The IHP CoPs are are a member-driven initiative, led by dedicated IHP volunteers from teams across the province. They provide resources, advice and opportunities for your staff, helping them improve their performance which in turn benefits the whole team.
Benefits of participation in a community of practice:
Online community of primary care professionals working in similar roles in teams across the province:
Sharing best practices and experiences; relevant updates; information on program and client-focused resources
Mentoring of new professionals by established peers
Networking sessions at AFHTO’s annual conference
According to evaluation results, in-person IHP networking is consistently considered one of the most valuable opportunities for networking and learning
How to sign up for a community of practice:
Each network has a listserv and online forum. Our community of practice leads, all within the FHT/NPLC community, have volunteered to create and maintain these to exchange knowledge and share best practices with their peers. Team members can join a CoP by sending an e-mail with their name, FHT/NPLC and e-mail address to their group’s email address (hyperlinked in the list below).
A Quality Improvement Plan (QIP) is “a public commitment to meet quality improvement goals. By developing a QIP, an organization outlines how they will address improving the quality of care it provides to its patients, residents or clients.” Health care organizations in Ontario are required to submit a QIP to Health Quality Ontario (HQO) by April 1st. QIPs are to be submitted online, using the QIP Navigator on HQO’s website. The resources below from HQO, AFHTO, our partners and members can help make the process easier.
Priority Issues for 2018-19
Each year, HQO identifies several priority issues – areas that urgently require improvement – for the system to work together on – in their Annual QIP Memo. For 2018-19, these issues are workplace violence prevention and the impact of opioids in Ontario.
NOTE: They are not required, but it is expected that organizations assess their performance on these indicators, and […] strongly consider these indicators for inclusion in their QIP. If organizations choose not to include a priority indicator, they should provide this rationale in the comments section only. [QIP Guidance Document, pp. 11-12]
Workplace Violence Prevention
New question in the QIP Narrative:Please describe how workplace violence prevention is a strategic priority for your organization. For example, is it included in your strategic plan or do you report on it to your board?
AFHTO Member Policies and Procedures on Workplace Health & Safety. These tools were developed by AFHTO member teams, who have agreed to share them with others. Near the bottom of the page, you will find a section on Workplace Violence, Harassment, and Discrimination, with policies and guidelines from three FHTs.
New question in the QIP narrative: Describe what steps your organization is taking to support the effective treatment of pain, including reviewing opioid prescribing practices and promoting alternatives to opioids. Think about access to addiction services, social services, (sub) populations, etc.
Consider using these resources to help you develop a plan to lessen the impact of opioids on your patients
Some AFHTO members are already doing important work to reduce their patients’ need for opiates. Consider reaching out to these teams to find out if what they’re doing might work in your setting.
Healthy Living With Pain
The Mount Sinai Academic FHT won a Bright Lights award for this initiative in 2016
An NP from the Sinai Health System shared details about the initiative at the Managing Medication as a Team workshop in November 2017.
New recommended indicator for 2018-19: Diabetic foot ulcer risk assessment
Indicator Description (from the QIP Technical Specifications for 2018-19):Percentage of patients with diabetes, age 18 or over, who have had a diabetic foot ulcer risk assessment using a standard, validated tool within the past 12 months.
Inlow’s 60-second diabetic foot-screening tool was developed by the Canadian Association of Wound Care. The assessment is comprised of 12 parameters and is divided into three categories – Look, Touch, and Assess. The assessment is usually performed by an RN or an RPN with certification in foot care.
The tool is also available for Accuro, from the publisher (accessible directly from within your EMR).
Use a different EMR? If you have an EMR tool for Diabetic Foot Assessments, consider sharing it with your peers. If you would like to help develop one or want to find out if someone else has already done so, consider joining one of our EMR Communities of Practice – contact us for more information.
More QIP Resources from HQO
HQO has many resources to help you with your QIPs.
HQO presented two training webinars for primary care QIPs (Beginnerand Advanced) on December 18th, 2017. If you were unable to attend and would like access to a recording, please email qip@hqontario.ca.
Quorum is an online Quality Improvement Community managed by HQO. It’s a great way to learn from your peers across the sector, and it includes posts from provincial leaders in quality improvement, questions and answers from QI specialists across the province, and a bank of QI projects to learn from.
The Quality Compass is a searchable tool of evidence-informed best practices, change ideas, and tools, arranged by QIP indicators.
Query QIPs and QIP downloads let you see what other organizations have included in previous QIPs.
With D2D 5.1 right around the corner (submission platform will be open from January 11th through February 8th, 2018), there’s no better time to remind you that you can use your D2D data to help you choose areas for improvement. Remember that although teams are required to submit a QIP, the content of the QIP is up to the team. By reviewing your D2D interactive report with your team, you can work together to identify areas where there is room for improvement on indicators that matter to you and your patients.
