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  • Updates on AFHTO support for members

    Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement.   Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary. Primary care recruitment and retention:  Letter to Premier and Finance Minister The Ontario Government has not yet declared whether it will extend the Public Sector Compensation Restraint Act beyond its current expiry date of March 31.  As part of our joint advocacy to address the challenges in recruiting and retaining qualified staff in primary care, AFHTO, in partnership with the Association of Ontario Health Centres and the Nurse Practitioners Association of Ontario, has sent a letter to Premier McGuinty and Minister Duncan urging Government to avoid extending this freeze on compensation and for immediate action to enable the HOOPP pension plan to be offered to primary care staff.   Click here to read the letter.   Support for 2012-13 Operating Plan development On Friday FHT EDs received a link, username and password to an online platform for FHT EDs to raise issues, ask questions of their peers and discuss potential solutions in a safe and secure environment.  You are welcome to provide input for AFHTO’s March 6 meeting with the Ministry’s FHT Unit on common operational issues. This is an initial pilot to support FHTs in the Operating Plan submission process.  As we learn from this collaborative space the approach will be fine-tuned and spread to support communication and collaboration among all team members across Ontario’s FHTs. Click here for a brief video (under 2 min.) on how to make the most of this collaborative space. If you are a FHT ED and did not receive your username and password please contact Sal Abdolzahraei at info@afhto.ca. New resources to help FHTs implement AODA Click here for templates, a checklist and additional resources to assist FHTs in meeting requirements of the Accessibility for Ontarians with Disabilities Act, 2005 (AODA).  Template documents may be edited to match individual FHT branding and accessibility requirements. As of January 1, 2012, FHTs must comply with the first standard – Customer Service. (If you require your login information for the Member’s Only website please contact info@afhto.ca) Health Equity: tools and resources for program development If your FHT is doing strategic planning and/or program development, the following resources may be helpful. The Health Equity Impact Assessment (HEIA) tool is one part of the repertoire of equity-driven planning tools.  It analyzes the potential impact of service, program or policy changes on health disparities and/or health-disadvantaged populations.  It can both help to plan new services, policy development or other initiatives or assess existing programmes. The Wellesley Institute has health equity resources available on their website focused on operationalizing health equity strategies. Resources include a Health Equity Impact Assessment Tool, evidence based planning tools, sample equity strategies from LHINs, and more. Feedback survey on Provider Education Tools of the Ontario Breast Screening Program Cancer Care Ontario (CCO), in partnership with the Centre for Effective Practice (CEP), developed Provider Education Tools for healthcare providers (family physicians, nurse practitioners, genetic counsellors, radiologists) to support the changes to Ontario Breast Screening Program (OBSP). The CEP is conducting an online survey to evaluate the Provider Education Tools.  This survey will take approximately 7 minutes to complete. All individual responses will remain confidential. The survey results are analyzed in aggregate only, such that you cannot be identified in any way. Please complete the survey here:  https://www.surveymonkey.com/s/OBSP If you would like more information or have any questions, please contact Mary Clelland-Dube at 416 260-7885 or mary.clelland-dube@effectivepractice.org. AFHTO membership renewal invoices will go out March 1 For FHTs that may have funds remaining in their general overhead budget, AFHTO membership renewal notices will go out on March 1. If you want to use funds remaining from other overhead lines to pay for your FHT’s membership renewal, the FHT Unit has confirmed you must speak to your Ministry Rep first.

  • Advancing a Performance-Oriented Model for Primary Care

    Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement.   Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary.

  • Outcome of Meeting with ADM on Primary Care Recruitment & Retention

    Outcome of AFHTO-AOHC-NPAO meeting with ADM on primary care recruitment & retention This morning representatives of our three associations met with senior Ministry staff to review the findings and recommendations of our joint report – Toward a primary care recruitment & retention strategy for Ontario. (See details below).  Ministry attendees included three members of MOHLTC’s Health Human Resources Strategy Division – Suzanne McGurn, ADM; Jeff Goodyear, Director, HHR Policy; and Debra Bournes, Provincial Chief Nursing Officer – as well as Phil Graham, Manager of the FHT Unit in Negotiations and Accountability Management Division. The ADM and Ministry staff were receptive to the report. They welcomed the information it contained, saying it validated a number of issues being looked into by the Health Human Resource Strategy Division. They particularly appreciated seeing the three associations representing all interprofessional models of primary care delivery working jointly on this issue, and doing so from the perspective of strengthening all of these primary care organizations. Two statements from the ADM stand out – “there is no disagreement with the principles in the report” and “timing is the big issue”. The key constraint is the province’s need to rein in spending. While the Drummond report does not endorse a continuation of public sector wage restraint (it suggests that broader public sector employers and bargaining agents should be responsible for bargaining outcomes and bear responsibility for delivering value for public money), there remains the possibility that public sector compensation restraint could be continued past March 31. The Ministry representatives clearly understand that the inability of primary care organizations to offer both the HOOPP pension plan and reasonable benefits creates significant disadvantage in competing for staff with other parts of the health system.  While the likelihood of funding increases for compensation in the next fiscal year is very small, the Ministry has agreed to look into the idea of giving greater flexibility to allow primary care organizations to go beyond the 20% cap for pension and benefits, within their current overall budgets. Immediately after this meeting we briefly touched base with Shawn Kerr, Policy Advisor for primary care in the Minister’s Office and will meet with him in the near future to discuss more fully.  As always, we will keep our members informed. For further information, please view past AFHTO, AOHC and NPAO message to members:

  • 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.

  • Ontario’s Action Plan for Health Care: Highlights for primary care

    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.

  • Responding to staff about media speculation on public sector salaries

    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.

  • AFHTO sets up Operational Issues table with MOHLTC’s FHT Unit

    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):
    • For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
    • For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
    • For FHT EDs in LHINs 13-14 (North East, North West):
      • Randy Belair, ED Sunset Country FHT,  AFHTO Secretary
      • E-mail:  rbelair@kfht.ca
    • For FHT Clinical Leads:
      • 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.

  • AFHTO Bylaw #4 approved at October 2011 Annual Meeting

    Click here to access AFHTO Bylaw #4.  Having received membership approval at the October 25, 2011 Annual Meeting, this bylaw is currently in force.

  • Leading For Change

    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.

  • Using IT to Solve Process Problems

    2011 AFHTO conference presentation PRESENTER (S): Dave Sellers, Director of Operations; Dr. Mark Fraser, Lead Physician FHT/ORG: West Carleton FHT ABSTRACT: This presentation will describe how innovative approaches within the FHT IT infrastructure have been used to solve process issues and improve efficiencies and data quality. The quality of the data in your EMR has a direct impact on quality of care and your ability to identify care issues, promote self care and identify population care needs. The presenter will demonstrate approaches that have been used and the impact that they have made in the FHT using tools that you may already have and did not know it. This is a highly technical presentation; therefore you should have a good understanding of your current Information Technology Infrastructure and processes to glean the most from this presentation. This presentation is not specific to single vendors EMR. Click here to view presentation.