By Tara Kiran, MD, MSc, Sam Davie, MSc, Rahim Moineddin, PhD, and Aisha Lofters, MD, PhD; St. Michael’s Academic FHT
Background: There is good evidence that cancer-specific patient outreach improves rates of cervical, breast, and colorectal cancer screening. However, it is unclear how primary care practices should implement integrated outreach for all 3 types of cancer screening. They aimed to understand whether integrated outreach using mailed letters or phone calls were more effective at increasing screening uptake in a primary care organization.
Authors: Tara Kiran, Noor Ramji, Mary Beth Derocher, Girdhari Rajesh, Samantha Davie, Margarita Lam-Antoniades; St. Michaels Academic FHT
Abstract
Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.
Providers who listen to their feelings and concerns.
Teams who contribute data to D2D have the opportunity to share data about how they are doing in terms of these indicators. One of the easiest ways to obtain this data is through a patient experience survey.
The PPPC is a 14-question survey that will let your patients tell you how patient-centered THEY think their care is. Some of the questions are similar to the ones you know from the HQO’s PES, or some of the questions in Data to Decisions – but they dig a little deeper into the relationship between patient and provider, and how that relationship affects the care they receive. It can give you a fresh perspective on the care your team is providing, amplify your patients’ voice, and maybe help relieve some of the “survey fatigue.”
But what does it all mean? Once your patients have sent back their surveys, check out the Instructions for Scoring the PPPC [PDF] and enter the data in the PPPC Score Calculator [downloads an Excel workbook]. The calculator will automatically turn your patients’ answers into aggregate scores for the following:
Each of the 14 questions
Each of the 3 components of patient-centredness
How thoroughly their illness experience has been explored
Whether they found common ground with their physician
Whether they feel understood as a whole person
Overall patient-centrednesss.
Wondering where the PPPC might fit in with your existing patient experience survey, how the questions relate to D2D indicators, or what to do with the results once you’ve seen them? Check our our FAQ for answers!
Consider sharing your results! The more we hear back from teams like yours, the more we can help all teams deliver more patient-centered care. Send your completed calculator worksheet to us at improve@afhto.ca.
Beyond the Survey: Engaging Your Patients in Quality Improvement
HQO’s Insights on Patient Engagement looks at the different ways health care organizations engage their patients. Across the health sector, surveys are the most common way to engage patients: 93% of home care organizations; 79% of interprofessional primary care teams, 74% of long-term care patients, and 66% of hospitals use patient surveys. In addition to surveys, here are some other ways organizations are engaging their patients, and how many interprofessional primary care teams are using them:
Focus groups, town halls and community meetings: 23% of iteams
Advisory council or similar: 9% of teams
Patients on the board: 10% of teams
Patient advisors on QI committees: 12% of teams
Patients involved in co-design: 9% of teams
At 10%,interprofessional primary care teams have a small lead when it comes to including patients on their boards. At 23%, interprofessional primary care teams are in the middle of the pack (tied with long-term care) when it comes to engaging patients through focus groups, town halls, and community meetings. Interprofessional primary care teams lag behind when it comes to including patients in other leadership and planning activities.
80% of long-term care facilities, 72% of hospitals, and 71% of home care organizations have patient advisory councils.
59% of hospitals, 36% of home care organizations, and 23% of long-term care facilities engage patients in developing their QIP.
43% of home care organizations, 33% of hospitals, and 14% of long-term care facilities include patient advisors in QI committees.
38% of hospitals, 14% of home care organizations, and 14% of long-term care facilities include patients in co-design.
Patients Canada has pioneered the practice of bringing the authentic patient voice to health care decision-making, ensuring decisions reflect patient priorities.
Health Quality Ontario (HQO) define patient engagement as “patients, families and health providers actively collaborating to improve Ontario’s health system.” They encourage and help providers to work with patients and families to understand and respond to their needs.
Patient and caregiver engagement is an ongoing focus for The Change Foundation, an independent health policy think-tank that works to inform positive change in Ontario’s health care system.
Provincial policy manual for primary care teams and practices
It’s finally here! We have developed a set of standardized policy templates for primary care. These templates can be used by teams across the province or shared with other primary care practices, such as solo physicians and non-team-based clinics.
The manual gives you the flexibility to determine, for your own practice or setting, what policies are required, and whether/how they should be tailored for your unique circumstances. It includes policies such as substance abuse focusing on marijuana, among other substances.
Whether you’re updating your own organizational polices or in the process of developing them, we hope you find this to be a useful aide.
In this Issue:
Provincial policy manual for primary care teams and practices
Using antibiotics wisely
Collaborative governance case studies – how collaborative are you?
Making the case for nutrition screening in team-based primary care to meet the needs of your frail clients
Webinar: Opioid tapering and tools for use in clinical practice
Leadershift applied leadership e-learning series
Upcoming events regarding follow-up in the north and more
Using antibiotics wisely
Using Antibiotics Wisely is a national campaign to help clinicians and patients engage in conversations about unnecessary antibiotic use. Current priorities include addressing overuse in the community, where 92% of antibiotics are prescribed. This year, one area of focus is antibiotics for acute upper respiratory tract infections in primary care.
