient Available 95.0% 96.0% 96.7% 96.4% 96.9% 97.1% 96.1% 96.6% 95.2% 96.2% 96.7% 96.2% 96.7% Timely Date % of complex patients who received their first personal support service within 5 95.0% 86.1% 84.6% 81.4% 95.3% 88.0% 78.9% 84.4% 79.7% 81.0% 85.7% 83.9% 87.2% days of the service auth date % of complex patients receiving their first personal support visit within 5 days of 95.0% 89.5% 92.7% 86.4% 95.6% 92.3% 87.5% 91.4% 85.2% 91.8% 92.5% 85.2% 88.1% Patient Available Date Person experience % of patients who responded Good/Very Good/Excellent for Overall rating of: 94.5% 94.3% 92.7% 93.3% CCAC services, mgmt/handling of care by CC & service provided by SP Patient - Patient/Caregiver complaints not resolved at the Care Coordination level Centred recorded in the QI Tool 8 7 10 4 13 15 11 21 9 12 14 6 Palliative Care % of palliative/end of life patients who died in preferred place of death 76.7% 74.0% 74.3% 83.3% 75.0% 77.8% 80.4% 75.3% 74.7% 69.9% 72.8% 74.2% See Appendix for indicator definitions 4

Report Comments Where data is not provided, it is not yet available. There is significant data lag for ED Visit and Hospital Readmission provincial indicators. Targets, where available, have been carried forward from 2016-17. In cases where no target is in place, the indicator is developmental and we are monitoring to establish baseline. We have changed our definition for complaints for the current fiscal year. Current complaints are reported in alignment with submissions to the MOHLTC. The data published in this report is accurate on the day that it was extracted. Due to delayed event reporting and internal data quality control efforts, this information is subject to change, including addition, deletion and reclassification of any and all data. 5

Patient Safety Our rate of falls for long stay patients in the community continues to fluctuate. A standardized falls protocol was implemented as part of our QIP and we continue to monitor and reinforce uptake of applying the protocol. An evaluation of the protocol was completed in Q3. Our rate of completion of emergency plans for high risk patients continues to improve steadily. Safety questions for CCEE survey KPI9 appeared lower for Q1 but is back to expected performance levels in Q2. The CCEE results are cumulative for the fiscal year. There was 1 adverse event reported in Q3. 6

Adverse Events There was 1 adverse event reported in the third quarter related to a patient injury that has since healed. An event analysis was completed, and final disclosure with the patient has been completed. Learnings were shared in a Quality Alert with our internal staff and our contracted personal support service providers. 7

Effectiveness Our local measure for ED visits within 30 days returned to target levels in Q3. Overall rate of ED visits is above our local target. Engagement with Health Links and expanding the use of Coordinated Care Plan is expected to reduce ED visits although we may not see a significant shift within the next fiscal year. We are exploring whether improvements to wound care practice may improve ED visits within 30 days of discharge from hospital as part of our QIP for 2018-19. The latest available results for hospital readmission is close to the provincial average of 17.7%. We have developed a local proxy indicator and will begin to review baseline data in Q4. In the next fiscal year, we will be able to conduct analysis to better understand hospital readmission rates. 8

Timeliness Nursing wait time from authorization date was just below target (less than 1%) in Q2. The new provincial accountability metric will measure wait time from Patient Available Date. We are consistently above target for nursing wait time from Patient Available Date. Personal support service wait time from authorization date for complex patients affects a small number of patients. We did not reach the target in Q3. The new provincial accountability metric will measure wait time from Patient Available Date. Our results for wait from Patient Available Date appear to be better but are still below target. 9

Person Centered Our overall patient experience is stable; we were at target for fiscal 2016/17. Results are available from Q2 appear lower than last year, but the sample size is not representative as CCEE results are cumulative for the fiscal year. We will revisit when a full year of data is available. Palliative/end of life patients who die in their preferred place of death is an additional QIP indicator. A target has not been set for this fiscal year and we are collecting baseline data as input to quality improvement planning next year. 10

Other Risks/Issues Appeals, Litigation, Insurance Claims There are no active HSARB appeals, litigations or insurance claims currently open 11

Quality Improvement Highlights for Q3 2017/18 Home and Community Care have initiated the planning process for the 2018-19 QIP and completed a draft year end progress report for 2017-18. This is included as a separate document from this report. Additional QI Work underway: Continuing to work closely with Contracts to develop a number of strategies to address service quality issues including expanding the special conditions language in service provider contracts regarding minimum qualifications and training Agreement reached to develop a test regarding Personal Support Service prioritization to reschedule PSWs from lower to higher need patients Developing options for service standards in the Retirement Home environment that minimize time-specific visits and reduce inequities with care in homes 12

References Quality Improvement Plan Health Quality Ontario quality improvement QIP guidance document and indicator definition http://www.hqontario.ca/portals/0/documents/pr/hc-qualityindicators-definitions-table-2013-en.pdf 13

