www.HQOntario.ca

HQO Quality Improvement Framework.

Sandie Seaman & Lynn Dionne

www.HQOntario.ca

Objectives

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Participants will be able to:

Apply HQO’s QI Framework in

planning activities that will contribute

to the achievement of Health Link

year one goals and objectives

Briefly describe 3 evidence informed

improvement packages that can be

used by Health Links.

.

How to

Participate

Today

• Open and close your Panel

• View, Select, and Test your audio

• Submit text questions

• Raise your hand

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How to use this time well

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5

Presenter Disclosure

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Presenter(s)

• Sandie Seaman

• Lynn Dionne

Relationships with commercial interests:

• Grants/Research Support: Not Applicable

• Speakers Bureau/Honoraria: Not

Applicable

• Consulting Fees: Not Applicable

• Other: Not Applicable

6

Disclosure of Commercial

Support

www.HQOntario.ca

• This program has received no commercial

or financial support

• This program has received no in-kind

commercial or financial support

• Potential for Conflict(s) of interest:

No speaker has received payment or

funding from any for-profit organization

No organization has a product that will

be discussed in the program

Who is joining the call today?

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Health Links:

Partnering Around Patients

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Ministry of Health and Long Term Care, June 25, 2013

Health Links:

A New Way of Working Together

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Ministry of Health and Long Term Care, June 25, 2013

Healthcare: The Current State

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Ministry of Health and Long Term Care, June 25, 2013

Health Links’ initial focus

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Indicators of success

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Health Links: Work-planning & the Path Forward July 2013 Ministry of Health & Long-Term Care

bestPATH & Health Links

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bestPATH

• Build quality improvement capacity

• Help to identify and address gaps in the quality

of care & services

• Facilitate discussions health link teams about

implementing patient & family engagement

strategies

• Provide leadership and support in measurement

and implementation of evidence supported

change ideas

bestPATH – A Support to Health Links

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bestPATH – A Support to Health Links

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16

Sustainability Theory

Phillips-Kirkpatrick Model

Teams

Why HQO developed a framework

17

Sources Reviewed

• The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (Langley, et al.)

• Leading Change: Why Transformation Efforts Fail (John P. Kotter)

• NHS Sustainability Model

• IHI Spread Model

• Adult Learning Principles

• Dr. W. Edwards Deming body of work

• Lean literature

• Kaoru Ishikawa

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PLANACT

STUDY DO

What are we trying

to accomplish?

How will we know that a change

is an improvement?

What change can we make that

will result in an improvement?

MODEL FOR IMPROVEMENT

Overview

www.HQOntario.ca 19

• Implement

Spread Plan

• Communicate

broadly

• Collect

Measures, Look

for Slippage

• Sustain Change

• Assemble Team

• Create Project

Charter

• Set Aims

• Capture Voice of

Customer

• Create and

Validate Current

State Map

• Identify

Measures

• Create and Test

Measurement

Plan

• Gather and

Share Baseline

Data

• Create List of

Improvement

Opportunities

• Define

Opportunity

or Problem

• Analyze Data

• Share Results

• Future State

Map

• Update Charter

• Prioritize

Opportunities

• Brainstorm

Change Ideas

• Create Sub-

aims that Align

with High-level

Aims

• Create PDSA

Plan

• Test Changes -

PDSA

• Collect

Measures – is

there

improvement?

• Share Results

Broadly

• Formalize and

Standardize

Changes

• Collect

Measures, Look

for Slippage

• Sustain Change

• Implement

Sustainability

Plans

• Engage

“Spread” team

members

GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

20

Poll

Using the HQO framework- where do you think your

Health Link is in the QI journey? (use the #s below)

OR- use zero, “0”, if your HL is not yet in the getting

started phase.

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GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

1 3-4 5-62

21

Poll Results

How can I apply the Quality Improvement

Framework to Health Links?

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22

Getting started

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• Assemble Team

• Create Project

Charter

• Set Aims

• Capture Voice of

Customer

• Create and

Validate Current

State Map

GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

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GETTING

STARTED

24www.HQOntario.ca

GETTING

STARTED

People with respiratory disease who are high risk for (re) admission to hospital.

People with congestive heart failure who find it challenging to cope at home.

25

By September 1, 2014 we will reduce the number of people

with COPD who require hospital admissions by 25%.

