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  • AFHTO 2013 Conference – Leadership and Governance for Quality

    Theme Description: The primary care sector is at the centre of transformational change in Ontario. FHTs are faced with an increased need to be accountable to patients and the ministry for providing excellent quality care to their communities. Presentations in this category will focus on how FHT leaders are developing the skills, structures, processes, relationships and culture to govern effectively and advance quality in all its dimensions. This includes the board’s role in developing, implementing and monitoring quality improvement plans and overall performance. A1 – Reflections on Board Development Thames Valley Family Health Team having  had more than 6 years of experience in evolution of its Board from a steering committee working on a proposal, to a policy Board fully engaged in their Governance role. This presentation will describe this journey, with particular focus being on the sharing of the tools and templates that we have found and/or developed to support a high level of functioning as a Board. B1 – Effective Governance for Quality and Patient Safety in Primary Care in Ontario This study examines and identifies the governance structures and processes, which enable quality and safety of care in effectively governed primary care organizations in Ontario. C1 – Integrating a Critical Incident Reporting Framework into your FHT This presentation will outline our academic family health team’s on-going journey to develop a critical incident reporting framework and how it fits into our broader quality improvement and patient safety framework. D1 – Identifying opportunities for QI Planning in Primary Care Identifying Opportunities for QI Planning in Primary Care – This session is designed to support primary care teams in the process of identifying and prioritizing quality improvement opportunities. E1 – Strengthening the Leadership Triad:  The critical partnership of Board Chair, Lead Physician and Executive Director A survey of FHT specific challenges around effective governance and a discussion of strategies to meet those challenges. F1 – Effective Governance in Primary Care and F1 – Quality Improvement Plans Year 1: A Giant Step Forward Share key observations from QIPs submitted by primary care organizations in year 1 (HQO). Illustrate how QIPs can be used to support shorter and longer term improvement planning (HQO). Discuss leadership and governance role in supporting the development of QIPs and driving improvement (CPSI)

  • QIDs Implementation Update-2013-10-10

    Highlights:

    • Members named to the Quality Improvement Decision Support Steering Committee (QSC)
    • Arrival of the first QIDS Specialists and the Provincial QIDS Team
    • Steps underway to improve information and knowledge exchange with EMR Vendors, including EMR user sessions at the AFHTO 2013 Conference
    • Community of Practice for Decision Support Team Members is being established
    • ACTION REQUESTED: please complete a brief QIDS Implementation Status Survey to help shape priorities and inform the work of QSC and the Provincial QIDS Team. Please complete a brief QIDS Implementation Survey

    The survey will be open until 12 noon on October 17th, 2013. QSC Named: Your Quality Improvement Decision Support Steering Committee (QSC) has been named. It reflects widespread enthusiasm and support for the goals of the QIDS program. According to QSC Chair Ross Kirkconnell, “this is a great opportunity to provide more effective support to the great work FHTs are doing in Quality Improvement, and build greater capacity to tell our story to the rest of the system. I am really looking forward to working with this very talented and committed group.” Membership Chair:    Ross Kirkconnell, Executive Director, Guelph FHT; AFHTO Board Members:

    • Katherine Campbell, Director, Service Quality Integration, Dryden Regional Health Ctr.
    • Gail Czukar, Executive Director, Humber River FHT
    • Sanjeev Goel, Lead Physician, Wise Elephant FHT
    • Karen Hall-Barber, Family Physician and Assistant Professor Dept.  of Family Medicine, Queen’s
    • Monique Hancock, Executive Director STAR FHT
    • Sherry Lynn Harrington, Director, Program Innovation &Evaluation, Peterborough FHT
    • Mary Keith, Executive Director, Garden City FHT
    • Karl Langton, Health Informatics Coordinator Hamilton FHT; Peer Leader OntarioMD
    • Kevin Samson, Physician, East Wellington FHT, Co-Lead AFHTO PSS User Group

    Advisors:

    • Rick Glazier,  Family and Community Medicine, St. Michaels; Sr.  Scientist ICES, AFHTO Board
    • Michelle Griever, North York Family Health Team

