Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario

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1 Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario March, 2016 North Simcoe Muskoka Community Care Access Centre 1

2 Overview Quality improvement plans (QIPs) are an important health system transformation tool. Aligned to achieving better health for all Ontarians, the North Simcoe Muskoka Community Care Access Centre (NSM CCAC) continues to mark significant improvement milestones since their first publicly reported QIP ( ). Year over year NSM CCAC has continued to build on a strong foundation in delivering on the commitment to work hand in hand with patients, their caregivers and families to make the system better, improve overall health care experiences, and achieve the best value from finite health resources. NSM CCAC s objectives support achieving improvements in both health experiences and health outcomes of patients, their caregivers and families, and recognizes that providing safe, quality care by design requires their meaningful engagement in both shaping improvement plans and participating in change initiatives. NSM CCAC efforts related to improving safety, quality and timely access to care were recognized in by Accreditation Canada, in receiving exemplary standing for two consecutive surveys, and as a spotlight of excellence at Health Quality Ontario s (HQO) Health Transformation Day regarding the culture of continuous quality improvement in 5 day wait times. NSM CCAC s QIP aligns strongly to HQO s three year strategic plan Better has no limit: Partnering for a Quality Health System, and through learnings garnered from QIP activities, NSM CCAC looks to achieve targets focused on the quality dimensions of access, safety, effectiveness and patient centeredness. Community Care Access Centres (CCACs) in Ontario are advancing the health care quality agenda. There is a collective strategy to improve quality outcomes in six priority areas for the purpose of improving experience and care outcomes, integration, safe care coordination, and value. Specifically, the six common areas of focus for CCACs in QIPs are: 1. Reduction in falls experienced in the home by patients. 2. Reduction in number of unplanned emergency department visits experienced by home care patients that occur within 30 days of their transition home from hospital. 3. Reduction in number of unplanned hospital readmissions experienced by home care patients that occur within 30 days of their transition home from hospital. 4. Wait times, for all patients requiring nursing services and for patients with complex needs who require personal support services, targeted to align to the provincial 5 day wait time measure. 5. Patient experience regarding overall satisfaction with care provided in the home. 6. Palliative experience regarding patients who died in their preferred place. In addition, NSM CCAC will focus on a local indicator specific to patient safety and continue to engage patients, their caregivers, and families for feedback to enhance the Safe at Home web resource, and develop improvements in both the reporting and identification of risk for falls to yield strategies which support patient safety self management in the home setting. In leveraging learnings from the QIP, NSM CCAC aims to achieve targets in: Improving access to care while supporting a greater number of people with high care needs through the achievement of our 5 day wait time targets. Improving patient safety in the home while enhancing the corporate safety culture with a focus on falls prevention and safety conversations in the home. North Simcoe Muskoka Community Care Access Centre 2

