WestEndQualityImprovement(WEQI):

CollaborationinAction!June7,2017

AmyHuang–ServicesandProgramSecretary(AA)AxelleJanczur--ExecutiveDirector(AA)

FatenMitchell–QIDirector,WEQICollaborationRimaAl-Dajani–DecisionSupportSpecialist(atUnisonduringthe

project)TammyDécarie–DirectorofHealthServices(DPN)

Presentersdonothaveanyconflictofinteresttodisclosure

ConflictofInterest

*  WEQIBackground*  YTDResults–thegamblepaysoff*  DecisionSupportSpecialistandFrontLinePerspectiveoftheProcess*  CancerScreeningEquityAnalysis*  KeyLearnings

Agenda

WEQIOverview

ExecutiveDirectorPerspective

*  DevelopcommonQIPelements*  WechoseaQIprojectthataddressMSAAaccountabilities* Year1:*  CancerScreening(CS)*  ChosetofocusoncancerscreeningbecauseitwasadefinedprocessandaneasierprojecttobuildQIcapacityinyearone*  Equityanalysisofcancerscreeningrates

*  Year2:*  AccesstoCare(A2C)*  WithsomeQIknowledgeunderourbelt,abletofocusonthehigh-priority

accountabilityofaccesstocare/panel

FocusofQIProject

Blockages(Fishbone)

AccountabilityvsQuality:Dis$nctbutrelated

Accountability*  Compliance*  Legisla$on*  LHINAct(2006)*  ExcellentCareForAllAct(2010)*  Pa?entsFirstAct(2016)

*  Accredita$on*  CCA

*  Contracts/Agreements* MSAA

Quality*  Process

*  Engagingpeople:*  TrainingstaffandbuildingcapacityforQIwork

*  Genera$ngideas*  QIP:Iden?fica?onofchangesandmethodstoachieveandmonitortheprocessesthatleadtothechanges

*  MakingChange*  QITeams/WEQI:ClinicalQualityImprovementTeam

*  AccountabilityandQualityarenotthesamething*  Qualityiscontinuousimprovementoverthelongterm*  Improvingqualityimprovesaccountability=achievement

oftargets*  Example:* Targetsvsmedian* Settingtargetsbasedonmedian(quality)notquarterlyperformance(accountability)

QI=ImprovesClientandTargetOutcomes

ImprovementinServiceDelivery

*  Individuallyandcollectively…cancerscreeningratesimprovedduringPhase1ofthework*  TheImprovementisrealandisbeingsustained*  BreastCancerScreening:DPNC(medianpercentincreaseby16%)*  ColonCancerScreening:FourVillages(medianpercentincreaseby8%)*  CervicalCancerScreening:AccessAlliance(medianpercentincreaseby14%)

YTDResults…istheinvestmentpayingoff?

DecisionSupportSpecialistPerspectiveoftheProcess

THEROADTOSUCCESSIS: ALWAYSUNDERCONSTRUCTION

Ø  RegularmeetingsofDMCswithaclinicaldirectorpresentq  Ensurecommonunderstandingofcommondefinitionsandmetricsq  Forumtoexplainthelimitationandexploreopportunitiesinq  availabledatasourcesandtoolsq  VenueforDMCsandDecisionSupportto“TechTalk”.q  Exchangestoriesofwhatworksandwhatdoesnot.

Ø  QIWorkingGroupsateachCHC.Iterativeprocessofo  Definingquantifiablemetricstomeasureoutput(e.g.Calculating“Due”)o  PreparePDSAs,undertakeimplementationandtrackresultso  Documentanynotanticipatedby-productinformation,andanalyzeito  Identifygapsincrucialactivities-ortheirtiming-thathavehighestimpactonthe

outcomes.o  Incorporatealllearningsintodesigningabetterprocess:updatedworkflows,

examinationofavailableresources,andidentificationofgapsinstafftraining

Ø  Diversityofstaffrolesq Movingtheindividualteammembersfromthe“ME“tothe“WE”.q Bettercommunication,keenerengagement,personalsenseofownership

Ø Definitions:q AHAMoment:Technicaldefinitionsarenotstatic..

o  Lessonlearned:Refertolatestversionofdocumentation,annotatewhenchangesoccur

q Operationalmetricsareaggregatesoftheindicatormeasures,compiledusingthemethodologiesandformulasofcalculations

q  CommonmistakeofusingEFterminologyinterchangeablywithEMRdataitemsespeciallywhenaddressingdifferentstakeholders(frontendversusmanagement)

Ø DataSources:Whatdatasourcetouseandwhen

q  ChoosingtheDatasourcemostsuitedtotheanalysis,andbestdescribesthecontextofthefindings.

q Understandingthelimitationsofthedataavailabilityandthedataqualityinalldatasources