    Ex Officio:

    • Elizabeth Keller,  Director Product Management, OntarioMD
    • Ben King, Senior Program Consultant, eHealth Liaison Branch, Ministry of Health and Long-Term Care
    • eHealth Ontario (confirmed, rep. TBD)

    Staff:     Tim Burns, Provincial Lead QIDS, AFHTO QIDS Specialists are coming on board: Some QIDS Specialists are now in place. Say hello to Melanie Young (Kenora), Meghan Peters (Sudbury- Val Caron), and Thiv Paramsothy (East GTA). Several more are expected to start within the next few weeks.  Please be sure to put newly appointed QIDS Specialists in touch with Tim Burns (tim.burns@afhto.ca) as they join up.  Employers are also encouraged to send QIDS Specialists to the AFHTO Conference for networking opportunities and a great deal of content that should be really interesting for them and highly relevant to their roles. Provincial QIDS Team Members: AFHTO is also very pleased to welcome Carol Mulder and Jenya Doudareva to the provincial team: Carol Mulder: Quality Improvement Decision Support Specialists Practice Lead Carol comes very well prepared to this role as she has extensive background in teaching and decision support capacity building. In addition to being a trained veterinarian, Carol holds an MSc in Epidemiology and is pursuing a doctorate in Quality improvement Knowledge, Beliefs and Behaviour. She has held senior roles in information management and was most recently the co-lead for the South West Regional Integrated Decision Support strategy.  Carol will be starting on October 21, 2013. Jenya Doudareva: EMR/Technical Lead for QIDS Jenya has an M.A.Sc in Industrial Engineering from the Centre for Research in Healthcare Engineering at the University of Toronto. Jenya has worked on projects including multi-site process improvement in cancer screening and decision support models for orthopedic surgery scheduling. Jenya will be starting on October 16, 2013. EMR Vendor relationships: The QIDS Program will be working with the EMR vendor community to improve information and knowledge exchange and increase value for members. This approach builds on progress made by the Telus/PSS User Group (and thanks to Kevin Sampson, Fok-Jee Leung, Clarys Tirel and the rest of the PSS User Group). Responsibility for vendor relationship strategies is now transferring to the QIDS Program where it will be expanded under the guidance of the QSC. As a first step, EMR Vendor reps and Information and Knowledge Exchange Sessions have been set up for 8:00 to 8:45am on October 22 at the AFHTO conference for Bell, Nightingale, OSCAR, QHR Technologies and Telus. A vendor rep was not available from P&P Data Systems, however there will be an opportunity for users of their EMR to share information. In all, over 320 individuals have registered for these sessions. Thanks to registrants for over40 specific suggestions for topics to be addressed by vendors. These will be shared with vendors this week.  Please contact Tim (tim.burns@afhto.ca) if you have any questions or need information regarding EMR vendor sessions. Community of Practice for Decision Support Team Members: Family Health Teams already have a lot of capacity in analytics and decision support and have a great deal to be proud of in what has already been accomplished. One of Carol Mulder’s primary roles will be to develop a Community of Practice for FHT professionals primarily focused (or interested in) Quality Improvement, Data Management and Analysis or Decision Support. This Community of Practice will help to will create relevant learning and knowledge sharing opportunities for many FHT team members in addition to the QIDS Specialists themselves. To assist us understanding how to identify and plan for this community we request that you take a moment to complete the survey. QIDS Implementation Survey: ACTION REQUESTED Please take a moment to complete the attached survey. It collects information which is of interest to all FHTs and is especially timely as the QSC will be starting its work this month. The information will help to provide QSC with a good snapshot of the program’s overall status and help the provincial team to launch a community of practice that will be open to all FHTs. Please complete a brief QIDS Implementation Survey

    The survey will be open until 12 noon on October 17th, 2013.

