Kenora Daily Miner and News article published on March 9, 2016. Article in full pasted below. Kenora is home-base to the first memory clinic in Northwestern Ontario. The Sunset Country Family Health Team became the 78th clinic in Ontario and the first in the Northwest when it opened in February 2016 under the guidance of Dr. Linda Lee and her team from the Centre for Family Medicine Family Health Team in Kitchener-Waterloo. Lee established the first primary care memory clinic in 2006. Randy Belair, executive director of the Sunset Country Family Health Team, said the benefits of having a memory clinic in Kenora and the Lake of the Woods region are numerous. “We will increase the potential for improving diagnosis, which will have a significant impact on people’s lives,” said Belair. “Our team will provide team-based management and care throughout transitions, including system navigation.” A primary care memory clinic has a team of caregivers like nurses, social workers, pharmacists, dieticians, occupational therapists and Alzheimer Society team members working together and led by family physicians to better care for and meet the needs of persons with memory difficulties and associated conditions. Lee and her team helped set up the memory clinic for Sunset Country Family Health Team in mid-February and were back in Kenora March 7-9 to train staff on observership and mentorship, the latter of which involves interacting with patients. Once the staff at Sunset Country Family Health Team is fully trained and the program is implemented, they should be able to manage about 90 per cent of “memory loss” cases within the clinic. Lee first became interested in the idea of memory clinics when she took over an elderly practice in the late 1980s where she began to understand the needs of people with memory problems and how difficult giving them proper care was in a regular doctor’s office. “I was touched by the magnitude of suffering these people and their family members go through and very aware of the huge gaps in care for them,” said Lee. “We became a family health team in 2006 and I thought this was my opportunity to try to change the system of care and use the inter-professional health-care providers that were part of the team in the efficient, evidence-based way that would help me offer the kind of care these people need. “We were able to create a model of care that didn’t exist before — a point of access for persons living with dementia and their care partners, between the specialist and the primary care physician, but rooted in the primary care practice setting,” added Lee. “Based on our studies with this model, we can manage up to 90 per cent of the cases without relying on specialist referrals.” This frees up specialists to focus on the most complex cases of memory loss and dementia cases.
Author: sitesuper
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Results of member feedback: AFHTO response to the Patients First discussion paper
Click here to read AFHTO’s response to the Ministry’s Patients First discussion paper, approved by the AFHTO board and submitted today to the Minister, Ministry and LHIN CEOs.
Response is grounded in feedback from members
In early January, AFHTO hosted 14 web meetings for FHT and NPLC leaders in each of the LHIN regions, resulting in priority action items. These provided the basis for AFHTO’s response.Member input on question of accountability and contractual relationships
The January meetings revealed this topic to be the top priority item. The driving concerns appeared to be:- Potential for misalignment since Patients First proposes to keep FHT/NPLC contracts and funding with the Ministry while accountability for planning and performance management goes to LHINs.
- Added burden and potential conflict in reporting requirements to the Ministry, LHIN and HQO.
In these meetings AFHTO members had expressed diverging views on the question of reporting to LHINs versus the Ministry, and so all FHT/NPLC leaders were invited to explore this topic more deeply. With the goal to develop with AFHTO members a position on accountability and funding relationships with the ministry and LHIN, about 30% of FHT and NPLC leaders responded via survey and/or two web meetings.
Respondents considered 10 facets of accountability and funding relationships between a FHT/NPLC and the Ministry or LHIN. Consensus emerged on the view that it’s important for performance expectations and funding decisions to be set by the same level; however, the membership was split on the ultimate question of funding relationship the Ministry versus LHIN. Click here to see the full report on the survey and web meeting results.
