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TRANSCRIPT
Spreading Quality Improvement Using the Ontario Common Assessment of Need (OCAN)
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Agenda
Spreading quality improvement through OCAN
Three presentations on experiences with quality improvement projects:
Excellence through Quality Improvement Project (EQIP)
Community Care Information Management (CCIM), Oak Centre Clubhouse and CMHA Niagara
CMHA-Cochrane Timiskaming
Update on OCAN 3.0
Update on the OCAN Community of Interest (CoI)
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Excellence through Quality Improvement Project(E-QIP)
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Michael DunnDirector of Quality Improvement
CMHA Ontario
What is Quality Improvement (QI) in health care?
Quality Improvement is a systematic approach to making changes that lead to better client outcomes (health), stronger system performance (care) and enhanced professional development. It draws on the combined and continuous efforts of all stakeholders — health care professionals, clients and their families, researchers, planners and educators — to make better and sustained improvements.
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Source:Health Quality Ontario - Quality Improvement pagePaul Batalden and Frank Davidoff. What is "quality improvement" and how can it transform healthcare? Qual Saf Health Care. 2007 Feb; 16(1): 2–3. (PubMed)IDEAS Glossary: http://online.ideasontario.ca/terms/quality-improvement/
Working Together to Achieve a Quality Culture
March 2018 5
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Quality dimensions defined…(HQO)• Safe: People should not be harmed by the care that is intended to help them.
• Effective: The best science and evidence should be used to make sure the service we give is the best, most appropriate possible.
• Timely: Reduce waits and sometimes harmful delays for both those who receive and those who give care.
• Client-centred: Provide care that is respectful of and responsive to individual client preferences, needs, and values and ensuring that client values guide all service decisions.
• Efficient: Avoid waste, including waste of equipment, supplies, ideas, and energy.
• Equitable: Provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
(Don’t hurt me!)
(Support me!)
(Don’t make me wait!)
(Treat me fairly!)
(Provide me with well coordinated care, without any duplication!)
(Be nice to me! Provide me with a positive experience!)
E-QIP is a partnership project between Addictions & Mental Health Ontario, Canadian Mental Health Association, Ontario & Health Quality Ontario to promote and support quality improvement (QI) in the community mental health and addictions sector.
E-QIP is based on the sectors existing commitment to providing high quality, person-centered care to individuals and families.
March 2018
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The Excellence through Quality Improvement Project (E-QIP)
March 2018 E-QIP - Diagnositc QI Learning Session 8
E-QIP Cohort 2 Projects
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Project Coaching
Addiction Services of Thames Valley (London) Good Shepherd/St. Joseph's Healthcare
(Hamilton)
Bisno (Thunder Bay) Houselink
Changes Recovery Homes (Kenora) Mainstay Housing (Toronto)
CMHA Durham
CMHA Sault St. Marie
Maison Fraternite (Ottawa)
CMHA York-South Simcoe Nipissing Housing and Support Services
(North Bay)
Community Mental Health Services,
Collingwood General & Marine Hospital
Wendat Community Programs
COTA (Toronto) WoodGreen Community Services (Toronto)
E-QIP Cohort 2 Projects
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General Coaching Network Coaching via COP
CMHA Lambton-Kent Kenora MH&A Group (transitions)
CMHA Sudbury Niagara Crisis Line
Fred Victor Miss LHIN/ TEACH (peer support)
Maison Renaissance (Hearst) OCAN
Example: KRRDMHA Network
• Problem: Transitions between community MH&A services and the local hospital are often challenging for clients, including lack of coordinated and communicated care plans and follow-up appointments.
• Next Steps: Articulate the problem and diagnose the root causes!