  • Quality Improvement tools from CCO and program update from HQO

    Cancer Care Ontario Toolkits: Cancer Care Ontario (CCO) has developed an Advance Care Planning (ACP) toolkit for primary care practices that decide to include ACP as part of their QIP. Please click here for the ACP Toolkit. This new toolkit is in addition to the previously distributed toolkit Cancer Screening toolkit which some FHTs are already using to improve cancer screenings in their practices. Please click here for the Cancer Screening toolkit. Many thanks to Dr. Suzanne Strasberg from the Jane Finch FHT who was part of the development of these toolkits and is supporting the dissemination of these toolkits Update on the Advanced Access, Efficiency, and Chronic Disease Management initiative from HQO: Forwarded on behalf of Susan Taylor, HQO: Health Quality Ontario’s Advanced Access, Efficiency, and Chronic Disease Management initiative will no longer be restricted to a cycle of waves. Their new, more versatile continuous intake model will allow Health Quality Ontario to offer support through:

    • An extensive series of accredited e-learning modules
    • A variety of quality improvement resources and tools
    • Consultations with Primary Care Champions and Quality Improvement Advisors

    In order to engage in the new and improved Advanced Access, Efficiency & Chronic Disease Management initiative, please contact HQO’s quality improvement specialists at: learningcommunityinfo@hqontario.ca.

  • Update from AFHTO-PSS working group: report from meeting with TELUS-HEALTH

    The AFHTO – PSS working group continues to meet with the PS Suite team from TELUS-Health to address the FHTs issues with the EMR. Recently, representatives from the working group met with the leadership team at TELUS Health to ensure that the FHT priorities and concerns were being heard by TELUS and would be addressed. Background: The AFHTO- PSS working group has been meeting since February 2012 (click here for the last update). Working within the priorities identified by the FHTs in the June 2012 AFHTO survey, the working group developed a list of actionable items in collaboration with the TELUS PSS team.  These priority actionable items were presented to the TELUS team during the summer. Over this period most of the responses from the TELUS team had not provided as much clarification as expected by the AFHTO working group.  To address some our concerns, representatives from the AFHTO working group met with the TELUS-Health leadership on September 23. Update from the meeting with TELUS Health Leadership Team:

    • TELUS Health Leadership heard and acknowledged the concerns expressed around communications and the non-committal answers to the actionable items. A candid and positive discussion took place with all present at the meeting.
    • TELUS Health stated that they:
      • Remain committed to PS Suite and the FHT users.
      • Plan to invest in PS Suite along with the two other EMR platforms that it supports.
      • Do not expect users to change their EMRs and users can expect improvements to the functionality over time.
    • TELUS Health Leadership and AFTHO agreed on the following next steps:
      • TELUS PS Suite clarified that the responses to the priority action items were “initial” and that there would be updates. TELUS PS Suite will review each item with their team and provide more specific responses prior to the AFHTO conference. AFHTO requested, where possible, to be provided a point person for items and an indication when there would be a status update.
      • TELUS team will work closely with the AFHTO working group on communication to FHT users.  TELUS is committed to improve communication with FHT users.
      • AFHTO and TELUS will establish regular leadership meetings to ensure accountability for the agreed processes and outcomes.

    Present at the TELUS-AFHTO meeting: Ron Sparks, Head of Sales, TELUS Physician;  Shawn Vincent, Director, R&D; Charles Funk, Manager, Product Management;  Ken Piaggio, Director, Client Services; Shannon Jackson, Manager, Health business consulting; Manon Greer, Senior Product manager; Jeremy Gordon, Client Services manager; and  Fok-Jee Leung (Bruyere FHT); Kevin Samson (East Wellington FHT); Tim Burns (AFHTO); Clarys Tirel (AFHTO). PS Suite User Session at AFHTO conference: About 200 people have registered for the PS Suite User session. The AFHTO PSS user group will give an update on the work that they have completed and on the responses from TELUS Health to our priority action items. TELUS Health Leaders will be at the session and will outline the next steps in our collaboration to ensure that FHT PS Suite users’ needs are heard and, where possible, met. Please send an email to Clarys Tirel (clarys.tirel@afhto.ca) with any specific questions that you want answered at the session.  We will make time for questions, but given that the tight timeframe, we want to plan ahead as much as possible.

