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Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario

3/29/2016

This document is intended to provide health care organizations in Ontario with guidance as to how they can develop a Quality Improvement Plan. While much effort and care has gone into preparing this document, this document should not be relied on as legal advice and organizations should consult with their legal, governance and other relevant advisors as appropriate in preparing their quality improvement plans. Furthermore, organizations are free to design their own public quality improvement plans using alternative formats and contents, provided that they submit a version of their quality improvement plan to Health Quality Ontario (if required) in the format described herein.

OverviewThe 2014/2015 year was one of continued growth and change for the Greenbelt FHT. With 3 physician practices still growing we have accepted over 2000 new patients in the last year alone. Changes in the senior management team meant most of the year was spent ensuring stability in operations and little time was left for anything else. While we were unable to strongly pursue our QIP objectives as originally planned for the past year, quality is always an important element of our business and service delivery. We have been able to make small inroads into our 2014/2015 QIP plan and where we were unable to proceed we ensured that at a minimum we maintained the progress we had achieved to date.

For 2016/2017 our quality improvement efforts will focus on the following areas:

1 – Access – this is critically important for us and we want to make sure that every patient who needs to be seen can be seen. Moving beyond the use of the Third Next Available (TNA) tracking system we want to focus on those patients who go elsewhere through the use of our Outside Use Reports and examine how many patients seek care elsewhere during our open hours, why this is and if they tried to see come see us first. Low level tracking of this has us suspecting that this relates strongly to convenience and not to actual availability so we will look more closely at that in the coming year.

2 – Engagement - we will continue to engage with others in the coming year. The focus will be to continue working with other FHTs in the Champlain LHIN to improve Hospital Report Manager (HRM) to get it to a place where we feel we can successfully implement it in our clinic as well as further engagement with our SONG Health Link.

3 –Equity – This is a new focus for us but we feel that it is an important one to have. In the coming year we want to explore how we can incorporate equity into our quality measures. To begin with it will start will cultural competency training for staff and from there we will investigate further ways to bring this topic to the forefront of our quality initiatives.

4 – Preventative Care – this is a continued focus for us and is something we strive to work on year round. The preventative care reports generated by our EMR in addition to the SAR database are the best ways for us to track who is in need of screening. Our patient portal can import targeted lists of patients who require those services and allows us to quickly and securely communicate that with the patient. This year will work to fully maximize the use of our portal for preventative care needs year round to ensure we can meet our target for screening.

5 – Incidence Reporting – given the nature of our business a low error rate is critical. Major errors and incidents are given the most attention; we tend to overlook the no harm incidents that can be just as vital. This year we will be implementing a No Harm Incident tracking system clinic wide to bring these everyday issues out front and find out exactly where we need to improve. QI Achievements From the Past YearOver the past year we have continued our focus on quality in these ways:

1 – Patient Experience: We took last year’s survey results and shared them among our group of providers to highlight the areas in which we needed to improve. Some of the most critical survey questions are based entirely out of the patient – provider experience and can only be improved by helping the provider to understand where the need is. Although we did not meet our target in every area we feel that this exercise was a valuable one and will continue to share the results again this year for further improvement. We made an effort to reach a broader audience this year with our survey and were successful in reaching 35 more responses this year than last year. We installed a Feedback box in our main reception area which allows patients to leave good or bad feedback in an anonymous way. Our established system of complaints continues to serve those patients wishing to speak in person or on the phone with one of our management team.

2 – Hospital discharge follow up: Over the past year we have tracked hospital discharge summaries as well as emerge reports and followed up directly with those patients who were told to see their primary care provider. Anyone over 65yrs is contacted directly by our Geriatrics RN who screens them and determines what additional supports they may need – follow up with MD/RD etc. – anyone under the age of 65 is contacted by admin and invited to see their MD. In addition to this we track every discharge summary (DS)/emergency report (ER) in that allows us to monitor the date the patient was seen/admitted; when they were discharged and what date we received the report. This enables us to verify if we are able to comply with 7day post discharge measure which is significantly influenced by the hospitals and when we receive the report. This tracking gives us a great picture of what hospitals send us the results in a timely manner and who we need to target specifically to improve this delivery timeline.

3 –Patient Access: We continued to track our Third Next Available (TNA) reports over the past year and found that with our model of Advanced Access we consistently have access for our patients the same day. We were unable to track multiple measures of access this past year but will continue to focus on access for next year in new ways. We find that there is often a difference in perception between what availability we have to offer patients and what the patient deems is acceptable to them – even if we are offering same day availability.

4 – Other Areas of Quality include our participation in D2D 3.0; our focus on cancer screening and utilization of SAR and our EMR records to monitor our preventative care efforts; our robust system of reminders and searches in our EMR and this year we transitioned most of our stamps over to Encounter Assistants that allow for continuity of visits among providers, ensure nothing is left out of the visit and provides enhanced searching capabilities. Integration & Continuity of CareOur tracking of hospital discharge summaries and emergency report continues. We have collaborated with the Ottawa Hospital to provide us with a relevant primary care follow up time frame on ER reports as they do not provide a triage code.

Our participation with our SONG Health Link continues to grow and now that we have reached the referral stage we are working to allow our providers read-write access to the care plan for our patients who are in the link so avoid lost time and duplication of services. Engagement of Leadership, Clinicians and StaffQuality improvement is an integral part of Greenbelt’s culture. And beyond the points we have already highlighted in the sections above, we have other specific ways in which we engage our staff including:

1 – Clinical staff measure patient satisfaction as part of our program outcomes and are constantly monitoring the results so we can make changes and improvements to the patient experience every time they are in the clinic.

2 – The physicians, management and IHPs have a daylong meeting once a year where we focus on our programs for the upcoming year and quality improvement is a part of this process.

3 – We have regular monthly meetings with the admin staff, nursing staff, interdisciplinary health providers (IHPs) and physicians and any issue relating to quality is brought forward at these meetings for investigation and discussion. Patient/Resident/Client EngagementCurrently Greenbelt engages patients through our annual patient experience survey which we strive to increase the respondents for each year.

We also have a couple of avenues to receive feedback. Our feedback/suggestion box in the waiting room has been useful for those wishing to leave anonymous feedback while any member of the management team is available to speak or meet with a patient at any time to hear a concern.

Looking forward we are discussing the possibility of creating an engagement committee with community members but this has yet to be formalized. OtherTo bring quality even further into focus we are putting into place a Quality Committee which will be a committee of the whole and will meet bi-monthly. Implementing this as part of our regular board work plan for the coming year will provide us with a more systematic approach to monitoring and making changes to our QIP which we found is a key component that we have been lacking.

Sign-off

It is recommended that the following individuals review and sign-off on your organization’s Quality Improvement Plan (where applicable):

I have reviewed and approved our organization’s Quality Improvement Plan

Board Chair Caitlin Schwartz

Quality Committee Chair or delegate Jacqui Lauder

Executive Director / Administrative Lead Ainsley Charles

CEO/Executive Director/Admin. Lead _______________________ (signature)

Other leadership as appropriate _______________________ (signature)

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