Appendix Definitions CCEE: Client & Caregiver Experience Evaluation is a satisfaction survey of patients or their advocate conducted 4 times per year. It provides information about the patient s experience with receiving services from the LHIN and its contracted service providers. Patient Safety: is defined as the absence of preventable harm to a patient during the process of health care. Quality Care: Providing sustainable care that is safe, effective, timely, centered around the patient, respectful of the family, and results in a positive experience. 14

Definitions Quality Improvement Tool (QI Tool): An Automated reporting system to report, monitor and track events related to patient care/service provision. Events are tracked by established categories; Compliment, Patient/Caregiver Safety, Privacy & Security, Communication & Reporting, Complaint, LHIN/Service Provider Staff Safety, Service Delivery, and Placement. RAI- HC: Resident Assessment Instrument for Home Care: It s a Minimum Data Set (MDS) screening tool that enables a home care provider to assess multiple key domains of function, health, social support, and service use. InterRAI Patient and Caregiver complaints not resolved at the Care Coordinator level relate to: Quality of service, availability of service, business process. 15

Indicator Definitions % of adult long-stay HC patients who record a fall on their follow up RAI-HC assessment: Percentage of adult long stay home care patients who say they have fallen within the last 90 days or since last assessment during a follow-up RAI-HC assessment. Patients with ERL codes 1 and 2 with contingency plan: % of patients with Emergency Response Level of 1 or 2 with a contingency plan documented in CHRIS. % of patients responded Agree to I was satisfied with the support received from the care coordinator/agency to address safety concerns at home, CCEE: Client & Caregiver Experience Evaluation, % of respondents answered Somewhat Agree/Strongly Agree to I was satisfied with the support received from the care coordinator/agency to address safety concerns at home. Adverse Events recorded in QI Tool: # of adverse events recorded in the QI Tool. There are 3 definition criteria for an adverse event: 1. An unintended injury or complication, AND 2. Which results in disability, death or increased use of health care resources (i.e. additional attendance by health care professionals, prolonged home care stay, hospitalization), AND 2. Is caused by health care management*. (*Health care management is defined as: Any care or treatment provided as part of a formal care plan that is provided by healthcare workers, formal or informal caregivers or as self-care by the patient.) 16

% of HC patients with an unplanned, less-urgent ED visit within the first 30 days of discharge from hospital: Percentage of adult home care patients with an unplanned less urgent (triage level) emergency department visit with the first 30 days of hospital discharge. % of HC patients presenting to ED within 30 days of discharge from hospital: Percentage of home care patients who present to emergency department within the first 30 days of Hospital Discharge. (all triage levels). % of HC patients who experienced an unplanned readmission to hospital within 30 days of discharge from hospital: Percentage of adult home care patients who experienced an unplanned return to hospital with 30 days of hospital discharge. % of HC patients presenting to ED: Percentage of adult home care patients with an unplanned emergency department visit. 17

% of patients who received their first nursing visit within 5 days of the service authorization date: Percentage of adult home care patients who received their first nursing visit within 5 days of the service authorization date (includes RN, RRN, nursing clinics and NP palliative) % of patients who received their first nursing visit within 5 days of the patient available date: Percentage of adult home care patients who received their first nursing visit within 5 days of the patient available date (includes RN, RRN, nursing clinics and NP palliative) % of complex patients who received their first personal support service visit within 5 days of the service authorization date: Percentage of adult home care patients with CCM population of Complex who received their first personal support service within 5 days of the service authorization date % of complex patients who received their first personal support service visit within 5 days of the patient available date: Percentage of adult home care patients with CCM population of Complex who received their first personal support service within 5 days of the service patient available date 18

% of patients who responded Good/Very Good/Excellent for Overall rating of: LHIN services, mgmt/handling, of care by CC & service provider by SP: Client & Caregiver Experience Evaluation, Key Performance Indicator 1: Percentage of Good, Very Good & Excellent, responses on a 5 point scale (Poor to Excellent) to three client Experience survey questions: Overall rating of LHIN services Overall rating of management/handling of care by care coordinator Overall rating of service provided by service provider Patient/Caregiver complaints not resolved at the Care Coordinator level recorded in the QI Tool: A concern brought forward by a patient or caregiver concerning the services provided by home and community care services or any contracted service provider agency, that is not resolved at the level of the Care Coordinator, and is recorded in the QI Tool. A complaint can relate to any component of the services provided through home and community care (e.g., placement, in-home services, medical supplies and equipment). % of palliative/end of life patients who died in preferred place of death: The % of adult palliative/end of life patients with discharge disposition of death who died in their preferred place of death as indicated in the discharge disposition. Palliative/end of life patients are identified as those with CCM population of complex Palliative, chronic Palliative or End of Life (SRC 95) at time of discharge. 19