  • Report from quarterly meeting with MOHLTC FHT unit – September 18, 2013

    FHT Directors representing AFHTO and AOHC members met with the FHT Unit on Wednesday. To access the full report, please click here. The main focus of the meeting was the discussion on budget flexibility and accountability. The FHTs presented the position proposed by the Executive Director Advisory Council at their meeting of August 28, which was to achieve:

    • A global budget divided into two envelopes, one for HR and the other for operations, such that:

    The EDAC position was approved by the AFHTO board and is supported by the AOHC C-FHT Executive Directors. (To access the briefing note on this position, please click here.) The MOHLTC FHT unit agrees that, given the current fiscal constraints and the stage of development of some of the FHTs, moving towards increased budget flexibility and reviewing the accountability framework is the right direction.  All parties agreed that a staged approach that would be developed with a goal of moving a number of FHTs to a hybrid global budget for the next fiscal year, contingent on final ministry decisions. All have committed to collaborate on the first two steps to move this forward:

    1. Readiness assessment: Through EDAC, AFHTO will prepare initial draft of criteria for assessing FHTs in terms of their readiness to govern and manage a more flexible budget.
    2. More meaningful accountability reporting:  MOHLTC will share their initial work to review the reporting structure as a starting point for further discussion on changing the accountability framework.

    There remains the need to find ways to ensure decisions about the size of budgets can remain consistent with changing demands and conditions over time. The meeting also provided the opportunity to review with the Ministry the process to address current budget pressures. The Ministry re-affirmed its commitment to ensure that the budget reductions do not impact negatively on patient care.  The Ministry coordinators have been instructed to be flexible and to work with FHTs on a case-by-case basis to free up funds within the approved FHT budget, or if necessary consider other measures. The Ministry provided updates on a number of issues identified by EDAC:

    • Status of the BSM review
    • Sessional fees
    • Transfer of rostered patients
    • Quality Improvement Plans
    • QIDSS Program
    • IHPS in non-FHT models
    • Physiotherapy in FHTs

  • EDAC Update: background on 2013/14 budget reduction and input on future budget flexibility

    AFHTO’s Executive Director Advisory Council (EDAC) met on August 26 with the main purpose of preparing for the quarterly meeting with the FHT unit later in September. At the same meeting, EDAC invited Phil Graham, (manager, Family Health Teams & Related Programs, Primary Health Care Branch) and Fernando Tavares (program manager) to clarify the context and the process for 2013/14 budget adjustment experienced by many FHTs. EDAC’s mandate is to advise the AFHTO board and staff on matters affecting the operations of our member organizations. Budget Reduction in 2013/14: Phil Graham, manager of MOHLTC’s FHT Unit, gave EDAC the following background on the ministry’s decisions to adjust the budgets of a number of FHTs:

    • In a managed-growth budget environment, the MOHLTC wants to maximize the use of existing dollars available within the FHT program.
    • In reviewing expenditure trends over the past three years, the MOHLTC determined there is on average a ~12% gap between what is allocated by the ministry and what is spent by FHTs. This means that $20-$40 million has been recovered following the end of each fiscal year.
    • Based on this data, the ministry undertook a budget right-sizing effort to bring the ministry’s allocation in better alignment with FHT expenditures. This included a 0.5% base funding adjustment for FHTs with budgets between $1-$2 million and a 1% base funding adjustment for FHTs with budgets in excess of $2 million. FHTs with budgets less than $1 million were not impacted by this adjustment nor were FHTs who were utilizing their full allocation.
    • The ministry also looked at Specialist Sessional funding and found that this area in particular was considerably underspent. Adjustments were made to Specialist Sessional funding based on historical trends.
    • Looking forward, this adjustment will help to enhance financial flexibility for other FHT initiatives and to address service needs.

