Session A: Transforming healthcare through a common quality agenda - - PowerPoint PPT Presentation

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Session A: Transforming healthcare through a common quality agenda

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Session A: Transforming healthcare through a common quality agenda

Moderator:

Nizar Ladak, Executive Vice President and COO, Health Quality Ontario

Panelists:

• Dr. Michael Sherar, President and CEO, Cancer Care Ontario

Pat Campbell, President and CEO, Ontario Hospital Association Susan Fitzpatrick, ADM, Negotiations and Accountability Management, MOHLTC Don Ford, CEO, Central East Community Care Access Centre Kim Baker, CEO, Central Local Health Integration Network

• Dr. Michael Rachlis, Consultant, Health Policy Analysis

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Disclosures

The Moderator and Panelists have nothing to disclose

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Session Format

Moderated Panel Format Panelists will present their message utilizing a few slides to illustrate the key strategies and or tactics needed to move towards a common quality agenda. The Audience will have an opportunity to participate in two ways:

• Answer questions, provide opinion during session using key pad

technology.

• Q&A Session

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Audience Participation

We want to know what you think

• Panelists will ask for your input on a

variety of questions throughout the discussion this morning.

• Using the key pads on your chair,

answer by choosing only one response.

• Answer within the time allotment
• See the aggregate response instantly.

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Warm-up Question

What exactly is PROROGUING?

• 1. A Polish delicacy you eat with sour cream
• 2. Something you did as a teenager, hoping no one

would find out

• 3. An infectious disease
• 4. Something your dog drags around the house
• 5. A new boy band

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Session A: Transforming healthcare through a common quality agenda How do we all move in the same direction?

• ECFAA: Strengthen focus on quality and emphasizes continuous quality

improvement

• Ontario’s Action Plan for Healthcare: better access, better quality and better

value

• HQO, working with partners to promote a common Quality Plan (page 11 Strat Plan) that will:

– Focus on evidence, benchmarks and standards – Support quality improvement; – Identify priorities; – Utilize common measures to monitor, report progress and provide feedback; – An integrated approach (cross-sectoral)

• Gathering of Key Stakeholders today to discuss - moving forward

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Panelist Presentation

• Dr. Michael Sherar

President and CEO, Cancer Care Ontario

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Data/Information

• Incidence, mortality, survival
• Analysis
• Indicator development
• Expert input

Knowledge

• Research production
• Evidence-based guidelines
• Policy analysis
• Planning

Transfer

• Publications
• Practice leaders engaged
• Policy advice
• Public reporting
• Technology tools
• Process innovation

Performance Management

• Institutional agreements
• Quarterly review
• Quality – linked funding
• Clinical accountability

CCO’s Performance Improvement Cycle

1 2 3 4

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Key pad question

Where do you feel the greatest emphasis should be when focusing on the need to improve the quality of patient care?

1. Safety (Avoiding, preventing, and ameliorating adverse outcomes or injuries caused by healthcare management.) 2. Effectiveness (Providing services based on scientific knowledge to all who could benefit.) 3. Accessibility (Making health services available in the most suitable setting in a reasonable time and distance.) 4. Responsiveness (Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.) 5. Equitability (Providing care and ensuring health status does not vary in quality because of personal characteristics (gender, ethnicity, geographic location, socioeconomic status, age.) 6. Integration (Coordinating health services across the various functions, activities and operating units of a system.) 7. Efficiency (Optimally using resources to achieve desired outcomes.)

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Panelist Presentation

Pat Campbell

President and CEO, Ontario Hospital Association

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The Ontario Hospital Association: A common quality agenda is multilayered

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We know a common quality agenda includes:

Growing recognition that high performance within organizations misses key issues that impact patients and outcomes

The Change Foundation. Who Is the Puzzle Maker? Patient/Caregiver Perspectives on Navigating Health Services in Ontario. [Report]. June 2008. Toronto: The Change Foundation.

