AFHTO is pleased to announce that it will soon reach another of its objectives from the 2011-13 Strategic Plan – to have a full-time Executive Director, at least one additional staff member, and an office. On February 1 AFHTO will move into shared office space on College Street in Toronto, close to Ontario government offices and many of the other associations and agencies with whom we collaborate. The search has begun to hire a Membership Coordinator / Administrative Assistant. For more information about this new position, please go to the “FHT Careers” link – http://www.afhto.ca/about-fhts/fht-careers/ .
FHTs want to deliver optimal interprofessional care to their patients and communities, and face many day-to-day challenges along the way. Some of the operational issues we deal with require collaboration with or assistance from the MOHLTC’s FHT Unit. To help FHTs become much more effective in raising and resolving these operational issues, AFHTO has established an Operational Issues Working Group, supported by a continuous process to engage FHTs in identifying issues and potential solutions. The FHT Unit has agreed to meet quarterly with this Working Group. The first meeting was held today to review plans for the 2012/13 budget process. Four main topics were discussed:
2012-13 budget process:
AFHTO Working Group expressed appreciation for the Unit’s on-going work to improve budget processes and tighten up response time.
For next round, AFHTO Working Group has asked for a 2 month window to prepare submissions and get FHT board approvals, as well as the opportunity to receive feedback on previous submissions.
FHT Unit will communicate information about the budget process in the next “FHT to Print” newsletter, to be distributed in next week or so.
Need for greater flexibility in budgets:
FHT Unit is seeking internal approvals to introduce greater flexibility among some FHT budget lines. If approved, FHTs would still be required to report on a line-by-line basis but would be able to shift funding among specific groups of budget lines to meet needs.
Sector-wide funding pressures:
AFHTO Working Group presented two key issues: need for funding to recruit and retain staff and for IT.
While acknowledging government’s goal to limit expenditure growth to 1%, AFHTO Working Group pressed the urgent need to address compensation as the Public Sector Compensation Restraint Act comes to a close. AFHTO, in partnership with the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners Association of Ontario (NPAO) is seeking a meeting at the ADM level to review findings and recommendations from our joint research on recruitment and retention in primary care. (Report will be shared with members of all three associations in the new year.)
For IT, FHT Unit has agreed to develop some guidelines for a “life-cycle” approach to planning and funding IT, and AFHTO has offered assistance in doing so.
FHT reporting and evaluation:
AFHTO and the FHT Unit share a common interest in revamping reporting so that it conveys more useful information about quality and performance. FHT Unit will arrange consultations with AFHTO, AOHC and Health Quality Ontario. Meanwhile the AFHTO board has set up a Performance and Sustainability Working Group to look into questions such as indicators and data needs.
NPAR pilot, involving 40 FHTs, will be evaluated in April/May. Decisions about further implementation will take place after the evaluation is complete.
AFHTO’s Executive Director will continue to maintain on-going contact and follow up on these and other issues between the quarterly meetings. Engaging FHTs in raising and resolving operational issues Each member of the Operational Issues Working Group is the “point person” for a group of AFHTO members:
For FHT EDs in LHINs 1-4 and 12 (Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant, North Simcoe Muskoka):
John McDonald, Lead Physician PrimaCare Community FHT, AFHTO Past President E-mail: john.mcd1@sympatico.ca
We will be developing additional communication tools via social media, SurveyMonkey and the AFHTO members only website to support the goal to raise and resolve operational issues. We look forward to the progress we can make for all through this collaboration.
Information to Action is a collection of resources and tools that teams can use to start improving the quality of care they deliver now. Through Information to Action, we will provide dedicated support to teams interested in using the momentum of D2D to move from measurement to improvement. It is also meant to teach us what really works for all AFHTO members to translate Information to Action. The overall goal is to help teams deliver higher quality care. How will we know if it’s working? Hopefully, we will see the results in the data teams submit to future iterations of D2D.
Who is Information to Action for?
All teams are invited to assess how ready they are to be part of Information to Action. Just like with D2D, not all teams will be ready to make this move right away. And just like D2D, teams can start slowly, taking advantage of only those parts of Information to Action that work for them right now.
