Dec.17- AFHTO forwarded the following information to all AFHTO members on behalf of the Chief Medical Officer of Health: Please see the memo regarding recommendations in response to current influenza activity, including circulation of potentially mismatched influenza A/H3N2 strains. For more information, please contact your local public health unit. Visit the ministry’s website to locate your local public health unit. French translation of this memo will be distributed in the coming days.

It’s D2D time again! We’ve made a list – we’d like you to check it twice! Please provide your input into the selection of indicators for the second iteration of Data to Decisions (D2D 2.0).  We would like to finalize the list early in the new year to give everyone as much time as possible to get the data and pull the report together.  To that end, please complete the survey by Jan 23 2015. What is D2D 2.0? Data to Decision 2.0 is AFHTO’s way of “keeping going” in the journey to advance manageable meaningful measurement.  It is the second iteration of a membership-wide report summarizing performance on indicators that are both possible for members to measure and that are meaningful to them.  It follows the lead of D2D 1.0, which was AFHTO’s attempt to “get started” on this journey  (see FAQ for more background on D2D 1.0).  “Keeping going” is different than “getting started”.  For example, the goal this time is to get as many teams as possible contributing data.  This is partly to ensure that all members have equally good opportunities to use the report to fuel their own local efforts to improve quality.  It is also important to ensure that the results are truly representative of AFHTO members as a whole.  And finally, it is critical to making sure that the new ministry contract focuses on measures that matter to members.  Input from the MOHLTC suggests they are very open to the idea of using D2D 2.0 as a basis for this contract, assuming it represents the vast majority of members. Where did the short-list of indicators come from? The short list of indicators for D2D 2.0 is based on input from an advisory panel of clinicians and EDs, the QIDSS host ED forum, Patients Canada and consultation with members regarding the new Ministry contract as well as ongoing informal input from members before, during and after the release of D2D 1.0 in a variety of forums.  The list is also heavily influenced by the recent work to prioritize the long list (i.e. 200+) of indicators in the PCPMF.  The criteria for selecting indicators that emerged from this input is as follows:

• Be part of D2D 1.0 unless there is a clear indication against including them again
• Address a clear and important-to-members gap among D2D 1.0 indicators
• Be possible for majority of AFHTO members to access data with reasonable effort
• Align as much as possible with sector wide reporting processes/capacity (i.e. to facilitate inter-model comparisons)
• Be among the top-weighted indicators in the Starfield Primary Care Index (to extend capacity to measure quality of comprehensive, patient-centered care aligned with patient expectations)

What is the short list of indicators? There are 3 groups of indicators for members to provide input on.

1. Existing D2D 1.0 indicators: All of the D2D 1.0 indicators will be retained in 2.0 unless there is clear evidence that it is not possible for a large proportion of AFHTO members to do so in a consistent way.  The definitions and data capture processes for some indicators have been modified to address concerns raised about feasibility and data quality in the D2D 1.0 process.
2. Potential additions for D2D 2.0: Several indicators are proposed to fill perceived gaps in coverage in D2D 1.0.  The specific rationale for each indicator is provided in the survey materials.  Only a small number of candidates are offered for input, given the very clear guidance against having large numbers of indicators.
3. Context indicators: In addition to the “peer group” characteristics included in D2D 1.0 (i.e. roster size, rurality and EMR access to hospital discharge data), several other indicators (e.g. teaching status) are proposed to make it more meaningful for teams to compare to peers.

See survey instructions for detailed list of indicators. How do AFHTO members provide input for indicator selection?

1. Find out what your team thinks about the indicators:  You may choose to ask your Board, your Quality Improvement committee, your physician group and/or your staff about what indicators matter most to them.   If you want to do a local “first round” of the survey, we have a provided a mechanism for that.   We have also provided a short handout about D2D 1.0 in case that helps start the conversation.  See survey instructions for more details.
2. Complete the survey by Jan 23, 2015: You can complete the survey as an individual or as a group.  Just indicate how many are in your group when you do, so we can account for that in the results.
3. Talk to us! Contact Carol Mulder (carol.mulder@afhto.ca), any QIDSS or member of the Indicator working group.  All of these people are actively involved in the actual implementation of the report so they can give you more background and/or bring your comments forward.
4. Take the lead! AFHTO has is asking for members to volunteer for a variety of leadership roles related to advancing manageable meaningful measurement.  One of the newest of these is the Physician Leadership Council.  More information will be forwarded to all members soon.  In the meantime, please consider these opportunities for you to provide further input.

