welcome to cancer care ontario
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Welcome to Cancer Care Ontario
September 11, 2013
Garth MathesonCAPCA - COO Roundtable
We do more than Cancer now
Performance Management and
Management Cycle
Standards and Guidelines
Public Reporting and Transparency
IM/IT
Health System Policy Expertise
Clinical Engagement and Alignment
Regional Partnerships
Cancer
As mandated
by the Cancer Act;
Ontario Cancer Plan
III
Access to Care
Building on Ontario’s Wait Time Strategy
Chronic Kidney Disease
Ontario Renal
Network launched
June 2009;
Driving performance and quality
Core Competencies
2
Our new Mission
Together, we will improve the performance of our health systems by driving quality, accountability, innovation, and value
Our new Vision
Working together to create the best health systems in the world
Vision and Mission
3
New Corporate-wide Areas of Focus
Patient-Centred Care
Prevention of Chronic Disease
Integrated Care Value for Money
Knowledge Sharing & Support
4
Organizational Structure
Audit and Finance Committee
Vice President, CIO
Vice President,
Ontario Renal
Network Vice President, Clinical
Programs and Quality Initiatives
Vice President,
Planning and RegionalPrograms
Vice President,
Chief Financial
Officer
Vice President, Prevention and Cancer Control
Vice President, Communications
Board of Directors
President and CEO
Vice President, Corporate
Services, General Counsel and Chief
Privacy Officer
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14 Regional Vice
Presidents
14 Local Health Integration Networks =14 Regional Cancer Programs
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Population = 13.5M
~ 65,000 new cases~ 25,000 deaths
17 facilities delivering radiation (103 Linacs)
77 facilities delivering chemo
Cancer Survival in Ontario
7
The System Strategic Plan
S I X STRATEGIC PRIORITIES
The Ontario Cancer Plan III (2011 – 2015)
1 Develop and implement a focused approach to cancer risk reduction
2 Implement integrated cancer screening
3 Continue to improve patient outcomes through accessible, safe, high quality care
4 Continue to asses and improve the patient experience
5 Develop and Implement innovative models of care delivery
6 Expand our efforts in personalized medicine
www.cancercare.on.ca
88
CCO does not operate facilities or deliver care
• Principle advisor to govt.• Plan the system• Oversight of the system• Pay for volume / purchase service ($1.6B)• Establish quality and access targets • Monitor and drive performance
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The Performance Structures
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Provincial and regional leadership accountability
Ministry of Health and Long-Term Care
Cancer Care OntarioCancer Quality
Council of Ontario
Other regional cancer providers (e.g., home care,
hospice, etc.)
Provincial Clinical Programs with
Clinical Leads
Regional Cancer Programs led by Regional Vice
Presidents
Clinical Accountability• Prevention• Family Medicine• Screening• Cancer Imaging• Pathology and Laboratory
Medicine• Surgical Oncology• Systemic Treatment• Radiation Therapy• Psychosocial Oncology• Patient Education• Survivorship• Palliative Care
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Provincial Leadership Council Clinical Council
The performance improvement cycleUsing key levers to improve the system
1. Data/Information• Incidence, mortality, survival• Analysis• Indicator development• Expert input
2. Knowledge• Research production• Evidence-based guidelines• Policy analysis• Planning
3.Transfer• Publications• Practice leaders engaged• Policy advice• Public reporting• Technology tools• Process innovation
4. Performance Management• Institutional agreements• Quarterly review• Quality–linked funding• Clinical accountability
Horizon-scanning and championing innovation
Identifying quality improvement opportunities
Standardizing development and guidelines
Developing and implementing improvement strategies
Monitoring performance
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Setting the performance priorities
• Meant to drive performance in the cancer system in areas that need improvement
• Priorities are determined annually Access/Wait times Evidence-based clinical priorities (e.g.: thoracic
surgery guidelines, pathology reporting) Provincial priorities (e.g.: colorectal cancer
screening program)• Proposed/approved by:
clinical expert panels programs at CCO Regional Cancer Programs
13
Indicator selection and target settingIndicators must be: in alignment with OCPIII and accountability agreements actionable for the Regional Cancer Programs areas requiring significant improvement provincially and/or in
at least 5 regions capable of data updates quarterly/annually and lag of 3 months
or less
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Targets:• Expert panels recommend targets designed to improve quality• Program areas set provincial targets using evidence and consensus• Programs determine “ultimate or maximum” target first then set annual
targets• Annual target must be achievable by at least 50% of the regions by year
end• Targets approved by Clinical Council and Provincial Leadership Council
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Prevention
Family doctor/health centre
Routinescreening
Hosp or SMRCCto undergo tests
Cancer notdiagnosed
Diagnosis of cancer
Radiation
Systemic
End of treatment
Cure Survivorship
Palliative/Supportive care
Terminal care
Death
Relapse
Continuing treatment
Goes to
Referred toReferred to
Long-term monitoringand follow up
Surgery
Considers the full Cancer continuum
Example of a priority indicatorSystemic Treatment – Referral to Consult (RCC)
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- one target for all- Confidence intervals- Rank order
Shows relative position against target and change from previous period
From indicators to motivating performance in the Field
How do we do it without line authority?