Start with the”Free-Choice” resources and activities. These are things your team can start doing now – or may already be doing. They have no prerequisites.
Consider the “Resources with Strings Attached.” These are more intensive supports you might consider signing up for if your team is ready. There is some homework you will have to do to help you prepare for them.
Volunteer to tell the story of your team’s QI journey as part of AFHTO’s QI enablers study. Teams from all stages of the QI journey are needed. This will make it easier to identify which characteristics, processes and tools are truly effective enablers for improving quality.
Access EMR Maturity Development resources from Ontario MD
Sign up for support from the EPEP consultants and/or OntarioMD peer leads to access topic or task-specific support. This support can help you make better use of your EMR in your quality improvement efforts. The EPEP consultants will help teams narrow down their focus to specific tasks that can be achieved in the context of the improvement initiative.
Join a Quality Improvement Community of Practice: Join the discussions that launch another AFHTO Community of Practice (CoP), focused specifically on QI. It is open to all interested teams, especially those taking advantage of the more intense resources.
Access continuing medical education for physicians
The following resources are more intensive and require some investment on the part of AFHTO and the participating teams. To make sure that everyone gets value out of this investments interested teams will be expected to participate in certain activities, including some of the “free choice” activities described above. At a minimum, teams participating in any of the services below will be asked to:
Develop a team-specific improvement focus. Work with your clinicians, IHPs, QIDS Specialist (if you have one), and anyone else on your team who has an interest in quality improvement. Choose a focus that is manageable and meaningful for your team, appropriate for your setting, and relevant to your patients’ needs.
Do a special one-time patient survey using the Patient and Family Centered Care scale, and
Participate in an interview later in the Information to Action process to share what changed (if anything) in your team’s area of focus on improvement.
NOTE: All of the spaces are fully booked for the Winter 2018 LEAN training session.
One person from each participating team will be invited to participate in one 5-day on-site training session plus remote coaching for 2 months (up to 6 trainees). The participant will be awarded a Green Belt on completion of the program. Unsure if LEAN training is right for your team? Read more about it here.
Team expectation: In addition to the minimum expectations described above, participating teams may need to cover travel and accommodation for the LEAN trainee. Participating teams will also need to cover tuition for any staff they send for LEAN trainee beyond the 6 positions available. Teams will also be expected to collaborate with their trainee in improving performance in the area of focus identified by the team and the trainee.
LEAN coaching will be available at no charge on a weekly basis for 8 weeks for teams enrolled in LEAN training. Additional coaching may be available at a charge to participating teams beyond the period offered through Information to Action. Join the discussions that launch a Quality Improvement Community of Practice (CoP), focused specifically on QI. It is open to all interested teams, especially those taking advantage of the LEAN training.
You do not have to participate in the LEAN training or coaching to be part of this CoP.
As in other CoPs, members of the community will be supported by facilitators and themselves in navigating available resources such as those listed here and those that might be available in specific LHINs or for specific topics, such as:
Teams interested in topics supported by these various coaching resources (among others) will be introduced to those providing the resources, to make it easier for teams to take advantage of these services.
The CoP will also support teams in monitoring progress against milestones on a monthly basis and/or troubleshooting challenges.
Progress in translating Information to Action: Interested teams may want to review their progress and that of their peers at special forums throughout the year. There may also participate in the orientation of the next cohort of interested participants, tentatively planned for the 2018 AFHTO conference.
Self-Assessment of Readiness
Interested teams are invited to complete a self-assessment of their readiness to succeed in this initiative by asking themselves the following questions. Once you have completed the self-assessment, send in your answers to us through this online survey..
Have all of our leaders agreed to participate in this initiative?
You know who your leaders are. Are they ready to make sure that the team follows through on their home work?
Do your team’s physicians know what their role is?
Is there at least one physician who agrees to champion the project and encourage other team staff and physicians to participate? If not, is there at least one physician who agrees to accommodate the project and allow access to their staff, patients and/or data as necessary for the project to proceed?
Can you agree on at least one problem you all want to solve?
There is likely no end of things that bother someone or other on your team. Is there one problem (or possibly 2) that you all want to do something about sooner rather than later? You do not need to have a fully defined “QI project” or research question – you will do that as part of this initiative. You just all have to agree that you want to take on this problem.
