Below are examples of patient and provider experience surveys from various family health teams. When using a survey, please remember to acknowledge the team that created it.
Originally posted March 31, 2020, updated on April 3, 2020.
Dear AFHTO EMR CoP Members,
As many of you are aware the EMR communities of practice (CoP) will be transitioning from AFHTO to OntarioMD effective March 31, 2020. AFHTO would like to thank all members for their continuous support and participation. We would also like to sincerely thank CoP leads for their dedication to these groups! We look forward to a smooth transition.
OntarioMD is in the process of updating membership lists for existing CoPs. Please take a few minutes to fill in this form through which contact info is being collected. OntarioMD will use this information to send all meeting invitations and updates regarding the CoPs after March 31, 2020. Moving forward, the central contact email will be communities@ontariomd.com
Listserv emails have been updated to:
For OSCAR users: oscaromdcop@emaildodo.com
For Accuro users: accuroomdcop@emaildodo.com
For Telus PS users: telusomdcop@emaildodo.com
For P&P users: p-pomdcop@emaildodo.com
If you have any comments, questions or concerns about this transition, please take a few minutes to fill out the following surveys:
Increasing access to patients through virtual care visits webinar Dec. 10
Members’ stories
QIDS-ESSENTIAL: the making & meaning of the Quality Improvement Decision Support program
Happy Nurse Practitioner Week
Primary Care Virtual Community
Upcoming events on Digital health and technology in integrated care and more
Digital health toolbox webinar Nov. 28
The current healthcare landscape poses pressure to modernize health care delivery, striving for an integrated, higher-quality patient-centred model.
Digital health tools, when designed, deployed and maintained to meet user needs, play an important role in enhancing patient and provider experience, and unlocking opportunities for a greater understanding of patient population and the delivery of proactive care, while optimizing the use of resources.
Increasing access to patients through virtual care visits webinar Dec. 10
Minto Mapleton FHT is a small team that has set an example of how to use multi digital solutions to increase rural patient centred care. They currently use digital tools such as e-faxing, Ocean tablets, Telus apps and much more to increase office efficiency. They are taking advantage of OTN tools and are ranked 4th out of 125 FHTs in the use of eVisits with the most referrals for respirology and psychiatry. They have also piloted the eHealth Centre for Excellence Virtual Care initiative that allows patients remote access to visits.
Peterborough FHT has been supporting unattached patients since August 2018 through their Virtual Care Clinic (VCC) in Peterborough and a NP-run PFHT Clinic in Lakefield that supports rural unattached patients and seasonal visitors. Along with access to the VCC & PFHT Clinics, PFHT has opened their group programs and services to these patients who can now register online without a referral from a primary care provider thereby removing unnecessary barriers.
QIDS-ESSENTIAL: the making & meaning of the Quality Improvement Decision Support program
As the QIDS program turned five last fall, the QIDS Secretariat within AFHTO decided that the milestone merited not just another report or case study but a different kind of account, one that would capture the QIDS journey with a wider lens, from both a philosophical and practice perspective. QIDS-Essential: The Making and Meaning of the Quality Improvement Decision Support (QIDS) Program is the result.
Happy Nurse Practitioner Week
Happy Nurse Practitioner Week to all the NPs working in primary care teams across Ontario!
Thank you for your hard work, your dedication to your patients and your teams. Please take some time this week to reflect on the work that you do and know that you make a difference in the lives of your patients and your communities.
To celebrate this important week, the NPAO has developed a NP Week Toolkit.
Primary Care Virtual Community
Next webinar: Nov. 21, 2019 | 8 a.m. to 9:30 a.m.
The Primary Care Virtual Community (PCVC) is a collaboration designed to support the front-line practitioner experience of the Quadruple Aim. The PCVC has been developed by AFHTO and the Ontario College of Family Physicians and is facilitated through The Change Foundation.
The upcoming webinar will continue a dialogue on 10 Ontario-based “High Impact Actions,” which have been co-defined by the Community, and offer examples of how these actions may already be enabling meaningful improvement in primary care.
