The Government of Ontario’s recently released Action Plan for Health Care puts a strong emphasis on primary care, placing “Family Health Care at the Centre of the System”. In the last week the final set of reports on Strategic Directions for Strengthening Primary Care in Ontario were also released by the Ministry to participants involved in the five working groups engaged in the process. While these reports have no “formal” status in the Ministry, they may give some insight and ideas to government and stakeholders moving forward on this Action Plan. AFHTO has received the go-ahead to share these reports with members, please click to access:
The Strengthening Primary Care initiative grew out of the McMaster Health Forum’s June 2010 stakeholder dialogue on “Supporting Quality Improvement in Primary Healthcare in Ontario”. It was chaired by Susan Fitzpatrick, Assistant Deputy Minister, Negotiations and Accountability Management Division and overseen by a planning group consisting of the Ontario Medical Association, Registered Nurses’ Association of Ontario, Ontario College of Family Physicians and Association of Ontario Health Centres. (PHPG was set up before AFHTO had staff in place and did not have the capacity to participate at that time.) The process involved working groups on Quality, Access, Efficiency, Accountability and Governance. AFHTO participated in 3 of these 5 groups. The synthesis report was developed thereafter. A draft was discussed with participants in the working groups in September. The final product, entitled Strategic Directions for Strengthening Primary Care in Ontario: Overview of the Recommendations of the Primary Healthcare Planning Group states, “it is not meant to be a stand-alone document, rather a high-level summary and synthesis of the recommendations of PHPG’s five Working Group reports and our joint grouping of the strategic directions for strengthening primary care in Ontario under five core themes:
Primary care is fundamental to the health of patients and our health system. Family Health Teams have been working hard to innovate, to improve care, and from that, to improve health. For this reason, AFHTO is pleased to see the Ontario Government is placing “Family Health Care at the Centre of the System”. Released today, Ontario’s Action Plan for Health Carecalls for faster access to primary care, expanded access to house calls from health care professionals, and greater integration of primary care with all the other providers involved in the patient journey. The experience of Family Health Teams provides some guidance for moving forward. Since their first introduction in 2005, Family Health Teams have made significant strides in providing faster access to care for patients and integrating care. Some examples can be found at:
AFHTO looks forward to working with the Ministry and primary care colleagues to share what Family Health Teams have learned, to work out the best way to implement the Action Plan, and to ensure the necessary conditions are put into place that will enable the Teams (and all of primary care) to improve quality and access to primary care for the patients of Ontario.
The Minister made two presentations today, an early-morning prelude for a healthcare audience and the lunchtime launch of Ontario’s Action Plan for Health Care hosted by the Board of Trade. Below you’ll find links to the full plan and related communications pieces, as well as a bullet-point summary of the Action Plan. The general direction of the Action Plan is consistent with the content of AFHTO’s presentation to the Drummond Commission (http://www.afhto.ca/news/afhto%E2%80%99s-submission-to-drummond-commission-on-broader-public-sector-reform/ ). In particular, the Action Plan points to the critical role of primary care as the “natural anchor for patients in our health system”, a focus on quality in primary care, and the need for more formal connections between primary care organizations and other entities to coordinate care. In our Drummond submission AFHTO went further to identify the need to support the critical enablers required for primary care to play its full role in the health system: leadership, team based care, information systems and clinician involvement. FHTs are well-positioned, and with some evolution and support, could play a key role in advancing health system transformation at the local, regional and provincial levels. Of these enablers, “information” is the one that is the least well-developed – FHTs need sufficient support to collect, manage, analyze and act on data to improve access, improve outcomes, and deliver better value for money. Details for implementing the Action Plan remain to be developed. To get a read on this, I had the opportunity to compare notes with leaders from a number of other health associations, have a follow up meeting with the primary care lead in the Minister’s Office, and exchange a few words with the Minister. Despite the Toronto Star’s report that “Matthews hopes to achieve this by placing the provinces’ 200 family health teams under the control of Ontario’s 14 local health integration networks,” the Minister’s Office confirmed that the processes, accountability and funding relationships would be developed with key stakeholders such as AFHTO, to meet the goal of creating a more seamless journey for patients through the LHINs. For the most part FHTs have developed their own LHIN-based networks – AFHTO will be tapping into these networks for advice, direction and assistance as this implementation goes forward. Other areas that AFHTO will be monitoring include the implementation plans around access, house calls, funding reform, and the concept of “Care Coordinators” for seniors recovering after hospital stays to reduce readmissions. Having touched base with colleagues at the Ontario Association of CCACs, it’s not yet known whether the Care Coordinator is seen to be a role within a CCAC, hospital or primary care. AFHTO’s overall assessment of the Action Plan is posted at http://www.afhto.ca/news/afhto-welcomes-ontario%E2%80%99s-focus-on-family-and-community-care/ . We are pleased with the general direction, and look forward to collaborating with the Ministry and others to work out the details that will lead to sustainable improvement. Links:
Quick summary of Action Plan (Courtesy the Minister’s Office) Faster Access and a Stronger Link to Family Health Care
Family Health Care at the Centre of the System: Through the LHINs, we will hold the entire health system accountable for substantial progress towards fewer hospital readmissions.