Item BRIEFING NOTE FOR EXECUTIVE MEETING Title 2017-18 Client and Caregiver Experience Evaluation (CCEE) Survey Results Q2 Update Date January 25, 2018 Description The 2017-2018 Q1/Q2 results from the Client and Caregiver Experience Evaluation have been received for Home and Community Care services. The survey provides the Home and Community Care sector with statistically meaningful information about the patient s experience with Care Coordination services and services provided by contracted service providers. While the results can inform performance manangement for SPOs, the tool supports Home and Community Care in identifying strengths to leverage and opportunities for quality improvement initiatives. Moreover, the overall satisfaction rating from the CCEE survey is reported publicly HQO and included as a sector QIP indicator. The South East continues to perform very well across the 9 Key Performance Indicators (KPIs). The overall results are summarized below: 2017-18 (Q1/Q2) 2016-17 (Q1/Q2) FY2016-17 KPI South East South East South East Provincial Average Overall 93.3% 94.3% 94.4%* 92.2% Experience Patient 89.5% 89.1% 89.6% 88.4% Centred Care Patient 93.6%* 94.8%* 94.4%* 91.1% Centred Care Appointments Quality of Care 95.1% 94.8% 94.9%* 93.6% Building 94.0%* 93.7%* 93.9%* 92.2% Relationships and Trust Linking to 78.3% 83.3% 82.9%* 77.8% Other Services Willingness to 96.7% 97.1% 97.3%* 96.4% Recommend Expectations 62.1% 63.9% 64.0%* 59.3% of Quality Safety 91.5%* 91.6%* 93.1% 92.2% *Significantly Higher than provincial results Page 1 of 4

Item BRIEFING NOTE FOR EXECUTIVE MEETING Overall, the results to date are consistent with past results, with all KPIs being within 2% of 2016-17 Q1/Q2 results with the exception of Linking to Other Services. To date, we are scoring statistically significantly higher than the provincial average (to date) in the KPIs of: Client Centered Cared Appointments Building Relationships and Trust Safety It should be noted that the due to low response rates within the set sampling period, the timeline was extended. The response rate captured is consistent with the plan submitted to NRC and it should not impact the sampling plan for the remainder of the year. Next Steps Background Further details on the CCEE, including sampling method and inclusion/exclusion criteria can be found in Appendix 1. The current results will be shared with the Home & Community Care Directors and will inform planning for the 2018-19 Quality Improvement Plan. The CCEE provides the Home and Community Care sector with statistically meaningful information about the patient s experience with Care Coordination services and services provided by contracted service providers. It also supports Home and Community Care in identifying strengths to leverage and opportunities for quality improvement initiatives. The overall satisfaction rating from the CCEE survey is reported publicly by Health Quality Ontario, and included as a sector QIP indicator. Moreover, it provides Home and Community Care programs with comparable data that can be used for public reporting and supports Service Provider performance management. All 14 LHINs participate in the CCEE core survey. NRC Health conducts the patient and caregiver experience surveys on behalf of the LHINs. This is a telephone survey conducted with a sample of our patients each quarter, with questions being asked on a 5-point rating scale. There is one open-ended question at the end "What is the most important thing the LHIN can do to improve the quality of care you received?" Sampling and surveying takes place in 4 waves over the course of one year. This is based off of the sampling plan set annually based on volumes for the previous year by service type and provider Page 2 of 4 Key Performance Indicators (KPIs) help LHINs define, measure, and track progress towards their organizational goals. Each KPI is based on a series of questions in the survey that were found to be highly correlated with each other, thus representing a definition of each respective KPI:

Item BRIEFING NOTE FOR EXECUTIVE MEETING Appendix 1: Sampling Plan Development Page 3 of 4 1. Overall Experience (reported publicly and is a priority QIP indicator for LHINs) 2. Patient Centred Care 3. Patient Centred Care Appointments 4. Quality of Care 5. Building Relationships and Trust 6. Linking to Other Services 7. Willingness to Recommend 8. Expectations of Quality 9. Safety Sampling Plan Development LHINs stratify the sample by service type, by service provider (and or geography) to allow for random sampling. A 10% annual Margin of Error by sample stratification is expected. The respondents to the surveys were selected to ensure sufficient numbers of responses according to service type, provider agency and/or geography. However, due to variation in response rates, the sample population are not a perfect random sample of the LHIN patient population and may not be perfectly representative of the patient population. Weights are applied to the survey responses to ensure that the reported survey results are representative of the actual population served by the LHIN and provider agencies. Inclusion Criteria All unique active or discharged patients receiving home and community care services for one of the following contracted services: Nursing, Personal Support, Occupational Therapy, Physiotherapy, Speech Therapy, Social Work, Nutrition/Dietetics Discharged patients to one of the following placement categories within the specified time period: Admission final Withdrawn, interim became final Withdrawn, placement by other LHIN Refused bed Exclusion Criteria Patients that received in-school service only. Respite Services Medical Supplies and Equipment End of life patients (SRC 95) Patients not yet categorized (SRC 99) Home and community care patients classified as out of region Convalescent care patients

Item BRIEFING NOTE FOR EXECUTIVE MEETING Patients who do not want to participate in any survey conducted on behalf of the LHIN patients with NO SURVEY risk code in CHRIS Page 4 of 4