A webcast for IHPs: OHTs and health system transformation, Nov. 14, 2019
Please join us on from 12 PM to 1:30 PM for an overview of OHTs, and to hear from teams proceeding to full application whose OHT development has included close collaboration with IHPs. They will speak to their work to date and highlight how IHPs are engaged. All members are encouraged to join (not just IHPs!) Register today!
Health Justice Tuesdays – Health and Human Rights Law, Nov. 19, 2019
Register for the last Health Justice Tuesday session held by one of our members, St Michael’s Hospital Academic FHT. Learn more here.
Cyber Security and Data Breaches- How Vulnerable are you? Nov. 20, 2019
The next Financial Webinar Series webcast co-hosted by AFHTO and Grant Thornton LLP is right around the corner. Join us for an hour on data, cyber security and policies and procedures to mitigate possible issues. Register today!
Digital health and technology in integrated care, Nov. 20, 2019
The next session of the International Foundation for Integrated Care (IFIC) Canada Virtual Community. Find out more here.
As the QIDS program turned five in the Fall of 2018, the QIDS Secretariat within AFHTO decided that the milestone merited not just another report or case study but a different kind of account, one that would capture the QIDS journey with a wider lens, from both a philosophical and practice perspective. QIDS-Essential: The Making and Meaning of the Quality Improvement Decision Support (QIDS) Program is the result.
There is a story to tell about that journey: a narrative less about projects, and more about people. Less about what was done and more about how (and if) it was done; less about data and indicators and more about building collective capabilities, confidence, and communities to make change in the field, from the ground up.
It’s also a story about progress in primary care performance measurement — in some cases, first steps. It’s a story for the primary care community to learn from and share with each other and all partners in health care.
The intent is to prompt reflection about the key components and characteristics of that approach. As the quality improvement decision support specialist (QIDSS) positions were introduced, allocated and integrated into FHTs and new measurement tools launched and embraced, what fuelled the momentum? What stalled it? How far did it take FHTs in their sometimes circuitous journey along the data-measurement- performance-and-quality- improvement continuum? What can be leveraged today from the QIDS program to position FHTs as ideal partners in emerging primary care innovations?
Plenty, as it turns out. If you want to learn more, read QIDS-Essential: The Making and Meaning of the Quality Improvement Decision Support (QIDS) Program. Even though Ministry funding for the AFHTO QIDS Program was cut earlier this year, there is a lot to celebrate from the learnings of the program. AFHTO remains committed to ensuring quality remains a priority in the health system transformation under way by leveraging the great integration work already being done by interprofessional primary care teams in Ontario.
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.
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.
Five iterations of D2D data show that some teams tend to improve more over time compared to others. AFHTO members want to know what some of the “tricks of the improvement trade” are so they can try them out in their own teams. This QI enablers study is aimed at learning more about what makes it easier or harder to improve so that all teams can take advantage of the wisdom from the field.
The QI Enablers study will be based on in-person interviews with teams. It will provide a snapshot of how teams think and work to get better at what they do. We will ask teams “what works and why” when they try to get better at what they do. Details on the interview process are outlined below. The study will describe what is happening with teams at a single point in time – ie it is not ongoing, the way that D2D is. The data from the interviews (which will mostly be in the form of stories) will be compared to D2D performance. This will point out any patterns between the stories of how teams work and their D2D scores which will provide hints regarding what works best to move beyond measurement to improvement. The key is to have teams from ALL stages of the QI journey so we can compare and contrast. We will share the stories first with the participating teams to confirm that we have heard them right. Then we will be sharing the collective wisdom from the stories with all members and also with external partners, so that everyone (AFHTO members and beyond) can learn together. The stories will be shared anonymously – unless a team is keen to see their name in lights, in which case we would happily oblige!
How will the study be done?