3 Improving effectiveness through reduced unplanned and avoidable emergency department visits and hospital admissions through our Telehomecare program and the implementation of nursing ambulatory care clinics. Improving patient centeredness by efficiently delivering a better patient experience and health outcome. QI Achievements from the Past Year Access to timely care is a measure of the quality of health care that a person receives. NSM CCAC identified five day wait time for nursing and complex personal support as a priority area in the QIP. Efforts in benchmarked performance provincially and established stretch targets to move towards being best in the province. Using a QI approach in , barriers to achieving five day wait time were identified and focused on cycle time from service authorization to first visit. Change ideas with the greatest impact were selected and included error proofing, automating processes and revising standards. Planned improvement initiatives were communicated through frequent staff and service provider education, and through control charting, progress was monitored on a weekly, monthly and quarterly basis through the year. NSM CCAC successfully achieved the stretch target for both nursing and complex personal support by March 2015; a 15 percent improvement in personal support access for complex patients. These achievements were highlighted provincially at HQO s Health Quality Transformation conference and through the Insights into Quality Improvement report on CCACs. NSM CCAC is proud to be a partner in advancing the health care quality agenda, and champions a culture that believes better has no limit. While NSM CCAC s overall QIP achievements are reported in the progress report for , the 5 day wait time target is noted as it continues to be a priority within NSM CCAC s QIP. With new stretch targets established, NSM CCAC remains committed to year over year improvements, while sustaining the previous year s gains, and will continue to analyze factors that contribute to variance, particularly patient choice and availability. Integration and Continuity of Care Home and community care has a bright future. It is increasingly recognized as a critical part of the health system that will contribute to the long term sustainability of our publicly funded health care system. As Ontario s health care system starts to undergo transformational change in effort to improve access to consistent, accountable and integrated primary care, home and community care, population health and public health services, NSM CCAC will continue to perform essential work which will be critically important in supporting the Ministry s vision of a more sustainable and responsive health care system where patients receive the best care possible. As always, NSM CCAC s focus is on patients, their caregivers and families first. Care experiences are key inputs to the CCAC s culture of continuous quality improvement and in the co design of policies, programs and education. Quality improvement initiatives outlined in this plan exemplify NSM CCAC s strategic commitment to improving the safety and quality of services provided through the use of data and other evidence, in collaboration with the NSM Local Health Integration Network (LHIN), contracted service providers and crosssector health system partners. Further, NSM CCAC s expert in quality and risk jointly stewards the regional Quality Improvement Network agenda in the role of co chair with the NSM LHIN. North Simcoe Muskoka Community Care Access Centre 3

4 NSM CCAC is a strong collaborator between sectors in support of improved integration and coordination, and is strategically representation at all 5 Health Links in the region in support of continued partnership opportunities which enable safe patient transitions and collaborative care plans. NSM CCAC champions continuity of care through strategies to enhance enrollment in the Telehomecare coaching and monitoring programs, and collaborates with partners to increase equitable access to nursing services provided through community ambulatory care clinics. Engagement of Leadership, Clinicians and Staff Leadership for the development of our QIP has been provided by the NSM CCAC s Directors Forum with oversight by the Senior Leadership Team. Directors Forum brings organizational leaders together across all divisions to collaborate in problem solving and knowledge transfer, in support of developing and delivering on NSM CCAC s annual operating plan and QIP. Director co leads are assigned to each core QIP objective and are tasked to engage front line management, staff, and service providers (where appropriate) in the identification of change ideas. Contracted service providers are very important partners in the delivery of care. Where appropriate, change ideas outlined in the QIP have been developed in collaboration with services providers and primary care partners to collectively achieve improvements in quality, safety and the care experiences. Additionally, contracted service providers continue to develop QIPs in alignment to the NSM CCAC s plan. NSM CCAC has built considerable strength in business intelligence and quality, which enables the CCAC to use data to create meaningful information to identify quality improvement opportunities and measure the impact to continuity of care. As part of the NSM CCAC risk management culture, a robust risk identification and assessment process is undertaken for each QIP initiative with improvement targets to ensure the most significant risks are appropriately managed. Clear accountability for delivering on quality improvement objectives and targets is established through the assignment of a Director lead and Senior Leadership Team champion. Progress on QIP deliverables is monitored quarterly by the Senior Leadership Team and full management team. Reports are submitted to both the Client Service and Quality Committee of the Board and full Board of Directors. Client, Patient, Resident Engagement NSM CCAC will continue to create purposeful opportunities throughout to empower patients, their caregivers, families and care partners across communities, to contribute to service delivery improvement ideas in effort to ensure care is truly patient and family centered. Health Link patient advisory groups and feedback from the Client and Caregiver Experience Evaluation (CCEE) survey will continue to be leveraged to inform efforts in local and system level improvements. Patients receiving services from NSM CCAC and its contracted service providers report high levels of satisfaction with their care experience. In commitment to ongoing improvements in patient experience, NSM CCAC will focus on leveraging the CCEE survey tool to measure positive change in the rating of CCAC services, including care coordination and service provision through contracted service providers. North Simcoe Muskoka Community Care Access Centre 4

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