    A total of 105 out of Ontario’s 185 FHTs experienced this adjustment. While each of these FHTs received notice of the reduction to their own FHT’s budget, based on the feedback received, the communication process will be improved in the future. Phil acknowledged there may be some gaps that have resulted from this approach, particularly but not exclusively related to Specialist Sessional adjustments. To ensure that the budget reductions do not impact negatively on service delivery, he noted that the Ministry coordinators have been instructed to be flexible and to work with FHTs on a case-by-case basis to free up funds within the approved FHT budget. Other options will be considered if solutions can’t be found within the FHT’s current budget.  He also confirmed the Ministry is looking at enhancing budget flexibility in future years, to give FHTs greater ability to manage their budget to meet patient need. Preparation to address Budget Flexibility and Accountability with MOHLTC: The ministry’s interest in greater budget flexibility is welcome news for FHTs, however the question for FHTs is, what is the “desired future state” to aim for?  To help answer this question, a group of EDAC volunteers looked into the advantages, constraints and risks associated with global budgets. Having reviewed and discussed the issues, EDAC members are recommending to the AFHTO Board the following position to take in discussions with the FHT Unit:

    • A global budget divided into “two buckets”, one for HR and the other for operations.
    • The HR “bucket” should allow for complete flexibility in determining the positions.
    • A provincial salary grid for each position should continue to be enforced to avoid unproductive competition for staff.  (AFHTO continues to join with our primary care partners in advocacy for a more competitive primary care compensation structure.)
    • Ask MOHLTC for clarity on existing funding formulas, in order to understand and advise on ways to ensure global budgets remain current with service needs and market conditions.

    Accountability for wise use of the funds goes hand-in-hand with the desire for greater budget flexibility; EDAC will engage in further discussion on this topic. Agenda items for the quarterly meeting with the Ministry FHT unit: The EDAC members are recommending the following agenda items for the September meeting with the MOHLTC FHT unit:

    • Preparing for the 2014/15 Budget process
      • Budget flexibility is a particular focus
    • Current fiscal year budget issues
    • Request for updates on:
      • Transfer of Rostered patient issue
      • QIDSS program
      • IHPs in non- FHT models
      • Physiotherapy in FHTs
      • QIP – process for determining mandated domains for next year.
      • Possible review of sessional fees in MOHLTC-OMA negotiations
    • “Good news” items: AFHTO conference and Bright Lights Award nominees

  • FHTS to receive QIP feedback in next week (+ other support to come from HQO)

    AFHTO is working on a number of fronts to support members in their work to improve quality. Last week we reported on support available to help members implement the QIDSS partnership agreements and recruitment/orientation for these new positions, and the sessions available at the AFHTO Annual Conference to help FHTs in streams such as Leadership and Governance for Quality and Using Data to Improve Care. AFHTO also continues to work with Health Quality Ontario (HQO) to ensure FHTs receive the support they need to implement their Quality Improvement Plans (QIPs). Here’s an update on the support activities HQO is rolling out: 1. HQO to send individual reports on the Quality Improvement Plan by end of August 2013: HQO will be sending individual feedback to the FHT Board Chair and Executive Director on the QIP that they submitted. The feedback is intended to support the on-going improvement efforts and provide constructive feedback that will enhance the ability of the FHT to move forward with their improvement initiatives. At the AFHTO Annual Conference in October, FHTs interested to meet with an HQO QIP specialist to discuss in person their QIP feedback will have the opportunity to do so. AFHTO will provide space and coordinate the feedback sessions with HQO staff. 2. Upcoming Webinar on Survey Methodology in mid- September 2013: In response to request from some FHTs, HQO is planning a webinar on “survey methodology” that will provide FHTs with an overview of methodologies relevant to FHTs: sampling approaches, good survey practices, focus surveys as a mechanism for improvement and change. The webinar will discuss practical strategies to answer questions from FHTs. 3. Navigator Tool to be launched in November 2013: Starting in November 2013, FHTs will be able to develop and submit their QIPs using an online tool called the QIP Navigator. Announcements will be sent out as testing opportunities are created as well training sessions. 4. Primary Care Sector Report in November 2013: HQO received 295 QIPs from the Ontario’s four primary care models this year (FHTs, CHCs, NPLCs, AHAs).  Each QIP was reviewed by QIP specialists and a quantitative and qualitative analysis of the QIPs was completed.  A complete report of the results of the analysis will be published to acknowledge the work and commitment of primary care organizations to improving quality, to identify strength and challenges encountered during the development of the QIPs, and to provide guidance and recommendations to support the strengthening of quality improvement initiatives in primary care.

