Moving from a Culture of Measurement to a Culture of Improvement

Summary from the Board visioning exercise on the next level of D2D| May 30^th, 2018

  As an organization, AFHTO has led the primary care sector provincially over the last 4 years in the development of a culture of measurement across the membership, not only because of D2D but also through QIDSS support and good governance. There are countless examples of successful Quality Improvement in our member teams. Nonetheless, performance at the aggregate provincial level has held steady over the past four years of our progress in measurement. The Board recognizes that it is now time to accelerate Ontario’s primary care improvement strategy by driving improvement initiatives at the provincial level. Tied to that, the Board also recognizes a need to expand the support already provided for measurement to more robustly support the improvement efforts of members. With this in mind, the AFHTO Board held a facilitated session on May 30^th, 2018. The goal was to take D2D to the next level, taking into account the input of AFHTO members from two consultation sessions earlier in May. We emerged with a renewed vision for D2D. Our renewed vision: We will move to a culture of data-driven improvement across the primary care sector – a culture that is nimble, provincial, regional, and also, as always, local. AFHTO’s Board invites teams to make this vision a reality in two ways:

1. Demonstrate the capacity of teams for higher performance. Work together to establish a collective improvement focus on one indicator. When all teams work together on this one indicator (chosen through member input), we can achieve better outcomes relative our baseline and relative to the rest of the primary care sector.
2. Demonstrate the capacity of teams for sustained improvement. Work together to identify a small number of areas for improvement that matter to front line providers. Celebrating our ability to make sustained progress is just as important as being able to show high performance.

AFHTO’s Board invites its secretariat to support members in achieving this vision through the following enablers:

• Enable transparent measurement reporting.
• Advocate for front line support for QI, leveraging the strong relationships internally (within and between our teams) and externally with like-minded provincial organizations.
• Develop a process for reporting sustained improvement, not just performance, via D2D.
• Foster a “learning” mindset that learns and grows from every effort, successful or not.
• With external partners, assemble and share roadmaps for quality to guide teams to the processes and resources needed to support change.
• Advocate for receptivity of funders to work alongside AFHTO members to co-design the potential of future accountability agreements with primary care teams (e.g. LHIN MSAAs).

AFHTO’s Board is asking teams to respond to this online survey to help choose areas in which to focus our efforts, so we can demonstrate performance and improvement. In order to ensure that all teams are equally represented, we ask that each team’s ED or someone designated by the ED complete the survey. Members who complete the survey will be helping the AFHTO board in the following ways:

• Picking a winner:

AFHTO’s Board needs to know which one indicator we can pick that all AFHTO members can work on together to not only measure but improve performance. With all members working on this one measure, there is a better chance that we can demonstrate higher performance of teams in the next cycle of D2D.

• Building a farm team:

AFHTO members are already moving the needle on local measures that are important to them and their patients. We want to know what these measures are. AFHTO staff will then compile a roadmap and toolkit of resources for the most promising recruits for the “farm team”. At that point (probably Feb 2019), members will be invited to pick 3 areas important to them and report on their progress (not their performance). This will make sure we focus on our ability to improve (which is considerable!) as well as our ability to perform.

• Unmasking:

When you can talk to someone who is truly like you, the tips and tricks you share are more likely to be useful to you. But don’t take our word for it – talk to the teams who have already unmasked to find out how this is working for them. Consider what your team’s timeline is for unmasking your data in D2D. Remember that team-level data in D2D is only for AFHTO members so you are only unmasking yourselves to your fellow members, not to the world.

A high-level timeline for implementing this vision is outlined below, subject to input from members and steering committees charged with doing the work needed to make this happen.