For UPDATED technical notes, please see page 26 of the Data Dictionary.
Interpretive Notes
Tips to help you understand the data and put it in context.
The Diabetes Care Score represents the % of diabetes measures (aspects of care) that a team’s patient population has achieved. For example, if your team’s score is 68, this means that your population or registry of patients with diabetes has achieved 68% of the 4 measures included in the calculation (HbA1C testing, HbA1C level, blood pressure level and statin therapy). In future iterations of D2D, the composition of the indicator will be modified to include other measures of diabetes care like foot and eye exams, based on increasing EMR maturity/data quality and capacity to access data on personalized targets.
Your score may be low if you have a lot of patients with diabetes that have only one process/outcome measure within the appropriate target.
Your score may also be low if you have patients with no measures in range, even though others have most of the measures in range.
How you document and are able to access blood pressure, HBA1c and medication data in your EMR will affect the numerator – i.e., your score will be low if documentation is an issue for your team.
The way your team documents diabetes diagnoses in the EMR affects your denominator (i.e., number of patients with diabetes). Your diabetes score may be over- or understated depending on how “clean” your diabetes registry is.
Steps to Improvement
Concrete steps you can take to improve care, based on your data.Assuming you have established that the data are good enough to direct action AND that improving performance in this area is a priority for your team, you may wish to discuss the following options with your clinical leaders, Quality Improvement committees, team staff and/or patients:
Check out self-management resources from the Ministry of Health and Long-Term Care to help you support your patients in managing their own care. There’s a localized program available in each of the 14 LHIN regions!
Work with patients to help them set their own SMART (Specific, Measurable, Achievable, Realistic, Time-Bound) goals. Consider using a something like the ePRO (electronic patient-reported outcomes) Tool to help with goal-setting and tracking.
Check out what your peers are already doing to help patients meet their goals through increased physical activity and healthier eating habits – and share your knowledge, too!
Read about Walking Wonders – a seniors’ indoor walking and healthy lifestyle program developed by IHPs at Clinton FHT.
Use a foot-screening tool such as Inlow’s 60-second diabetic foot-screening tool to evaluate foot ulcer risk in your patients with diabetes. Developed by the Canadian Association of Wound Care, the assessment is comprised of 12 parameters in three categories – Look, Touch, and Assess. The assessment is usually performed by an RN or an RPN with certification in foot care.
It’s also available from for Accuro, from the publisher (accessible directly from within the EMR).
Use a different EMR? If you have an EMR tool for Diabetic Foot Assessments, consider sharing it with your peers. If you would like to help develop one or want to find out if someone else has already done so, consider joining one of our EMR Communities of Practice – contact us for more information.
Data Quality Actions
Tips to help you understand the quality of your data and, if necessary, take steps to improve it.
Estimate the impact of data quality
Access the Imperfect Data Impact Calculator to find out whether the data quality issue(s) you think you have would change your initial decision regarding the need to improve.
If the “imperfect data impact calculator” shows that the issues in your data may point you to a different action than suggested in the report, you might consider:
Increasing your team’s awareness about the importance of having “clean” data in your EMR: Project ALIVE shows that having clean data in your EMR allows you to create quick and flexible reports to better inform your team about the needs of patients and which patients require follow-up care.
Creating a diabetes registry: Identify patients with diabetes more accurately by using the standard queries and processes developed by QIDS Specialists, to get started on a diabetes registry.
Tracking and demonstrating your progress cleaning in up your data to improve data quality. Before you start the cleanup process run a “coded” query to capture baseline data, then every few months re-run the query and plot your results over time. You may want to use a tracking form to help you document your progress.
Hiring a student to help you clean up your diabetes data. Check page 26 in the “hire student” handbook for details about cleaning up diabetes data.
Once your diabetes registry is clean, running the D2D diabetes queries on an ongoing basis – don’t just wait till the end of the year. This will help you keep track of data quality and progress with diabetes care on an ongoing basis.
Signing up forCPCSSN or EMRALD to get ongoing, patient-specific reports to help you help your patients manage their diabetes.
Joining an EMR CoPto share new tools and solutions to help you make better use of your EMR.