Ø Reporting:q  BIRTisvalidatedbythesector:MSAAIndicatorreportingisevaluationof

performance.q  BIRTMSAAdashboardcalculationsareconsistentandcomparableacrosssectorand

provinceq  ThefactthatMSAAdashboard/reportsarecalculatedinadatawarehouseyields

resultsthataremorereliableandaccuratethanoperationalreportsderivedfromlivedata

DataQualityStandardizationAcrossallCHCs

Input:completeness,timeliness,consistency,accuracy

q  Workflow:InternalizedlearningofprovidersinexecutingMSAAworkflowsintheEMRq  Callinlists:Sustainableimprovementofperformancethroughconsistentfollowupq  Regularchartreviews:Proactiveactionon“due”and“overdue”chartsproducesbetter

outcomestoclient

Processing:q  Linkbetweeninputandoutput:

o  Clarityaroundthemethodologyofcalculatingtheindicatorsinthedatawarehouse,producedabetterunderstandingofthekeydataelementstowhichtheindicatorsaremostsensitive

q  Keydataelementsupdates:o  “RosteredTo”checkbox:linkbetweenthisdataitemanddeterminingtheOPCCstatusofthecharto  Client“Sex”and/or“dateofBirth”and/ormergingofchartsontheindicatornumbers

q  ClinicOperationalProcedureso  Timelysigningallincompleteencounterso  EntrenchingthesystemicpracticeofclientbeingseenbyMD/NPatleastoncein3years,inaclinicwhereother

primarycareprovidertypeslike(RN,RPN,PA)exercisetheirbroadestscopeofpracticeeo  Newclientvisit:BuiltinworkflowthatensuresclientMSAAhistoryiscapturedasearlyaspossibleintheir

OPCjourneyOutput:

q  Trendingofresults,usinggraphsthatincludeTargetsandMediansprovidedavisualcuetointerpretperformanceresultsandthepathtoimprovement

q  knowledgetransfer:Sharingresultsandprovidingfeedbacktoprovidersleadstointernalizedlearning,renewalofstaffengagementandincreaseoverallbuyin

DataQualityCHCSpecificFocus

Technology:Combiningdatasources

toproduceoptimalresults

BIAnalysisTools

Used•  MSExcel•  MSAccess•  PowerBI•  Othertools

Bonus

Trendingwith•  ExternalDatai.e.

CHCTargets•  Mediancalculations•  Annotation

BuildinginternalCHCDashboard

*  Processmaps*  QIBoard*  KaizenConference*  TrackingToolforPrimaryCareProviders*  DividingData&PopulatingTrackingsheet*  CompletingActionItemsafterPrimaryCareProviders

Review*  AppliedQItoolstoOtherProjects

FrontLinePerspectiveofBeingonQITeam

Current State Process Map

START END

QIBoard

KaizenExperience

*  Exchangeofideas/processes/etc.*  LearningdifferentrolesandresponsibilitiesatdifferentCHCs*  AllCHCshavesimilarchallenges*  Morethanonewaytodothings*  Highlevelprocessstepswerehelpful(FutureState)

LessonsLearnedfromKaizen

Non-insuredInvoicesPaymentProcess(AA)

* Therighttoolattherighttime* Rootcauseanalysisateachsite* Lookingatindividualproviders’dataallowedustounderstandthereasonforlowmammogramratesfortheCHC* Preferenceforafemaleprovidertodoapap

Howwegotfromtheretohere:Tools

ForceFieldAnalysis

FiveWhys

*  Equityincancerscreening*  Usedatawehaveandlearn*  Wantedtoknow:*  Differencesincancerscreeningbasedondemographics*  Successesincancerscreeninginrelationtoequityandwheredowe

needtomakeimprovements

*  Ranreportsoncancerscreeningratesbasedonindicatorswehaveconfidencein:*  Income*  Education*  Insurancestatus*  Placeofbirth

WEQIHighlights:Equity

WhichCountriesHavetheHighest#ofNon-insureddueforPapscreening

1stBirthPlace 2ndCountry

3rdCountry

4thCountry

5thcountry

AA Portugal

Mexico

Brazil

Hungary Jamaica

QW Portugal Canada China

Brazil US

DPN Portugal Mexico Brazil

Grenada St.Vin/Grenadines

PD Portugal Hungary Brazil Canada India

KR Portugal

Missing

St.Vin/Grenadines

Mexico

Brazil

FV

69.1%

84.8% 80.4%90.0%

50.0%

50-54years 55-59years 60-64years 65-69years 70-74years

BreastCancerScreeningRatebyAge

*  Pickaprojectthatmatters(MSAA)

*  CollaborationisKey*  Groupdynamics(storming,norming…)taketimeandeffort*  Learningfromeachother*  ProcessesfromoneCHCadaptedandappliedatotherCHCs*  WEQImeetings–clinicaldirectorstooversee,plan,prioritize,drive*  DMCmeetings–measuringthesamethingthesameway

KeyLearnings

*  InvestmentofTime*  Earlyinvestmentcriticalforsolidresults*  Can’tbedone“onthesideofthedesk’’

*  CreateaCultureofQualityinyourOrganization*  QIboard,useoftools,excitementfornextproject,engagement*  Includethepeoplewhodotheworktomakethechange

* QIExpertisacriticalrole*  supporting,coaching,mentoring,coordinating,researching

* UltimateResultisBetterClientCare

KeyLearnings

ServiceDelivery

Sustain

CancerScreeningRates

LHIN(MSAA)

Pullreports

PDSA

QIWorkgroups

DMCMeeKng

ShareQIKnowledge

AccesstoCareLHIN(MSAA)

PresentonWEQI

HQO CCO

DataDay

EDMeeKng

Kaizen QualityImprovement“CreateaCulture”

LHIN(MSAA)

CCO

JointQIPHQO

EquityDataLHIN

CollaboraKonHQO

EquityLHIN

(MSAA)

CollaboraKonwithPartnersEquity

CleanData

Fishbone-Before

Fishbone–After

Q&A