In assessing the responses and the response rate, the AFHTO board determined the following recommendations would best express the collective views of the membership:
- Ministry must establish minimum requirements for the LHINs’ role in planning and overseeing primary care, and hold LHINs accountable for meeting those requirements
- Ministry and LHINs must ensure that funding and performance requirements set out in contracts with primary care organizations, individual or groups of primary care providers, and other entities are aligned to achieve desired outcomes for the population and the health system
- Consistent performance measurement is critical
- Streamline multi-level reporting requirements and processes, and provide feedback to teams
- As capacity and trust are developed within each LHIN over time, evaluate whether funding and contractual relationships should remain with Ministry or shift to LHIN
Developing a unified response for primary care
AFHTO is chairing work by the Ontario Primary Care Council (OPCC) to develop a joint response to the Minister, to be finalized at its March 9 meeting. In a letter to Minister Eric Hoskins on January 25, 2016, six associations of the OPCC have provided initial feedback on the Province’s plans to strengthen our health care system. This work has been greatly informed by AFHTO’s consultation with members. -
AFHTO’s response to Patients First Discussion Paper
Click here to read AFHTO’s overall response to the ministry’s Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario discussion paper, approved by the AFHTO board and submitted on March 3rd, 2016. An initial response was issued with a statement from Dr. Sean Blaine, AFHTO President and Clinical Lead, STAR Family Health Team in Stratford. This was published in various newspapers including The Kingston Whig-Standard, Woodstock Sentinel Review and Beacon Herald.
Response is grounded in feedback from members
In early January, AFHTO hosted 14 web meetings for FHT and NPLC leaders in each of the LHIN regions, resulting in priority action items. Member input was further requested on the question of accountability and contractual relationships, summary of results available. These provided the basis for AFHTO’s response.
A unified response for primary care
AFHTO chaired work by the Ontario Primary Care Council (OPCC) to develop a joint response to the Minister on the Province’s plans to strengthen our health care system. The six associations of the OPCC provided initial feedback in a letter to Minister Eric Hoskins on January 25, 2016. Finalized at its March 9 meeting, the joint response was submitted on March 24. It offered advice on the following key areas:
- Ministry stewardship and LHIN mandate
- Access to interprofessional health providers and access to teams
- Embedding care co-ordination in primary care and the next steps to support implementation
- The interface between primary care, mental health and addictions
- Clinical leadership
- Governance, performance and accountability
- Critical enabler: data and information management
This work has been greatly informed by AFHTO’s consultation with members.
What’s happening in each region?
AFHTO members are meeting with their LHINs and working together to strengthen the primary care voice within the LHIN. See below for resources to further support this engagement:
LHIN # LHIN Implementation Plan (Oct. 9th submission) Results from Regional Consultations 9 Central East Link Online 11 Champlain Link Online 8 Central Link Online 4 Hamilton Niagara Haldimand Brant Link Online 6 Mississauga Halton Link Online 13 North East Link Online 12 North Simcoe Muskoka Link Online 14 North West Link Online 10 South East Link Online 2 South West Link Online 3 Waterloo Wellington Link Not currently available 1 Erie St Clair Not currently available Online 7 Toronto Central Not currently available Online 5 Central West Not currently available Online -
Data to Decisions eBulletin #30: Higher quality and lower cost
News Flash: Patients of higher quality teams have lower healthcare costs! From D2D 3.0 comes concrete evidence that the work you put into quality does make a difference! Early notice that D2D 4.0 is now scheduled for Fall 2016. Watch this space for emerging details. Focus Groups with IHPs – looking beyond measurement to improvement in interprofessional care: IHPs will be sharing their clinical perspectives on how AFHTO can help teams move from measurement to improvement. Some focus groups have already been scheduled, and we are still seeking participants for others. How is D2D working for you? We are currently scheduling interviews between Dan Wagner (MSc student) and EDs/Admin Leads to find out what teams have to say about D2D. Contact Carol Mulder for more information. Quality Improvement Toolkits from Cancer Care Ontario: Toolkits are now available for advance care planning and improving cancer screening for quality improvement planning. Program Planning Tools available online: Program Planning & Evaluation Tools and a newly developed Indicator Catalogue are now available to support teams in completing Schedule A requirements.
Help spread the word about D2D – invite others to sign up for the e-Bulletin online. Getting too many emails? Scroll to the bottom of the original email for the unsubscribe link.
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Higher quality care linked to lower healthcare costs
The biggest news coming out of D2D 3.0 is the concrete data that higher quality comprehensive, patient-centered care is related to lower healthcare costs.
Data to Decisions (D2D) is making an impact well beyond what it means to individual teams.
In addition to showing teams how they compare to their peers, D2D is making it easier for AFHTO to advocate for how team-based primary care could be measured across the province. With all the data submitted by members, we can show that measuring in a way that is meaningful and manageable for front-line providers makes a difference.
What difference does this make to your team?