Additional information for estimating the impact of data quality for this measure:
The data are almost certainly not a definitive estimate of your team’s actual performance. However, they might be “good enough” to help you decide if your team needs to improve or not. To determine if the data are “good enough” for that, estimate how likely it is that one or more of the issues outlined in the interpretive notes are a problem with your team. Then, run the “imperfect data impact calculator” to see if the issue(s) could lead to a different decision related to the need for improvement. To do this, work with your clinical leaders and staff to establish an approximate impact of data quality – i.e., is the data quality issue causing your performance to look like TWICE or HALF or 10% (or other number) less or more than it actually is? Plug that number into the “imperfect data impact calculator”. It will show you whether the data quality issue(s) you think you have would change your initial decision regarding the need to improve. Click here to access the Imperfect Data Impact Calculator. You may find it hard to generate consensus about the impact of data quality issues on the level of performance shown in the D2D report. In that case, consider the following options:
Track the next 10 (or 20 or other small number) encounters to get a better estimate of the extent of the data quality issue. Perhaps the rate among these patients will shift your team’s overall rate to be TWICE or HALF or 10% (or some other number) of the rate in the report. Plug that number into the “imperfect data impact calculator” and proceed accordingly.
Estimate how many of your patients with diabetes have blood pressure (or HBA1c) recorded properly in the EMR. Perhaps the rate among these patients will shift your team’s overall rate to be TWICE or HALF or 10% (or some other number) of the rate in the report. Plug that number into the “imperfect data impact calculator” and proceed accordingly.
Estimate how many of your patients with diabetes are not coded in a consistent manner in your EMR. Perhaps the rate among these patients will shift your team’s overall rate to be TWICE or HALF or 10% (or some other number) of the rate in the report. Plug that number into the “imperfect data impact calculator” and proceed accordingly.
If none of the above is helpful, consider instead experimenting with possible “error” rates to see how much error (i.e., TWICE or HALF or 10% of some other number) would be needed to change the decision made on the basis of the performance of the indicator in D2D. If, in the opinion of the team, such an amount of error is reasonable, then it may be worth considering efforts to improve data quality. Alternatively, if that amount of error is considered to be unlikely, then the data are likely good enough to support the initial decision regarding the need to improve, based on the performance shown in D2D.
If the “imperfect data impact calculator” points to the same decision (e.g., a need to improve or NOT) even after data quality issues are considered, the data are likely “good enough” to base your decision on regarding the need to improve. The next step is to consider strategies to improve, assuming the area of care measured by the indicator is a priority for your team. If your data are not “good enough”, you may then consider taking action to improve your data quality, before or at the same time as you try to improve processes of care.
Now, more than ever, we need to show the value of team-based primary care. Your team can help by sharing your stories via AFHTO’s QI enablers study. AFHTO members have gained the respect of many through their high and ongoing participation in D2D. It is not enough to just measure, though. The next step is to use that data to explore if and how relationship-based primary care is also better care, as Starfield’s work suggests. We need to learn more about how teams run their shops and use their data, so we can see what kinds of structures and processes make a difference in performance. This can give us all bigger hints about what to try to get to better outcomes for all teams. If we can pull this off, it would make a very clear case for the value of team-based care. Here is what you can do:
Keep measuring: This is the fuel for all kinds of fires to support improvement in, demonstrate value of and advocate for teams!
Extra demand on your time: none if you are already doing D2D.
Extra demand on your time: about 10 minutes if you are already doing D2D.
Tell your peers how you work: Sit down with AFHTO staff to explain how you do what you do in your teams in terms of measuring and improving. This will help teams compare and contrast with one another to find hints to act on, to get to better outcomes.
Extra demand on your time: 4 hours for in-person or phone interviews.
Dive deeper into team functioning: Join a research study looking at what difference integration and collaboration makes on patient outcomes.
Extra demand on your time: 15 minutes for each provider who completes a Provider Questionnaire, which includes the Collaborative Practice Assessment Tool (CPAT) and seven demographic questions. NOTE: You don’t need to get every provider to complete the questionnaire, as long as you can get representation from across the key disciplines in your team (family doctors, nursing staff, and IHPs). If you get 20 staff to participate, that’s about 5 hours of staff time – or the first 15 minutes of a team meeting.
The more data we have, the more we learn. With only a few teams participating, we can’t be sure we’re making the right connections. We need teams from across the province, at all levels of performance and all stages of quality improvement, to help us understand what they are doing and connect it to how they are doing. Want to know more? Send your questions to Carol Mulder, Provincial Lead for the Quality Improvement Decision Support Program.
OntarioMD (OMD) has launched a new online Privacy and Security Training Module along with other privacy resources. In addition to being a critical obligation for Health Information Custodians, privacy and security training is necessary to support access to provincial digital health assets, such as the ConnectingOntario Clinical Viewer, HRM, eNotifications, and OLIS – along with future digital health assets as they become available. The OntarioMD Privacy and Security Training Module covers topics such as safeguarding PHI from breaches and security incidents, and how to comply with obligations under PHIPA. The Module is open to all Ontario clinicians, interprofessional health care providers, Executive Directors (and equivalent), administrative staff, as well as IT specialists, QIDSS, and other staff involved in quality improvement and/or data analysis. Access the Privacy and Security Training Module here.