Does your QIDSS (or similar person) have access to your EMR?
It is almost certain that you will need to get at your EMR data to succeed with this. Administrative staff supporting the initiative (usually QIDSS or similar person) must have be able to extract data from your EMR. Have you got that set up yet or at least in progress?
Are you prepared to do your homework?
Your part in the initiative involves completing some baseline activities to measure and increase your access to data. These activities are listed below. Is your team ready to do these things as best you can?
Plan to take action on at least one area reflected in D2D: Choose an improvement focus based on at least one aspect of your team’s D2D performance, in addition to any other topic you wish to examine.
Share experience: Join your fellow participants to share your experience in various forums such as surveys, one-on-one discussions, focus groups and/or presentation at the next AFHTO annual conference.
Are you still working on getting ready?
Maybe your team wants to do some of your own work first before signing up for this initiative. Perhaps you have other pressing issues. If your team is not yet ready to participate in this improvement initiative, all is not lost. You can still participate in the improvement activities available to all members. You can also work on the criteria above at your own pace. There will likely be additional supports for improvement after the initial cohort for this improvement initiative is completed. The exact nature of the second cohort depends on how things go with the first. In addition, you may be able to make progress on your own even outside the improvement initiative because some of the services/supports are already available to members on request.
Frequently Asked Questions
As they think about signing up for this initiative, members have been asking questions. These are summarized below. They will be updated throughout the planning and implementation of the initiative.
What is the charge for participating?
The supports are free for this first cohort with the possible exception of some travel/accommodation costs for training activities.
How much information should we include in the readiness self-assessment?
The readiness self-assessment is available to help you decide how ready you are, so you can include as much (or as little) information as you like. Keep in mind, only teams who complete the readiness self-assessment will be eligible to participate in the “strings attached” resources.
How do teams sign up for the “strings attached” resources and how are the teams chosen?
Teams were invited to sign up for the “strings attached” resources (LEAN training) after the orientation session at the AFHTO conference. Teams were chosen on a first-come, first-served basis.
What if we don’t have very good performance?
Performance is NOT AT ALL a criterion for participation.
What if our team and our physicians have different priorities?
If the team and physicians are not yet in agreement on a priority problem but can agree on one problem they want to work on together and there is at least one physician who is supportive, you may decide you are ready to give this a try. Or you may decide to take a bit more time to work on getting to that point on your own before you enrol in an initiative like this. Many of the free choice supports are already available to all teams and may be useful in getting over this hurdle.
What if we don’t have a QIDS Specialist?
You don’t need to have a QIDSS to participate. In fact, you may find that that Information to Action will helps you cope without a QIDSS even better than you already are doing. If you don’t have a QIDSS, you will just have to ask someone else on your team to be the point person to support the data access/decision-support functions within your team.
Can we sign up as a group of teams or with non-AFHTO providers?
For sure!
What happens if we don’t improve?
Don’t worry. The goal is to build capacity for improvement activities and learn what it takes to improve. If you have tried something and it hasn’t worked to improve performance, at least you will know one thing NOT to do! As long as there is increased awareness and skill and lessons learned, the program will have met one of its most important goals.
Is this “one and done” or will there be a second cohort?
We hope for many cohorts. Improvement is one of AFHTO’s key strategic priorities. As long as that is true, AFHTO will be in the business of supporting improvement. One of the goals of this first cohort is to learn what it takes to do that well. Supports for future cohorts may or may not look the same as those for this first cohort, depending on what we learn.
What if we don’t want to work on anything in D2D?
Part of the goal is to demonstrate improvement in performance in the next iteration of D2D. To that end, we would prefer teams to choose something relevant to D2D. This will also make it easier to compare progress to others. However, if there really is nothing related to D2D that your team wants to work on, its probably not a deal-breaker to choose something else. Either way, you will be helping achieve the other goals for this initiative ie build capacity for improvement and learn more about what works best to build that capacity. To reach that latter goal, we will evaluate baseline and post-initiative data as well as have much conversation with participants about what worked for them throughout the initiative.