Choosing Wisely Canada has worked with partners to produce a few resources including posters, evidence-based tools, and patient materials. In addition, there are over 20 Choosing Wisely Canada recommendations that encourage judicious antibiotic use, created by over 15 national specialty societies. Visit their website for clinician and patient resources, in time for Antibiotic Awareness Week (Nov. 12-18, 2018).
Collaborative governance case studies – how collaborative are you?
Collaborative governance is simply multiple boards partnering together to collectively achieve results for shared communities and/or stakeholders, including patients. Read these case studies to learn how two FHTs took a differing approach to collaborative governance, and to learn where your board falls on the spectrum of collaboration.
Making the case for nutrition screening in team-based primary care to meet the needs of your frail clients
Presented by Dr. Heather Keller on Wed., Nov. 21, from 12 p.m. to 1 p.m.
Did you know that ….
Malnourished patients cost $2000 more per hospital stay and cost an addition 2 billion dollars per year in health care costs?
Malnourished seniors are three times more likely to fall?
Malnutrition = fragility?
Primary care is the optimal place for the identification and treatment of malnutrition by team-based care. Nutrition screening in FHTs started in 2016 and now over a hundred teams are screening. This webinar will make the case for nutrition screening as a means of shifting primary care to ‘upstream’ prevention of undernutrition and eventual frailty. Register here.
Webinar: Opioid tapering and tools for use in clinical practice
On Mon., Nov. 19, from 12 p.m. to 1 p.m. join Dr. Andrea Furlan, co-chair of ECHO Ontario Chronic Pain and Opioid Stewardship, to learn about and discuss opioid tapering and tools for use in clinical practice. It offers the following learning objectives:
Describe barriers and facilitators for a successful opioid taper
Develop an approach for managing opioid withdrawal
Remember some tools for use in clinical practice to assist in opioid tapering
LeaderShift is happy to announce the Applied Leadership E-Learning Series, an online series on key leadership topics that will give you practical, actionable insights you can use. The first topic in this series will be “How to Give Better Feedback.”
Learn more today about this interactive online session and how to connect with leaders from across community and primary health care. Seats to participate live are limited. Apply before Fri., Nov. 16! Information is also posted on our website.
NPAO MAiD Conference, Thunder Bay, Nov. 10, 2018
Participate in the MAiD Conference hosted by the NPAO and MOHLTC. Learn more here. More sessions are also being planned in Toronto (Nov. 30) and London and Sudbury (dates TBD).
Altering Challenging Behaviours In Persons With ABI, Nov. 14, 2018
Acquired Brain Injury Behaviour Services at Ontario Neurotrauma Foundation presents this full-day Toronto workshop. You can register here.
Focus on Follow-up, Nov. 27, 2018
A full-day, interprofessional workshop highlighting northern teams and their solutions on how they can help their patients get the right follow-up from the right providers at the right time. Learn more here.
Governance Webcast Series: Board Orientation and Education, Dec. 6, 2018
Learn why board orientation and education is important. Register now!
The governance attestation requires every board have an executive director performance evaluation process in place. For guidance, a framework has been developed by Accompass to support boards in meeting this requirement. During this webcast, Accompass reviewed the Lead Executive Performance Guide. It includes the role of the board, key principles and best practices in ED performance management. One board chair also spoke to his FHT’s ED performance appraisal process and reviewed their appraisal document. Below are the materials from the webcast:
My Algoma Manitoulin Now The Webbwood Public Library is being recognized for its health services, not just its books. For their work to bring more services to Webbwood, two institutions have been named North East LHIN Healthy Change Champions says LHINS CEO, Jeremy Stevenson. He says the Espanola and Area Family Health Team and Public Health Sudbury & Districts took the lead in providing various services such as the From Soup to Tomatoes program, it includes a certified kitchen for healthy cooking and an Ontario Telemedicine Network is also in place. He adds the North East LHIN applauds the work of the two outstanding health service providers whose leadership is helping to meet the needs of people closer to home. Together, the two institutions have implemented several programs including the From Soup to Tomatoes arm chair-based exercise program, the snowshoe and urban pole lending program, health promotion programming, and group programming. The kitchen has been certified, and provides a space for the community to cook together and learn more about healthy eating. In addition, an Ontario Telemedicine Network (OTN) connection was established in the library’s community room, allowing health care providers to offer OTN appointments, including specialist appointments, to residents of Webbwood, eliminating the need for them to travel to a health care facility in another community. “Together we are able to increase opportunities so that all residents in the Espanola and surrounding area can have control over their health, while knowing that more accessible and client-centred health care is available when needed,” said Aimee Belanger, Public Health Nurse, Public Health Sudbury & Districts. Many other organizations also offer services to residents in Webbwood. Both plan to continue to strengthen partnerships and encourage more providers to explore similar models to service delivery. “It is our goal to develop or modify programming to meet the needs of the residents of Webbwood,” said Brunetti. “By working together with the North East LHIN and other partners, we can create a service delivery model that enhances access for individuals in the community.” “Public Health recognizes the strengths in working together with community partners to address health inequities in our communities,” said Belanger. “Partnering with the Webbwood Public Library is a prime example of how unique partnerships can be used to improve the health and well-being of a whole community.” Click here to access My Algoma Manitoulin Now article
LeaderShift is thrilled to announce the launch of the Applied Leadership E-Learning Series. This online series will feature short, laser-focused learning on key leadership topics that will give you practical, actionable insights you can use right away. The first topic in this series will be “How to Give Better Feedback.” High-performing teams rely on effective, insightful feedback delivered the right way, at the right times, to keep them at their best. Learn how to optimize feedback, motivate your team and colleagues, and overcome barriers in the upcoming online delivery of “How to Give Better Feedback.” Learn more today about this interactive online session and how to connect with leaders from across community and primary health care. Seats to participate live are limited. Apply before Friday, November 16th! Also, stay tuned to the website over the coming weeks for a key announcement related to an online LEADS LITE Series. It’s coming soon!
