While FHTs await their 2013-14 funding letters (latest estimate is they’ll be out in 7-10 days), AFHTO has been working with a number of members to help FHTs prepare for implementation of the new Quality Improvement Decision Support Specialist (QIDSS) positions. A provincial lead has been recruited – Tim Burns joined the AFHTO team on July 17. In this role Tim is working closely with FHTs to support them in implementing these new positions and advancing the use of data and performance measurement to improve care. Tim’s role in the QIDS program is to foster collaboration and practice sharing among FHTs, and to help identify and coordinate execution on common priorities. He will also ensure key partners such as the Ministry, eHealth Ontario, CIHI, HQO and the EMR vendor community are effectively engaged in order to advance FHT measurement and quality improvement capacity. Click here for more information on Tim’s background; his e-mail address is tim.burns@afhto.ca . Tim has already begun working with a number of FHTs to accelerate implementation. Earlier this month FHTs recommended by the FHT Unit to host the QIDS Specialist positions were surveyed to explore their implementation needs and invited to participate in preparatory activity. (Their identities are confidential until the final funding is approved and the letters are released.) Three areas for coordinated action were identified and working groups launched in order to enable teams to move very quickly once the funding is announced:
QIDS Specialist Recruitment and Screening—to develop a job description and support as needed through the recruitment cycle.
Orientation and Training—to define immediate learning needs and plan a common curriculum for orientation and professional development.
Partnership Agreements—-to develop a model Partnership Agreement to clarify the relationship and support effective collaboration among “host” and participating FHTs.
Once the final Ministry-approved QIDSS allocations are known, AFHTO will convene a QIDSS Steering Committee to provide the collective mechanism for FHTs to advance best practice and optimize performance measurement capacity across the FHT sector. AFHTO also awaits confirmation of Ministry funding to employ additional provincial resources to foster collaboration and exchange and deliver support services to all FHTs participating in the QIDSS program. Details are described in the report of our membership consultation Recommendations on the Optimal Configuration of the Quality Improvement Decision Support Specialist (QIDSS) Role.
This is an update for AFHTO members on activities to advance use of data and measurement in FHTs (scroll below for more information):
Dr. Rick Glazier, Lead Scientist in ICES Primary Care and Population Health Program, joins AFHTO board
AFHTO recruitment is underway for a QIDSS Project Manager
AFHTO to establish QIDSS Steering Committee
Status of approvals for new QIDSS positions in FHTs
Practice Solutions Suite (PSS) EMR Working Group is collaborating to resolve common problems for users
AFHTO Conference 2013 features streams in using data to improve care and meaningful use of EMRs
Dr. Rick Glazier, Lead Scientist in ICES Primary Care and Population Health Program, joins AFHTO board
AFHTO’s strategic direction gives priority to ensuring FHTs are supported to measure and improve the quality of care they deliver. AFHTO’s board is thrilled that Rick Glazier, one of the key forces advancing the use of data for improvement in Ontario, agreed to fill a mid-term vacancy on the board.
AFHTO recruitment is underway for a QIDSS Project Manager
Following from AFHTO’s Recommendations on the Optimal Configuration of the Quality Improvement Decision Support Specialist (QIDSS) Role, AFHTO has just launched recruitment for a QIDSS Project Manager to coordinate start-up activities among the FHTs that will host QIDSS positions, and foster on-going mentoring, coordination and collaboration among the QIDSSs. The Project Manager will also support the QIDSS Steering Committee (see below) to achieve successful completion of QSC-approved projects, communications and provision of agreed support services to all participating FHTs.
Status of approvals for new QIDSS positions in FHTs
FHT budget proposals are part way through the Ministry’s internal approval process. FHTs would receive confirmation of funding with their budget approvals – best guess is this will be about the beginning of July. We anticipate seeing 32 – 33 positions allocated, to be shared amongst groups of FHTs.
Practice Solutions Suite (PSS) Working Group is collaborating to resolve common problems for users
The PSS Working Group was born out of user desire to get better value from this EMR, deployed in about half of all FHTs. With leadership from a couple of FHT EDs to get this off the ground, the PSS Working Group now comprises 22 members from FHTs and from TELUS, the parent company for PSS EMR. A progress report went out last week to the leaders of FHTs using PSS. (If your FHT uses PSS and did not receive this e-mail, please contact info@afhto.ca to be added to this distribution list.)
AFHTO Conference 2013 features streams in using data to improve care and meaningful use of EMRs
There will be plenty to learn on these topics at the AFHTO 2013 Conference, October 22-23 at the Westin Harbour Castle in Toronto. A highly-experienced working group is currently reviewing over 30 presentation proposals to choose the best for the concurrent sessions on Using Data to Improve Care and Meaningful Use Of EMRs. Conference registration opens in a month.
The discussion was framed in terms of what the FHT Unit must accomplish, i.e.:
Invest public dollars to improve better care/better value for money
Make timely decisions about budget allocations (between Feb.21 – Mar.31)
Ensure appropriate accountability for the funds and the results
Optimize the capacity of the FHT sector as a whole.
Ministry response to the recommendations was very positive. From this discussion AFHTO offers advice to increase your chance of getting approval for your proposal:
Priority will be given to partnerships. Find your partner(s), agree on who will be the employer and how the QIDSS will be shared, and make sure you all say this in your proposal.
Priority will be given to building capacity for information management among those FHTs that are committed to doing this but need help.
In the short-term the focus is on data standardization and cleansing, to be able to accurately identify patients in the roster and their conditions/risk factors. Over time this role will grow along the continuum of creating reports, supporting decision-making, process change and quality improvement.