Access to data to drive improvement

• G. Ross Baker, Anu MacIntosh-Murray, Christina Porcellato, Lynn Dionne, Kim Stelmacovich and Karen Born. High Performing

Healthcare Systems: Delivering Quality By Design. 2008.

Strong capable leaders with clear vision and determination Effective performance management building off evidence based medicine and clinical process management

What could be missing?

• Must allow a shared understanding of individual provider

responsibilities and shared areas (including primary care).

A system-wide performance framework applied in a comprehensive and meaningful way (e.g., Scorecard)?

• Using evidence to address multi-level challenges in

quality improvement.

Collaborative processes to examine and address the interfaces between

• rganizations?
• Patient experience, patient reported outcomes, staff

engagement

Investment in the development and deployment of key metrics that matter?

• Not just accountability – timely, relevant, easy

access.

Assurance that data is available to support QI?

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Question for the audience

Of the things that are missing, where should the focus be to support the development of a shared quality agenda?

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1. Articulate system-level strategic priorities and goals 2. Collaborative processes to examine and address patient transitions 3. Investment in the development and deployment of newer key metrics 4. Ensuring data is available to support QI efforts within and between service providers

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Panelist Presentation

Susan Fitzpatrick Assistant Deputy Minister Negotiations and Accountability Management MOHLTC

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Ontario’s Action Plan for Health Care – A Call to Action: Better Access; Better Quality; Better Value

1 2 3

Faster access and a stronger link to family health care Keeping Ontario healthy

• Family healthcare at the centre of the system
• Faster access
• House calls
• Local integration of family care
• A focus on quality in family healthcare
• Childhood obesity strategy
• A smoke-free Ontario
• Online cancer risk profile and expanded

screening

Right care, right time, right place

• High quality care
• Timely proactive care
• Care as close to home as possible
• Seniors strategy
• Local integration reform
• Moving procedures into community
• Funding reform

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The people of Ontario and their Government: … Believe that the patient experience and the support of patients and their caregivers to realize their best health is a critical element of ensuring the future of our health care system … Share a vision for a Province where excellent health care services are available to all Ontarians, where professions work together, and where patients are confident that their health care system is providing them with excellent health care … Recognize that a high quality health care system is one that is accessible, appropriate, effective, efficient, equitable, integrated, patient centred, population health focussed, and safe … Believe that quality is the goal of everyone involved in delivering health care in Ontario

The Excellent Care for All Act...a unified commitment to a shared vision

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Alignment of our key activities under the features of a high performing system1 to achieve the vision enshrined in Ontario’s Action Plan and ECFAA

Set the Direction & Priorities Build Capacity for Improvement Align Incentives and Levers

Positive Change @ Scale with strong clinical engagement

Excellent Care for All Strategy Provincial Quality Campaign Quality Alignment to Health System Funding Reform Quality Improvement Plans Health Quality Ontario Strategic Partnerships IDEAS

1High Performing Healthcare Systems: Delivering Quality By Design: by G. Ross Baker, Anu MacIntosh-Murray, Christina Porcellato, Lynn Dionne, Kim Stelmacovich and Karen Born.

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Keypad Question

What is the most important factor that is allowing your

• rganization to embed the quality agenda into your

services, programs or everyday work?

• 1. Collaboration with other groups or organizations
• 2. Clinical leadership
• 3. Provincial level support by Ministry and HQO
• 4. Strong evidence-based translation
• 5. Rigorous performance measurement and/or reporting

through QIP and other mechanisms

• 6. Other

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Panelist Presentation

Don Ford

Chief Executive Officer Central East Community Care Access Centre

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Transforming Healthcare Through A Common Quality Agenda

A good patient experience encompasses:

• Clear consistent reliable

communication

• Access to information and

exchange of information

• Coordinated and connected care
• Comprehensive care
• Engagement in decisions about

care

• Respectful, empathetic and

considerate interactions

• Timely and convenient care

Winning Conditions To Improve Patient Experiences Change Foundation - November 2011

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Using your key pads…

“Quality is not the absence of defects as defined by management, but the presence of value as defined by the customer.” “Quality is the measure of how well a product or service meets a need.” “Quality is rooted in customer satisfaction.”

