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A locally driven collaborative project (LDCP)

Strengthening continuous

quality improvement in

Ontario’s public health

units

PHO Grand Rounds

July 11, 2017

About us! On behalf of the CQI LDCP Team

Dr. Madelyn Law, BSM, MA, PhD. Associate Professor, Health Sciences, Brock University Director of the Interprofessional Education for Quality Improvement Program (I-EQUIP) Faculty Associate Experiential Education for Brock University LDCP Academic Lead

Nicole Stefanovici, BASc Continuous Quality Improvement and Education Advisor Organizational and Foundational Standards Division Niagara Region Public Health and Emergency Services LDCP Project – Co-Lead

Session Objectives

By the end of this session, participants will:

• Understand what continuous quality improvement is and the

emerging CQI landscape in public health units

• Understand where public health units rate in relation to their stage of

QI maturity

• Identify the core enablers that are needed to implement a CQI

approach in at the local level

Session Outline

• Overview of LDCP research projects

– QI Maturity Tool - Ontario Modified Version

– Scoping Review

• Knowledge Exchange Activities

• Next Steps

– LDCP Phase 2 Proposal highlights

• Discussion and Questions

How many people are tuned in on

the webinar on your end?

• 1

• 2-5

• 5-10

• 10-15

• 15-20

• 20 +

What organization are you from?

A. Public Health Unit

B. Hospital

C. Private Sector

D. Non profit organization

E. Community services

F. Academia

G. Other

Overview of LDCP research

projects

• QI Maturity Tool - Ontario Modified

Version

• Scoping Review

The Focus on Quality

What is CQI?

Continuous Quality Improvement

. . . is the overarching management philosophy or framework within the organizational culture that drives the daily work of all employees to improve their processes and systems.

Quality improvement (QI)

….. the deliberate and defined processes and methods that are used to continuously develop, design, evaluate and change practices and programs to ensure that they are of high quality

My current understanding of the

implementation of CQI in Ontario

PHUs is

A. Low (I really do not know anything about CQI in public health)

B. Medium (I have been involved/understand some CQI in public health)

C. High (I am involved/lead CQI activities or research in public health settings)

Questions from PH Professionals?

• What is needed in the organizational

structure to enable CQI?

• What are others doing? Are there best

practices in Ontario?

• What do we know from the literature that

might be helpful for public health?

Background • 2013 – Meeting in Toronto

• 2015 – LDCP proposal working group

• 2016 – LDCP project

• 2017 – to be included in the new OSPHPS

Research question

How can systematic CQI be strengthened within

Ontario’s public health units?

Specific research objectives

Describe the current state of CQI

in and across Ontario’s public

health units

Survey

Identify the drivers and attributes

of CQI that are applicable and

transferable to Ontario’s public

health sector

Scoping

review

QI Maturity Tool

Joly et al 2012, Measuring Quality Improvement in Public Health The Development and Psychometric Testing of a QI Maturity Tool

Joly et al 2013, Using the QI Maturity Tool to Classify Agencies Along a Continuum

Gearin et al 2013, Monitoring QI Maturity of Public Health

Organizations and Systems in Minnesota:

Promising Early Findings and Suggested Next Steps

Law et al 2015, Assessment of Quality Improvement in Ontario Public Health Units

Pilot Tested and refined in Ontario resulting in: - 23 questions on

a 7 point scale - 3 Yes/No

Questions.

QI Maturity Tool

• QI Organizational Culture: the values and norms about QI

that pervade throughout the organization relative to how the

public health unit interacts with staff and stakeholders.

• QI Capacity and Competency: the skills, functions, and

approaches used to assess and improve quality in an

organization.

• QI Perceived Value: the perceptions of employees that QI is a

priority in the organization and supported by leaders while also

having the potential to impact services and the community.