  • QIDS Program: Links to information from Aug.21 “Town Hall”

    Yesterday’s interactive QIDS Program “Town Hall” was an opportunity to share information and gather input.  Participants raised questions concerning sharing of QIDS Specialist positions, costs, and lines of accountability among other issues.  These questions and others are posted on a “Frequently Asked Questions” document that will be updated from time to time as new information becomes available.  Input received via participant polling and comments are already being used to plan next steps. Finally, in our update we indicated that funding approval for the AFHTO provincial team was “expected shortly.”  I am very pleased to share the news that this funding was confirmed almost immediately following the Town Hall.  We are very pleased to have been supported by the province to work with all of you on this exciting and timely program. Links to QIDS program information:

    Keep in mind the AFHTO Annual Conference, Oct. 22-23, features a number of sessions that will help your FHT in its use of data to improve care, in streams such as Leadership and governance for quality, Using Data to Improve Care, Meaningful use of EMRs and EMR vendor sessions.

  • Invitation to participate in a QIDS program town hall meeting for members

    Please join AFHTO for an interactive, online “members town hall” on the QIDS program. When: Wednesday, August 21, 2013, 12:00pm to 12:45pm The town hall is open to all members and will provide an opportunity for you to:

    • Hear about work your colleagues are doing to develop QIDS partnerships and QIDS Specialists recruitment
    • Learn more about the status of implementation supports and resource available from AFHTO
    • Contribute your ideas and advice to key elements of the program, such as QIDS Specialist role descriptions, partnership agreements and the provincial steering committee
    • Get answers to Frequently Asked Questions

    To register for the webinar:

    1. Click on the registration link: https://attendee.gotowebinar.com/register/290705729229163008
    2. Enter your contact information in the form.
    3. You will receive an email confirming your registration for the webinar and a unique link to join the session, along with the option to add the webinar information to your Outlook® Calendar.

    If you cannot access the online webinar, you can join the session by phone in “listen only” mode. (Unfortunately, those who are not connected to the webinar as well will not be able to speak.) To phone in :

    • Dial (647) 497-9416 or toll-free 1-866-952-7297.
    • Enter Access Code: 969-381-144.

  • FHTs are moving forward with QIDS partnership agreements and Specialist Recruitment

    Family Health Teams have now received their 2013/14 funding packages. AFHTO is very pleased that funding for 34 full time equivalent Quality Improvement Decision Support (QIDS) Specialist positions has been confirmed for 33 “Host” FHTs.  Up to 110 additional FHTs will have access to QIDS Specialist support and expertise through partnership agreements with Host FHTs. The final groupings for partnerships were arrived at by the ministry based on its review of Annual Submissions and discussions with the field. Although it is not stated explicitly in the funding package, the Ministry has confirmed that it expects Host FHTs to work toward a formal arrangement with each partner identified for them in either the Annual Submission or through subsequent discussions. Many Host FHTs are already in active discussion with their partners. However, if you are uncertain who you should be working with as a “partner” or “Host” please get in touch with Tim Burns at 647-234-8738 or your Ministry Contact. AFHTO is working with FHTs in the development of partnership agreement and recruitment tools:

    • Partnership agreements: The Partnership Agreement Working Group is due to meet again August 13 to provide its feedback on a draft QIDS Partnership Agreement for Host FHTs and their partners.  A template agreement will be available for broader circulation by the end of August.  (Earlier working drafts can be shared on request if this would be helpful for local discussions).
    • Recruitment of QIDSS positions: Host FHTs are eager to initiate QIDS Specialist recruitment and some will begin posting the positions immediately. Click here for a sample job posting to assist with recruitment.
    • Tools and Resources on AFHTO website: AFHTO has created a QIDS Program page on the Members Only website, check this section regularly for the latest updates, tools and newest resources.