How do we find out more? AFHTO will be launching a regular bulletin to better share emerging news about advancing manageable meaningful measurement.  Watch for this coming soon to your inbox.  In the meantime, please check out the D2D page  or contact Carol Mulder (carol.mulder@afhto.ca) for more information.

Registration details for the ministry briefing on the five-year FHT evaluation report on December 10, 2014 from 12:00 to 1:00 pm have been confirmed. This message has been sent to the Executive Director, Lead MD/NP and Board Chair of all AFHTO member organizations. Register for the webinar here: https://attendee.gotowebinar.com/register/8399439067843427073

• After registering, you will receive a confirmation email containing information about joining the webinar.
• You are invited to share this information with your colleagues and staff. However, due to the limited capacity of the webinar, we ask that each team limit the number of separate log-ins and view the webinar together.

This webinar will give participants a brief overview of the findings of the report and give an opportunity to ask questions. Click here for background information on the study and ministry briefing. To help prepare members for the public release of the five-year FHT evaluation results, AFHTO will be hosting the webinar and providing supporting materials as follows:

Monday, December 8	An embargoed copy of the report and briefing slides will be shared with members in advance of the briefing.
Wednesday, December 10	Attend briefing, several methods for participation: Log-in to the webinar when it starts using the link provided in your confirmation e-mail. Participants will be able to send in questions during the session. Participants can access the webinar by computer or on their smartphone (Download the app for iPhone or Android). Phone in to the webinar. You will be able to listen but not ask any questions.
Friday, December 12	A recording of the webinar and any other supporting materials will be available on the AFHTO members only website.

FHTs and NPLCs are invited to take advantage of the following opportunities, some of which are time-sensitive. This post includes information on the following:

• QIP Education and Navigator Training to prepare for the launch of the QIP Navigator on Nov. 24
• Nominate an individual for The Change Foundation’s 20 Faces of Change Awards by Nov. 28
• New resources available to support patient care
  •    Opportunity for patients: Diabetes Hope Foundation scholarship  available for youth
  •    Online resources on prenatal education in Ontario
  •    Online course – Radon: Is it in your patients’ homes?
  •    Cancer screening app available from Cancer Care Ontario
• Call to participate in expert panels with the Provincial Council for Maternal and Child Health

QIP Education and Navigator Training to prepare for the launch of the QIP Navigator on Nov. 24

Health Quality Ontario (HQO) is offering four opportunities to attend education sessions (Nov. 24- Dec. 2) to support QIP development and submission. These webinars will also be archived and posted on the Navigator site for later reference. Click here for the webinar invitation and registration details. The QIP Navigator will go live on November 24, 2014. Should you have any questions, please contact the QIP team at QIP@hqontario.ca.

Nominate an individual for The Change Foundation’s 20 Faces of Change Awards by Nov. 28

The Change Foundation needs your nominations for their 20 Faces of Change Awards, which will honour those who have inspired positive, patient-focused change in our healthcare system. Do you know a health care champion who has improved care for patients and families in your community? Help shine a spotlight on their work to advance our system for all Ontarians – good ideas are worth spreading. Click here to submit a nomination before November 28, 2014.

New resources to support patient care:

Opportunity for patients: Diabetes Hope Foundation Scholarship available for youth

Teens making the transition from high school to post-secondary education, and from pediatric care to adult care for 2015, can apply for one of the $2,500 scholarships offered annually through Diabetes Hope Foundation. Applications must be received by March 9^th, 2015.  Please share this information with your patients and send any questions to heather@diabeteshopefoundation.com.

New online resources on prenatal education in Ontario

Best Start Resource Centre’s report explores the current status of prenatal education in Ontario and identifies existing gaps and needs. It summarizes relevant results and the fact sheets share highlights including recommendations. Click here to access research findings and fact sheets for clinicians.

Free online course for clinicians – Radon: Is it in your patients’ homes?

Linked to the lung cancer deaths of 3,200 Canadians every year, MacHealth, the Ontario College of Family Physicians and Clean Air Partnership are pleased to present an online course to help health-care professionals better understand radon. Click here for more information.

Online cancer screening app for clinicians from Cancer Care Ontario

Cancer Care Ontario’s free cancer screening app for healthcare providers includes:

• Quick access to Ontario’s breast and cervical cancer screening guidelines
• Easy-to-navigate recommendations for follow-up of abnormal results
• Instant viewing, printing and emailing of patient and provider resources

Download it by searching “Ontario Cancer Screening” in your app store. For more information about cancer screening programs and other relevant resources, please call 1.866.662.9233, email screenforlife@cancercare.on.ca or visit www.cancercare.on.ca/pcresources.