Michael Dunn
Director of Quality Improvement
CMHA Ontario
1.800.875.6213 (Toll-free in Ontario)
Debbie Bang
Director of Quality Improvement
Addictions and Mental Health Ontario
416.490.8900 ext. 236
Improving the Completion and use of OCAN Recovery Plans
Ru Tauro: Oak Centre Clubhouse
Jennifer Zosky: CCIM
OUR TEAMOak Centre Clubhouse, CMHA Niagara and Community Care
Information management (CCIM) Partnership
Ian Masse Clinical Manager& Data Coordinator
Jennifer ZoskyOCAN Specialist
Josie GrossiDirect Service Staff
Ru TauroExecutive Sponsor
Problem
• The client’s voice is often underrepresented in health care decisions
• OCAN recovery plans focus health care decisions on what clients voice as their priority needs
• Oak Centre and CMHA Niagara implemented OCAN, but the tool is not consistently being completed and directing client care
What We Hope to Achieve
• Identify and address the barriers to completing and using OCAN recovery plans
• Improve client outcomes by effectively completing and using OCAN recovery plans
Our Elevator Pitch
AIM Statements
Big Dot Aim• By October 2018, improve client outcomes by addressing client
identified needs through the completion and use of OCAN recovery plans
Small Dot Aim • By February 2018 both Oak Centre and CMHA Niagara will Increase
the completion rate of OCANs by 10%
Experience Based Co-Design: Emotion Mapping of OCAN Process
Hopeful Anxious Frustrated Enthusiastic
Get to know the client better
Unfamiliar with technology
Challenging to come up with strategies to address needs
Possibility of accomplishing goals
The Diagnostic Journey:
Experienced Based Design: Capturing and Understanding Staff Experience in Pareto Chart and Bar Chart
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Asked staff the emotion they felt at each process step for completing and using OCANs. Negative Emotions were experienced most often in the following steps:#5 = Enter OCAN into computer#8 = Use OCAN recovery plans in workflow
Fishbone
Driver Diagram
Time and UsePrimary Drivers
Change Ideas for “Time” Primary Driver
Setting Clear Expectations
Use of Technology to Alert Staff
Measure Time to Enter OCAN –
Median 41 Minutes
Time study
What did the time study accomplish?
• Provided information that is being used as a guideline for staff
• Median of 41 minutes helps staff to schedule the time required to enter an OCAN
New staff
Median 41 minutes
Change Idea for “Use” Primary Driver
• Purpose:
– To improve the use of OCAN recovery plans in day to day practice
• Questions we want to answer:
– Will the use of OCAN for client reviews in supervision and team meetings increase the use of OCAN in practice?
– Will this increase the number of client needs that get addressed?
• Our Predictions:
– The answers will be YES to the above questions
• Data we’re collecting:
– # of supervision sessions and team meetings that include OCAN
– Number of completed OCANs
PDSA Cycles
Use OCAN Recovery Plans in supervision and team meetings
Data CollectionOutcome Measures:
• Client Perception of OCAN
• Staff Perception of OCAN
• Addressing unmet needs (converting unmet needs to met needs or no needs over time)
Process Measures:
• Number/Percentage of OCANs completed: primary measure collected weekly
o Numerator = Number of OCANs completed
o Denominator = Number of clients that should have an OCAN completed
• Time it takes to enter OCAN into computer
• Number of team meetings where OCAN recovery plans are used
• Number of supervision session where OCAN recovery plans are used
Balancing Measure
• Direct Service Hours
Staff Survey on Primary Drivers
22% positive
47% Positive
Time: Baseline
Use: Baseline65% Positive
70% Positive
Current
Current
Results: # of OCANs Completed
UCL 20.619
CL 10.773
LCL 0.926
0
5
10
15
20
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Raw
Dat
a fo
r C
Ch
art
# o
f C
om
ple
ted
OC
AN
s
April 2017-Jan 2018 weeks
# of Completed OCANs c Chart
Baseline data
* No special cause variation.
PDSA 1 PDSA 2
Straight Count – every 2 weeks
PDSA 3
Qualitative ImpactCulture Shift Standardization
• Integrating OCAN into the work flow rather
than an “add on”
• Using the language of OCAN
• Energizing staff – e.g. started to do more
outreach to clients
• Improving technology
• Consistency in what clients are receiving
improves quality
• The structure OCAN recovery plans provide
helps workers to be more effective
• Use of an evidence-based tool
Lessons Learned
• Enabler: Team Work – Formed a team – with diverse experiences, strengths and skills
– Role clarity
• Challenges: Data Newbies– Continue to explore how we collect, understand and use data to
inform the QI process
Applying IDEAS learnings
What excited us the most!
The importance of diagnosing the problem:• Experience based co-design
• Fish Bone – root cause analysis
• Surveys
Training alone will not sustain quality• In addition to training we implemented other strategies
e.g. technology enhancements, setting clear expectations, embedding use of OCAN recovery plans into everyday practice
Next Steps
1. Continue with the IDEAS project
• Track progress - # OCANs completed
• Do PDSAs for other change ideas captured in driver diagram
• Expand the OCAN QI team to include service users and more staff
• Gather more feedback from service users
2. Develop the OCAN QI Network:
• Spread OCAN QI learnings to others in the province with the support of the Excellence through Quality Improvement Project (E-QIP)
Domain Oriented Recovery Record: Impact of Recovery Plans (RP) on Client
Recovery
CMHA-Cochrane Timiskaming
Kathy King and Deb PultzE-QIP Co-Leads
May 2018
CMHA-Cochrane Timiskamingis
E-QIPed
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OCAN
Problem vs Aim: Two sides of the same coin
Problem Statement: On December 12, 2016, 55% of clients have a Recovery Plan.
