Navigating Change Through Strengthened Leadership: Regional Governance Workshops

Primary Care is in a period of transition, and FHT/NPLC leaders across the province are asking what we can we be doing now to prepare for the future.

To address this question, AFHTO facilitated Governance & Leadership workshops in 13 of the 14 LHIN regions. These focused on strengthening governance practices, understanding the current primary care landscape, and encouraging generative conversations within boards to help us collectively prepare for change in our primary care system.

In these sessions, we observed was that there are many primary care leaders who are motivated to help in the transformation of the health system and ensure that it remains grounded in primary care, as is the intent of the Patients First legislation. While there is a tremendous amount of great work occurring across the province, there also remains plenty of opportunity for improvement.

AFHTO will continue to monitor each LHIN region as Patients First implementation gets underway and share successes and challenges so we can learn from each other and encourage a level of provincial consistency where needed.  The summary below provides key take-aways from the regional workshops and highlights potential areas of focus for FHT/NPLC leadership.

Strengthening Governance Practices

• Assess the current skill mix on your board – implementing a skills-based board is likely to be required in the next FHT contract!
  • Check out sample skills matrices
  • Consider developing strategies to address skill gaps –targeted board recruitment, committee involvement, education, training, etc.
  • Contact AFHTO if your board wants help transitioning to a skills-based, mixed board.
  • Remember the ‘sweet spot’ for boards is 7-9 people
• Review the required Governance & Compliance Attestation and identify areas your board may need to focus on.
• Conduct a board evaluation – check out the Governance Centre of Excellence (GCE) Board Assessment Tool and other examples of board evaluations.

Engage in strategic and generative discussion at the board

• Consider implementing a ‘consent’ agenda – to allow more time for the board to engage in strategic and generative discussion
• ‘Flip’ your agenda – start each meeting with a generative question to enhance the dialogue, and leave standard items and reports until the end.
  • Consider bringing these reflective questions to your board for further discussion.

Establish a culture of quality and patient safety

• Does your team have a culture of quality? Transparency? A just culture?
• Assess your team culture with tools and surveys from Accreditation Canada or Imagine Canada; incorporate culture questions in staff surveys.
• Consider having physicians sign off on the QIP to improve collective buy-in and encourage a team culture of quality.
• Consider implementing monthly “Doing It Better” rounds to review “good catches” (a.k.a. “near misses”). This supports a commitment to transparency and establishing a just culture.

Bring the patient voice to the board!

• There are plenty of ways to hear from patients and the community!
• Consider hosting patient stories or lunch ‘n learns, recruit patients/community members to your committees, set up a 1-day citizen panel, etc.
• Check out  South East Toronto FHT Patients Advisory Council and other patient engagement tools.

Engage with other teams and HSPs in LHIN sub-regions

• Consider establishing board-to-board relationships.
• Adopt a “soft” approach, such as a jointly-held education day on privacy, Medical Assistance in Dying legislation (MAID), or collaborate on your QIPs.
• Ask your LHIN about opportunities to bring boards together!

Keep building relationships with the LHIN

• Get involved to ensure the primary care voice is heard!
• Encourage physician leaders to apply for the sub-region clinical lead positions.
• Invite LHIN leaders to attend regional ED meetings. Possible areas of focus may include:
  • Supporting the sub-region clinical leads – finding ways to inform, consult, and collaborate with them to identify and promote a shared agenda.
  • Integrating care coordinators into primary care
  • Opportunities/education/training for clinical Leadership
  • Quality Improvement – leveraging D2D and QIDSS support
  • Capacity Assessment Framework – each LHIN is required to complete this framework – and we need to provide primary care input!

Manageable, Meaningful Measurement

• Align your QIP with your strategic plan or D2D
  • Choose metrics that are meaningful to your organization. Remember the QIP is mandatory, but the contents of it are not!
  • Access QIPS for your sub-regional peers to see what others are measuring
• Think about participating in D2D if you haven’t already. This is our opportunity to lead primary care performance measurement.
  • Ask your board if they would be willing to remove the anonymity in D2D.
  • Please see (and share!) the handouts linked below for more information about D2D
    • What is D2D, and Why? This primer introduces D2D, summarizes the steps to participate, and gives links to some resources you may find helpful.
    • D2D 4.1 Results: A summary of the results from the last iteration of D2D – highlights on the front page, with more details on the reverse.
    • D2D 4.1: LHIN-Specific Summary: A breakdown of D2D 4.1 performance by LHIN region.
    • Quality/Cost Relationship: More information about the relationship between cost and quality, and about the Quality Roll Up indicator.

Workshop Materials

• Slides:
  • Welcome & Overview
  • Knowledge, Skills and Role
  • Culture
  • Relationships
  • Strategy & Meaningful Measurement
• Key Questions Handout