Perhaps you and your team will be encouraged to hear the good news that high quality care is related to lower health system costs. The work you put into quality improvement does make a difference. You may also be encouraged by the early evidence from D2D (consistent with other published literature[1] ) that AFHTO members deliver better quality than the rest of the province on average. The comparison is not totally valid (because of differences in data sources and patient demographics) but it IS a comparison that many are interested in making. AFHTO is using D2D data to support arguments for a provincial solution for consistent capture of patient experience data as well as easier, more timely access to other important data sources. Finally, you and your team may also be encouraged that AFHTO now has an even more compelling argument for aligning performance in primary care with what really matters to patients and primary care teams. In the meantime, you may find the quality roll-up indicator useful at the local level (select the “Roll-up” tab at the top of the display). We have put together some tips for using your results to focus improvement efforts. And if you’d like to spread the good news around, consider sharing this handout with your colleagues. [1] Kiran, T., Victor, J., Kopp, A., Shah, B., & Glazier, R. 2014. The Relationship between Primary Care Models and Processes of Diabetes Care in Ontario. Canadian Journal Of Diabetes, 38(3), 172-178.
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Re: Update on Compensation Commitment Announced in 2016-17 Provincial Budget 2016-17
Dear Colleagues
As we all now know, the Government announced in their budget funding for compensation related to interprofessional primary care teams. Specifically, the commitment stated: “To ensure these clinics (CHCs, NPLCs, FHTs, AHACs and nursing stations) can effectively recruit and retain qualified interprofessional staff in primary care settings, Ontario will invest an additional $85 million over three years.”
Yesterday, AOHC, AFHTO and NPAO met with the Ministry primary care team to get a better understanding of the implications of this announcement and to discuss an implementation plan.
This is what we learned:
- The organizations included in this announcement are AHACs, CHCs, NPLCs, FHTs as well as other primary care organizations and team members such as nursing stations, providers such as social workers hired by family health groups and other funded independent Primary Care NPs.
- The funding for year one is effective April 1 2016.
- The plan is to rollout these funds over 2 years.
- The $85M is a cumulative amount but the annualized amount is to base and is permanent.
The AFHTO-AOHC-NPAO proposal remains our goal – we continue to advocate to achieve the 2012 recommended salary rates for all staff (IHP and admin) in primary care teams, to be implemented over 4 years. The Ministry recognizes that this $85M commitment is the first step in a process and is committed to working with us to achieve our overall goal. Two years from now, the opportunity for further increases is likely to open up. The Government is committed to eliminating the deficit by the end of 2017-18 and some of the compensation constraints may be lifted for the following fiscal year. This will provide opportunities to address the remaining gaps.
Given this context, in the first 2 years of this rollout (the $85M), AOHC, AFHTO and NPAO continue to be guided by the principles that our members agreed to in 2012, specifically:
- Increasing benefits from 20% to 22.5% to enable HOOPP
- Placing all professions in the correct salary band, i.e. band corrections for health promoters, registered dietitians, and nurse practitioners
- Funding allocations that would equitably close the gap between current rates for each salary band and the 2012 recommended rates for those bands. These salary bands apply to all members of primary care teams.
Next Steps:
- Given these principles, the MOHLTC is doing some calculations and developing options. They have the full information they need for FHTs and NPLCs and are collecting additional information from CHCs and AHACs – specifically the number of FTEs per band.
- Once these calculations are completed, the MOHLTC will reconvene with the three associations to discuss next steps.
The MOHLTC and the three associations are committed to getting you this information as soon as possible; but we need to ensure that we collectively take time to get this right and to ensure the equitable outcomes for all your staff. Please do not hesitate to let us know if you have any further questions or concerns at this time.
