Quality, Safety & Risk Framework & Strategy Mississauga Halton CCAC June 10, 2014
Purpose Share MH CCAC s approach to answering the question: What do we need to do to ensure the delivery of high quality, safe care and manage risk effectively? o What does the organization look like when it s doing these things? o How does the organization behave when it s doing these things?
MH CCAC Strategic Directions
What We Did Assess Organization Informal scan of needs, strengths, gaps Accreditation Canada Patient Safety Culture Tool Accreditation Canada Self Assessment Research High Performing organizations Quality, safety, risk best practices Framework Development Identify key areas of focus to support quality, safety & risk Graphic Desk Aids Strategy Development Identify the specific actions and pieces of work to support and advance quality, safety & risk Consultation & input from key audiences
Organizational Assessment Informal Scan Improvement Opportunities o Events Management Process o Reporting (quality, safety, risk information) o Patient Engagement o Improvement tools & competencies o Policies & Procedures Accreditation Tools & Assessments Patient Safety Culture Tool Results o Yellow & Red flags Self Assessment Results o Yellow & Red flags reflecting Gaps to fill Need to educate on what was in place
Research High Performing Organizations Client Centred Customer Approach Highly efficient & effective processes & structures Openness Action oriented Senior management actively participates in quality Quality improvement teams are clinician led Sensitivity to operations Pre occupation with failure Reliability is king evidence is the driver Continuous improvement (good enough is not good enough) Resilience & flexibility Need critical mass (not consensus) No excuses High Performing Organizations Nimble, responsive Balanced leadership chemistry Want to be great Share even when it hurts Problem solving & learning Reluctance to simplify Embrace the potential of technology wisely Innovate Set high goals & care that they meet them Accept insights & recommendations from those most knowledgeable Strong communication and coordination across disciplines & departments Management quality Learn from customers
Research Consistent themes appear in the literature around the key elements which support leading practices in quality, safety & risk within organizations The achievement of quality in health care requires a focus on 4 main components*: o Value of Care (Content Quality) o Quality of Service (Delivery Quality) o Quality of Evaluation o Quality of Management To become a high performing organization we also need to focus on maturing the organization through 4 key stages**: o Define (Bring Clarity) o Sustain (Safeguard) o Improve (There must be a better way) o Innovate (Get Ahead, Stay Ahead, What if? ) *Source: Brent C. James, MD, 1989. Quality Management for Health Care Delivery. **Adapted From: National Health Service Department of Health, 2009. Transforming Community Services Quality Framework: Guidance for Community Services.
Framework Development
Framework Development Desk Aid
Quality, Safety & Risk Strategy Inner circle reflects the 4 components of the Quality, Safety & Risk Framework The outer circle outlines the key goals we will work to achieve
Strategy 1) Keep Patients Safe 1 Keep Patients Safe GOALS Providing our patients and families with safe, effective, and accessible care based on evidence and best practice. Safe Effective Accessible ACTION ITEMS Establish a Professional Practice Framework. Provide access to evidence (ex. Journals) for all leaders and staff. Embed evidence-based and professional practices throughout the organization. Prevent and detect errors in the system of care. Provide a mechanism for sharing evidence-based professional practices within our organization and with our SPOs. Embed policies and procedures into day-to-day work processes and tools. o Ensure evidence is built into policy and procedure development o Assess learning and compliance of staff o Identify and address any gaps Detect o Improve event reporting response rates and on-going management o Improve communication of the actions taken to address the event. o Improve identification and response to trends in reporting events. o Share learnings regarding high risk and adverse events with others (ex. Staff, SPOs, Hospitals, other CCACs). Prevent o Incorporate prospective analysis into our programs and processes and implement sustainable changes to mitigate high risk events o Build human factors engineering into our work o Falls and safety screening for every patient
Strategy 2) Deliver Personalized Care 2 Deliver Personalized Care GOALS Supporting a positive patient and family experience. Integrated Equitable Patient-Centred Efficient ACTION ITEMS Patients and families are members of every team in the organization. Engage patients and families for input and feedback in designing and improving programs, processes, and services. Share patient stories with Board, leaders, staff, SPOs, and others. Provide information and education to improve and develop our patients and families understanding of their health status. Patients and families are armed with the information and supports to meet their whole health and well-being needs. Improve access and coordination of services to address social determinants of health (eg. Finances, legal advice, housing). Improve supports for caregivers. Improve identification and access to resources to support the diverse needs and composition of our community (eg. Cultural, religious, gender, age, language, etc).
Strategy 3) Evaluate, Measure & Improve 3 Evaluate, Measure, Improve GOALS Evaluating the work we do every day to provide high quality, safe care to patients. Monitor Measure Analyze Report Act ACTION ITEMS Assess progress in creating a quality and patient safety focused culture. o Employee Engagement Survey o Client and caregiver experience evaluation o Patient safety culture tool Build quality and outcome measurement into the way we work. Regular assessment of performance and comparison to external benchmarks, reports and standards. o Health Quality Ontario o Canadian Institute for Healthcare Improvement o HIROC Self-assessment o Accreditation Canada Improve use of quality, safety, and risk data and information. o Quality Improvement Plan, Balanced Scorecard o Client and caregiver experience evaluation o Event Tracking Management System reporting o Ensure quality, safety, and risk input into IM strategy work. o Risk map o QSR Dashboard Build continuous quality improvement into the way we work. Build in Accreditation Canada assessment and compliance into regular activities. Implement daily management system or equivalent (eg. Clinical microsystem, CUSP).
Strategy 4)Lead by Example Ensuring the supports, services, and systems are in place to support care delivery 4 Lead by Example now and in the future. Anticipate Plan Learn GOALS Equip front line staff with the skills to support quality, safety, and risk. ACTION ITEMS Provide regular patient safety education. o Elder Abuse o Falls, medication management o Psychosocial/behavioural risk o Other (ex. informed by risk trends, patient safety culture tool, etc). Provide regular self-safety education and training. o Non-violent crisis intervention o Legal requirements and scope of practice. Provide data analysis education. Equip management and leaders with the skills to support quality, safety, and risk. Implement organizational structure to enable quality, safety, and risk learning and sharing. Provide quality improvement education and tools. o LEAN training o Process improvement training (e.g. HQO IDEAS Framework) o QSR Toolkit development (and integration with project management and change management tools). Focused leader and staff quality, safety, and risk conversations. o Leadership QSR walkabouts Focused staff sharing conversations. o QSR Rounds Focused sharing with partners. o QSR case studies/briefs o Practice alerts
Next Steps 1 2 3 4 5 Complete final draft (work plan and written document) Finalized draft to be reviewed & endorsed Communication Plan Implement Evaluate
Thank You! Questions?