Collaborative governance is simply multiple boards partnering together to collectively achieve results for shared communities and/or stakeholders.
Read these case studies to learn how two FHTs took a differing approach to collaborative governance, and learn where your board falls on the spectrum of collaboration.
The policy templates can be used by primary care teams across the province or by other primary care practices (solo physicians and non-team based clinics). The manual gives you the flexibility to determine, for your own practice or setting, what policies are required, and whether/how they should be tailored for your unique circumstances. To be effective, policies should be reviewed on a regular basis (e.g. every 2 to 3 years) to ensure that they continue to be compliant with legislation, and to assess whether they are achieving their stated goal.
AFHTO will be updating policies in this manual annually. Although all the policy templates in the manual have been reviewed by legal and HR expertise, users should consult with their own legal counsel for advice pertaining to the use of these policies.
We would like to thank the Partnering for Quality Program for its contribution to the development of this policy manual, with special thanks to Clinton FHT, West Durham FHT and Thames Valley FHT. The Partnering for Quality Program is a regional program in the South West LHIN that aims to improve information management and collaboration between primary care and community health care partners with the ultimate goal of improving chronic disease prevention.
Halloween is done. Conference 2018 is done. It’s time to get back to demonstrating the value of the work primary care teams do every day! Based on member input, AFHTO’s board chose ‘follow-up after hospitalization” as a priority for improvement across the membership for the coming year. This bulletin highlights activities that might help in that regard. Focus on Follow-Up in the North East: Scared of having your patients fall through the cracks? Join us in Sudbury on November 27thfor a full-day, interprofessional workshop for teams (and hospital partners) in the North East LHIN.
Focus on Follow-Up will help your team make concrete progress in three areas: getting hospitalization information, tracking follow-up in EMRs, and doing the follow-up in a patient-centered way.
As always, we’ll be highlighting the wisdom of the field, so you’ll hear what’s already working for your peers in the North East, and how you can do it in your team.
Patient Oriented Discharge Summaries (PODS): It’s been a year! It’s time to check in about how well they’re working and why. The PODS research team is sponsoring the upcoming Focus on Follow-up session for AFHTO members (see above). Please help thank them by giving them 3 minutes of your time to complete a post-implementation survey of primary care teams. Sound familiar, but you’re not quite sure? Read on …
The questionnaire asks whether you’re sharing PODS with patients who go into hospital and/or getting them from patients when they come out of hospital. It also asks whether your team finds PODS helpful when it comes to doing follow-up.
PODS, introduced in 2017, are a tool that can help your patients get the information they need when they leave hospital. Twenty-seven hospitals across Ontario are giving PODS to patients at discharge.
Think you’ve seen this survey before? You may have done the original, baseline survey when PODS were first implemented. That survey helped the research team understand the potential value of PODS for primary care. This follow-up survey (see what we did there?) will help the measure the outcome of the intervention.
Use your Schedule A to help track progress with follow-up (among other things): Follow the North Star to make your Schedule A more useful tool. Or consider reviewing the Program Performance Measures Catalogue (PPMC) to find more meaningful and consistent measures for your Schedule A. More consistency shows measurement maturity, further demonstrating the value of teams to the MOHLTC. If you’re not ready to redesign your Schedule A yet, maybe you would consider at least sharing the current version of your Schedule A. This will help us update the catalogue and make it more useful.
Congratulations to everyone who presented at the AFHTO 2018 conference! We’re especially proud to toot the horn of our QI professionals – QIDS Specialists, QIIMS, and other QIDSS-like folks, now collectively known as the Q. Missed their presentations? Check out the links below. You may want to borrow some of their ideas for your own measurement and quality improvement work.