The team visits and interviews will be done by Carol Mulder, Provincial Lead for Quality Improvement and Decision Support and Laura Belsito, Clinical Knowledge Translation and Exchange Specialist, supported by any graduate students we are able to recruit and the QIDS program staff at AFHTO. We will spend about 4 hours at each team site, talking to whoever the team wants us to talk to. We have put together a “straw dog” schedule to give teams a sense of who might be included. However, it is totally up to the team to decide who will meet with us to tell their story. In addition, the conversations can take place in any order the team wants – ie Hour 1 doesn’t have to be the first hour if that doesn’t work for the team.
Hour 1: ED, Medical Lead and Board Chair
Hour 2 (2 groups): Separate conversations with QI staff (QIDSS and others?) and patients
Hour 3: IHPs and physicians together
Hour 4 (2 groups): Separate conversations with clerical staff (including physician staff, if different from FHT clerical staff) and possibly LHIN performance staff
When will the study happen?
Visits to teams will be scheduled starting September 2017. See below for draft timeline. Note that this study will be taking place at the same time as patient focus groups to learn more about patient priorities for primary care measurement (see the patient priorities survey information on the AFHTO web site for more information). Interested teams may choose to volunteer for both the QI enablers visits and a patient focus group if they choose.
Activity
Start
End
Invite teams to participate
NOW!
July 31, 2017
Schedule interviews
August 4, 2017
September 26, 2017
Conduct interviews
September 27, 2017
ongoing
Summarize input
October 30, 2017
January 31, 2018
Reflection with participants and QSC
February 15, 2018
February 22, 2018
Take action
NOW!
April 30, 2018
What we want to talk with teams about
We will visit teams and ask them “what works and why” when they try to get better at what they do. This approach is loosely grounded in theories of “appreciative inquiry”, “solutions focus” and “positive deviance.” In keeping with these theories, the interview questions will follow the stories of the people we are talking to. That means the questions won’t be the same for each person or team we talk to. However, the stories we are looking for are the same for all teams. They include:
Stories about your attempts to get better at something: How did you know you needed to get better? Who decided? What happened when you tried to change things? Who worked on it? How do you know if it worked or not? Who was happy about it? Who wasn’t? Why?
Stories about learning from what you tried in the past: How do you feel now about being able to make something else better? What makes you feel that way?
Stories about the “perfect storm” for improvement: When did it last happen for you? What does it look like? Who is there? What made the storm? Who likes the storm?
Stories about your special skills/people/processes (ie superpowers) for improvement or good primary care: What are they? How did you get them? What do you use them for?
When we are hearing the stories, we will be looking for some particular ideas in the data (see below). Even if they are not there, that might mean something. For example, if nobody talks about how many people need to be on board for improvement to work, that might be as interesting as finding out that teams agree on a certain minimum number.
Drivers for quality improvement
Triggers for improvement
Confidence and appetite for change in the team (improvement = change)
Culture of innovation/tendency to try new things FIRST vs wait for tried/tested solutions
Minimum critical mass of staff to enable improvement (if any)
Role of leadership and/or intentional planning in successful improvement
Absolute requirements for successful improvement (if any)
Role of EMR functionality and data
QI as an approach to work vs a separate project
Significant team events (eg Change in ED) that might affect QI activity
What we won’t ask teams about
Teams will not be asked why they are doing better (or worse) than others in making things better over time. This is partly because they might not know – and partly because it doesn’t matter that much. For example, maybe all (or no?) teams feel they have superpowers. Yet some teams may find it easier to get better than other teams, even if they all have the same superpower. This might mean that superpowers matter for other reasons but might not be the answer we thought they were in terms of making things better.