Do these clients find the Recovery Plan helpful in meeting their Recovery Goals?
Aim Statement:
By June 1, 2017, 90% of clients will report the Recovery Plan is helpful
in meeting their recovery goals.
Percentage of Clients with a Recovery Plan: Baseline Data
Tools for Defining the Problem
Process map
Fishbone
5-Whys
Pareto
Clients with Recovery Plans
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
RP helping me meet my recovery goals
RP used at my appointments
Helped develop my RP
Know what a RP is
21 clients (44% return rate)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Excellent guide! RP helps my anxiety. It [RP] helps me focus.BaselineProcess
Measurement
Root Causes Leading to Recovery Plan Project
1. Lack of communication within organizationregarding Recovery Plan (RP) procedure withrationale.
2. Lack of organizational accountability regarding RP expectations.
3. Lack of staff completing RPs.
Data Measures: Pareto ChartVoting Frequencies as No Baseline Data
Challenges• Use of technology: 5 sites
• Lack of client baseline data related to project
• Implementation of a new database April 2017
Lessons Learned
Aha’s• Start small
• Back up or slow down based on feedback (two steps forward, one step back)
• Follow the QI Process
• Administrative support
E-QIP process
Attend workshops (clients, staff, managers)
• Committed Project and Pilot Team
• Everyone has a voice
Nothing about us without us
Project Team Pilot Team
• Weekly meetings, workshops and change ideas
Great participation from clients, staff and managers
Factors Enabling Project Progress and Pace
Project Team at IDEAS
What We Would Do Differently Next Time
• Introduce the entire organization to E-QIP and the notion of QI throughout the organization
• Introduce Pilot Team to E-QIP earlier
Impact on the Organization Beyond the Project and Project Team
• Administration integrating the concepts of Project Charters, QI, and Change theory into Strategic Planning
• Administration open to using QI Process including PDSA across the organization
– Organization approach a Recovery
Plan and any initiative with the
PDSA model
Ministry of Health and Long Term Care
New Improved Version
Of OCAN
OCAN 3.0
• To improve the consumer experience
• To improve the clinical value of OCAN in supporting consumers’ recovery
• To respond to stakeholder feedback on recommended changes to OCAN
• To align with current standards and terminology
• To enhance the quality of client information collected in OCAN to support service delivery and planning at organizations, LHINs and at the provincial levels.
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Why Update OCAN?
• We are currently in the roll out phase
• CCIM is working with organizations and software vendors to transition from OCAN 2.0 to 3.0
• Feedback and questions can be sent into the CCIM Service Desk at the phone number/email address below:
– Phone: 1-866-363-CCIM (2246)
– Email: [email protected]
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Roll-Out OCAN 3.0
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OCAN Community of Interest (CoI)
Ru TauroLead, OCAN CoIExecutive Director, Oak Centre
Jessica Elgie Knowledge Broker, Evidence Exchange NetworkCentre for Addiction and Mental Health
What is a Community of Interest?
Communities of Interest bring together people who share a common interest to develop and spread new knowledge to improve understanding and action around an issue.
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About the OCAN CoI• Provincial forum for knowledge exchange and creation
• Led by Oak Centre, with support from the Evidence Exchange Network (EENet) at the Centre for Addiction and Mental Health and Community Care Information Management (CCIM)
• Purpose: Bring together a diverse group of stakeholders to share information around the common topic of OCAN use in the interest of improving practice, service and systems planning at various levels.
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• Knowledge exchange products
• Webinars, Promising Practices
articles, FAQ doc, Training Check-list
• Knowledge exchange events
• Think Tank 2017, 2018
• EENet Connect online space
• 100+ members from across the province
• Discussion forum and resource
• sharing
OCAN CoI Successes
Resources & Contact
For more information on:
• Community of Interest: http://eenet.ca/project/ontario-common-assessment-need-community-interest#about
• Online CoI Space: http://www.eenetconnect.ca/g/ocan-community-of-interest
• EENet: eenet.ca (includes links to webinars)
• Frequently asked questions about OCAN: http://www.eenetconnect.ca/g/ocan-community-of-interest/topic/frequently-asked-questions-infographic
Contact
Jessica Elgie
Knowledge Broker
EENet, Centre for Addiction and Mental Health
613-542-4266 ext. 78096
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56Thoughts or Questions?