“Faster access and a stronger link to family health care” is one of three key planks in Ontario’s Action Plan for Health Care. To do this, the Ministry of Health and Long-Term Care has intensified focus on improving quality in this sector. Here is an overview and update on Ministry and related initiatives to promote and support quality:
- Quality Improvement Plans (QIPs): As AFHTO reported in a Sept.24 e-mail to members, all FHTs must submit a QIP by April 1. Ministry plans were presented at the AFHTO 2012 Conference. See update below.
- Primary Care Performance Measurement Framework: Health Quality Ontario and the Canadian Institute for Health Information are leading this development. AFHTO e-mails on Nov.7 and 13 invited members to attend an HQO-CIHI webcast on this initiative and give input on priorities for measurement.
- Governance for quality: AFHTO is working with the Ministry, Association of Ontario Health Centres and Canadian Patient Safety Institute on plans to support primary care boards with skills and tools.
- Data and measurement support: AFHTO has been advocating for this critical requirement for quality improvement. The Ministry clearly understands this need and is investigating ways to do this, recognizing fiscal constraints. To support the QIP process, HQO is developing a few standardized patient survey questions and EMR searches for some measures.
Quality Improvement Plans The key facts about QIPs in primary care:
- All inter-disciplinary team-based organizations will be required to submit a QIP to HQO through existing contractual requirements with the Ministry.
- The Ministry (with HQO) will develop a template and guidance material that will be available and applicable to all primary care settings, most likely by January 2013.
- QIPs are to be submitted to HQO by April 1, 2013.
On November 15th, the Ministry and HQO held a forum with 14 FHTs to get feedback on the design of the QIP template and on the supports required by FHTs to develop and implement QIPs. AFHTO identified 12 individuals who provided a cross-section of: all regions of the province; rural and urban settings; large and small-sized FHTs; all 3 governance types; those experienced in quality improvement planning and those that are not; academic and non-academic FHTs; those focused on aboriginal and francophone populations; and ED, physician, and IHP roles. The AOHC CFHT ED group was invited to name two representatives as well. During the forum Ministry representatives confirmed that QIPs are a tool for improvement. FHTs will be accountable for submitting a plan, however the improvement results will not be used to adjust funding levels. They emphasized – perfection is not the goal – the initial focus will be on getting started. The group was told the purpose of QIPs is to ensure there is a uniform commitment and consistent approach to improving the quality of care delivered to Ontarians. For this reason, the Ministry has identified three quality dimensions for this first round of quality planning – access, integrated and patient-centred – and core set of measures will be provided. Participants noted the dimension of “effectiveness”, i.e. clinical outcomes for chronic disease, should also be included as an option. As well, the group suggested the “access” dimension should go beyond physicians to include same day access to other interprofessional health providers. HQO presented the supports they would provide to build capacity for improving quality. These include live and web-based learning opportunities, programs in Advanced Access and Efficiency and Chronic Disease Management, and a 1-800 “dial-a-specialist” service. FHT participants identified additional needs, in particular the need for standardized EMR queries and other support to get data out of EMRs. Peer training and on-site coaching were also identified as highly desirable supports. HQO committed to consider these ideas within their resource capacity. As reported in AFHTO’s Sept.24 e-mail to members, the Ministry had also committed to reduce administrative reporting on a quarterly and annual basis so as to free-up capacity to focus on quality improvement planning and implementation. Work is underway to streamline the reporting burden on FHTs. The direction of these initiatives are consistent with AFHTO’s vision – that FHTs are recognized by patients, FHT boards and staff, other health organizations, the public at large and their government as an innovative and efficient model for delivering accessible, comprehensive, high-quality, patient-centred primary health care. As the advocate, champion, network, and resource center for FHTs, AFHTO will continue to work to ensure FHTs are well-positioned and appropriately supported to succeed in improving and delivering optimal interprofessional care.