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Motivate through passion for the cause -a growing demand for care
It is estimated that
will develop cancer in their lifetime
45% of males
40% of females
and
Incidence + Prevalence Chronic Disease18
Motivate with credibility -clinical engagement throughout
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Provincial VP, Planning and Regional Programs
RCP leads in Surgery
CCO Chief Executive Officer
Surgery
Radiation
Systemic Treatment
Cancer Staging
Palliative Care
Path & Lab Medicine
PEBC
Nursing + HR Planning
Provincial VPClinical Programs
Patient Education
Etc.
RVP 1
RVP 2
RVP 3
Etc.
RCP leads in Systemic Treatment
RCP leads in Radiation
Hospital CEO
Motivate through formal structures for accountability
Administrative and Clinical Leadership
Motivate with money - Contracts/Agreements
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• Purpose is to clearly lay out the roles and obligations of all parties:• Volume• Funding• Performance requirements
• Management of performance Quarterly reviews Reconciliation Funding adjustments (volume
re-allocations) Quality and reporting requirements
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Motivate through regional participation - the RCP
Working together to ensure that every patient, regardless of where they live, can rely on high quality cancer care – as close to home as possible.
An alliance is formed.
patients& clients
Cancer CentreHospital
PHUs
Other Health Care
Providers
Physicians
Academic Centres
CCACs
Palliative Care
Research Prevention
Screening
Acute CareSupportive Care
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Motivate with data -comparative reporting
Motivate through healthy competition -overall ranking of RCPs
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Z Score Ranking: relative distance between the centres
Region RANKCentral 1Central East 2Waterloo Wellington 3Central West & Mississauga Halton 4South East 5North West 6Hamilton Niagara Haldimand Brant 7North Simcoe Muskoka 8Toronto Central North 9Erie St. Clair 10Champlain 11North East 12Toronto Central South 13South West 14
Critical Success Factors
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Strong policy and planning capacity
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“As RVP … I am responsible for the quality and performance of the Program.”– Dr. Craig McFadyen, RVPCentral West / Mississauga Halton Regional Cancer Program
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Regional Vice Presidents (RVP) are key to leading the Regional effort
A must… a strong IT/IM backbone
Information Strategy Framework
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Innovation Informatics Instrument the System Infrastructure
Monitoring tools
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Regional Cancer Scorecard
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Quarterly Performance Reviews (text, data, voice) dialogue key process in driving accountability and improving performance provides a focus for accountability designed to be efficient for CCO and regions to administer reinforces need for continuous attention attended by RCP partners (Alliance) embeds “how can CCO help” tool for the RVP clearly identified follow-up
Culture of public reporting on performance
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• MOHLTC Wait Times site• Cancer System Quality Index
(CSQI)• CCO Web site
A watch-dog - CSQI 2012 summary
Cancer Quality Council of Ontario 32
A must…many partnerships
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Health care providers
A must…infrastructure/capacity
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A must…good leaders who are:
Passionate Creative Change agents Influencers Motivators Thinkers Etc.
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dissatisfied with current performance
performance managers, not performance reporters
There is always variation in performance?• Hospital/ Program size - too big and complex or too small and lack the
infrastructure• Competing mandates - consumed with major capital developments, issues in
other non-cancer portfolios or academic pursuits• Host Hospital Issues- experiencing major financial difficulties, is under
review, or can’t allocate appropriate supporting resources• Infrastructure – lack of treatment and/or clinic space, equipment needs
replacement, information management systems are too old• Health Human Resources – short staffed and/or face physician shortages• Seasonal variation – Q2 includes the summer months / Q3 includes Christmas
when operations slow down or shut down in some cases• Information – stakeholders don’t trust the data• Leadership – performance / style
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What’s next? Expanding funding levers through Health System
Funding Reform Pay for performance Sustainability metrics More quality indicators tied to volume contracts Dealing with project/initiative related indicators
that need qualitative scoring
So Much More to do
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