NOTE: Each person who accesses the module needs to be a registered user of the OntarioMD portal. IHPs and other staff members can have a physician or office manager create a sponsored account for them. To do this, the physician or office manager simply, signs into their account, goes to ‘My Account’, then the ‘Sponsored Users’ tab and clicks on the ‘Invite User’ button.
For physicians completing the training, it offers up to two MAINPRO+ CME credits. It has had the input and support of the Canadian Medical Protective Association (CMPA), the College of Physicians and Surgeons of Ontario (CPSO), the Ontario Medical Association (OMA), and eHealth Ontario, along with feedback from the Information and Privacy Commissioner of Ontario and the Ministry of Health and Long-Term Care. Please feel free to share this information with your colleagues and staff.
The provincial Ministry of Labour (MoL) is visiting family practice health teams (FHTs & CHCs) across Ontario to carry out proactive inspections. These inspections are designed to determine compliance with the Ontario Health and Safety Act (OHSA) and associated regulations.AFHTO has partnered with Public Services Health & Safety Association (PSHSA) to help our members get ready.
Everybody plays an important role in preventing injuries and illnesses at work. Our partnership with PSHSA prepares you for MoL initiatives by providing additional resources to make your workplace healthy and safe. Here is the list of the recent webinars with links:
This new section of our website contains a collection of free health and safety resources, including fact sheets, checklists, web tutorials and posters, tailored specifically to the unique occupational hazards faced by AFHTO members. The resources change regularly, so remember to check back often for new information and tools.
Health and Safety Resource Manual: a compilation of essential tools, information, and steps to developing a health and safety program within your team. Everything you need to know in one, simple manual!
Sample Policies : As part of this new partnership with AFHTO, PSHSA is developing a core set of occupational health and safety policies and procedures. Policies and Programs including the following are now available to AFHTO members free of charge* on the webpage :
Health and Safety Policy
Roles and Responsibilities
Hazard Recognition
JHSC/Health and Safety Representative
Training
Incident/Injury Investigation
Workplace Violence and Harassment Policy/Program
First-Aid Requirements
* Other customizable health and safety policies and procedures are available for purchase.
eLearning training courses for basic compliance are available as a bundled package or individual purchase through PSHSA. More information is available here.
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.
Teams rightfully pride themselves on the relationships they build with patients, but most of the data teams use to demonstrate their value is the number of patients they serve. The PPPC gives you a way to demonstrate the quality, not just the quantity, of service you provide.
Please consider sharing your results with AFHTO staff, to be used as part of the QI enablers and patient priorities studies. Our hope is that teams will have completed their patient-centeredness survey by May 2018.
Access a CME accredited privacy training module and resources through Ontario MD. The module and resources are designed to facilitate your use of technology and ensure accountability that Health Information Custodians have with respect to the appropriate collection, viewing, use, disclosure and safeguarding of personal health information.
Resources with Strings Attached
The resource described below (Lean training and Practice Facilitation training) 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 do the following:
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.
Administer the Patient Perception of Patient Centeredness Questionnaire (email us to get a copy), 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: Winter 2018 Lean training session has concluded. Stay tuned for future opportunities!
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.
Practice Facilitation Training for QIDSS
NOTE: The Practice Facilitation Training sessions are finished. If interested, please consider contacting the Centre for Effective Practice to learn about other opportunities for this.
Offered in partnership with the Centre for Effective Practice (CEP), this is a free, three-day training session in Toronto for QIDS Specialists and other QI professionals (QIDSS-like folks). The course will introduce you to academic detailing, a service that offers one-on-one educational outreach visits to family physicians to discuss objective, evidence-informed ways to improve care quality. By taking part in the training, QIDSS and QIDSS-like folks will be more confident working with clinicians about how to apply evidence and data to their practice. They’ll also learn about the CEP’s academic detailing service and how this could benefit their teams.
Team expectation: In addition to the minimum expectations described above, participating teams may need to cover travel and accommodation for the trainee. There are a limited number of spaces, and these are available on a first-come, first-served basis.
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.
Starting in Fall 2017, the provincial Ministry of Labour (MOL) is conducting proactive inspections of family practice health teams (FHTs & CHCs) across Ontario. These inspections are intended to determine compliance with the Ontario Health and Safety Act (OHSA) and associated regulations.
AFHTO has partnered with Public Services Health & Safety Association (PSHSA) to help our members get ready. How to Engage Everyone in an Integrated FHT webinar was featured on December 7. The participants were introduced to legal requirements of the workplace, including various ways to define roles and responsibilities to ensure all health and safety minimum requirements are met. Various strategies aimed at increasing engagement of all workplace parties in health and safety were examined and discussed .