Faster Access: More patients will have access to same-day and next-day appointments and after-hours care. This means better care for our patients and less strain on other areas of our health care system.
House Calls: We will be expanding access to house calls from health care professionals, like doctors, nurses, and occupational therapists. We will also be improving access to online and phone consultations.
Local Integration of Family Health Care: We will integrate family health care planning under the LHINs. Together, we will identify a model that brings planning and accountability for the full patient journey. However, the Ministry of Health and Long-Term Care will continue to have a funding role with Ontario’s doctors.
A Focus on Quality in Family Health Care: We will expand our focus on quality improvement to family health care, and ensure that all family health care providers are equipped to integrate the latest evidence based care into their practice.
Right Care, Right Time, Right Place
High Quality Care: Evidence will drive our decisions and it will drive our funding. IF there is evidence to support a new procedure or test, we will fund it. We will also continue to find ways to fully maximize the potential of our range of health care professionals.
Timely, Proactive Care: We will implement our mental health strategy starting with children and youth, including getting mental health nurses into our schools, supporting people with eating disorders, and smoothing the transitions of people between mental health care providers.
Seniors Strategy: We will launch a Seniors Strategy with an intense focus on supporting seniors to stay healthy and stay at home longer, reducing strain on hospitals and long-term care homes. It will include:
An expansion of house calls
More access to home care through an additional 3 million Personal Support Worker hours
Care Co-ordinators that will work closely with health care providers to make sure the right care is in place for seniors recovering after hospital stays to reduce readmissions.
The Healthy Homes Renovation Tax Credit, which will support seniors in adapting their home to meet their needs as they age, so they can live independently at home, longer.
Empower LHINs with greater flexibility to shift resources where the need is greatest, such as home or community care.
Moving Procedures into the Community: We will shift more procedures out of hospital and into non-profit community-based clinics if it will mean offering patients faster access to high-quality care at less cost. We will not compromise on quality, oversight, or accountability.
Funding Reform: Funding must follow the patient. We will accelerate the move to patient-based payment, as patients move through our health care system.
Keeping Ontario Healthy
Childhood Obesity Strategy: We will take on the challenge to reduce childhood obesity by 20 per cent over five years. Success on this front will require partnership, so we will bring together a panel of advocates, health care leaders, non-profit organizations, and industry to develop the strategy to meet our target.
Online Cancer Risk Profile: All Ontarians will have access to an online Personalized Cancer Risk Profile that will us medical and family history to measure risk of cancer and then link people at higher risk to screening programs, prevention supports, or genetic testing.
Expanded Screening: We will expand our comprehensive screening programs for cervical, breast and colorectal cancer to notify and remind participants when they are due for their next screening.
Media reports on public sector salaries may be stirring up concerns among staff at your FHT. To help you respond, this e-mail gives you a brief summary of what’s being reported, and what AFHTO is doing about concerns over inequity in compensation. Headlines on the Toronto Star and National Post websites this evening (Jan. 24, 2012) leave the impression that public sector salaries are at risk in the upcoming budget. This is following from Premier McGuinty’s speech today to the Canadian Club. Spurred by PC Leader Tim Hudak’s comments to the press last Thursday, on Friday, CBC radio and other on-line reports fuelled speculation that the current freeze could be extended. To date government has not committed one way or the other. FHT staff and managers are very concerned about inequities in compensation across health care. This fact emerged quite clearly in last fall’s survey of interprofessional primary care organizations (FHTs, Community Health Centres, Aboriginal Health Access Centres and Nurse Practitioner-Led Clinics), conducted jointly by their representative bodies – AFHTO, the Association of Ontario Health Centres and the Nurse Practitioners Association. Over 85% of EDs of primary care organizations identified lower compensation as one of the 3 main reasons potential candidates turn down job offers, and about half report this as being one of the 3 main reasons for staff leaving the primary care organization. Our three associations have been raising this issue at various levels in the Ministry and the Minister’s Office. We are scheduled for a joint meeting on February 9 to review the findings from our study with the ADMs of Negotiations and Accountability Management Division and Health Human Resources Strategy Division. Once we have reviewed the findings with the ADMs, the three associations will share the report with our respective members. While media reports are raising a lot of speculation, the key message for FHT staff is that it is only speculation at this stage. AFHTO continues to give priority to advocate for compensation funding to recruit and retain the staff needed to deliver interprofessional primary care. The current economic situation means that achieving equity in compensation will be an incremental process.