QI Maturity Stages

Beginning

Have not adopted formal QI projects, applied QI

methods in a systematic way, or engaged in efforts to

build a culture of QI

Emerging

Newly adopted QI approaches, albeit with limited

capacity. They have a limited QI culture and few, if

any examples of attempts to incorporate QI as a

routine part of practice

Progressing

Some QI experience and capacity but often lack

commitment, have minimal opportunity for QI

integration throughout the agency and are less

sophisticated in their application and approach

Achieving

Fairly high levels of QI practice, a commitment to QI

and an eagerness to engage in the type of

transformation change described by QI experts

Excelling Achieving high levels of QI sophistication and a

pervasive culture of QI

Where do you think your organization would rate on the QI Maturity Stages?

A. Beginning

B. Emerging

C. Progressing

D. Achieving

E. Excelling

QI Maturity Tool Survey Results Ontario PHUs – Mapped to QI Maturity Stages

# of

health

units

Stage Description

13 Beginning Have not adopted formal QI projects, applied QI methods

in a systematic way, or engaged in efforts to build a

culture of QI

10 Emerging

Newly adopted QI approaches, albeit with limited

capacity. They have a limited QI culture and few, if any

examples of attempts to incorporate QI as a routine part

of practice

11 Progressing

Some QI experience and capacity but often lack

commitment, have minimal opportunity for QI integration

throughout the agency and are less sophisticated in their

application and approach

0 Achieving Fairly high levels of QI practice, a commitment to QI and

an eagerness to engage in the type of transformation

change described by QI experts

0 Excelling Achieving high levels of QI sophistication and a

pervasive culture of QI

QI Maturity at a Glance

Resulting Reports

• 34 Individual PHU reports were completed

and distributed in January 2017

• One Provincial report created with all data

– March 2017

Scoping review

A scoping review enables the research team to summarize and

disseminate research findings by identifying the type of evidence, study

designs and high-level findings that are found in existing academic and

grey literature (Arksey, H. and L. O'Malley (2005)

Search strategy question

What critical elements (organizational structures,

systems processes and activities as well individual

capabilities) are needed to create, support and sustain

CQI in public health?

Scoping review

• 18,960 articles retrieved

• Screened, reviewed by research teamwith extensive

calibration exercises

• Data extracted in to tables

• Categories and themes related to key enablers for CQI

were identified

• Stakeholder meeting

• Iterative writing process

Organizational culture

• Innovative and non punitive: create

an environment that allows for

innovation, risk taking and is non-

punitive

• Strategic alignment: ensure that

CQI and QI activities are aligned to

the mission/vision

Organizational structures

• Training and education: Varied across the research – workshops, online, events, locally tailored, just in time

• Human resources: ingraining CQI principles in to hiring, job descriptions and performance reviews

• Internal Resources: funding to support current staff or hire new staff, and for costs associated with interventions

• Multidisciplinary teams: teams, committees, working groups that focus on a project

Engaged & supportive leaders

• Senior Leadership: understanding of CQI, aligning organizational priorities and visibly supporting CQI.

• Middle Management: encouraging and supporting the implementation of QI activities through coaching, mentoring, resources.

• QI Facilitators: expert staff or consultants who engage in training and help to structure QI efforts.

• Front line Leaders: front line staff who engage in QI activities in their daily work and engage their peers in QI activities as well.

Data

• Characteristics of the data: Real time,

reliable and robust

• Leveraging Data Sources: identify essential

data and leverage existing data sources when

possible to inform QI efforts

External supports

• Quality Improvement Collaboratives: collaboratives of organizations sharing knowledge and ideas on QI work related to common areas of interest

• Accreditation: Findings related to accreditation and QI practice vary but some highlight that they assist in building learning for the organization to enhance QI efforts.

• Funding and Resources: access to external funding to support the implement of their QI endeavors.

What does it all mean?

QI Maturity Tool

• Provided a baseline for understanding CQI at the

individual level of public health units and as a

province

• Provide an understanding of areas that may

require focused attention at the individual Public

Health Unit Level

What does it all mean?