To get some ideas of what this entails, look at presentations from Queens FHT and North York FHT on their journeys to establish data discipline. Click here to access additional presentations from the AFHTO 2012 Conference on using data to improve care.
For those FHTs that are more advanced, partner with FHTs that need help and describe how the QIDSS position will help spread capacity.
Be as specific as you can be about what you aim to achieve with this position in the next year.
On March 31 the FHT Unit’s budget recommendations will move up through the Ministry review and approval process.Through April to June, the FHT Unit will follow up with the FHTs they’ve recommended to receive QIDSS positions, to flesh out the expectations to be specified in the final funding agreements, and to make sure there are appropriate MOUs in place among the proposed partners.Provincial level resources Once the operating plan submissions are in and the FHT-level review begins, the FHT Unit will assess the question of provincial level resources. The AFHTO report recommended 2 – 4 positions to:
Foster coordination and collaboration among the local QIDSS resources, including orientation of new QIDSSs, leveraging knowledge, sharing lessons learned from across the partnerships.
Develop deep specialization in specific EMRs in order to act as an “escalation point” for local QIDSS with challenging EMR specific questions and issues.
Bring strong data analytical/epidemiological skills to support local QIDSS with complex analytical problems and to support projects such as indicator development.
Assess the degree to which the QIDSS role has enhanced information management capacity across the FHT sector to support planning for continued capacity building.
The Ministry’s intent is to invite a FHT to house these provincial resources.Their work would be governed on behalf of all FHTs through an AFHTO-sponsored provincial committee structure. Through AFHTO, job descriptions for these positions and terms of reference for the committee structure will be developed.Thank you for the membership input and feedback Thank you to all who gave input to create the draft recommendations and those who gave feedback on the draft to help us finalize the report. The results of this membership consultation are summarized in the final appendix of the document. Click here to download the full report.
This notice to members sums up all the recent quality-related initiatives to make sure you have all the information, and to introduce new resources available through AFHTO to support your FHT’s quality journey. Quality Improvement Plans to be submitted to HQO by April 1: The Ministry’s templates and guidance materials are found at:
For questions about completing the QIP templates, e-mail qip@hqontario.ca . Stay tuned – information to follow in the next week or so on HQO’s webinar offerings to support the field.
Effective Governance for Quality in Primary Care: a one-day training program: Registration opened yesterday (click here for AFHTO announcement). At least one session is already filled – The Ministry will consider adding more sessions, based on demand. In the meantime please sign up to a session or add your name to the waiting list. Click here for the registration guidelines and link to the registration site.Proposals for Quality Improvement Decision Support Specialists (QIDSS): A week ago AFHTO circulated draft recommendationsto guide FHTs in developing proposals for QIDSS positions (due Feb.20 with operating plan submissions). We are collecting member feedback (click here) until end of day tomorrow (Jan.31) to finalize the recommendations then present them to the Ministry next week.Health Quality Ontario’s development of a Primary Care Performance Measurement (PCPM) Framework: Click here to access the proceedings from the Nov. 21 PCPM Summit. The PCPM Steering Committee has been expanded to include representatives from AFHTO, AOHC, OCFP and OMA. The ultimate aim is finalize the PCPM Framework by this summer, and by the fall of 2013, recommendations that will support the development of infrastructure, data collection, analysis and reporting.A former FHT ED joins AFHTO staff: Clarys Tirel has joined AFHTO on a three-month contract. Clarys was ED of the North York Family Health in 2008-2011, and most recently, interim executive director of the Mount Sinai Academic Family Health Team. Her main focus will be to support FHTs as they respond to their reporting and operational requirements in the January to April time frame, namely annual operating plans and QIPs, as well as governance and leadership development. To contact Clarys, e-mail her at clarys.tirel@afhto.ca or phone 647-234-8601.AFHTO launches Members’ Discussion Forum: Go to the AFHTO members-only website and log-in using your FHT username and password, then follow the instructions to access the Members’ Forum. (Contact Sal at info@afhto.ca if you need help.)
You will see three discussion forums, open to all AFHTO members and intended for asking questions and sharing ideas, advice and information resources among peers. Clarys Tirel will moderate and respond. These are:
FHT Governance Forum: focuses on the roles, responsibilities, structures, policies, processes and leadership that all combine to promote good governance in FHTs.
Quality Improvement Planning Forum: is about developing and submitting QIPs, implementing the plans, collecting and reporting data, and other factors that contribute to advancing improvement.
General Forum: for any other topics affecting Family Health Teams across Ontario
Two secure forums have also been launched, with usernames and passwords issued to participants in these forums:
Executive Directors Forum: enables discussion on topics that could possibly be sensitive, such as operating plans, HR issues, relations with vendors and funders, risk management, etc.
Health Links Forum: for FHT leaders involved as the coordinating body for one of the early adopter Health Links. Membership in this forum is restricted at the moment as Health Links work their way through the early “growing pains”. Access to this forum will expand over time.
Additional forums can be set up as interest emerges.
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.
Join a Quality Improvement Community of Practice: Join the discussions that launch another AFHTO Community of Practice (CoP), focused specifically on QI. It is open to all interested teams, especially those taking advantage of the more intense resources.
Access continuing medical education for physicians
The following resources 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:
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.
Do a special one-time patient survey using the Patient and Family Centered Care scale, 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: All of the spaces are fully booked for the Winter 2018 LEAN training session.
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.
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.