‘Lean thinking’ originated in the automotive sector and is now being utilized by various industries. It is especially valuable in the health care realm, where demand for care continues to grow and budgets are perennially tight, making both effectiveness and efficiency vital. “Lean” gives this industry not just a set of tools to use and procedures to follow, but a comprehensive and integrated thought process, culture and system of beliefs in the pursuit of improved patient care within available resources. The result of Lean Healthcare is a process that delivers value without waste, with high quality, at a low cost. A Lean Tool Box is available to support the elimination of waste and the streamlining of process flows. In health care, one must always remember that the product (laboratory test results or samples) or service (patient care) can make the difference between life and death. The needs of the patient are paramount. The Lean Sigma Green Belt program is designed for Healthcare professionals, to discover ways to implement core Lean concepts, tools and practices to optimize and error-proof care-critical business processes and create ongoing and sustainable improvements. Application of the knowledge and skills gained will improve primary care teams for all staff from those delivering direct care to the Executive Director, as well as the care delivery for all patients. Lean is predicated upon meeting the Voice of the Customer, and the instructors will utilize these principles to deliver relevant participatory curricula grounded in adult learning principles. The objectives for each section of the curriculum are designed according to Bloom’s Taxonomy, maximizing the experience and outcome of learning for each student. Figure 1: Bloom’s taxonomy classifies the objectives that educators set for students into three domains: cognitive, affective, and psychomotor (sometimes loosely described as “knowing/head,” “feeling/heart,” and “doing/hands,” respectively). The delivery method comprises a mix of didactic and interactive portions, triggering the inductive and deductive learning cycles of each student, encouraging the conversion from knowledge to application and analysis of the methodologies, tools and concepts. Moving from passive to active learning, the Lean Six Sigma Green Belt students will be supported to build a Lean skill set that will increase their ability to not only see new opportunities, but to move them to action. Figure 2: Inductive and Deductive Reasoning In addition to a focus on Lean approaches, methodologies and tools, a strong Facilitation component will be designed for the internal improvement facilitators. A module on Change Management to assist the facilitators to engage and coach staff in achieving improvements will also be a feature of the curriculum. Through a learn-by-doing approach, the program will work to mentor the Lean Six Sigma Green Belt students towards building self-starting capability within the organization. The measure of success will be when the candidates are able to design and deliver change independently, in alignment with the goals and objectives of their teams and the strategic objectives of AFHTO. While classroom education can be a useful vehicle for learning, leveraging real projects, a “hands-on” integrated approach to the coaching, mentoring and training of management and staff across an organization is far more effective with respect to knowledge transfer. In line with the Lean approach, focusing purely on financial metrics would not only drive the wrong behaviours, but would also disengage the majority of the workforce. The program will therefore take a balanced approach to opportunity identification using QCAPS (Quality, Cost, Access, People & Safety) in optimizing services for clients and patients. An overall evaluation of each cohort of Lean Six Sigma Green Belts will be performed in consultation with the Leadership team to ensure that projects are aligned with organizational goals.
AFHTO was invited to present to the Commission on Broader Public Sector Reform, chaired by economist Don Drummond and announced in the 2011 Ontario Budget speech last spring. The Commission is to report in early 2012, in time to inform development of Government’s 2012-13 Budget, on its mandate to examine long-term, fundamental changes to the way government works including:
Programs that are no longer serving their intended purpose and could be eliminated or redesigned;
Areas of overlap and duplication that could be eliminated to save taxpayer dollars; and
Areas of value in the public sector that could provide a greater return on the investment made by taxpayers.
AFHTO prepared a formal submission to provide the basis for discussion. Last week the AFHTO board of directors formally adopted this paper as policy direction for AFHTO’s advocacy work. Click here to access the paper. AFHTO’s advocacy work with and on and behalf of members continues. In addition to the Drummond Commission, recent meetings have included the OMA Negotiations Committee, the Minister of Health and Long-Term Care’s Office, MOHLTC’s FHT Unit, NPAR Advisory Committee and others. We look forward to continuing to keep you informed.