Scoping Review

• Identified potential interventions to enhance CQI within

the public health setting

Contributions

• Development of an evidence based and tested tool to assess QI Maturity in public health in the Ontario context

• Identification of various interventions from the literature that will aid in the development of a CQI approach in public health

• Identification of gaps in current knowledge and practices related to CQI

Phase 2 Project

• Development of a two-year project based

on phase one results

– Terminology clarification document

– Case study

– Repository of cases

Discussion

• Do our results make sense from your perspective?

• Any surprises?

• What tools / resources would support increased CQI capacity in your health unit?

• Phase 2 thoughts / suggestions?

• Opportunities related to the new OSPHPS?

• Anything else?

CQI Community of Practice (CoP)

• Online community dedicated to sharing

information between those interested in QI

in public health

• Space to share, brainstorm, and learn

collectively

• Email nicole.stefanovici@niagararegion.ca

if you would like more information or would

like to join

Roadmap to a culture of Quality

Improvement

• http://qiroadmap.org/

CQI LDCP Team Alex Berry, Manager, Communications & Foundations Services, Northwestern Health Unit at March 2017

Andy Bilodeau, LDCP Project Coordinator, Northwestern Health Unit

Annette Sonneveld, Supervisor, Performance Management, Toronto Public Health

Carla Walters, Manager, Health Promotion & Clinical Services Division, Renfrew County & District Health Unit

Chimere Okoronkwo, Program Manager, Middlesex-London Health Unit

Cyndy Johnston, Manager, Quality Assurance & Professional Practice, Brant County Health Unit

Danielle Hunter, Senior Research and Evaluation Analyst, North Bay Parry Sound District Health Unit

Donna Poon, Manager (A), Health Protection, York Region Public Health

Graham Hay, Project Research Assistant, Brock University

Jane Beehler, Librarian, Kingston, Frontenac and Lennox & Addington Public Health

Jennifer Duffin, Public Health Manager, Infectious Diseases and Immunization & Chief Nursing Officer, Perth District Health Unit

Jordan Steffler, Strategic & Quality Improvement Specialist, Region of Waterloo Public Health

Judy Hope, Manager, Health Protection, York Region Public Health

Katie Jackson, Manager, Quality, Information, and Standards, Leeds, Grenville & Lanark District Health Unit

Krista Galic, Quality & Monitoring Specialist, Sudbury & District Health Unit

Dr Madelyn Law, Professor, Brock University

Marc Frey, Performance Improvement and Accountability Coordinator, Windsor-Essex County Health Unit

Mary VandenNeucker, Primary Health Care Nurse Practitioner, Oxford County Public Health

Meighan Finlay

Dr Kyle Wilson, Director of Information Systems, Wellington-Dufferin-Guelph Public Health

Nancy Wai, Continuous Quality Improvement Supervisor, Lambton Public Health

Neal Mattes, QACQI Senior Public Health Inspector, Durham Region Health Department

Nicole Stefanovici, CQI & Education Advisor, Niagara Region Public Health

Samantha Jibb, Planning & Evaluation Specialist, Northwestern Health Unit

Sandra Labelle, Manager, Continuous Quality Improvement, Eastern Ontario Health Unit

Sarah Thompson, CQI Specialist, York Region Public Health

Stanley Ing, Epidemiologist, Chatham-Kent Health Unit

Tanya Harron, Librarian, Wellington-Dufferin-Guelph Public Health

For more info

Project co-leads

Alex Berry

Manager, Communications &

Foundations Services

Northwestern Health Unit

aberry@nwhu.on.ca

(807) 274-9827, x 3663

Nicole Stefanovici

Continuous Quality Improvement and

Educations Advisor

Niagara Region Public Health & Emergency

Services

nicole.Stefanovici@niagararegion.ca

(905) 688-8248, x 7478

The CQI LDCP Team would like to thank Public Health Ontario (PHO) for its support of this project. The team gratefully

acknowledges funding received from PHO through the Locally Driven Collaborative Projects program. The views expressed in this

publication are the views of the project team, and do not necessarily reflect those of Public Health Ontario.