Call to participate in expert panels with the Provincial Council for Maternal and Child Health

The Provincial Council for Maternal and Child Health is looking for expert participants for the following:

• Sickle Cell Quality Based Procedures (QBP) Expert Panel- deadline to join Nov. 21

We are seeking a variety of paediatric and adult clinicians from specialties involved in optimizing care for people with sickle cell disease.

• Transition to Adult Health Services (TAHS) Discharge Planning Implementation work group – meeting on Dec. 9

Primary Care input (MD and/or NP) would be of tremendous benefit. If you have any questions about either group, please contact Mary Ellen Salenieks, Senior Project Manager at 416-813-7654 x 203667 or Maryellen.salenieks@sickkids.ca.

The results of the first phase in our collective journey toward the next Ministry contract has been e-mailed to all AFHTO member Board Chairs, Lead MD/NPs and EDs of AFHTO member organizations. New contracts will come into force for FHTs on April 1, 2016; their content could influence Ministry-NPLC contracts as well. Click here to review the principles and guidance for moving forward. As described in a September 10 e-mail, the objective at this stage has been to develop a common statement of principles and set of agreed priorities to guide AFHTO’s work toward the new contract template. This has been done through a survey of our FHT and NPLC leaders (115 responses) and the leadership session held immediately before the AFHTO conference (over 180 participants). From this process, strong support has emerged for a clear set of principles for:

• Governance of primary care organizations
• Accountability and reporting to funders
• Determining accountability measures

In addition, the process has revealed priority needs to help strengthen team collaboration and move toward accountability for agreed upon outcome measures. AFHTO members also reported their hopes and concerns as we go through this journey. Overall, AFHTO members have indicated they want to be accountable for achieving meaningful outcomes.  They are hopeful this will provide clear evidence of the value their organizations deliver, and as a result, will lead to improvements in the funding relationship with the ministry as well as greater efficiency in reporting. Members have urged caution in choosing measures, to ensure they meet the stated principles (e.g. evidence-based, clinically important, aligned with other priorities, easy-to-track on an on-going basis, able to reflect variation in teams and complexity of populations). The ministry must collaborate to define these measures, and AFHTO members must have the opportunity to engage in this process. There is indisputable need for sufficient support so that FHTs and NPLCs have the capacity to collect and report their data. Please review the report (in your e-mail) for full details on the conclusions that have been drawn and the membership response that led to these conclusions. The principles and priorities are also posted on the AFHTO members-only website (log-in required). With this clear direction from the leaders of AFHTO member-organizations, the AFHTO board will continue to guide this journey toward the next ministry contract and advance meaningful, manageable measurement. Along the way, ongoing advice from various membership councils and consultations with the broad AFHTO membership will continue. Thank you to all who participated in the survey and in the leadership session. Comments are welcome at any time – please send to info@afhto.ca.

FHTs and NPLCs have matured over the 5 – 9 years that each organization has been in existence. Contracts between MOHLTC and FHTs expire on March 31, 2016, with this comes the opportunity to develop a much more mature and meaningful approach to governing these organizations, from the Ministry and through to the board of each FHT and NPLC, to deliver high-quality primary care and improve the health of people in the communities served.

As the representative voice for FHTs and NPLCs, AFHTO’s board, committees and staff embarked on a process with the membership to identify the key principles to guide this journey toward more mature relationships, including contracts that support high-quality comprehensive interprofessional primary care.  To date the process has included:

1. Initial issues identification and concept development through the Governance + Leadership (GLAC) and ED (EDAC) Advisory Committees
2. Survey e-mailed to the board chair, lead MD/NP and executive director of each AFHTO member organization (115 responses received between Sept. 10-29, 2014)
3. Leadership session held immediately before the AFHTO conference (about 180 attended on Oct.15, 2014)
4. Resulting from steps 2 + 3, this report-back to the membership on principles + priorities to guide AFHTO’s work

Guided by the principles and priorities that have emerged from the AFHTO membership, this journey will continue with on-going:

• Oversight by AFHTO board
• Advice from GLAC, EDAC and soon-to-be-established Lead MD/NP Council
• Updates and further consultations with the full AFHTO membership as the process unfolds

1         Principles to guide our way forward

1.1      Principles for governance of primary care organizations

Given the strong level of support indicated through the survey of leaders of AFHTO member organizations AFHTO adopts the following governance principles: FHTs and NPLCs are not-for-profit corporations in a health system mandated to provide appropriate, equitable, sustainable care.  Their boards:

• Are accountable to the patients, funders and members of their organization.
• Ensure their organizations are appropriately managed and advocate for appropriate resources so that patients can access high-quality comprehensive care that is sustainably delivered and strives to meet patient and public expectations.
• Ensure the culture of their organization supports development of high-functioning interprofessional teams.
• Provide leadership to harmonize and optimize policies and practices for effective and efficient teamwork within the organization and with other entities contributing to the health and health care of the organization’s patients and community.
• Provide leadership and collaborate with other organizations to spread best practice and encourage growth in capacity so that all Ontarians can have access to high quality interprofessional comprehensive primary care.
• Ensure that patients and community members are engaged in the development of programs and services.

These principles describe the more mature relationship the leaders of AFHTO’s member organizations want to have with their funders, members, staff and other stakeholders. They will guide AFHTO’s work in advocacy and in developing learning opportunities and support for members to succeed in their roles as governors and leaders.

1.2      Principles for accountability and reporting to funders

The strength of the survey results also lead AFHTO to adopt the following principles for accountability and reporting to funders. These principles will guide AFHTO’s advocacy with government, on behalf of members, on development of the next set of contract templates:

• Financial and clinical reporting should minimize duplication in data collection and reporting.
• Accountability should be defined in terms of collectively agreed upon measures that reflect value delivered.
• Reporting requirements should place more emphasis on the work of the team to achieve outcomes and less on individual member activities and patient encounters.

1.3      Principles for determining accountability measures

While AFHTO members are strongly in favour of accountability and reporting based on meaningful measures, they are also cautious about how these measures will be determined. Leaders who attended the Oct. 15 leadership session provided the following guidance on principles for determining accountability measures that should be followed by AFHTO, the Ministry and any other stakeholders involved in the process:

• MOHLTC must engage in a collaborative process to define outcome measures to be used for reporting.
  • Input from providers/engagement of AFHTO membership is essential.
• MOHTLC must provide adequate support so that FHTs/NPLCs have the capacity (i.e. the people and technology needed) to collect and report their data.
• Measures must be meaningful, measurable, consistent and comparable.
  • More specifically, measures must be evidence-based, clinically important, include process and outcome, be easy-to-track on an on-going basis, clearly defined and standardized for meaningful comparisons, and aligned with other Ministry priorities and reporting requirements.
  • Measures must also incorporate patient experience, and involve patients in what the measures will be.
• The approach to accountability measurement must be sufficiently flexible to account for variation in patient complexity and their social determinants of health, in regional and rural-urban settings, and in size and maturity of teams.

2         Additional guidance received from members

2.1      Help needed to move toward accountability for outcomes

If FHTs and NPLCs are to be held accountable for meaningful outcomes, what is the evidence as to what must be in place to achieve this? Participants in the Oct.15 leadership session were presented findings from a not-yet-published study by the Ontario College of Family Physicians to identify characteristics and predictors for high performance in FHTs. The factors found to be associated with quality outcomes included:

• Strong leadership is associated with better governance and integration of FHT and Family Health Organizations (FHO).
• Team leadership promotes higher team functioning.
• Understanding and respecting practitioner scope of practice is essential to optimal team functioning.
• Co-location and effective office design impacts team functioning.
• Differential pay among co-workers as a result of dual funding creates problems in teams.

The September 2014 AFHTO leadership survey had also found that 80% of respondents agreed that “greater harmony between the physician-funded groups and the FHT-funded groups is essential to the FHTs moving forward to ensure optimal interprofessional comprehensive primary care.” Through small group discussion followed by voting on top ideas, FHT and NPLC leaders in AFHTO’s leadership session then identified their priority needs “to help strengthen team collaboration and move toward team accountability for agreed upon outcome measures.” These priorities emerged:

• The critical need for alignment:
  • Between FHTs/NPLCs and their associated physician groups
  • Among objectives of key players, including the Ministry, Ontario Medical Association and Ontario Primary Care Council
  • Among all team members, invested in a common purpose
  • Between performance and funding to encourage people to work towards clearly defined and transparent measures
• Joint accountability of physician group and FHT/NPLC to increase provider participation and engagement, and mechanisms by which such engagement is supported financially and otherwise
• Addressing system conflicts that FHTs/NPLCs are being held accountable to but have no authority over (e.g. hospital efficiency, ER visits etc.)

