Quality and Governance

Purpose• Explore the relationship between Governance and Quality

• Examine Quality Improvement

• Roles and Responsibilities

Why Focus on Quality?In Canada… ~7.5% of hospital admissions involve an

adverse event

37% of adverse events considered preventable

Extrapolate to all Canadian admissions: 9,000 –24,000 preventable deaths due to adverse events

Patient’s deserve quality care, not just care.

Because it is codified in legislation (and MSAA)

The Excellent Care for All ActRoyal Assent: June 8, 2010

Implemented in hospitals first

Implemented in Primary Care April 1 2013

1. The client is at the centre of the health care system

2. Decisions about client care are based on the best evidence and standards

3. The health care system is focused on the quality of care and the best use of resources

4. The main goal of the health care system is to get better and better at what it does

The Excellent Care for All Act

ECFAA requires that all health careproviders:

Annual quality improvement plans (QIPs)

Link executive compensation to the achievement of targets set out in the QI plan

Client / care provider satisfaction surveys

Conduct staff surveys

Develop a declaration of values

Establish a patient relations process

What does quality mean to you?

Quality

Efficient

Pop Health

Effective

Accessible

EquitableResourced

Integrated

Client Centre

d

Safe

Quality Improvement is…A management philosophy and system which involves management, staff and health professionals in the continuous improvement of work processes to achieve better outcomes of patient/client/resident care. (Health Canada, 2000)

Quality Improvement PlansRequired by ECFAA (April 1, 2013)

Oversight by the board

Embedded in the strategic plan

Has specific measures, timelines and targets

Action oriented, outcome driven

Staff involved in execution

Quality

Efficient

Pop Health

Effective

Accessible

EquitableResourced

Integrated

Client Centre

d

Safe

The QIP TemplateAIM

Quality Dimension

Objective

Measure

Measure/ Indicator

Current Performance

Target for 2015/16

Target Justification

Change

Planned Improvement Ideas (Change Ideas)

Methods and process measures

Goals for change ideas (2015/16)

Comments

The QIP Indicators - AccessAIM MEASURE

Quality dimension Objective Indicator

Access Timely Access to Primary Care when needed

Percent of clients able to see a doctor or nurse practitioner on the same day or next day, when needed

Change Ideas

1) Reduce unused appt.2) Train medical secretary on triage.3) Educate clients on appt. types.4) Reduce late cancelations and no-shows.

The QIP Indicators – Client Experience

AIM Measure

Quality Dimension Objective Indicator

Client Experience Receiving and utilizing feedback regardingpatient/client experience with the primary health care organization.

When you see your doctor/NP how often do they or someone else in the office give you and opportunity to ask questions about recommended treatment?

Change Ideas

1) Update client survey to reflect HQO measure.2) Build/enhance awareness of client-centred

measures among clinical team.

The QIP Indicators - IntegrationAim Measures

Quality Dimension

Objective Measure/indicator

Integration Timely access to primary care appointments post‐discharge throughcoordination with hospital(s).

Percent of clients who see their primary care provider within 7 days after discharge from hospital for selected conditions.

Change Ideas

1) Educate clients about importance of informing the CHC of their admission/discharge to hospital, and in booking follow-up visits with primary care provide.

Toronto Central LHIN

(go to pdf)