AFHTO is pleased to support Health Quality Ontario’s (HQO) Learning Community Wave 4 in Advanced Access and Efficiency for Primary Care. I’m writing to let FHTs know about an upcoming opportunity to participate in this valuable learning experience. An important goal for a clinic implementing advanced access is that patients calling to schedule a visit are offered an appointment with their provider on their day of choice, which may be the same day or a prebooked appointment for a future day . Advanced Access and Efficiency for Primary Care has been designed to assist providers in reaching this goal by offering Independent and Coach-Supported Learning. Providers can join the Independent Learning approach at any time by visiting www.hqolc.ca/wave4. Applications for Coach-Supported Learning are being accepted at www.hqolc.ca/wave4 until January 13, 2012. There are 150 available spots and spaces may fill with approved applicants prior to the deadline. The 6-month initiative begins on February 1, 2012 and ends July 31, 2012. For a full description of the initiative, including how to join or apply, what participation entails, and how others have already benefited from their experience with Advanced Access, you are encouraged to visit the Advanced Access and Efficiency for Primary Care website at www.hqolc.ca/wave4 to review the initiative’s brochure, backgrounder, project charter and other useful information. You can also get answers to your questions by reviewing the attached brochure, emailing learningcommunityinfo@hqontario.ca or calling 1-877-794-7447, ext. 201. Health Quality Ontario is a government agency that was formed by consolidating the expertise of the Ontario Health Quality Council, the Medical Advisory Secretariat, the Ontario Health Technology Advisory Committee, and the Ontario Health Technology Evaluation Fund, the Centre for Healthcare Quality Improvement and the Quality Improvement and Innovation Partnership.
From www.ohatoday.com — As part of their Safe at Work Ontario strategy, the Ontario Ministry of Labour (MOL) is conducting an Infection Prevention and Control heightened enforcement campaign at healthcare organizations throughout the month of November.
This campaign, otherwise known as a blitz will see MOL inspectors and infection control specialists conducting both scheduled and unscheduled visits to healthcare facilities. As stated in a recent background information document, Ministry inspectors will check for contraventions to the Occupational Health and Safety Act, Health Care and Residential Facilities Regulation, Needle Safety Regulation, and Other regulations as needed. These contraventions involve, but are not limited to, an employer’s responsibility to protect workers, such as establishing safe work practices, providing worker training and ensuring personal protective equipment is used and maintained. Particular focus will be paid to certain priority areas, including: Employer Duties:
Ensure all reasonable precautions are taken to protect the health and safety of workers from infection hazards.
Report occupational illnesses to the MOL, trade union (if any) and the workplace’s Joint Health and Safety Committee.
Safe Work Practices:
Employers develop practices such as respirator fit-testing, safe use and disposal of sharps, maintenance of ventilation systems, and cleaning and disinfection, for the protection of workers from infection hazards.
Workers follow the safe work practices and use the required personal protective equipment.
Workplace parties inspect the workplace for infection hazards.
Personal Protective Equipment and Safety Devices:
Proper use and maintenance of personal protective equipment, for example gloves, eye protection and respirators.
Workers access to appropriate hygiene facilities.
Safe handling and using safety-engineered needles.
Worker Information, Education and Training:
Worker awareness of infection hazards in the workplace and training in the safe handling, storage, use, disposal and transport of infectious agents.
Workers have appropriate information, instruction and supervision to protect their health and safety.
You can access thirteen medical directives on a variety topics by clicking on the links below. These directives have been created by the North York Family Health Team, and are posted for information and use by other FHTs.
AFHTO 2011 Conference Presentation Steven Lewis, well-respected Canadian health policy consultant, opened the Leadership Program with his thoughts on the future of family health teams in Ontario. To access his presentation slides, please click here. Steven Lewis’ knowledge and analysis of health integration issues across Canada make him a valuable resource for Ontario’s Change Foundation and the province. Based in Saskatoon, Steven was recently a Visiting Scholar at Vancouver’s Simon Fraser University, where he also works as an adjunct professor. He has headed a health research granting agency and spent seven years as CEO of the Health Services Utilization and Research Commission in Saskatchewan. He has served on various boards and committees, including the Governing Council of the Canadian Institutes of Health Research, the Saskatchewan Health Quality Council, the Health Council of Canada, and the editorial boards of several journals, including the newly launched Open Medicine. His published work covers topics such as reforming and strengthening medicare, improving health-care quality, primary health care, regionalization and integration, and the management of wait times. Click here to view presentation.