Frequently Asked Questions
Is this a formal research study? Yes. This is an observational, qualitative cross-sectional study. AFHTO will be getting approval from the Research Ethics Board for it. Why do this as a formal research study? AFHTO Board has recently affirmed its commitment to playing a leadership role in primary care and, more broadly, in the Ontario healthcare sector. AFHTO needs to be able to tell the story of its leadership in a wide variety of forums to demonstrate that leadership. A formal research study (with formal ethical approval) makes it possible to share the collective wisdom of AFHTO members in credible and high profile way to support leadership activity. Do members HAVE to participate? Practically everything AFHTO does is voluntary and intended to serve the members. Members can choose not to be interviewed simply by not volunteering. Nobody but they themselves will ever know that. Can I tell my story to AFHTO but not be in the research study? We will only include the stories of teams who agree to be part of the published study but we will listen to and share ALL the stories among the members for their own use. And all the stories will be anonymous unless a team is keen to have their name in lights, in which case we would happily oblige! What if our team is really struggling to improve? You are so not alone! And your story is really important. You may be doing everything “right” and still be in the place you are. That is the kind of story that will help us all see what actually is important on the ground (vs in theory). If we only talk to teams who are making good progress, we will not get useful information for those who are in the trenches, pulling out all the stops and still frustrated. You (all of you!) really are the answer! Who should be part of the interviews? Bring whoever you want to the table. We have a hunch about some roles that tend to be important in a team’s efforts to get better – see our list above. You may have different ideas. It is your call. What is the risk for our team? All of your stories will be masked (i.e., “Team X”) unless you want to see your team’s name in lights. No team’s story will be shared without their consent with any external group (Eg MOHLTC) except in an anonymous way as part of the collected stories from the study. Why don’t we just go to the literature to find out what the enablers of Quality improvement are? We would love to. If you have suggestions of studies we should look at, please tell us! So far, most studies about “high performing teams” describe the way teams work but don’t compare that to a measure of performance. Teams are identified as high performers mostly by self-report or nomination by peers. Teams that self-report as high performers may or may not be the same as those with high performance on measures of quality such as those in D2D. Other studies identify high performers on the basis of administrative data (eg cancer screening rates, readmissions etc). These indicators do not reflect the overall quality of care provided nor the contribution of the team, which is problematic, given the interest in high performing teams. This study addresses those gaps by comparing team characteristics (such as those examined in other studies) with demonstrated ability to improve over several iterations of D2D (which we define as “high performance”). What is a “high performing” team? This study focuses on enablers for improvement. That means high performance is defined as “demonstrated improvement in D2D indicators over time”. D2D indicators reflect the patient perspective (patient experience survey indicators), the provider perspective (eg cancer screening etc) and the system perspective (e.g., readmissions). This is not a perfect definition of performance. It is, however, the most broad, current and ongoing source of primary care performance data available to describe the performance of primary care teams.
Patients First calls for collaboration across subLHIN regions. It also calls for spreading measurement for quality improvement and performance monitoring. AFHTO members’ experience in building QIDS partnerships (about 150 AFHTO member organizations are actively involved) provides a foundation for both these objectives. These QIDS partnerships have been a critical ingredient in the advances AFHTO members are making to meaningfully measure primary care. This new resource – Building Collaboration and Increased Capacity through QIDS Partnerships – illustrates three different approaches to organizing these partnerships. It describes each approach and then examines all three to identify the challenges they faced, the enablers for success and the lessons learned. This knowledge, together with that gained from other types of partnerships AFHTO members have developed, can be applied to strengthen your QIDS partnership, evaluate existing partnerships (e.g. Health Links and other community programs) and help to broaden your reach into other areas of collaboration. Learning from your peers: additional case studies AFHTO has developed a series of case studies for our members to share the experience of colleagues on topics identified as being important to you:
The purpose of the EMR Data Management (EMR-DM) subcommittee is to facilitate improvement of quality of care through the implementation and enhancement of EMR data management tools by:
Guiding the development of a working knowledge base of functionality requirements and utilization strategies,
Prioritizing issues identified,
And leveraging relationships with vendors and supply chain partners to resolve these issues.
The working group, essentially a sub-committee of the QIDS Steering Committee (QSC) informs the development and implementation of indicators, processes and principles for measuring, reporting and ultimately driving continued high performance in primary care.