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GETTING

STARTED

Set AIM Statement

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GETTING

STARTED

Map the value stream

Understand the experience

or voice of the customer

1. Have you included a Value Stream Mapping

(VSM) exercise in the beginning stages of your

Health Link planning?• Yes, No, Unsure

Poll

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2. Have you included patients and their family

members in the VSM exercise?

• Yes, No, Unsure

Poll

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29

Defining the problem

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• Identify

Measures

• Create and Test

Measurement

Plan

• Gather and

Share Baseline

Data

• Create List of

Improvement

Opportunities

• Define

Opportunity

or Problem

GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

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DEFINING

THE

PROBLEM

31

Understanding your system

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GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

• Analyze Data

• Share Results

• Future State

Map

• Update Charter

• Prioritize

Opportunities

• Brainstorm

Change Ideas

• Create Sub-

aims that Align

with High-level

Aims

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UNDERSTANDING

YOUR SYSTEM

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Future state map depicts a newly designed process that

provides maximum value to the person who requires

care, is effective and efficient

UNDERSTANDING

YOUR SYSTEM

34

Identify Change Ideas

Change concepts and ideas can come from a variety of

places, including:

- Evidence based guidelines and improvement

packages

- Improvement Guide

- Peers – what have others implemented?

- Patients, clients, residents

- Staff

- Other stakeholders

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UNDERSTANDING

YOUR SYSTEM

35www.HQOntario.ca

GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

• Create PDSA

Plan

• Test Changes -

PDSA

• Collect

Measures – is

there

improvement?

• Share Results

Broadly

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DESIGNING AND

TESTING

SOLUTIONS

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Use teach back at every discharge – ensure the person knows how to

recognize worsening respiratory symptoms and how to manage at home.

Use teach back at every primary care visit – ensure the person knows how

to recognize worsening respiratory symptoms and how to manage at home.

Enable patients to email their primary care provider(s) with questions about

their symptoms and /or treatment.

At time of admission to hospital, phone primary care provider to discuss plan

of care and notify of admission.

Sample Change IdeasDESIGNING AND

TESTING

SOLUTIONS

38

Is your PDSA working?

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DESIGNING AND

TESTING

SOLUTIONS

39www.HQOntario.ca

GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

• Formalize and

Standardize

Changes

• Collect

Measures, Look

for Slippage

• Sustain Change

• Implement

Sustainability

Plans

• Engage

“Spread” team

members

40

Hierarchy of Controls to Sustain

Changes

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Automation

Fundamental Change of the Process

Visual Control, Error Proofing, Standard Work

Checklists, Audits, Signs, Memos

IMPLEMENTING

AND SUSTAINING

CHANGES

41www.HQOntario.ca

GETTING

STARTED

DEFINING

THE

PROBLEM

UNDERSTANDING

YOUR SYSTEM

DESIGNING AND

TESTING

SOLUTIONS

IMPLEMENTING

AND SUSTAINING

CHANGES

SPREADING

CHANGE

• Implement

Spread Plan

• Communicate

broadly

• Collect

Measures, Look

for Slippage

• Sustain Change

42

Where can you find more

information about the QI

Framework on our website?

http://www.hqontario.ca/qua

lity-improvement/quality-

improvement-framework

Objectives

www.HQOntario.ca

Participants will be able to:

Apply HQO’s QI Framework in planning activities

that will contribute to the achievement of Health

Link year one goals and objectives

Briefly describe 3 evidence informed improvement

packages that can be used by Health Links.

.

44

Some helpful resources: HQO

improvement packages

Supporting

Health

Independence

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Transitions

of Care

Chronic Disease

Management

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www.HQOntario.ca

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48

Transitions improvement package

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Individualized care planning

Health literacy

Risk assessment and follow-up care planning

Medication Reconciliation Client

49

Transitions improvement package

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Change

Concept

Guest Speakers Date

Individualized care

planning

Dr.Jocelyn Charles & Dr.David Kaplan. Thursday

November 28th

12-1

Medication

Management

Kimindra Tiwana, BSc(Pharm),

Project Leader

Institute for Safe Medication Practices Canada

(ISMP Canada)

Thursday

December 5th

12-1

Health literacy Kelly O'Halloran, RN(EC), MScN

Project Manager, HHS Health Links & HNHB LHIN

Discharge Transitions Bundle

Wednesday

December 11th ,

12-1

Risk assessment

and follow-up care

planning

Dr Tara O’Brien, Internal medicine physician at

Women’s College Hospital Toronto.

Wednesday

December 18th,

12-1

50

Q&A

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www.hqontario.ca