Ultimate Blogging Championship

Tag: Highlights

  • Toward a Primary Care Recruitment & Retention Strategy for Ontario

    The Association of Family Health Teams (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners’ Association of Ontario (NPAO) are pleased to share our joint report with our members.

    It has been a challenge for primary care organizations to recruit and retain the skilled and compassionate staff needed to deliver accessible, high quality, patient-centred primary care. Our three associations – representing all of Ontario’s interprofessional primary care organizations – teamed up in September to gather the facts and create the solid case to address the issues. About half of the 295 organizations – 10 aboriginal health access centres (AHACs), 73 community health centres (CHCs), 186 family health teams (FHTs) and 26 nurse practitioner led clinics (NPLCs) – responded to our survey.  This information, together with data from salary studies by the Hay Group, has been combined to make the compelling case. Our joint report was finalized this week and sent to the ADMs of Negotiations and Accountability Management Division and Health Human Resources Strategy Division in advance of our meeting on Feb.22.  The meeting had been scheduled for Feb.9 but was postponed due to personal circumstances. The report makes the case that:

    • The full compensation package – salaries, pensions and benefits –must be addressed to make working in primary care sufficiently attractive to recruit and retain competent staff in this sector.  Recognizing current economic constraints, it is well understood that reaching a competitive compensation level will need to be phased in over a few years.
    • As an immediate first step, the barrier to labour mobility must be removed to enable all primary care organizations to offer the HOOPP pension plan and reasonable benefit package.  This entails a 2.5% increase in compensation funding, for a total of $10.36M.
    • Since staff are required to contribute a minimum of 6.9% of gross earnings toward the pension, a matching increase of 2.5% should be added for all staff to defray their reduction in take-home earnings.  This would bring the total investment across all of primary care to $19.48M.

    The investigation found:

    • The biggest vacancy rates appear among the largest staff groups, e.g. 19% for Nurse Practitioners, 14% for dietitians, 10% for RNs, and 5-12% for administrative managers.  Add to this an 18% vacancy rate for pharmacists, and the result is a serious gap in skills to provide the full scope of primary care, particularly chronic disease prevention and management.
    • Factoring in turnover rates and the time needed to fill each type of position, roughly 6-7% of overall staff service capacity is lost each year due to turnover.
    • The most troubling finding is that the majority of staff who leave are then lost to the primary care sector – only 1/3 move to other primary care settings, but about 1/2 go to work in hospitals and other health care settings.
    • While Ontario’s Action Plan for Health Care calls for placing “Family Health Care at the Centre of the System,” there are barriers to attracting health providers to primary care and keeping them in this part of the health system.
    • There is overwhelming evidence that compensation packages are the root cause. Independent review found salaries to be 5 – 30% below market. Lack of the HOOPP plan makes it hard to compete with the other health sectors that do offer it.
    • Growing inequity in compensation is creating conditions for rapid expansion of unionization in this sector, beyond the 10% of PCOs who currently have staff under collective agreements.

    Please click here to read about the outcome of the joint meeting.

  • Strengthening Primary Care in Ontario: Reports are now available

    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:

    1. Integration Supported by Governance
    2. Patient Centered Approach
    3. Strategically Aligned Goals and Measures
    4. Accountability Levers and Incentives
    5. Continuous Quality Improvement.”

  • AFHTO welcomes Ontario’s focus on family and community care

    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 Care calls 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.

  • AFHTO response to Globe and Mail comment about FHTs

    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’s submission to Drummond Commission on Broader Public Sector Reform

    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.

  • Registrations now being accepted for Wave 4 of HQO’s Advanced Access and Efficiency for Primary Care

    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.

  • Ministry Of Labour Blitz on Infection Prevention and Control

    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.

  • Changes to Nurse Practitioners’ practice

    Changes to Nurse Practitioners’ (NPs) practice resulting from legislative amendments will take effect on Oct. 1, 2011; therefore, the College of Nurses of Ontario has released a new Nurse Practitioner practice standard, which includes new expectations for NP practice. Visit www.cno.org/np to download a copy of the new practice standard and to read other information related to the changes to NP practice, including frequently asked questions and NP practice resources. For an overview of changes to nursing practice, go to  http://www.cno.org/en/what-is-cno/regulation-and-legislation/legislation-governing-nursing/faq-bill-179/

  • Status of Nurse Practitioner Access Reporting (NPAR) pilot project

    Click here to access an update bulletin from MOHLTC’s Primary Health Care Branch on the NPAR pilot project.

  • Accessibility Standards for Customer Service: reminder of requirements

    By January 1st, 2012 Family Health Teams must comply with the Accessibility Standards for Customer Service. The information below is provided for your reference, from MOHLTC’s FHT to Print newsletter, Winter 2011 edition. In addition, click here for  a brief, practical, self-assessment tool intended to assist primary health care settings to increase their awareness of the needs of disabled patients, and to enhance accessibility in the practice. The Accessibility for Ontarians with Disabilities Act, 2005 (AODA) is legislation that sets out specific standards of accessibility in a number of key areas. The Accessibility Standards for Customer Service, Ontario Regulation 429/07, is the first standard to be developed under the AODA. Effective Dates The customer service standard designates that Family Health Teams must comply with the standard by January 1st, 2012. Additionally, FHTs with 20 or more employees will have to file online accessibility reports. FHTs with fewer than 20 employees are currently exempt from filling out the report, but must still comply with the standard. Types of Accessibility When thinking about accessibility in primary care clinics, physical space is what usually comes to mind first. However, there are four broad areas of accessibility to consider: 1. Physical: The space should allow for disabled patients to freely enter and move around in the practice; 2. Attitudinal: The level of service provided at the clinic should be proportionate with the needs and abilities of the patients; 3. Expertise: FHT staff a should have an understanding and awareness of disability and its effect on the clinic and practice; and 4. Systemic: FHT policies, practices and procedures (both formal and informal) should be designed with the following four principles in mind: independence, dignity, integration and equal opportunity. Step by Step: Meeting the requirements of the customer service standard There are 11 compliance requirements associated with the Standards, with an additional three for providers with 20+ employees. Please refer to the Guide to Accessibility Standards for Customer Service for a complete listing. Here is a quick overview with additional detail in the links below.  Establish policies, practices and procedures related to providing services to persons with disabilities. They should be consistent with the principles of dignity, independence, integration and equality of opportunity.  Develop a policy for dealing with various assistive devices/methods used by persons with disabilities.  Develop a strategy for communicating with people with various disabilities (i.e. in person, over the phone or online).  Allow persons with disabilities to be accompanied by service animals as well as support persons.  Provide advance notice of any situation where admission fees would be charged for a support person.  Provide notice when facilities or services that persons with disabilities rely on are temporarily disrupted.  Establish a training program and train staff on accessibility and customer service.  Establish a feedback process on how you provide services to persons with disabilities.  FHTs with 20 or more employees must prepare documentation on accessibility standards.