Adrianna Tetley Association of Ontario Health Centres of Ontario Angie Heydon Association of Family Health Teams of Ontario Theresa Agnew Nurse Practitioners’ Association of Ontario -
New temporary clinic for those without a doctor |The Peterborough Examiner
The Peterborough Examiner article published on Mar. 2, 2016. Article in full pasted below. Jason Bain, The Peterborough Examiner A temporary clinic for patients without a primary health-care provider scheduled to open near the downtown core Monday aims to do far more than simply care for patients, according to Peterborough Family Health Team officials. The PWD (People Without Doctors) clinic at 239 Charlotte St. will be open for six months to provide care to the nearly 2,200 city and county residents registered with Health Care Connect as being without a family doctor or nurse practitioner. But the temporary clinic won’t be your typical walk-in clinic, where health care providers general react to patients’ immediate medical needs. Staff will also be proactive, gathering data to reflect the true number of those without a family doctor. That information will be used to demonstrate to the ministry that the city is underserviced, from a primary care provider perspective, and to lobby for more doctors for the region, family health team officials stated. The Ministry of Health deemed the city fully serviced in the spring of 2015 and put a freeze on new doctors joining the health team, unless they are a replacement for a retirement. That is leaving thousands with limited options when it comes to their health care – something officials want to change. “While we have great service here, we know it’s not enough,” health team executive director Lori Richey said. The volume of unattached patients, anticipated population growth and unnecessary use of the PRHC emergency department for non-urgent care are other reasons family health team officials felt “compelled” to “improve this unacceptable situation.” “It is our hope that the People without Doctors Clinic will provide some much needed care to the unattached patients of Peterborough city, while providing accurate information on just how enormous that need is,” family health team medical director Dr. Kaetlen Wilson stated. The clinic will also be an opportunity for health care providers to get a sense of the needs of those without a primary care provider and to connect patients with other services in the community they may not be utilizing, Richey said. “We’re trying to inform our planning.” Those without a family doctor or nurse practitioner should register with Health Care Connect, a provincial service, as soon as possible, Richey said, noting how the actual number of those without a primary care provider is much higher. That figure is key because it is what will be used by the ministry to decide how many doctors the area needs, she said. “The list is what drives funding decisions.” It’s also important for those who have been on the list for a long time to ensure their health status is up-to-date and accurate, Richey added. The process to open the clinic happened quickly, the executive director said, noting how it is in line with expected Ontario health care reform. In aligning with new provincial priorities, the family health team will have a handle on the needs of local patients when the changes are implemented, she said. For example, walk-in clinics are not ideal care, Richey said, explaining how having a primary care providers who provide longitudinal care for every patient is the “ultimate goal.” The clinic will be open on weekdays and will close Aug. 22. The doctors working there are all retired or semi-retired and are assisting because they are passionate about being a part of the solution, Richey said, noting how leveraging all the players in the health care system is necessary. The temporary clinic, announced Monday, has been a community effort. AON is providing a subsidized rent cost as a community service, Brant Office Supply has loaned office furniture and McWilliams Moving and Storage picked up and delivered medical equipment. Castle Voice and Data Communications Inc. also provided a discounted rate for the phone system while Your Family Health Team Foundation supported the purchase of clinical equipment. The temporary clinic is the first phase of a two-pronged effort, with more details on the latter expected to be released soon. The second phase relates to the 109,000 city and county residents who do have a doctor, Richey said. To reach the clinic, call 705-741-2260 (phone lines open Monday) for an appointment or walk in during office hours. To register with Health Care Connect, call 1-800-445-1822 or register online at www.ontario.ca/page/find-a-family-doctor-or-nurse-practitioner. Those in need of assistance registering are encouraged to call the clinic. Click here to access the article on The Peterborough Examiner website.
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ED Mentor Resources
AFHTO’s Executive Director mentorship program, developed in response to member requests, aims to provide peer support for any member EDs or Administrative Leads who feel they could benefit from it. We strive to match mentors and mentees whose teams work in similar environments, taking into consideration geography, size, governance structure, academic or Francophone status, and other characteristics that reflect the diversity of our membership.
ED Mentorship Orientation
The mentorship program was launched in February 2016 with an orientation webinar for ED mentors, presented in partnership with the Centre for Effective Practice (CEP).
- View the CEP Mentorship slide deck [PDF]
- View the Mentorship Program Overview slide deck [PDF]
- Watch a recording of the Orientation Webinar [YouTube]
Mentors have been matched with mentees and will be reaching out to them over the coming weeks.
Additional Resources for ED Mentors
The following supplemental materials are available to assist our ED mentors in fulfilling this role:
- ED Mentorship Checklist [PDF]
- Mentoring Partnership Agreement [opens a Word document]
As the program evolves, more materials will be made available.
ED Mentorship Program Overview
Mentoring is about supporting people to develop more effectively. It is a relationship based on trust, designed to build confidence and to help a mentee take increasing initiative. Mentoring occurs when two individuals decide to work together to achieve specific objectives for skills, growth and development. One individual has the skill, knowledge and experience that the other individual aims to acquire.