On January 17, Globe and Mail columnist Adam Radwanski wrote about the upcoming MOHLTC-OMA negotiations, focusing on costs and value for money (echoing the Auditor General of Ontario’s report). Unfortunately he used the term “family health team” when he was refering to physicians in capitated models in his statement, “The province will continue trying to get more family doctors away from fee-for-service. But that won’t do much good if it doesn’t get better value out of ‘family health teams,’ which a majority of doctors have already moved toward because the Liberals provided financial incentives to do so.” AFHTO’s response appears below. To read the Globe column, go to: http://www.theglobeandmail.com/news/politics/adam-radwanski/ontario-sets-out-to-change-the-way-doctors-work/article2304673/ Dear Mr. Radwanski, Thank you for your article this morning on the upcoming OMA-MOHLTC negotiations. You’ve hit on a number of key issues, including the need to know what value is being received from increased investment in primary care. As pointed out in Auditor General of Ontario’s press release regarding his chapter on Funding Alternatives for Family Physicians, “What concerned me about this was not that these doctors were making more money but rather that the Ministry of Health and Long-Term Care has not analyzed whether this has actually resulted in Ontarians getting better access to a doctor.” I’m writing to you for two reasons — One is to clarify and correct the terminology and concepts you used in your column. This is the challenge of the alphabet soup of Ontario’s primary care system! There is an important distinction between Family Health TEAMS (the term used in your column)and the methods for paying family physicians, i.e. Family Health Groups (FHG), Family Health Organizations (FHO), and Family Health Networks (FHN). The Auditor General’s report was focused on the latter (i.e. FHG, FHN, FHO). He reported that in the 2010/11 fiscal year, these three types of arrangements accounted for over 90% of family physicians (7,739) participating in an alternate funding arrangement and over 90% of enrolled patients (9.6 million enrolled Ontario residents). Just over 2000 of these family physicians also participate in Family Health Teams (FHTs), and over 2.6 million Ontarians are enrolled. FHTs are organizations that bring together a group of physicians (FHO or FHN or salaried physicians) with other health care professionals (e.g. nurse practitioners, pharmacists, dietitians, social workers) to provide comprehensive primary care and health promotion for their patients. In addition to reporting on FHG, FHN and FHO arrangements, the Auditor General’s report made a few brief comments to explain what FHTs are, and offered the following observation:
In December 2008, the Ministry commissioned the Conference Board of Canada to conduct a five-year study on Family Health Teams to identify their successes and shortcomings. Each year, the Ministry has been receiving interim study results, which focus on areas such as team functioning, patient access, and chronic disease management. The Ministry indicated that it will use the final report—expected in 2013—to assist it in determining whether any changes should be made regarding Family Health Teams. … We also noted that interim results of the Ministry-commissioned study on Family Health Teams have indicated that enrolled patients were generally satisfied with their access to health services.
We reiterate that the key issue, as pointed out by the Auditor General, is the need for a plan for on-going collection and reporting of data to monitor and improve on the value being delivered for Ontario’s investment in primary care. The only data from FHTs that is currently available is from the Conference Board study; the Association of Family Health Teams of Ontario (AFHTO) continues to encourage the Ministry to release the results to enable FHTs to learn from it and improve. This brings me to point #2. FHTs have been committed to improving quality, and the interprofessional model has enabled a number of interesting innovations. I draw your attention to one example – Dorval Medical Associates Family Health Team – which monitors the quality, capacity and cost of their operation, together with a unique method for engaging patients in determining priorities, and uses the results to continually improve in all three of these domains. Over the past 3 years, Dorval has evidence of that accomplishment. A report on Dorval’s method and results is posted at – http://www.dorvalmedical.ca/about-us/the-dorval-model/ If you’d like to pursue any of this further, I’d be pleased to speak to you further about Family Health Teams and connect you to leaders and thinkers in this area. FYI — AFHTO’s ideas for improving value in the delivery of health care services are outlined in our presentation to the Drummond commission, posted at http://www.afhto.ca/news/afhto%E2%80%99s-submission-to-drummond-commission-on-broader-public-sector-reform/ . Thanks again for your interest in bringing these issues to the public. Sincerely, Angie Heydon Executive Director Association of Family Health Teams of Ontario (AFHTO)
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.