AFHTO is guided by the fact that some FHTs have already undertaken measures to harmonize working conditions and expectations between their physician-funded and FHT-funded groups, i.e.:

• Close to half of leadership survey respondents have:
  • Adopted one common set of HR policies
  • One ED with reporting authority over all physician-funded and FHT-funded staff
• Close to half of leadership survey respondents have:
  • A common compensation scheme for FHT-funded and physician-funded employees
  • One common employer arrangement
  • A service contract between the physician group and FHT
• Over one-third have no formal arrangements in place at all.

2.2      Basis for funding allocation

When it comes to the factors that should be reflected in allocation of funds, the leadership survey revealed:

• Solid agreement that case mix (patient complexity) is a critical factor (91% agree or somewhat agree, 3% disagree)
• Support for other factors as well:
  • achievement of performance targets (80% agree, 5% disagree)
  • geography/dispersion of services (77% agree, 5% disagree)
  • degree to which organization plays a system role (78% agree, 11% disagree)
  • number of patients enrolled (77% agree, 15% disagree)

Comments overwhelmingly pointed to the need for sufficient funding to recruit and retain staff and for greater budget flexibility. Additional comments concerned the timing for budget approvals and other needs for added funds.

2.3      Hopes and concerns regarding accountability for outcomes

The final question asked of the 180 participants in AFHTO’s leadership session was – “If we move in this direction, what are you most hopeful about, and concerned about, the next set of contract templates?” About 100 responses indicated members are hopeful that the move toward strengthened team collaboration and team accountability for outcomes would lead to:

• Improvement in outcomes (including both patient experience and provider engagement/satisfaction) and evidence of value delivered
• Improvement in funding and greater flexibility in using funds
• Greater efficiency in measurement and reporting (less duplication, less waste of time)

Another 100 responses clustered around concerns about:

• The choice of measures
• Capacity to measure
• Funding ( potential expectation to “do more with less”, consequences of failing to meet targets)
• The Ministry and other stakeholders (e.g. lack of transparency, lack of common vision, power imbalance)
• The need to be able to reflect differences among teams and the communities they serve

3         Next steps

Thank you to all of the leaders in AFHTO’s member organizations who have made their views known through the September survey and/or the October 15 Leadership Session.  Guided by the principles and priorities that have emerged from the AFHTO membership, this journey will continue with on-going:

• Oversight by AFHTO board
• Advice from Governance + Leadership Advisory Committee, Executive Director Advisory Council and soon-to-be-established Lead MD/NP Council
• Updates and further consultations with the full AFHTO membership as the process unfolds.

AFHTO members are welcome to send further comments and ask questions at any time:

• Regarding work toward new contract templates, to Executive Director Angie.Heydon@afhto.ca
• Regarding the governance and leadership of FHTs and NPLCs, to the Provincial Lead for the Governance and Leadership Program, Bryn.Hamilton@afhto.ca
• Regarding AFHTO’s work to advance measurement capacity, to the Provincial Lead for the Quality Improvement Decision Support Program, Carol.Mulder@afhto.ca
• General questions/comments, to info@afhto.ca.

All who work within an AFHTO member organization or serve on its board are welcome to attend the AFHTO Annual Meeting. It takes place just before the official opening of the AFHTO 2014 Conference, on:

Wednesday October 15, 2014 at 9:00AM Harbour Ballroom A+B, Westin Harbour Castle One Harbour Square, Toronto, Ontario.

At this Annual Meeting, the AFHTO board will present its Annual Report to the Members.

• Click here for a PDF copy of the Annual Report.
• A print copy of the Annual Report will be mailed to each member organization, and conference attendees will receive a copy in their registration kits.
• Further updates will be provided at the meeting, with particular focus on AFHTO’s work on recruitment and retention and on promoting the value of comprehensive interprofessional primary care.

The meeting also includes a report on AFHTO’s financial outlook, in addition to the annual Audited Financial Statements, as well as the board’s Nominations Report and acclamation of five new board of directors. These reports are attached. There will be plenty of opportunity for AFHTO members to ask questions and present opinions. Each AFHTO member organization is entitled to designate one voting representative for the meeting.  Voting delegates will be required to register before the meeting to receive their voting card. The Notice of Meeting, agenda and reports for AFHTO’s Annual Meeting have been sent to the e-mail addresses AFHTO has on file for the Board Chair, Executive Director and Lead MD/NP of these eligible organizations. AFHTO members may request this package from Sombo.Saviye@afhto.ca. Each member organization is asked to contact her in advance to indicate who will be the organization’s voting representative so that a voting package can be prepared in advance for that person.