KEY PAD CHOICES ARE: 1.These quotes from industry do not have any applicability to health care

• 2. These quotes from industry have a little applicability to health care
• 3. These quotes from industry have a moderate applicability to health care
• 4. These quotes from industry have a fairly high applicability to heath care
• 5. These quotes from industry apply fully to health care

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Panelist Presentation

Kim Baker

Chief Executive Officer Central Local Health Integration Network

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Building a common quality agenda: A system perspective

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• ~ 1% of Ontario’s population accounts for 49 % of hospital and home care

costs and 10 % of the population accounts for 95 % of such costs (2010 study CHSRG)

• ICES looked at system-wide health care costs (excluding inpatient mental

health and non-fee-for-service physician costs) and found a similar trend: 1 %

• f the population accounts for 34 % of costs and 10 % accounts for 79 % of

system-wide costs

• JAMA recently published an article stating that about 10 % of the U.S.

population consumes about 64 % of health care expenditures

• If the province can find efficiencies that reduce these costs by even just 10 %,

that could amount to at least $1.5 billion a year in savings, a portion of which could be achieved through better co-ordination of services

• Analysis undertaken by Bridgepoint Health and Boston Consulting Group in

2011 suggests the savings achieved through better co-ordination of care in Ontario could be even greater, in the realm of $4 billion to $6 billion per year

Commission on the Reform of Ontario’s Public Services (Drummond) 2012

Can High Users Lead us to Quality?

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May create the system we “ask” for … How do we ensure it is the system we want….

A common quality agenda …

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Key Pad Question

What will have the biggest impact to improve care and quality?…

1. Responsiveness to patient choice 2. Shared accountability for quality 3. Greater standardization through evidence informed care (across the continuum) 4. Reduction in adverse events 5. Greater alignment of prevention and promotion resources/initiatives

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Panelist Presentation

• Dr. Michael Rachlis

Consultant Health Policy Analysis

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Achieving a common quality agenda: Utopian Dream, Oxymoron, or Democratic Wish

Michael M. Rachlis MD MSc FRCPC LLD Toronto October 23, 2012 Health Quality Ontario www.michaelrachlis.ca

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“There is a remarkable consistency and repetition in the findings and recommendations for improvements in all the information we reviewed. Current submissions and earlier reports highlight the need to place greater emphasis on primary care, to integrate and coordinate services, to achieve a community focus for health and to increase the emphasis

• n health promotion and disease prevention. The panel notes

with concern that well-founded recommendations made by credible groups over a period of fifteen years have rarely been translated into action.”

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• Ontario Health Review panel, 1987

The ideal health system would emphasize the prevention of poor health. It would be patient-centric and would feature co-

• rdination along the complete continuum of care that a

patient might need. Primary care would be the main point of contact, but there would be much less emphasis on treating patients in hospitals. All professionals would exercise the full scope of their skills in their work; nurses, for example, would administer vaccines, and nurse practitioners would manage chronic illnesses such as diabetes and high blood pressure. Payment schemes and information gathering would support the patient-centric notion.

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• Commission on the Reform of Ontario’s

Public Services, 2012.

How can we inject knowledge into policy?

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How would you ensure that a 2037 Ontario Health Report didn’t make the same recommendations as the 1987 Health Review Panel and the 2012 Drummond Report?

• 1. Increase funding for meeting quality targets
• 2. Decrease funding for failing to meet quality targets
• 3. Draw and quarter CEOs who fail to meet quality

targets

• 4. Pass legislation which makes doctors salaried

employees like the doctors at the Mayo Clinic

• 5. None of the above

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