Benefits of AFHTO’s Executive director (ED) Mentoring Program
Benefits to Mentors
Benefits to Mentees
- Being part of a solution to build capacity for leadership in primary care
- Pleasure of giving back and passing on skills, knowledge and wisdom
- Satisfaction of enhancing a mentee’s understanding of the FHT/NPLC workplace
- Heightened profile within their workplace
- Coaching practice and leadership skills
- Heightened self-awareness
- Access to wisdom and expertise in a confidential safe relationship
- Opportunities for self-assessment
- Greater understanding of current business practices
- Introduction to business networks and related supports
The Program So Far
Since the launch of the mentorship program in February 2016, we have matched 15 mentor-mentee pairs. All of them have connected, and most have had a face-to-face meeting followed by ongoing email support. What we have heard from them is very encouraging and a testament to the strong leaders in our membership. Mentees overwhelmingly agree that their mentors are well-suited to support them, knowledgeable, and able to provide needed support. Mentors are telling us that their mentees are receptive and open to receiving it. Here is a sample of what the program participants are saying:
- “My mentor is awesome, very helpful! She provides amazing support.”
- “My mentor is very knowledgeable and easy to work with. She always makes time to answer questions and provide guidance when required.”
- “I would suggest having a mentor work with all new EDs when they come onboard.”
- “I can learn as much from my mentee as she can from me. Seems to be working for both of us.”
More Information
Follow this link to learn more about AFHTO’s mentorship program, including the ideal qualities for successful mentors and mentees.
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CCO Cancer Screening & Advance Care Planning QI Toolkits
Cancer Care Ontario is pleased to share two updated Quality Improvement Toolkits. These resources have been developed to support Ontario’s inter-professional, team-based primary care organizations with their annual Quality Improvement Plans (QIPs), which are due to Health Quality Ontario by April 1st. Cancer Screening Quality Improvement Toolkit
- This toolkit has been developed to assist primary care providers in planning, implementing, monitoring and reporting on improvements in colorectal, cervical and breast cancer screening
- Cervical and colorectal cancer screening have been identified as priority indicators for the 2016/2017 QIP cycle
- The toolkit includes: 1) instructions; 2) a measurement, tracking and evaluation tool; and 3) a patient tracking tool
Advance Care Planning Quality Improvement Toolkit
- Family physicians and other primary care providers are ideally positioned to initiate Advance Care Planning (ACP) conversations, and there are numerous benefits to incorporating ACP into primary care practices
- This updated toolkit reinforces its connection to the Health Care Consent Act and ensures alignment with Ontario’s legal landscape
Where can I find the Quality Improvement Toolkits? The toolkits and supporting resources are available for downloading at cancercare.on.ca/pcresources. Questions/suggestions? If you have any questions or suggestions about the cancer screening toolkit, please send them to screenforlife@cancercare.on.ca or call 1-866-662-9233. For questions or suggestions about the ACP toolkit, please send them to Tara.Walton@cancercare.on.ca. We encourage you to use these toolkits as part of your quality improvement planning and share these resources with your networks.
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AFHTO & MOHLTC Joint Webinar: Program Development for FY 2016-17
AFHTO & the Ministry of Health and Long-Term Care have introduced a suite of program planning and evaluation tools, created by AFHTO and the Ministry to assist our member teams in developing programs for the 2016-17 fiscal
- Program Planning & Evaluation Framework [PDF]: developed jointly between AFHTO member ED Work Group and the Ministry, the framework is intended to be a guide for FHTs and NPLCs to use when developing new or evaluating current programs, and to help promote the delivery of effective programs. The Framework will be a valuable reference to support teams in completing their program reporting requirements.
- Indicator Catalogue [opens an Excel spreadsheet]: the indicator catalogue is another supportive guide developed for FHTs/NPLCs to use when selecting meaningful measures for their programs that are based on clinical guidelines. The catalogue will enable teams to find sample indicators that can be used to measure progress on specific objectives and select indicators that align most appropriately with the goals of their programs.
These were presented in a webinar offered in two sessions, Wednesday, February 24, 2016 and Tuesday, March 1, 2016. The March 1 session was recorded and can be found here, along with the presentation slide deck and a number of other resources which were designed for use with the Framework and Catalogue.