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

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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

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New Corporate-wide Areas of Focus

Patient-Centred Care

Prevention of Chronic Disease

Integrated Care Value for Money

Knowledge Sharing & Support

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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

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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

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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

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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